Running head: EVIDENCE-BASED PAPER 1

Evidence-Based Paper
Elizabeth Hares and Kerielle Williams
Touro University Nevada






EVIDENCE-BASED PAPER 2

Research Question
What are the benefits of parents interactively playing with their children versus the child playing
independently or with another child?
How does this study relate to your research question?
This study looks at the effectiveness of group parent-child interaction therapy (PCIT) with
community families. This is directly related to the question of what are the benefits of parents
interaction while playing with their children versus their children playing independently or with
another child. The study states that previous research has shown that the PCIT has revealed both
statistical and clinical significance that showed improvement in both reported and observes child
behavior and measures of the family and parent functioning.
What is the purpose of the study?
The study was based on improving the parent-child relationships by using different techniques to
teach more effective behavior management skills. This study was aimed at improving both
reported and observed child behavior and measures the family and parent functioning. The study
suggests that there is evidence that PCIT is a promising treatment format for dissemination
research and practice (Neiter, 2012). The study focuses on the idea the PCIT is centered around
increasing the overall warmth in parent-child relationships by using the skills that are positive
such as praise and reflections, in addition to teaching more effective behavior management skills.



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What are the research questions/hypotheses?
The hypothesis was that caregivers would display positive behaviors and fewer negative
behaviors at post-treatment relative to pre-treatment behavior observations. Also it was predicted
that treatment completers would report a high level of satisfaction with the PCIT group.
Does the literature review justify the need for this study?
The literature review justifies the need for such a study. It specifies that that evidence suggests
that minority families find group programs more acceptable than traditional therapy services. It
also states that families who are at high-risk for further child and family problem development
may be more likely to seek services if they are packages as parenting support group.
What is the study design/type of study? What is the level of evidence?
The type of study design was a clinical sample of primarily low-socioeconomic status
community families. The level of evidence in this study was not addressed.
How many participants? all together and in each group if applicable
The participants of the study were forty families that were referred to the project, of those, 27
families were presented for the intake assessment and enrolled in the study, however, only 17 of
those families completely the 12 week group PCIT program. Two caregivers from each of the
different families were encouraged to participate in the study. The study included 3 male
caregivers as well as 24 female caregivers.


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How were the participants recruited and selected?
The participants of the study were required to meet the following criteria: their child was
between 2 and 8 years of age, caregivers had physical custody of target child, English being the
primary language spoken, caregivers and children had no history of mental retardation,
families self-identified as needing assistance to deal with child behavior problems. The
participants were either self-referred, referred by Child Protective Services following an incident
of child abuse or neglect, or they were referred by a local school or daycare. The majority of
caregivers reported having a high school education. The caregivers of the family ranged in age
from 24 to 57 years. The majority of the caregivers were high school graduates. Prior to the
study, the caregivers completed a demographics questionnaire at the pre-treatment assessment in
hopes to gather information on the childrens age, gender, and ethnicity.
If applicable, how were participants assigned to groups?
The participants of the study were not assigned to groups.
How are the participants described demographics e.g. diagnosis, age, gender, race
Of the children, 17 of them were males, and 10 were females. Out of the male children, 9 were
Caucasian and 8 were African American. Out of the female children, 9 were Caucasian and 1
was African American.
What are the variables? Independent and dependent if applicable.
In this particular study, there were neither independent nor dependent variables.

