ParentChild Interaction Therapy PCIT

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Parent-Child Interaction Therapy(PCIT)

• The Relationship/Discipline Components
• Naomi Perry, MSW
• Harborview Center for Sexual Assault and
  Traumatic Stress
• 206-521-1800
• November 14, 2006

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Children and Violence

• Family violence
• Between 25 and 30 of American women are beaten
  at least once in the course of intimate
  relationships
• 95 of reported cases of domestic violence
  involve a male batterer and female victim
• Based on one study, children were present in 81
  of the households when the domestic violence
  occurred
• 48 of these children were under the age of 5
  years
• Fartuzzo, J., Boruch, R., Berjama, A., et al.
  Domestic Violence andchildrenPrevalence and risk
  in five major U.S. Cities. Journal of the
  American Academy of Child and Adolescent
  Psychiatry (1997) 36116-22

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The Mothers Responsibility

• Women are considered responsible for the
  well-being and safety of their children AND for
  mediating the relationships between children and
  fathers
• However, these responsibilities are exercised in
  a context of relative powerlessness in terms of
  adult familial relationships

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Violence in the Family Impacts Roles

• Abusive men often attack womens ability to
  mother, the one thing women try to preserve
• Mothering is centered not around what is best for
  the child, but around efforts to limit further
  harm to themselves or their children
• Externally controlled motherhood
• Insisting the children are quiet keeping toys
  out of sight, sending the children to bed early
  so they are not targeted for criticism (or
  worse), hitting or shouting at children before
  the father did, since the harm would be less

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What is Domestic Violence?

• Definition of Domestic Violence
• Abuse by a caregiver, a parent, a spouse or an
  intimate partner
• The goal of domestic violence is to establish and
  maintain power and control
• Physical abuse
• Use of physical force
• Sexual abuse
• Any forced sexual activity
• Emotional abuse
• Threats, constant criticism and put-downs,
  controlling access to money and controlling
  activities

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What is Exposure to Domestic Violence?

• Definition of exposure to domestic violence
• Watching or hearing violent events
• Direct involvement
• attempting to intervene calling the police
• Experiencing the aftermath
• Seeing bruises/other injuries
• Observing maternal depression

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Definition of Exposure to Domestic Violence

• Being within sight or sound of the violence
• Examples
• Hitting or threatening a child while in his or
  her mothers arms
• Taking the child hostage in order to force the
  mothers return to the home
• Using a child as a physical weapon against the
  victim
• Forcing the child to watch assaults against the
  mother or to participate in the abuse
• Using the child as a spy or interrogating him or
  her about the mothers activities

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What We Know About The Relationship Between
Domestic Violence and Children

• 50 of residents in battered womens shelters are
  children
• Almost 80 of women in shelters are accompanied
  by one or more children
• Arizona Coalition Against Domestic Violence,
  1999

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What We Know About The Relationship Between
Domestic Violence and Children

• Historically, children were considered
  secondary victims of domestic violence and
  therefore were not primary targets of service
  interventions
• Children in battered womens shelters appear to
  have more health problems than do children in the
  general population, and therefore a greater need
  for medical attention

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The Facts..

• Between 45 and 70 of children exposed to
  domestic violence are also the victims of
  physical abuse
• Children in households with domestic violence
  were also found to be at higher risk for sexual
  abuse than were children in nonviolent households
• Exposure to domestic violence produces different
  developmental problems at different ages

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Behavioral Therapy Approach

• Parent Child Interaction Therapy
• Provides structure, predictability, and
  consistency in the parent child role
• Develops creativity and encourages curiosity,
  exploration, discovery, pleasure, repetition, and
  mastery
• PCIT is an experience between the parent and the
  child, and EXPERIENCE changes the relationship
  between parent and child!

