Study Protocol: The Coaching Alternative Parenting Strategies (CAPS) Study of Parent-Child Interaction Therapy in Child Welfare Families

Abstract

Background: Child maltreatment (CM) constitutes a serious public health problem in the United States with parents implicated in a majority of physical abuse and neglect cases. Parent-Child Interaction Therapy (PCIT) is an intensive intervention for CM families that uses innovative "bug-in-ear" coaching to improve parenting and child outcomes, and reduce CM recidivism; however, the mechanisms underlying its effects are little understood. The Coaching Alternative Parenting Strategies (CAPS) study aims to clarify the behavioral, neural, and physiological mechanisms of action in PCIT that support positive changes in parenting, improve parent and child self-regulation and social perceptions, and reduce CM in child welfare-involved families.

Methods: The CAPS study includes 204 child welfare-involved parent-child dyads recruited from Oregon Department of Human Services to participate in a randomized controlled trial of PCIT versus a services-as-usual control condition (clinicaltrials.gov, NCT02684903). Children ages 3-8 years at study entry and their parents complete a pre-treatment assessment prior to randomization and a post-treatment assessment 9-12 months post study entry. Dyads randomized to PCIT complete an additional, abbreviated assessment at mid-treatment. Each assessment includes individual and joint measures of parents' and children's cardiac physiology at rest, during experimental tasks, and in recovery; observational coding of parent-child interactions; and individual electroencephalogram (EEG) sessions including attentional and cognitive control tasks. In addition, parents and children complete an emotion regulation task and parents report on their own and their child's adverse childhood experiences and socio-cognitive processes, while children complete a cognitive screen and a behavioral measure of inhibitory control. Parents and children also provide anthropometric measures of allostatic load and 4-5 whole blood spots to assess inflammation and immune markers. CM recidivism is assessed for all study families at 6-month follow-up. Post-treatment and follow-up assessments are currently underway.

Discussion: Knowledge gained from this study will clarify PCIT effects on neurobehavioral target mechanisms of change in predicting CM risk reduction, positive, responsive parenting, and children's outcomes. This knowledge can help to guide efforts to tailor and adapt PCIT to vary in dosage and cost on the basis of individual differences in CM-risk factors.

Keywords: Parent-Child Interaction Therapy; cardiac physiology; child maltreatment; high density electroencephalogram; parent-child interaction; parenting; self-regulation; socio-cognitive processes.

Figure 1

Conceptual model of the study. Known (in bold) and hypothesized (in dashed) PCIT intervention effects on child maltreating (CM) parent and child outcomes.

Figure 2

Coaching Alternative Parenting Strategies (CAPS) Study Flowchart.

Figure 3

Schematic of the Social Engagement Task is presented. Children and parents engage in three fixed-interval activities that are presented on a screen while cardiac physiology is monitored.

Figure 4

Schematic of the Auditory Attention Task to assess attentional control. While fitted with an EEG net and electrocardiograph, both parents and children are instructed to listen to a children’s story presented from a free-field speaker situated 90° to their right or left, while another story is playing simultaneously from the speaker on the opposite side. During each story, one speaker presents a male voice while the other speaker presents a female voice, each reading different narratives ranging from 2.5 to 3.5 min in length and edited to remove pauses greater than 1 second. An arrow at the bottom of the screen reminds the listener which speaker to attend to. ERPs are recorded according to stimuli (ba, buzz) that are superimposed over each of the stories.

Figure 5

Depiction of the Stop Signal Task sequence for parents. Participants press the arrow on a keyboard that corresponds to the direction of the arrow in each trial. Participants are instructed to withhold a response when an auditory stop signal is played immediately after the go signal at a variable latency (SSD, stop signal delay; ITI, intertrial interval).

Figure 6

Depiction of the Zoo Go No-Go Task for children. Participants respond with a button-press when an animal (e.g., deer) appears in the go task. Children are instructed to withhold a response when the monkey appears. Children are presented with smiley-face feedback for correctly withholding a response, and angry-face feedback for incorrectly responding to a monkey.

Figure 7

From the Emotional Go/No-Go task, depictions of the “happy” block for children, and of the “neutral” block for parents are presented. Other emotion blocks follow a similar schema for children and adults, respectively. Participants are instructed to respond with a button press to the target emotion of each block and withhold a response for all other emotions in that block. Face stimuli were selected from the MacBrain Face Stimulus set available at www.macbrain.org.