arent-ChildInteractionTherapy-Pennsylvania：家长和孩子的互动疗法-宾夕法尼亚.ppt

Parent-Child Interaction Therapy Gwen Burkholder, LCSW, CAADC October 9, 2013 A Network of Services. A World of Possibilities. 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., Office for Victims of Crime, U.S. Department of Justice, 2004) /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) Youth Violence: A Report of the Surgeon General (Elliott, Hatot, & Sirovatka, Eds., U.S. Department of Health and Human Services, 2001) /library/youthviolence The California Evidence-Based Clearinghouse for Child Welfare (2006) 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 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 post- treatment 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 PCITs Effectiveness with Physical Abuse Conceptual Stage Urquiza & McNeil R21 Grant Submission (1995) Urquiza & McNeil Conceptual Paper (1996) Case Reports and Single Subject Designs 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 Masters 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 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 Number Session Content Assessment of appropriateness for PCIT 1Child Directed Interaction/Relationship Enhancement Skills Teaching Session 2-9Coaching in Child Directed Interaction/Relationship Enhancement Skills 10Parent Directed Interaction/Discipline Skills Teaching Session 11-19Coaching in Parent Directed Interaction/Discipline Skills 20Graduation 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 childs 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. Corresponds with the Parent-Child Interaction Therapy Protocol (2011 Edition) Graduation After special playtime, practice PDI in a 5-min clean-up situation Practice PDI for 2-4 carefully selected direct commands each day Use PDI as necessary for running commands throughout the day Use PDI for House Rules Assign at least two Public Behavior practice outings Do two practice sessions of play with two siblings together Practice PDI in daily 5-10 min play situation at home 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 Parent- Child 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 CountyCityAgency AlleghenyPittsburghAllegheny Childrens 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 Womens Center and Shelter Milestone, Inc. ArmstrongLeechburgFamily Counseling Center ButlerButlerFamily Services of Butler Health System Family Pathways Kids Count/Family Psychological Pennsylvania Agencies Providing Parent-Child Interaction Therapy (8/30/13) Pennsylvania Agencies Providing Parent-Child Interaction Therapy (8/30/13) CountyCityAgency Bedford/ Somerset BedfordAlternative Community Resource Program BerksFleetwoodConcern Counseling ReadingFamilicare Counseling Center Reading Behavioral Health BucksLanghornePenndel Mental Health Center Carbon/Monroe/ Pike WeissportBehavioral Health Associates PalmertonCarbon/Lehigh Intermediate Unit #21 - Behavioral Health Service EastonColonial Intermediate Unit #20 CentrePhilipsburg Cen-Clear Child Services ChesterPhoenixvilleDevereux Community Services CoatsvilleChild Guidance Resource Centers Clearfield/ Jefferson DuBoisClearfield-Jefferson Community Mental Health Center, Inc. CrawfordMeadvilleCounseling and Child Guidance CumberlandCarlisleNHS The Stevens Center DelawareHavertownChild Guidance Resource Centers UplandCrozer-Chester Medical Center ErieErieSafe Harbor Behavioral Health Sarah A. Reed Childrens Center Pennsylvania Agencies Providing Parent-Child Interaction Therapy (8/30/13) CountyCityAgency FayetteUniontownChestnut Ridge Counseling Services, Inc Connellsville Counseling Connellsville Stern Center for Developmental and Behavioral Health Franklin/FultonChambersburgLaurel Life Camp HillFranklin Family Services Huntington/Mifflin/ Juniata HuntingtonUniversal Community Behavioral Health (UCBH) IndianaWhiteFamily Psychological Associates Lehigh EastonColonial Intermediate Unit #20 Lackawanna/ Susquehanna ScrantonFriendship House Scranton Counseling Center CarbondaleNHS Northeastern PA LancasterLancasterCommunity Services Group, Inc LawrenceNew CastleHuman Services Center Luzerne/WyomingWilkes Barre Childrens Service Center