PCIT Training Center

PC-CARE: Fostering Secure Placements for Traumatized Children in Transition

UC Davis PCIT Training Center September, 2017

OBJECTIVES

1. Hear about the state of foster care in Sacramento County

2. Understand the goals of this project

3. Hear about the PC-CARE protocol

4. See some PC-CARE data so far

Rates of foster care entry

0

2

4

6

8

10

12

14

Sacramento County California

Rate

per

100

0 ch

ildre

n

3-5 year olds1-2 year olds

• In Sacramento County, children enter foster care at a higher rate than children statewide (Webster et al., 2016)

Placement stability: an essential part of young children’s mental health

• Young children in Sacramento County appear to change placements more frequently (Webster et al., 2016)

0102030405060708090

100

Sacramento County California

Perc

ent o

f chi

ldre

n

Placement stability between January and June 2015

Two or more fosterplacementsOne foster placement(stable)

Project Goals:

• Provide trauma screener to all 1 - 5 year old children entering new foster homes

• Provide PC-CARE intervention for those children and their foster caregivers for 6 weeks

• Increase foster placement stability

• Reduce child trauma-related symptoms

• Refer to other services as needed

Project Goals:

• Year 1: 250 children • Year 2: 500 children • Year 3: 500 children • Year 4: 500 children • Year 5: 375 children

• Project lifetime: 2,125 children served over 5

years

The Process: Where we come in

Child placed in new

foster home

UC Davis contacts

family

CPS clerical logs/tracks

and sends to UC Davis

CPSU: Submit PC-CARE referral to UCD-PC-CARE-Referrals inbox

8

Communication • As part of our efforts

to increase placement stability, we plan to provide aggregate information to all parties regarding outcomes

So what is involved in PC-CARE?

Trauma Screening (1st session):

1. Therapist goes to home first 1-2 months of placement

2. Engage with foster family 3. Assess child’s trauma exposure

and adjustment to new family, using ECTSS (0-6yrs)

4. Assess for disruptive behaviors and trauma-related symptoms

5. Provide psycho-education to foster caregivers regarding common reactions to trauma

PC-CARE Course of Treatment

Intake

• Collect information: clinical interview, standardized measures; Define treatment goals, describe treatment; 12-minute observation; Trauma Didactic

Session 1 •PRIDE Skills; Transitions; Creating a compliance-friendly

environment

Session 2 •Selective Attention; Redirect; Modeling; Calming

Session 3 •Rules; Choices; When-then & If-then

Session 4 •Direct Commands; Two-choice removal of privileges

Session 5 •Recovery; Redo; Hand-over-hand (for very young children)

Session 6

•Review all skills; Discuss what works and what doesn’t; 12-minute observation; Collect standardized measures

Who will we treat in PC-CARE? • Children aged 1-5 years old • Entered a new foster placement in the

previous 60-90 days • Children in foster homes: County foster

homes, FFA foster homes, kin caregivers • Assessment, preventive intervention

Eyberg Child Behavior Inventory

• N = 40 caregiver-child dyads

• Variety of referral sources • Aged 1.3 – 10.9 yrs • 74% had clinical levels of behavior problems pre-PC-CARE; 32% at post

• Behavior problems decreased significantly from pre- to post-PC-CARE

• 93% retention rate

PC-CARE OUTCOMES

ECBI Intensity Scale

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Much better(36+ pts, 1 SD)

Better (18 to35 pts)

Slightly better(8 to 17 pts)

No change (-4to 4 pts)

Slightly worse(-6 to -7 pts)

(N = 40 caregiver-child dyads)

HOW MUCH IMPROVEMENT?

PC-CARE OUTCOMES

WACB-N Intensity Scale (N = 43 caregiver-child dyads)

PC-CARE OUTCOMES

38.81

36.16

33.14

31.26

29.28

18

23

28

33

38

43

Session 1 Session 2 Session 3 Session 4 Session 5

WACB-N Change Scale (N = 43 caregiver-child dyads)

PC-CARE OUTCOMES

6.17 5.56

5.34 4.93

4.32

0

1

2

3

4

5

6

7

Session 1 Session 2 Session 3 Session 4 Session 5

Caregiver Skill Acquisition (N = 43 caregiver-child dyads)

PC-CARE OUTCOMES

7.5

12.2

16.8

18.1 17.8 18.0

17.0 17.8

15.8 15.1

13.3 12.4 11.7 12.4

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

PRIDE

AVOID

TSCYC (N = 10 caregiver-child dyads)

TRAUMA SYMPTOM CHANGE

72.2

59.9

40

45

50

55

60

65

70

75

Pre-treatment Post-treatment

Change in PTS-Total T-Scores

PC-CARE OUTCOMES

Project so far… • Barriers:

– CPS: Where do we fit into a well established system

– Refusal of services – Training SWs and resource caregivers

• Completed Tx with 3 clients! – All with good outcomes!

• 14 clients currently in Tx

WRAP UP &

QUESTIONS

CONTACT US Website: pcit.ucdavis.edu

Web Course: pcit.ucdavis.edu/pcit-web-course

www.facebook.com/UCDPCIT PCIT LinkedIn Group

Contact info: hs-pccare@ucdavis.edu