A Network of Services. A World of
Possibilities.
Parent-Child Interaction Therapy
Gwen Burkholder, LCSW, CAADC
burkholderg@csgonline.org
October 9, 2013
Welcome and Introductions!
Photos are courtesy of Amy Herschell, Ph.D.
Thank you to the following people:
• Cheryl Bodiford McNeil, Ph.D., Department of
Psychology, West Virginia University, who provided
my initial five-day training to become a PCIT clinician
in November 2010
• Amy D. Herschell, Ph. D., University of Pittsburg
School of Medicine, who has provided ongoing
supervision and consultation to me regarding
providing PCIT in Lancaster, PA over the past three
years.
What is PCIT?
• Work with the parent (birth, kin, foster, adoptive) and child
together
• Designed to treat children age 2 to 7 years exhibiting
disruptive behaviors
• Use of coaching with a ‘bug-in-the-ear’ from a one-way
mirror
• Consists of two phases of treatment:
– Relationship Enhancement
– Behavior Management
• Initially developed by Sheila Eyberg, University of Florida.
McNeil, C.B., & Hembree-Kigin, T. (2010). Parent-Child
Interaction Therapy. Second edition. New York: Springer.
PCIT Set-up
Photos are courtesy of Amy Herschell, Ph.D.
What is PCIT?
• Elements of family systems, social learning
theory, and traditional play therapy
• Emphasis on restructuring parent-child patterns,
not modifying target behaviors
• Parents are not blamed, but are given
responsibility for improving the child's behavior
• Program is completed in 12-20 sessions,
depending on the needs of the family
• Empirically evaluated in over 30 controlled
studies
McNeil, C.B., & Hembree-Kigin, T. (2010). Parent-Child
Interaction Therapy. Second edition. New York: Springer.
Critical Components of PCIT
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Parent and Child are seen together
Relationship Focused
Not Time Limited
Coaching Model – Active, Directive
Assessment Driven
Scientifically Based
Empirically Supported
Clinically Validated
Information provided by Amy Herschell, Ph. D.
Who is PCIT Appropriate For?
• Young Children (Age 2-7)
• Children exhibiting externalizing behavior
problems (e.g., verbal and physical aggression,
defiance, noncompliance, temper tantrums)
• Parents who could benefit from enhanced
relationship and/or behavior management skills
with young children
Information provided by Amy Herschell, Ph. D.
Who is PCIT Appropriate For?
• Extensive contact with Primary Caregiver
(or person completing PCIT with child)
• Families with young children and who have
experienced violence
• Families with young children and
relationship difficulties
Information provided by Amy Herschell, Ph. D.
Developmental Progression of
Conduct Disordered Behaviors
Oppositional
Argues
Stubborn
Loud
Offensive
Cruelty
Sulks
Swears
Aggressive
Destroys
Attacks
Delinquent
Sets fires
Truancy
Temper tantrums
Demands attention
Disobeys at home
Bragging
Teases
Impulsive
Disobeys at School
Screams
Poor peer relations
Fights
Lying/cheating
Bad friends
Threatens Others
Steals at home
Steals Outside/Home
Alcohol/drug use
Runs away
Vandalism
Information provided by Amy Herschell, Ph.D.
Sample Course of Treatment
Session Session Content
Number
Assessment of appropriateness for PCIT
1
Child Directed Interaction/Relationship Enhancement Skills
Teaching Session
2-9
Coaching in Child Directed Interaction/Relationship
Enhancement Skills
10
Parent Directed Interaction/Discipline Skills Teaching Session
11-19
Coaching in Parent Directed Interaction/Discipline Skills
20
Graduation Session
Information provided by Amy Herschell, Ph. D.
Assessment of Appropriateness
for PCIT – Intake Process
Agency Intake
Supplemental PCIT Questions
Standardized, self-report measures
– Eyberg Child Behavior Inventory (ECBI)
– Sutter-Eyberg Student Behavior Inventory (SESBI-R)
– Child Behavior Checklist (CBCL)
– Parenting Stress Inventory – Short Form (PSI-SF)
Standardized, behavior observation measure
– Dyadic Parent-Child Interaction Coding System-IV
(DPICS-IV)
Information provided by Amy Herschell, Ph. D.
