1. Group Parent-Child Interaction Therapy: Application to Children with Prenatal Substance Exposure
Robin H. Gurwitch, Ph.D.
Vicki Cook, M.Ed.
Mark Chaffin, Ph.D.
David Bard, M.S.
Matt Grim, M.S.
Beverly W. Funderburk, Ph.D.
University of Oklahoma Health Sciences Center
Department of Pediatrics

2. Rationale for Group Format
Too many referrals, too few therapists
Attrition
Time efficiency
Cost efficiency
Vicarious learning opportunities
Increased generalization opportunities
Feedback and praise from others
Support group for caregivers

3. Group Application Traditional PCIT Families
Families in Substance Abuse Treatment Centers
Families with children with FASD/other substance exposure in clinical setting

4. Caregivers of Children with Prenatal Exposure
Perceptions of the child are negative
Parenting satisfaction is lower than those w/o substance exposure
Higher levels of parenting stress
Increased risk for attachment problems and failed placements
Increased risk of relapse

5. Rationale for Applying PCIT to Prenatal Substance Exposure
Many unrewarding child behaviors associated with prenatal substance exposure
Increased risk for behavioral difficulties as secondary disabilities
Hyperactivity
Inattention
Poor Impulse Control
Problems with compliance
Increased risk for parenting stress
Increased risk for failed placement

6. Rationale for Applying PCIT to Prenatal Substance Exposure
Parents perceive children as behaviorally disordered solely due to drug/alcohol exposure
They are more receptive to an approach offering effective behavior management
Needs of caretakers with children considered “at risk” are consistent with the skill training focus of PCIT

8. Population Child Diagnosed with FASD or other substance exposure
Functioning at a minimum of 30 months of age in cognitive development
Between 2 ½ and 7 years of age
Parent/Caregiver
>65 IQ based on KBIT

9. Measures
Developmental measures (e.g., Bayley Scales of Infant Development-II; WPPSI-R)
Genetics evaluation
ECBI
PSI
DPICS-II

10. Progression of Group PCIT Treatment
15 weeks of treatment
Session 1: Education about substance abuse and child development and advocacy
Session 2: Introduction to PCIT and group intake session
Session 3: Individual intake session and DPICS
Session 4: CDI Didactic
Sessions 5-7: CDI coaching sessions (specific skill goals and homework for each family)

11. Progression of Group PCIT Treatment
Session 8: PDI Didactic
Sessions 9-13: PDI coaching sessions (specific skill goals and homework for each family)
Session 12: House Rules and Generalization session with all families
Session 13: Public Behavior and Generalization session with all families
Session 14: Managing Future Behaviors and Termination
Session 15: Post-treatment assessment
Follow-up sessions (6, 12, 18 months)

12. Results of PCIT with Children with Prenatal Substance Exposure (n=38)

13. New Model for Data Analysis
Pre ECBI=143
Post ECBI=105
Pre PSI=95
Post PSI=81

14. Bivariate Difference Score Model

15. Next Steps: Dissemination in the Community
Stakeholder buy-in
Commitment from community sites
Training of licensed mental health professionals
One week (40 hours)
Six weeks later (16 hours): Focus on PDI
On-going consultation (random assignment)
Phone
Phone + Live videotechnology consultation
Videotape submissions
Data collection (DPICS, weekly ECBI, PSI at each treatment phase)

16. Continued Challenges Drop-out Foster care placement issues
Reunification and substance abuse
Transportation
Even if treatment is 100% effective—the child still has FASD/other prenatal substance exposure

17. Funding to Help Us Keep Looking for Answers
Centers for Disease Control and Prevention (CDC)
Oklahoma Department of Substance Abuse and Mental Health Services
Native American Research Centers for Health (NIH)
Oklahoma Department of Human Services

19. When that Fails: Thank Goodness for PCIT