Evidence-Based Strategies

Parent-Child Interaction Therapy (PCIT)

From PCIT International and the National Registry of Evidence-based Programs and Practices at SAMHSA.

Parent-Child Interaction Therapy (PCIT) is an empirically-supported treatment for children ages 2 to 7 that places emphasis on improving the quality of the parent-child relationship and changing parent-child interaction patterns. One primary use is to treat clinically significant disruptive behaviors. 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 intentional play 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 has several unique features which support interaction between parents and children:  The therapist does not interact directly with the child and are not in the room for most sessions. Instead, two-way mirrors or cameras and ear pieces provide feedback and suggestions to parents while they are interacting with their child. The average number of sessions is 14, but varies from 10 to 20 sessions. Treatment continues until the parent masters the interaction skills to pre-set criteria and the child's behavior has improved to within normal limits.

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.

Research

PCIT was developed by Sheila M. Eyberg, PhD, University of Florida.

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.

Chaffin, M., Funderburk, B., Bard, D., Valle, L.A., & Gurwitch, R. (2011). A combined motivation and parent-child interaction therapy package reduces child welfare recidivism in a randomized dismantling field trial. Journal of Consulting and Clinical Psychology, 79, 84-95. doi:10.1037/a0021227

Berkovitz, M.D., O’Brien, K.A., Carter, C.G., & Eyberg, S.M. (2010). Early identification and intervention for behavior problems in primary care: A comparison of two abbreviated versions of parent-child interaction therapy. Behavior Therapy, 41, 375-387.

Callahan, C.L.& Eyberg, S.M. (2010). Relations between parenting behavior and SES in a clinical sample: Validity of SES measures. Child & Family Behavior Therapy, 32(2), 125-138. doi:10.1080/07317101003776456 PDF.File

Lanier, P., Kohl, P. L., Benz, J., Swinger, D., Moussette, P., Drake, B. (2011). Parent-child interaction therapy in a community setting: Examining outcomes, attrition, and treatment setting. Research on Social Work Practice, Only found online. 

Prevention matrix

Tertiary

Clearinghouse rating

California Evidence Based Clearinghouse Rating (CEBC) – 1 (Well Supported by Research Evidence)

According to the CBEC, PCIT was developed for families with young children experiencing behavioral and emotional problems. Therapists coach parents during interactions with their child to teach new parenting skills. These skills are designed to strengthen the parent-child bond; decrease harsh and ineffective discipline control tactics; improve child social skills and cooperation; and reduce child negative or maladaptive behaviors. PCIT is a treatment for disruptive behavior in children and is a recommended treatment for physically abusive parents.

Also recognized by the National Registry of Evidence-Based Programs (NREPP) by SAMHSA

 

Assessments and measures

Currently in use in Nebraska communities:

Eyberg Child Behavior Inventory (ECBI)

The ECBI is a 36-item parent report scale of conduct problem behaviors in children between the ages of 2 and 16.

Dyadic Parent-Child Interaction Coding System (DPICS)

The DPICS is a behavioral coding system that measures the quality of parent-child social interactions.  

Training

Trainees must have a master’s degree or higher in the mental health field and must be actively working with children and families. Trainees must be licensed in the field or receive supervision from a licensed individual trained in PCIT.  Basic training requirements include the following:

  • 40 hours of face-to-face contact with a PCIT trainer than includes an overview of the theoretical foundations, coding practice, case observations, and guided coaching with families, with a focus on mastery of Child Directed Interaction (CDI) and Parent Directed Interaction (PDI) skills and coaching.
  • Advanced live training with real cases approximately 2-6 months after the initial training that focuses on refining coaching skills, addressing complex treatment issues, and a check-off on coaching criteria.
  • Case experience: trainees must treat a minimum of two PCIT cases to completion as the primary therapist or co-therapist.  Unit the two cases are completed, trainees must remain in regular contact, (recommended weekly but no less than monthly) via telephone, live observation, or tape review, with a PCIT trainers.  This tends to take one year.
  • Skill review: trainees must have their treatment reviewed by a PCIT trainer for CDI Didactic, PCI Didactic, CDI coaching, and PDI coaching.

Please refer to the information for Professionals on the PCIT website.

 

State partners

Nebraska Children and Families Foundation

Nebraska Child Abuse Prevention Fund Board

Nebraska Children and NCAPF Board Grantee communities

Dakota County Connections - Dakota County

West Central Partnership Child and Family Alliance - Lincoln County

Zero2Eight - Platte and Colfax Counties

Fremont Family Coalition - Dodge County

PCIT providers in these and other Nebraska communities, including Lincoln, Omaha and Grand Island are listed on the Magellan of Nebraska website. 

News

Medicaid reimbursement. 

PCIT became a Medicaid covered service on April 15, 2013.   It requires prior authorization by providers approved by Magellan.  Criteria have been published. With specified billing codes, PCIT will be reimbursed at the fee-for-service and managed care rates established for the CPT code Family Psychotherapy 90847.

National Learning Collaborative. 

Teams from two Nebraska community collaborations, Dakota County and Platte-Colfax Counties, have been selected to participate in the national Parent Child Interaction Therapy Learning Collaborative in 2013-2014. The Learning Collaborative is part of the Families Increasing Resilience, Strength, and Trust through Positive Relationships, or “FIRST” Program. A year-long, state-of –the-art series of learning experiences will increase fidelity and enhance practice while overcoming implementation barriers. National partners include a consortium of Duke University, North Carolina Center University, and the University of North Carolina at Chapel Hill, along with the Oklahoma Health Science College and SAMHSA.

Related strategies

Teacher Child Interaction Therapy (TCIT)

Child Adult Relationship Enhancement (CARE)

Parent-Child Psychotherapy

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