arent-ChildInteractionTherapy-Pennsylvania：家长和孩子的互动疗法-宾夕法尼亚课件.ppt

1、Parent-Child Interaction Therapy Gwen Burkholder,LCSW,CAADCburkholdergcsgonline.orgOctober 9,2013A Network of Services.A World of Possibilities.Welcome and Introductions!Photos are courtesy of Amy Herschell,Ph.D.Thank you to the following people:Cheryl Bodiford McNeil,Ph.D.,Department of Psychology,

2、West Virginia University,who provided my initial five-day training to become a PCIT clinician in November 2010Amy D.Herschell,Ph.D.,University of Pittsburg School of Medicine,who has provided ongoing supervision and consultation to me regarding providing PCIT in Lancaster,PA over the past three year

3、s.What is PCIT?Work with the parent(birth,kin,foster,adoptive)and child togetherDesigned to treat children age 2 to 7 years exhibiting disruptive behaviors Use of coaching with a bug-in-the-ear from a one-way mirrorConsists of two phases of treatment:Relationship Enhancement Behavior ManagementIniti

4、ally developed by Sheila Eyberg,University of Florida.McNeil,C.B.,&Hembree-Kigin,T.(2010).Parent-Child Interaction Therapy.Second edition.New York:Springer.PCIT Set-upPhotos are courtesy of Amy Herschell,Ph.D.What is PCIT?Elements of family systems,social learning theory,and traditional play therapy

5、 Emphasis on restructuring parent-child patterns,not modifying target behaviors Parents are not blamed,but are given responsibility for improving the childs behavior Program is completed in 12-20 sessions,depending on the needs of the family Empirically evaluated in over 30 controlled studiesMcNeil,

6、C.B.,&Hembree-Kigin,T.(2010).Parent-Child Interaction Therapy.Second edition.New York:Springer.Critical Components of PCIT Parent and Child are seen together Relationship Focused Not Time Limited Coaching Model Active,Directive Assessment Driven Scientifically Based Empirically Supported Clinically

7、ValidatedInformation provided by Amy Herschell,Ph.D.Who is PCIT Appropriate For?Young Children(Age 2-7)Children exhibiting externalizing behavior problems(e.g.,verbal and physical aggression,defiance,noncompliance,temper tantrums)Parents who could benefit from enhanced relationship and/or behavior m

8、anagement skills with young childrenInformation provided by Amy Herschell,Ph.D.Who is PCIT Appropriate For?Extensive contact with Primary Caregiver(or person completing PCIT with child)Families with young children and who have experienced violence Families with young children and relationship diffic

9、ultiesInformation provided by Amy Herschell,Ph.D.Developmental Progression of Conduct Disordered BehaviorsOppositionalArguesTemper tantrumsBraggingStubbornDemands attentionTeasesLoudDisobeys at homeImpulsiveOffensiveCrueltyDisobeys at SchoolFightsSulksScreamsLying/cheatingSwearsPoor peer relationsAg

10、gressiveDestroysBad friendsSteals at homeAttacksThreatens OthersDelinquentSets firesSteals Outside/Home Runs away TruancyAlcohol/drug useVandalismInformation provided by Amy Herschell,Ph.D.Sample Course of TreatmentSession NumberSession ContentAssessment of appropriateness for PCIT1Child Directed In

11、teraction/Relationship Enhancement Skills Teaching Session2-9Coaching in Child Directed Interaction/Relationship Enhancement Skills 10Parent Directed Interaction/Discipline Skills Teaching Session11-19Coaching in Parent Directed Interaction/Discipline Skills 20Graduation SessionInformation provided

12、by Amy Herschell,Ph.D.Assessment of Appropriateness for PCIT Intake ProcessAgency IntakeSupplemental PCIT QuestionsStandardized,self-report measures Eyberg Child Behavior Inventory(ECBI)Sutter-Eyberg Student Behavior Inventory(SESBI-R)Child Behavior Checklist(CBCL)Parenting Stress Inventory Short Fo

