ISSUE BRIEF January 2013 Parent-Child Interaction Therapy With At-Risk Families Parent-child interaction therapy (PCIT) is a family-centered What’s Inside: treatment approach proven effective for abused and at-risk children ages 2 to 8 and their caregivers—birth parents, • What makes PCIT unique? adoptive parents, or foster or kin caregivers. During PCIT, • Key components therapists coach parents while they interact with their • Effectiveness of PCIT children, teaching caregivers strategies that will promote • Implementation in a child positive behaviors in children who have disruptive or welfare setting externalizing behavior problems. Research has shown that, as a result of PCIT, parents learn more effective parenting • Resources for further information techniques, the behavior problems of children decrease, and the quality of the parent-child relationship improves. Child Welfare Information Gateway Children’s Bureau/ACYF 1250 Maryland Avenue, SW Eighth Floor Washington, DC 20024 800.394.3366 Email: [email protected] Use your smartphone to https:\\www.childwelfare.gov access this issue brief online. Parent-Child Interaction Therapy With At-Risk Families https://www.childwelfare.gov This issue brief is intended to build a better of the model, which have been experienced understanding of the characteristics and by families along the child welfare continuum, benefits of PCIT. It was written primarily to such as at-risk families and those with help child welfare caseworkers and other confirmed reports of maltreatment or neglect, professionals who work with at-risk families are described below. make more informed decisions about when to refer parents and caregivers, along with their children, to PCIT programs. This information may also help parents, foster parents, and “Parent-child interaction therapy is one other caregivers understand what they and of the most effective evidence-based their children can gain from PCIT and what practices in the field today. Using an in to expect during treatment. This brief also vivo training technique, parents acquire may be useful to others with an interest in more effective parenting skills, children’s implementing or participating in effective behavioral problems improve, and parent-training strategies. together they develop a more positive and affectionate relationship. The positive affiliative nature developed as a result of participation in PCIT strengthens What Makes PCIT Unique? attachment and builds resilience in at-risk families.” Introduced in the 1970s as a way to treat Anthony Urquiza, Ph.D., Director of Mental Health young children with serious behavioral Services and Clinical Research at the University of California at Davis CAARE Center problems, PCIT has since been adapted successfully for use with populations who have experienced trauma due to child Reduces Behavior Problems in abuse or neglect. The distinctiveness of this Young Children by Improving approach lies in the use of live coaching Parent-Child Interaction and the treatment of both parent and child together. PCIT is the only evidence-based PCIT was originally designed to treat children practice in which the parent and child are ages 2 to 8 with disruptive or externalizing treated together throughout the course of behavior problems, including conduct all treatment sessions. As a result, it is a and oppositional defiant disorders. These more intensive parenting intervention and children are often described as negative, most applicable for children with serious argumentative, disobedient, and aggressive. behavioral problems, parents with significant PCIT addresses the negative parent-child limitations (e.g., substance abuse, limited interaction patterns that contribute to the intellectual ability, mental health problems), disruptive behavior of young children (Bell & and/or parents at risk for child maltreatment. Eyberg, 2002). Through PCIT, parents learn In randomized testing, including families to bond with their children and develop more identified by the child welfare system, PCIT effective parenting styles that better meet has consistently demonstrated success in their children’s needs. For example, parents improving parent-child interactions. Benefits learn to model and reinforce constructive This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 2 Information Gateway. Available online at https://www.childwelfare.gov/pubs/f_interactbulletin/ Parent-Child Interaction Therapy With At-Risk Families https://www.childwelfare.gov ways for dealing with emotions, such as child discipline, as most physical abuse does. frustration. Children, in turn, respond to these While child behavior problems and child healthier relationships and interactions. As a physical abuse