The Effectiveness of PCIT

Child Welfare Information Gateway

www.childwelfare.gov

The effectiveness of PCIT is supported by a growing body of research and increasingly identified on inventories of model and promising treatment programs. 

Demonstrated Effectiveness in Outcome Studies

At least 30 randomized clinical outcome studies have found PCIT to be useful in treating at-risk families and children with behavioral problems. Research findings include the following:

Reductions in the risk of child abuse.

In a study of 110 physically abusive parents, only one-fifth (19%) of the parents participating in PCIT had re-reports of physically abusing their children after 850 days, compared to half (49%) of the parents attending a typical community parenting group (Chaffin et al., 2004). Reductions in the risk of abuse following treatment were confirmed by another recent study among parents who had maltreated their children (Timmer, Urquiza, Zebell, & McGrath, 2005). 

Improvements in parenting skills and attitudes. 

Research reveals that parents and caretakers completing PCIT typically demonstrate improvements in reflective listening skills, use more prosocial verbalization, direct fewer sarcastic comments and critical statements at their children, improve physical closeness to their children, and show more positive parenting attitudes (Hembree-Kigin & McNeil, 1995).

Improvements in child behavior. 

A review of 17 studies that included 628 preschool-age children identified as exhibiting a disruptive behavior disorder concluded that involvement in PCIT resulted in significant improvements in child behavior functioning. Commonly reported behavioral outcomes of PCIT included both less frequent and less intense behavior problems as reported by parents and teachers, increases in clinic- observed compliance, reductions in inattention and hyperactivity, decreases in observed negative behaviors such as whining or crying, and reductions in the percentage of children who qualify for a diagnosis of disruptive behavior disorder (Gallagher, 2003).

Benefits for parents and other caregivers.

Examining PCIT effectiveness among foster parents participating with their foster children and biological parents referred for treatment because of their children’s behavioral problems, researchers found decreases in child behavior problems and caregiver distress for both groups (Timmer, Urquiza, & Zebell, 2005). 

Lasting effectiveness.

Follow-up studies report that treatment gains are maintained over time (Eyberg et al., 2001; Hood & Eyberg, 2003). 
Usefulness in treating multiple issues. Adapted versions of PCIT also have been shown to be effective in treating other issues such as separation anxiety, depression, self-injurious behavior, attention deficit hyperactivity disorder (ADHD), and adjustment following divorce (Johnson, Franklin, Hall, & Preito, 2000; Pincus, Choate, Eyberg, & Barlow, 2005). 

Adaptability for a variety of populations.

Studies support the benefits of PCIT across genders and across a variety of ethnic groups (Capage, Bennett, & McNeil, 2001; Chadwick Center on Children and Families, 2004; McCabe, 2005).

Recognition as an Evidence-Based Practice

Based on systematic reviews of available research and evaluation studies, several groups of experts and Federal agencies have highlighted PCIT as a model program or promising treatment practice, including: 

Closing the Quality Chasm in Child Abuse Treatment: Identifying and Disseminating Best Practices (Chadwick Center, 2004); http://www.chadwickcenter.org/kauffman.htm
The National Child Traumatic Stress Network (Empirically Supported Treatments and Promising Practices, supported by The Substance Abuse and Mental Health Services Administration, 2005) www.nctsn.org/nccts/nav.do?pid=ctr_top_trmnt_prom
Child Physical and Sexual Abuse: Guidelines for Treatment (Saunders, Berliner, & Hanson, Eds., National Crime Victims Research and Treatment Center and The Center for Sexual Assault and Traumatic Stress; Office for Victims of Crime, U.S. Department of Justice, 2004) http://musc.edu/ncvc/resources_prof/OVC_guidelines04-26-04.pdf
Evidence-Based Treatment for Children and Adolescents (The Society of Clinical Child and Adolescent Psychology, a division of the American Psychological Association, and the Network on Youth and Mental Health) www.effectivechildtherapy.com
Youth Violence: A Report of the Surgeon General (Elliott, Hatot, & Sirovatka, Eds., U.S. Department of Health and Human Services, 2001) www.surgeongeneral.gov/library/youthviolence/
The California Evidence-Based Clearinghouse for Child Welfare (2006) www.cachildwelfareclearinghouse.org/

What to Look for in a Therapist

Caseworkers should become knowledgeable about commonly used treatments before recommending a treatment provider to families. Caregivers should receive as much information as possible on the treatment options available to them. If PCIT is an appropriate treatment model for a family, seek a provider who has received adequate training, supervision, and consultation in the PCIT model. If feasible, both the caseworker and family should have an opportunity to interview potential PCIT therapists prior to beginning treatment. 

PCIT Training

Mental health professionals with at least a master’s degree in psychology, social work, or a related field are eligible for training in PCIT. Training involves 40 hours of direct training, with ongoing supervision and consultation for approximately 4 to 6 months. Fidelity to the model is assessed throughout the supervision and consultation period. See Training and Consultation Resources, below, for contact information.

Questions to Ask Treatment Providers

In addition to the appropriate training, it is important to select a treatment provider who is sensitive to the individual and cultural needs of the child, caregiver, and family. Caseworkers recommending a PCIT therapist should ask the treatment provider to explain the course of treatment, the role of each family member, and how the family’s cultural background will be addressed. Family members should be involved in this discussion to the extent possible. The child, caregiver, and family should feel comfortable with, and have confidence in, the therapist with whom they will work. 

Some specific questions to ask a potential therapist regarding PCIT include:

• What is the nature of your PCIT training? When were you trained? By whom? How long was the training? Do you have access to follow-up consultation? What resource materials on PCIT are you familiar with? Are you clinically supervised by (or do you participate in a peer supervision group with) others who are PCIT trained?
• Why do you feel that PCIT is the appropriate treatment model for this child? Would the child benefit from other treatment methods at the same time or after they complete PCIT (i.e., group or individual therapy)?
  
• What techniques will you use to help the child manage his or her emotions and related behaviors? How will the parent be involved in this process?
  
• Do you use a standard assessment process to gather baseline information on the functioning of the child and family and to monitor their progress in treatment over time?
  
• Do you have access to the appropriate equipment for PCIT (one-way mirror, ear bug, video equipment)? If not, how do you plan to structure the sessions to ensure that the PCIT techniques are used according to the model?
  
• Is there any potential for harm associated with treatment?
  

Conclusion

PCIT is an innovative parent-training strategy with proven benefits for:

Children with serious behavior problems (ages 2½ to 8)
Parents, foster parents, and other caregivers caring for children with behavior problems (ages 2½ to 8)
Physically abusive or at-risk parents (with children ages 4 to 12)

PCIT’s live coaching approach guides parents while they develop needed skills to manage their children’s behavior. As parents learn to reinforce positive behaviors, while also setting limits and implementing appropriate discipline techniques, children’s behavioral problems decrease. Notably, the risk for re-abuse in these families also declines.

While the empirical support and established track record for PCIT is impressive, the model is not yet widely implemented. Challenges to more widespread availability include (1) the high costs for the room set-up and audio and visual equipment; (2) the time-intensive training program; and (3) resistance among service delivery systems to implement new approaches. In addition, many professionals whose clientele would benefit from participation in PCIT remain unaware of its advantages. Nevertheless, availability and awareness are growing along with the research base. With increased use, PCIT holds much promise to continue helping parents and caregivers build nurturing relationships that strengthen families and provide healthy environments for children to thrive. 

 

Information from Child Welfare Information Gateway (January 2007). Parent-Child Interaction Therapy With At-Risk Families.