13、rm(PSI-SF)Standardized,behavior observation measure Dyadic Parent-Child Interaction Coding System-IV(DPICS-IV)Information provided by Amy Herschell,Ph.D.Eyberg Child Behavior Inventory(ECBI)Assesses behaviors associated with the primary childhood disruptive behavior disorders(e.g.,noncompliance,defi

14、ance,aggression)Appropriate for children aged 2-16 years Contains 36 items and two scales the Intensity and Problem Scales 10 Minutes for parents to complete,2 minutes to scoreInformation provided by Amy Herschell,Ph.D.Child Behavior Checklist(CBCL)Survey social competencies and problem behaviorsCom

15、plete by parent or regular caregiverSeparate forms for two age groups(1.5 5 years&6-18 years)Approximately 100 items,15 to 25 minutes to administerComprised of two broad band scales and a total problem scale Externalizing disruptive or under controlled behaviors Internalizing anxiety,depression,with

16、drawal Total problems scaleInformation provided by Amy Herschell,Ph.D.Parenting Stress Index(PSI)-Short Form Composed of three subscales:Parental Distress Dysfunctional Parent-Child Interaction Difficult Child Characteristics Added together,these subscales yield a Total Stress Score Information prov

17、ided by Amy Herschell,Ph.D.Dyadic Parent-Child Interaction Coding System(DPICS)Structured observational assessment Child-directed play Parent-directed play Clean-up Observing and coding parent-child interactions for PCIT specific Skills Labeled Praise,Behavioral Descriptions,Reflections Questions,Co

18、mmands,CriticismInformation provided by Amy Herschell,Ph.D.Recognition as an Evidence-Based PracticeClosing the Quality Chasm in Child Abuse Treatment:Identifying and Disseminating Best Practices(Chadwick Center,2004)www.chadwickcenter.org/kauffman.htm The National Child Traumatic Stress Network(Emp

19、irically Supported Treatments and Promising Practices,supported by The Substance Abuse and Mental Health Services Administration,2005)www.nctsn.org/nccts/nav.do?pid=ctr_top_trmnt_prom Child Physical and Sexual Abuse:Guidelines for Treatment(Saunders,Berliner,&Hanson,Eds.,National Crime Victims Resea

20、rch and Treatment Center and The Center for Sexual Assault and Traumatic Stress;Office for Victims of Crime,U.S.Department of Justice,2004)www.musc.edu/ncvc/resources_prof/OVC_guidelines04-26-04.pdf Evidence-Based Treatment for Children and Adolescents(The Society of Clinical Child and Adolescent Ps

21、ychology,a division of the American Psychological Association,and the Network on Youth and Mental Health) Youth Violence:A Report of the Surgeon General(Elliott,Hatot,&Sirovatka,Eds.,U.S.Department of Health and Human Services,2001)http:/www.surgeongeneral.gov/library/youthviolence The California Ev

22、idence-Based Clearinghouse for Child Welfare(2006)www.cachildwelfareclearinghouse.org Information provided by Amy Herschell,Ph.D.Kauffman Best Practices Project(2004)Identified Three“Best Practices”for Children who have experienced abuse and are experiencing mental health concerns:Abuse-Focused CBT

23、Parent-Child Interaction Therapy Trauma-Focused CBTInformation provided by Amy Herschell,Ph.D.Key Research Areas Efficacy/Effectiveness Diagnostic Classifications Child Maltreatment Populations Cultural Variables Therapist Variables Treatment Delivery Attrition Maintenance DisseminationInformation p

24、rovided by Amy Herschell,Ph.D.Treatment Outcome Research with Children Experiencing Behavior Problems Main Findings:Parent skill increases in reflective listening,physical proximity,and prosocial verbalizations Decreases in sarcasm and criticism of the child More positive parental attitudes toward c

