Parent-Child Interaction Therapy
Parent-Child Interaction Therapy (PCIT) at the Center for Developmental Disabilities in Memphis, TN is a behavioral family-oriented therapy and an evidence-based practice for children with disruptive behavior problems between the ages of two and six. The PCIT clinic is managed by the psychology department, with psychology trainees and community providers serving as therapists. Supervision is provided by licensed psychologists and postdoctoral psychology fellows who have extensive training and expertise in the PCIT model.
Developed by Dr. Sheila Eyberg, President and CEO of PCIT International, PCIT integrates concepts from social learning theory, traditional play therapy, and attachment theory to enhance the parent-child relationship, increase children’s prosocial behaviors, and increase parents’ behavior management skills. The program is implemented in two phases: The first phase is the Child-Directed Interaction (CDI) phase during which parents develop child-centered interaction skills. The second phase is the Parent-Directed Interaction (PDI) phase during which effective discipline skills are the focus. PCIT gives equal attention to the development of the parent-child relationship and the development of parents’ behavior management skills.
A critical goal of PCIT is to increase positive, nurturing interactions by including the child and caregiver in treatment, both in session and during daily homework assignments. In contrast to the traditional approach to parent training that focuses on discussion and role play of techniques, caregivers in PCIT rehearse skills weekly in session through live interactions with their children. Further, during parent-child interactions, immediate feedback is given by the therapist from an observation room, while the parent wears a radio frequency earphone.
Services Provided to Families
The PCIT Clinic at CDD serves children functioning at the age of 2-6 years and their families. Children’s primary or secondary diagnoses typically include disruptive behavior disorders, (e.g. ADHD, oppositional defiant disorder) although children with Autism Spectrum Disorders, developmental delays, anxiety, or mood problems are also served. Clients are referred to the PCIT Clinic from CDD evaluations, as well as from the community. The typical population served is diverse in ethnicity and socioeconomic status. Services provided are billed under the supervisor.
The PCIT Clinics at CDD typically begin in late September to early October, and again in late January to early February. However, this schedule is subject to change, and there may be other appointment times depending on therapist availability. Sessions are once weekly and last 60-90 minutes each. Both the caregiver and child are expected to attend each session. This specialized program typically takes 16-20 weeks to complete, but is dependent on families consistently completing “homework” and attending scheduled sessions.
If a family is interested in PCIT services, it is highly recommended that they contact the PCIT Clinic as soon as possible, for there is typically a waitlist for services.
Professional Referrals
The CDD PCIT Clinic serves children functioning between the ages of 2-6 years and their families. PCIT services have been found most effective in treating children with disruptive behavior problems (ADHD, Oppositional Defiant Disorder), but may also benefit children with Autism Spectrum Disorders, developmental disabilities, anxiety, or mood problems.
The preferred method of referral is to have the family personally contact the PCIT Clinic at 901-448-6536. If a family is interested in PCIT services, it is highly recommended that they contact the PCIT Clinic as soon as possible, for there is typically a waiting list for services.
PCIT International Training Guidelines
Standards for professional training in PCIT are determined by PCIT International. Individuals seeking training in the PCIT model must have their Masters degree or higher in the mental health field, be licensed (or supervised by a licensed individual), and must actively work with children and families. Initially, beginning trainees must complete a m inimum 40 hours of direct training with a PCIT trainer, which includes an overview of the theoretical foundations of PCIT, coding practice, case observations, and guided coaching with families, with a focus on mastery of CDI and PDI coaching skills. After the initial training, trainees must treat a minimum of two PCIT cases to completion as a primary therapist or co-therapist with supervision/consultation with a PCIT trainer. This is estimated to take 6-12 months. Fidelity of the PCIT model is assessed throughout the supervision and consultation period.
In terms of appropriate set-up, the trainee’s agency must provide appropriate space and equipment for conducting PCIT. Appropriate space includes a stripped therapy room, a separate observation room with either two-way mirror or video monitoring, and a communication system that allows the therapist to speak in real time to the parent during parent-child interaction. The trainee’s agency must serve a population of clients within the age range for PCIT services, and must allow time for trainees to participate in ongoing training and consultation.
Training at the Center for Developmental Disabilities
At the CDD, psychology trainees (practicum students, predoctoral interns, and postdoctoral fellows) gain experience working in co-therapy teams while learning the basic tenets of PCIT. Trainees complete didactic training regarding the PCIT International empirically supported treatment protocol and the structured behavioral coding system for parent-child interactions. Throughout the clinical services phase, trainees receive live supervision and group supervision. The CDD PCIT Training Clinic is a 2-hour evening clinic held weekly that requires at a minimum a first and second rotation commitment from interns. This includes didactic and experiential trainings on the PCIT protocol, as well as direct clinical service provision, which takes approximately 16-20 weeks to complete. Approximately 6-10 individuals are trained in PCIT techniques each year.
Training at the Center of Excellence for Children in State Custody
The Center of Excellence (COE) for Children in State Custody provides PCIT training to community mental health providers. The training includes three phases that encompass didactic learning sessions, live and group supervision of an initial case, and ongoing supervision/consultation for two additional cases. Because this dissemination training model assists community agencies in establishing a sustainable PCIT program, several agency personnel are expected to participate in the training (i.e., administrator, senior-licensed co-therapist, and junior co-therapist). Thus, through collaborative efforts, the COE assists community agencies in developing an organizational climate that supports evidence-based practices. Approximately one to two community agencies receive training in PCIT each year.
PCIT Ongoing Research
PCIT is one of the most effective treatments known for children with behavior problems between the ages of 2 and 6 years. Previous research has shown that families who complete PCIT services demonstrate improvements in the interactional style of caregivers, and improvements in the behavior problems of children at home and at school. Additionally, caregivers report less personal distress and more confidence in their ability to control their child’s behavior. PCIT has been shown to generalize to other siblings in the family and to maintain treatment gains up to 6 years following completion of services. The treatment has been found to be efficacious in treating behavior problems in children in the general population, in children with developmental disabilities, and children of varied ethnic groups.
At the CDD, PCIT research includes evaluating the procedures, methods, and outcomes of provider training and service delivery. In particular, studies examine the use of PCIT with the specific populations served at CDD and various other community agencies in Tennessee that provide mental health treatment to children. PCIT program evaluation informs future implementation of PCIT by determining the best methods of service delivery and training.
Dissemination
In addition to disseminating the clinical practice of PCIT through training programs, the PCIT Clinic is dedicated to encouraging the exchange of knowledge through community presentations and research conferences. Our Center has presented on PCIT at local and national conferences, as well as contributed to interdisciplinary leadership seminars that offer continuing education credits for mental health providers. As part of the dissemination efforts associated with PCIT, participation in training and research activities are expected to occur on an ongoing basis.