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A Childs Confusion

• Children grow up expecting their mothers to
  fulfill their needs, care for and protect them
• They do not understand, in the context of
  domestic violence, why their mother are unable to
  do this

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Based on Developmental Theory

• Nurturance and firm limits with young children
  are both necessary for healthy adolescent
  outcomes
• PCIT draws from both attachment and social
  learning theory to achieve authoritative parenting

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Purpose of Assessment

• Helps us understand the unique problems of each
  family
• Allows us to decide if PCIT may be of help for
  these problems
• Guides us in choosing treatment techniques for
  each session
• Permits evaluation of our effectiveness

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Inclusion Criteria for Child

• Child is between 2 to 7 years old (other ages
  dependent on circumstances)

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Inclusion Criteria for Child

• Caregiver (foster parent, relative, etc.) are
  willing to participate in the service

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Inclusion Criteria for Child

• The bond between the parent and child needs to be
  improved

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Inclusion Criteria for Child

• Child is displaying problem behaviors such as
  physical and/or verbal aggression such as
• Hitting - Kicking -Tantrums -Not listening -
  Argumentative - Over activity - Poor social
  skills

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Inclusion Criteria for Child

• There are
• Significant conflict in parent-child relationship
  
• Significant classroom or daycare problems

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Inclusion Criteria for Parent

• Parents lack necessary parenting skills
• Parents need to learn appropriate discipline
  methods
• Bond between the parent and child needs to
  improve
• Child in the home meets age criteria
• For reunification, there must be parent/child
  visitation 3 or more times per week and a formal
  plan to return home in place

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Exclusion Criteria Checklist

• Outside of 2 to 7 year old range (will be
  considered on a case by case basis)
• Pervasive development disorder in child or adult
  (such as autism)
• There is no plan to return the child to the home

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Exclusion Criteria Checklist

• There is on-going, serious domestic violence in
  the home
• Participating caregiver has a severe untreated
  mental illness (such as schizophrenia, active
  psychosis, etc)
• Parents sexually offended against child

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We Want to know if.

• Requested services are
• Home based PCIT
• Clinic based PCIT
• Child resides
• At home
• In foster care or relative placement
• ( Of months already in placement)
• Permanency plan
• Terminate Parental rights
• Return to home
• Adoption

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The Parent Interview

• Provides information about the childs problem
  behaviors useful for tailoring treatment goals
• Gives us information about the history of these
  problems
• Allows the therapist to understand family
  structure, routines, and discipline strategies

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Parent Factors

• Parent factors
• Sees child as intentionally disruptive or
  disobedient
• Childs positive and negative behaviors
  misperceived
• Focuses on negative behaviors ignore positive
  behaviors

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Parent Factors

• Parent factors
• More physical punishment as a means of control
• More punitive strategies, fewer reasoning
  strategies
• Rely heavily on power-assertion techniques
• Less emotional interaction
• (J.S. Miller C. Chilamurti, 1991)

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Child Factors

• Child factors
• Aggressive, anti-social, under-controlled
• More negative verbalizations, less social
  interactions
• Temper tantrums

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Purpose of Child Directed Interaction (CDI) Play

• Purpose of CDI
• Helps children feel safe and calm
• Helps parent to feel better towards child
• Teaches parent how to communicate/play with their
  child
• Teaches parent how to teach child
• Improves self-esteem
• Improves social skills
• Results in warm, secure relationship

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Treatment Goals

• Decrease aggressive behavior by 75 which will be
  monitored by parent report and observation in
  session
• Increase pro-social skills (e.g., sharing, turn
  taking) by 75 which will be monitored by parent
  report and observation in session

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CHILDREN BY NATURE
ALREADY KNOW
HOW TO PLAY
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PCIT IS AN EVIDENCED BASED TREATMENT PROGRAM
THAT TEACHES PARENTS
HOW TO SUCCESSFULLY
ENJOY THEIR CHIIDS PLAY
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Its not easy to be a parent period!Its
especially not easy to be a single parent.
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A child who is hyperactive, impulsive,
inattentive, aggressive, demanding and
temperamental

• can increase daily stress and make some parents
  angry and regretful of their parenting decisions!

