Project Connect: Adapting PCIT to Foster Care

Background

7/1/11-06/30/14

Parent-Child Interaction Therapy (PCIT) is an empirically validated treatment for externalizing behavior problems in young children. Foster children are at an especially high risk of developing externalizing problems, difficulties that their foster parents are not often trained to manage effectively.

PCIT is typically delivered by therapists in 12-14 individual, weekly sessions. Although efficacious, standard PCIT is resource intensive, so it is unlikely to be adopted as a routine service by child welfare agencies. Therefore, the objective of this study was to implement and test the efficacy of a novel adaptation of PCIT with foster families using group-based and in-home treatment.

The intervention coupled two innovative treatment modalities: (1) an intensive PCIT group training with foster parent-child dyads, and (2) daily in-home rehearsal of PCIT skills reinforced by regular telephone counseling sessions. A total of 129 foster families were randomly assigned to three groups, including two experimental conditions receiving different treatment doses. Both treatment groups received a two-day training followed by 8 weeks of in-home clinical services. One of the two treatment groups then received a one-day booster session of PCIT training along with 6 more weeks of in-home services. The two experimental groups were compared to each other and a third waitlist control group.

The study had three central aims: (a) to examine whether two treatment conditions receiving different doses of PCIT demonstrate gains in parent and child outcomes compared to each other and to a control group receiving child welfare services as usual, (b) to identify predictors of treatment non-response, and (c) to explore mediators of main-effect findings. Assessments were conducted at baseline and several subsequent time points for each group. Multiple informants and measures were used to assess study outcomes, including children’s externalizing behaviors, compliance, and emotion regulation as well as caregivers’ behavior management skills, parenting attitudes and stress.

 

Results

Results from mixed-model, repeated measures analyses demonstrated that, compared to wait-list controls, children who received the brief and extended PCIT interventions exhibited a greater reduction in externalizing and internalizing scores over time.  Results also have shown that children in both PCIT groups were associated with a significant decrease in self-reported parenting stress over time and a significant increase in observed indicators of positive parenting. Notably, the brief course of PCIT was as efficacious as the extended PCIT intervention.

This investigation made several significant practical and scientific contributions. The use of a randomized, controlled design along with psychometrically validated measures, triangulated assessments, and fidelity safeguards increased internal validity and strengthened statistical conclusions. Likewise, the analytic approach enhanced causal inferences and contributed to future program development and design.

Results showed that PCIT can be implemented successfully in a community setting with foster families using group-based training and follow-up in-home activities. The proposed intervention built on existing child welfare service structures, thereby increasing the likelihood of successful (a) implementation of the intervention, (b) replication in future effectiveness trials, and (c) integration into the child welfare service system.3

  1. Mersky, J. P., Topitzes, J., Janczewski, C. E., & McNeil, C. B. (2015). Enhancing Foster Parent Training with Parent-Child Interaction Therapy: Evidence from a Randomized Field Experiment. Journal of the Society for Social Work and Research, 6(4), 591-616.
  2. Mersky, J. P., Topitzes, J., Grant-Savela, S. D., Brondino, M. J., & McNeil, C. B. (2016). Adapting Parent–Child Interaction Therapy to Foster Care: Outcomes from a Randomized Trial. Research on Social Work Practice 26(2), 157-167.
  3. Topitzes, J., Mersky, J. P., & McNeil, C. B. (2015). Integrating Parent Child Interaction Therapy into Foster Care. Journal of Public Child Welfare, 9(1), 22-41.

Team

Principal Investigators
Joshua Mersky
Dimitri Topitzes

Co-Investigators
Cheryl McNeil
Michael Brondino
Steven McMurtry

Funding

National Institutes of Health, National Institute of Child Health & Human Development
Award No. R15 HD067829

Resources

Enhancing Foster Parent Training with Parent-Child Interaction Therapy: Evidence from a Randomized Field Experiment.

Adapting Parent–Child Interaction Therapy to Foster Care: Outcomes from a Randomized Trial.

Integrating Parent Child Interaction Therapy into Foster Care.

 

 

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