|Type||Target Age Group||Setting||Outcomes|
|Delinquency & Recidivism||Elementary School||Classroom |
|5.1% reduction in recidivism|
Parent-Child Interaction Therapy (PCIT) is an empirically-supported treatment for conduct-disordered young children that place emphasis on improving the quality of the parent-child relationship and changing parent-child interaction patterns. In PCIT, parents are taught specific skills to establish a nurturing and secure relationship with their child while increasing their child’s prosocial behavior and decreasing negative behavior. This treatment focuses on two basic interactions: Child Directed Interaction (CDI) is similar to play therapy in that parents engage their child in a play situation with the goal of strengthening the parent-child relationship; Parent Directed Interaction (PDI) resembles clinical behavior therapy in that parents learn to use specific behavior management techniques as they play with their child.
PCIT draws on both attachment and social learning theories to achieve authoritative parenting. Attachment theory asserts that sensitive and responsive parenting provides the foundation for the child's sense of knowing that he or she will be responded to when necessary. Thus, young children whose parents show greater warmth, responsiveness, and sensitivity to the child’s behaviors are more likely to develop a secure sense of their relationships and more effective emotional and behavioral regulation. For this reason, in the first phase of PCIT parents learn the Child-Directed Interaction (CDI), which aims to restructure the parent-child relationship and provide the child with a secure attachment to his or her parent.
Social learning theories emphasize the contingencies that shape the interactions of conduct-disordered children and their parents. Patterson’s coercion theory provides a transactional account of early conduct-disordered behavior in which child conduct problems are inadvertently established or maintained by the parent-child interactions. Thus, in the second phase of PCIT parents learn the Parent-Directed Interaction (PDI), which specifically addresses these processes by establishing consistent contingencies for child behavior.
Treatment goals include:
- An improvement in the quality of the parent-child relationship or, in residential treatment centers and foster homes, the caregiver-child relationship
- A decrease in child behavior problems with an increase in prosocial behaviors
- An increase in parenting skills, including positive discipline
- A decrease in parenting stress
PCIT was initially targeted for families with children ages 2-to-7 with oppositional, defiant, and other externalizing behavior problems. It has been adapted successfully to serve physically abusive parents with children ages 4-to-12. PCIT may be conducted with parents, foster parents, or others in a parental/caretaker role. Caregiver and child must have regular, ongoing contact to allow for daily homework assignments to be completed.
References and/or Published Evaluations
PCIT outcome research has demonstrated statistically and clinically significant improvements in the conduct-disordered behavior of preschool age children: After treatment, children’s behavior is within the normal range. Studies have documented the superiority of PCIT to waitlist controls and to parent group didactic training. In addition to significant changes on parent ratings and observational measures of children’s behavior problems, outcome studies have demonstrated important changes in the interactional style of the fathers and mothers in play situations with the child. Parents show increases in reflective listening, physical proximity, and prosocial verbalization, and decreases in sarcasm and criticism of the child after completion of PCIT. Outcome studies have also demonstrated significant changes on parents’ self-report measures of psychopathology, personal distress, and parenting locus of control. Measures of consumer satisfaction in all studies have shown that parents are highly satisfied with the process and outcome of treatment at its completion.
For a summary of PCIT and information about the future research directions of PCIT see:
Zisser, A., & Eyberg, S.M. (2010). Treating oppositional behavior in children using parent-child interaction therapy. In A.E. Kazdin & J.R. Weisz (Eds.) Evidence-based psychotherapies for children and adolescents (2nd ed., pp. 179-193). New York: Guilford.
For evaluation studies of the effectiveness of PCIT, please see:
Boggs, S. R., Eyberg, S. M., Edwards, D., Rayfield, A., Jacobs, J., Bagner, D., & Hood, K. (2004). Outcomes of parent-child interaction therapy: A comparison of dropouts and treatment completers one to three years after treatment. Child & Family Behavior Therapy, 26(4), 1-22
Chaffin, M. et.al. (2004). Parent-child interaction therapy with physically abusive parents: Efficacy for reducing future abuse reports. Journal of Consulting and Clinical Psychology, 72, 500-510.
Harwood, M., & Eyberg, S. M. (2004). Effect of therapist process variables on treatment outcome for parent-child interaction therapy. Journal of Clinical Child and Adolescent Psychology, 33, 601-612.
Hood, K. K., & Eyberg, S. M. (2003). Outcomes of parent-child interaction therapy: Mothers' reports on maintenance three to six years after treatment. Journal of Clinical Child and Adolescent Psychology, 32, 419-429.
Nixon, R. D. V., Sweeny, L., Erickson, D. B., & Touyz, S. W. (2003). Parent-child interaction therapy: A comparison of standard and abbreviated treatments for oppositional defiant preschoolers. Journal of Consulting and Clinical Psychology, 71, 251-260.
Eyberg, S .M., Funderburk, B. W., Hembree-Kigin, T., McNeil, C. B., Querido, J., & Hood, K .K. (2001). Parent-child interaction therapy with behavior problem children: One- and two-year maintenance of treatment effects in the family. Child & Family Behavior Therapy, 23, 1-20.