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Teaching the Basic Rule

• FOLLOW
• THE
• CHILDS
• LEAD

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THE DONT RULES

• Commands
• Commands lead the behaviors
• Risk negative interaction
• Questions
• Often hide commands
• Takes the lead from the child
• Can suggest disapproval
• Can suggest caregiver is not listening
• Criticism
• Points out mistakes rather than correcting them
• Lowers self-esteem
• Creates unpleasant interactions

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THE DONT RULES

• make me sad
• shut me down
• lowers my self-esteem
• makes me angry
• escalates my negative behaviors
• brings out oppositional behaviors in me
• No, Dont, Stop, Quit and Not

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CDI DO RULESARE THE P-R-I-D-E SKILLS
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Child Directed Interaction (CDI)

• Relationship Enhancement Overview
• DO RULES
• Praise
• Reflection
• Imitation
• Description
• Enthusiasm
• P-R-I-D-E

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Coaching PCIT
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Effectiveness Of CDI The Relationship Component

• Childs behaviors decrease by 75
• Children genuinely become more eager to please
  the parent
• Parents feel more confident
• Childs self-esteem improves
• Oppositional children become less angry
• Childs attention span increases
• Bottom line The family is happier

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(No Transcript)
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• STOP

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• Questions
• Commands
• Critical talk

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GO
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Increase use of..

• P. R. I. D. E
• r e m e n
• a f I s t
• I l t c h
• s e a r u
• e c t I s
• t I p I
• I o t a
• o n I s
• n o m
• n

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PARENT DIRECTED INTERACTION (PDI)

• THE
• DISCIPLINE
• COMPONENT

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PARENT DIRECTED INTERACTION (PDI)

• Parents lead the activity
• Contingency management
• Limit-setting
• Problem solving
• Reasoning

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Parent-Directed Interaction (PDI)
BE DIRECT

• The first step in getting compliance is to Be
  Direct with the child. Being direct helps
  children understand exactly how you expect them
  to behave.

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Parent-Directed Interaction (PDI)

• B
• E
• D
• I
• R
• E
• C
• T

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Parent-Directed Interaction (PDI)
B

• E Specific with your commands
• Make commands specific rather than vague

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Parent-Directed Interaction (PDI)

• Very command positively stated
• Continue to avoid using
• NO
• DONT
• STOP
• QUIT
• NOT!

E
E
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Parent-Directed Interaction (PDI)

• evelopmentally Appropriate
• Give developmentally appropriate commands
• Each childs age and maturity level is unique, so
  it is important to have different expectations
  for younger and older children

D
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Parent-Directed Interaction (PDI)

• ndividual rather than compound
• Instructions should be provided one at a time,
  rather than stringing several commands together

I
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Parent-Directed Interaction (PDI)
R

• espectful and polite
• Start most instructions with the word please

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Parent-Directed Interaction (PDI)

• ssential commands only
• Commands should be essential and noncompliance
  followed through with consequences

E
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Parent-Directed Interaction (PDI)

• hoices when appropriate
• Giving children the opportunity to make choices
  can help them to become independent
• you can either wear the red shirt or the green
  shirt to school

C
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Parent-Directed Interaction (PDI)

• one of voice is neutral
• Commands should be given in a firm and a matter
  of fact voice

T
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Practicing 'Minding'

• Tell the child what to do instead of asking
• Avoid repeating commands
• Commands should be positively stated
• Give instructions one at a time
• Avoid vague commands (e.g., Straighten up)

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PCIT DOESNT SAY
ITS OUR WAY OR ITS NO WAY
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THE MISSION
INCREASE THE PARENTS GOAL TO
STOP THE WALKING/TALKING CYCLE OF ABUSE
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Effectiveness of PDIThe Discipline Component

• Teaches the parent the need for consistency,
  predictability and follow-through
• Teaches the parent to give good (effective)
  commands
• Teaches the parent how to give an effective
  consequence for non-compliance
• Teaches a safe and easy, but effective, time-out
  procedure

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Referrals

• Who can be referred to PCIT?
• Parents of children ages 2 7 year olds
• Older/Younger if minor adaptations are made
• Parents with poor parenting skills and/or history
  of physical and/or verbal abuse of their children
• Parents of children with oppositional, defiant,
  non-compliant behaviors
• Single or two-parent homes

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Referrals

• Who Can be referred to PCIT?
• Grandparents and/or significant extended family
  members in caretaker roles
• Foster care parents
• Court ordered
• Parents and children exposed to domestic violence
  but not actively living in domestic violence

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THANK YOU