Difficult behaviors improved, communication increased after PC-CARE — ScienceDaily

Only about 25% of children with challenging behaviors receive mental health treatment, and dropout rates are high for those who do. This necessitates brief and effective intervention programs to improve the relationship between children and their caregivers.

A growing number of open trials (clinical trials in which researchers and participants know which treatment is being given) and comparative studies have supported the use of Parent-Child Care (PC-CARE), an intervention program in seven sessions developed at the UC Davis CAARE Center.

A new study by researchers at UC Davis Children’s Hospital uses the first randomized controlled trial to assess the effectiveness of PC-CARE for children with challenging behaviors and their parents or caregivers. The study design randomly assigns participants to an experimental or control group and is often referred to as the gold standard of research. The results of the study were recently published in the Journal of Child Psychiatry Human Development.

“Many families struggle to manage challenging child behaviors, but finding behavioral health support is difficult. Because PC-CARE is brief and can be conducted in many places, it can empower providers to help more families in less time,” said Brandi Hawk, co-developer and supervisor of PC-CARE and principal investigator of the study. “As the first randomized controlled trial of PC-CARE, these results are needed to solidify PC-CARE as an evidence-based treatment.”

Helping children and their caregivers through lessons, coaching

In this study, primary care pediatricians referred 102 children to the study from September 2018 to March 2020. Study participants were referred by two pediatric clinics in the University Health System.

To be included in the study, participants:

  • Were 2 to 10 years old
  • Had a participating primary caregiver who lived with the child at least 50% of the time
  • Were pediatric patients in an academic healthcare system
  • Have family who may have participated in services in English
  • Had challenging behaviors as reported by caregiver

From these referrals, parents or caregivers of 49 eligible children agreed to participate in the study, attended an initial assessment, and were randomly assigned to a treatment group or a waitlist group. (which was the control group).

For those in the treatment group, the PC-CARE treatment consisted of six weekly 50-minute treatment sessions. Children and their caregivers participated in all sessions. The sessions were as follows:

  • Caregivers filled out a form, measuring their child’s behavior. The therapists made a brief review of the week with the caregivers and the children.
  • The therapists taught a 10-minute lesson on positive communication, calming skills and behavior management skills to caregivers and children. New skills were taught weekly and built upon each other.
  • Therapists conducted a four-minute observation of the child and caregiver playing together, coding the caregivers’ use of five specific positive communication skills known as PRAISE (meaning praise, reflections, imitations, behavioral descriptions and pleasure).
    • Congratulations: A positive assessment of the child, including both non-specific congratulations (eg, “Good!”) and specific congratulations (eg, “Well done playing gently with the toys!”).
    • Reflections: Repetition or reformulation of appropriate child verbalizations (eg Child: “I am building a house.” Parent: “You are building a house.”).
    • Imitation: An overt statement that the caregiver is following the child’s example (eg, Parent: “I drive my car like you do.”).
    • Behavioral Descriptions: A non-evaluative description of the child’s behavior (eg, “You are drawing a rainbow.”) or progress towards goals (eg, “You are really focused.”).
    • Pleasure: A verbal expression of positive feelings about the current situation that would not be considered praise (eg, “I am having fun playing with you.”).
  • Although the therapists taught and trained the parents to use the PRIDE skills, they also focused on teaching other behavior regulation and management strategies to help the family find the strategies that work best for them. in different situations.
  • Therapists trained caregivers to use the skills in the context of play for 20 minutes.
  • The therapists reviewed the accomplishments of the caregiver and the child in session, assigned 5 minutes of play per day, and encouraged them to use the learned skills throughout the day.

Families placed on the waitlist did not receive any PC-CARE services and were contacted after six weeks to attend another assessment and begin treatment.

The study therapists provided services either in a pediatric primary care clinic or in an outpatient mental health clinic associated with the same academic health system. Each family’s schedule and preferences dictated where their sessions took place.

Communication, behavior improvement in seven weeks

After seven weeks, the results of the study showed that:

  • Parents reported that the children’s behavior had improved.
  • Caregivers demonstrated improvements in their positive communication skills.
  • Caregivers reported less parenting stress after completing treatment.
  • Caregivers doubled their total number and proportion of PRIDE skills between pre- and post-treatment, unlike caregivers in the waitlist or control group.

“These results provide evidence that PC-CARE can increase access to services by addressing barriers related to attrition, duration and location of other parenting interventions,” said Hawk, who noted that their seven sessions had a retention rate of 81%. “While other effective interventions exist, they are often time-consuming, have high attrition rates, and may not be easily adapted to different sites.”

Hawk added that there is a need for effective interventions that can keep families engaged.

“These study results show that PC-CARE provides noticeable benefits to children and caregivers within seven weeks,” Hawk said.

The study was funded by a grant from the Children’s Miracle Network at UC Davis.

The study’s co-authors were Susan Timmer, Lindsay Armendariz, Deanna Boys, Anthony Urquiza, and Erik Fernandez y Garcia of UC Davis Children’s Hospital.

Source of the story:

Materials provided by University of California – Davis Health. Original written by Tricia Tomiyoshi. Note: Content may be edited for style and length.

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