The Effect of a School-Based Transitional Support Intervention Program on Alternative School Youth’s Attitudes and Behaviors

Viki P. Kelchner, Kathy Evans, Kathrene Brendell, Danielle Allen, Cassandre Miller, Karen Cooper-Haber

This investigation examined the potential impact of a school-based youth intervention program on the attitudes and behavioral patterns of at-risk youth. The sample size used in this study was 52; 24 participants received the school-based intervention and 28 participants did not receive the intervention. A two-group pretest-posttest design approach was implemented. A two-phase behavioral intervention was used with at-risk youth who were returning from a remanded period at an alternative school in lieu of expulsion from school. After the conclusion of the intervention program, school attitudes, behavioral indicators and academic success indicators were evaluated. The results of this study revealed that there was a significant treatment effect on youth’s school attitudes.

Keywords: school-based youth intervention, at-risk youth, alternative school, transitional support, behavioral intervention

According to the National Center of Education Statistics (2016), in the United States, almost 7% of students drop out of high school. Evaluations of on-time graduation rates reveal that approximately 30% of students fail to graduate in the traditional 4-year time frame (Berger, 2011; Kelchner, 2015; Levin, 2009; Stout & Christenson, 2009). There are some common predictors of high school dropout. Suh, Suh, and Houston (2007) identified 16 predictors of school dropout. Of those 16 predictors, low socioeconomic status, academic failure and behavior problems were the primary risk factors. Academic failure was found to have the most significant impact. Suh, Suh, and Houston (2007) determined that (a) early intervention (prior to a student accumulating multiple risk factors) is more easily targeted and effective and (b) multiple interventions may be necessary to keep students with multiple risk factors in school. Youth who have been suspended from school are twice as likely to drop out (Smith & Harper, 2015). Often, youth who have been sent to alternative schools have incurred multiple suspensions, making the likelihood of dropping out of school even greater. Academic failure can lead to repeating courses, grade retention, and academic apathy, and ultimately may lead to dropping out altogether (Berger, 2011).


Frequently, students who are the most susceptible to dropping out are those who are in or have attended alternative schools (Kelchner, 2015). Alternative education proliferated in the 1960s and early 1970s as educational priorities shifted to the progressive education movement (Kim, 2006). Alternative schools were initially designed to provide a positive alternative to conventional learning environments for students who were unable to succeed in traditional learning environments, but the trend today is for alternative schools to function as separate retributory schools for undesirable children (Prior, 2010; Richardson, 2012). Originally, people who were dissatisfied with traditional curricula welcomed alternative public schools that subscribed to the ideas of progressive education, which called for a free, open policy that emphasized the development of self-concept, problem solving and humanistic approaches (Conley, 2002). Alternative schools tried to offer more freedom and prospects for success for students. However, most alternative schools from this era were short-lived.


In the mid-1990s, alternative learning environments started providing programs to schools (including public and private voucher programs, charter schools, and magnet programs) in an effort to solve issues of poor student achievement, ineffective pedagogical methods, and an increasing inability to meet the needs of diverse families (Kim, 2006). Two pieces of legislation were introduced that modified the number and types of students being served by alternative education settings. The first legislation was the Gun Free Schools Act of 1994, which mandated that students who brought weapons to school be expelled and/or sent to alternative educational settings for a period of 1 year (Prior, 2010; Stone, 2003). Zero tolerance policies were a product of this legislation and created the stage for a dramatic increase in student suspensions and expulsions from school. These referrals led to more placements in alternative education schools. The second piece of legislation introduced was the Individuals with Disabilities Act of 1997, which allowed individualized education program teams to place students with disabilities in appropriate interim alternative education settings for up to 45 days (Prior, 2010).


According to Prior (2010), Richardson (2012), and Stone (2003), there are three types of alternative schools: Type I alternative schools are schools of choice that mimic magnet schools; Type II alternative schools are last-chance programs; and Type III alternative schools are disciplinary programs that focus on remediation or rehabilitation. Typically, the goal of Type II and Type III schools is to return students to their home schools after successful treatment (Stone, 2003). Today, alternative schools are often viewed by the public as places for students who are disruptive, deviant and dysfunctional, rather than as positive alternative solutions for students whose needs are not being met by traditional schools. Many believe these schools exist to segregate troublemakers in one place to better protect the students in traditional schools (Conley, 2002; Kim, 2006).


Out-of-school suspension and expulsion are widely used practices in American school systems, which only further isolate students from education. As a result, more than 3.3 million students are suspended each year and these students are at greater risk of not remaining in school (T. Lee, Cornell, Gregory, & Fan, 2011; Smith & Harper, 2015). Students who have received disciplinary infractions for excessive absenteeism, disrespectful behavior, disrupting class, fighting, profanity, refusal to obey, tardiness, theft, truancy and verbal altercations may be recommended for expulsion from school. In lieu of expulsion, students may be allowed to attend an alternative academy within the school district. One of the goals of alternative schools is to provide students with a second chance (Kim, 2006). The alternative academy is a smaller, more supportive Type III environment that focuses on providing students with academic and behavioral skills. In some alternative schools, short-term placements are utilized for students who are suspended or expelled, offering the students opportunities to return to traditional school settings (Blythewood Academy, 2013; Richardson, 2012). The eligibility for the student to return to the traditional school setting is based on fulfillment of certain requirements or assessments (Richardson, 2012).


Students returning from alternative academies to their home schools may face an array of challenges. The transition back to the home school can be difficult for a number of reasons. Students returning from an alternative school setting to a traditional school setting have to readjust to the larger classroom sizes and less one-on-one assistance with their academic studies. The students are often behind in their studies because they are placed in classes at their home schools that are further along than the classes they were taking at the alternative academies. In addition, they tend to be labeled “at-risk” for school failure because of their attendance at an alternative school, no matter how much academic potential they may possess (Kim, 2006). Likewise, there is a sense of disconnectedness to the home school and its faculty and staff (Boutelle, 2010; Kelchner, 2015). Students’ performance tends to be greater when they bond with their school, are connected and feel someone at the school cares about them (Flower, McDaniel, & Jolivette, 2011). Many at-risk youth are not given compulsory support and are not nominated to receive remedial services (Kayler & Sherman, 2009). Because the transition back to their home schools can be very challenging, students who fail to make this transition either are sent back to the alternative academy, expelled from school or drop out. Rumberger and Lim (2008) classified the reasons students leave high school before completion into individual predictors and institutional predictors. There are four major categories of individual predictors: (a) academic failure, (b) expectations (e.g., future academic success), (c) behaviors, especially engagement, and (d) background and life experiences (Rumberger & Lim, 2008). Students who are sent to an alternative school are more than twice as likely to drop out of school as students who have not been sent to an alternative school setting, and support with this transition is needed for students returning to their home schools (Berger, 2011; Brownstein, 2010; Kelchner, 2015; Stone, 2003).


Alternative School Transition


The literature was reviewed to assess interventions for use in our study. The primary goal of alter-native programs is to transition students back to their traditional educational environment, the home school. There is little research about this transition and how to best meet the needs of transitioning youth. Coordinated planning can minimize the anxiety and negative elements experienced by students, families and teachers that can accompany the transition from one educational setting to another (Kelchner, 2015; Richardson, 2012; Wolf & Wolf, 2008). A lack of appropriate transition and support programming can negate the benefits received from the alternative school. Students have the potential to regress to prior negative behaviors and poor performance because of the loss of support, a return to the environment that already failed them, negative peer influences, and labeling and stigmatization by both peers and school personnel, which may lead to re-suspension (Stone, 2003; Valore, Cantrell, & Cantrell, 2006; Wolf & Wolf, 2008). As a result, students who attend an alternative school and have the fortitude to improve behavior, improve school relations and catch up academically often return to the prior negative conditions in their home school that caused them to fail in the first place. Because of an apparent lack of support and services throughout the transition, many students return to the alternative schools or end up in more restrictive placements, such as juvenile detention or jail (Berger, 2011; Richardson, 2012; Stone, 2003).


School-Based Transitional Support Intervention


Exiting an alternative school and re-entering a traditional school setting can present many stressors for youth. The purpose of this study is to provide an intervention to support youth returning to a traditional educational setting from alternative school to assist in preventing youth from dropping out of school.  The  intervention in this study, focused on the area of the individual and how the individual accesses systemic supports within the school community, local community and family. Empowerment, school engagement and academic success were the three major variables focused on in the development of this intervention. The final intervention was based on 10 systemic reviews of intervention programs, eight meta-analyses of various school interventions for at-risk youth, 25 various studies of design, six articles describing implementation of specific programs and six components articles relevant to one or more of the identified key variables. Interventions had to encompass the following criteria to be included in the development of the intervention: target at least one of the factors identified by the target population, be deliverable in a group format, not require direct teacher involvement, and not require unavailable resources.


The theoretical foundation for this research was an ecosystemic approach. This approach was chosen because it is important to look at all of the systems that support the youth, such as the school community, social community, family community and local community. The ecosystemic approach offers perspective on emotional and behavioral difficulties in schools by offering a particular analysis of the interactional patterns observable in social systems (Cooper & Upton, 1990; Wolf & Wolf, 2008). Ecosystemic theory takes into consideration all parts of the students’ systems and how these systems can assist students to have a successful transition to a traditional educational setting and high school experience. A smoother transition also may be promoted by empowering students.



Empowerment is a way people gain control over their lives through actively participating and focusing on their strengths and not their weaknesses, while embracing diversity and using the language that reflects empowerment ideals (Chinman & Linney, 1998). Empowerment is a cyclical process in which adolescents develop their identity variables, including self-efficacy, self-confidence, self-esteem and self-acceptance (Berger, 2011; Chinman & Linney, 1998). Students are given a sense of control through this process. Empowerment shapes how youth interact with their entire environment, including their school environment, while facilitating attitudes and motivation.


The empowerment component of our intervention was based on the intervention program Empowerment Groups for Academic Success (EGAS; Bemak, Chung, & Siroskey-Sabdo, 2005). The EGAS intervention was initially used with African American female students who were referred because of extremely poor academic performance, behavior issues and a lack of desire to finish high school (Bemak, Chung, & Siroskey-Sabdo, 2005). The authors only retrieved qualitative data through taped interviews with students 6 months post-intervention and follow-up surveys at 1 year (Bemak et al., 2005; Berger, 2011). Empirical evaluations of the study were planned and approved, but because of administrative changes, researchers were prohibited from collecting empirical data. EGAS was initially designed for use with African American females (Bemak et al., 2005) and later adapted for use with African American middle school females (Hilton-Pitre, 2007). Weekly group sessions provided support throughout the school year in a format in which group members chose the discussion agenda and facilitators guided the discussion, while the overarching goal was academic success. Bemak and colleagues (2005) proposed to empower group participants by acknowledging their ability to evaluate their own needs and implement topics for discussion. EGAS was designed to encourage empowerment through the group process and move away from the psychoeducational format, with the goal of facilitating self-efficacy and empowerment (Bemak et al., 2005; Berger, 2011). The group was also aimed at improving attendance and academic performance.


