Parent-Child Interaction Therapy: Application of an Empirically Supported Treatment to Maltreated Children in Foster Care

By Timmer, Susan G.; Urquiza, Anthony J. et al. | Child Welfare, November/December 2006 | Go to article overview

Parent-Child Interaction Therapy: Application of an Empirically Supported Treatment to Maltreated Children in Foster Care


Timmer, Susan G., Urquiza, Anthony J., Herschell, Amy D., McGrath, Jean M., et al., Child Welfare


One of the more serious problems faced by child welfare services involves the management of children with serious behavioral and mental health problems. Aggressive and defiant foster children are more likely to have multiple foster care placements, require extraordinary social services resources, and have poor short- and long-term mental health outcomes. Interventions that work with challenging foster children and enhance foster parents' skills in managing problem behaviors are necessary. This article presents the successful results of a single case study examining the application of Parent-Child Interaction Therapy (PCIT) with an aggressive young boy and his foster-adoptive parent. PCIT is a dyadic intervention that has been identified as an empirically supported treatment for abused children and for children with different types of behavioral disruption. The application of PCIT to assist foster parents is a promising direction for child welfare services.

The number of children entering out-of-home care nationwide increased 15.4% between 1998 and 2003, from 255,415 to 294,656 (CWLA, 2006a), and estimates reflect that about 74% of the children in out-of-home care in 2003 were in foster care (CWLA, 2006b). Clausen and colleagues (1998) reported 61% of their sample of children in foster care in San Diego showed evidence of mental health problems. Subsequent examination of the same group of children after a year in foster care showed that children experiencing multiple placements were at greater risk for mental health problems, even if they were not judged to be at risk when they entered foster placement (Newton, Litrownik, & Landsverk, 2000).

This evidence, combined with other research documenting a strong connection between placement disruption, behavior problems, and longer term negative consequences (for example, Cook, 1994; Newton, Litrownik & Landsverk, 2000) gives substance to the general belief that every attempt should be made to preserve a child's initial foster placement. There is currently some effort to design interventions for foster parents in order to reduce the risk of placement volatility (for example, Fisher, Burraston, & Pears, 2005; Fisher, Gunnar, Chamberlain, & Reid, 2000). This article reports on the effectiveness of Parent-Child Interaction Therapy (PCIT) in reducing a foster parent's stress in coping with a foster child's behavior problems, hence increasing the likelihood of placement stability.

Although ample evidence exists for the presence of mental health problems in foster children, examining some of the reasons why these children exhibit these problems is of value. On its own, entry into foster care increases the likelihood of developing mental health problems (Lawrence, Carlson, & Egeland, 2006). Maltreated children are removed from familiar environments and into environments they know are temporary. In fact, Needell and colleagues (2006) found that of the children who entered foster care in 2000 in California and remained in care for at least six months, 29% had three or more placements during that six-month period. The uncertainty of their current living situations, and their future placement(s) may create considerable anxiety, over and above that already created by the trauma of maltreatment and the chaotic environment of abusive households.

The family environments that sustain child maltreatment often involved substance abuse (McNichol & Tash, 2001), mental illness, a high degree of emotional dysregulation, and limited or inconsistent child management skills (Kelly, 1983; Wolfe, 1987; Wolfe, Aragona, Kaufman, & Sandier, 1980). The combination of the uncertain, insecure nature of the foster care experience; and their maltreatment; and their abusive parents' limited parenting skills help explain why many children in foster care have problems related to behavioral disruption, such as defiance, aggression, and noncompliance.

Children's externalizing such behavior problems are particularly troublesome for foster parents. …

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