Schuhmann, E., Foote, R., Eyberg, S. M., Boggs, S., & Algina, J. (1998). Parent-child interaction therapy: Interim report of a randomized trial with short-term maintenance. Journal of Clinical Child Psychology, 27, 34-45.
- Has this program been replicated at other sites? If so, how many and where are they?
Yes, in many sites throughout the United States, as well as in Australia, Canada, England, Hong Kong, Russia, The Netherlands and Australia.
- Is there a formal curriculum or program guidelines in place? What is the approximate cost for these materials?
Assessment instruments and scoring forms as well as the step-by-step clinician guide are needed for training (Hembree-Kigin & McNeil, 1995). Manuals for detailed implementation of the treatment program, coding of sessions, and handouts for use in treatment will complement the guide.
Assessment procedures and instruments include:
- Semi-structured intake interview
- Child Behavior Checklist (parent form)
- Eyberg Child Behavior Inventory
- Parenting Stress Index (short form)
- Dyadic Parent-Child Interaction Coding System
- Sutter-Eyberg Student Behavior Inventory (as appropriate)
PCIT concludes with a post-treatment evaluation. In most cases, the pre-treatment assessment procedures are repeated, including parent reports, teacher report, child report, and direct observation measures. The Dyadic Parent-Child Interaction Coding System observations are repeated at the end of the last discipline coaching session. Parents also complete a parent-report measure of consumer satisfaction called the Parenting Stress Index) can be completed at booster sessions to assist in tracking maintenance of behavioral improvements or for long-term follow-up of treatment.
- What kind of training and technical assistance is available for this program?
There are a number of settings within the Network that are available for training, such as the University of Oklahoma Health Sciences Center and the Trauma Treatment Training Center (Cincinnati Children’s Hospital), the University of Florida and the University of California, Davis, CAARE Center. Please see opens in a new windowwww.pcit.org for more information about non-network trainings and other resources.
The training is for mental health professionals with a minimum of a master’s degree in psychology or a related field. It involves 40 hours of direct training with ongoing supervision and consultation for approximately the next four-to-six months. The latter can be accomplished through conference calls, videotapes, and distance-learning technology. Competency criteria will be assessed at the completion of the 40-hour training with fidelity checks throughout the supervision and consultation period.
- Once the program has been implemented, can an organization obtain assistance with fidelity monitoring or quality assurance?
Session-by-session protocols and fidelity checklists filled out by the therapist and parent are essential. During the four to six months of supervision and consultation, the session-by-session protocols and fidelity checklists should be reviewed on a continual basis.
- Can an organization obtain assistance with data collection or measurement of outcomes?
There are variations among training and technical assistance providers, however, the University of California, Davis CAARE Center’s training program includes 16-hours of didactic training for clinicians, clinical supervisor, home visitors, and school-based personnel. This training covers an overview of PCIT, training on assessment and use of standardized measures, introduction to PCIT protocol, practice in the relationship enhancement component of PCIT, and the application of these techniques to maltreated and at-risk populations.
- Is a risk assessment tool typically used to identify referrals for this program? If so, which one?
Risk assessment tools are not needed. Appropriate referrals are children between the ages of 2-7 years who are exhibiting some challenging behavioral issues. PCIT is most effective with young children and parents who want to improve their relationship with their children.
- Other considerations:
Implementation involves two rooms, one for treatment, and one for observations and coaching. Generally this is accomplished through use of a one-way mirror system, “bug in the ear” device, video camera, and monitor, although in-room therapist coaching is also possible. The therapist is extremely active and directive during the sessions and must be able to commit to the family for up to 22 sessions. The therapist should have a referral network in place to address issues not covered by PCIT.
Washington State Institute for Public Policy (WSIPP)
The Washington State Institute for Public Policy (WSIPP) uses the meta-analysis methodology to conduct evaluations of evidence-based practices, but also considers the cost of such programs and strategies to taxpayers and crime victims and weighs these costs against possible benefits (i.e., costs avoided through reduced crime). Programs and strategies are not ranked, but effect on recidivism is measured and the number of evaluations is reported. Recidivism, cost to tax payers and crime victims, and benefits are estimated using data specific to Washington State.
For the purposes of this paper, all cost and benefit information refers to the analysis conducted by WSIPP for the State of Washington. Accordingly, the information should be considered an estimate for the potential cost and dollar benefits for California. The data used for this project can be found in the article by Elizabeth K. Drake, Steve Aos and Marna G. Miller, titled “Evidence-Based Public Policy Options to Reduce Crime and Criminal Justice Costs: Implications in Washington State” (2009), and can be downloaded from their Web site, www.wsipp.wa.gov.
Selection Criteria: Meta-analysis & cost-benefit analysis.
Applicability: Meta-analysis & cost-benefit analysis.
Currency: Analyses are revised every few years.
Advantages: Predictability of outcomes; ability to compare cost effectiveness.
Limitations: Costs & benefits are based on WA data.