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“What the heck is PCIT?”

I was asked this question by a Head-Start preschool teacher the other day, smiled, and gave her the Parent-Child Interaction Therapy overview. Her next question,

“How do I make a referral?”

PCIT is a unique approach that uses intensive parent coaching to promote positive communication and discipline for families with children ages 2 ½ through 6 years. PCIT is the only evidence-based practice in which the parent and child are treated together throughout the course of treatment. The therapist communicates with the parents from behind a one-way mirror through a wireless in-ear speaker while the parent plays with the child. PCIT is a specific, step by step coachedbehavioral training model that has two phases: Child Directed Intervention, (CDI), and Parent Directed Intervention, (PDI).

In Child Directed Intervention, (CDI), the parent is taught specific skills to become an attuned caregiver, using play to restructure ways to effectively and positively respond to their child. The aim of the CDI is for parents to learn more appropriate and positive parenting practices and to establish a warm and rewarding relationship, thereby improving the parents’ ability to set limits and consistently follow through. PCIT is conducted as weekly sessions, and both parents are encouraged to attend therapy. When both parents attend, a session is first conducted with one of the parents, and a second session with the other parent immediately follows. This phase of treatment bolsters and reinforces a stronger attachment between the dyad as well as increasing child compliance. Here is a description of PCIT therapy and a demonstration of a PCIT CDI session.

Phase two is Parent Directed Intervention, (PDI), in which specific behavior management techniques based on social learning theory are taught to shape the child’s behavior when parents are coached to consistently implement clear limit setting. This phase of treatment strengthens behavioral and emotional regulation in both parent and child. PDI is effective in disrupting the cycle of social emotional challenges such as childhood aggression, low social competency, poor coping skills, low self-esteem, social struggles with peers, and struggles with behavioral and emotional regulation.

Parents who engage in PCIT treatment experience an increase in parental confidence, behavioral management skills, stronger attachment relationship with their children, and an overall sense of improving family well-being.

Early Childhood and Family Mental Health in Vermont, (ECFMH):

The PCIT program is within the ECFMH program within the division of Children, Youth and Family Services (CYFS).  ECFMH has existed in Vermont since 1998, when the Children’s Upstream Services (CUPS) grant was first obtained by the Child Adolescent and Family Unit of DMH. In some communities this work merged with the Children’s Integrated Services (CIS) grants allocated by the Child Development Division of DCF.

CIS Family Support providers assist parents with general support issues: parenting typically developing children, budgeting, managing daily routines, housing, school transition issues, etc. Early Intervention providers (EI) are specialists in screening and obtaining services for all the major developmental domains, and providing developmental education for children with delays or medical conditions, birth to three. ECFMH professionals specialize primarily in the Social/Emotional domain and treat children and families to resolve child and family relational and behavioral concerns. By providing mental health treatment early in the family’s lifespan, more significant and costly problems are prevented down the road.

ECFMH providers are trained to collaborate closely with all other providers using a systems framework. Whether these providers are situated within CIS, part of their designated agency, or connected to a therapeutic child care, ECFMH providers look holistically at the child and family and collaborate with the whole team.  When ECFMH is part of a designated agency, it can improve access to adult system of care providers for mental health and substance abuse treatment—a critical link for many parents. In designated agency ECFMH programs, there can also be access to other services that support families, such as respite care, psychiatric consultation and activity funding. Most ECFMH clinicians have weekly clinical supervision using a reflective supervision model.

Since October of 2017, the PCIT program at WCMHS has received over 25 referrals for treatment. Referrals come in through the local CIS committee and directly through the WCMHS Navigation team.  Currently, WCMHS has three Master’s level clinicians trained in PCIT.

PCIT Parent Feedback

Parent of 5 year old Liam

When I first sat down with Washington County Mental Health, I remember feeling desperate and hopeless with my son. He was struggling to keep his body safe at daycare and at home, he was defiant, unruly and just very disrespectful. I cried nightly, feeling like a terrible mother because I found myself struggling to like my son. So they suggested Parent Child Interaction Therapy (PCIT). At first, the thought of being watched was nerve racking, and then I thought to myself well how exactly is playing with him, going to fix him. But like I said, I was desperate and I was willing to try whatever they suggested.

My son and I graduated from PCIT several months ago now. I will say that I am glad that I was desperate and willing to do whatever they suggested. PCIT was one of the best things that have happened to the both of us. I learned through this process what my son truly needed from me, through just playing with him.

Sometimes as adults with the day to day tasks we lose sight of just how important it is to carve out five minutes to get on the floor with our kids and play. I learned how play can give them a sense of control, how praising them can lead to more positive behaviors, how reflections and behavior descriptions can make them feel like you’re interested in what they are doing, as well as giving them approval. All these things built my sons confidence, made our bond stronger than it was before, and gave me extra tools on how to deal with certain situations.

I also learned just how important it is to follow through, and I still at times struggle with this. As a working mother of two young boys, there are days that I have the energy to fight the battle and other days I just don’t have the energy to pick that battle with my children. That’s the great thing about PDI, it teaches you the language to use, gives you the steps, and the best part is that you’re being coached, so you’re not alone. Personally, I think that being coached was the most amazing part. I knew I wasn’t in this alone, I know that I had support. I had someone that I could lean on and someone to just tell me everything was fine and that I was doing great.

Even though we graduated we still use PCIT CDI skills twice a week and I even find my son asking me for “special time”. Half way through this process I made some big realizations. First, I realized it had nothing to do with fixing my son and had everything to do with fixing us. We needed a controlled environment to learn to communication and learn how to talk to each other, as well as need for setting clear boundaries. Secondly, I realized just how much I enjoyed my son, how much I valued his imagination and creativity. I realized how amazing it is to get on the floor and just play. I really started enjoying our time together and still do! It was a gift considering where we started from. I will forever be grateful to be given the opportunity to do PCIT.

It’s extremely challenging raising children, especially if they are strong willed. I would honestly recommend PCIT to anyone struggling with their young child. It can be a challenging process and it takes time to see the real progress. I remember being less than half-way through and feeling like nothing was ever going to change, but I stuck with it and things did change. If you put in the work, follow the steps, do the homework, and attend the weekly sessions it will be more than worth in in the end. If nothing else, you’ll grow a better understanding for your child, grow a better and stronger bond and gain some knowledge and tools, a swell as resources. IT was the best learning experience for both my son and I.

Parent of a 4 year old Ezio

We were struggling with our very rambunctious and inquisitive 4 year old. His failure to listen and follow through with tasks were on a daily basis. Our family was feeling a lot of stress with the constant battles. His was also acting out in school which made it difficult for him to learn and coexist with his peers. In our search for help, we were referred to PCIT. We were introduced to two very kind and supportive ladies who helped us realize what mistakes we were making and how to properly communicate with our son. There have been huge improvements which might not have happened without PCIT's assistance. We really appreciate having had the opportunity to take these classes and highly recommend it to anyone who is struggling with their child.

 

Submitted July 2018 by Maria T. D’Haene, LiCSW

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