- Title
- Using parent-child interaction therapy and a trauma-adapted version to treat young children and their caregivers in the statutory child protection system
- Creator
- Warren, Jessica May
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Complex trauma, trauma that occurs in the context of the caregiving system, is particularly impactful for young children. When young children are exposed to this type of trauma, they can experience a range of obstructive and harmful biopsychosocial sequelae. For young children to recover from these experiences and for treatment to be effective, they require a safe and predictable caregiver who can be active in their treatment. Parent-Child Interaction Therapy (PCIT), a dyadic treatment where children and caregivers are seen together, has a strong evidence base for the treatment of children with complex trauma. Despite this, there are concerns that PCIT treatment is limited by its minimal provision of specific skills to manage the child’s traumatic stress reactions. This thesis employed four studies which explored the clinical utility, feasibility, and acceptability of utilizing PCIT and a trauma-adapted version, PCIT with TDI, with children with complex trauma histories and their caregivers. First, a systematic review of the literature on PCIT and trauma gathered existing empirical studies to determine child and caregiver outcomes of PCIT treatment. As this was the second time the PCIT and trauma literature had been systematically reviewed (see Batzer et al., 2018) and many studies had been published since that review was conducted, the aim of this review was to provide a contemporaneous account of these outcomes. Of the 311 articles found in the initial search, a total of 40 were screened in and included in data extraction. Common child outcomes evaluated by the literature included problematic behaviours, and social and emotional problems. For caregivers, outcomes relating to parenting stress and caregiver mental health were commonly evaluated. Effect sizes ranged from very small to very large for children and small to large for caregivers. Child posttraumatic stress symptoms were not commonly assessed in the literature (3 studies) and caregiver posttraumatic stress symptoms were not examined by any of the studies. PCIT treatment had a positive effect on rates of child abuse recidivism (i.e., 13-66 months post intervention). Permanency of placement was not examined by any of the included studies. PCIT was modified in 42.5% of the studies with great heterogeneity between the studies. Despite this, modified PCIT treatment still had medium to large effect sizes with respect to child and parent outcomes, and child abuse recidivism. The second and third studies employed a single case study design to explore the implementation, theoretical underpinnings, limitations and strengths, and outcomes of treatment for PCIT and PCIT with TDI. Utilizing data from a real-world statutory child protection agency, these studies showed positive treatment outcomes in relation to child behaviour difficulties. For the PCIT case study, the child was able to maintain a permanent placement with his father and had no child protection notifications for a period of 4 years post-PCIT intervention. For the PCIT with TDI case study, additional outcomes that showed positive change from pre- to post-treatment included caregiver stress and posttraumatic stress, and child posttraumatic stress. The final study was a quasi-experimental design with two treatment conditions (PCIT and PCIT with TDI) with pre and post-assessment comparisons. The study was a naturalistic evaluation utilizing real world data from a statutory child protection agency. Children were included in the study if they were between the ages of 2 and 7 years, were experiencing behavioural difficulties or trauma symptoms and/or their caregivers were experiencing parenting stress. Caregivers were excluded if they had significant untreated mental health issues, were actively abusing drugs and/or alcohol, had an intellectual disability, or had perpetrated sexual abuse against the child. Children were excluded if they lacked sufficient communication skills to participate in the intervention (i.e., communication skills equivalent to 30 months of age). Sixty-eight children and their caregivers were treated with either PCIT (n = 22) or PCIT with TDI (n = 46). Children involved in treatment had an average of 5.91 traumas prior to participation and were commonly in out-of-home care (OOHC; 80.1% of the sample). Significant positive changes from pre- to post-treatment were observed in relation to child posttraumatic stress, child behavioural issues, caregiver general stress, and caregiver posttraumatic stress. Permanency outcomes were recorded for the first time in a quantitative analysis and most of the sample (88.9% for PCIT with TDI and 100% for PCIT) did not experience any placement changes in the six months post-treatment. No child protection reports were received for 66.7% of the PCIT and 72.2% of the PCIT with TDI treatment groups. There were no significant differences between the treatment arms on any of these outcomes. Overall, the studies illustrate the clinical utility, feasibility and acceptability of PCIT and PCIT with TDI treatment for children with a history of abuse and neglect of their caregivers. It also provides preliminary evidence for the bidirectionality (i.e., that caregivers also benefit from a treatment targeted at their children) of posttraumatic stress treatment for families undertaking this intervention as well as providing initial evidence of PCIT and PCIT with TDI’s impact on permanency. These findings have clinical implications for treatment engagement, assessment, and implementation of PCIT and PCIT with TDI with a population of children who have experienced trauma and their caregivers.
- Subject
- parent-child interaction therapy; childhood trauma; child abuse and neglect; PCIT
- Identifier
- http://hdl.handle.net/1959.13/1507216
- Identifier
- uon:55989
- Rights
- Copyright 2023 Jessica May Warren
- Language
- eng
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