PCIT/PCAT in Action - ECMHearlychildhoodmentalhealth-sandiego.com/presentations/IIB_PCIT WCW… ·...

PCIT/PCAT in Action: Strengthen the Parent-Child

Relationship and Reduce Problematic Behaviors

Presented by:

Laura Christofferson, LCSW, RPTEmma Girard, PsyD

Christina Moran, PsyD

Christofferson, L., Girard, E., & Moran, C

We Can't Wait 2012: From Science to Practice-Relationships Matter1

Introductions

• Laura Christofferson, LCSW, RPT• Private Practice, San Diego

• PCIT Trainer and Therapist

• Emma Girard, PsyD• Riverside County DMH

• PCIT Trainer of Trainers

• Christina Moran, PsyD• Home Start Inc., San Diego

• PCIT Trainer and TherapistChristofferson, L., Girard, E., & Moran, C

Objectives

1. Learn about key concepts and benefits of PCIT/PCAT

2. Practice PRIDE skills & understand the impact of special playtime

1. Learn target population and referral sources for PCIT/PCAT

What is PCIT/PCAT?Parent-Child Interaction TherapyParent-Child Attunement Therapy

• Created by Sheila Eyberg, PhD & Cheryl McNeil, PhD

• Evidence based practice with over 30 years research

• Combines play therapy, family systems & cognitive behavioral approaches

What is PCIT/PCAT?

• Caregiver and child together live in sessionCaregiver - Birth parent, Kin, Foster, Adoptive

• Coach caregiver with a ‘bug-in-the-ear’ from a one-way mirror

• Two components of treatment focusing on relationship enhancement and behavior management

Average Duration: 12-20 weekly sessions

Who is it for?

• PCIT – Ages 2-7 years

• PCAT – Ages 9-24 months

• Children exhibiting disruptive, oppositional, defiant behaviors

• Families where there is risk of abuse and/or a need to strengthen attachment

What PCIT/PCAT Does

• Decreases child behavior problems

• Improves parenting skills

• Enhances the quality of the relationship between parent and child

• Decreases abuse potential

• Decreases issues related to child mental healthChristofferson, L., Girard, E., & Moran, C

PCIT Overview

• Child Directed Interaction (CDI) – 6-10wksRelationship Enhancement, PRIDE

• Parent Directed Interaction (PDI) – 6-10wksCompliance Strategies, BE DIRECT

• Graduation based on outcome data

Special Playtime

• Done during most PCIT sessions

• Done at least 5 minutesper day as homework

Structure of 50-MinutePCIT Coaching Session

10 Check in (discusshomework)

DPICS Coding

Coaching

Review of Session

Document Session

We Can't Wait 2012: From Science to Practice-Relationships Matter 10

Taken from: Herschell, A.D., Calzada, E.J., Eyberg, S.M., & McNeil, C.B. (in press). Clinical issues in Parent-Child Interaction Therapy. Cognitive & Behavioral Practice.

Minutes

Child Directed Interaction (CDI)Relationship Enhancement

Praise

Reflection

Imitation

Description

EnjoymentChristofferson, L., Girard, E., & Moran, C

Praise Behaviors You Want

• Causes positive behaviors to increase

• Lets child know what you like

• Increases child's self-esteem

• Adds to warmth in relationship

• Both caregiver & child feel good!

Praise

Labeled Praise• Specific acknowledgement of positive attribute

• You’re very good at drawing.• I like how you’re sitting in your chair!• You’re listening very well.

Unlabeled Praise• General acknowledgement of positive attribute

• Great!• Good Job!• That’s wonderful!

Reflect Appropriate Talk

• Doesn't control the conversation

• Shows child you're really listening

• Demonstrates acceptance and understanding

• Increases verbal communication

• Improves child’s speech

ReflectionExamples

• Child: I made a star.

• Caregiver: Yes, you made a star.

• Child: The camel got bumps

• Caregiver: It has two humps on its back

• Child: Dis lello hair.

• Caregiver: That is yellow hair.Christofferson, L., Girard, E., & Moran, C

Imitate/Model Appropriate Behavior

• Lets child take responsibility for their own actions

• Approves child's choice of activity

• Shows child you are intrested and involved

• Teaches child how to interact with others (ex: taking turns)

• Tends to increase child's imitation of what you do

Imitation

Examples

• Child: I’m coloring it red.

• Caregiver: I’ll use a red crayon too. I’m holding mine like this.

