The Effectiveness of Parent-Child Interaction Therapy With Families At Risk of MaltreatmentRae Thomas and Melanie J. Zimmer-Gembeck

School of Psychology, Gold CoastAustralia

Abstract 

Child maltreatment is often viewed as an outcome of bi-directional influences between coercive parent-child interactions and perceived or actual child noncompliance (Kolko, 1996; Milner & Chilamkurti, 1991). The consequences of these interaction patterns can be observed as escalating coercive parent-child interactions. For this reason, interventions in child maltreatment should focus on coercive parent-child interactions in addition to individual characteristics within the family system. Parent-Child Interaction Therapy (PCIT) is a manualised treatment program designed to reduce coercive parent-child interactions, improve parenting skills, and decrease child behaviour problems in families with young children (age 3 to 7). Parent self-report, parent-report on child behaviour and observational measures were used to assess the effectiveness of PCIT in a sample of families at risk of maltreatment. Participants were randomly assigned at a ratio of 2:1 to a Treatment PCIT group or an attention only waitlist group (N=46 and 29 respectively). Over the first 12 weeks of treatment and when compared to an attention only waitlist comparison group, results indicated that children in PCIT decreased externalising child behaviour as reported by caregivers. Also female caregivers reported decreased stress levels, and increased positive communication between parents and children was observed by coders blind to treatment status. Additionally, following completion of treatment, the PCIT group continued to improve and child abuse potential also was significantly reduced.

Method 

Participants were families at risk of, or with a history of, child maltreatment referred to the Griffith University, Gold Coast Clinic for PCIT. Referral sources included the Department of Child Safety, Queensland Health, Education Queensland and non-government organisations.

148 families were randomly allocated to either the intervention group or attention only waitlist.

•N = 99 treatment participants •N = 49 attention only waitlist comparison participants

An attrition rate of 49.3% occurred between pre-treatment and 12-week assessment resulting in a final sample size for pre-treatment to 12-week assessment of

•N = 46 treatment participants•N = 29 attention only waitlist comparison group participants

70% of the children were males with a mean age of 4 years, 11 months.

94% of parents identified themselves as White Australians while 3.5% identified themselves as either Aboriginal or Torres Strait Islander.

Weeks in treatment ranged from 15 to 56 (M = 30.4, SD = 9.5).  

Measures 

Assessments were conducted at pre-treatment and at 12 weeks for all participants. For treatment participants only, post-treatment and 1 month follow-up assessments were completed. The measures included:

Child Behaviour •Child Behavior Checklist (Achenbach, 1991)•Eyberg Child Behavior Inventory (Eyberg & Pincus 1999)

Parent Characteristics•Parenting Stress Index (Abidin, 1990)•Child Abuse Potential Inventory (Milner, 1986)

Independent Observation•Dyadic Parent-Child Interaction Coding System (Robinson & Eyberg, 1981)

Clinical Implications and Future Directions

 Traditional behaviour management programs

of short-term duration significantly reduce child behaviour problems but may not significantly alter underlying cognitions that result in child maltreatment.

Long-term follow-ups of maltreating families who have received interventions are required to determine the effectiveness of programs specifically funded to work with child protection clients.

Results 

Compared to an Attention Only Waitlist, PCIT was an effective intervention for maltreating families.

Effect sizes for between group comparisons ranged from an absolute value of 0.3 to 2.0

PCIT reduced child externalising behaviours and parenting stress at 12-week assessment.

PCIT participants increased positive communication and decreased questions and commands at 12-week.

The Attention Only Waitlist group increased negative talk between pre and 12-week assessment.

Effect sizes for behaviour and parental change apparent at 12 weeks increased when PCIT participants completed treatment (approx 30 weeks).

There was a significant decline in child abuse potential for PCIT participants from pre-assessment to completion but not from pre-to 12-weeks.

