An Evaluation of Parent–Child Interaction Therapy With and Without Motivational Enhancement to Reduce Attrition

Abstract

Although many interventions for child externalizing behavior report promising outcomes for families, high attrition prior to program completion remains a problem. Many programs report dropout rates of 50% or higher. In this trial we sought to reduce attrition and improve outcomes by augmenting a well-known evidence-based intervention, Parent-Child Interaction Therapy (PCIT), with a 3-session individual motivational enhancement component. Participants were 192 Australian caregivers (91.7% female; M = 34.4 years) and their children (33.3% female; M = 4.4 years). Families (51% referred from child welfare or health services for risk of maltreatment) were assigned to PCIT or a supported waitlist, with families assigned to PCIT receiving either standard PCIT (S/PCIT) or motivation-enhanced PCIT (M/PCIT), depending on their time of entry to the study. Waitlist families received phone calls every week for 12 weeks. Parents in M/PCIT reported more readiness to change their behavior from preassessment to after the motivation sessions. Also, parents who reported high, rather than low, motivation at preassessment did have a lower attrition rate, and there was some evidence that enhancing motivation was protective of premature attrition to the extent that caregivers achieved a high degree of change in motivation. Yet comparison of attrition rates and survival analyses revealed no difference between M/PCIT and S/PCIT in retention rate. Finally, there were greater reductions in externalizing and internalizing child behavior problems and parental stress among families in S/PCIT and M/PCIT compared with waitlist, and there was generally no significant difference between the two treatment conditions.

Improved Perceptions of Emotion Regulation and Reflective Functioning in Parents: Two Additional Positive Outcomes of Parent-Child Interaction Therapy

“…PCIT falls within the broader category of a parent behavioral training approach (Comer et al, 2013), which is considered the gold-standard treatment for children's externalizing behavior and parenting problems (Colalillo & Johnston, 2017). PCIT in particular has demonstrated effectiveness, both using self-report and observational measures, among highly distressed families and across multiple pediatric diagnoses (e.g., Webb et al, 2017). The research on PCIT is quite consistent with the findings for the general behavioral training approach, showing success (with some variability across studies) in improving parenting and reducing behavioral problems in children (Comer et al, 2013;Kaminski & Claussen, 2017).…”

“…Thus, regular supervision and observation ensured treatment fidelity, but fidelity was not systematically assessed. The service has provided the 12-week version of PCIT for more than 10 years and have published the results of its efficacy and effectiveness (Thomas et al, 2017;Thomas & Zimmer-Gembeck, 2012;Webb et al, 2017).…”

“…Derived from social learning theory (Patterson, 1982) and attachment theory (Bowlby, 1969), the aims of PCIT are to reduce child externalizing behavior by increasing positive parent-child interactions and parenting skills (McNeil & Hembree-Kigin, 2010;Webb, Thomas, McGregor, Avdagic, & Zimmer-Gembeck, 2017). In PCIT, parents receive direct coaching, whereby a therapist observes structured parent-child interactions through a one-way mirror and coaches the parent, via an earpiece, to attend warmly, consistently and predictably to his or her child's behaviors and to apply adaptive behavior management strategies to manage child behavior problems.…”

“…Progression and cessation of PCIT is determined based on parents' attainment of particular mastery criteria, and, thus, usually varies in length across families (McNeil & Hembree-Kigin, 2010). However, PCIT limited to 12 weekly sessions has been shown to produce equivalent or superior outcomes to time-variable PCIT (Thomas & Zimmer-Gembeck, 2012;Webb et al, 2017). Therefore, this 12-week format was used in the present study.…”

A Randomized Controlled Trial of Parent-Child Interaction Therapy with and without Incentives in a Community Mental Health Setting

“…Used selectively, motivational interviewing may greatly impact family retention in PCIT for families with low motivation levels. More recently, PCIT researchers in Australia incorporated motivational interviewing and enhancement techniques prior to starting standard treatment protocol (Webb, Thomas, McGregor, Avdagic, & Zimmer-Gembeck, 2017). Although Webb and colleagues witnessed a change in parental motivation for those families receiving the motivational enhancement sessions, no differences were found between standard PCIT and motivationally-enhanced PCIT when comparing retention rates over time.…”