title: Parenting and Policy: Evidence from a Comparative Meta-analysis and Trial of Parent-Child Interaction Therapy with Families at Child Mistreatment Risk
Creators: name: Thomas, Rae-Louise
Publisher: name: Griffith University
Year: 2008
Subjects: subject: evidence-based
subject: parent-child interaction therapy
subject: parenting interventions
subject: child maltreatment
subject: risk
subject: PCIT
subject: Triple P

description: A series of two studies were conducted with the purpose of adding to the knowledge of evidence-based child and family practice. It was expected this knowledge inform and assist policy-makers and practitioners to make decisions about implementing interventions most likely to improve the lives of parents and their young children. In the first study, meta-analyses of 24 studies were conducted to evaluate and compare the outcomes of two widely disseminated parenting interventions - Parent-Child Interaction Therapy (PCIT) and Triple P-Positive Parenting Program (Triple P). In the second study, a randomised controlled trial of PCIT was conducted with families at risk of maltreatment. In general, the meta-analyses in Study 1 revealed positive outcomes for children and parents. Both PCIT and Triple P reduced parent-reported child behaviour and parenting problems. The effect sizes for PCIT were large when outcomes of child and parent behaviours were assessed with parent-report, with the exception of Abbreviated PCIT, which had moderate effect sizes. With the exception of Media Triple P which had small effects, all other forms of Triple P had moderate to large effects when outcomes were parent-reported child behaviours and parenting. PCIT and an enhanced version of Triple P were associated with improvements in observed child behaviours. These findings revealed that the efficacy of each program was somewhat dependent on intervention length, components, and source of outcome data. Findings also provide information about the comparable effectiveness of two programs that have received substantial funding in the USA and Australia, and should assist in making decisions about allocations of funding and dissemination of these parenting interventions in the future. However, questions remain regarding the comparable effectiveness of enhanced or abbreviated PCIT and Triple P intervention formats compared to typical intervention format delivery. The addition of concurrent treatment components to already efficacious interventions may not enhance intervention outcomes. In Study 2, participants were 150 female caregivers and their children aged between 2.5 and 7 years. Caregivers were at risk of child maltreatment and children had elevated levels of behavioural problems. Forty-two participants in the treatment group and 36 in a supported waitlist completed at least a pre- and 12-week assessment. Multi-method (observation and pencil and paper measures) and multi-source (independent observers, teachers and parents) data collection procedures were used. By 12 weeks, there were greater improvements among the PCIT Treatment group compared to the Attention Only Waitlist. These improvements included declines in externalising child behaviour, parenting stress, intrusive questioning, and the problems attributed to the child subscale of the Child Abuse Potential Inventory. Also there were greater increases in positive parental verbalisations (i.e., praise and descriptions/reflections) in PCIT participants compared to Attention Only Waitlist participants. However, no group difference was found for observed parent sensitivity or child abuse potential total score. With the exception of large effects for increases in positive communication of parents when playing with their children, other effect sizes tended to be small or moderate when assessed at 12 weeks of treatment and in comparison to the waitlist. In addition, with the exception of parent-report of total child abuse potential, reliable change criteria were met for a greater proportion of PCIT Treatment participants compared to Attention Only participants at 12-week assessment. At treatment completion, the PCIT Treatment group continued to improve in parent-report of child externalising behaviour and internalising symptoms, parent stress and observations of parent verbalisations. In addition, parent-report of total child abuse potential and observations of parent sensitivity improved. Within treatment group effects were usually moderate or large but there were small effects for parent sensitivity and total child abuse potential. With the exception of parent-report of rigidity and observed parent sensitivity, the proportion of families who met the criteria for reliable change increased from 12-week assessment to treatment completion. Treatment effects were maintained at 1-month follow-up. The results of the meta-analyses and randomised controlled trial reported in this program of research contribute to shaping the substantial evidence around two parenting interventions that have benefited from government funding in both Australia and the USA.