Eyberg Child Behavior Inventory (ECBI)
• Assesses behaviors associated with the
primary childhood disruptive behavior
disorders (e.g., noncompliance, defiance,
aggression)
• Appropriate for children aged 2-16 years
• Contains 36 items and two scales – the
Intensity and Problem Scales
• 10 Minutes for parents to complete, 2 minutes
to score
Information provided by Amy Herschell, Ph. D.
Child Behavior Checklist (CBCL)
• Survey social competencies and problem behaviors
• Complete by parent or regular caregiver
• Separate forms for two age groups (1.5 – 5 years & 618 years)
• Approximately 100 items, 15 to 25 minutes to
administer
• Comprised of two broad band scales and a total
problem scale –
• Externalizing – disruptive or under controlled
behaviors
• Internalizing – anxiety, depression, withdrawal
• Total problems scale
Information provided by Amy Herschell, Ph. D.
Parenting Stress Index (PSI)-Short Form
• Composed of three subscales:
– Parental Distress
– Dysfunctional Parent-Child Interaction
– Difficult Child Characteristics
• Added together, these subscales yield a Total
Stress Score
Information provided by Amy Herschell, Ph. D.
Dyadic Parent-Child Interaction
Coding System (DPICS)
• Structured observational assessment
• Child-directed play
• Parent-directed play
• Clean-up
• Observing and coding parent-child
interactions for PCIT specific Skills
• Labeled Praise, Behavioral Descriptions,
Reflections
• Questions, Commands, Criticism
Information provided by Amy Herschell, Ph. D.
Recognition as an Evidence-Based Practice
Closing the Quality Chasm in Child Abuse Treatment: Identifying and
Disseminating Best Practices (Chadwick Center,
2004) www.chadwickcenter.org/kauffman.htm
The National Child Traumatic Stress Network (Empirically Supported Treatments
and Promising Practices, supported by The Substance Abuse and Mental Health
Services Administration,
2005) www.nctsn.org/nccts/nav.do?pid=ctr_top_trmnt_prom
Child Physical and Sexual Abuse: Guidelines for Treatment (Saunders, Berliner, &
Hanson, Eds., National Crime Victims Research and Treatment Center and The
Center for Sexual Assault and Traumatic Stress; Office for Victims of Crime,
U.S. Department of Justice, 2004)
www.musc.edu/ncvc/resources_prof/OVC_guidelines04-26-04.pdf
Evidence-Based Treatment for Children and Adolescents (The Society of Clinical
Child and Adolescent Psychology, a division of the American Psychological
Association, and the Network on Youth and Mental
Health) www.effectivechildtherapy.com
Youth Violence: A Report of the Surgeon General (Elliott, Hatot, & Sirovatka, Eds.,
U.S. Department of Health and Human Services, 2001)
http://www.surgeongeneral.gov/library/youthviolence
The California Evidence-Based Clearinghouse for Child Welfare (2006)
www.cachildwelfareclearinghouse.org
Information provided by Amy Herschell, Ph. D.
Kauffman Best Practices Project (2004)
Identified Three “Best Practices”
for Children who have
experienced abuse and are
experiencing mental health
concerns:
• Abuse-Focused CBT
• Parent-Child Interaction
Therapy
• Trauma-Focused CBT
Information provided by Amy Herschell, Ph. D.
Key Research Areas
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Efficacy/Effectiveness
Diagnostic Classifications
Child Maltreatment Populations
Cultural Variables
Therapist Variables
Treatment Delivery
Attrition
Maintenance
Dissemination
Information provided by Amy Herschell, Ph.D.
