A combined motivation and parent–child interaction therapy package reduces child welfare recidivism in a randomized dismantling field trial.

TLDR

The study highlights methodological challenges in analyzing child welfare event histories with differential risk deprivation. The study aimed to evaluate the effectiveness of a combined self‑motivational orientation and parent‑child interaction therapy in a field agency and to disentangle the effects of the orientation and parenting components. A 2×2 sequential randomized design assigned 192 parents first to a self‑motivational or standard‑as‑usual orientation and then to parent‑child interaction therapy or standard‑as‑usual parenting, with follow‑up for child welfare recidivism over a median of 904 days and analysis via an imputation‑based survival approach. The combined self‑motivational orientation and parent‑child interaction therapy significantly reduced child welfare recidivism compared with standard‑as‑usual services, with the greatest benefit when children were returned to the home sooner, replicating laboratory results in a field setting.

Abstract

A package of parent-child interaction therapy (PCIT) combined with a self-motivational (SM) orientation previously was found in a laboratory trial to reduce child abuse recidivism compared with services as usual (SAU). Objectives of the present study were to test effectiveness in a field agency rather than in a laboratory setting and to dismantle the SM versus SAU orientation and PCIT versus SAU parenting component effects.Participants were 192 parents in child welfare with an average of 6 prior referrals and most with all of their children removed. Following a 2 x 2 sequentially randomized experimental design, parents were randomized first to orientation condition (SM vs. SAU) and then subsequently randomized to a parenting condition (PCIT vs. SAU). Cases were followed for child welfare recidivism for a median of 904 days. An imputation-based approach was used to estimate recidivism survival complicated by significant treatment-related differences in timing and frequency of children returned home.A significant orientation condition by parenting condition interaction favoring the SM + PCIT combination was found for reducing future child welfare reports, and this effect was stronger when children were returned to the home sooner rather than later.Findings demonstrate that previous laboratory results can be replicated in a field implementation setting and among parents with chronic and severe child welfare histories, supporting a synergistic SM + PCIT benefit. Methodological considerations for analyzing child welfare event history data complicated by differential risk deprivation are also emphasized.