During the weekly EGAS group meetings, care was taken to make sure that the group session was not held within the same class period from the previous week. A university professor facilitated the group and the co-facilitator was a school counselor. The facilitator worked closely with the school counselor to implement the group process. The program used five graduate student interns to co-lead during the semester. Participants acknowledged improved school attendance, behavior and grades. They discussed that they were better able to communicate and had improved relationships at home. Prior to participating in EGAS, students believed they would not graduate from high school. Upon completion of the program, students expressed the desire to attend college.


The intervention was conducted with a population demographically similar to the target population in this study with the exception that there were no male students. The intervention’s primary objective was to enhance student empowerment with the expected antecedent that empowered youth would self-correct academic and behavioral barriers to high school graduation (Bemak et al., 2005; Berger, 2011). The intervention in this study was designed to support students for an entire year and embraced an ecosystemic approach. All systems of the students were involved in the process to encourage success. Students’ teachers, administration, families, counselors, community and peers worked collaboratively in the intervention. The descriptive evidence provided in support of the treatment is promising and is reinforced by similar findings in the Hilton-Pitre study (Berger, 2011; Hilton-Pitre, 2007). Additionally, successful utilization of empowerment strategies by other adolescent group intervention designs targeted for the treatment of various youth populations maintains the adaptability of EGAS to a diverse population group format (Berger, 2011).


Bemak and colleagues (2005) were only able to use self-reported improvements to illustrate the effectiveness of the EGAS approach, and they limited their research to females. These limitations weaken the ability to generalize to other populations. The intervention in our study used empirical data to examine effectiveness and a control group. Our study also used a sample that included both females and males from more diverse backgrounds, which promoted the generalizability of this study to other populations. Each of the interventions designed to facilitate empowerment in adolescents was evaluated for efficacy, feasibility and ecosystemic suitability. EGAS was recommended for inclusion in the transition intervention.


School Engagement

Many terms define school engagement: school connectedness, school bonding, school attachment and school belonging (Berger, 2011; Boutelle, 2010; Caraway, Tucker, Reinke, & Hall, 2003; Catalano, Haggerty, Oesterle, Fleming, & Hawkins, 2004; Christenson & Anderson, 2002; Flower et al., 2011; Frydenberg, Care, Freeman, & Chann, 2009; Reschly & Christenson, 2006; Stout & Christenson, 2009).

Stout and Christenson (2009) suggested utilizing interventions designed to help students develop analytical skills and develop serviceable goals to increase academic performance. Behavioral engagement is an external indicator of school engagement that makes it directly observable by an array of indicators: attendance, time on tasks, classroom behavior, interpersonal relationships and participation (Berger, 2011; Jimerson et al., 2003; Stout & Christenson, 2009).


The transition to high school is a challenge for many students and is one of many developmental tasks for adolescents (Kayler & Sherman, 2009). Positive intrinsic motivation and positive self-attributes help adolescents achieve developmental tasks, such as academic achievement, transition to secondary school, forming close friendships and forming a sense of self. Kayler and Sherman (2009) implemented a psychoeducational study skills intervention with ninth-grade students whose academic performance was in the bottom 50th percentile (N = 90). The American School Counselor Association (ASCA) National Model was used as a framework for development, delivery and evaluation.


Kayler and Sherman found that a small group counseling intervention strengthened study behaviors. Increasing school counselor visibility and increasing positive relationships with parents and other stakeholders was also important to students’ success. The study skills program focused on three main skill sets that research has indicated contribute to improved academic performance: (a) cognitive and metacognitive skills, such as goal setting, time management and study skills; (b) social skills, including listening and teamwork; and (c) self-management skills, including motivation (Berger, 2011; Kayler & Sherman, 2009). The small group format permitted students to meet standards for the ASCA National Model in the academic, career, personal and social domains. Each theme of the ASCA National Model was expressed: leadership, collaboration, systemic change and most notably, advocacy (Kayler & Sherman, 2009).


Groups consisted of 12 students of both mixed gender and race and two counselors. The authors used a pretest-posttest study designed to evaluate the program. Data was collected utilizing the “How do you study?” survey (J. L. Lee & Pulvino, 2002) at both the second session and final session to evaluate the program’s effect on seven areas: time usage, persistence, organization, concentration, note-taking skills, reading skills and test-taking skills. Additionally, participants were asked for their input regarding the program at the final session. This study was implemented from a systemic perspective. School counselors collaborated with invested parties in the students’ lives, such as administration, families, peers, teachers and university partners. All of the systems were interactional and reflective of the ecosystemic approach. Posttest scores for all subscales were significantly higher than pretest scores, except in the area of concentration, signifying that students were using significantly more study skills after the program than before. Students’ GPAs also were compared and showed a significant increase in a number of individual students’ grades, but improvement was not significant overall. The authors discussed the possibility that GPAs were taken too soon after completion of the group and noted that there was no control group to offer a true comparison. The results of this study demonstrate that the use of study skills improved dramatically after participation in the group. Opening communication between students and parents was a significant outcome of the program (Kayler & Sherman, 2009), and provides evidence that utilization of a cognitive-behavioral grounded psychoeducational group to teach study skills can be effective (Berger, 2011; Kayler & Sherman, 2009). The intervention fits the needs of our target population. The study was conducted with ninth graders in the bottom half of their class; most students returning from alternative schools are true ninth graders or repeat ninth graders. Therefore, this intervention was recommended for inclusion in our final intervention.


EGAS and Kayler and Sherman’s psychoeducational study skills intervention encourage cultivation of self-regulation skills. One effective strategy in developing self-regulatory processes is goal setting (Bandura, 1991; Berger, 2011; Zimmerman, 2000). Short-term goals can be used to help students receive feedback success in a shorter time frame, which enables students to learn to adjust to meet desired goals (Berger, 2011). Goal setting as a group topic helps students learn from one another and understand other experiences while recognizing commonalities. Goal setting is a feature of the psychoeducational study skills intervention (Berger, 2011; Kayler & Sherman, 2009). Students who are empowered through the EGAS experience may increase confidence in their ability to employ self-regulation techniques in other areas of their lives (Bemak et al., 2005; Berger, 2011). This increased confidence may aid students in academic success.


Academic Success

     When students struggle to maintain positive academic self-perceptions, it can inhibit their abilities to succeed in academic environments. Inadequate academic competence has been shown to be the strongest predictor of high school dropout (Battin-Pearson et al., 2000; Berger, 2011; Newcomb et al., 2002). Goal setting, progress monitoring, memory skills, interpersonal skills, problem-solving skills, listening, teamwork, regulating attention, and regulating emotions and motivation are important skills that help facilitate students’ academic competence (Berger, 2011; Hattie, Biggs, & Purdie, 1996; Masten & Coatsworth, 1998). Berger (2011) reported that there are numerous variables that are attributed to academic success and related to students’ willingness and ability, including academic self-perception, cognitive ability, engagement, importance of education to the student, and academic self-identity. Longitudinal research has established correlations between early student behavioral patterns (i.e., absenteeism, lack of engagement, behavioral problems), academic performance and later dropping out of school (Alexander, Entwisle, & Kabbani, 2001; Archambault, Janosz, Morizot, & Pagani, 2009; Berger, 2011; Connell, Halpern-Felsher, Clifford, Crichlow, & Usinger, 1995; Fleming et al., 2005; Frydenberg et al., 2009).


Adult support is continuously present in research relating to dropout prevention interventions. Numerous studies have discussed the positive effect of adult support on academic achievement

(Berger, 2011; Blount, 2013; Croninger & Lee, 2001; Kayler & Sherman, 2009; Klem & Connell, 2004). Adult support may be given through teachers, administration, counselors, mentors and school staff. Students feel support when there is a caring relationship within the school context (Blount, 2012). Adult support is a key element of the interventions reviewed in either the form of group facilitators or one-on-one mentors or counselors (Bemak et al., 2005; Berger, 2011; Flower et al., 2011; Hilton-Pitre, 2007; Kayler & Sherman, 2009). The EGAS and the psychoeducational study skills intervention employ adult support through school counselors, facilitators, graduate interns and mentors. Therefore, our intervention included adult support in the form of group facilitators, mentors and a school advocate.


The three major variables of this study—youth empowerment, school engagement and academic success—were revealed in the literature and thus should be considered in the development of an intervention for transitioning at-risk youth. Youth empowerment helps youth explore positive self-variables. Empowerment enables youth to feel hopeful and confident in discovering roles during development. Empowerment shapes how youth interact with their entire environment, including their school environment, while facilitating attitudes and motivation. School engagement influences students’ attitudes, perceptions and feelings about school. School engagement also shapes youth behavior within the school context. Empowerment and school engagement are connected to academic success. The relationship of these variables is illustrated in Figure 1.


Figure 1. Variables connected to school success.


Based on the evaluation of research and the ability to fit in the parameters of this study, the decision was made to incorporate two interventions in our final treatment. Our final treatment was composed of a study skills intervention and an empowerment intervention. The intervention aimed to provide three foundational supports for the returning alternative academy students: group, mentor and advocate. The treatment was provided in a group format and students were supported by individual mentors and an advocate housed at their home school. Graduate student interns working toward their master’s, Ph.D. or Ed.S. degrees provided the mentoring. The advocate was a school counselor and designated point of contact in the home school system.


The group treatment consisted of two phases. The first phase was a psychoeducational study skills group consisting of six modules covered over 8 weeks: (a) goal setting, (b) self-regulation, (c) organizational strategies, (d) study strategies and directions, (e) note-taking strategies and (f) test-taking strategies/managing test anxiety. When Phase I was completed, students transitioned immediately into Phase II, the EGAS model developed by Bemak et al. (2005). Even though this model was originally implemented with African American students, it was chosen because often students with multiple risk factors can be marginalized and can benefit from empowerment (Berger, 2011), and a majority of students returning from the alternative academy were African American. During Phase II, students continued to meet weekly through the duration of the school year. The EGAS setting was student-driven in that students presented the topics while leaders facilitated the group discussion. Each week, the students chose as the group topic personal problems that impacted their academic success.


Ultimately, the four research questions guiding our investigation were: (1) What is the effect of a school-based youth intervention program on at-risk youth’s school attendance transitioning from an alternative educational setting to a traditional school setting as measured by number of periods absent? (2) What is the effect of a school-based youth intervention program on at-risk youth’s school disciplinary actions transitioning from an alternative educational setting to a traditional school setting as measured by number of discipline referrals? (3) What is the effect of a school-based youth intervention program on at-risk youth’s credit accrual transitioning from an alternative educational setting to a traditional school setting as measured by the percentage of classes passed? And (4) what is the effect of a school-based youth intervention program on at-risk youth’s school attitudes transitioning from an alternative educational setting to a traditional school setting as measured by the School Attitude Assessment Survey-Revised (SAAS-R)?