• Child: I’m making a tower.

• Caregiver: How fun! I’m going to make a tower too.

Describe Appropriate Behaviors

• Lets child lead activity

• Shows child you’re interested

• Teaches concepts/organization

• Models speech

• Increases child’s attention to task

Description

Examples

• “You’re building a tall tower”

• “You’re drawing a smiling face”

• “You’re sitting in your chair”

Show Enjoyment

• Demonstrates interest

• Models positive emotion

• Strengthens the relationship

• Helps the child to focus on the positive

Enjoyment

Examples

• “WOW!”

• “That’s super”

• High five, clapping, pat on the back

Coding Exercise

• Work with your team

• Code each verbalization with one of the following:

• Labeled Praise• Reflection• Behavior Description

Avoid Questions

• Doesn’t allow the child to lead

• Requires an answer

• May trigger an oppositional response

Avoid Questions

Examples

• “What color is this?”

• “That’s a blue one, right?”

• “Are you having fun?”

Avoid Commands

• Doesn’t allow the child to lead

• May cause unpleasantness

• Child obedience will be taught later

Avoid Commands

Examples

• Indirect• “Will you hand me the paper?”• “Let’s build a castle”

• Direct• “Hand me the paper”• “Please tie your shoe”

Avoid Critical Statements

• Doesn’t work to decrease bad behaviors

• Often increases the criticized behavior

• May lower the child’s self-esteem

• Creates an unpleasant interaction

Avoid Critical Statements

Examples

• “You’re being naughty.”

• “I don’t like it when you talk back.”

• “No, honey, that’s not right.”

• “That design is ugly.”

Selective Attention

Ignore inappropriate behavior unless dangerous/destructive

Reason

• Avoids increasing bad behavior

• Decreases mild/irritating behaviors

• Helps child notice difference between caregiver’s responses to positive and negative behavior

Selective Attention

Example

Child: Sasses caregiver and behavior of picking up object as directed

Caregiver: Ignores sass, praises picking up

Selective Attention

Silence

Redirect

Turn your eyes, face, back

Walk Away

• Avoid looking at child, smiling, frowning, etc...

• Be silent

• Ignore every time

• Expect behavior to increase at firstChristofferson, L., Girard, E., & Moran, C

Selective Attention Process

1. Prompt –Caregiver makes statement describing desired behaviors rather than what not to do.

• Instead of “Tony, stop talking out of turn”, caregiver waits until child stops talking and then states, “Tony is quiet & taking turns so now I can talk to him”

• Instead of “Janie, stop yelling!”, caregiver calmly states, “When Janie is using her quiet voice, then I can listen.”

Selective Attention Process

2. After child complies, caregiver gives child a labeled praise

• “Tony, thank you for waiting your turn to speak. Now I can listen to what you want to say.”

Prompt > Comply > Praise!!

PCIT Mastery CriteriaCoded During 5 minutes DPICS

10-10-10

• 10 labeled praises

• 10 behavioral descriptions

• 10 reflections

• 3 or less critical statements, commands, or Q’s

• Ignore all negative attention-seeking behaviors

Coding Activity

• Role-play

• Have cooperative child to learn skills

• Remember the “Don’t Skills”

• See live coaching in action

PCIT Research For Children Experiencing Behavior Problems

• High consumer satisfaction with process and outcome

• Maintenance of treatment gains at six and twelve months

• Generalization to untreated siblings

• Generalization to home and school

Referral Sources

• First 5 Commission for providers in your area

Internet

• pcit.org• PCIT trainers across the USA

• PCIT research articles

• pcit.ucdavis.edu• PCIT providers across the USA

• Web course with free information on PCITChristofferson, L., Girard, E., & Moran, C

Adaptations to PCIT

• PCAT: Parent-Child Attunement Therapy• Infants/toddlers 9-24 months old

• PCIT-BDI: Parent-Child Interaction Therapy with Bravery Directed Interaction• Children 2-7 with separation anxiety, fears

• TCIT: Teacher-Child Interaction Training• Schools/daycare settings

Thank you for your time, interest and attention!

Questions and Comments

(PRIDE skills encouraged!)

Christofferson, L., Girard, E., & Moran, C We Can't Wait 2012: From Science to Practice- Relationships Matter

PCIT/PCAT in Action - ECMHearlychildhoodmentalhealth-sandiego.com/presentations/IIB_PCIT WCW… ·...

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