Does Therapist Coaching Predict Outcomes in Parent-Child Interaction Therapy - Emotion Development?

• In Event: Early Childhood Parent Coaching Interventions: Examining Adaptations and Coaching Process

Abstract

Introduction: Parent-Child Interaction Therapy (PCIT), which was originally developed for child behavior problems, has been adapted into PCIT-Emotion Development (PCIT-ED) and found efficacious in treating early childhood depression. Given PCIT-ED’s efficacy, it is important to understand how the therapy works. Like PCIT, PCIT-ED focuses on improving children’s symptoms by changing parent behavior through a parent coaching model. In previous research, the frequency of PCIT therapists’ responsive coaching during the Child Directed Interaction (CDI) phase of therapy has been associated with parent skill acquisition (Barnett et al., 2014; 2017). This study will examine the associations between responsive coaching during CDI and parent and child outcomes in PCIT-ED.

Methods: Participants included 113 parent-child dyads who were randomized to receive PCIT-ED (n = 62) or who received PCIT-ED after waitlist (n = 51). Children were 63% male, and were 5.4 years old (SD = 1.1), on average, when starting treatment. Children were 78% white, 10% black, 12% multi-racial, and 11% Hispanic. All children were diagnosed with depression at baseline, and 47% were diagnosed with comorbid Oppositional Defiant Disorder. PCIT-ED included 3 phases of therapy: Child Directed Interaction (CDI; 6 sessions), Parent Directed Interaction (6 sessions), and the novel Emotion Development module (8 sessions). Frequency of responsive coaching was assessed from a 5-minute video from CDI session 3, using the Therapist Parent Interaction Coding System (TPICS; Barnett et al., 2014). Child behavioral and depressive symptom outcomes were assessed with the Eyberg Child Behavior Inventory (ECBI; Eyberg & Pincus, 1999) and the Preschool Feelings Checklist (PFC; Luby et al., 1999), respectively, at baseline, post-CDI, and post-treatment. Parent behavior outcomes were assessed at baseline, post-CDI and post-treatment by summing “Do” skills coded from the Dyadic Parent-Child Interaction Coding System (DPICS; Eyberg et al., 2014) during 5 minutes of child-led play.

Results: Controlling for baseline frequency of parent behaviors, therapists’ frequency of responsive coaching during CDI predicted parenting skills after the CDI phase of therapy, β = .31, and at post-treatment, β = .33, p’s = .001. Controlling for baseline ECBI scores, therapists’ responsive coaching predicted reductions in children’s behavioral problems after the CDI phase, β = -.13, p = .04, but not at post-treatment, β = -.12, p = .12. Therapists’ responsive coaching during CDI did not predict child depressive symptoms during or after therapy, β’s = -.05 and -.06, p’s > .50.

Conclusions: Consistent with prior research, these results demonstrate the importance of early PCIT-ED therapist coaching in predicting parenting outcomes, both during and after treatment. In addition, to our knowledge this is the first study to link therapist coaching to child outcomes, specifically, reductions in behavior problems. However, therapist coaching during CDI was not associated with child depression outcomes. Therapist coaching in the novel Emotion Development module of PCIT-ED may be more important than CDI coaching for understanding children’s depression outcomes, and should be examined in future research. Overall, these results reinforce the importance of therapists’ coaching in improving parenting and child behavior in parent coaching interventions.

Authors

• EB Caron, University of Hartford
  Presenting Author

• Leah M. Williams, Fitchburg State University
  Non-Presenting Author

• Alexa J. Russo, Fitchburg State University
  Non-Presenting Author

• Matthew Legere, Fitchburg State University
  Non-Presenting Author

• Joan L Luby, Washington University in St. Louis
  Non-Presenting Author