Effectiveness of Community-Delivered Parent-Child Interaction Therapy Compared to Treatment as Usual

Parent-Child Interaction Therapy (PCIT) is a probably efficacious treatment for children with disruptive behavior disorders (Eyberg, Nelson, & Boggs, 2008). However, many of the characteristics of the efficacy studies (e.g., therapy conducted in university-based clinics, graduate student therapists, supervision and feedback on integrity to the model, recruited families, homogeneous samples) supporting PCIT may limit the generalization of the results to the community setting where most families receive treatment (e.g., Weisz, Jensen-Doss, & Hawley, 2006). Few studies of PCIT have examined the effectiveness of PCIT implemented by community therapists, and these studies have many methodological limitations including no reliability of observational data, no examination of treatment integrity, and no comparison group. Almost no studies have compared PCIT to usual care (UC; for exception, see McCabe & Yeh, 2009). The current study was a prospective examination of the short-term treatment outcomes for young children with disruptive behavior who received PCIT delivered by community therapists compared to UC.;Thirty caregiver-child dyads participated in the study. Most children were male (57%) and Caucasian (79%) with an average age of 5 years. Most children had a disruptive behavior disorder diagnosis (63%) or Autism Spectrum Disorder (23%). Most caregivers were female (97%), biological parents (93%) with an average age of 29 years. Families received services from seventeen therapists at five agencies. All therapists were Caucasian females with master\u27s degrees. Therapists had an average of 6 years 6 months experience providing therapy. PCIT therapists had completed zero to four PCIT cases prior to enrolling families in the study.;Two assessments were conducted in the families\u27 homes about seven and a half months apart. Families in the PCIT group had not yet received more than two coaching sessions of Child-Directed Interaction. Families in the UC group had not yet received services for more than six weeks. Parent-reported child behavior was examined using the Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2000; 2001) and the Eyberg Child Behavior Inventory (ECBI; Eyberg & Pincus, 1999). Parent and child behavior during 15 minutes of observation was coded by undergraduate research assistants using the Dyadic Parent-Child Interaction Coding System (DPICS; Eyberg, Nelson, Duke, & Boggs, 2005), and the reliability of the observational coding was examined. Parenting stress was examined using the Parenting Stress Index (Abidin, 1995). Therapists provided descriptions of treatment, and their reports were compared to the PCIT manual (Eyberg & Funderburk, 2011) to estimate treatment integrity. Parental satisfaction with treatment was examined quantitatively and qualitatively. Therapists also provided a qualitative report of acceptability of PCIT.;Families in the PCIT group received a median of 10 sessions of PCIT and a median of 17 hours of total therapy. Thirty three percent of families in PCIT had completed treatment or were still participating in PCIT at the second assessment. UC families received approximately 162 median hours of therapeutic service in the home. Sixty percent of families in UC had completed therapy or were receiving the same treatment modality at the second assessment. Results indicated that PCIT was delivered with about 74% reported treatment integrity. PCIT significantly differed from UC in all aspects of treatment delivery examined in the current study (e.g., provision and review of homework, data collection of observed parent and child behavior).;Regarding treatment outcomes for child behavior, results indicate that PCIT was at least equivalent to UC in effectiveness and may have had a greater effect on child behavior based on outcomes measured in the current study. PCIT shows promise as a cost-effective treatment for young children with disruptive behavior, as it may produce larger effects with fewer service hours. Regarding the dissemination of PCIT, results indicate that few therapists trained in PCIT continue to actively implement it for a variety of reasons, including administrative responsibilities and insurance barriers. However, those who continue to use PCIT achieve meaningful improvements in child behavior and find it to be a preferred model for treating young children with disruptive behavior.;Attrition within the study limited the sample size and statistical power to find significant differences between the groups. Conclusions from the current study are also limited because participants were not randomized to condition. More research is needed to examine the effectiveness of PCIT in the community, including its cost-effectiveness compared to UC and identification of the critical components of PCIT. Also, effective training of community therapists in PCIT and strategies to decrease attrition from treatment are areas in need of further research. (Abstract shortened by UMI.)