Table of Contents
Every year nearly one million children experience maltreatment that results in harm (USDHHS, 2016). Most often it is younger children who are the victims of maltreatment. As for the prevalence rates, maltreatment is common among both boys and girls, however, girls are more prone to experience sexual abuse than boys. When comparing the four types of maltreatment, neglect and physical abuse account for 92% of the overall maltreatment that boys and girls experience, which is often perpetrated by a biological parent (USDHHS, 2016). Given these facts, child maltreatment is a pervasive problem within the United States.
Child maltreatment is an important topic because children suffer not only from instant effects such as physical marks, but they also may endure long-term effects such as health problems or develop a disorder. One barrier that prevents maltreating families from receiving PCIT is that it is an expensive treatment (Batzer, Berg, Godinet, & Stotzer, 2018). This leaves families in a coercive cycle of maltreatment, but Galanter et al. (2012) found PCIT to be effective when delivered in the home setting. Regarding maltreatment, there is debate surrounding the ability of social workers to recognize it and intervene. This was evident in The Trials of Gabriel Fernandez, where an eight year old boy died at the hands of his mother and her boyfriend after being tortured for eight months.
Overall, this paper will review the effectiveness of PCIT as an evidence-based treatment for child maltreatment. It will address the theoretical frameworks PCIT is based on, the stages of PCIT, the barriers for some families to receive PCIT, and the research behind PCIT. Thus, this paper will conclude that PCIT is an effective evidence-based treatment for child maltreatment because it has reduced children’s externalizing behaviors, parental stress, and physical abuse relapse (Kennedy, Kim, Tripodi, Brown, & Gowdy, 2016).
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Background of PCIT
Although there are many interventions that attempt to break the coercive cycle of maltreatment that many children are trapped in, one intervention that proves to break this cycle is parent-child interaction therapy (PCIT). PCIT is recognized as a highly evidence-based treatment for child maltreatment because it is based on valid theoretical frameworks, has an extensive research basis, and can be implemented in both clinic and home settings (Kennedy et al., 2016). At the core of PCIT are three theoretical frameworks: developmental, social learning theory, and attachment theories. All of these theories not only focus on how children learn from others and develop in a social world, but also how children form bonds with others.
Structure of PCIT
The two stages of PCIT are relationship enhancement and child behavior management. Through PCIT, parents learn PRIDE skills, which encompass praising good behavior, reflecting what the child says, imitating appropriate play, describing appropriate behavior, and showing enthusiasm. It is the implementation of PRIDE skills that makes PCIT a unique intervention that teaches parents how to manage their child’s externalizing behaviors. Throughout therapy, parents are coached during interactions they have with their child. Specifically, the parent wears an ear piece so that he or she can hear the therapist’s instructions on how to engage the child and respond appropriately to his or her behavior. Ultimately, PCIT provides parents with behavior modification strategies so that more positive interactions are shared with their child.
Barriers. Given that PCIT is a highly evidence-based treatment, it also is very expensive. The cost of PCIT can be a barrier for some families because child welfare services do not have enough funds to provide this treatment for all families (Batzer et al., 2018). In other words, the government only supplies child welfare services with a limited amount of funding for evidence-based treatments. Another barrier for some families is that they do not live near a clinic that offers PCIT. Thus, transportation becomes an issue because families have to travel to other locations. However, research by Galanter et al. (2012) has shown that PCIT in the home setting reduces barriers that prevent families from receiving this intervention in the clinic setting.
PCIT in the Home Setting
Galanter et al. (2012) conducted a study with 83 parent-child dyads who received PCIT in the home setting. The participants of this study consisted of at-risk parents (88% women, 12% men). As for the demographics, 55% of parents were Latina/o, 37% were African American, and 7% were White. By providing therapy in the home, barriers that previously prevented some families from receiving PCIT in the clinic setting were greatly reduced in this study. The measures used in this study were the Eyberg Child Behavior Inventory (ECBI) to gather information on children’s conduct problems, the Adult Adolescent Parenting Inventory (AAPI) to assess parenting behaviors, a Dyadic Parent-Child Interaction Coding System (DPICS) to code the interactions between parents and children, and lastly a satisfaction measure to measure participant contentment with the treatment.
As for the results, parents who completed treatment indicated that they found the treatment to be a beneficial experience. Not only were there significant decreases in negative interactions, but those who completed treatment had a significantly lower risk of child abuse (Galanter et al., 2012). Overall, this study demonstrated that PCIT delivered in the home setting is effective in increasing positive parent-child interactions and successful in reducing barriers that families may face when PCIT is offered in the clinic setting.
