Participation in parent-child therapy results in decreased behavior problems and improved caregiver-child relationships
When we walk by a toddler throwing a tantrum in the middle of a grocery store aisle, we may unconsciously label the child as a troublemaker. But to psychologists, these behavioral problems signal something else—a cry for help. In order to help children better manage their behavior and to improve caregiver-child relationships, members of the UC Davis Child and Adolescent Abuse Resource and Evaluation (CAARE) Center have developed a treatment program called Parent-Child Care (PC-CARE).
According to Brandi Hawk, a psychologist at the UC Davis CAARE Center and co-developer of PC-CARE, the program was pioneered six years ago to offer extra support to families struggling with behavior problems in children or difficulties in caregiver-child relationships.
Susan Timmer, a research psychologist at the CAARE Diagnostic and Treatment Center, worked for many years evaluating a longer parent-child treatment program called Parent-Child Interaction Therapy (PCIT). When she found that approximately 50% of participants dropped out of the therapy before receiving substantial information about how to help their child, she—along with Hawk and Lindsey Almendariz, another co-developer of PC-CARE—saw the need to create something new.
“We developed PC-CARE to be very brief—it’s only seven weeks long—so that we can help families identify what works best for them, improve caregiver-child relationships and set them on a good trajectory, while being short enough for families to be able to actually finish services and complete the treatment,” Hawk said.
Hawk explained that their team wanted to develop the PC-CARE program to teach positive communication skills. Rather than giving attention to negative behaviors, PC-CARE teaches parents and children to highlight positive behaviors exhibited by the child.
“We start with teaching positive communication skills because those are foundational for a good relationship, and then we add on each week either self-regulation and coping skills or behavior management strategies,” Hawk said.
Timmer elaborated that in addition to the contents of each session, the order of the program was planned so participants had the skills needed to move on to the next intervention. For example, she explained the need to teach calming and coping skills before teaching more difficult behavior management strategies such as effective commands or discipline skills.
“We finish with the emphasis on recovery because it’s so important that if we’re teaching behavior management strategies, we’re also teaching parents the importance of returning to a positive caregiver-child relationship and coming back to this idea that their child is a good kid and they are a good parent and that we can move forward from difficulties together,” Hawk said.
Ross Thompson, a distinguished professor in the department of psychology, explained via email that having the caregiver and child simultaneously involved in therapy is essential in addressing these behavior problems, as the child heavily relies on relationships within their family for support, behavioral regulation and a sense of well-being.
“In efforts to address a child’s behavioral problems, it is essential to also assist the family system that has had to accommodate these problems, or sometimes has contributed to them, but in any case has to change in order to enable children to change in healthy ways,” Thompson said via email. “It is not wise to consider healing children without healing the families in which they live.”
Recently, the co-developers of PC-CARE conducted a study in collaboration with the Department of Child, Family, and Adult Services to provide the program for foster children in the Sacramento area. Hawk stated that at the end of the program, foster children showed decreases in difficult behaviors—such as noncompliance, aggression and tantrums—in addition to increases in independence, creativity and emotional regulation. The caregivers also reported an improvement in their relationships with the foster children.
Hawk explained that the CAARE team began this project after seeing that young children in the Sacramento area were moving foster placements more often than those in California as a whole. The team wanted to see whether offering PC-CARE as a preventive intervention could help children stay in the same placement longer to promote their developmental wellbeing.
Hawk elaborated that all children in foster care have experienced a form of trauma, whether it is physical abuse, sexual abuse, domestic violence, neglect, a change in location or even removal from their primary caregiver. Thompson expressed via email that a thorough rethinking of the design and funding of the foster care system would prevent such problems.
“I have read experts on the child welfare system in the United States state that if we tried to create a system of care that would create stresses for children, we would create our foster care system,” Thompson said via email.
Due to the trauma foster children face, Hawk stated these children have a heightened risk of developing behavioral and mental health difficulties. She further explained that PC-CARE aims to direct foster children away from developing mental health issues and toward positive development.
“Oftentimes in young children, we see mental health difficulties start as difficult behaviors because children, especially when they’re pre-verbal or early verbal, don’t have the words to tell us that they’re feeling sad or scared inside, and they often don’t know how they’re feeling,” Hawk said. “What we instead see are behaviors like acting out, aggression, tantrum, clinginess. Those are a child’s way of saying, ‘There’s something wrong and I need help.'”
Although this specific project focuses on foster children, Timmer emphasized that PC-CARE is available to all children ages 1 to 10 who may be, or be at risk of, exhibiting behavior problems. As this program is shorter than PCIT, Timmer hopes that the therapy may be offered in settings that are more accessible and familiar to a child, such as a primary care setting or their school. Timmer added that they have recently received funding to begin a project providing PC-CARE to various schools.
Timmer highlighted that PC-CARE emphasizes the role of play in development as both a fun activity and an important component in promoting children’s mental health. PC-CARE provides an opportunity to not only help the children, but also remind parents how to have fun with their children and nurture a positive relationship.
“We want parents to feel confident and to be the best parent they can be, and for kids to feel safe and loved and happy within their caregiver-child relationship,” Hawk said.
Written by: Michelle Wong — science@theaggie.org
