Parent-Child Care (PC-CARE)

About This Program

Target Population: Caregiver and child age 1-10 years who has or is at high-risk of developing behavior problems or who is adjusting to a new home or family situation

For children/adolescents ages: 1 – 10

For parents/caregivers of children ages: 1 – 10

Program Overview

Parent-Child Care (PC-CARE) is a 7-week dyadic intervention, consisting of a pretreatment assessment/orientation to treatment and 6 one-hour-long treatment sessions, for a caregiver and child age 1-10 years who participate in treatment together. The caregiver can be biological, foster, kinship, adoptive, or another type of caregiver. This program is for caregivers and children who may:

  • Be disruptive or defiant
  • Have experienced a traumatic event
  • Be adjusting to a new home or family situation
  • Have difficulties within the caregiver-child relationship

PC-CARE has a variety of protocols for a wide range of populations and needs (e.g., trauma exposure, autism spectrum disorder). In PC-CARE each week, caregivers and children, if age appropriate, learn new strategies for enhancing the caregiver-child relationship and improving behavior management effectiveness. Therapists then coach caregivers while they play with the child, pointing out the strategies caregivers use that seem most effective for them and their child. The child is involved in the treatment process (teaching and coaching) as much as possible and appropriate.

Program Goals

The goals of Parent-Child Care (PC-CARE) are:

  • Improve the closeness, warmth, and sensitivity of the caregiver-child relationship
  • Reduce the child’s disruptive, defiant, and/or aggressive behaviors
  • Reduce the child’s trauma-related symptoms
  • Decrease stress and improve emotional regulation for the caregiver and their child
  • Increase the caregiver’s use of positive communication techniques
  • Increase the caregiver’s ability to manage their child's difficult behaviors
  • Increase child’s understanding and acceptance of positive communication and new behavior management strategies used by the caregiver

Essential Components

The essential components of Parent-Child Care (PC-CARE) include:

  • Pretreatment Assessment:
    • Caregiver completes measures related to their child’s behavior.
    • Caregiver and child participate in a standardized observational assessment.
    • Caregiver and child are provided information on the psychological aspects of the situations and treatment (i.e., psychoeducation):
      • Subject matters include:
        • Potential catalysts and contributors to child’s behavioral problems (e.g., trauma, autism spectrum disorder (ASD), feeding problems)
        • Treatment
      • Caregivers are provided this information at their level.
      • For young children, the explanation is kept very simple and developmentally appropriate.
      • As the child ages, more information is given to them.
      • The child at any age is included in this section so they feel free to talk and ask questions.
  • 6 Weekly One-Hour Treatment Sessions:
    • Caregiver and child attend all treatment sessions together.
    • Caregiver completes a brief measure of their child’s behavior every week to assess change during the course of treatment.
    • Specific skills are taught each week to the caregiver and the child together:
      • Session 1: Positive communication skills, avoiding or reducing certain types of communication, using transitions to promote compliance, and adjusting the environment to promote compliance.
      • Session 2: Using selective attention to give attention to positive behaviors and ignore inappropriate behaviors, modeling appropriate behaviors, redirecting children to encourage appropriate behaviors, using calming strategies to support emotional regulation.
      • Session 3: Implementing rules to reduce disruptive behaviors, giving choices to promote agency and compliance, and using when-then or if-them statements to teach cause and effect and to promote appropriate behaviors.
      • Session 4: Giving effective commands and consistent consequences to promote compliance.
      • Session 5: Using re-do to encourage appropriate behaviors and using recovery to promote positive relationships and future compliance.
      • Session 6: Review all skills learned and plan for the future.
    • The children are taught right alongside the parent, when developmentally appropriate:
      • Children are taught how they can use some of the skills for example:
        • Children can use positive communication skills with caregiver.
        • Children can use selective attention skills with siblings.
      • Children are informed about and exposed to the parent using new skills, for example:
        • Children are made aware that the caregiver is going to use choices, when-then statements, and effective commands with them when they want them to do something
        • Older children are taught that they can use these skills with classmates or siblings.
      • This strategy is designed to help the child get on board with the caregiver trying new things since children can react poorly to caregiver changes.
    • When a child is very young, most of the didactic is directed toward the caregiver; an occasional sentence is directed toward the child to keep the child engaged in the process.
    • Caregiver and child engage in a 4-minute behavioral observation during play.
    • Caregiver (and child when developmentally appropriate [i.e., 4 years older or older]) is coached to use the skills learned in that session, as well as skills learned in previous sessions. Coaching can occur via a one-way mirror with audio equipment or in the same room as the caregiver-child dyad (in the clinic or in the home).
    • Therapist presents caregiver and child progress in treatment on a visual chart to reinforce gains.
    • Caregiver is provided with a “Daily Care” sheet and asked to track whether caregiver and child played together each day, which positive communication and behavior management skills were used each day, and how the child’s overall day was.
    • During the 6th session, the caregiver completes posttreatment behavioral measures, and the caregiver and child again participate in a standardized behavioral observation.
  • Follow-Up:
    • One month after treatment completion, caregivers are contacted to obtain an update on the child’s functioning and offer a booster session.
    • If the caregiver chooses a booster session, the session includes a review of all the skills learned, 4-minute behavioral observation, coaching, and a discussion of the child’s ongoing needs.