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What measures were used?
In this study the following measures were used: Demographic Questionnaire, Parenting Stress
Index-Short Form, Eyberg Child Behavior Inventory, Behavior Assessment System for Children-
Parent Version, Dyadic Parent-Child Interaction Coding System, and the Therapy Attitude
Inventory.
If applicable, what is the intervention?
The study was a group that consisted of an intake assessment and 12 therapy sessions. The
intervention of the study consisted of the Pre-and Post-Treatment Parent Reports of Child
Behavior as well as the Pre- and Post-Treatment Observed Caregiver-Child Interactions, as well
as the Treatment Satisfaction form.
What statistical analyses were used?
For this study, the analysis showed that the participants who completed the treatment and had
usable pre- and post- treatment DPICS observations were included. Also, a treatment satisfaction
analysis was conducted by calculating descriptive statistics for the TAI.
What are the findings?
The study found that the caregivers gained skills needed to improve that child behavior
management over time as a result of their participation in the PCIT program.
Do these findings support the hypothesis?
The findings do support the hypothesis. The caregivers who completed the group PCIT program
perceived their childs behavior as significantly improved by the end of the 12 week group. The
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caregivers reported that their parenting stress was significantly decreased by the end of the
group. Also, in addition the caregivers displayed improvement in their parenting skills from pre-
to post-treatment during structured behavior observations.
How do the findings relate to previous research as described in the literature review?
The findings of this study coincide with another pilot study that suggested a positive treatment
effect of individual PCIT in a CMHC. More specifically that study should significant decreases
in the ECBI Intensity scale scores, which caused increases in positive parent skills in addition to
decreases in negative parent skills.
Does the author state any clinical implications for the findings?
PICT treatment is effective for a wide variety range of childhood problems, allowing for a larger
group of individuals to attend group therapy, lowering the total cost for low income families.
This provides an effective service model for potential community based clinics. PICT provides
low-cost treatment with an integrated social support network, giving families more resources and
peer support from families in similar situations. Findings from the study suggested caregivers
gained skills to improve child behavior management over time as a result of their participation in
the PICT program. Parents who completed the PICT program perceived their childs behavior as
significantly improved by the end of the group treatment and reported decreased parenting stress.
This has important clinical implications for children who come from low-income homes who are
exhibiting behavioral problems that to do not affect daily functioning. PICT program can be used
in community-based settings and with a large group of children who have a variety of problems,
making it more clinically relevant to a larger population. Not only does the program improve the
EVIDENCE-BASED PAPER 7

childs behavior but it educates parents on effective ways to manage their childrens behaviors,
so their good behaviors are rewarded and bad behaviors are handled appropriately.
What are the limitations that the author identifies?
A few limitations are noted in this study. A primary limitation to the study is the fact that they
did not use a wait-list control group, making it unclear how families who completed PICT would
have compared to untreated families. A second limitation is the lack of follow-up data,
researchers did not follow up with participants to see how families are functioning after the
treatment program finished. Lastly, since PICT treatment is effective for a large population,
though this is a positive aspect of the program, it is also considered a limitation. Due to a large
group of individuals during treatment at once, providing PICT to more than one family may be
less effective and more expensive than providing treatment to a single family.
What would you say about the sample size? Do you think it is adequate?
17 families completed the study, after 13 families dropped out. I do think this sample size is
adequate. The study was testing the effectiveness not just on the children but on the caregivers as
well. There were 17 children and 17 caregivers. So I would say this is an adequate sample size
for testing the effectiveness of the PICT program.
If the researcher did not find a significant difference between the groups, is it possible that
this is due to a Type II error? If so, why do you think so?
A type II error was not addressed; a control group was not present so the effectiveness of PICT
the study group compared to a control group was not tested.
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Is there a control or comparison group? If so, is the control or comparison group
comparable to the experimental group on key features?
A control group was not used to compare the effects of the PICT treatment with a group that was
untreated.
Are those administering the outcome measures blind to group assignment?
The team of investigators, who conducted the study on the effectiveness of the PICT program,
was aware of the nature of the study and the measures. The professional team consisted of
graduate level clinical psychology students, doctorates level professionals, and undergraduate
research students. Each of the professionals received training to administer assessments, sessions
of the program, and to code the results correctly.
Were the participants blind to the assessment?
Participants in the PICT program were aware that they were involved in a study for the
effectiveness of the PICT treatment program. The participants were recruited to the study by
email and flyers posted at pediatric clinics. Meals, transportation and childcare were provided to
participants who attended treatment sessions, and were given perks such as coupons for
completing homework and bringing them to the next session.
Does the researcher account for drop-outs in the study? Could drop outs have influenced
the outcomes?
The researchers do account for drop-outs in the study; individuals who dropped out of the study
completed an average of 3.5 sessions. The individuals who did not complete the sessions were
not considered in the final results. Though these individuals were not factored into the results,
EVIDENCE-BASED PAPER 9

