Mental Health Care for Children and Adolescents in Foster Care ...

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Parent-Child Interaction Therapy (PCIT) PCIT is a highly structured treatment model involving both parent and child. Originally developed for children with behavioral problems, PCIT has been adapted for physically abusive parents with children age 4 to 12 years. Treatment is brief (12-20 sessions) and involves live-coached sessions where the parent/caregiver learns skills while engaging in specific play with the child. The overarching goal of PCIT is to change negative parent-child patterns. The time in each session is usually divided between relationship-enhancing, positive discipline, and compliance skills. Specific parent and child behaviors are tracked and charted on a graph during each session, and the therapist provides feedback to the parent on his or her mastery of the skills. Some of the specific components of treatment include: • Relationship-enhancing skills • Positive discipline and compliance skills • Homework sessions of 5-10 minutes daily to reinforce skills taught in session • Parenting skills • Booster sessions following treatment completion Studies of PCIT fall in two categories: (1) those involving children with behavior problems regardless of whether they have any maltreatment history, and (2) those involving children with a history of abuse regardless of whether they have a diagnosable behavior problem. With respect to the first category, several quasi-experimental studies have been conducted. These have demonstrated improvement from pre- to post-treatment (Eyberg et al., 2001) and significantly better outcomes for children and parents who completed treatment versus families who were on the wait-list (Eyberg et al., 1995) or who did not complete treatment (Boggs et al., 2004). These positive outcomes have been maintained for as long as three to six years following treatment completion (Hood & Eyberg, 2003). With respect to the second category, one RCT and two quasiexperimental studies have been conducted. The RCT randomly assigned 36
abusive parents and their children to PCIT, to enhanced PCIT (with additional individualized services), or to a standard community-based parenting group (Chaffin et al., 2004). PCIT and enhanced PCIT were similarly superior to the parenting group at decreasing subsequent reports of physical abuse. The most recent quasi-experimental study examined PCIT for biological parent-child dyads with histories of maltreatment or at high risk for maltreatment (Timmer et al., 2005). From baseline to post-treatment, these families showed decreases in child behavior problems, parental stress, and risk for future abuse. Another earlier study examined a single case of a child and parent at risk for physical abuse (Borrego et al., 1999). The child’s behavior problems decreased following treatment as did the mother’s stress. The number of positive parentchild interactions also increased. Given the fact that PCIT has garnered evidence for its effectiveness with both children with behavior problems and children with abuse histories, it is viewed as having great potential for children and families in foster care in which these problems often overlap. In addition to these well-established interventions, four others have received support from controlled research and are cited or categorized as supported interventions in the reviews listed above. These treatments are also considered leading candidates, although the research lags slightly behind that of the three candidates presented above. These interventions, described briefly below, are included here to provide evidence for addressing types of trauma not targeted by the interventions above. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for Child Traumatic Grief TF-CBT for Childhood Traumatic Grief is designed to help children suffering from traumatic grief after experiencing the loss of a loved one in traumatic circumstances. These children often have PTSD symptoms, depression, anxiety, and/or behavior problems that prevent them from successfully grieving their loss. The therapy model is calibrated for two age 37
Page 1 and 2: Mental Health Care for Children and
Page 3 and 4: Medication for Disruptive Behavior
Page 5 and 6: OVERVIEW Introduction In Fall 2005,
Page 7 and 8: There is growing recent evidence th
Page 9 and 10: foster care could benefit the child
Page 11 and 12: Limiting the number of decrees to t
Page 13 and 14: Mental Health Care for Children and
Page 15 and 16: in particular may be more prevalent
Page 17 and 18: score in the suspect range (67%) as
Page 19 and 20: foster care had clinically signific
Page 21 and 22: foster care represented less than 4
Page 23 and 24: there was evidence of mental health
Page 25 and 26: at home instead of out-of-home. Les
Page 27 and 28: on children in foster care (Fisher
Page 29 and 30: In contrast to the strong evidence
Page 31 and 32: does not work for youth with emotio
Page 33 and 34: eview is described briefly below to
Page 35 and 36: Table 1. Well-established and proba
Page 37 and 38: TF-CBT for Childhood Traumatic Grie
Page 39: Abuse-Focused Cognitive Behavioral
Page 43 and 44: Child-Parent Psychotherapy for Fami
Page 45 and 46: In summary, several treatments appe
Page 47 and 48: time-out. The signal seat, on which
Page 49 and 50: Lyons, & Findling, 2002). These imp
Page 51 and 52: Reynolds, & Kaslow, 1987). In this
Page 53 and 54: 14 years) and/or heavy use of subst
Page 55 and 56: substance abuse occurs alongside be
Page 57 and 58: that about half of residential trea
Page 59 and 60: Medication for Substance Abuse Phar
Page 61 and 62: Wraparound Milwaukee, is jointly fu
Page 63 and 64: Transition to Independence 3 quasie
Page 65 and 66: community resources. An overarching
Page 67 and 68: temporarily provided by an alternat
Page 69 and 70: the effectiveness of TIP is just no
Page 71 and 72: family homes had fewer criminal off
Page 73 and 74: the demonstration is over; thus, th
Page 75 and 76: Treatment for Complex and Co-occurr
Page 77 and 78: • Learn from the challenges of in
Page 79 and 80: In summary, mental health care is a
Page 81 and 82: • Consider additional candidate i
Page 83 and 84: Frontier Recovery Network (FRN): ht
Page 85 and 86: Organizations and University-Based
Page 87 and 88: Appendix B Office for Victims of Cr
Page 89 and 90: Appendix C National Training Resour
Page 91 and 92:
Multisystemic Therapy (MST) The maj
Page 93 and 94:
II. Journal of the American Academy
Page 95 and 96:
Casey, R. J., & Berman, J. S. (1985
Page 97 and 98:
216. Cohen, J. A. (2005). Combined
Page 99 and 100:
Psychiatry, 44(9), 872-887. Diamond
Page 101 and 102:
Institute, The National Implementat
Page 103 and 104:
of multisystemic therapy on drug us
Page 105 and 106:
adolescent major depression: A rand
Page 107 and 108:
385-401. Liddle, H. A. (2002). Adva
Page 109 and 110:
A review of the growing evidence ba
Page 111 and 112:
Simeon, J. G., Dinicola, V. F., Fer
Page 113 and 114:
of the Surgeon General. Rockville,
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Mental Health Care for Children and Adolescents in Foster Care ...

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