Program Delivery

Child/Adolescent Services

Parent-Child Care (PC-CARE) directly provides services to children/adolescents and addresses the following:

  • Disruptive, aggressive, or defiant behaviors, trauma symptoms, adjustment difficulties, poor relationships with caregivers

Parent/Caregiver Services

Parent-Child Care (PC-CARE) directly provides services to parents/caregivers and addresses the following:

  • Ineffective parenting style, difficulty parenting a child with disruptive, aggressive, or defiant behaviors, adjusting to a new child in the foster system, parenting a child with trauma history, abusive parenting behaviors, difficult parent-child relationship
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Multiple caregivers may participate in treatment with the child, and psychological measures are administered to all caregivers involved. When problems in the sibling relationship are an issue, the child’s sibling(s) may participate in some aspects of treatment. In some cases, psychological measures may be filled out by the client’s teachers or other caregivers, even if they are not in treatment with the child.

Recommended Intensity:

One 60-minute session per week

Recommended Duration:

Approximately 3 months total: 7 consecutive weeks (1 pretreatment assessment plus 6 treatment sessions) and a 1-month follow-up

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Community Agency
  • Foster/Kinship Care
  • Hospital
  • Outpatient Clinic

Homework

Parent-Child Care (PC-CARE) includes a homework component:

Caregivers are asked to fill out a “Daily CARE” homework sheet and turn it in each session (once a week). The homework consists of playing with their child one-on-one for five minutes per day, documentation of which positive communication and behavior management skills were used each day, and feedback of their child’s overall behavioral functioning that day.

Languages

Parent-Child Care (PC-CARE) has materials available in languages other than English:

German, Russian, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Space (a clinic room, the home, or another venue) in which the child and caregiver can play together.
  • A selection of at least three different toys or activities that are age-appropriate, developmentally appropriate, and encourage interaction between caregiver and child
  • PC-CARE can be easily implemented using in-room coaching and no special equipment, or with any of the following equipment:
    • Two connected rooms with a two-way mirror for observation, with the therapist on the other side of the mirror
    • “Bug in ear” style audio communication device for therapist to communicate with caregiver
    • Computer or television monitor and recording equipment to record sessions for supervision, training, or research purposes

Education and Training

Prerequisite/Minimum Provider Qualifications

Providers must have at least a Bachelor’s level education to be trained in PC-CARE. They also must be able to have at least two families receiving PC-CARE added to their caseload as part of their training. Lastly, they must have approval to work individually with children and families. It is recommended that the supervisors of providers also receive some training in PC-CARE as well.

Education and Training Resources

There is a manual that describes how to implement this program , and there is training available for this program.

Timmer, S.G., Hawk, B.N., Lundquist, K., Forte, L., Aviv, R., Boys, D., & Urquiza, A. (2016). PC-CARE course of treatment manual. Unpublished manuscript, University of California, Davis. The manual is housed on the UC Davis CAARE Center’s server and access is given to trainees.

