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1、Parent-Child Interaction Therapy Gwen Burkholder, LCSW, CAADCburkholdergcsgonline.orgOctober 9, 2013A Network of Services. A World of Possibilities.Welcome and Introductions!Photos are courtesy of Amy Herschell, Ph.D.Thank you to the following people:Cheryl Bodiford McNeil, Ph.D., Department of Psyc
2、hology, West Virginia University, who provided my initial five-day training to become a PCIT clinician in November 2010Amy D. Herschell, Ph. D., University of Pittsburg School of Medicine, who has provided ongoing supervision and consultation to me regarding providing PCIT in Lancaster, PA over the
3、past three years.What is PCIT?Work with the parent (birth, kin, foster, adoptive) and child togetherDesigned to treat children age 2 to 7 years exhibiting disruptive behaviors Use of coaching with a bug-in-the-ear from a one-way mirrorConsists of two phases of treatment: Relationship Enhancement Beh
4、avior ManagementInitially developed by Sheila Eyberg, University of Florida.McNeil, C.B., & Hembree-Kigin, T. (2010). Parent-Child Interaction Therapy. Second edition. New York: Springer.PCIT Set-upPhotos are courtesy of Amy Herschell, Ph.D.What is PCIT?Elements of family systems, social learning th
5、eory, and traditional play therapyEmphasis on restructuring parent-child patterns, not modifying target behaviorsParents are not blamed, but are given responsibility for improving the childs behavior Program is completed in 12-20 sessions, depending on the needs of the familyEmpirically evaluated in
6、 over 30 controlled studiesMcNeil, C.B., & Hembree-Kigin, T. (2010). Parent-Child Interaction Therapy. Second edition. New York: Springer.Critical Components of PCITParent and Child are seen togetherRelationship FocusedNot Time LimitedCoaching Model Active, DirectiveAssessment DrivenScientifically B
7、asedEmpirically SupportedClinically ValidatedInformation provided by Amy Herschell, Ph. D.Who is PCIT Appropriate For?Young Children (Age 2-7)Children exhibiting externalizing behavior problems (e.g., verbal and physical aggression, defiance, noncompliance, temper tantrums) Parents who could benefit
8、 from enhanced relationship and/or behavior management skills with young childrenInformation provided by Amy Herschell, Ph. D.Who is PCIT Appropriate For?Extensive contact with Primary Caregiver (or person completing PCIT with child)Families with young children and who have experienced violenceFamil
9、ies with young children and relationship difficultiesInformation provided by Amy Herschell, Ph. D.Developmental Progression of Conduct Disordered BehaviorsOppositionalArguesTemper tantrumsBraggingStubbornDemands attentionTeasesLoudDisobeys at homeImpulsiveOffensiveCrueltyDisobeys at SchoolFightsSulk
10、sScreamsLying/cheatingSwearsPoor peer relationsAggressiveDestroysBad friendsSteals at homeAttacksThreatens OthersDelinquentSets firesSteals Outside/Home Runs away TruancyAlcohol/drug useVandalismInformation provided by Amy Herschell, Ph.D.Sample Course of TreatmentSession NumberSession ContentAssess
11、ment of appropriateness for PCIT1Child Directed Interaction/Relationship Enhancement Skills Teaching Session2-9Coaching in Child Directed Interaction/Relationship Enhancement Skills 10Parent Directed Interaction/Discipline Skills Teaching Session11-19Coaching in Parent Directed Interaction/Disciplin
12、e Skills 20Graduation SessionInformation provided by Amy Herschell, Ph. D.Assessment of Appropriateness for PCIT Intake ProcessAgency IntakeSupplemental PCIT QuestionsStandardized, self-report measuresEyberg Child Behavior Inventory (ECBI)Sutter-Eyberg Student Behavior Inventory (SESBI-R)Child Behav
