Adapting Parent Child Interaction Therapy (PCIT) to Custodial Grandparents

As the structure of the American family changes, it is becoming more common for children to be raised by their grandparents. In fact, over the past 40 years, there has been a 50% increase in grandparent-headed homes in the US (Ellis and Simmons, 2014). Custodial grandparents, who provide primary caregiving responsibilities for their grandchildren, often become responsible for their grandchildren due to distressing situations and report many social-emotional, physical, and psychological difficulties (e.g., Hayslip and Kaminski, 2005). Additionally, children of custodial grandparents have been found to have significantly more emotional and behavioral problems than non-custodial grandchildren (Smith and Palmieri, 2007). The main parenting resource for this population is often support-groups, which often do not provide needed assistance with discipline and behavior management. The overall purpose of this study was to adapt Parent Child Interaction Therapy (PCIT) to custodial grandparents, using a consumer-oriented approach. The study was completed in three discrete stages. During Stage 1, qualitative interviews with custodial grandparents were completed to collect further information about custodial grandparents' experience parenting their grandchildren, use of parenting resources, and opinion of parenting strategies and PCIT. Findings from this stage indicated that custodial grandparents were amenable to PCIT procedures, but experienced significant barriers in accessing parenting services. Due to these barriers, a service delivery adaptation was developed and an online intervention was created (Stage 2) to transcend treatment barriers. Finally, during Stage 3, this online intervention was tested in a small single-subject design pilot study. Multiple metrics supported the feasibility, accessibility, satisfaction, and initial treatment efficacy of this intervention. All participants demonstrated clinically significant reductions in at least two symptom measures and reported satisfaction with the online intervention. Overall, results provide preliminary support for the use of online interventions to teach PCIT strategies and support future research on online interventions for this population.