Parent Child Interaction Therapy in Head Start FamiliesJane G. Querido, M.S. And Sheila M. Eyberg, Ph.D.

Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida

A

Conduct-disordered behavior in preschool-age children constitutes the single most important behavioral risk factor for later antisocial behavior. Research suggests that certain family characteristics put children at risk for developing conduct problems and that several of these factors are present at high levels in Head Start families. One of the cornerstones of Head Start is the proactive belief in early identification and intervention, and it is necessary that effective services be provided to children who are deemed at-risk for developing conduct problems. Parent-Child Interaction Therapy (PCIT) is a brief, empirically supported treatment for conduct-disordered preschool children. However, PCIT has never been systematically studied for its effectiveness with Head Start families. The goals of the present study were to screen for behavior problems in preschool children enrolled in Head Start, gather normative data on several measures of child, parent, and family functioning, and examine the effectiveness of PCIT in a randomized, controlled pilot study of Head Start families of children at risk for the development of later antisocial behavior.

Early intervention in families with conduct-disordered youngsters may be critical. Conduct-disordered behavior represents the single most important behavioral risk factor for later antisocial behavior (Loeber & Dishion, 1983; White, Moffit, Earls, Robins, & Silva, 1990) and can be reliably identified in children as young as 3 (Olweus, 1979). Evidence suggests that interventions provided at the preschool age may be more effective than when children are older (Dishion & Patterson, 1992) and that effective intervention prior to school entry may prevent the associated problems with academic performance and peer relationships that require multiple interventions only a few years later (Reid, 1993; Campbell, 1997; Webster-Stratton & Herbert, 1994).

Head Start is a federally-funded preschool program available to children of low income families. This group of preschool children may be characterized as having increased risk for developing conduct disorders because so many risk factors are present at higher than average rates in this population (McLoyd, 1990). Webster-Stratton found that, out of approximately 500 Head Start families, thirty-five percent of the children were above the established cutoff point for conduct problems and over 74% of the sample of preschool children had four or more risk factors for developing conduct disorder (Webster-Stratton, 1995). Other large scaled investigations have also indicated that economically disadvantaged children are at increased risk for mental health problems (Belle, 1990; Goldberg, Roghmann, McInerny, & Burke, 1984).

Although not all of the risk factors for conduct disorders are amenable to intervention (e.g., economic status or parental history of psychopathology), risk factors such as inconsistent parenting behavior, a disruptive parent-child relationship, and lack of support are amenable to interventions designed to cultivate parents’ coping abilities and confidence in their parenting. Assessment of these factors plays an integral role in identifying interventions that are most appropriate for families. The potential for addressing these factors through parent-child interaction training programs suggests that PCIT would be a highly effective intervention with Head Start families.

INTRODUCTION

ABSTRACT

All Head Start teachers were contacted by the principal investigator to explain the procedure and obtain informed consent. Teachers passed out the Study I packet to all parents of children in their class. Included in the packet was a letter explaining the study, a demographic questionnaire, the Eyberg Child Behavior Inventory (ECBI), and a form which asked them to provide their name and phone number if they were interested in participating in Study II or Study III. For Study II, the principal investigator contacted families by telephone, explained that they would be asked to fill out additional measures of child, parent, and family functioning during a telephone assessment, and invited the family to participate. Families were also asked for permission to contact the child’s teacher to gather information on the child’s classroom behavior. Following the completion of the telephone assessment, families received $15 in the mail. For Study III, families of children with behavior problems (ECBI Intensity score > 132) were invited to participate in a treatment outcome study in which families were randomly assigned to receive PCIT or standard care through the Alachua County Head Start program.

PROCEDURE

PARTICIPANTSStudy I participants were 638 children enrolled in Head Start in Alachua County and their female caregivers. Fifty-four percent of the children were male (n = 343) and the children’s mean age was 4.50 (SD = .56) Children’s ethnic composition was 66% African American (n = 420), 25% Caucasian (n = 163), 4% Hispanic (n = 23), and 5% other (n = 23). The majority of female caregivers were mothers (91%; n = 581) although several grandmothers also participated (4%; n = 25). Most families (62%; n = 396) were single-parent families. Family income ranged from under $5,000 (18%; n = 114) to $21,000 to $30,000 (19%; n = 124), with the largest number of families earning between $11,000 to $20,000 (33%; n = 211). One hundred eighty-nine families agreed to participate in Study II, and eight families agreed to participate in Study III.

CONCLUSIONSThis study provided normative data for a collection of child, parent, and family variables for Head Start families. Univariate ANOVAS on these variables showed no significant differences for any variable according to children’s gender, age, and ethnicity breakdowns. In addition, our study showed that in families who received PCIT, compared to families who received standard care only, children exhibited fewer behavior problems as rated by their parents and teachers, and parents reported lower stress levels and greater social support. Families who completed treatment showed clinically significant and reliable change on measures of child and parent functioning. This study demonstrated the effectiveness of PCIT for treating child behavior problems in Head Start families and its potential for buffering some of the adverse effects of poverty by developing parents' coping abilities and confidence in their parenting.

RESULTS

Instrument Scale N M SDEyberg Child Behavior Inventory (ECBI) Intensity 638 97.57 32.78

Problem 591 6.63 7.27

Child Behavior Checklist (CBCL) Externalizing 160 52.14 10.47

Internalizing 160 46.49 8.91

Parenting Locus of Control-Short Form (PLOC-SF) Total 185 57.26 11.50

Parenting Stress Inventory-Short Form Parent Distress 187 30.56 10.66

(PSI-SF) Parent Child Dysfunctional Interaction

186 21.31 8.32

Difficult Child 185 30.10 10.84

Total 179 81.51 24.85

Family Relationship Index (FRI) Cohesion 184 7.20 1.98

Expressiveness 185 5.57 1.67

Conflict 185 2.37 1.90

Multidimensional Scale of Perceived Social Support(MSPSS)

Total 172 30.04 10.01

Parenting Scale (PS) Overreactivity 126 27.82 8.79

Laxness 128 33.26 11.31

Verbosity 128 29.53 5.40

Sutter-Eyberg Student Behavior Inventory- Intensity 150 88.56 53.29

Revised (SESBI-R) Problem 147 7.04 10.88

Conners’ Teacher Rating Scale-Revised: Long Oppositional 139 56.03 14.94

Version (CTRS-R:L) Conners’ Global Index: Total 140 57.24 15.45

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PCIT STANDARD CARECLINICALLY SIGNIFICANT CHANGE (Jacobson et al., 1999)

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