Procedure and Participants

A two-group pretest-posttest design, which included collecting data at two time points over the course of the school year, was utilized to investigate the effectiveness of the school-based transitional support intervention program on the youth’s attitudes and behavior. Prior to the recruitment of participants, we received approval from our university’s Institutional Review Board and from the school district to conduct the study. The setting for the treatment and control groups were in high schools in the southeastern United States. The high school within one school district with the highest number of expulsions was selected as the treatment site. The other high schools in the school district’s alternative school returnees were used as a control group for the study. The at-risk youth targeted for this study were students returning from at least a 45-day remanded period at the school district’s alternative academy. There were a total of 100 participants (N = 100), including 50 treatment and 50 control participants. Because of missing data, the sample size was reduced to 52 participants (N = 52). There were 24 participants (N = 24) in the treatment group and 28 participants (N = 28) in the control group. Although the initial sample was 100, with statistical listwise deletion the sample was reduced to 52. This study utilized a multivariate analysis of variance, an analysis that is unable to use datasets with missing data points because a likewise deletion is utilized (Pallant, 2016). When using listwise deletion, a case is dropped from an analysis because it has a missing value in at least one of the specified variables (e.g., attendance, grades, discipline, SAAS-R). When conducting research with this population, there is always the risk of not being able to obtain all needed data because a participant is no longer in the same school or school district.


The ethnicity of participants was as follows: 85% Black, 5% Hispanic, 6% White, 2% Multiracial and 2% Asian. Seventy-two percent of the participants were male and 28% were female. The ethnicity of the sample was aligned with the ethnicity of the students who attended the alternative school. The majority of students who attended the alternative school were Black. Sixty-eight percent of participants were receiving free lunch, 12% were receiving reduced fee lunch, and 20% were paying full lunch fees. The participants’ ages ranged from 14 to 19 years old. The demographics of the sample were representative of the alternative school demographics.


Recruitment of participants was facilitated through the alternative school exit interviews. All students exiting the alternative school must partake in an exit interview to ensure they have met all requirements to return to their home school. Parents and students were informed about the intervention program. They also were informed about which group the student would qualify to be in, which was determined by the home school the student attended. Parents and students were informed that students’ grades, attendance and behavioral information would be collected as part of an ongoing evaluation to determine the effectiveness of the program. Parents and students were made aware of the attitude assessments students would complete two separate times during the school year. They were provided with an information packet with consent forms, an explanation of the program and contact information. If consent was obtained, the participants were given the SAAS-R.


Behavioral and School Attitude Outcomes

The data collection packet consisted of one measure, the SAAS-R (McCoach & Siegle, 2002). The SAAS-R was administered during the exit process at the alternative school and after participants completed the intervention. In addition, the school district provided the attendance records (measured by individual class periods missed), discipline records (measured by discipline infractions [e.g., warnings, school suspension, out-of-school suspension, Saturday school detention]) and credit accrual (measured by the percentage of courses passed the school year prior to exiting the alternative school and the exiting school year) for the students in both the treatment and control groups.


     School Attitude Assessment Survey-Revised (SAAS-R). The SAAS-R (McCoach & Siegle, 2002) is a 35-question assessment with five subscales, including students’ academic self-perceptions, attitudes toward teachers, attitudes toward school, goal valuation and self-regulation. Students were assessed pre-treatment (pretest) and at the end of the school year and conclusion of the treatment group (posttest). Both groups were assessed pre-return to their home school during exit interviews (pretest), which served as the baseline pretest, and again at the end of the school year (posttest). Students answer the 35 questions on a 6-point Likert scale (1 = strongly disagree; 6 = strongly agree). Subscales were scored by totaling the response value of each question and then dividing that by the number of questions. The scores range from one to six. Scores of one to three suggest negative attitudes, and scores of four to six suggest positive attitudes (Berger, 2011; McCoach & Siegle, 2002; Suldo, Shaffer, & Shaunessy, 2008). McCoach and Siegle (2003) investigated the validity of the SAAS-R with 176 high school students while Suldo and colleagues (2008) investigated the validity of the SAAS-R with 321 high school students. Both found evidence of adequate construct validity, criterion-related validity and internal consistency reliability (McCoach & Siegle, 2002; Suldo et al., 2008).


Data Analysis

SAAS-R scores, attendance, discipline and credit accrual pre- and post-intervention data, and control data were entered into Statistical Package for the Social Sciences (SPSS Version 21) for analysis. Next, we screened for missing data. Then we conducted preliminary analyses to examine statistical assumptions (e.g., normality, outliers, linearity, homogeneity of regression, multicollinearity and singularity, and homogeneity of variance-covariance matrices). A repeated measures multivariate analysis of variance was performed to determine if there was a significant difference in participants’ school attitudes, credit accrual, discipline and attendance scores pre- and post- intervention intervals and control intervals (Pallant, 2016). Four dependent variables were used: SAAS-R (assessment), percentage of courses passed (credit and grade accrual), discipline referrals (incidents), and attendance. There were two forms of independent variables: treatment and control, and Time 1 and Time 2. Treatment and control were the between-subjects independent variables and Time 1 and Time 2 were the within-subjects independent variables. This study had four dependent variables (e.g., assessment, grades, incidents, attendance) and one grouping variable with two levels (time and control). The dataset should include more cases than dependent variables, which we satisfied (Pallant, 2016). The power analysis helped to decrease the probability of a Type II error (Balkin & Sheperis, 2011; Cohen, 1992; Faul, Erdfelder, Lang, & Buchner, 2007). For these reasons, a post hoc power analysis was conducted for the means of this study and established sufficient power for the overall model (.98).




There was no significant main effect due to treatment (time by treatment/control): Wilks’ Lambda = .890, F(4, 47) = 1.451, p = .232. However, the multivariate test did reveal a significant main effect for time: Wilks’ Lambda = .654, F(4,47) = 6.219, p < .001 (see Table 1.1). Because of the significant main effect for time, each dependent variable was investigated further by reviewing the univariate results. Examination of the simple effects indicated a significant difference between pre- and post-values for grades: F(1,50) = 13.178, p < .001. Both treatment and control grades decreased between pre- and post-grades. The simple effects indicated a significant difference in pre- and post-values for discipline: F(1,50) = 6.206, p < .05. Both treatment and control had a decrease in discipline referrals between pre- and post-values. All univariate effects are reported in Table 1.2. Overall multivariate results revealed that time was significant and time by treatment and control was not significant. The test of between-subjects effects results show that there was a significant effect of treatment on SAAS-R: F(1,50) = 5.159, p < .027. All between-subjects univariate effects are reported in Table 1.3. The effect of treatment on SAAS-R revealed a significant result, which indicated that participants who received the intervention scored higher on the SAAS-R at the end of the school year. The participants in the treatment group had higher attitudes toward school than the participants who did not receive the intervention.


Table 1.1


Multivariate Effects

Wilks’ Lambda







Time by Treatment/Control







Table 1.2


Univariate Effects for Time 1 and Time 2

Dependent Variables

Mean Square
















Error   11698.959




*Significant (p < .05)




Table 1.3


Between-Subjects Effects for Treatment and Control

Dependent Variables

Mean Square



Assessment   5268.134







Discipline         11.385



Attendance    1210.554



*Significant (p < .05)






Implications for Practice

The aim of this study was to determine the effect of a school-based youth intervention program on the attitudes and behavioral patterns of at-risk youth. The intervention did not have an effect on the youth’s school attendance. There was no significant difference between the treatment and control groups. Overall there was an increase in the number of periods missed for both the treatment and control groups. One of the most important predictors of academic success is remaining engaged in academic instruction (Berger, 2011; Kelchner, 2015); thus, if students are missing classes, they also are missing instructional time. After transitioning back to the traditional school setting, the participants’ attendance decreased, resulting in less time in the classroom to receive academic instruction and ultimately lower grades. Results from other research support these findings. Students who are regularly absent from school have less than a 10% chance of graduating and are disengaged, creating academic and behavioral issues (Allensworth & Easton, 2007). Students who are suspended or expelled are at greater risk of not going to classes and dropping out of school (Brownstein, 2010; T. Lee et al., 2011; Smith & Harper, 2015). Even though the intervention was not found to have an effect on attendance, the percentage of students remaining in school who attended the alternative school was higher than the percentage of students remaining in school the year prior to implementing the intervention. In the school year prior to the intervention, 59% of students returning from the alternative school setting to the home school were no longer in school at the end of the year. At the end of the school year after the intervention took place, the number of students returning from the alternative school setting that were no longer in school was reduced to 14%.


Other researchers have found that students returning from alternative school placement may have the tendency to revert back to prior negative behaviors, resulting in reoccurring suspension (Richardson, 2012; Stone, 2003; Wolf & Wolf, 2008). Many students return to the alternative school or end up in more restrictive placements like juvenile detention or jail (Berger, 2011; Richardson, 2012; Stone, 2003). This intervention had no significant effect on discipline. However, there was a decrease in the number of discipline referrals from Time 1 to Time 2. Both the treatment and control groups experienced a decrease in the number of discipline referrals received. The researcher met the control group participants during exits and established a relationship with the participants. This could have contributed to gains the controls made simply because the participants may have felt someone cared about them. It is important to find ways to sustain positive gains when students leave an alternative school setting. This can be facilitated via support through the transition from alternative educational setting to the traditional school setting (Berger, 2011; Stone, 2003; Valore et al., 2006; Wolf & Wolf, 2008).


The participants in the treatment and control group did not exhibit gains in credit accrual. This finding is supported by other research. School transitions are associated with absenteeism, re-suspensions, disengagement to the school community and poor academic performance (Berger, 2011; Richardson, 2012; Stone, 2003; Wolf & Wolf, 2008). School transition also can affect social relationships that enhance academic accomplishments (Richardson, 2012; Stone, 2003). It is difficult for some students to re-integrate in a traditional school setting and do well academically. The decrease in credit accrual may be a reflection of this difficulty.


What our intervention did obtain was a positive effect on school attitudes as measured by the SAAS-R. There was a significant effect of treatment on assessments. The control group assessment scores remained almost exactly the same, whereas the treatment group assessments scores increased. This is an indication of more positive attitudes toward school. One component of the intervention was empowerment. Empowerment shapes how youth interact with their environment and facilitates improvement in attitudes and motivation (Berger, 2011). Interventions that promote empowerment promote positive self-perception and help develop self-esteem (Berger, 2011; Thomas, Townsend, & Belgrave, 2003). Another component of the intervention was engagement. Participants in the treatment group were taught strategies to facilitate engagement. School engagement influences students’ attitudes (Stout & Christenson, 2009). The increase in the assessment scores within the treatment group is reflective of this. The treatment group was given the assessment at the end of the year by facilitators and mentors the participants had developed a relationship with. This could be a reason the participants had higher scores. They may have better attitudes toward school because they have someone they know who cares about them and they interact with this mentor at least twice a week, if not more often (during group sessions and during individual counseling sessions). Supportive relationships can help promote students’ success in school (Berger, 2011; Richardson, 2012; Stone, 2003). Our findings lend support for the use of school-based transactional supports for youth returning to a traditional education environment from an alternative school to increase positive school attitudes.


Limitations of the Study

     Although measures were taken to ensure the fidelity of the study, there were limitations because of the nature of the research. An important strength of the study was the fact that it was effectiveness research in a real-world, everyday setting (Singal, Higgins, & Waljee, 2014). The sample used in this research is a community sample and the intervention took place in an actual school setting. The nature of this setting creates limitations because a number of factors were out of the researchers’ control and created an inability to control for any independent variables. When conducting research with this population, there is always a risk of not being able to obtain all needed data because some participants are no longer in the same school or school district, reflecting a high attrition rate. This resulted in incomplete data sets and drastically reduced our sample size. Overall, this sample is not representative of the entire population because it was studied in one school district in the southeastern United States, which may have unique qualities as compared to other school districts and high schools. Lastly, fidelity can be a challenge in research. The intervention delivery involved several people. Even though every measure was taken to properly train facilitators and oversee all aspects of the research, fidelity in this area may have been an issue.