13、ior Checklist (CBCL)Parenting Stress Inventory Short Form (PSI-SF)Standardized, behavior observation measureDyadic Parent-Child Interaction Coding System-IV (DPICS-IV)Information provided by Amy Herschell, Ph. D.Eyberg Child Behavior Inventory (ECBI)Assesses behaviors associated with the primary chi
14、ldhood disruptive behavior disorders (e.g., noncompliance, defiance, aggression)Appropriate for children aged 2-16 yearsContains 36 items and two scales the Intensity and Problem Scales10 Minutes for parents to complete, 2 minutes to scoreInformation provided by Amy Herschell, Ph. D.Child Behavior C
15、hecklist (CBCL)Survey social competencies and problem behaviorsComplete by parent or regular caregiverSeparate forms for two age groups (1.5 5 years & 6-18 years)Approximately 100 items, 15 to 25 minutes to administerComprised of two broad band scales and a total problem scale Externalizing disrupti
16、ve or under controlled behaviorsInternalizing anxiety, depression, withdrawalTotal problems scaleInformation provided by Amy Herschell, Ph. D.Parenting Stress Index (PSI)-Short FormComposed of three subscales:Parental DistressDysfunctional Parent-Child InteractionDifficult Child CharacteristicsAdded
17、 together, these subscales yield a Total Stress Score Information provided by Amy Herschell, Ph. D.Dyadic Parent-Child Interaction Coding System (DPICS)Structured observational assessmentChild-directed playParent-directed playClean-upObserving and coding parent-child interactions for PCIT specific S
18、killsLabeled Praise, Behavioral Descriptions, ReflectionsQuestions, Commands, CriticismInformation provided by Amy Herschell, Ph. D.Recognition as an Evidence-Based PracticeClosingtheQualityChasminChildAbuseTreatment:IdentifyingandDisseminatingBestPractices(ChadwickCenter,2004)www.chadwickcenter.org
19、/kauffman.htmTheNationalChildTraumaticStressNetwork(EmpiricallySupportedTreatmentsandPromisingPractices,supportedbyTheSubstanceAbuseandMentalHealthServicesAdministration,2005)www.nctsn.org/nccts/nav.do?pid=ctr_top_trmnt_promChildPhysicalandSexualAbuse:GuidelinesforTreatment(Saunders,Berliner,&Hanson
20、,Eds.,NationalCrimeVictimsResearchandTreatmentCenterandTheCenterforSexualAssaultandTraumaticStress;OfficeforVictimsofCrime,U.S.DepartmentofJustice,2004)www.musc.edu/ncvc/resources_prof/OVC_guidelines04-26-04.pdfEvidence-BasedTreatmentforChildrenandAdolescents(TheSocietyofClinicalChildandAdolescentPs
21、ychology,adivisionoftheAmericanPsychologicalAssociation,andtheNetworkonYouthandMentalHealth)YouthViolence:AReportoftheSurgeonGeneral(Elliott,Hatot,&Sirovatka,Eds.,U.S.DepartmentofHealthandHumanServices,2001)http:/www.surgeongeneral.gov/library/youthviolenceTheCaliforniaEvidence-BasedClearinghousefor
22、ChildWelfare(2006)www.cachildwelfareclearinghouse.orgInformation provided by Amy Herschell, Ph. D.Kauffman Best Practices Project (2004)Identified Three “Best Practices” for Children who have experienced abuse and are experiencing mental health concerns:Abuse-Focused CBTParent-Child Interaction Ther
23、apyTrauma-Focused CBTInformation provided by Amy Herschell, Ph. D.Key Research AreasEfficacy/EffectivenessDiagnostic ClassificationsChild Maltreatment PopulationsCultural VariablesTherapist VariablesTreatment DeliveryAttritionMaintenanceDisseminationInformation provided by Amy Herschell, Ph.D.Treatm
24、ent Outcome Research with Children Experiencing Behavior Problems Main Findings: Parent skill increases in reflective listening, physical proximity, and prosocial verbalizationsDecreases in sarcasm and criticism of the child More positive parental attitudes toward childParent report of child behavio
