Project Connect: Adapting PCIT to Foster Care

描述（由申请人提供）：亲子互动疗法（PCIT）是一种经经验验证的治疗幼儿外化行为问题的方法。寄养儿童特别容易出现外部化问题，而这些问题往往是寄养父母没有受过有效处理培训的。PCIT通常由治疗师在12-14个单独的每周会议中提供。虽然有效，标准的PCIT是资源密集型的，所以它不太可能被儿童福利机构作为一项常规服务。因此，本研究的目的是实施和测试一种新的适应PCIT与寄养家庭使用基于组和家庭治疗的疗效。干预将结合两种创新的治疗方式：（1）密集的PCIT小组培训与寄养父母-儿童二人组，和（2）每天在家里排练PCIT技能加强定期电话咨询会议。总共132个寄养家庭将被随机分配到三个相等的组（n=44），包括接受不同治疗剂量的两个实验条件。两个治疗组将接受为期两天的培训，然后进行8周的家庭临床服务。然后，两个治疗组中的一个将接受为期一天的PCIT强化培训，沿着6周以上的家庭服务。这两个实验组将相互比较，并与第三个候补名单对照组进行比较。该研究有三个主要目的：（a）检查接受不同剂量PCIT的两种治疗条件是否显示出彼此相比以及与正常接受儿童福利服务的对照组相比在父母和儿童结局方面的增益，（B）确定治疗无应答的预测因子，以及（c）探索主效应发现的中介物。将在基线和随后的几个时间点对每组进行评估。本研究将采用多个被试和多个测量指标来评估研究结果，包括儿童的外化行为、依从性和情绪调节，以及照顾者的行为管理技能、养育态度和压力。这项研究将作出若干重大的实际和科学贡献。分析将显示是否可以成功地实施PCIT在社区环境与寄养家庭使用基于小组的培训和后续活动在家里。通过在治疗条件下使用相同的治疗方式，还可以检测剂量效应。此外，拟议的干预措施建立在现有儿童福利服务结构的基础上，从而增加了成功的可能性：（a）实施干预措施，（B）在未来的有效性试验中推广，（c）纳入儿童福利服务系统。从方法上讲，使用随机对照设计，沿着心理测量学验证的测量，三角评估和忠诚保障将增加内部效度并加强统计结论。同样，拟议的分析方法将加强因果推理，并有助于未来的方案开发和设计。 公共卫生相关性：年幼的寄养儿童面临着外部化问题的高风险，寄养父母通常没有接受过基于证据的行为管理技术的培训。本研究将评估寄养儿童及其照顾者对亲子互动疗法（PCIT）的创新适应，采用基于小组的方法并辅以家庭培训。结果将产生新的知识的可行性翻译PCIT，经验验证的临床治疗，到社区环境中，以减轻年轻的寄养儿童的外化问题。

DESCRIPTION (provided by applicant): Parent-Child Interaction Therapy (PCIT) is an empirically validated treatment for externalizing behavior problems in young children. Foster children are at an especially high risk of developing externalizing problems, difficulties that their foster parents are not often trained to manage effectively. PCIT is typically delivered by therapists in 12-14 individual, weekly sessions. Although efficacious, standard PCIT is resource intensive, so it is unlikely to be adopted as a routine service by child welfare agencies. Therefore, the objective of this study is to implement and test the efficacy of a novel adaptation of PCIT with foster families using group-based and in- home treatment. The intervention will couple two innovative treatment modalities: (1) an intensive PCIT group training with foster parent-child dyads, and (2) daily in-home rehearsal of PCIT skills reinforced by regular telephone counseling sessions. A total of 132 foster families will be randomly assigned to three equal groups (n=44), including two experimental conditions receiving different treatment doses. Both treatment groups will receive a two-day training followed by 8 weeks of in-home clinical services. One of the two treatment groups will then receive a one-day booster session of PCIT training along with 6 more weeks of in-home services. The two experimental groups will be compared to each other and a third waitlist control group. The study has three central aims: (a) to examine whether two treatment conditions receiving different doses of PCIT demonstrate gains in parent and child outcomes compared to each other and to a control group receiving child welfare services as usual, (b) to identify predictors of treatment non-response, and (c) to explore mediators of main- effect findings. Assessments will be conducted at baseline and several subsequent time points for each group. Multiple informants and measures will be used to assess study outcomes, which include children's externalizing behaviors, compliance, and emotion regulation as well as caregivers' behavior management skills, parenting attitudes and stress. This investigation will make several significant practical and scientific contributions. Analyses will show whether PCIT can be implemented successfully in a community setting with foster families using group-based training and follow-up in-home activities. Through the use of the same therapeutic modalities across treatment conditions, it will also be possible to detect dosage effects. Furthermore, the proposed intervention builds on existing child welfare service structures, thereby increasing the likelihood of successful (a) implementation of the intervention, (b) replication in future effectiveness trials, and (c) integration into the child welfare service system. Methodologically, the use of a randomized, controlled design along with psychometrically validated measures, triangulated assessments, and fidelity safeguards will increase internal validity and strengthen statistical conclusions. Likewise, the proposed analytic approach will enhance causal inferences and contribute to future program development and design.111 PUBLIC HEALTH RELEVANCE: Young foster children are at a high risk of externalizing problems, difficulties that foster parents typically are not trained to address with evidence-based behavior management techniques. This study will evaluate an innovative adaptation of Parent-Child Interaction Therapy (PCIT) with foster children and their caregivers using a group-based approach reinforced with in-home training. Results will produce new knowledge about the feasibility of translating PCIT, an empirically validated clinical treatment, into a community setting in order to mitigate externalizing problems in young foster children.