Treatment Outcome Research with Children
Experiencing Behavior Problems
Main Findings:
 Parent skill increases in reflective listening, physical
proximity, and prosocial verbalizations
 Decreases in sarcasm and criticism of the child
 More positive parental attitudes toward child
 Parent report of child behavior problems to within normal
limits
 Parent self-reported improvements in psychopathology,
personal distress, and parenting locus of control
 High consumer satisfaction with process and outcome
 Maintenance of treatment gains up to 6 years posttreatment
 Generalization to untreated siblings
 Generalization to home and school
Herschell, A. D., Calzada, E. J., Eyberg, S. M., & McNeil, C. B. (2002). Research
Issues In Parent-Child Interaction Therapy. Cognitive & Behavioral Practice, 9.
Studies that have demonstrated PCIT’s
Effectiveness with Physical Abuse
• Conceptual Stage
– Urquiza & McNeil R21 Grant Submission (1995)
– Urquiza & McNeil Conceptual Paper (1996)
• Case Reports and Single Subject Designs
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Borrego, Urquiza, Rasmussen, & Zebell (1999)
Fillcheck, McNeil, Herschell (in press)
Fricker, Ruggiero, & Smith (2005)
Herschell, Calzada, Eyberg, & McNeil (2002)
Urquiza, Timmer, Herschell, McGrath, Zebell, & Porter
(2005)
• Treatment Outcome Studies
– Chaffin and colleages (2007, 2010)
– Urquiza, Timmer, Zebell, & McGrath (in press)
– McNeil, Herschell, Gurwitch, & Clemens-Mowrer (2005)
Information provided by Amy Herschell, Ph. D.
Limitations and Caveats
• Focus on child behavioral problems, parenting
skill, and changing relationships, not on all
aspects of family (e.g., active substance abuse,
parent psychopathology)
• Continued need for coordination with other
treatment/support agencies
• Limited age range
• Parent and child must have regular ongoing
contact
Information provided by Amy Herschell, Ph. D.
Clinician Training in PCIT
 Training Requirements for Clinicians
 Master’s degree or higher in the mental health field
 Actively working with children and families.
 Licensed in his or her field or receive supervision from a
licensed individual trained in PCIT.
 Training Program
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40-hours of face-to-face contact with a PCIT trainer
4-6 months later a 2-day advanced live training
Case Experience (at least 2 families, preferably 5)
Regular (bi-weekly) consultation/Supervision over 1 year
Skill review
Information provided by Amy Herschell, Ph. D.
Sample Course of Treatment
Session Session Content
Number
Assessment of appropriateness for PCIT
1
Child Directed Interaction/Relationship Enhancement Skills
Teaching Session
2-9
Coaching in Child Directed Interaction/Relationship
Enhancement Skills
10
Parent Directed Interaction/Discipline Skills Teaching Session
11-19
Coaching in Parent Directed Interaction/Discipline Skills
20
Graduation Session
Information provided by Amy Herschell, Ph. D.
Child Directed Interaction
In the effort to enhance the relationship between the
parent and child, the therapist coaches the parent to
do the behavioral and play therapy techniques of:
•Reflecting what child says
•Describing what child is doing
•Giving specific praise for child’s positive behavior
The parent is also coached to avoid doing
questions, commands, and criticism and to ignore
minor annoying behavior.
Parent Directed Interaction
• The therapist coaches the parent to gain
increased compliance from the child by
teaching how to give direct commands
and how to follow-up with consistent
consequences for non-compliance, as part
of the behavioral and play therapy.
Graduation
Do two practice sessions of
play with two siblings
together
Assign at least two Public Behavior
practice outings
Use PDI for House Rules
Use PDI as necessary for running commands
throughout the day
Practice PDI for 2-4 carefully selected direct commands
each day
After special playtime, practice PDI in a 5-min clean-up situation
Practice PDI in daily 5-10 min play situation at home
Corresponds with the Parent-Child Interaction Therapy Protocol
(2011 Edition)
How PCIT has become more
common in Pennyslvania
• The Pennsylvania Department of Public
Welfare and the Pennsylvania Keys in
collaboration with the Heinz Foundation,
solicited Requests for Applications for
Licensed Outpatient Psychiatric Clinics to
send clinical staff to be trained to do ParentChild Interaction Therapy beginning in 2010.
Several cohorts of training groups have been
trained since that time.
