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A Good Tree Bearing New Fruit: Alternate Formats of PCIT

A Good Tree Bearing New Fruit: Alternate Formats of PCIT. Larissa N. Niec Central Michigan University. Branches for us to climb…. Overview of the core components of PCIT New questions to be answered Review of alternate PCIT formats Project HOPE at CMU Questions still to be answered.

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A Good Tree Bearing New Fruit: Alternate Formats of PCIT

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  1. A Good Tree Bearing New Fruit: Alternate Formats of PCIT Larissa N. NiecCentral Michigan University

  2. Branches for us to climb… • Overview of the core components of PCIT • New questions to be answered • Review of alternate PCIT formats • Project HOPE at CMU • Questions still to be answered

  3. In the beginning there was the seed of PCIT… Key, innovative features • parent and child both in sessions • active practice • live coaching/immediate feedback • 2 components – • relationship enhancement and appropriate discipline • assessment driven – coding, weekly, goal-focused

  4. And it grew… • Reduction in child disruptive behaviors to WNL. • Increase in parent positive verbal interaction & discipline strategies • Generalization of gains to school setting • Generalization to untreated siblings • Maintenance of tx gains up to 6 years post

  5. New questions sprouted… • Can we implement PCIT effectively in settings other than the clinic? • Is PCIT effective if we alter the amount of therapist-client contact? • Can we deliver PCIT in ways that overcome additional treatment barriers?

  6. Branches stretched in different directions • Setting changes • Abbreviated formats • Developmental innovations • Delivery format changes

  7. Setting Changes • School • U.S. Preschoolers (McIntosh, Rizza, & Bliss, 2000; Filcheck, McNeil, Greco, & Bernard, 2004) • Norwegian kindergartens (Kvarum, 2006) • Home • (Ware, 2006)

  8. Teacher-Child Interaction Therapy (TCIT) • Child age range: Preschool • Dx population: Disruptive behavior • Tx Goals: Consistent with standard PCIT • Research: single case study (McIntosh, et al., 2000), ABACC’ classroom design (Filcheck, et al., 2004)

  9. Modifications for TCIT • Teacher trained instead of parent • Didactic sessions as for PCIT • Coaching outside and inside classroom • From single to multiple children • Immediate feedback in classroom for 2 days of CDI and PDI • Training time 11.5 hours • Behavioral Assessment – components of SOCS & DPICS

  10. Abbreviated Formats • Brief PCIT (Nixon, Sweeney, Erickson, & Touyz, 2003, 2004) • Foster Parent Workshop (McNeil, Herschell, Gurwitch, & Clemens-Mowrer, 2005)

  11. Brief PCIT • Child age range: 3-5 years • Dx population: Disruptive behavior disorders • Tx goals: consistent with standard PCIT in a theoretically more cost effective format • Research: RCT with 1 & 2 year follow-up (N=54)

  12. Modifications for Brief PCIT • Focus on same skills - CDI & PDI • Taped didactic sessions watched at home • 5 clinic coaching sessions alternated with 5 phone sessions • Time to administer = 9.5 hours (vs. 15.5 standard PCIT)

  13. Foster Parent Workshop • Child age range: 2-8 years • Dx population: foster parents • Tx goals: consistent with PCIT & training for foster parents • Research: 1 pre-post study

  14. Modifications for Workshop • Two days of training – • 1 day didactic, 1 day coaching/planning • Group format • Role play of skills • Foster parents observe each other • No home practice during training • No DPICS coding • Coaching time = 1.5 hours vs. 7 hours standard

  15. Developmental Innovations • PCIT with younger children • Parent-Child Attunement Therapy • PCIT with older children • Alternatives for Families

  16. Younger Children: PCAT(Dombrowski, Timmer, Blacker, & Urquiza, 2005) • Child age range: 12-30 months • Dx population: maltreated toddlers • Tx goals: • increase appropriate parenting • strengthen caregiver-child relationship, • Research: Single case study

  17. PCIT with Older Children(Chaffin, et al., 2004) • Child age range: 4-12 years • Dx population: physically abused • Tx goals: consistent with standard PCIT • Research: RCT N=110 families

  18. Service Delivery Format • Group PCIT with families with CPS involvement (Brestan, 2006) • Group PCIT with children with disruptive behavior disorders (Niec, et al., 2004; Project HOPE)

  19. Project HOPE: Helping Out Parents Effectively* Central Michigan University • NIMH-funded pilot of group PCIT • Sample: 3-6 year olds with ODD/CD dx *NIMH1R34MH070483-01A1

  20. Big Four: Critical Questions • Does the new format include the core components of PCIT? • Is it driven by a theoretical approach consistent with the underpinnings of PCIT? • Does it have something additional to offer? • Is the new format effective?

  21. 1. Does group PCIT include the core PCIT components? • Live coaching • Immediate feedback • Assessment driven • CDI • PDI • Homework

  22. 2. Is group PCIT driven by a theoretical approach consistent with standard PCIT? • Attachment theory • Focus remains on the parent-child dyad • Social learning theory • Therapists and other parents model appropriate behaviors • Social reinforcement from peers

  23. Modifications for Group • Initial cohesion-building session • All parents observe coaching • Parents code each other w DPICS • Group peer feedback • Individual 1st PDI session • Children’s group – free play w CDI

  24. 3. Does group PCIT have something additional to offer? • Cost-effectiveness • Treatment accessibility • Parent-to-parent support • Breaking barriers of stigma • Social reinforcement from peers • Increase adherence • Decrease attrition

  25. 4. Is group PCIT effective? • Pilot data show reductions in child behavior problems and parent stress. • Ongoing 3-year NIMH-funded pilot study • Random assignment to group or individual PCIT: first two groups finishing now.

  26. PDI session during group • Fifth PDI coaching (of 6) • Single parent with 4-yr-old twins w ODD • Need: to manage time out with both children present

  27. Good group cohesion leads to… • Parent support in group! • Car pooling! • PCIT Picnics! • Homework reminders! • Extra support during difficult PDI sessions!

  28. Forbidden Fruit? Need for caution! • Modified formats have only preliminary evidence • Consider appropriateness of populations to modification • Answer Big Four questions

  29. Future fruit to be harvested… Mindfulness? Attributions? More motivation interventions? P C I T

  30. Thank you to all the clinicians and research assistants in the CMU PCIT Lab! PCIT

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