Key Research Questions Answered
How is PCIT helpful for parents and their children?
Treatment outcome studies demonstrate improvements in parent skill and child behavior (for reviews see Gallagher, 2003: Herschell, Calzada, Eyberg, & McNeil, 2002b). More specifically, behavior observations of parent-child interactions indicate pre-post changes in parent behavior such as increased rates of praise, descriptions, reflections, and physical proximity as well as decreased rates of criticism and sarcasm (e.g., Eisenstadt et al., 1993).
Additionally, parents report lower parenting stress, more internal (rather than external) locus of control, and increased confidence in parenting skills after completing PCIT. Similarly, observations of child behavior have demonstrated decreases in disruptive behavior and overactivity as well as increases in compliance. Pre- to post-treatment compliance rates have been reported to change as follows: 29-43%; 41-72%; 21-46%; 39-89%; 21-70%; 64-81% (Herschell & McNeil, 2005).
Parents report their child’s behavior to improve from the clinical range to within normal limits on multiple parent report measures including the Eyberg Child Behavior Inventory (both problem and intensity scales; McNeil, Clemens-Mowrer, Gurwitch, & Funderburk, 1994; Schuhmann, et al., 1998) and the Child Behavior Checklist (both internalizing and externalizing scores; Eisenstadt, et al., 1993). In addition to being highly satisfied with the outcome of treatment, parents also report high satisfaction with the process of PCIT (e.g., Schuhmann, et al., 1998).
Generalization: Do the results generalize to untreated children and settings?
Studies have indicated that the treatment results of PCIT generalize to untreated siblings (Brestan, Eyberg, Boggs, & Algina, 1997) as well as school settings (McNeil, Eyberg, Eisenstadt, Newcomb, & Funderburk, 1991). Brestan and colleagues (1997) found that both mothers and fathers of treated children reported improvement in the behavior of untreated siblings. These improvements were not reported by the comparison group (waitlist control parents).
Children who experience behavioral difficulties at home often experience these same difficulties as school. Some have suggested that school problems must be directly addressed in order to successfully reduce them (Breiner & Forehand, 1981); however, McNeil, et al., (1991) found that preschool children who completed PCIT demonstrated behavioral improvements at school without any direct classroom intervention. In a follow-up study, Funderburk, Eyberg, Newcomb, McNeil, Hembree-Kigin, and Capage (1998) found that these school gains maintained up to 12-months post-treatment; however, at 18-months post-treatment, only compliance gains maintained.
Maintenance: How long do treatment benefits last?
A series of studies have been conducted to understand the endurance of treatment benefits (Boggs et al, 2004; Eyberg, Funderburk, Hembree-Kigin, McNeil, Querido, & Hood, 2001; Funderburk et al, 1998; Hood & Eyberg, 2003). At 2-years post-treatment, the majority of children (69%) maintained gains on measures of child behavior problems, child activity level, and parenting stress as well as remained free of disruptive behavior disorder diagnosis (54%; Eyberg et al., 2001). In comparison to completers of treatment, those who did not complete treatment reported significantly more symptoms of disruptive behavior disorders 10 to 30 months after pre-treatment assessment. Treatment completion was associated with decreased parenting stress and higher satisfaction (Boggs et al., 2004). At 3 to 6 years post-treatment mothers reported the frequency of child externalizing behavior and their confidence to be unchanged compared to post-treatment (Hood & Eyberg, 2003).
Adaptations: Can the model be adapted to help other families?
PCIT has been applied to a wide array of childhood disorders. In addition to externalizing behavior disorders and child physical abuse (Chaffin et al., 2005), PCIT has been applied to separation anxiety disorder (e.g., Choate, Pincus, Eyberg, & Barlow, 2005), chronic pediatric illness (cancer; Bagner, Fernandez, & Eyberg, 2004), developmental disorders (Eyberg & Matarazzo, 1975) including autism (Masse, McNeil, Wagner, & Chorney, 2007; Solomon, Ono, Timmer, & Goodlin-Jones, 2008), Attention Deficit Hyperactivity Disorder (Martos et al., 2006), general child maltreatment (Fricker-Elhai, Ruggerio, & Smith, 2005), and domestic violence (Pearl, 2008; Timmer, Ware, Urquiza, & Zebell, 2010). It also has been adapted to fit younger (Dombrowski, Timmer, Blacker, & Urquiza, 2005) and older (McCoy, Funderburk, & Chaffin, in press) children.
To fit different treatment modalities, PCIT has been successfully abbreviated (Nixon, Sweeney, Erickson, & Touyz, 2003; Nixon, Sweeney, Erickson, & Touyz, 2004) as well as adapted to fit home (Masse, 2010), school (Lyon et al., 2009; Ware, McNeil, Masse, & Stevens, 2008), and primary care (Berkovits, O’Brien, Carter, & Eyberg, 2010) settings and to be used as a group intervention (Niec, Hemme, Yopp, & Brestan, 2005). Similarly, PCIT has been successfully used with foster parents, both kinship and nonkinship caregivers (McNeil, Herschell, Gurwitch, & Clemens-Mowrer, 2005; Timmer, Urquiza, Herschell, et al., 2006).
Cultural Relevance: Is PCIT appropriate for socially and culturally diverse families?
Studies of the efficacy of PCIT have included diverse samples. While additional studies are needed, the existing literature provides support for the use of PCIT with African American (Capage, Bennett, McNeil, 2001; Querido & Eyberg, 2002; Werba et al., 2002), Latino (i.e., Dominican, Puerto Rican, Mexican American; Calzada & Eyberg, 2002; Matos, Bauermeister, & Guillermo, 2009), Chinese (Leung, Tsang, Heung, & Yiu, 2009), Australian (Nixon, Sweeney, Erickson, & Touyz, 2003; 2004), and Norwegian (Bjørseth & Wormdal, 2005) families. PCIT also has been used extensively with families from moderate to low socio-economic groups.
Cost Effectiveness: Is PCIT Cost Effective?
In 2003 the Washington State Legislature assigned the Washington State Institute for Public Policy the task of determining if there was “credible scientific evidence that for each dollar legislature spends on research-based prevention or early intervention programs for youth, more than a dollar’s worth of benefits would be generated.”
In a systematic examination of several early intervention programs, including PCIT, the Washington State Institute for Public Policy (2004) found that for every dollar spent on PCIT services, benefits were estimated to be $3.64 so that for each youth treated, the benefits minus costs total was $3,427. In a follow-up study, these estimates were found to be similar when PCIT was applied to children in the Child Welfare System.
In comparing costs to benefits (e.g., reduced child welfare expenditures, reduced cost to the victims of child maltreatment, long-term outcomes such as improved educational performance and lower criminal activity), the total benefits minus costs per participant in PCIT was $3,746 (Lee, Aos, & Miller, 2008). Interestingly, within the same report PCIT had one of the largest effect sizes (-0.846) and smaller program costs ($1441) compared to treatment-as-usual. Notable is that PCIT was more expensive to provide that treatment-as-usual.