Home-Based PCIT: How does it look in Durham?

By: Metta Prieto

Within the past few years, funders of human service agencies have become increasingly interested in investing in programs that employ research-based therapy models. This trend towards evidence-based practice encourages the use of models that are evaluated and found not only to create positive change that can be noticed by families and clinicians, but also change that can be statistically analyzed and shown to demonstrate real effectiveness of the therapy model. Research-based models are not successful by chance alone, but are successful because they make a real difference for families.

Two years ago, Rachel Galanter, Family Support Program Manager at the Exchange Clubs' Family Center, sensed the trend toward research-based models and began searching for an evidence-based model of therapy that was consistent with the goals and values of the Exchange Club. The model she found that was closest to the coached play model already being used in the Family Support Program, and which we are currently using, is called Parent Child Interaction Therapy (PCIT).

What is PCIT?

Parent Child Interaction Therapy (PCIT), developed by Sheila Eyberg, is a highly structured intervention commonly employed in a clinic for parents with children two to eight years of age exhibiting problematic externalizing behaviors (such as refusing to listen to their parents or being aggressive). PCIT is designed as a 12-week therapy, encompassing two components: Child Directed Interaction (CDI) and Parent Directed Interaction (PDI). The two components of PCIT are designed to strengthen the parent-child bond through positive play techniques, and teach parents consistent, calm disciplinary skills.

How is PCIT employed at the Exchange Club's Family Center?

When Parent Child Interaction Therapy was introduced to the Family Support Program wing of the Center nearly two years ago, the Family Support Program took PCIT into the community and worked with families in their homes. The home-based approach made it possible for families without transportation to participate in the program, as well as families with multiple children who did not have a form of childcare. The Exchange Clubs' Family Center strongly felt that providing a convenient, cost-free program would be the best match for the population of families served in the Durham area. As soon as clinicians from the Family Support Program had been trained in the Parent Child Interaction Therapy model, they integrated PCIT into their home visits and the results have been very positive. Parents are generally very happy with the changes they see in their family life as a result of their participation in Parent Child Interaction Therapy.

What do the results of home-based PCIT look like?

As Sheila Eyberg was developing the PCIT model, it was important to her that clinicians would be able to assess whether or not their client families were improving. In order to test progress in a manner consistent with the needs of the PCIT model, she developed the Eyberg Child Behavior Inventory (ECBI), which we at the Center administer to all of our client families directly before and after therapy.

At the end of last year, we decided to undertake the project of comparing the ECBI pre-test scores and post-test scores of all of the client families the Family Support Program has worked with since the introduction of PCIT nearly two years ago. In order to examine differences between pre-intervention and post-intervention test scores on the Eyberg Child Behavior Inventory we ran statistical tests, and results showed that the average pretest scores were in the clinically significant range, but dropped to the clinically insignificant range on the posttest. Further, differences between the pretest and posttest scores were statistically significant.

In laymen's terms, the average family we work with begins Parent Child Interaction Therapy with at least one child with a level of behavior problems beyond what is typical, and parents feel significant levels of stress. When the family finishes the program, the child is behaving in a way more typical for his or her age, and the parent experiences levels of stress similar to other parents. For us as clinicians, this statistical evidence adds to our therapeutic intuition that Durham families are indeed being influenced positively by home-based Parent Child Interaction Therapy.