Recommendations for Future Research

Previous researchers have neglected to look at the most effective way to support youth transitioning from an alternative school setting back to a traditional education setting. There is research on youth who are involved in the juvenile justice system, but researchers have neglected to investigate youth who are transitioning to traditional educational settings and who are not engaged with the justice system. Often, students who have been placed up for expulsion or received out-of-school suspensions will inevitably become a part of the juvenile justice system (Berger, 2011; Blount, 2012; Kelchner, 2015). This research has demonstrated to some extent the importance of developing caring relationships with youth. The intervention employed in this study facilitated a change in the school attitudes of at-risk youth. The results provide evidence for the need for more research in the area of interventions to prevent school dropout or reduce justice system involvement, creating an environment in which fewer youth would end up incarcerated.


Our utilized intervention included empowerment strategies to encourage youth to feel connected with others in school and the community. Adult support through facilitators, mentors and advocates helps to change school attitudes with at-risk youth transitioning back to the traditional educational setting. Adult support creates positive effects on academic achievement for at-risk youth (Berger, 2011; Blount, 2012; Croninger & Lee, 2001; Kayler & Sherman, 2009; Klem & Connell, 2004).


In summary, this study of high school youth returning from an alternative school environment to a traditional school setting found that school-based transitional support intervention was effective in changing school attitudes of at-risk youth. There is a great need for additional research to investigate ways to support this vulnerable population, but this study is a step in the right direction.


Conflict of Interest and Funding Disclosure

Data collected in this study was part of a

dissertation study and was supported through

a partnership with Richland School District

Two and Family Intervention Services. The

dissertation was awarded the 2016 Dissertation

Excellence Award by the National Board

for Certified Counselors.






Alexander, K. L., Entwisle, D. R., & Kabbani, N. S. (2001). The dropout process in life course perspective: Early risk factors at home and school. Teachers College Record, 103, 760–822. doi:10.1111/0161-4681.00134

Allensworth, E., & Easton, J. Q. (2007). What matters for staying on-track and graduating in Chicago public high schools: A close look at course grades, failures and attendance in the freshman year. Chicago, IL: Consortium on Chicago School Research.Retrieved from

Archambault, I., Janosz, M., Morizot, J., & Pagani, L. (2009). Adolescent behavioral, affective, and cognitive engagement in school: Relationship to dropout. Journal of School Health, 79, 408–415.

Axelrod, M. I., Zhe, E. J., Haugen, K. A., & Klein, J. A. (2009). Self-management of on-task homework behavior: A promising strategy for adolescents with attention and behavior problems. School Psychology Review, 38, 325–333.

Balkin, R. S., & Sheperis, C. J. (2011). Evaluating and reporting statistical power in counseling research. Journal of Counseling & Development, 89, 268–272. doi:10.1002/j.1556-6678.2011.tb00088.x

Bandura, A. (1991). Social cognitive theory of self-regulation. Organizational Behavior and Human Decision Processes, 50, 248–287. doi:10.1016/0749-5978(91)90022-L

Battin-Pearson, S., Newcomb, M. D., Abbott, R. D., Hill, K. G., Catalano, R. F., & Hawkins, J. D. (2000). Predictors of early high school dropout: A test of five theories. Journal of Educational Psychology, 92, 568–582.

Bemak, F., Chung, R. C.-Y., & Siroskey-Sabdo, L. A. (2005). Empowerment groups for academic success: An innovative approach to prevent high school failure for at-risk, urban African American girls. Professional School Counseling, 8, 377–389.

Berger, K. C. (2011). A research utilization project: Implementation of an evidence-based behavioral treatment for students at-risk of dropout at Richland Northeast High School (Doctoral dissertation). Retrieved from Proquest. (3454672)

Blount, T. (2012). Dropout prevention: Recommendations for school counselors. Journal of School Counseling, 10(16).

Blythewood Academy. (2013). Program requirements. Retrieved fromz


Boutelle, M. (2010). Pooling resources reduces number of dropouts. Education Digest: Essential Readings Condensed for Quick Review, 75(5), 50–55.

Brownstein, R. (2010). Pushed out. Education Digest: Essential Readings Condensed for Quick Review, 75(7), 23–27.

Caraway, K., Tucker, C. M., Reinke, W. M., & Hall, C. (2003). Self-efficacy, goal orientation, and fear of failure as predictors of school engagement in high school students. Psychology in the Schools, 40, 417–427. doi:10.1002/pits.10092

Catalano, R. F., Haggerty, K. P., Oesterle, S., Fleming, C. B., & Hawkins, J. D. (2004). The importance of bonding to school for healthy development: Findings from the Social Development Research Group. Journal of School Health, 74(7), 252–261. doi:10.1111/j.1746-1561.2004.tb08281.x

Chinman, M. J., & Linney, J. A. (1998). Toward a model of adolescent empowerment: Theoretical and empirical evidence. The Journal of Primary Prevention, 18, 393–413. doi:10.1023/A:1022691808354

Christenson, S. L., & Anderson, A. R. (2002). Commentary: The centrality of the learning context for students’ academic enabler skills. School Psychology Review31, 378–393.

Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159. doi:10.1037/0033-2909.112.1.155
Conley, B. (2002). Alternative schools: A reference handbook. Santa Barbara, CA: ABC-CLIO.

Connell, J. P., Halpern-Felsher, B. L., Clifford, E., Crichlow, W., & Usinger, P. (1995). Hanging in there: Behavioral, psychological, and contextual factors affecting whether African American adolescents stay in high school. Journal of Adolescent Research, 10, 41–63. doi:10.1177/0743554895101004

Cooper, P., & Upton, G. (1990). An ecosystemic approach to emotional and behavioural difficulties in schools. Educational Psychology, 10, 301–321. doi:10.12691/education-1-9-1

Croninger, R. G., & Lee, V. E. (2001). Social capital and dropping out of high school: Benefits to at-risk students of teachers’ support and guidance. Teachers College Record, 103, 548–581. doi:10.1111/0161-4681.00127

Diganth, C., Buettner, G., & Langfeldt, H.-P. (2008). How can primary school students learn self-regulated learning strategies most effectively? A meta-analysis on self-regulation training programmes. Educational Research Review, 3, 101–129. doi:10.1016/j.edurev.2008.02.003

Duckworth, A. L., & Seligman, M. E. P. (2005). Self-discipline outdoes IQ in predicting academic performance of adolescents. Psychological Science, 16, 939–944. doi:10.1111/j.1467-9280.2005.01641.x

DuPaul, G. J., & Eckert, T. L. (1997). The effects of school-based interventions for attention deficit hyperactivity disorder: A meta-analysis. School Psychology Review, 26, 5–27.

Fleming, C. B., Haggerty, K. P., Catalano, R. F., Harachi, T. W., Mazza, J. J., & Gruman, D. H. (2005). Do social and behavioral characteristics targeted by preventive interventions predict standardized test scores and grades? Journal of School Health, 75, 342–349. doi:10.1111/j.1746-1561.2005.00048.x

Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175–191. doi:10.3758/BF03193146

Flower, A., McDaniel, S.C., & Jolivette, K. (2011). A literature review of research quality and effective practices in alternative education settings. Education and Treatment of Children, 34, 489–510. doi:10.1353/etc.2011.0038

Frydenberg, E., Care, E., Freeman, E., & Chan, E. (2009). Interrelationships between coping, school connectedness and wellbeing. Australian Journal of Education, 53, 261–276. doi:10.1177/000494410905300305

Hattie, J., Biggs, J., & Purdie, N. (1996). Effects of learning skills interventions on student learning: A meta-analysis. Review of Educational Research, 66, 99–136.

Hilton-Pitre, T. Y. (2007). Counseling minority adolescent girls in a predominately White middle school setting: Perceptions of Empowerment Group for Academic Success (EGAS) model (Doctoral dissertation). Retrieved from ProQuest. (304861985)

Jimerson, S. R., Campos, E., & Greif, J. L. (2003). Toward an understanding of definitions and measures of school engagement and related terms. The California School Psychologist, 8, 7–27. doi:10.1007/BF03340893

Kayler, H., & Sherman, J. (2009). At-risk ninth-grade students: A psychoeducational group approach to increase study skills and grade point averages. Professional School Counseling, 12, 434–439.

Kelchner, V. P. (2015). The effect of a school-based youth intervention program on at-risk youth’s school attitudes and behavior returning from an alternative school setting to a traditional school setting (Doctoral dissertation). Retrieved from ProQuest. (1690276858)

Kim, J.-H. (2006). For whom the bell tolls: Conflicting voices inside an alternative high school. International Journal of Education & the Arts, 7(6), 1–21.

Klem, A. M., & Connell, J. P. (2004). Relationships matter: Linking teacher support to student engagement and achievement. Journal of School Health, 74, 262–273. doi:10.1111/j.1746-1561.2004.tb08283.x

Lee, J. L., & Pulvino, C. J. (2002). Self-exploration inventories: 16 reproducible self-scoring instruments (3rd ed.). Minneapolis, MN: Education Media Corporation.

Lee, T., Cornell, D., Gregory, A., & Fan, X. (2011). High suspension schools and dropout rates for Black and White students. Education and Treatment of Children, 34, 167–192. doi:10.1353/etc.2011.0014

Levin, H. M. (2009). The economic payoff to investing in educational justice. Educational Researcher, 38, 5–20. doi:10.3102/0013189X08331192

Masten, A. S., & Coatsworth, J. D. (1998). The development of competence in favorable and unfavorable environments: Lessons from research on successful children. American Psychologist, 53, 205–220. doi:10.1037/0003-066X.53.2.205

McCoach, D. B., & Siegle, D. (2002). The School Attitude Assessment Survey-Revised: A new instrument to identify academically able students who underachieve. Educational and Psychological Measurement63, 414–429. doi:10.1177/0013164403063003005

National Center of Educational Statistics. (2016). The condition of education 2016. Retrieved from

Newcomb, M. D., Abbott, R. D., Catalano, R. F., Hawkins, J. D., Battin-Pearson, S., & Hill, K. (2002). Mediational and deviance theories of late high school failure: Process roles of structural strains, academic competence, and general versus specific problem behaviors. Journal of Counseling Psychology, 49, 172–186. doi:10.1037/0022-0167.49.2.172

Pallant, J. (2016). SPSS survival manual: A step by step guide to data analysis using SPSS (6th ed.). Maidenhead, UK: Open University Press/McGraw-Hill.

Prior, N. (2010). Alternative education and juvenile delinquency (Doctoral dissertation). Retrieved from ProQuest. (877950658)

Reschly, A. L., & Christenson, S. L. (2006). Prediction of dropout among students with mild disabilities: A case for the inclusion of student engagement variables. Remedial and Special Education, 27, 276–292.

