Home-Based Parent–Child Interaction Therapy to Prevent Child Maltreatment: A Randomized Controlled Trial

Abstract

High treatment attrition and limited reach of mental health services for at-risk families remains an important problem in order to effectively address the global concern of child maltreatment and child disruptive behavior problems. This study evaluated the effectiveness of a home-based and time-limited adaptation of Parent–Child Interaction Therapy (PCIT). Twenty families with children (70% boys) aged between three and seven years were randomly assigned to an immediate treatment group (IT, n = 10) or a waitlist control group (WL, n = 10). After receiving treatment and compared to mothers in the WL group, mothers in the IT group reported fewer child behavior problems and more improved parenting skills. Although initial analyses revealed no significant differences, additional analyses showed a significant decrease in the primary outcome of the study, namely child abuse potential, between the baseline and follow-up assessment for the total treated sample. A low treatment attrition rate (15%) was found, indicating higher accessibility of treatment for families. Findings suggest that the brief home-based PCIT is a potentially effective intervention to prevent child maltreatment and disruptive behavior problems in at-risk families. Results also reinforce the importance of addressing the specific needs of these families to increase treatment effectiveness.

A Cohort Study on the Effect of Parental Mind-Mindedness in Parent−Child Interaction Therapy

“…The PCIT-Home sample consisted of 19 children participating in a longitudinal study on the prevention of child maltreatment [33]. Children were referred for treatment of disruptive behavioral problems and a history of maltreatment of the child through the usual community channels (mental health services, internal referrals, child's school or by general practitioners) and as with the PCIT-Clinic sample, treatment took place in a community mental health center in the Amsterdam region, the Netherlands.…”

“…The original sample from Abrahamse et al [33] consisted of 20 children. One family was excluded from the present study because parents did not give permission for scientific use of the video-recordings (and therefore mind-mindedness could not be assessed).…”

“…As a consequence, the number of total sessions may vary among families participating in PCIT-Clinic. In contrast, PCIT-Home consists of four CDI sessions and four PDI sessions [33], regardless of mastery skills or the child's behavior at the end of treatment. Additionally, treatment takes place at the parent's home and because there is no one-way screen available, the therapist coaches the parents from a distance using a wireless headset or the therapist takes a strategic position behind the parent.…”

“…The four parent categories were the percentage of positive following (including behavior descriptions, reflections, labeled praise, and unlabeled praise; coded in CLP only); the percentage of negative leading (including commands, questions, and negative talk; coded in CLP only); praise (the sum of all praise in the three situations, including labeled and unlabeled praise); and demandingness (the sum total of indirect and direct commands, coded in PLP and CU only). The observations were recorded and both samples were coded by independent master-level research assistants and undergraduate students and had 80% agreement with the first author of the original studies [17,33]. All observations were transcribed and one random situation (CLP, PLP, or CU) per child was also coded by a second coder to estimate inter-rater reliability.…”

“…Furthermore, PCIT has been adapted to a time-limited version, based on the less-is-more principle of Bakermans−Kranenburg [32], which assumes that brief interventions with a moderate number of sessions and a clear end point are more effective than interventions with a large number of sessions. In this line, Abrahamse et al [33] examined the effectiveness of a time-limited, home-based adaptation of PCIT, with lower rates of attrition (15%), and a potentially protective effect against child maltreatment.…”