measures were taken to test if the small dose of PICT decreased their childs disruptive
behaviors. Surveys were given at each session, and scores show that with each session there was
a decrease in the childs disruptive behavior. This information was presented in the discussion
section of the paper. Before beginning the program, participants were given pre-treatment
surveys. Results showed that the drop-outs had lower pre-treatment scores on measures of child
behavior problems and parenting stress. This could have been a reason why these individuals did
not complete the program; they felt they were not benefiting from the program or that they did
not need more treatment.
Does the researcher report reliability and validity of the outcome measures? Are there
questions about the outcome measures chosen?
Researchers used different types of outcome measures throughout the program; validity and
reliability were stated for each type of measurement.. The following items were used to record
measures. The parenting stress index-short form, which received a .86 on test-retest reliability
coefficient for the total stress scores. The Eyberg Child Behavior inventory (ECBI), which
received a .86 and .88 for test-retest reliability coefficient. The Behavior Assessment System for
Children-Parent version, which received a range of .72 to .91 for test-retest reliability coefficient.
The Dyadic Parent-Child interaction Coding system 3rd edition, which received a .91 for
reliability and .80 to .98 for inter-rater reliability. Lastly the Therapy Attitude Inventory which
measures satisfaction with both the process and the outcome and shows good evidence for
reliability and validity. The use of valid and reliable tools to measure outcomes for the study
adds validity and reliability to the effectiveness of the PICT program.

EVIDENCE-BASED PAPER 10

What confounding factors could contribute to or influence the study outcomes?
Prior to this study, it was unclear whether the PICT program was effective for a group format or
for a group of mixed community families. This study included a group format of mixed families
which may have been a large influence on the study outcomes and its success. Another
successful aspect of this study was the amount of sessions the families participated in, an average
of 7.5 sessions were completed by the children and caregivers. These results suggest that
participants gained skills to improve their child behavior management skills over time as a result
of their participation in the PICT program.
What are the major strengths of this study?
Three major strengths to this study was the number of participants who stayed for 7.5 sessions,
the mixed ratio of families within the study, and that study provided the PICT in a non-
traditional group format. A previous study did not use a group community format for the PICT
program and yielded different results. Though there were many families who dropped out, the
remaining families stayed for many of the sessions, and showed improved skills for managing
their childs disruptive behavior. The use of a group format in this study increases the
transferability of the PICT program and decreases overall costs per individual to complete the
program.
What are the major weaknesses of the study?
Three major weaknesses within the study were the number of dropouts in the PICT program, the
lack of a wait-list control group, and the lack of follow-up data. Though many families
completed a large number of sessions, there were 10 family drop-outs and they only completed
an average of 3.5 sessions. The PICT did yield valid results for improved behavior management
EVIDENCE-BASED PAPER 11

skills in caregivers and improved behavior in the children but the study did not have a control
group to compare results with; therefore not knowing if the family would have improved with or
without the study. Lastly, the researchers did not follow up with the families after completing the
PICT program to see if there was skill carry over from the program into the home. This does not
give them enough evidence to say the PICT program effects are long lasting and effective
outside of the treatment center once the program was complete.
How would you use this article as a therapist?
As a therapist, I would use the results of the article to explore the use of PICT in a community
setting for low-income families who cannot afford one on one treatment for child behavior
management. I would also look at the specific techniques they used for the group format and
apply to this other programs I feel may be beneficial for a group of individuals, such as
increasing child playfulness, child social participation, and parent-child involvement. I may also
use some of the assessments that were included in the study for parents who are having trouble
managing their childs behavior or for related services.
How does this article support/not support participation in occupation and the field of
occupational therapy?
This article does support participation in occupation; ParentChild Interaction Therapy
incorporates both operant learning and play therapy techniques to treat child disruptive behavior
problems. Play is an important area of occupation for children, and children with disruptive
behavior problems can have trouble in play, affecting their functioning in play and in social
participation with other children their age. The PICT treatment program is an effective way for
parents to learn ways to manage their childs behavior and promote play in their childs daily
EVIDENCE-BASED PAPER 12

activities. The program also teaches the parents to let the children lead the play and can be used
with children who have a variety of childhood based behavioral problems. PICT teaches the
parent how to react and address their childs behavior using praise, reflection, and increase
warmth in parent-child relationships. This is important to promote a better relationship between
child and caregiver, fostering better overall behavior from the child and a better learning
environment.













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References

Nieter, L., Thornberry, T., & Brestan-Knight, E. (2013). The Effectiveness of Group Parent
Child Interaction Therapy with Community Families. Journal of Child and Family
Studies, 22(4), 490-501.