25、r problems to within normal limitsParent self-reported improvements in psychopathology, personal distress, and parenting locus of controlHigh consumer satisfaction with process and outcomeMaintenance of treatment gains up to 6 years post-treatmentGeneralization to untreated siblingsGeneralization to
26、 home and schoolHerschell, A. D., Calzada, E. J., Eyberg, S. M., & McNeil, C. B. (2002). Research Issues In Parent-Child Interaction Therapy. Cognitive & Behavioral Practice, 9.Studies that have demonstrated PCITs Effectiveness with Physical AbuseConceptual Stage Urquiza & McNeil R21 Grant Submissio
27、n (1995)Urquiza & McNeil Conceptual Paper (1996)Case Reports and Single Subject DesignsBorrego, Urquiza, Rasmussen, & Zebell (1999)Fillcheck, McNeil, Herschell (in press)Fricker, Ruggiero, & Smith (2005)Herschell, Calzada, Eyberg, & McNeil (2002)Urquiza, Timmer, Herschell, McGrath, Zebell, & Porter
28、(2005)Treatment Outcome Studies Chaffin and colleages (2007, 2010)Urquiza, Timmer, Zebell, & McGrath (in press)McNeil, Herschell, Gurwitch, & Clemens-Mowrer (2005)Information provided by Amy Herschell, Ph. D.Limitations and CaveatsFocus on child behavioral problems, parenting skill, and changing rel
29、ationships, not on all aspects of family (e.g., active substance abuse, parent psychopathology)Continued need for coordination with other treatment/support agenciesLimited age rangeParent and child must have regular ongoing contactInformation provided by Amy Herschell, Ph. D.Clinician Training in PC
30、ITTraining Requirements for Clinicians Masters degree or higher in the mental health field Actively working with children and families.Licensed in his or her field or receive supervision from a licensed individual trained in PCIT.Training Program40-hours of face-to-face contact with a PCIT trainer 4
31、-6 months later a 2-day advanced live training Case Experience (at least 2 families, preferably 5) Regular (bi-weekly) consultation/Supervision over 1 yearSkill reviewInformation provided by Amy Herschell, Ph. D.Sample Course of TreatmentSession NumberSession ContentAssessment of appropriateness for
32、 PCIT1Child Directed Interaction/Relationship Enhancement Skills Teaching Session2-9Coaching in Child Directed Interaction/Relationship Enhancement Skills 10Parent Directed Interaction/Discipline Skills Teaching Session11-19Coaching in Parent Directed Interaction/Discipline Skills 20Graduation Sessi
33、onInformation provided by Amy Herschell, Ph. D.Child Directed InteractionIn the effort to enhance the relationship between the parent and child, the therapist coaches the parent to do the behavioral and play therapy techniques of:Reflecting what child saysDescribing what child is doingGiving specifi
34、c praise for childs positive behaviorThe parent is also coached to avoid doing questions, commands, and criticism and to ignore minor annoying behavior.Parent Directed InteractionThe therapist coaches the parent to gain increased compliance from the child by teaching how to give direct commands and
35、how to follow-up with consistent consequences for non-compliance, as part of the behavioral and play therapy.Corresponds with the Parent-Child Interaction Therapy Protocol(2011 Edition)GraduationAfter special playtime, practice PDI in a 5-min clean-up situation Practice PDI for 2-4 carefully selecte
36、d direct commands each day Use PDI as necessary for running commands throughout the dayUse PDI for House RulesAssign at least two Public Behavior practice outingsDo two practice sessions of play with two siblings together Practice PDI in daily 5-10 min play situation at home How PCIT has become more
