Transcript 2 Day Fundamental

The 3 Faces of DPICS:
Examining coding protocols for
research & practice
Susan Timmer, PhD., Nancy Zebell, PhD.
Anthony Urquiza, PhD
CAARE Diagnostic and Treatment Center
Department of Pediatrics
UC Davis Children’s Hospital
Sacramento, CA
916 734-6610
www.pcittrainingcenter.org
Copyright 2004. UC Regents. All rights reserved.
Acknowledgments
Michelle Culver
Ryan Fussell
Dianne Thompson
Lindsay Klisanac
Erica Goude
Alan Chan
Natalie Lambdin
David Benjamin
Grace Silvia
Objectives
• Explore different ways of using
DPICS to assess treatment
progress at mid-treatment.
• Discuss the usefulness of
conducting a mid-treatment
DPICS assessment.
Reviewing the Goals of CDI
• General Treatment Goal:
– Help parent develop warm, sensitive parenting
style while still able to set limits in a non-coercive
way (Baumrind, 1966).
• Goal of PCIT therapist:
– Adjust specific patterns of parents’ verbal
behavior, thereby adjusting parents’ and
children’s expectations of one another, and the
quality of their relationships.
PCIT Model of Change
Model:
Proximal: primary goal
Secondary Goal
Change parent verbal
responses to child behavior
Change of quality
of parenting
Change child’s
behavior
Mid-treatment DPICS Assessment:
Current practices at UCD CAARE
• Parents must meet mastery criteria twice during the
5-minute coding in CDI sessions. Decision to move
dyad to PDI is based on CDI performance, not midtreatment assessment.
•15 Minute DPICS videotaped
•Only CDI segment of DPICS is coded (live) to check
parents’ continued use of PRIDE skills. A 5-minute
coding is done throughout treatment using CDI
instructions.
•Agencies trained by UCD CAARE are told that MidTreatment DPICS is optional.
Goals & Purposes of a Assessment
at Mid-Treatment
• Goals:
– Measure the degree to which therapists’ have
–
changed parents’ verbal behavior
Measure the degree to which the changes in verbal
behavior have changed the quality of the parent-child
relationship.
• Purposes:
– Better understanding of parents’ generalization of CDI
–
–
skills to different situations.
Better understanding of child’s response to parent’s use
of power and control in context of their new CDI skills.
Greater sensitivity to dyads’ strengths and weaknesses.
Method & Procedure
•CODING OF 15-MINUTE DPICS ASSESSMENT MIDTREATMENT
– DPICS II coding of mother & child verbalizations
– 5-minute CDI
– 2 minutes each of CDI, PDI, and Clean Up
–Emotional Availability (CDI, PDI, & CU) using EA Scales, 3rd
Ed. (Biringen, 1998). Parent scales quantify sensitivity,
hostility, intrusiveness, & structuring. Child scales quantify
responsiveness to parent & involvement of parent in play.
–Why the first 2 minutes of CDI, PDI & CU? (Maximizes times of
transition)
–Why use EA scales? (Need to measure the global quality of
the parent-child relationship)
Sample Description
25 Biological Mother-Child dyads:
ChildrenSex :
80% male (20 boys)
Mean age:
4.00 yrs (Range, 2 – 6 yrs)
Ethnicity:
80% Caucasian
Physically abused: 49%
MothersMean age:
28.9 yrs (Range, 22 – 42 yrs.)
Education:
64% HS grad or less, mean 12.6 yrs.
Marital status: 32% married, 40% divorced/separated,
28% single
Perpetrators of abuse: 20%
Victims of domestic violence: 24%
Question 1: Is 2 minutes of coding a representative sample
of a 5 minute segment of CDI at Mid-treatment?
Question 2: What does 2 CDI-2 PDI-2 CU coding indicate that
5 minutes of CDI does not?
Table 1: % of Verbalizations in 5 minutes of CDI, 2 minutes of CDI,
and 2 minutes of CDI, PDI, and CU combined (6 minutes total)
5 min CDI 2 min CDI
2 CDI -2 PDI -2 CU
7.4%
35.7
10.2
10.6
8.2
5.9
7.5
0.8
4.9
3.7
36.4
9.3
6.7
5.7
6.6
20.4
1.3
16.7
% of parent total
BD %
ID
UP
LP
RF
Q
DC + IC
CR
Child CR
5.5% *
34.2 ns
10.1 ns
9.1 ns
10.4 *
6.6 ns
8.3 ns
0.8 ns
4.8 ns
***
ns
ns
**
***
ns
***
ns
**
Summary of analyses of DPICS II coding
• 5 min vs 2 min CDI comparisons revealed few
differences. Only fewer BDs and more RFs are observed.
Other percentages of parent verbalizations did not differ
significantly.
–
Conclusion: Coding for 2 minutes may be sufficient to obtain
a representative sample of parent-child interactions.
• 5 minutes of CDI vs. the first 2 minutes of CDI, PDI, and CU
show significantly more commands, and fewer BDs, RFs,
and LPs. A significant increase in child critical statements
were also observed.
