Prevention of Child Maltreatment; A randomized controlled trial on the effectiveness of Parent-Child Interaction Therapy in the home situation (PCIT-Home)

In the Netherlands child maltreatment is a national concern. The prevalence
rate is high (3%). Many risk factors influence the occurrence of child
maltreatment. Biological, social, cultural and environmental factors may lead
to the inability of parents to provide their children a healthy and secure
developmental environment. The extent of maltreatment, its far-reaching
individual health and social consequences and high economic costs emphasize the
importance of the prevention of child maltreatment. Prevention is necessary to
lessen the negative consequences. Preventive interventions which are accessible
and provided on the home-situation of the family are able to strengthen the
empowerment of parents and children. Therefore, prevention programs focusing on
this empowerments and the enhancement of the parent-child relationship can
contribute to the prevention of child maltreatment.

Research focusing on the prevention of child maltreatment is limited.
Parent-Child Interaction Therapy (PCIT) has been identified as an evidence
based treatment for families with young children who have experienced physical
abuse and thereby research provides evidence for the effectiveness of the
prevention of child maltreatment. In the Netherlands, PCIT is provided since
2007 and a randomized controlled trial on the effectiveness of PCIT indicated
important improvements in observations of positive parent*child interactions,
reductions in child externalizing behavior and parent stress. However,
premature termination of treatment has come up as a dominant problem during
this study. International research supports the evidence of PCIT in the home
situation. By providing PCIT in the home situation, attrition based on
practical issues can be prevented. To make PCIT more accessible for families at
risk for child maltreatment the primary purpose of the study is therefore to
implement and study the effectiveness of PCIT in the home situation
(PCIT-Home).

To study the (cost)effectiveness of Parent-Child Interaction Therapy in the
home situation, several measures including questionnaires, interviews and
video-observations are used for the pre-, post and follow-up assessments. The
study is a randomized controlled trial using a waitlist control condition.
Sixty families are included in the study. Thirty families start treatment
directly after baseline assessment and thirty families start treatment after a
waiting period of two months. For the families in the wait-list condition an
extra assessment is included covering the end of the waiting period and the
pre-treatment assessment.

Parent-Child Interaction Therapy (PCIT) is a manualized intervention for
parents and young children. In PCIT-Home parents are coached by the therapist
using a bug-in-the-ear device. In two phases of treatment the therapist teaches
parents communication skills that foster positive parent*child relationships
and strategies of differential reinforcement. Also parents are taught to use an
effective and secure strategy to discipline their child. PCIT-Home is an
adaptation of the original manual of PCIT. PCIT-Home is provided in the
family*s home situation and includes eight sessions of treatment.

No more risks are expected when participating in current study than receiving
Parent-Child Interaction Therapy by the regular protocol. Participation in the
study only requires some time from the parents and children. The research
included three or four assessments (1 hour each). The researcher is visiting
the parents and children at home to decrease to burden for the family.