Parent-Child Interaction Therapy: Applications for Physically Abusive Families Mark Chaffin, Ph.D...
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Transcript of Parent-Child Interaction Therapy: Applications for Physically Abusive Families Mark Chaffin, Ph.D...
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.
copyright CCAN 2005copyright CCAN 2005
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
copyright CCAN 2005copyright CCAN 2005
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
copyright CCAN 2005copyright CCAN 2005
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
copyright CCAN 2005copyright CCAN 2005
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
copyright CCAN 2005copyright CCAN 2005
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)
copyright CCAN 2005copyright CCAN 2005
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
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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
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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
copyright CCAN 2005copyright CCAN 2005
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
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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
copyright CCAN 2005copyright CCAN 2005
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
copyright CCAN 2005copyright CCAN 2005
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
copyright CCAN 2005copyright CCAN 2005
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?
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PCIT with Out of Home PCIT with Out of Home PlacementsPlacements
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
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PCIT with Out of Home PCIT with Out of Home PlacementsPlacements
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
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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 . . .
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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?
copyright CCAN 2005copyright CCAN 2005
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