25、hild Parent report of child behavior problems to within normal limits Parent self-reported improvements in psychopathology,personal distress,and parenting locus of control High consumer satisfaction with process and outcome Maintenance of treatment gains up to 6 years post-treatment Generalization t

26、o untreated siblings Generalization to home and schoolHerschell,A.D.,Calzada,E.J.,Eyberg,S.M.,&McNeil,C.B.(2002).Research Issues In Parent-Child Interaction Therapy.Cognitive&Behavioral Practice,9.Studies that have demonstrated PCITs Effectiveness with Physical Abuse Conceptual Stage Urquiza&McNeil

27、R21 Grant Submission(1995)Urquiza&McNeil Conceptual Paper(1996)Case Reports and Single Subject Designs Borrego,Urquiza,Rasmussen,&Zebell(1999)Fillcheck,McNeil,Herschell(in press)Fricker,Ruggiero,&Smith(2005)Herschell,Calzada,Eyberg,&McNeil(2002)Urquiza,Timmer,Herschell,McGrath,Zebell,&Porter(2005)Tr

28、eatment Outcome Studies Chaffin and colleages(2007,2010)Urquiza,Timmer,Zebell,&McGrath(in press)McNeil,Herschell,Gurwitch,&Clemens-Mowrer(2005)Information provided by Amy Herschell,Ph.D.Limitations and Caveats Focus on child behavioral problems,parenting skill,and changing relationships,not on all a

29、spects of family(e.g.,active substance abuse,parent psychopathology)Continued need for coordination with other treatment/support agencies Limited age range Parent and child must have regular ongoing contactInformation provided by Amy Herschell,Ph.D.Clinician Training in PCIT Training Requirements fo

30、r Clinicians Masters degree or higher in the mental health field Actively working with children and families.Licensed in his or her field or receive supervision from a licensed individual trained in PCIT.Training Program 40-hours of face-to-face contact with a PCIT trainer 4-6 months later a 2-day a

31、dvanced live training Case Experience(at least 2 families,preferably 5)Regular(bi-weekly)consultation/Supervision over 1 year Skill reviewInformation provided by Amy Herschell,Ph.D.Sample Course of TreatmentSession NumberSession ContentAssessment of appropriateness for PCIT1Child Directed Interactio

32、n/Relationship Enhancement Skills Teaching Session2-9Coaching in Child Directed Interaction/Relationship Enhancement Skills 10Parent Directed Interaction/Discipline Skills Teaching Session11-19Coaching in Parent Directed Interaction/Discipline Skills 20Graduation SessionInformation provided by Amy H

33、erschell,Ph.D.Child Directed InteractionIn the effort to enhance the relationship between the parent and child,the therapist coaches the parent to do the behavioral and play therapy techniques of:Reflecting what child saysDescribing what child is doingGiving specific praise for childs positive behav

34、iorThe parent is also coached to avoid doing questions,commands,and criticism and to ignore minor annoying behavior.Parent Directed Interaction The therapist coaches the parent to gain increased compliance from the child by teaching how to give direct commands and how to follow-up with consistent co

35、nsequences for non-compliance,as part of the behavioral and play therapy.Corresponds with the Parent-Child Interaction Therapy Protocol(2011 Edition)GraduationAfter special playtime,practice PDI in a 5-min clean-up situation Practice PDI for 2-4 carefully selected direct commands each day Use PDI as

36、 necessary for running commands throughout the dayUse PDI for House RulesAssign at least two Public Behavior practice outingsDo two practice sessions of play with two siblings together Practice PDI in daily 5-10 min play situation at home How PCIT has become more common in Pennyslvania The Pennsylva

37、nia Department of Public Welfare and the Pennsylvania Keys in collaboration with the Heinz Foundation,solicited Requests for Applications for Licensed Outpatient Psychiatric Clinics to send clinical staff to be trained to do Parent-Child Interaction Therapy beginning in 2010.Several cohorts of train

