Prevention Through Parenting (part 2)

Question 1

Which Parenting Models are Prevention?

Answer 1

• Nurse Family Partnership [NFP]
• Attachment and Biobehavioral Catch up [ABC]

Question 2

Which Parenting Models are Treatment?

Answer 2

• Parent Child Interaction Therapy [PCIT]
• Multidimensional treatment foster care [MTFC]

Question 3

What is Child Parent Psychotherapy? [CPP]

Answer 3

Evidence-based intervention for:
- Children 0-5 and their parents

• Children have experienced trauma
• Children have some socioemotional, attachment, or behavioral problems
• Types of trauma: domestic violence, physical abuse, neglect, sexual abuse, etc.

Question 4

What are the CPP Guiding Theories/principles?

Answer 4

• Attachment theory is foundational to model:
  Warm, safe, and supportive parent-child relationship will support healthy development
• Parents own trauma can get in the way of responsive parenting (think intergenerational transmission)

Question 5

How is CPP delivered?

Answer 5

• Therapy includes both child and parent
• Weekly 1-hour sessions
• Typically a year in length (~50 sessions)

Question 6

What is the goal of CPP?

Answer 6

to support and strengthen parent-child relationships towards restoring child’s sense of safety following trauma

Question 7

What are the Targets/processes of CPP?

Answer 7

• Reduce emotion dysregulation
• Help parent promote themes of safety and stability
• Increase reciprocity in relationship
• Process traumatic events and maladaptive patterns
• This is unique, compared to other parent behavior models

Question 8

What is Trauma Processing?

Answer 8

• Process traumatic events and maladaptive patterns
• Help parent talk with child about what they witnessed/remember
• Acknowledge child’s and parent’s experience of trauma
• Explore how parent’s own trauma history influences their parenting
• Support parent and child in creating a joint narrative to make sense of the trauma together

Question 9

How Effective is Child Parent Psychotherapy?

Answer 9

• Randomized clinical trial: CPP vs. control

CPP mothers showed:
- Reduction in PTSD symptoms and avoidance
- Improvement in overall mental health

CPP children showed:
- Less behavior problems
- Less traumatic stress symptoms
- Less likely to have PTSD diagnosis

Question 10

What is Parent-Child Interaction Therapy (PCIT)?

Answer 10

Evidence-based intervention for:

• Children 2-7 and their parents and their parents
• Children have behavior problems (e.g., defiance, aggression)
• Was not designed to address trauma, but has some evidence for maltreated children

Question 11

What are the Guiding Theories/Principles of PCIT?

Answer 11

• Attachment theory
  Sensitive/warm parent-child relationship is foundational for other parenting skills to be effective
• Social learning theories
  Social behavior is learned in part through parent-child interaction and parent modeling
• Behavioral theories
  Reinforcing positive behavior and ignoring problematic behavior will selectively reinforce desired behavior

Question 12

How is PCIT delivered?

Answer 12

• Child and parent together
  Therapist “coaches” parent through “bug in the ear”
• Parents practice specific skill set
• Weekly sessions
• Mastery-oriented, rather than session-limited
• Therapy progresses when parents meet certain criteria
• Typically 12 – 20 weeks

Question 13

What is the Goal of PCIT?

Answer 13

to decrease child behavior problems, increase prosocial behavior, improve parent-child relationship quality

Question 14

What are the Targets/processes of PCIT?

Answer 14

• Child-directed interaction (PRIDE skills)
• Parent-directed interaction (commands & time-out)

Question 15

What is Child-Directed Interaction?

Answer 15

• Parents engage in ‘special time’ using specific skills to completely follow the child’s lead [PRIDE]:

-Praise (labeled)
-Reflect
-Imitate
-Describe
-Enjoy

• Ignore problematic behavior (selective attention)

Question 16

What is Parent-Directed Interaction?

Answer 16

• Predictable and consistent parent responses to compliance
• Parents deliver effective commands (Clear, simple, neutral tone, etc.)
• Warning and time-out sequence when child is non-compliant

Question 17

How Effective is Parent-Child Interaction Therapy?

Answer 17

PCIT parents:
- Interact more positively with their children
- Report less parenting stress

PCIT children:
- Less behavior problems
- increased compliance

• Similar effects seen in RCT with families with histories of maltreatment

Question 18

What is Multidimensional Treatment Foster Care? [MTFC]

Answer 18

Evidence-based intervention for:

• Children and adolescents in foster care or involved in youth justice system
• Typically children with higher emotional and behavioral needs
• Help prevent placement in residential/institutional care

Question 19

What is MTFC Guiding Principles/theories?

Answer 19

Social Learning theories
- Use of residential/group care can worsen problem behavior because of peer contagion (reinforce negative behavior through modeling); insufficient supervision/support for youth

Family systems theories:
- Families better provide stable and supportive care
- Children can develop coping/resilience
- Children with trauma histories especially need support to heal in the context of family relationships

Question 20

How is MTFC delivered?

Answer 20

• Foster parents receive intensive training in parenting skills, mostly behavior management and supervision
• Daily check-ins and weekly support meetings
• Child receives individual therapy to develop coping skills
• Family may receive family therapy to reduce conflict
• Ongoing consultation with teachers to promote positive behavior in school
• Case management to coordinate services

Question 21

How Effective is MTFC?

Answer 21

• Evidence from RCT with families of preschool-aged children (MTFC compared to traditional foster care)
• Reduced foster care placement changes
• Increased child attachment security
• Improved child cortisol regulation (more typical diurnal rhythm)
• Increased prosocial child behavior