Richardson, T. (2012). An examination of school re-enrollment procedures for juvenile offenders re-entering urban school districts in southern New England: Implications for school leaders delinquency (Doctoral dissertation). Retrieved from ProQuest. (961696398)

Rumberger, R., & Lim, S. (2008). Why students drop out of school: A review of 25 years of research. (Policy Brief No.15). Santa Barbara, CA: California Dropout Research Project, An Affiliated Project of the University of California Linguistic Minority Research Institute, UC Santa Barbara, Gevirtz Graduate School of Education.

Singal, A. G., Higgins, P. D. R., & Waljee, A. K. (2014). A primer on effectiveness and efficacy trials. Clinical and Translational Gastroenterology, 5(45), 1–4. doi:10.1038/ctg.2013.13

Smith, E., J., & Harper, S. R. (2015). Disproportionate impact of K–12 school suspension and expulsion on Black students in southern states. Philadelphia, PA: University of Pennsylvania, Center for the Study of Race and Equity in Education. Retrieved from

Stone, P. J. (2003). At-risk youth: Making the transition from alternative high school settings to regular high schools (Doctoral dissertation). Retrieved from ProQuest. (3073573)

Stout, K. E., & Christenson, S. L. (2009). Staying on track for high school graduation: Promoting student engagement. The Prevention Researcher, 16(3), 17–20.

Suh, S., Suh., J., & Houston, I. (2007). Predictors of categorical at-risk high school dropouts. Journal of Counseling & Development, 85, 196–203. doi:10.1002/j.1556-6678.2007.tb00463.x

Suldo, S. M., Shaffer, E. J., & Shaunessy, E. (2008). An independent investigation of the validity of the School

Attitude Assessment Survey-Revised. Journal of Psychoeducational Assessment, 26, 69–82. doi:10.1177/0734282907303089

Thomas, D. E., Townsend, T. G., & Belgrave, F. Z. (2003). The influence of cultural and racial identification on the psychosocial adjustment of inner-city African American children in school. American Journal of Community Psychology, 32, 217–228. doi:10.1023/B:AJCP.0000004743.37592.26

Valore, T. G., Cantrell, M. L., & Cantrell, R. P. (2006). Preparing for passage. Preventing School Failure, 51, 49–54.

Wolf, E. M., & Wolf, D. A. (2008). Mixed results in a transitional planning program for alternative school students. Evaluation Review, 32, 187–215. doi:10.1177/0193841X07310600

Zimmerman, B. J. (2000). Self-efficacy: An essential motive to learn. Contemporary Educational Psychology, 25, 82–91. doi:10.1006/ceps.1999.1016


Viki Kelchner, NCC, is an Assistant Professor at the University of Central Florida.  Kathy Evans is an Associate Professor at the University of South Carolina. Kathrene Brendell is Clinical Assistant Professor at the University of South Carolina. Danielle Allen is a Licensed Marriage and Family Therapist in Columbia, South Carolina. Cassandre Miller is a graduate student at Syracuse University. Karen Cooper-Haber is a Licensed Marriage and Family Therapist at Lexington Five School District in Columbia, South Carolina. Correspondence can be addressed to Viki Kelchner, Department of Child, Family and Community Sciences, College of Education, P.O. Box 161250, Orlando, FL 32816-1250,

Parent–Child Interaction Therapy for Children With Special Needs

Carl Sheperis, Donna Sheperis, Alex Monceaux, R. J. Davis, Belinda Lopez

ParentChild Interaction Therapy (PCIT) is an evidence-based method for reducing disruptive behavior in children and improving parent management of behavior. PCIT is a form of behavioral intervention that can be used in clinical, home and school settings. Although initially designed for intervention related to oppositional defiant disorder and conduct disorder, PCIT has been found to be a promising intervention for addressing behavioral issues among children with special needs. We present methods, research-based instructions and a case example of PCIT with a child diagnosed with autism. This article is intended to assist professional counselors in designing appropriate interventions for both children and parents.

Keywords: autism, parent–child interaction therapy, special needs, behavioral intervention, case example

Counseling techniques for children stem from a myriad of theoretical perspectives, and professional counselors are often in the unique position to provide systems intervention and training to families when a child has disruptive behavior. Despite the seniority of behaviorism in the field of psychology, behavioral family approaches have only recently been acknowledged as an effective practice in professional counseling. According to Gladding (2011), the following three premises underlie behavioral family counseling: (a) all behaviors are learned, (b) maladaptive behaviors are the target for change and (c) not everyone in the family has to be treated for change to occur. With these assumptions, it is easily deduced that the following also are true: (a) behavior can be unlearned and that new behaviors can be taught, (b) underlying, unresolved issues are not the key components of treatment, and (c) positive changes for one family member will impact the entire family system and surrounding ecology.

When working with children of preschool or early elementary age, it is important to directly involve the child’s caregivers. Parents’ influence on their children is significant and some parenting practices may exacerbate some children’s problems (McNeil & Hembree-Kigin, 2010). Behavioral family counseling models recognize the relationship between the child’s behavior and the family system. One behavioral family counseling technique, Parent-Child Interaction Therapy (PCIT), helps families work together with their children in reaching therapeutic goals. PCIT involves teaching parents some fundamental relationship-building strategies, including therapeutic play techniques for parents to use in the home environment (Johnson, Franklin, Hall, & Prieto, 2000). The clinician typically teaches and models PCIT techniques for the parents over the course of 8–10 weeks.

The purpose of this article is to demonstrate the practicality of PCIT as a component of behavioral family counseling, to facilitate the professional counselor’s understanding of the model through a review of PCIT and to illustrate the utility of this model for children with special needs through a case study.


An Overview of PCIT

PCIT (Neary & Eyberg, 2002) is an assessment-driven form of behavioral parent training designed for families with preschool-aged children. We present a brief overview of PCIT, define the key components integral to the process, provide the framework for implementation and discuss the application of PCIT to special populations. The core of PCIT is twofold—to create nurturing parent–child relationships and to model prosocial behaviors while increasing a child’s appropriate, compliant behaviors (Eyberg & Boggs, 1989). Play therapy skills are introduced to parents within the PCIT model to enhance the relationship between the parent and child. Additionally, PCIT cultivates problem-solving skills with parents who can then generalize gains made in the therapeutic milieu into the family environment. Similar to other models of family counseling, PCIT begins with the assessment process. Counselors using PCIT collect psychosocial information from the family through either structured or semistructured clinical interviews. Because PCIT is a behavioral model, family dynamics also are assessed through direct observation of clients. Once clinical interview and observational data are collected and evaluated, the counselor can explore family relationship dynamics.

PCIT counselors attempt to identify family roles, interactions and maladaptive disciplinary techniques (e.g., yelling, lack of follow-through, unrelated consequences) inherent in the system. The ultimate goal of these observations is to derive methods for replacing current ineffective parenting strategies with more adaptive ones, thus creating greater stability in the family system. Similar to other parenting approaches, family counselors using PCIT offer support and assistance in improving parent–child relationships without placing blame on the child or the parents (Webster-Stratton & Herbert, 1993).


The Benefits of PCIT

There are many benefits to PCIT; it is a brief, short-term family counseling procedure that teaches effective parenting skills and helps parents interact better with their children on a daily basis. Fundamentally, PCIT’s two-tailed approach benefits both parents and children (Asawa, Hansen, & Flood, 2008) by reducing the internalization of problems and parent–child stress. Additionally, PCIT empowers parents through teaching positive interactive techniques that build parent–child rapport. PCIT fosters creativity and increases child self-esteem, decreases noncompliance or disruptive behavior, and increases the quality of parent-provided positive regard through developmentally appropriate play (Eyberg et al., 2001). These positive interactions effectively decrease problem behavior, resulting in a reduction or elimination of emergency counseling visits. One PCIT study reported that only 19% of participants in a randomized controlled trial with physically abusive parents re-reported physical abuse more than 2 years after the implementation of the PCIT model (Chaffin et al., 2004).

While PCIT sessions may focus on home and play, the behavioral skills that the parent learns can be generalized to other children and additional settings, building stronger interactions across a spectrum of familial and social settings. According to Urquiza and Timmer (2012), PCIT focuses on the following three essential non-fixed elements: (a) increased positive parent–child interaction and emotional communication skills, (b) appropriate and consistent discipline methods, and (c) direct scaffolding for parent training in the interventions. Thus, once the parent has mastered these skills in the session with the child and therapist, the parent is able to transfer the skills to any location or setting to maintain positive interactions, emotional communication and disciplinary consistency with the child.


The Effectiveness of PCIT

Eyberg and her colleagues have researched and published extensively on the efficacy of PCIT and have empirically supported the effectiveness of PCIT with children exhibiting a range of behavioral and emotional problems (Neary & Eyberg, 2002). Specifically, PCIT has proven effective with problems including attention-deficit/hyperactivity disorder (ADHD), conduct disorders, separation anxiety, depression, postdivorce adjustment, self-injurious behavior and abuse (Eyberg et al., 2001; McNeil & Hembree-Kigin, 2010). For example, Nieter, Thornberry, and Brestan-Knight (2013) conducted a pilot study with 17 families completing PCIT treatment and found a significant decrease in disruptive child behaviors as well as a decrease in inappropriate parent behaviors over the 12-week group program. This study was the first to deliver PCIT via group sessions. The researchers found that treatment effects remained in place for more than 6 months after the group’s completion.

Eyberg et al. (2001) investigated long-term treatment outcomes of PCIT for families of preschoolers with conduct disorders over a period of 1–2 years, and found that treatment effects were sustained over time. According to the researchers, the study was the first of its kind to include long-term follow-up with families receiving PCIT treatment (Eyberg et al., 2001). Hood and Eyberg (2003) established further evidence in another follow-up study on PCIT treatment effects over a period of 3–6 years. In the study of treatment effects on families with young children diagnosed with oppositional defiant disorder, the researchers found that treatment effects and behavioral change were again sustained over time. Thomas and Zimmer-Gembeck (2007) conducted a review of behavior outcomes in 24 studies on PCIT and another parenting intervention, Triple P—Positive Parenting Programs. All of the studies involved children aged 3–12 and their caregivers. Meta-analyses revealed positive effects for PCIT as well as the other intervention, adding support within the literature on the efficacy of PCIT.

To demonstrate the effectiveness of PCIT for treating ADHD, Guttmann-Steinmetz, Crowell, Doron, and Mikulincer (2011) examined the interactions of children with ADHD and their mothers. Their findings suggest that while Behavior Parent Training is useful in managing ADHD, PCIT may be highly effective in impacting the attachment-related processes during the child’s later developmental stages. These researchers suggested that parents’ successful adaptation of PCIT’s verbal and behavioral skills during interaction with their child might increase the child’s sense of security.

The effectiveness of PCIT has been expanded to other disorders such as separation anxiety. For example, Choate, Pincus, Eyberg, and Barlow (2005) conducted a pilot study involving three families with children 4–8 years of age diagnosed with separation anxiety disorder. The researchers found that the child-directed activities fostered children’s sense of control and reduced separation anxiety symptomology to normative levels by the conclusion of treatment. Again, the treatment effects were shown to persist long after treatment ceased. This study was replicated by Anticich, Barrett, Gillies, and Silverman (2012), providing further support of PCIT’s effectiveness in alleviation of separation anxiety disorder symptomology.

