Parent-Child Interaction Therapy: Applications for Physically Abusive Families Mark Chaffin, Ph.D Beverly Funderburk, Ph.D. Jane Silovsky, Ph.D. University

Parent-Child Interaction Parent-Child Interaction Therapy:Therapy:

Applications for Physically Applications for Physically Abusive FamiliesAbusive Families

Mark Chaffin, Ph.DMark Chaffin, Ph.DBeverly Funderburk, Ph.D.Beverly Funderburk, Ph.D.

Jane Silovsky, Ph.D.Jane Silovsky, Ph.D.University of Oklahoma Health Sciences CenterUniversity of Oklahoma Health Sciences Center

Department of PediatricsDepartment of Pediatrics

copyright CCAN 2005copyright CCAN 2005

Alternatives for Families I and Alternatives for Families I and IIII

Research supported by:Research supported by: – Office of Child Abuse and NeglectOffice of Child Abuse and Neglect

Administration on Children, Youth and Families Administration on Children, Youth and Families – Oklahoma Department of Human ServicesOklahoma Department of Human Services– Parents Assistance Center, OKCParents Assistance Center, OKC

Acknowledge contributions of:Acknowledge contributions of:– Linda Ann Valle, PhD, CDCLinda Ann Valle, PhD, CDC– Elizabeth Brestan, PhD, Auburn UniversityElizabeth Brestan, PhD, Auburn University– Tatiana Balachova, PhD, OUHSCTatiana Balachova, PhD, OUHSC– Shelli Shultz, PhDShelli Shultz, PhD– Many interns, practicum studentsMany interns, practicum students

Alternatives for Families IIIAlternatives for Families III

Research supported by:Research supported by: – Centers for Disease Control and PreventionCenters for Disease Control and Prevention

National Center for Injury Prevention and National Center for Injury Prevention and ControlControl

Division of Violence PreventionDivision of Violence Prevention– Oklahoma Department of Human ServicesOklahoma Department of Human Services– Parents Assistance Center, OKCParents Assistance Center, OKC

Acknowledge contributions of:Acknowledge contributions of:– Linda Valle, Ph.D. Allison Garrett, M.Ed.Linda Valle, Ph.D. Allison Garrett, M.Ed.– Jane Silovsky, PhD Rebecca Hurst, M.S.Jane Silovsky, PhD Rebecca Hurst, M.S.– Carol McCoy, M.Ed.Carol McCoy, M.Ed.– Desi Vasquez, M.S.Desi Vasquez, M.S.– Carol Moore, M.S.Carol Moore, M.S.


Alternatives for Families IIIAlternatives for Families III

Parents Assistance Center Parents Assistance Center Therapists:Therapists:

– Barbara CulbertsonBarbara Culbertson– Gayla WestbrookGayla Westbrook– Elizabeth AltshulerElizabeth Altshuler– Amanda WiensAmanda Wiens– Rebecca ThompsonRebecca Thompson


AFF-I Inclusion AFF-I Inclusion CriteriaCriteria

– Confirmed physical abuse Confirmed physical abuse – Child age 4 to 12Child age 4 to 12– Parent IQ Parent IQ >> 70 70– No evidence of child sexual abuseNo evidence of child sexual abuse


PCIT AdaptedPCIT Adapted

Modifications to PCIT:Modifications to PCIT:

6 session ME orientation group 6 session ME orientation group 14 PCIT sessions rather than criterion 14 PCIT sessions rather than criterion

basedbased Developmentally appropriate approaches Developmentally appropriate approaches

for children ages 8 to 12 yearsfor children ages 8 to 12 years Special issues related to physically Special issues related to physically

abusive families abusive families


PCIT: Motivation GroupPCIT: Motivation Group

Reasons for Motivation GroupReasons for Motivation Group– PCIT requires considerable parent PCIT requires considerable parent

activity and can not be passively activity and can not be passively consumedconsumed

– Parents may be coerced into Parents may be coerced into treatment and be unmotivated to treatment and be unmotivated to change behaviorchange behavior

Group based on Stages-of-Change Group based on Stages-of-Change Theory and Motivational InterviewingTheory and Motivational Interviewing


Adaptations for Physical Adaptations for Physical AbuseAbuse

Trauma Focus in CDI:Trauma Focus in CDI:

– AcknowledgeAcknowledge child’s feelings child’s feelings

– ReassureReassure child of security child of security

– ContainContain the emotions (Return to the emotions (Return to PRIDE skills)PRIDE skills)


Adaptations for Physical Adaptations for Physical AbuseAbuse

PDI Modifications:PDI Modifications:

- Include stress monitoring- Include stress monitoring

- 30 minute time limit- 30 minute time limit

- Menu of timeout backup options- Menu of timeout backup options

- Range of PDI coaching options (e.g, siblings, - Range of PDI coaching options (e.g, siblings, homework, role play)homework, role play)

Design

Referrals from Child Welfare

ME + PCIT

Follow-upAssessment

Data CollectionPre- testing

Post- testing

Follow-up CPS reports

Recruitment&

Randomization

Refusers

ME + PCIT +Wrap-Around

StandardCommunity Orientation +Parent Training Groups

6 months

112 42

33

35

Treatment Dropouts

Study Design: AFF-IStudy Design: AFF-I


Physical Abuse Outcome Physical Abuse Outcome Project: Participants Project: Participants

111 participants111 participants– 66% female66% female– White = 50% African Am = 39% White = 50% African Am = 39%

