Child abuse and neglect are serious public health problems in the United States, affecting nearly 1 million children each year, resulting in substantial economic burdens for the public and harmful outcomes in children, including anxiety, trauma, and depression and conduct problems. Few parenting programs have been shown effective in reducing child abuse and neglect after it has already begun.
However, one very effective program, called Parent-Child Interaction Therapy (PCIT), is the focal point of a 5-year $3.5 million study led by Dr. Elizabeth Skowron and Dr. Phil Fisher in the Center for Translational Neuroscience at the University of Oregon, funded by the NIH/NIDA. The Coaching Adaptive Parenting Strategies (CAPS) is designed to test PCIT’s effectiveness in preventing new episodes of child abuse and neglect, and to learn more about how it effects biological and behavioral markers emotion regulation and self-control in parents and their children.
Originally designed to improve disruptive behavior problems in children, PCIT is a parenting program that helps empower parents at risk for child maltreatment to make changes in their parenting that lead to more nurturing, positive, and secure relationships with their children. In PCIT sessions, parents wear a tiny earpiece while they play together with their children, and a PCIT therapist “coaches” the parent via a headset from the other side of a one-way mirror, providing positive feedback, support, and guidance while a parent practices new skills.
Early PCIT sessions focus on supporting parents to use positive parenting behaviors and tips to avoid minor misbehavior, whereas in later PCIT sessions, therapists guide parents in practicing effective, non-violent guidance and behavior-management skills with their child. PCIT improves parents’ confidence, competence, and enjoyment in parenting, effectively reducing families’ vulnerability to coercive family processes. It is effective with diverse families who have children ages 3 to 7 years old. Previous outcome research on PCIT has shown that it improves children’s behavior, parents report feeling more confident (and less distress) at program completion, and program satisfaction is high. Cost-benefit analyses conducted by the Washington State Institute for Public Policy show an excellent return on investment for PCIT with child welfare-involved families: For every 1 dollar invested, there is $5.93 return.
Dr. Skowron theorizes that PCIT’s unique, live-coaching approach helps to provide struggling parents with support in managing the strong emotions that arise in parenting, helping parents stay calmer while they learn and practice new skills in the moment with their child. “In our experience working with child welfare-involved families, we find that the vast majority of parents struggling with child abuse care deeply about their children and want things to improve,” Dr. Skowron said. “But they feel at a loss for what to/how to change. Many themselves have often experienced adversity as children and are trying to cope with countless other stressors. PCIT produces real and lasting changes in parents’ warmth and effective discipline practices, leading to lower future risk for child abuse in families. We know that PCIT is generally effective—our work in the CAPS study will help us better understand whether and how PCIT supports change in underlying biomarkers of parent and child self-regulation on the way to achieving its positive outcomes.”
The CAPS study enrolled over 200 Lane County families. Mothers, fathers, and a child between the ages of 3 and 7 are invited to participate in the year-long study. CAPS study families complete two assessment interviews at study entry and again 9-12 months later, and researchers collect information about parents’ and children’s heart rate (ECG), brain activity (EEG), and physical health markers (blood spots), and other measures of stressors and supports in the family. Half of study families were invited at random to participate in the PCIT program at no cost, while other study families continued receiving services as usual in the community. Over 80 eligible Lane County families received PCIT services from Dr. Skowron, a certified PCIT therapist and trainer, and her graduate students.
The CAPS study also provides research training in clinical translational research to undergraduate and graduate students at the University of Oregon. Over 30 undergraduate students in psychology, human physiology, and related fields have gaining valuable research experience in the lab, and the project has hosted four high school and undergraduate students from across the country for 8-week research internships funded by the National Institute on Drug Abuse, designed to provide traditionally underrepresented students with experiential research training to prepare for successfully entry into graduate school.