Introduction 

Aggressive communication and coercive parent-child interactions practised within family systems have been identified as risk factors for child maltreatment. To address these challenges among families with a history of child maltreatment or those at high risk of maltreatment, The Family Interaction Program at Griffith University provides treatment for families at-risk of or engaged in child maltreatment using Parent-Child Interaction Therapy (PCIT). PCIT is a behavioural skills program for families with children aged between three and seven years experiencing challenging, externalising behaviours. PCIT was developed by drawing from social learning theory and attachment theory (Herschell, Calzada, Eyberg & McNeil, 2002) in understanding parent-child interactions and potential mechanisms for change. There are two phases of PCIT, Relationship Enhancement and Additional Skills (also known as Child Directed Interaction and Parent-Directed Interaction). Progression from one phase to the next is predominantly dependent on attaining prescribed levels of specific skills known as ‘Mastery Criteria’ (Hembree-Kigin & McNeil, 1995). Direct coaching sessions are conducted with the parent and child in a play therapy room with the psychologist in another room behind a one-way mirror. The psychologist and the parent communicate through a “bug-in-the-ear” device. This device permits the therapist to provide direct coaching of parental communication and behavior management skills, immediate feedback and social reinforcement of the parent. Parents are expected to practice the skills at home. Through PCIT parents are taught strategies to increase positive interactions and reduce the potential for child maltreatment.

Pre 12 weeks Pre 12 weeks

Measures M (SD ) M (SD ) M (SD ) M (SD ) time Ftime X

group F d

Ecbi int 150.4 (28.6) 153.3 (27.6) 160.6 (36.7) 135.8 (37.3)a

12.6*** 20.2*** -0.8

Avpsich 2.9 (.4) 2.8 (.4) 2.9 (.6) 2.6 (.5)a

15.9*** 4.9* -0.6

Avpsipar 2.7 (.5) 2.7 (.5) 2.7 (.7) 2.5 (.6)a

4* 6.4*** -0.3

Avpsitot 2.8 (.4) 2.8 (.4) 2.8 (.6) 2.6 (.5)a

12*** 7.3** -0.5

Cbcl ext t 67.3 (7.3) 65.9 (9.4) 67.6 (11.7) 62.1 (12.0)a

12.9*** 4.6* -0.7

Capi abuse 176.8 (107.9) 175.1 (113.0) 172.8 (100.8) 168.7 (117.8) 0.1 0.0 _

DPICS - %praise 3.9 (4.6) 3.8 (3.6) 4.6 (4.7) 13.7 (10.4)a

15.8*** 16.5*** 2.0

DPICS - %des/ref 49.0 (11.6) 48.8 (12.1) 51.0 (13.2) 66.54 (11.5)a

13.8*** 14.5*** 1.2

DPICS - %questions 36.4 (12.8) 34.4 (13.5) 33.2 (12.51) 12.7 (8.6)a

28.25*** 18.34*** -1.5

DPICS - %commands 9.7 (8.5) 9.8 (5.28) 11.5 (9.7) 6.3 (4.4)a

3.8 4.28* -0.5

DPICS - %neg talk 1.0 (2.0) 3.13 (4.71)b

1.4 (2.4) 0.8 (1.7) 2.8 8.69** -1.4

Measures: Eyberg Child Behavior Inventory (ECBI) - Intensity Scale; Parenting Stress Index (PSI) - Average scores for Child Scale , Parent Scale, Total Stress Scale; Child Behavior Checklist (CBCL) - Externalising t-score; Child Abuse Potential Inventory

a T reatment group changed significantly from pre to 12-weeks, bAttention Only group changed significantly from pre to 12-weeks

* p <.05, **p < .01, ***p < .001

Attention Only Treatment

Note N ranges from 27 - 29 Attention Only group, 43 - 46 Treatment group

Figure 1. Comparison of Waitlist and Treatment Child Abuse Potential and Child Behaviour Problems

153.3

175.1

160.6

121.5

168.7

133.9

150.4

176.8

135.8

172.8

120.0

130.0

140.0

150.0

160.0

170.0

180.0

pre-treatment 12-weeks completion

Time

Sco

res

on

Mea

sure

s

Waitlist ecbi

Waitlist capi

Treatment ecbi

Treatment capi

Figure 2. Comparison of Treatment and Waitlist for Observed Praise and Parenting Stress

3.8

2.4

4.6

15.4

2.8

2.83.9

2.82.6

13.7

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

pre-treatment 12-weeks completion

Time

Sco

res

on

Mea

sure

s

Waitlist psi total

Waitlist percentage praise

Treatment psi total

Treatment percentage praise