Parent-Child Interaction Therapy (PCIT) is an empirically supported, parent-training program designed to teach parents specific techniques to manage the behavior of children between the ages of two and seven exhibiting extreme disruptive behavior. Over 30 published studies (see Herschell, Calzada, Eyberg, & McNeil, 2002b for a review) have lent support to the efficacy of this clinic-based program. The current paper will highlight the need for disruptive behavior disorder treatment for children in foster care, discuss the appropriateness of applying PCIT to children in foster care, and report on the effectiveness of and reported satisfaction with a modified procedure for training foster parents in PCIT skills.
In the United States population, it is estimated that between 10 and 12 percent of children exhibit disruptive behavior that could benefit from intervention (The National Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment, 2001). A substantially higher percentage of children in foster care (50-61) demonstrate clinically significant behavior problems, and children with these behavior concerns in foster care often display even higher rates of hyperactivity, noncompliance, and aggression in comparison to other children with disruptive behavior who are not in foster care (e.g., Clausen, Landsverk, Ganger, Chadwick, & Litrownik, 1998). These types of disruptive child behavioral difficulties have been linked with numerous short- and long-term negative life outcomes. For example, untreated disruptive behavior in young children has been linked to increased rates of adolescent juvenile delinquency (Loeber, 1990) and adult antisocial behavior (Loeber & Dishion, 1983; White, Mofitt, Earls, Robins, & Silva, 1990).
Similarly, disruptive behavior has been linked to negative outcomes within the child welfare system including an increased length of stay in foster care (Urquiza, Wirtz, & Singer, 1994), multiple placements (Pardeck, 1984), unstable care (Pardeck, Murphy, & Fitzwater, 1985), and movement to residential placement (Barber & Delfabbro, 2002). For example, children with externalizing behavior problems were one half as likely to be reunified with their families within 18 months of entry into foster care as children without behavior problems (Landsverk, Davis, Ganger, Newton, & Johnson, 1996), and externalizing behavior evident at the time of placement proved to be the strongest predictor of placement changes for a sample of 415 children (Newton, Litrownik, & Landsverk, 2000).
Foster parents are often asked to care for children exhibiting disruptive behavior; however, they seldom receive training in how to manage such behavior. Few foster parents report receiving adequate training on how to deal with specific emotional and behavioral child problems (e.g., Hochstadt, Jaudes, Zimo, & Schachter, 1987) despite the finding that approximately one quarter of placement failures result from specific child behaviors that parents feel incapable of handling (Cooper, Peterson, & Meier, 1987). In general, foster parents receive limited amounts of training (Berry, 1989). The training they do receive lacks empirical support (Lee & Holland, 1991), and typically emphasizes the role of foster parents in the child welfare system, rather than emphasizing parenting skills or behavior management (Berry, 1989). When 34 foster mothers were interviewed to inquire about positive and negative aspects of being a foster parent, one of the most common responses was the need for training in child-rearing skills (Hampson & Tavormina, 1980).
There have been few studies on the effectiveness of foster parent training, and they have produced mixed findings. For example, Puddy and Jackson (2003) discuss the need for foster parents to have special parenting skills to address the challenging behaviors of foster children. …