38、ing groups have been trained since that time.2011 Pennsylvania Agencies Providing Parent-Child Interaction Therapy2012 Pennsylvania Agencies Providing Parent-Child Interaction Therapy2013 Pennsylvania Agencies Providing Parent-Child Interaction TherapyLast Updated September 20,2012CountyCityAgencyAl

39、leghenyPittsburghAllegheny Childrens Initiative Glade RunLaughlin CenterFamily Resources of PAMatilda Theiss Child Development Center WPIC Private PracticeThe Melting PotUniversity of Pittsburgh/Western Psychiatric Institute and Clinic Wesley SpectrumWomens Center and Shelter Milestone,Inc.Armstrong

40、LeechburgFamily Counseling CenterButlerButlerFamily Services of Butler Health SystemFamily Pathways Kids Count/Family Psychological Pennsylvania Agencies Providing Parent-Child Interaction Therapy(8/30/13)Pennsylvania Agencies Providing Parent-Child Interaction Therapy(8/30/13)CountyCityAgencyBedfor

41、d/Somerset BedfordAlternative Community Resource ProgramBerksFleetwoodConcern CounselingReadingFamilicare Counseling CenterReading Behavioral HealthBucksLanghornePenndel Mental Health CenterCarbon/Monroe/PikeWeissportBehavioral Health AssociatesPalmertonCarbon/Lehigh Intermediate Unit#21-Behavioral

42、Health ServiceEastonColonial Intermediate Unit#20CentrePhilipsburg Cen-Clear Child ServicesChesterPhoenixvilleDevereux Community ServicesCoatsvilleChild Guidance Resource CentersClearfield/JeffersonDuBoisClearfield-Jefferson Community Mental Health Center,Inc.CrawfordMeadvilleCounseling and Child Gu

43、idanceCumberlandCarlisleNHS The Stevens CenterDelawareHavertownChild Guidance Resource Centers UplandCrozer-Chester Medical CenterErieErieSafe Harbor Behavioral HealthSarah A.Reed Childrens CenterPennsylvania Agencies Providing Parent-Child Interaction Therapy(8/30/13)CountyCityAgencyFayetteUniontow

44、nChestnut Ridge Counseling Services,IncConnellsville Counseling ConnellsvilleStern Center for Developmental and Behavioral Health Franklin/FultonChambersburgLaurel LifeCamp HillFranklin Family ServicesHuntington/Mifflin/JuniataHuntingtonUniversal Community Behavioral Health(UCBH)IndianaWhiteFamily P

45、sychological Associates LehighEastonColonial Intermediate Unit#20Lackawanna/SusquehannaScrantonFriendship House Scranton Counseling CenterCarbondaleNHS Northeastern PALancasterLancasterCommunity Services Group,IncLawrenceNew CastleHuman Services CenterLuzerne/WyomingWilkes Barre Childrens Service Ce

46、nter of Wyoming ValleyLycoming/ClintonWilliamsportCommunity Services Group,IncMercerHermitageCommunity Counseling Center Paoletta CounselingNorthumberlandSunburyNorthumberland County Counseling ServicesPennsylvania Agencies Providing Parent-Child Interaction Therapy(8/30/13)PhiladelphiaPhiladelphiaC

47、hildrens Crisis Treatment CenterChildrens Hospital of PhiladelphiaPresbyterian Childrens Village SchuylkillPottsvilleProfessional Counseling,Consulting&Human ServicesThe ReDCO groupVenangoOil CityRegional Counseling Center,Inc.WashingtonFredericktownCenterville Clinic WestmorelandGreensburgFBRNew Ke

48、nsingtonFBR/AERIMaking referrals for PCITRefer to a behavioral health agency in your area who is providing PCIT.Consider offering PCIT at your community health center if space is available,and the necessary licensure and billing issues can be worked out for the provision of behavioral health care on site.Recommended books on PCITAvailable on AAvailable on www.pcit.org