Mental health services for preschool children in primary care: a survey of maternal attitudes and beliefs.

OBJECTIVE: This study examined maternal attitudes and practices that may prevent preschoolers from receiving needed mental health services. METHODS: Mothers of 110 children ages 3-6 completed a survey of maternal attitudes and practices and the Eyberg Child Behavior Inventory (ECBI). RESULTS: Mothers wanted pediatrician assistance with child behavior concerns. Mothers of children with elevated ECBI scores reported most often discussing disruptive behaviors with their pediatrician, and preferred clinician-provided services, whereas mothers of children with normal range ECBI scores most often discussed developmental issues with the pediatrician and preferred parenting help from handouts and books. Mothers reported receiving clinician-provided services almost never. CONCLUSIONS: Mothers were open to psychosocial services for child behavior problems, particularly via primary care, and ratings of barriers were relatively low despite reporting infrequent service use. Mothers' responses highlight the need for mental health providers in primary care to ensure accessibility of desired services.

Child-directed interaction: prediction of change in impaired mother-child functioning.

The first phase of parent-child interaction therapy (PCIT), called child-directed interaction, teaches parents to use positive and differential social attention to improve the parent-child relationship. This study examined predictors of change in mother and child functioning during the child-directed interaction for 100 mother-child dyads. The children were 3-6-years-old and diagnosed with oppositional defiant disorder. After establishing that significant improvements occurred in mother report of child disruptive behavior, parenting stress, and parenting practices, these three variables were combined to form a latent impaired mother-child functioning construct. Structural equation models were examined using maternal demographic and psychosocial variables as predictors of impaired mother-child functioning before and after the child-directed interaction. Mothers' self-reported daily hassles and depressive symptomatology predicted 74% of variance in impaired mother-child functioning before treatment. Mothers' report of social support predicted impaired mother-child functioning after the child-directed interaction, with 57% of the variance accounted for in this longitudinal model. These findings suggest the importance of improving maternal social support during the initial phase of PCIT.

Therapist verbal behavior early in treatment: relation to successful completion of parent-child interaction therapy.

We examined the role of specific therapist verbal behaviors in predicting successful completion of Parent-Child Interaction Therapy (PCIT) in 22 families, including 11 families that successfully completed treatment and 11 that discontinued treatment prematurely. The children were 3 to 6 years old and diagnosed with oppositional defiant disorder (ODD). Chamberlain et al.'s (1986) Therapy Process Code (TPC) was used to measure therapist verbalizations during therapist-parent interactions during the initial clinical interview and the second treatment session. Results indicated that therapists' use of the categories Question, Facilitate, and Support during these sessions accurately predicted treatment dropout versus completion for 73% of families. Findings suggest that the early therapist-parent relationship in PCIT may be critical to successful treatment completion.