The 3 Faces of DPICS: Examining coding protocols for research & practice Susan Timmer, PhD., Nancy Zebell, PhD. Anthony Urquiza, PhD CAARE Diagnostic and.

The 3 Faces of DPICS:Examining coding protocols for

research & practice

Susan Timmer, PhD., Nancy Zebell, PhD.

Anthony Urquiza, PhD

CAARE Diagnostic and Treatment CenterDepartment of Pediatrics

UC Davis Children’s HospitalSacramento, CA916 734-6610

www.pcittrainingcenter.orgCopyright 2004. UC Regents. All rights reserved.

Acknowledgments

Michelle CulverRyan Fussell

Dianne ThompsonLindsay Klisanac

Erica GoudeAlan Chan

Natalie LambdinDavid 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 Change of qualityresponses to child behavior 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 mid-treatment 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 Mid-Treatment 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 MID-TREATMENT

– 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 Description25 Biological Mother-Child dyads:

Children-

Sex : 80% male (20 boys)

Mean age: 4.00 yrs (Range, 2 – 6 yrs)

Ethnicity: 80% Caucasian

Physically abused: 49%

Mothers-

Mean 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

% of parent total

BD % 7.4% 5.5% * 3.7 ***ID 35.7 34.2 ns 36.4 ns

UP 10.2 10.1 ns 9.3 ns

LP 10.6 9.1 ns 6.7 **RF 8.2 10.4 * 5.7 ***Q 5.9 6.6 ns 6.6 ns

DC + IC 7.5 8.3 ns 20.4 ***CR 0.8 0.8 ns 1.3 ns

Child CR 4.9 4.8 ns 16.7 **

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

qualityTable 2: Mean scores parent EA scales in CDI,

PDI, and CU

CDI PDI CU (Range/ Opt.)

Parent Scales Sensitivity 6.7 5.6 5.4 (1-9/ 6+) Hostility 4.9 4.6 4.4 (1-5/ 5) Intrusiveness 4.0 3.8 3.7 (1-5/ 4+) Structuring 4.3 3.4 3.6 (1-5/ 4+)Child Scales Responsiveness5.2 4.1 4.0 (1-7/ 5+) Involvement 5.3 4.4 4.0 (1-7/ 5+)

Using EA to detect differences in parenting

qualityTable 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.

# Non-optimal CDI PDI CU None 13 5 51 – 2 9 10 73 – 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-# Positiveverbalizations CDI PDICUOptimal 38.4 16.8 29.3Mixed 39.5 10.9 13.3Non-optimal 23.2 15.123.6

Figure 1: Number of positive verbalizations (BD, RF, LP, & UP) in CDI, PDI, & Clean Up for Optimal, Mixed, and Non-optimal groups

051015202530354045

Optimal

parenting

Mixed

parenting

Non-optimal

parenting

CDI #

PDI#

CU#

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 CDI # PDI# CU#

Optimal 2.7 5.7 9.1Mixed 1.6 6.3 13.2Non-optimal 5.5 7.5 7.2

Figure 2: Mean number of negative (IC, DC, & CR) verbalizations in CDI, PDI, & Clean Up for Optimal, Mixed, and Non-optimal groups

0

2

4

6

8

10

12

14

Optimal parenting Mixed parenting Non-optimal

parenting

CDI

PDI

CU

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+)

1

5

Optimal

parenting

Mixed parenting Non-optimal

parenting

CDI

PDI

CU

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

0%

20%

40%

60%

80%

100%

Optimal Mixed Non-optimal

% Clean up

% Clean up withprompts

% Non-comply

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!