Abstract
BackgroundChild maltreatment (CM) constitutes a serious public health problem in the United States with parents implicated in a majority of physical abuse and neglect cases. Parent-Child Interaction Therapy (PCIT) is an intensive intervention for CM families that uses innovative “bug-in-ear” coaching to improve parenting and child outcomes, and reduce CM recidivism; however, the mechanisms underlying its effects are little understood. The Coaching Alternative Parenting Strategies (CAPS) study aims to clarify the behavioral, neural, and physiological mechanisms of action in PCIT that support positive changes in parenting, improve parent and child self-regulation and social perceptions, and reduce CM in child welfare-involved families.MethodsThe CAPS study includes 204 child welfare-involved parent-child dyads recruited from Oregon Department of Human Services to participate in a randomized controlled trial of PCIT versus a services-as-usual control condition (clinicaltrials.gov, NCT02684903). Children ages 3–8 years at study entry and their parents complete a pre-treatment assessment prior to randomization and a post-treatment assessment 9–12 months post study entry. Dyads randomized to PCIT complete an additional, abbreviated assessment at mid-treatment. Each assessment includes individual and joint measures of parents’ and children’s cardiac physiology at rest, during experimental tasks, and in recovery; observational coding of parent-child interactions; and individual electroencephalogram (EEG) sessions including attentional and cognitive control tasks. In addition, parents and children complete an emotion regulation task and parents report on their own and their child’s adverse childhood experiences and socio-cognitive processes, while children complete a cognitive screen and a behavioral measure of inhibitory control. Parents and children also provide anthropometric measures of allostatic load and 4–5 whole blood spots to assess inflammation and immune markers. CM recidivism is assessed for all study families at 6-month follow-up. Post-treatment and follow-up assessments are currently underway.DiscussionKnowledge gained from this study will clarify PCIT effects on neurobehavioral target mechanisms of change in predicting CM risk reduction, positive, responsive parenting, and children’s outcomes. This knowledge can help to guide efforts to tailor and adapt PCIT to vary in dosage and cost on the basis of individual differences in CM-risk factors.
Highlights
Child maltreatment (CM) is a serious public health problem in the United States, affecting nearly one million children each year, with serious negative developmental outcomes including trauma, dysregulation, and a host of behavioral challenges that are resistant to intervention [1,2,3,4]
Initial recruitment efforts focused on mothers, as many child welfare families are headed by mothers who are single parents, and because our underlying theoretical model centers on the role of neurobehavioral regulatory processes best characterized to date in human and nonhuman primate studies of mother-child dyads
Upon request from Department of Human Services (DHS) collaborators, we extended our recruitment efforts to include fathers as they composed a significant proportion of primary caregivers in child welfare-involved families
Summary
Child maltreatment (CM) constitutes a serious public health problem in the United States with parents implicated in a majority of physical abuse and neglect cases. The Coaching Alternative Parenting Strategies (CAPS) study aims to clarify the behavioral, neural, and physiological mechanisms of action in PCIT that support positive changes in parenting, improve parent and child self-regulation and social perceptions, and reduce CM in child welfare-involved families
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