2011 Pennsylvania Agencies Providing
Parent-Child Interaction Therapy
2012 Pennsylvania Agencies Providing
Parent-Child Interaction Therapy
2013 Pennsylvania Agencies Providing
Parent-Child Interaction Therapy
Last Updated – September 20, 2012
Pennsylvania Agencies Providing
Parent-Child Interaction Therapy (8/30/13)
County
Allegheny
City
Pittsburgh
Agency
Allegheny Children’s Initiative
Glade Run
Laughlin Center
Family Resources of PA
Matilda Theiss Child Development Center @ WPIC
Private Practice
The Melting Pot
University of Pittsburgh/
Western Psychiatric Institute and Clinic
Wesley Spectrum
Women’s Center and Shelter
Milestone, Inc.
Armstrong
Leechburg
Family Counseling Center
Butler
Butler
Family Services of Butler Health System
Family Pathways
Kids Count/Family Psychological
Pennsylvania Agencies Providing
Parent-Child Interaction Therapy (8/30/13)
County
City
Agency
Bedford/
Somerset
Bedford
Alternative Community Resource Program
Berks
Fleetwood
Concern Counseling
Reading
Familicare Counseling Center
Reading Behavioral Health
Bucks
Langhorne
Penndel Mental Health Center
Carbon/Monroe/
Pike
Weissport
Behavioral Health Associates
Palmerton
Carbon/Lehigh Intermediate Unit #21 - Behavioral Health Service
Easton
Colonial Intermediate Unit #20
Centre
Philipsburg
Cen-Clear Child Services
Chester
Phoenixville
Devereux Community Services
Coatsville
Child Guidance Resource Centers
Clearfield/
Jefferson
DuBois
Clearfield-Jefferson Community Mental Health Center, Inc.
Crawford
Meadville
Counseling and Child Guidance
Cumberland
Carlisle
NHS – The Steven’s Center
Delaware
Havertown
Child Guidance Resource Centers
Upland
Crozer-Chester Medical Center
Erie
Safe Harbor Behavioral Health
Erie
Sarah A. Reed Children’s Center
Pennsylvania Agencies Providing
Parent-Child Interaction Therapy (8/30/13)
County
Fayette
City
Uniontown
Agency
Chestnut Ridge Counseling Services, Inc
Connellsville Counseling
Connellsville
Stern Center for Developmental and Behavioral Health
Franklin/Fulton
Chambersburg
Laurel Life
Camp Hill
Franklin Family Services
Huntington/Mifflin/
Juniata
Huntington
Universal Community Behavioral Health (UCBH)
Indiana
White
Family Psychological Associates
Lehigh
Easton
Colonial Intermediate Unit #20
Lackawanna/
Susquehanna
Scranton
Friendship House
Scranton Counseling Center
Carbondale
NHS – Northeastern PA
Lancaster
Lancaster
Community Services Group, Inc
Lawrence
New Castle
Human Services Center
Luzerne/Wyoming
Wilkes Barre
Children's Service Center of Wyoming Valley
Lycoming/Clinton
Williamsport
Community Services Group, Inc
Mercer
Hermitage
Community Counseling Center
Paoletta Counseling
Northumberland
Sunbury
Northumberland County Counseling Services
Pennsylvania Agencies Providing
Parent-Child Interaction Therapy (8/30/13)
Philadelphia
Philadelphia
Children’s Crisis Treatment Center
Children’s Hospital of Philadelphia
Presbyterian Children's Village
Schuylkill
Pottsville
Professional Counseling, Consulting & Human Services
The ReDCO group
Venango
Oil City
Regional Counseling Center, Inc.
Washington
Fredericktown
Centerville Clinic
Westmoreland
Greensburg
FBR
New Kensington
FBR/AERI
Making referrals for PCIT
•Refer to a behavioral health agency in your
area who is providing PCIT.
•Consider offering PCIT at your community
health center if space is available, and the
necessary licensure and billing issues can be
worked out for the provision of behavioral
health care on site.
Recommended books on PCIT
Available on www.pcit.org
Available on Amazon.com