often co-occur, PCIT may help result, children treated using PCIT typically change the parental response to challenging show significant reductions in behavior child behaviors, regardless of the type of problems at home and at school (Brinkmeyer behavior problem. & Eyberg, 2003; Gallagher, 2003; McNeil, Foundational research has shown that many Eyberg, Eisenstatdt, Newcomb, & Funderburk, complex factors contribute to abusive 1991; McNeil & Hembree-Kigin, 2010; behaviors, including a coercive relationship Nixon, Sweeney, Erickson, & Touyz, 2003; between the parent and child (Fisher & Kane, Schuhmann, Foote, Eyberg, Boggs, & Algina, 1998; Urquiza & McNeil, 1996). Abusive 1998). and at-risk parents often interact in negative Treats the Parent and Child Together ways with their children, use ineffective and inconsistent discipline strategies, and rely too While many treatment approaches target much on punishment. These same parents either parents or children, PCIT focuses on rarely interact in positive ways with their changing the behaviors of both the parent and children (e.g., rewarding good behavior). At child together. Parents learn to model positive the same time, some physically abused and behaviors that children can learn from and are at-risk children learn to be aggressive, defiant, trained to act as “agents of change” for their noncompliant, and resistant to parental children’s behavioral or emotional difficulties direction (Kandel, 1992; Larzelere, 1986). The (Herschell & McNeil, 2005). Sitting behind reciprocal negative behaviors of the parent a one-way mirror and coaching the parent and child create a harmful cycle that often through an “ear bug” audio device, therapists escalates to the point of severe corporal guide parents through strategies that reinforce punishment and physical abuse. The negative their children’s positive behavior. In addition, behaviors of the parent—screaming and PCIT therapists are able to tailor treatment threatening—reinforce the negative behaviors based on observations of parent-child of the child—such as unresponsiveness and interactions. As such, PCIT can help address disobedience, which further aggravates the specific needs of each parent and child. parent’s behavior and may result in violence. PCIT helps break this cycle by encouraging Decreases the Risk for Child Physical positive interaction between parent and child Abuse and Breaks the Coercive Cycle and training parents in how to implement consistent and nonviolent discipline PCIT has been found effective for physically techniques when children act out. abusive parents with children ages 2 to 12 (Borrego, Urquiza, Rasmussen, & Zebell, Parents and caretakers completing PCIT 1999; Chaffin et al., 2004; Chaffin et al., 2009; typically: Hakman, Chaffin, Funderburk, & Silovsky, • Show more positive parenting attitudes and 2009; Chaffin, Funderburk, Bard, Valle, & demonstrate improvements in the ways that Gurwitch, 2011). PCIT is appropriate where they listen to, talk to, and interact with their physical abuse occurs within the context of children (McNeil & Hembree-Kigin, 2010) This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 3 Information Gateway. Available online at https://www.childwelfare.gov/pubs/f_interactbulletin/ Parent-Child Interaction Therapy With At-Risk Families https://www.childwelfare.gov • Report less stress (Timmer, Urquiza, Zebell, • Parents are provided with opportunities to & McGrath, 2005) practice newly taught skills. • Use less corporal punishment and physically • Therapists can correct errors and coercive means to control their children misunderstandings on the spot. (Chaffin et al., 2011) • Parents receive immediate feedback. In addition, parent satisfaction with PCIT is • Parents are offered support, guidance, and typically high (Chaffin et al., 2004). encouragement as they learn. Offers Support for Caregivers • Treatment gains (e.g., increases in child Including Foster Parents compliance) are recognized by the parent “in the moment”–which supports continued PCIT is now recognized as a way to help use of effective parenting skills. support foster parents caring for children with behavioral problems by enhancing the Research is currently underway to determine relationship between foster parents and if PCIT training can be administered via the foster children and by teaching foster parents Internet with Remote Real-Time (RRT) training. behavior management skills. In addition The University of Oklahoma is piloting to reporting decreases in child behavior these studies (see http://www.oumedicine. problems, foster parents frequently report com/pediatrics/department-sections/ less parental stress following PCIT and high developmental-behavioral-pediatrics/child-