Am Indian= 5% Hispanic = 5%Am Indian= 5% Hispanic = 5%– Mean Child Age = 7.9Mean Child Age = 7.9– Mean Physical Abuse Reports = 2.0Mean Physical Abuse Reports = 2.0

Mean Past Neglect Reports = 2.1 Mean Past Neglect Reports = 2.1 – Mean CAPI = 172 (cut-off = 166).Mean CAPI = 172 (cut-off = 166).– Modal income range $7,200 - $15,000 Modal income range $7,200 - $15,000

annually annually


Percent Re-Report of Percent Re-Report of AbuseAbuse

in Groups after 850 in Groups after 850 DaysDays

36

19

49

0

10

20

30

40

50

EPCIT PCIT Standard Care

Results of first study published in Results of first study published in Journal of Consulting and Clinical PsychologyJournal of Consulting and Clinical Psychology, 2004, 2004

Parent Negative Behaviors Parent Negative Behaviors (Criticism, Sarcasm, Negative (Criticism, Sarcasm, Negative

Touch)Touch)

0

5

10

15

20

25

30

35

PCIT EPCIT SC

Pre

Post

30-min DPICS observation


Questions RemainingQuestions Remaining

Relative contributions of ME and PCIT Relative contributions of ME and PCIT for reducing future reports of physical for reducing future reports of physical abuseabuse– ME group alone sufficient for gains?ME group alone sufficient for gains?– ME group reduce dropout in ME group reduce dropout in

parenting program?parenting program? University lab vs. community agencyUniversity lab vs. community agency Cost-effectiveness in field settingCost-effectiveness in field setting


AFF-III Inclusion AFF-III Inclusion CriteriaCriteria

– ““Parenting” on DHS treatment plan Parenting” on DHS treatment plan – Child aged 2.5 to 12Child aged 2.5 to 12– Parent IQ Parent IQ >> 70 70– No evidence of child sexual abuse No evidence of child sexual abuse

by participating caregiverby participating caregiver

AFF-III Design: all services AFF-III Design: all services provided in community provided in community

agencyagency Follow for CPS Reports Follow for CPS Reports

Standard Standard Orientation Orientation RR PCIT PCIT

GroupGroup

Volunteers Baseline Volunteers Baseline RR Mid Mid Post Post

MEME Parenting and Parenting and Orientation Orientation RR Anger Anger

GroupsGroups GroupGroup


HypothesesHypotheses ME group participants will show higher ME group participants will show higher

completion rates and better outcome in completion rates and better outcome in parenting programs than standard orientation parenting programs than standard orientation group participantsgroup participants

Higher completion rates in parenting Higher completion rates in parenting programs will be moderated by the quality of programs will be moderated by the quality of the parenting intervention, favoring PCIT the parenting intervention, favoring PCIT

Improved retention will improve cost Improved retention will improve cost effectiveness of the relatively more effectiveness of the relatively more expensive PCITexpensive PCIT


AFF-III: Issues with AFF-III: Issues with Community ImplementationCommunity Implementation

Children Placed Out of HomeChildren Placed Out of Home– AFF-I: 20 % had child removed at AFF-I: 20 % had child removed at

intake (32% ever)intake (32% ever)

– AFF-III: 57% of target children out AFF-III: 57% of target children out of home at intakeof home at intake


PCIT with Out of Home PCIT with Out of Home PlacementsPlacements

Transportation To and From SessionsTransportation To and From Sessions– Case management issuesCase management issues– Need for agency transportationNeed for agency transportation

PCIT HomeworkPCIT Homework– Practice with other children?Practice with other children?– Drills/Role Play homework?Drills/Role Play homework?– Will skills generalize?Will skills generalize?



TransportationTransportation– case management issuescase management issues– need for agency transportationneed for agency transportation

HomeworkHomework– other children available?other children available?– drills/role playdrills/role play

In-session IssuesIn-session Issues– sessions as visits sessions as visits



Tracking status and progress – very messy Tracking status and progress – very messy datadata

- track how much contact/practice- track how much contact/practice

- track access/practice with other - track access/practice with other childrenchildren

- changes in contact during treatment- changes in contact during treatment

PCITPCIT


Predicting Long-term Predicting Long-term OutcomeOutcome

Meeting CDI/PDI criteria predicts Meeting CDI/PDI criteria predicts maintenance of treatment gains in maintenance of treatment gains in ODD childrenODD children

We are trying to maintain reduced We are trying to maintain reduced rates of physical abuse . . .rates of physical abuse . . .


PCIT Skills AcquisitionPCIT Skills Acquisition

Preliminary Findings on Skills Preliminary Findings on Skills AcquisitionAcquisition– CDI: 30% (n = 44)CDI: 30% (n = 44)– PDI: 63% (n = 27)PDI: 63% (n = 27)

So, how good do their skills need to So, how good do their skills need to get? How long should we try?get? How long should we try?


Ongoing Community PCIT Ongoing Community PCIT ServicesServices

Need to plan for post-grant Need to plan for post-grant continuation of PCIT services in agencycontinuation of PCIT services in agency– Payment/contract issuesPayment/contract issues– Agency/board supportAgency/board support– Support from contracting agenciesSupport from contracting agencies– Ongoing consultationOngoing consultation

Documents

Parent-Child Interaction Therapy: Applications for Physically Abusive Families Mark Chaffin, Ph.D Beverly Funderburk, Ph.D. Jane Silovsky, Ph.D. University