Individuals or populations with special needs also appear to respond positively to PCIT. Bagner and Eyberg (2007) found that mothers of young children diagnosed with mental retardation and oppositional defiant disorder reported a reduction in disruptive behaviors, increased compliance and less parenting stress after participating in a randomized, controlled trial study utilizing PCIT. PCIT also has been cited as a promising evidence-based intervention for autism (Agazzi, Tan, & Tan, 2013). Solomon, Ono, Timmer, and Goodlin-Jones (2008) conducted a randomized trial of PCIT for treating autism and found the same results as researchers studying other disorders have. PCIT was shown to reduce behavioral disruptions, increase adaptability and increase positive parental perceptions of child behavior. While PCIT was originally developed to address behavioral disorders, it clearly serves as an intervention for various other disorders that impact parent–child interactions.


The impact of PCIT on parents. PCIT has been shown to have equally effective outcomes for parent-related issues as it does for child behavioral disruptions. For example, Luby, Lenze, and Tillman (2012) reported highly favorable results for using PCIT to reduce behavioral disruptions and improve executive function among preschoolers. However, PCIT also showed significant effects for parents. Specifically, PCIT interventions helped to reduce depression severity and parenting stress while increasing emotion recognition. Furthermore, Urquiza and Timmer (2012) found that parental depression decreases the likelihood that the child will complete the treatment course. However, if the parents are persuaded to continue until completion, their own psychological symptoms may be relieved.

PCIT has been shown to have positive effects on parents in a variety of circumstances. For example, Baker and Andre (2008) suggested that PCIT might offer a unique and promising advantage in the treatment of postdivorce adjustment issues in children. PCIT also has been found to be effective in working with abusive parents, many of whose histories included depression, substance abuse and violent behavior (Chaffin et al., 2004). Although still effective in reducing parenting stress and child behavior problems, Timmer et al. (2011) found that PCIT was less effective in foster parent homes than in non-foster parent homes. While PCIT is clearly an effective intervention for both children and parents, in cases with complex systems like foster care placement and abuse, PCIT could be used in conjunction with other interventions. The same is true for clients with special needs.

Diverse population efficacy. Although we recognize that one size does not fit all, PCIT has shown significant results with ethnic minorities and underserved populations. Different cultural and ethnic group parenting styles (strict vs. relaxed styles) vary across the United States. In addition to effectively increasing positive parenting behaviors and deceasing behavioral problems in children, treatment outcomes and efficacy studies support the notion that PCIT is culturally effective and produces robust modifications among diverse groups (see Bagner & Eyberg, 2007; Borrego, Anhalt, Terao, Vargas, & Urquiza, 2006; Matos, Torres, Santiago, Jurado, & Rodríguez, 2006; McCabe & Yeh, 2009). Additional literature and empirical research is available for review regarding work with specific populations such as African Americans and Asians. There also is promising evidence pointing to PCIT’s efficacy in populations exhibiting neurological and behavioral disorders such as autism (Tarbox et al., 2009).

Efficacy through translation. Matos et al. (2006) conducted research in Puerto Rico with parents of children aged 4–6 with ADHD. The manual and handouts were translated into Spanish with a few modifications. Results showed significant decreases in behavior problems and hyperactivity. A recent follow-up study using the culturally adapted version further revealed that significant and robust outcome measures resulted from large treatment effect sizes. Mothers reported reductions in “hyperactivity-impulsivity, inattention, and oppositional defiant and aggressive behavior problems, as well as a reduced level of parent-child related stress and improved parenting practices” (Matos, Bauermeister, & Bernal, 2009, p. 246). Additionally, in a single-case study with a Spanish-speaking foster mother and a 3-year-old Mexican-Chilean-Filipina child, PCIT proved to be effective; reports from other family members noted substantive behavior improvement (Borrego et al., 2006). Thus, we can deduce that PCIT can be used effectively across cultural groups.


Key Components

There are three main components of PCIT: child-directed interaction (CDI), parent-directed interaction (PDI) and cleanup. Depending on the session being held, the components are presented in 5-minute segments with varying degrees of parent control required. CDI is characteristically the first stage in PCIT. Similar in approach to filial play therapy, this first stage creates an opportunity to strengthen the parent–child relationship. Because PCIT is utilized in the context of dyadic play, it is conducted in a room conducive to play (McNeil & Hembree-Kigin, 2010). Thus, a room designated for CDI should contain a variety of toys, crayons, paper, modeling compounds and other developmentally appropriate activities for a child. As with other play techniques, in order to give children the opportunity to determine the rules by which they will play, games with rules are generally excluded from a CDI playroom. Children engaged in CDI should be allowed to play with any or all of the items in the room. Encouraging free play indicates to the child that he or she is the creator of the play, not the caregiver. This approach allows the time to truly be child-directed.

Within CDI, the establishment of a positive therapeutic relationship is a crucial step in building a foundation for the introduction of compliance training. Compliance training is simply teaching a child to mind or comply over a period of time, through small compliance goals set by the parents. To lay the groundwork for this process during CDI, the parents are instructed to praise, reflect, imitate and describe their child’s play, while not asking questions, placing demands or criticizing the activities that transpire unless harmful to the child (McNeil, Eyberg, Eisentadt, Newcomb, & Funderburk, 1991).

Another essential concept introduced during CDI, includes fostering the enthusiasm and willingness of the parent. Although responding positively to a child’s free play during CDI may appear simple, parents often need considerable practice to master this response set. For example, one of the toys in our clinic is a Mr. Potato Head. Young children can be very creative in their placement of the various accessories that come with the toy. Often they will place an arm on top of the head, lips on the ear hole or eyes over the mouth hole. In PCIT, we view this action as an expression of creativity. However, when we observe parents in free play with their children, we often witness the parents limiting their children’s creativity by redirecting the placement of the appendages on Mr. Potato Head. Parents often say, “No, honey, the lips go here,” or “That’s not where the arms go.” Instructing parents to refrain from making such comments is generally all that a PCIT counselor needs to do. PCIT counselors understand that this is a difficult skill for most parents to master, and they teach parents the acronym PRIDE for use during CDI as well as other elements of PCIT. PRIDE simply stands for praise, reflection, imitation, description and enthusiasm (Eyberg, 1999). Table 1 provides some practical examples of desired responses from parents during CDI using the PRIDE approach.

Table 1

Responses Using PRIDE model



Praise Parent: “Thank you for putting away the toys.”
Reflection Child: “I’m drawing a dinosaur.”Parent: “I see. You are drawing a dinosaur.”
Imitation Child is playing with a car. Parent gets a similar car and begins playing in the same manner.
Description Child is playing with a toy airplane. Parent says, “You are making the airplane fly.”
Enthusiasm Parent: “Wow. Your drawing is very creative.”


In the second stage of PCIT, PDI usually is initiated once parents master CDI. Mastery is evidenced during the child’s play by the parents exhibiting proper implementation of the PRIDE responses. PDI also is conducted in the playroom or room selected for CDI. PDI consists of teaching parents how to manage their child’s behavior and promoting compliance with parental requests (Bahl, Spaulding, & McNeil, 1999). Parents should understand that PDI is more difficult for children than CDI and will likely be challenging for both the child and parent. When beginning PDI, parents must understand the importance of appropriate discipline techniques and receive training in giving clear directions to their children. Because children require a great deal of structure, professional counselors emphasize the importance of consistency, predictability and follow-through in this training (McNeil & Hembree-Kigin, & 2010). In order to initiate compliance training, parents practice giving effective instructions to their child. McNeil and Hembree-Kigin (2010) offered several rules for giving good instructions as part of the parent training element of PDI that can be conceptualized in the following ways: Command Formation, Command Delivery and Command Modeling:

Command Formation

  1. Give direct commands for things you are sure the child can do. This increases the child’s opportunity for success and praise.
  2. Use choice commands with older preschoolers. This fosters development of autonomy and decision making. (e.g., “You can put on this dress or this dress” rather than “What do you want to wear?” or “Wear this”).
  3. Make direct commands. Tell the child what to do instead of asking whether they would like to comply (e.g., “Put on your coat”).
  4. State commands positively by telling child what to do instead of what not to do. Avoid using words such as “stop” and “don’t.”
  5. Make commands specific rather than vague. In doing so, the child knows exactly what is expected and it is easier to determine whether or not the child has been compliant.

Command Delivery

  1. Limit the number of commands given.
  • Some children are unable to remember multiple commands. The child’s opportunity for success and praise increases with fewer, more direct instructions given at a time.
  • When giving too many commands, parents have difficulty following through with consequences for each command. Additionally, the parent’s ignoring some minor behaviors may be best.
  1. Always provide a consequence for obedience and disobedience. Consequences are the quickest ways to teach children compliance. Consistency when providing consequences is the key to encouraging compliance.
  2. Use explanations sparingly. Some children would rather stall than know the answer. Avoiding the explanation trap prevents children from thinking they have an opportunity to talk their way out of it.

Command Modeling

  1. Use a neutral tone of voice instead of pleading or yelling. Interactions are more pleasant in this manner and the child learns to comply with commands that are given in a normal conversational voice.
  2. Be polite and respectful while still being direct. This models appropriate social skills and thus interactions are more pleasant.

After teaching parents to deliver effective instructions and allowing time for in vivo practice, professional counselors introduce appropriate discipline strategies to be used in PDI. The in vivo coaching model utilizes an observation room with a two-way mirror and the ability to for the counselor to communicate with the parent via microphone. The focus on training includes communication and behavior management skills with additional homework sessions (Urquiza & Timmer, 2012). In a study by Shanley and Niec (2010), parents who were coached via a bug-in-ear receiver with in vivo feedback during parent–child interactive play demonstrated rapid increases in positive parenting skills and interactions. Of these strategies, timeout is the most common as it is “a brief, effective, aversive treatment that does not hurt a child either physically or emotionally” (Eaves, Sheperis, Blanchard, Baylot, & Doggett, 2005, p. 252). Furthermore, Eaves et al. (2005) wrote that timeout benefits both children with problematic behaviors and those who view the technique being used on other children, in addition to those children and adolescents demonstrating developmental delays, psychiatric issues and defiance. However, for the parent to experience timeout’s full benefit, the technique must be appropriately and consistently administered. Eaves et al.’s (2005) article, “Teaching Time-Out and Job Card Grounding Procedures to Parents: A Primer for Family Counselors” is an excellent article on timeout and why it is an effective intervention.

All aspects of timeout are reviewed with the parents, such as the rationale for timeout, where timeout should take place in the home, what to do when the child escapes timeout, what to do if the child does not comply with timeout, the length of timeout, what should happen right before timeout and what should happen right after timeout. Parents receive written instructions illustrating each step of timeout and offering guidance on how to implement the procedure. These discipline strategies may not be necessary if a child is motivated to be compliant. Determining compliance is often a very hard decision for parents to make. According to McNeil and Hembree-Kigin (2010) there are several rules used to help parents determine compliance or noncompliance.

