Parent-Child Interaction Therapy and Resilience Within Child Welfare

Abstract

Background: Children in foster care and their substitute caregivers (i.e., foster parents) lack access to evidence-based interventions designed to 1) mitigate the effects of maltreatment on child behavior and 2) strengthen parenting skills needed to effectively care for children with a history of maltreatment. Previous research has established that Parent-Child Interaction Therapy (PCIT) is an evidence-based intervention for children with a history of maltreatment. Yet, PCIT’s broader impact on child welfare outcomes (i.e., placement and permanence) and the implications of adapting PCIT for foster families remains largely unknown. Furthermore, intervention effects on children’s resilience remain largely unstudied, although interventions that facilitate child resilience may help to advance children’s overall well-being. Methods: First, using foster parent reports from a randomized controlled trial of group PCIT and child welfare administrative data, logistic regression and survival analyses were employed to compare placement outcomes, permanency outcomes, and whether foster parents maintained their licenses between foster parent-child dyads who received group PCIT and foster parent-child dyads who received child welfare services-as-usual while accounting for child and parent-level covariates. Second, thematic analysis of focus group data explored PCIT practitioners’ and foster parents’ perceptions of PCIT within the context of child welfare. Third, a new measure of child resilience, the Early Childhood Measure of Resilience (ECMR), was developed and piloted with a sample of foster parent-child dyads to examine its psychometric properties using traditional and contemporary (i.e., Rasch modeling) analysis strategies. Results: Results from the first study indicated that children who received group PCIT were significantly more likely to have permanence within 12 months post-baseline compared to children who received services-as-usual. Furthermore, differences were observed across the groups on placement disruption, with children in the intervention condition having better placement stability, though analyses did not rise to the level of statistical significance. Foster parents’ license status was comparable across the intervention and control groups. In the second study, analysis of PCIT practitioners’ and foster parents’ perceptions resulted in four exploratory themes related to the implementation of PCIT within child welfare: 1) Barriers to implementing PCIT in child welfare, 2) Factors that facilitate the implementation of PCIT in child welfare, 3) Developing a trauma-informed approach to PCIT, and 4) Strategies to facilitate the translation of PCIT into child welfare. Results from the third study revealed that the ECMR had acceptable internal consistency, concurrent validity, divergent validity, test re-test reliability, person reliability and item reliability. Exploratory factor analysis revealed four factors underlying the ECMR. Rasch analyses provided insight into future instrument refinement. Implications: The current study findings contribute to the field’s understanding of the effects of PCIT on placement and permanence, highlight the potential benefits of relying on multiple stakeholders’ perspectives to help guide PCIT implementation within child welfare, and draw attention to assessing positive well-being (e.g., resilience across various domains of functioning). Collectively, study results help to support the translation of PCIT and the resilience framework into child welfare.