A Meta-Analysis of PCIT
Furthermore, Kennedy et al. (2016) investigated whether PCIT can reduce future physical abuse among physically abusive families. This review involved a systematic search that selected six studies for a meta-analysis. Of the six studies, it resulted in 571 parent-child dyads. The outcomes of interest were: parenting stress, physical abuse recurrence, and child abuse potential. Parents were mostly female (85.3%) and more than half of the children were male (66.8%). Most parents identified as Caucasian (71.9%) and African American (21.1%). As for the methodology, the Child Abuse Potential Inventory (CAPI) was used to assess the possibility of child abuse, and the Parenting Stress Inventory (PST) along with the Parenting Stress Index-Short Form (PSI-SF) were utilized to assess stress levels. As for the results, parents who were physically abusive and received PCIT were significantly less likely to have a reoccurrence of physical abuse than parents who did not receive PCIT (Kennedy et al., 2016). Thus, it can be concluded that PCIT is an effective intervention for maltreatment because it not only reduced future occurrences of physical abuse, but also decreased parental stress.
A Review of Research About PCIT
Similarly, a review of research about PCIT showed that it is an appropriate and efficacious treatment for child maltreatment. The methodology consisted of a literature search and then a selection process of which studies were going to be included in the review. There were a total of eleven studies in this review that comprised mainly female parents, with 85% or higher being mother-child dyads; whereas children were mostly male (Batzer et al., 2018). The outcomes taken into consideration were: child welfare recidivism, reduction in child abuse risk, reduction in negative parenting behaviors, increase in positive parenting behaviors, and reduction in children’s externalizing behaviors. As for the results, eight of the eleven studies showed significant decreases in children’s externalizing behaviors. Overall, all studies in this review demonstrated that PCIT was effective in reducing social service referrals, negative parenting methods, and stress caused from the parent-child relationship (Batzer et al., 2018).
Conclusions
Child maltreatment is a widespread problem in the United States. It is the job of child welfare agents, social workers, and DCFS to serve as a source of protection and trust for maltreated children. PCIT has been shown to be an effective evidence-based treatment for child maltreatment because parents learn how to appropriately respond to their child. Although there are barriers for some families to receive PCIT in the clinic setting, the delivery of PCIT in the home setting can reduce them. Based on the literature review, PCIT is a highly valid and reliable intervention for maltreatment because it not only leads to a reduction in negative parenting behaviors and parental stress, but it also reduces physical abuse relapse and children’s externalizing behaviors, which results in positive parent-child interactions.
Directions for Future Research
After the literature review, the work that still needs to be done is to further analyze the effectiveness of PCIT in the home setting and whether it provides advantages over the clinic setting. Furthermore, there needs to be a comparison between families who receive PCIT in the home setting versus those who receive it in the clinic setting to see which setting yields a larger completion rate. One gap in the current research is whether PCIT would be effective in helping adoptive parents create a healthy and positive bond with their adopted child. Most importantly, there needs to be further research that considers how PCIT can be applied to the field of social work so that at-risk families and maltreating populations can receive the help they need.
References
- Batzer, S., Berg, T., Godinet, M. T., & Stotzer, R. L. (2018). Efficacy or chaos? Parent–child interaction therapy in maltreating populations: A review of research. Trauma, Violence & Abuse, 19(1), 3–19. https://doi-org.flagship.luc.edu/10.1177/1524838015620819
- Galanter, R., Self-Brown, S., Valente, J. R., Dorsey, S., Whitaker, D. J., Bertuglia-Haley, M., & Prieto, M. (2012). Effectiveness of parent–child interaction therapy delivered to at-risk families in the home setting. Child & Family Behavior Therapy, 34(3), 177–196. https://doi-org.flagship.luc.edu/10.1080/07317107.2012.707079
- Kennedy, S. C., Kim, J. S., Tripodi, S. J., Brown, S. M., & Gowdy, G. (2016). Does parent–child interaction therapy reduce future physical abuse? A meta-analysis. Research on Social Work Practice, 26(2), 147–156. https://doi-org.flagship.luc.edu/10.1177/1049731514543024
- U.S. Department of Health & Human Services. (2016). Administration for children and families, administration on children, youth, and families, children’s bureau. Child Maltreatment 2014. Retrieved from http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment
