COURSE of TREATMENT MANUAL: PC-CARE Version: 1.2 1/2019 · M INIMUM R EQUIREMENTS FOR B ECOMING A PC-CARE P ROVIDER Trainee must: 1) Be able to enroll at least two families in PC-CARE

Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Forte, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript.

UC Davis PCIT Training Center

pcit.ucdavis.edu

COURSE of TREATMENT MANUAL: PC-CARE

Version: 1.2 1/2019

Attached is an outline and step-by-step process of your PC-CARE sessions. Behind each section are the forms and handouts you need to successfully complete that session.

UC Davis CAARE Center 3671 Business Drive, Ste. 100

Sacramento, CA 95820

Anthony Urquiza, Ph.D. , Director [email protected]

mailto:[email protected]



PC-CARE

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Section A: GENERAL INFORMATION

PC-CARE Training Competencies………………………………..…………………………..… A.1

PC-CARE Protocol………………………………………………………………………….……………A.5

Non-Standard Protocol: Multiple Children, Multiple Caregivers………………. A.19

Inclusion & Exclusion Criteria.…………………………………………………………………… A.23

Selecting the Right Toys.………………………………..………………………………………….A.25

Section B: DOCUMENTATION INFORMATION

Client Folder Set Up…………..…………………………………………...……………………….. B.1

PC-CARE Data Log………………….……………………………………......…………… ………… B.3

PC-CARE Progress! Graph……………….……………………………………………………….. B.5

Maximizing the WACB-N………………………………………………………………………….. B.7

WACB-N Coaching Words……………….……………………..………………………………….B.9

Levels of Coaching…………………………...………………………………………………………. B.15

Level 3 Coaching Worksheet…………………………………………………………………….. B.19


Section C: PRE-TREATMENT INFORMATION

Assessment Measure Schedule…………………………………………………………......... C.1

What to do with Standardized Measures…………………………………………………. C.3

12 Minute Behavior Observation Instructions….………………………………………. C.5

12 Minute Behavior Observation Coding Sheet………………………………………… C.7

Pre-Treatment Session Checklist………………………………………………………………. C.9

Pre-Treatment Assessments

• WACB-N (Weekly Assessment of Child Behavior)

• ECTSS (Early Childhood Traumatic Stress Screen) – Ages 0-6 Years

• CATS (Child and Adolescent Trauma Screen) – Ages 7-17 Years

• Family Life Questionnaire

• TAI (Therapy Attitude Inventory)

• PSI-Short Form (Sample)

• Talking About Treatment – for Biological Parents

• Talking About Treatment – for Resource Parents

Pre-Treatment Parent Handouts

• Child Trauma Handout (Young Children)

• Child Trauma Handout (Older Children)

• Stress Handout (Ages 2-6)

• Difficult Behaviors Handout

• What is PC-CARE? Handout

• What to Expect in PC-CARE Handout


• PC-CARE Syllabus Handout

• The How & Why of Daily CARE Handout

Section D: SESSION 1 MATERIALS

All Sessions – Video Review Worksheet……………………………………………………. D.1

Session 1 Coding Sheet & Checklist………………………………………………………….. D.3

PRIDE Skills Handout………………………………………………………………………………… D.5

Session 1 Strategies to Manage Behaviors………………………………………………… D.7

Daily CARE Handout………..……………………………………………………………………..… D.9

Session 1 Strategies Questionnaire…………………………………………………………... D.11

Weekly Assessment

• WACB N

Section E: SESSION 2 MATERIALS

All Sessions – Video Review Worksheet..………………………………………………….. E.1

Session 2 Coding Sheet & Checklist….…........................................................ E.3

Session 2 Strategies to Manage Behaviors………………………………………………… E.5

CoRegulation Techniques……………………………………………………………………………E.7

Calming Strategies 1……………….………………………………………………………………….E.9

Calming Strategies 2………………………………………………….……………………………….E.11

Daily CARE Handout………..……………………………………………………………………..… E.13

Session 2 Strategies Questionnaire…………………………………………………………... E.15

Session 2 How Well Did They Work Questionnaire…………………………………… E.17


Weekly Assessment

• WACB N

Section F: SESSION 3 MATERIALS

All Sessions – Video Review Worksheet……..…………………..……………………….. F.1

Session 3 Coding Sheet & Checklist……………..………….................................... F.3

Session 3 Strategies to Manage Behaviors………………………………………………… F.5

Daily CARE Handout………..……………………………………………………………………..… F.7

Session 3 Strategies Questionnaire…………………………………………………………... F.9

Session 3 How Well Did They Work Questionnaire…………………………………… F.11

Weekly Assessment

• WACB N

Section G: SESSION 4 MATERIALS

All Sessions – Video Review Worksheet……………………..……………………………. G.1

Session 4 Coding Sheet & Checklist……………..……………….............................. G.3

