(PS10-B47) Parent-child Interaction Therapy (PCIT) as a Treatment for Families Impacted by the Opioid Crisis

The number of children living with an adult suffering from opioid use disorder has increased by 30% since 2002 (Bullinger & Wing, 2019). Children of caregivers with opioid use disorders have an increased risk for a variety of health concerns, including adverse childhood experiences (ACEs), toxic stress, attachment concerns, and behavior problems (Bucci et al., 2016; Romanowicz et al., 2019). As disruptive behavior can often increase parent stress (Eyberg et al., 1993), those who are in recovery from substance use are more likely to relapse when experiencing stress (Sinha, 2001). Thus, it is critical to intervene with a parent and child focused treatment, such as Parent-Child Interaction Therapy (PCIT), an evidence-based intervention that emphasizes coaching caregivers to improve parent-child relationships and early childhood disruptive behaviors (Eyberg & Funderburk, 2011).

The current study aims to demonstrate the effectiveness of PCIT in decreasing child behavior problems in families directly impacted by the opioid crisis. Through structured interviews, 33 therapists in West Virginia reported treatment data for 72 cases affected by the opioid crisis. The frequency and problematic nature of child disruptive behaviors were reported using the Eyberg Child Behavior Inventory (ECBI; Eyberg & Pincus, 1999). Parenting techniques were coded using the Dyadic Parent Child Coding System (DPICS; Eyberg et al., 2013). Therapists also described their experiences providing PCIT to families impacted by the opioid crisis. The interviews were transcribed, qualitatively coded using an iterative, deductive approach, and then analyzed.

Paired samples t-tests were conducted to evaluate the impact of the intervention on child disruptive behavior. Families who completed PCIT reported statistically significant decreases in ECBI Intensity scores from pretreatment (M  = 162.54, SD = 36.19) to posttreatment (M = 99.92, SD = 27.01;) t (12) = 8.3, p</span> < .05. The average decrease in Intensity scores was 62.62 with a 95% confidence interval ranging from 46.18 to 79.05. There was also a significant decrease in ECBI Problem scores from pretreatment (M = 18.46, SD = 9.44) to posttreatment (M = 8.23, SD = 5.10) t (12) = 6.31, p < .001 (two tailed). The average decrease in Problem scores was 10.23 with a 95% confidence interval ranging from 6.70 to 13.76. DPICS codes demonstrated an increase in positive caregiver verbalizations and a decrease in negative caregiver verbalizations. These findings demonstrate that PCIT is an effective treatment to reduce child behavior problems within this unique population. However, therapists reported several challenges in providing PCIT to families impacted by the opioid crisis, including frequent crises (18%), inconsistent attendance (36%), low resources (18%), and strained family relationships (21%). Additionally, several therapists modified treatment to address specific needs of the families related to child attachment concerns, ACEs, and elevated caregiver stress. 

With the rise of the opioid crisis, it is important to evaluate how opioid use affects treatment engagement and child and family outcomes. These findings provide important insight into the ways that clinicians can work with families impacted by the opioid crisis.