  1. Parents must be sure that the instructions are developmentally appropriate for the child. If the child is asked to bring the orange cup to the parent, one must know that the child can determine which cup is actually orange.
  2. Parents should know that the request is completely understood by the child. If there are any questions about this the parents should point or direct the child to help him or her fully understand the request.
  3. Parents should allow the child approximately 3 seconds to begin to attempt the task. If the child has not begun to attempt the task by this time it should be considered noncompliance.
  4. Parents should state the request only once. If the child pretends not to hear the request, this should be considered noncompliance.
  5. Parents should not allow the child to partially comply with instructions. If parents accept half-compliance then children will often repeat the negative behavior because they know they can get away with it.
  6. Parents should not respond to a child’s bad attitude in completing a request. As long as he or she completes the instruction, it is compliance.
  7. Parents should consider it compliance if a child does what is asked and then undoes what is asked. Compliance is compliance no matter how long it lasts.

When a parent determines that a child is compliant, verbal praise should be provided. This praise should be given immediately and focus on the child’s compliance. Parents are encouraged to practice the skills of giving good directions by delivering multiple commands to the child. These commands are given during the playtime and may include requests to hand things to the parent (e.g., “Give me the red block”) or play with certain toys (e.g., “Place the blue car in the box”). This activity allows the child to practice following directions, while also affording the parent the opportunity to practice praise (McNeil & Hembree-Kigin, 2010). The child begins to learn that when he or she follows directions, his or her parents are very appreciative and excited. After the small tasks are accomplished, parents begin to place demands on the child that are less desirable, such as cleaning up the toys or moving on to another task (McNeil & Hembree-Kigin, 2010). By assigning less desirable tasks, parents find themselves in a position to practice a timeout procedure with the child. The professional counselor is there to model timeout and coach the parents when practicing timeout.

The third and final component to consider is called cleanup, which occurs as part of PDI. This time during the PCIT process is exactly what one might think; it is intended to teach the child to clean up the toys at the end of the parent–child interaction in both the counseling and home milieus. Cleanup should be done without the parents’ help but with the parents’ direction. Although this component may seem simple, it tends to be a challenging situation, as significant behavior problems often are displayed during this phase. The expectation is that this phase lasts 5 minutes, but time varies depending upon the behavior of the child (McNeil & Hembree-Kigin, 2010). Cleanup occurs only at the end of parent-directed play, not at the end of child-directed play, to avoid confusing the child about the role of parental help during cleanup. All three components—CDI, PDI and cleanup—are opportunities for behavioral observation and data collection.

Implementing PCIT

According to McNeil and Hembree-Kigin (2010), there are six steps in conducting PCIT with a family. These authors have briefly described the contents of each step as well as provided guidelines for the number of sessions typically devoted to completing the tasks within each step. Step 1 requires one to two sessions for the intake process, Step 2 requires one session to introduce and teach parents CDI skills, and Step 3 requires two to four sessions in which the parents are coached on these skills. Steps 4 and 5 introduce and coach the PDI and may take up to six sessions. The final session is the follow-up session. These six steps complete a 10- to 15-session triadic training program.

Step 1 is the initial intake and can be accomplished in one to two counseling sessions, unless classroom or other observations are warranted. These sessions consist of assessing family dynamics, obtaining the family’s perception of the presenting problems, probing for insights into the current disciplinary beliefs and methods held by the parents, and observing the natural interactions between parents and child. In addition to the information-gathering component, the clinician defines the parameters of the sessions as well as the rules and expectations. Certain parameters involve an understanding by the parents that this CDI time is designated for the child to lead and for the parent to follow—a time often described to the parents as time-in for the child. Thus, time-in is defined as a time when the child facilitates play by selecting the type of play and initiating all play interactions.

The initial informal observation usually takes place in a sitting area while the family is waiting to visit with the counselor. In this informal observation, the counselor looks for “the child’s ability to play independently, strategies the child uses to engage the parent’s attention, parental responsiveness to child overtures, parental limit-setting, warmth of parent-child interactions, and evidence of clinging and separation anxiety” (McNeil & Hembree-Kigin, 2010, p. 20). After this stage of observation, a more formal observation is completed using the Dyadic Parent–Child Interaction Coding System (DPICS; Eyberg & Robinson, 1983). This observation is typically accomplished in three 5-minute increments in which behaviors and verbalizations are marked on the DPICS sheet. The formal observation occurs over the three PCIT stages previously described—CDI, PDI and cleanup. Following the initial observations, a third observation may be executed as a classroom observation. This type of observation is done with students who attend day care, preschool or elementary school, and allows one to see the child interact within his or her daily environment. Observation occurring in an alternate setting increases the chances of obtaining normative behavior (McNeil & Hembree-Kigin, 2010).

In Steps 2 and 3, the counselor presents and provides coaching on the CDI skills. Step 2 typically requires one counseling session. During this time the parents are taught the behavioral play therapy skills of CDI. The third step, coaching the CDI skills, may take two to four sessions depending on how the family adopts these principles into their daily interactions with their child. Coaching is described as modeling the behavior for the family, allowing the family to practice in session with feedback and prompts as needed, assigning the family homework to practice, and then repeating these steps until the parents are comfortable and fluent in the process.

In Steps 4 and 5, respectively, the counselor teaches and coaches the parents about discipline skills. These skills include both PDI and compliance training. Step 4 is typically accomplished in one session. Coaching may last from four to six sessions. Again, coaching is described as modeling, in-session practice with feedback and prompts, assigning homework, and evaluating success.

Step 6 consists of having a follow-up counseling session. This session is an opportunity to assess the family’s progress with proper implementation of each component of the PCIT model, gauge the strides made in compliance and assess the overall family satisfaction gained throughout the journey. Finally, one should use boosters to help parents maintain learned skills as they face new challenges with their children. Table 2 delineates the steps to implementing PCIT over a typical 10–15-session treatment plan.

Table 2

Implementing PCIT


Number of sessions




Informal and formal observation




Coaching CDI skills


Teaching discipline skills via PDI and compliance training






Case Study

PCIT was selected for use in the treatment of Manny, a 6-year-old Hispanic male diagnosed with autism and noncompliant to his mother. Like many children with autism, Manny had difficulty with unpredicted changes and verbalization of concerns. As Manny’s frustration with communication increased, he demonstrated stereotypies such as hand flapping and eventually progressed to tantrum behavior. The two goals of treatment were to increase the frequency of appropriate verbalizations and to decrease the frequency of inappropriate behavior including physical aggression, noncompliance and making noises. Manny was experiencing other issues related to autism, but his mother indicated that the behavioral problems were preventing him from making progress in other area.

As a result, we decided to conduct a functional behavior analysis prior to beginning treatment. This assessment of Manny’s behavior indicated that some of the behavior disruptions were a means of seeking attention, and therefore it was determined that PCIT would teach the mother to provide more consistent attention for appropriate behavior and to encourage appropriate communication more effectively. If needed, the addition of the timeout component was available after the mother began adequately attending to Manny’s appropriate behavior and ignoring inappropriate behavior.

Session 1

The counselor explained the procedure and rationale for PCIT to the mother, including CDI, PDI and timeout. CDI was modeled and demonstrated with Manny. The mother was uncomfortable about being judged on her parenting skills, so it was decided that she would practice the skills at home using the Child’s Game nightly with Manny. The Child’s Game is simply defined as any free play activity the child chooses. The family would return to the clinic in 1 week.

Session 2

The counselor reviewed CDI and had the mother conduct the Child’s Game for 5 minutes. During CDI, the counselor observed and noted the mother’s responses. The mother included 13 questions, one criticism and one demand in the 5-minute session. The mother praised Manny frequently, but did not use the other desired skills often. Manny was compliant with the demand that the mother gave and did not exhibit any of the disruptive behaviors. Following the CDI, feedback was given to the mother about increasing descriptions, reflections, imitations and praises, and reducing questions. The mother also was encouraged to recognize and praise communication attempts. Overall, the mother was directed to allow Manny to lead the play. When queried about CDI practice at home, the mother reported that the activity the family had used for the Child’s Game was watching television. Because there is no inherent interaction in television viewing, the mother was directed to provide a choice to play with action figures or art materials, both indicated as reinforcing by Manny, in place of video games or television. The Child’s Game was again given as homework.

Session 3

The professional counselor reviewed CDI and viewed the family during the Child’s Game. The mother showed improvement using descriptions (16), reflections (3), imitations (1) and praises (15). She also limited her use of questions (6), criticisms (0) and demands (0). However, Manny exhibited disruptive behavior in 23% of the observed intervals. The mother also reported that Manny continued to be noncompliant and make noises at home. The professional counselor introduced PDI and timeout. Each was modeled with Manny, and his mother was allowed to practice and receive feedback. Homework was to continue the Child’s Game, issue 10 demands throughout the day and follow through with the brief timeout procedure. Also, the mother was asked to develop five house rules to bring the following week. To keep a record of the number of instructions with which Manny complied before going to timeout, and the number of timeouts per day, the mother received a homework compliance worksheet to keep for 1 week. This log allows the parent to record the homework—in this case, using the Child’s Game daily, issuing 10 demands throughout each day and recording the Manny’s compliance to each, and using timeout as indicated.

Session 4

The counselor reviewed PDI, giving effective instructions and timeout to begin the session. The counselor then observed the family during CDI/PDI. The mother gave clear, concise instructions six out of nine times, only failing to wait before reissuing instructions when Manny did not immediately comply. Manny complied with all issued demands except when the mother reissued the demands too quickly. The mother followed Manny’s compliant behavior with praise statements four out of nine times. Manny was put in timeout for disruptive behavior and the mother used the procedure correctly. Manny demonstrated disruptive behavior during 33% of the observed intervals. A review of the homework compliance worksheet from the previous week indicated that Manny complied with 10 out of 10 instructions on 5 out of 9 days, and nine out of 10 instructions the remaining 2 days. The mother was encouraged to continue generalizing the skills she had learned throughout the day. The house rules developed by the family over the previous week were discussed and worded in positive statements and then introduced to Manny. The rules were explained and both examples and non-examples were modeled. Homework was given to continue incorporating the Child’s Game, issuing 10 demands in a brief period of time, using timeout as needed and recording compliance rates for 1 week.

Session 5

The counselor reviewed PDI, EID, timeout and the homework compliance worksheet. The mother indicated that Manny had been compliant before timeout 10 out of 10 times for 6 days and nine out of 10 times for 1 day. The mother also noted that Manny had been placed in timeout for breaking house rules. The mother reported that Manny’s behavior had improved and he had had fewer tantrums related to schedule changes. She was encouraged to continue using the PCIT skills and adapting them to more situations. Because compliance was increasing, it was not necessary to continue CDI and PDI in this session. The family was given homework to continue the Child’s Game, PDI, using timeout as needed and recording compliance rates. This time, the family was to work at home for 2 weeks before the next session.

Session 6

The counselor reviewed the family’s progress and addressed further generalization and concerns about daycare. The mother indicated that the child had been compliant before timeout on 10 out of 14 days. Two of the other days Manny had been placed in timeout 10 times and six times for violating house rules. The zero out of 10 compliance rating occurred during his birthday party, and the six out of 10 compliance rating was primarily the result of an unexpected trip to the grocery store. The family was again given homework to continue practicing generalizing CDI, PDI, using timeout as needed and recording compliance rates for 2 weeks.