Session 4 Strategies to Manage Behaviors……………………………………………….. G.5

Daily CARE Handout………..…………………………………………………………………..…… G.7

Session 4 Strategies Questionnaire…………………………………………………………... G.9

Session 4 How Well Did They Work Questionnaire…………………………………… G.11

Weekly Assessment

• WACB N


Section H: SESSION 5 MATERIALS

All Sessions – Video Review Worksheet..………………………………………………….. H.1

Session 5 Coding Sheet & Checklist……………..………….................................... H.3

Session 5 Strategies to Manage Behaviors………………………………………………… H.5

Daily CARE Handout………..…………………………………………………………………..…… H.7

Session 5 Strategies Questionnaire…………………………………………………………... H.9

Session 5 How Well Did They Work Questionnaire…………………………………… H.11

Weekly Assessment

• WACB N

Section I: SESSION 6 MATERIALS

All Sessions – Video Review Worksheet..………………………………………………….. I.1

12 Minute Behavior Observation Instructions….………………………………………. I.3

12 Minute Behavior Observation Coding Sheet……………………………………….. I.5

Session 6 Checklist……………..………………........................................................ I.7

Complete Strategies to Manage Behaviors……………………………………………..… I.9

Problem Behaviors & Solutions handout………………………………………………….. I.13

Complete Strategies Questionnaire: What Works Best/Like the Most………I.15

Weekly Assessment

• WACB N

Section J: FOLLOW UP SESSION MATERIALS

Follow Up Session Coding Sheet & Checklist…………………………………………….. J.1


Follow Up Assessment

• WACB N

Appendices: SPECIAL POPULATIONS

Appendix 1: PC-CARE EN ESPANOL

PC-CARE Manual Cover en Español………………………………….............….……….App1.1

PC-CARE Flyer & Syllabus en Español………………………..…….............….……….App1.3

Pre-Tx en Español

Coding Observation Instructions en Español..………………….............….……….App1.5

Coding Observation en Español for Toddlers……………………….…..…..……..….App1.7

WACB 0-2 en Español…………..………………………………………….............….……….App1.9

WACB-N en Español………………..…………………………………….............….……….App1.11

ECTSS en Español……………………………………….............………………..…………..….App1.13

CATS en Español………………………………………………….............….…………….…….App1.15

Family Life en Español..……………………………………….............….……………….….App1.17

TAI en Español………...……………………………………….............….………………….….App1.19

PSI-4 SF en Español………...……………………………….............….………………….….App1.21

Talking about Tx en Español………...……………………………….....……………….….App1.23

Talking about Tx for Resource Caregivers en Español……....……………….….App1.25

Babies & Toddlers Trauma Handout en Español………...………………...….….App1.27

Child Trauma Handout en Español………...………………………………………….….App1.29

Session 1 en Español

PRIDE Skills en Español: A DIARIO……………..……..……..……..………………….….App1.33


Session 1 Strategies to Manage Behaviors en Español...……..……….…….….App1.35

Session 1 Coding & Checklist with Instructions en Español………...…….….App1.37

Daily Care: Cuidado Diario……………...……..……..……..……..…………………...….App1.39

Session 1 Questions en Español………...……..……..……..……..………………….….App1.41


Session 2 Coding & Checklist with Instructions en Español.…………….….….App1.43

Session 2 Strategies to Manage Behaviors en Español…...………………….….App1.45

Coping Skills for Young Children en Español.……..……..……..………………….….App1.47

Coping Skills for Older Children en Español……..……..……..…………………..….App1.49

Session 2 Questions en Español………...……..……..……..……..………………….….App1.51


Session 3 Coding & Checklist with Instructions en Español..……………….….App1.53

Session 3 Strategies to Manage Behaviors en Español..……………………...….App1.55

Session 3 Questions en Español.………...……..……..……..……..………………….….App1.57


Session 4 Coding & Checklist with Instructions en Español...……..………….App1.59

Session 4 Strategies to Manage Behaviors en Español...……………………...….App1.61

Session 4 Strategies to Manage Behaviors en Español for Toddlers……..….App1.63

Session 4 Questions en Español…………………………………..……………………...….App1.65

Session 4 Questions en Español for Toddlers……………………….……………...….App1.67


Session 5 Coding & Checklist with Instructions en Español.………………...….App1.69

Session 5 Strategies to Manage Behaviors en Español………..……………...….App1.71


Session 5 Questions en Español…………………………………..……………………...….App1.73


PRIDE: A DIARIO & All Strategies en Español………………….…………………...….App1.79

Problem Behaviors & Solutions handout en Español.………………………….….App1.81

Coding Observation Instructions en Español..………………….............….……….App1.5

Follow-up en Español

Follow-up Session Coding & Checklist with Instructions en Español.……...App1.83

Other Handouts en Español

ASD/IDD handout en Español.……………………………………………………..……..….App1.85

Body Safety en Español.…………………….………………………………………..……..….App1.87

Appendix 2: TODDLERS

Developmental Milestones Handout…………………………….............….……………………..

