Do Family Risk Classes Predict Attrition in Parent Child Interaction Therapy? Public Deposited

http://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/pz50gz90h

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  • Child behavior disorders are the second most prevalent form of mental illness affecting children in the United States (Perou et al., 2013), with lifetime prevalence estimated at 10% (Nock, Kazdin, Hiripi & Kessler, 2007). Negative outcomes associated with ODD during childhood and adolescence include conflict in families, poor peer relationships, peer rejection, and academic difficulties (Burke, Rowe & Boylan, 2013). Parent training programs are shown to be effective in reducing child behavior disorders (Thomas & Zimmer-Gembeck, 2011). One such program, Parent Child Interaction Therapy (PCIT), is a widely disseminated intervention implemented in diverse settings with populations of at-risk families. PCIT is an intervention shown to be effective in preventing and reducing behavior disorders in children aged 2- to 7- years old (Brinkmeyer & Eyberg, 2003). However, a large barrier to treatment success is that families often dropout before therapy is completed (Fernandez & Eyberg, 2009). A small collection of studies specifically examining attrition in PCIT have explored family risks as treatment barriers. Models exploring the shared influence of multiple risk factors in the literature on PCIT attrition are uncommon, but given the co-occurring contextual risks often seen in families enrolled in PCIT, studies documenting the shared influence of multiple risks on attrition are important and have potential value in research and practice. Studies associating family risks with PCIT attrition have typically operationalized single variables and findings have been inconsistent. Although children and parents in parent-child therapies are known to have adverse family experiences (i.e. abuse, neglect, witnessing violence) (Kazdin, 1996), studies on the influence of adverse family experiences in PCIT attrition are few, and none have looked at the combined influences of family risks. To help address these gaps, the current study will examined the ways in which family risks operate in combination with one another to help explain attrition in PCIT. More specifically, this study examines whether or not families participating in PCIT differ not only in the number of risks they present, but also in the ways in which risks combine, forming distinct patterns of risks. To address this question, we conduct a Latent Class Analysis to identify family risk classes examining how two overarching types of risk; low-SES, and adverse family experiences. We addressed our main study aim by examining how the classes predicted the likelihood of dropping out of PCIT overall, and prior to the completion of the CDI component. To help address these gaps, the current study will examine the ways in which family risks operate in combination with one another to help explain attrition in PCIT. More specifically, this study examines whether or not families participating in PCIT differ not only in the number of risks they present, but also in the ways in which risks combine, forming distinct patterns of risks. The goals of the present study were to explore patterns of risks among families participating in PCIT, and to examine associations between these patterns and the likelihood of dropping out of PCIT, both prior to completing the first component (CDI) of the therapy and prior to completion of the full program. Findings pointed to three distinct patterns of risk but did not detect any significant associations between these patterns of risk and attrition in PCIT. These findings are important for guiding future research and provide preliminary information for practitioners to better understand the complexity of risks among families attending PCIT. Although the primary study aim was to examine links between classes of risk and attrition in PCIT, preliminary analysis detected two specific risk variables linked with PCIT attrition prior to completion of CDI: low parental education and having a mental health disorder in the household. There was also a trend toward low parental education being associated with attrition from PCIT overall
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