Elsevier

Child Abuse & Neglect

Volume 33, Issue 7, July 2009, Pages 461-470
Child Abuse & Neglect

Change trajectories for parent-child interaction sequences during parent-child interaction therapy for child physical abuse

https://doi.org/10.1016/j.chiabu.2008.08.003Get rights and content

Abstract

Objective

Parent-child interaction therapy (PCIT) has been found to reduce future child abuse reports among physically abusive parents. Reductions in observed negative parenting behaviors mediated this benefit. The current study examined session-by-session interaction sequences in order to identify when during treatment these changes occur and how much the trajectory varies from case-to-case.

Method

Session-by-session parent-child interaction sequences, using the Dyadic Parent-Child Interaction Coding System-II (DPICS-II) categories, were coded for 22 child welfare involved parent-child dyads undergoing PCIT for child physical abuse. A total 5,436 interactions across PCIT were coded and analyzed using growth curve analysis.

Results

At pre-treatment baseline, negative and positive parental responses were about equally likely to follow a child positive behavior. This pattern changed rapidly during PCIT, with rapid increases in positive parental responses and decreases in negative parental responses to appropriate child behavior. A quadratic growth pattern accounted for 70% of observed variance and virtually all change occurred during the first three sessions.

Conclusion

Changes in observed abusive parent-abused child interaction patterns can occur early in PCIT, a parenting intervention that involves direct coaching and practice of skills. These benefits sustained throughout treatment.

Practice implication

Prior to receiving behavioral parent training (PCIT), parents who have physically abused their children failed to match their parental response to their children's behavior. This pattern of interaction improved rapidly and substantially during the first three sessions of PCIT. The changes in the patterns of interaction also remained relatively stable for the remainder of treatment while parents continued to practice positive parental responses as well as began practicing effective discipline techniques. This suggests that use of immediate parent feedback through coaching, explicit directions to parents in how to respond to child behavior, and customization of the application of skills to the problems that arise in session are important components to effective parenting programs with physically abusive parents. Targeting these behaviors with PCIT has been found to reduce rates of recidivism, further supporting clinical application of PCIT in these cases.

Section snippets

Participants

The present study was part of a larger randomized clinical trial (RCT) of PCIT for physically abusive parents in which families were randomly assigned (a) PCIT, (b) PCIT enhanced with additional services to address risk factors, or (c) Services As Usual (Chaffin et al., 2004). (See citation withheld for purposes for blind review for additional information regarding the larger study.) All cases were child welfare referrals for physical abuse where (a) the abused child was between the ages of 4

Interactions

A total of 5,436 interaction sequences were coded. The vast majority (94%) of sequences were initiated by an appropriate child behavior. On average across sessions, the children demonstrated 38 appropriate (SD = 10.8) and .5 (SD = 1.4) inappropriate behaviors, with greater frequency of appropriate and lower frequency of inappropriate behavior during the relationship enhancement phase (CDI) than the discipline phase (PDI: t = 3.9, p < .01; t = −3.8, p <. 01, respectively). On average across the sessions,

Discussion

The results underscore several key conclusions. First, physically abusive parents demonstrate rapid and substantial in-session change in their responses to appropriate child behaviors during PCIT. Initial parental responses to child appropriate behavior were about as likely to be negative as to be positive. As predicted, parents demonstrated increases in positive parental responses as well as decreases in negative (undesirable) parental responses to appropriate child behavior. These changes

Acknowledgements

The investigators wish to acknowledge the contributions of Tatiana Balachova, Linda Ann Valle, Elizabeth Brestan, Tamiko Mitchell, Trudy Ali, Amy Cherry, Misty Boyd, Michelle Ondersma, Georgina Smith, Ernestine Jennings, Steve Sternlof, Laura Spiller, Jennifer Robertson, Anita Brazil, Rebekah Lorinsque, Tracy Fehrenbach, Mary Ann Brisco, Karen Landofi, Mary Rolison, Lisa Rhoades, Shelli Deskins, and Amy Hudson. Special thanks to Margaret Duvalt, John Gelona and Kathy Simms of the Oklahoma

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    This project was supported by grant numbers: 90CA1671 to Jane F. Silovsky, Melissa Hakman, and others and 90CA1633 to Mark Chaffin, from the US Department of Health and Human Services, The Administration on Children, Youth and Families, Children's Bureau, Office on Child Abuse and Neglect.

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