Training Contact:
Training is obtained:

At the UC Davis CAARE Center; in phases at regional trainings; in phases at periodic workshops; via telehealth (video and audio observation and contact with a trainer)

Number of days/hours:

Training is provided in two main phases. Phase I is a six-hour Skill Building Workshop that can take place on site at an agency, at a conference, at the UC Davis CAARE Center organization, or remotely via telehealth. Phase II involves three training tasks to be completed while working with clients: Weekly group calls & sample case review, Individual case prep, and Video review & competency sign off. Including both phases, training takes between three and six months to complete, which includes being signed off on 24 competencies and graduating two successful cases.

Relevant Published, Peer-Reviewed Research

Hawk, B. N., & Timmer, S. G. (2018). Parent-Child Care as a brief dyadic intervention for children with mild to moderate externalizing problems: A case study. Clinical Case Studies, 17(5), 263-279. doi:10.1177/1534650118774417

Type of Study: One-group pretest-posttest
Number of Participants: 3

Population:

  • Age — Parents: 38 years old; Children: 5 years old
  • Race/Ethnicity — 100% Caucasian
  • Gender — Parents: 1 Male and 1 Female; Children: 1 Male
  • Status — Participants were a child with mild externalizing problems and his parents.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to demonstrate the effectiveness of the Parent-Child Care (PC-CARE) program. Measures utilized include the Eyberg Child Behavior Inventory (ECBI), the Parenting Stress Index, 4th Ed. - Short Form (PSI-4-SF), the Therapy Attitude Inventory (TAI), and the Weekly Assessment of Child Behaviors-Negative Behaviors (WACB-N). Results indicate the child’s behavioral symptoms improved from pretreatment to posttreatment (per parents’ reports and observation), and he maintained this improved behavior 1 month after treatment. The parents similarly demonstrated improvement in their use of parenting skills and emotional availability. Limitations include this is a case study, small sample size, lack of randomization, and length of follow-up.

Length of postintervention follow-up: 1 month.

Timmer, S. G., Hawk, B. N., Forte, L. A., Boys, D. K., & Urquiza, A. J. (2019). An open trial of Parent–Child Care (PC-CARE) - A 6-week dyadic parenting intervention for children with externalizing behavior problems. Child Psychiatry & Human Development. 50(1), 1-12. doi:10.1007/s10578-018-0814-8

Type of Study: One-group pretest-posttest
Number of Participants: 63

Population:

  • Age — Parents: Not specified; Children: 1-10 years (Mean=5.52 years)
  • Race/Ethnicity — Parents: 50% White/non-Hispanic, 27% Latino, 13% African American, 3% Native American, 3% Asian American, and 4% Other Ethnicities; Children: 44% White/non-Hispanic, 30% Latino, 19% African American, 6% Asian American, and 2% Native American
  • Gender — Parents: Not specified; Children: 56% Male
  • Status — Participants were children and their primary caregivers referred by physicians, social workers, or self-referred for help with their children’s difficult behaviors.

Location/Institution: Community health center in Sacramento County – California

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to determine the feasibility of Parent-Child Care (PC-CARE) and examine preliminary outcomes. Measures utilized include the Eyberg Child Behavior Inventory (ECBI), the Parenting Stress Index, 4th Ed. - Short Form (PSI-4-SF), the Brief Family Life Questionnaire (BFLQ), and the Weekly Assessment of Child Behaviors-Negative Behaviors (WACB-N). Results indicate preintervention to postintervention scores showed significant improvements in child behavioral problems as well as improvements in parenting stress and positive parenting skills. Limitations lack of control group, small sample size, and lack of follow-up.

Length of postintervention follow-up: None.

Additional References

Hawk, B. N., Timmer, S. G., & Urquiza, A. J. (2018) PC-CARE: A promising brief parent-child intervention. Section on Child Maltreatment Insider, 23(1), 8-10.

Contact Information

Lindsay Forte, M.S.
Agency/Affiliation: UC Davis CAARE Center
Website: pcit.ucdavis.edu/pc-care
Email:
Phone: (916) 732-8983

Date Research Evidence Last Reviewed by CEBC: January 2019

Date Program Content Last Reviewed by Program Staff: April 2019

Date Program Originally Loaded onto CEBC: April 2019