Varying Treatment Intensity in a Home‐based Parent and Child Therapy Program for Families Living in Poverty: A Randomized Clinic Trial

Abstract

This study addressed the question of whether increasing the intensity of a parent and child therapy program would improve results for young children with significant behavior problems from families living in poverty. Children were randomly assigned to either a standard condition or an intensity condition that provided 50% more treatment over a standard 8‐week treatment period. Based on multiple parent‐report, direct observation, and clinician‐report measures of the children and their caregivers, both groups improved on all measures from pretest to posttest and from pretest to follow‐up. No differences in outcomes were found between the standard and intensity groups at posttest or follow‐up. These counterintuitive results are discussed within the parent and child intervention literature. Also, the heuristic potential of this study to encourage continued research with this challenging population is addressed.

In-Home Counseling for Young Children Living in Poverty

“…Further, the participants in this study were predominately White and female. Although these professionals seem to demonstrate high levels of counseling competence as evidenced by the effectiveness their work (Carassco & Fox, 2012; Fox, Mattek, & Gresl, 2013; Gresl, Fox, & Fleischmann, in press), this imbalance in racial/ethnic and gender diversity may have biased the results of this study. Finally, this was a study conducted using qualitative methods, which inherently include the subjective judgments of the researchers conducting the analysis.…”

“…This is an important factor in regard to this study, as such experience training counseling students provides the staff with a unique perspective on the competencies that their counselors and interns need in order to work effectively in this context. Most importantly, this site was chosen because the counseling model employed by this program (Fox & Nicholson, 2003) has proven its effectiveness in providing in-home counseling for young children living in poverty (Carassco & Fox, 2012; Fox, Mattek, & Gresl, 2013; Gresl, Fox, & Fleischmann, in press), which is quite important, given the goal of this study is to explore competencies for effective counseling in this context.…”

Treatment Outcomes for At-Risk Young Children With Behavior Problems: Toward a New Definition of Success

“…As a result of these differing definitions, reports of child and family attrition percentages are highly variable. For example, attrition rates vary from as low as 10% (Nicholson et al, 2002) to as high as over 70% (Carrasco & Fox, 2012;Chaffin et al, 2009). At other times attrition rates are not even reported.…”

Assessment of Trauma Symptoms in Toddlers and Preschoolers Living in Poverty

“…As an initial effort to determine whether the PITS-TC scores and subscale scores would be sensitive to change following participation in an in-home, trauma-informed treatment specifically designed for very young children in poverty (Fox, 2018), we conducted a separate pilot study with 93 children referred to our clinic. This treatment program has been analyzed for efficacy through four separate randomized controlled studies (Carassco & Fox, 2012; Fung & Fox, 2014; Harris, Fox, & Love, 2015; Love & Fox, 2019) with similar samples of children. We did not include a control group in this preliminary study.…”

“…The treatment sensitivity of the PITS reported in this study should be considered as only a preliminary finding as no control group was included. However, four previous randomized controlled studies of this evidence-based, trauma-informed treatment program did show that it significantly reduced trauma symptoms compared with a control group using more established trauma measures (Carassco & Fox, 2012; Fung & Fox 2014; Harris et al, 2015; Love & Fox, 2019). Given the paucity of sound screening measures combined with the growing recognition of the critical need to identify, assess, and treat trauma symptoms in very young children (nctsn.org), having a relatively short screening measure with at least the potential to accurately assess trauma symptoms following trauma-informed treatment programs will be a welcome addition to the various welfare and child protective service agencies who routinely serve the population sampled in this study.…”