37、 common in PennyslvaniaThe Pennsylvania Department of Public Welfare and the Pennsylvania Keys in collaboration with the Heinz Foundation, solicited Requests for Applications for Licensed Outpatient Psychiatric Clinics to send clinical staff to be trained to do Parent-Child Interaction Therapy begin
38、ning in 2010. Several cohorts of training groups have been trained since that time.2011 Pennsylvania Agencies Providing Parent-Child Interaction Therapy2012 Pennsylvania Agencies Providing Parent-Child Interaction Therapy2013 Pennsylvania Agencies Providing Parent-Child Interaction TherapyLast Updat
39、ed September 20, 2012CountyCityAgencyAlleghenyPittsburghAllegheny Childrens Initiative Glade RunLaughlin CenterFamily Resources of PAMatilda Theiss Child Development Center WPIC Private PracticeThe Melting PotUniversity of Pittsburgh/Western Psychiatric Institute and Clinic Wesley SpectrumWomens Cen
40、ter and Shelter Milestone, Inc.ArmstrongLeechburgFamily Counseling CenterButlerButlerFamily Services of Butler Health SystemFamily Pathways Kids Count/Family Psychological Pennsylvania Agencies Providing Parent-Child Interaction Therapy (8/30/13)Pennsylvania Agencies Providing Parent-Child Interacti
41、on Therapy (8/30/13)CountyCityAgencyBedford/SomersetBedfordAlternative Community Resource ProgramBerksFleetwoodConcern CounselingReadingFamilicare Counseling CenterReading Behavioral HealthBucksLanghornePenndel Mental Health CenterCarbon/Monroe/PikeWeissportBehavioral Health AssociatesPalmertonCarbo
42、n/Lehigh Intermediate Unit #21 - Behavioral Health ServiceEastonColonial Intermediate Unit #20CentrePhilipsburg Cen-Clear Child ServicesChesterPhoenixvilleDevereux Community ServicesCoatsvilleChild Guidance Resource CentersClearfield/JeffersonDuBoisClearfield-Jefferson Community Mental Health Center
43、, Inc. CrawfordMeadvilleCounseling and Child GuidanceCumberlandCarlisleNHS The Stevens CenterDelawareHavertownChild Guidance Resource Centers UplandCrozer-Chester Medical CenterErieErieSafe Harbor Behavioral HealthSarah A. Reed Childrens CenterPennsylvania Agencies Providing Parent-Child Interaction
44、 Therapy (8/30/13)CountyCityAgencyFayetteUniontownChestnut Ridge Counseling Services, IncConnellsville Counseling ConnellsvilleStern Center for Developmental and Behavioral Health Franklin/FultonChambersburgLaurel LifeCamp HillFranklin Family ServicesHuntington/Mifflin/JuniataHuntingtonUniversal Com
45、munity Behavioral Health (UCBH)IndianaWhiteFamily Psychological Associates LehighEastonColonial Intermediate Unit #20Lackawanna/SusquehannaScrantonFriendship House Scranton Counseling CenterCarbondaleNHS Northeastern PALancasterLancasterCommunity Services Group, IncLawrenceNew CastleHuman Services C
46、enterLuzerne/WyomingWilkes Barre Childrens Service Center of Wyoming ValleyLycoming/ClintonWilliamsportCommunity Services Group, IncMercerHermitageCommunity Counseling Center Paoletta CounselingNorthumberlandSunburyNorthumberland County Counseling ServicesPennsylvania Agencies Providing Parent-Child
47、 Interaction Therapy (8/30/13)PhiladelphiaPhiladelphiaChildrens Crisis Treatment CenterChildrens Hospital of PhiladelphiaPresbyterian Childrens Village SchuylkillPottsvilleProfessional Counseling, Consulting & Human ServicesThe ReDCO groupVenangoOil CityRegional Counseling Center, Inc.WashingtonFred
48、ericktownCenterville Clinic WestmorelandGreensburgFBRNew KensingtonFBR/AERIMaking referrals for PCITRefertoabehavioralhealthagencyinyourareawhoisprovidingPCIT.ConsiderofferingPCITatyourcommunityhealthcenterifspaceisavailable,andthenecessarylicensureandbillingissuescanbeworkedoutfortheprovisionofbehavioralhealthcareonsite.Recommended books on PCITAvailable on AAvailable on www.pcit.org