–
Conclusion: Greater total numbers of parent commands and
child critical statements suggest that CDI skills might not be
generally maintained across PDI and Clean-Up.
Using EA to detect differences in
parenting quality
Table 2: Mean scores parent EA scales in CDI, PDI,
and CU
Parent Scales
Sensitivity
Hostility
Intrusiveness
Structuring
Child Scales
Responsiveness
Involvement
CDI
PDI
CU
(Range/ Opt.)
6.7
4.9
4.0
4.3
5.6
4.6
3.8
3.4
5.4
4.4
3.7
3.6
(1-9/ 6+)
(1-5/ 5)
(1-5/ 4+)
(1-5/ 4+)
5.2
5.3
4.1
4.4
4.0
4.0
(1-7/ 5+)
(1-7/ 5+)
Using EA to detect differences in
parenting quality
Table 3: Number of mothers with no, 1-2, or 3-4 parent EA
scales in non-optimal range (sensitivity, hostility,
intrusiveness, structuring) in CDI, PDI, and CU.
# Nonoptimal
CDI
PDI
CU
None
13
5
5
1–2
9
10
7
3–4
3
10
13
• Cluster analysis using numbers of non-optimal scales in
CDI, PDI, & CU revealed 3 groups with different patterns of
parenting quality in the DPICS assessment:
–
–
–
Optimal parenting CDI, PDI, CU (N=9)
Mixed: Optimal parenting CDI, non-optimal PDI & CU (N=10)
Non-optimal parenting CDI, PDI, CU (N=6)
Question 3: How can we tell these groups apart by
looking at parents’ DPICS verbalization
patterns?
Table 4: Number of positive verbalizations (BD, RF, LP, & UP) in
CDI, PDI, & Clean Up for Optimal, Mixed, and Non-optimal
groups
DPICS# Positive
verbalizations CDI
PDI
CU
Optimal
38.4
16.8
29.3
Mixed
39.5
10.9
13.3
Non-optimal
23.2
15.1
23.6
Figure 1: Number of positive verbalizations (BD, RF,
LP, & UP) in CDI, PDI, & Clean Up for Optimal,
Mixed, and Non-optimal groups
45
40
35
30
25
20
15
10
5
0
CDI #
PDI#
CU#
Optimal
Mixed
Non-optimal
parenting
parenting
parenting
Parenting quality group differences (cont’d.)
Table 5: Mean number of negative verbalizations
(IC, DC, & CR) in CDI, PDI, & Clean Up for
Optimal, Mixed, and Non-optimal groups
# Negative
Optimal
Mixed
Non-optimal
CDI #
2.7
1.6
5.5
PDI#
5.7
6.3
7.5
CU#
9.1
13.2
7.2
Figure 2: Mean number of negative (IC, DC, & CR)
verbalizations in CDI, PDI, & Clean Up for Optimal,
Mixed, and Non-optimal groups
14
12
10
CDI
8
PDI
6
CU
4
2
0
Optimal parenting
Mixed parenting
Non-optimal
parenting
Question 4: Can we discriminate between types of
parents by assessing children’s behavior during the
15 minute DPICS?
Child Responsiveness (Range = 1 – 7; Optimal range= 5 - 7)
• Willing to go along with parent’s ideas
• Engages easily with parent, does not ignore parent’s bids to play
• Happy
• Relaxed
• Willing to let parent be in charge, doesn’t give parent a lot of
commands
• Balance between focus on autonomous play and parent’s
engagement
• No negative affect apart from possible initial protest to activity
change
Figure 3: Children’s responsiveness (EA) to parents
by parenting quality in DPICS (Optimal range= 5+)
CDI
5
PDI
CU
1
Optimal
parenting
Mixed parenting
Non-optimal
parenting
Reflections of the parenting quality: Assessing
child’s behavior from looking at the 15 minute
DPICS (cont’d.)
• Clean up performance:
– Compliant- cleans up when asked, does not have
–
–
to be asked repeatedly to clean up, may protest
mildly when initially asked to clean-up
Compliance with considerable prompting- Cleans
up, but gets easily side-tracked and is repeatedly
prompted, or tries to distract parent from need to
clean up.
Mostly to completely non-compliant- Does not
comply with most requests. May put a few things
away, or put toys away then refuse to come back
to chair, but predominantly non-compliant.
Figure 4: % of children who clean up when parents
are in optimal, mixed, and non-optimal
parenting quality groups
100%
80%
% Clean up
60%
% Clean up with
prompts
40%
% Non-comply
20%
0%
Optimal
Mixed
Non-optimal
Clinical Implications
• Goals of assessment
– Better understanding of parents’
–
–
generalization of CDI skills to different
situations.
Better understanding of child’s response to
parent’s use of power and control in context
of their new CDI skills.
Greater sensitivity to dyads’ strengths and
weaknesses.
• Implications for quality of treatment
provision
Questions?
Comments
Thank You!