Session 7

The counselor addressed concerns including the beginning of school in a few weeks and provided suggestions to ease the transition. While the mother indicated that Manny had been compliant before timeout on only 4 of the previous 14 days, a review of the compliance rates revealed that on the other 10 days, Manny was compliant no less than 80% of the time. These compliance rates from various family settings were indicative of behaviors being generalized across settings. The mother also showed evidence of her generalization of skills by adapting the house rules to address new problematic behaviors. The family was encouraged to begin reviewing material learned in the previous session and work on behavioral skills such as sitting for appropriate lengths of time. The mother was instructed to continue both the use of her attending skills in order to reinforce appropriate behavior, as well as the use of the timeout procedure to diminish inappropriate behaviors.

Session 8

For the final follow-up session, the counselor reviewed the family’s progress and determined that treatment goals were met. Concerns about how to get other family, friends and teachers to use PCIT skills with Manny were addressed in this final session. The family noted the improvements made as a result of PCIT and felt equipped to maintain the behavioral changes gained as a result of this counseling approach. Termination of the PCIT intervention was appropriate at this time; the case provided clear evidence of the application and utility of the PCIT model. Manny’s mother was offered the opportunity to continue interventions related to the other autism-specific issues that Manny was experiencing.



Professional counselors, whether working with children who have disruptive behavior or providing parenting training to families, should be knowledgeable of the application of various behavioral techniques in order to utilize them effectively and to teach them to parents. Researchers have proven that when implemented appropriately, PCIT procedures are effective in reducing undesirable and problematic behaviors in children and adolescents. Furthermore, it is clear that PCIT can be effectively applied to behavioral issues faced by children with special needs. We suggest that counselors who are interested in PCIT seek additional training to develop mastery of the techniques.

PCIT is a complex process that is often mistakenly viewed as simplistic. Thus, counselors who use PCIT without appropriate training will likely provide ineffective parental coaching. This point is especially poignant when working with children who have special needs. These children often present with numerous significant issues and deserve appropriate application of evidence-based intervention. We strongly suggest that counselors complete the web-based training provided by the University of California at Davis Children’s Hospital. The training is free and can be accessed at Given that PCIT is an effective approach and that the effectiveness of the model increases with appropriate education, professional counselors who further educate themselves on PCIT’s uses and applications can benefit their practices and the families they serve through the correct use of this empirically validated method of behavioral family counseling.

Counselors who are interested in PCIT also should consider advancing research related to counseling applications. While PCIT has been shown to be an effective intervention for autism and other disorders, more research is needed. We encourage counselors to consider implementation of studies that determine outcomes of PCIT for various child disorders and to conduct program evaluation for PCIT-based clinics.

Conflict of Interest and Funding Disclosure

The authors reported no conflict of  interest or funding contributions for  the development of this manuscript.



Agazzi, H., Tan, R., & Tan, S. Y. (2013). A case study of parent–child interaction therapy for the treatment of autism spectrum disorder. Clinical Case Studies, 12, 428–442. doi:10.1177/1534650113500067

Anticich, S. A. J., Barrett, P. M., Gillies, R., & Silverman, W. (2012). Recent advances in intervention for early childhood anxiety. Australian Journal of Guidance and Counselling, 22, 157–172. doi:10.1017/jgc.2012.24

Asawa, L. E., Hansen, D. J., & Flood, M. F. (2008). Early childhood intervention programs: Opportunities and challenges for preventing child maltreatment. Education and Treatment of Children, 31, 73–110.

Bagner, D. M., & Eyberg, S. M. (2007). Parent–child interaction therapy for disruptive behavior in children with mental retardation: A randomized controlled trial. Journal of Clinical Child and Adolescent Psychology, 36, 418–429. doi:10.1080/15374410701448448

Bahl, A. B., Spaulding, S. A., & McNeil, C. B. (1999). Treatment of noncompliance using parent child interaction therapy: A data-driven approach. Education and Treatment of Children, 22, 146–156.

Baker, A. J. L., & Andre, K. (2008). Working with alienated children & their targeted parents. Annals of the American Psychotherapy Association, 11(2), 10–17.

Borrego, J., Jr., Anhalt, K., Terao, S. Y., Vargas, E. C., & Urquiza, A. J. (2006). Parent-Child interaction therapy with a Spanish-speaking family. Cognitive and Behavioral Practice, 13, 121–133.

Chaffin, M., Silovsky, J. F., Funderburk, B., Valle, L. A., Brestan, E. V., Balachova, T., . . . Bonner, B. L. (2004). Parent–Child interaction therapy with physically abusive parents: Efficacy for reducing future abuse reports. Journal of Consulting and Clinical Psychology, 72, 500–510. doi:10.1037/0022-006X.72.3.500

Choate, M. L., Pincus, D. B., Eyberg, S. M., & Barlow, D. H. (2005). Parent–Child interaction therapy for treatment of separation anxiety disorder in young children: A pilot study. Cognitive and Behavioral Practice, 12, 126–135. doi:10.1016/j.cbpra.2005.09.001

Eaves, S. H., Sheperis, C. J., Blanchard, T., Baylot, L., & Doggett, R. A. (2005). Teaching time-out and job card grounding procedures to parents: A primer for family counselors. The Family Journal: Counseling and Therapy for Couples and Families, 13, 252–258. doi:10.1177/1066480704273638

Eyberg, S., & Boggs, S. (1989). Parent training for oppositional-defiant preschoolers. In C. E. Schaefer & J. M. Briesmeister (Eds.), Handbook of parent training: Parents as co-therapists for children’s behavior problems (pp. 105–132). New York, NY: Wiley & Sons.

Eyberg, S. M. (1999). Parent-Child interaction therapy: Integrity checklists and session materials. Retrieved from

Eyberg, S. M., Funderburk, B. W., Hembree-Kigin, T. L., McNeil, C. B., Querido, J. G., & Hood, K. K. (2001). Parent-Child interaction therapy with behavior problem children: One and two year maintenance of treatment effects in the family. Child & Family Behavior Therapy, 23(4), 1–20. doi:10.1300/J019v23n04_01

Eyberg, S. M., & Robinson, E. A. (1983). Conduct problem behavior: Standardization of a behavioral rating scale with adolescents. Journal of Clinical Child Psychology, 12, 347–354. doi:10.1080/15374418309533155

Gladding, S. T. (2011). Family therapy: History, theory, and practice (5th ed.). Upper Saddle River, NJ: Prentice Hall.

Guttmann-Steinmetz, S., Crowell, J., Doron, G., & Mikulincer, M. (2011). Associations between mothers’ and children’s secure base scripts in ADHD and community cohorts. Attachment & Human Development, 13, 597–610. doi:10.1080/14616734.2011.609010

Hood, K. K., & Eyberg, S. M. (2003). Outcomes of parent–child interaction therapy: Mothers’ reports of maintenance three to six years after treatment. Journal of Clinical Child and Adolescent Psychology, 32, 419–429. doi:10.1207/S15374424JCCP3203_10

Johnson, B. D., Franklin, L. C., Hall, K., & Prieto, L. R. (2000). Parent training through play: Parent-Child interaction therapy with a hyperactive child. The Family Journal: Counseling and Therapy for Couples and Families, 8, 180–186. doi:10.1177/1066480700082013

Luby, J., Lenze, S., & Tillman, R. (2012). A novel early intervention for preschool depression: Findings from a pilot randomized controlled trial. Journal of Child Psychology and Psychiatry, 53, 313–322. doi:10.1111/j.1469-7610.2011.02483.x

Matos, M., Bauermeister, J. J., & Bernal, G. (2009). Parent-Child interaction therapy for Puerto Rican preschool children with ADHD and behavior problems: A pilot efficacy study. Family Process, 48, 232–252. doi:10.1111/j.1545-5300.2009.01279

Matos, M., Torres, R., Santiago, R., Jurado, M., & Rodríguez, I. (2006). Adaptation of parent–child interaction therapy for Puerto Rican families: A preliminary study. Family Process, 45, 205–222. doi:10.1111/j.1545-5300.2006.00091.x

McCabe, K. & Yeh, M. (2009). Parent–Child interaction therapy for Mexican Americans: A randomized clinical trial. Journal of Clinical Child and Adolescent Psychology, 38, 753–759. doi:10.1080/15374410903103544

McNeil, C. B., Eyberg, S., Eisentadt, T. H., Newcomb, K., & Funderburk, B. (1991). Parent–Child interaction therapy with behavior problem children: Generalization of treatment effects to the school setting. Journal of Clinical Child Psychology, 20, 140–151. doi:10.1207/s15374424jccp2002_5

McNeil, C. B., & Hembree-Kigin, T. L. (2010). Parent-Child interaction therapy. New York, NY: Springer.

Neary, E. M., & Eyberg, S. M. (2002). Management of disruptive behavior in young children. Infants and Young Children, 14(4), 53–67.

Nieter, L., Thornberry, T., Jr., & Brestan-Knight, E. (2013). The effectiveness of group parent–child interaction therapy with community families. Journal of Child and Family Studies, 22, 490–501.

Shanley, J., & Niec, L. N. (2010). Coaching parents to change: The impact of in vivo feedback on parents’ acquisition of skills. Journal of Clinical Child and Adolescent Psychology, 39, 282–287. doi:10.1080/15374410903532627

Solomon, M., Ono, M., Timmer, S., & Goodlin-Jones, B. (2008). The effectiveness of parent–child interaction therapy for families of children on the autism spectrum. Journal of Autism and Developmental Disorders, 38, 1767–1776. doi:10.1007/s10803-008-0567-5

Tarbox, J., Wilke, A. E., Najdowski, A. C., Findel-Pyles, R. S., Balasanyan, S., Caveney, A. C., . . . Tia, B. (2009). Comparing indirect, descriptive, and experimental functional assessments of challenging behavior in children with autism. Journal of Developmental and Physical Disabilities, 21, 493–514. doi:10.1007/s10882-009-9154-8

Thomas, R., & Zimmer-Gembeck, M. J. (2007). Behavioral outcomes of parent-child interaction therapy and triple p—positive parenting program: A review and meta-analysis. Journal of Abnormal Child Psychology, 35, 475–495.

Timmer, S. G., Ho, L. K. L., Urquiza, A. J., Zebell, N. M., Fernandez y Garcia, E., & Boys, D. (2011). The effectiveness of parent–child interaction therapy with depressive mothers: The changing relationship as the agent of individual change. Child Psychiatry & Human Development, 42, 406–423. doi:10.1007/s10578-011-0226-5

Urquiza, A. J., & Timmer, S. (2012). Parent-Child interaction therapy: Enhancing parent-child relationships. Psychosocial Intervention, 21, 145–156. doi:10.5093/in2012a16

Webster-Stratton, C., & Herbert, M. (1993). “What really happens in parent training?” Behavior Modification, 17, 407–456. doi:10.1177/01454455930174002


Carl Sheperis, NCC, is the Chair of the Department of Counseling and Special Populations at Lamar University. Donna Sheperis, NCC, is an Associate Professor at Lamar University. Alex Monceaux is an instructor at Lamar University. R. J. Davis and Belinda Lopez are Assistant Professors at Lamar University. Correspondence may be addressed to Carl Sheperis, Box 10034, Beaumont, TX 77710,