PC-CARE Protocol for Toddlers……………………………………….............….………..App2.1

Babies & Toddlers Coding Instructions……………………………………………….……App2.15

Babies & Toddlers Trauma Handout………………………………………………….…….App2.17

PC-CARE for Toddlers Syllabus Handout.………………………………………….….….App2.19

PRIDE Skills Handout for Toddlers………………….............…………………………….App2.21

Session 1 Strategies to Manage Behaviors for Toddlers……….………….………App2.23

Session 2 Strategies to Manage Behaviors for Toddlers…………………………..App2.25

Calming Strategies for Toddlers………………………………………….……………………App2.27

Session 3 Strategies to Manage Behaviors for Toddlers…………………..………App2.29

Calmly Tell Your Child What to Do, Then Wait Handout for Toddlers………..App2.31

Session 4 for Toddlers Strategies Questionnaire………….…………………………….App2.33


Session 5 Strategies to Manage Behaviors for Toddlers……………………………..App2.35

Session 5 for Toddlers Strategies Questionnaire…………………………………….….App2.37

Complete Strategies to Manage Behaviors for Toddlers…………………………….App2.39

WACB 0-2………………………………………………………………………………….……………….App2.43

Appendix 3: SEXUAL BEHAVIOR PROBLEMS

Body Safety Rules handout…………………………………………………….……………….…App3.1

Daily CARE Sheets for SBP…………………………………………………….…………….….…App3.3

PC-CARE Protocol for SBP…………………………………………………….………………..…App3.5

Appendix 4: ASD & IDD

ASD/IDD Handout (English)…………………….……………….………….………………….…App4.1

PRIDE Skills for ASD/IDD…………………….…………………………………………..….…..…App4.3

CoRegulation Techniques for ASD/ISD…………………….………………………..…….…App4.5

PC-CARE Protocol for ASD/IDD…………………….…………………………….……….…….App4.7

PC-CARE Coding System: Manual

TABLE OF CONTENTS……………………….……………………….…………………….….1

PRIDE SKILLS (PRIDE) ………………………………………….…………………….………10

PRAISE………………………………………….……………………………………….10

REFLECTIONS………………………………………………….…………………….19

IMITATION………………………………………….…………………………………23

DESCRIPTIONS………………………………………………….…………………..24

ENJOY………………………………………….………………………………………..28


NEGATIVE TALK (NTA) ……………………….……………………………….…………….38

CHILD RESPONSES………………………………………………….………………………...41

ANSWERS TO QUESTIONS……………………………………………………..41

ANSWER (AN) ………………………………………………….…………………….41

NO ANSWER (NA) ………………………………………….……………………...43

NO OPPORTUNITY FOR ANSWER (NOA) ………………………………………..…..….44

RESPONSE TO COMMANDS……………………….………………………………………………...…..45

COMPLIANCE (CO) ……………………….……………………………………………..…..…...47

NOT COMPLY (NC) ……………………………………………………………….…...........…..49

NO OPPORTUNITY TO COMPLY (NOC) …………………………………....…………….51

STRATEGIES TO MANAGE BEHAVIOR……………………………….………………………..…….50

PARENT-CHILD INTERACTION QUALITY INDEX…………………………………………….…..62


PC-CARE

• PC-CARE Training Competencies • PC-CARE Protocol • Non-Standard Protocol: Multiple Children, Multiple Caregivers • Inclusion & Exclusion Criteria • Selecting the Right Toys


PC-CARE Trainee Name: _______________________________ PC-CARE Agency Name:_______________________________

Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Armendariz, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript.

A.1

PC-CARE

PC-CARE COMPETENCIES FOR PROVIDERS ESSENTIAL COMPONENTS OF PC-CARE Standardized pre/post treatment measurement – Brief PSI, ECBI, ECTSS In vivo coaching of the parent-child dyad Inclusion of the PRIDE and strategies for managing behaviors concepts Use of Daily CARE handout Agency provides appropriate space and equipment, and allows providers to

participate in ongoing training and consultation.

MINIMUM REQUIREMENTS FOR BECOMING A PC-CARE PROVIDER Trainee must: 1) Be able to enroll at least two families in PC-CARE and 2) have

approval to work individually with children and families. Read revised or updated training handouts, training curriculum Meet PC-CARE training Competencies for Therapist/Coach (UCDMC CAARE

Center, 2016) Administer, score and interpret pre/post measures (PSI, ECBI, ECTSS, 12-minute

observation with behavioral coding) Supervision and case consultation through the course of treatment for two PC-

CARE cases. Complete two PC-CARE cases through the full course of treatment.



A.2

PC-CARE COMPETENCIES Date

complete

SECTION 1: SKILL BUILDING

1-1. Completion of PC-CARE pre-work

1-2. Ability to code 4 minutes of parent verbalizations with 80% reliability using PC-CARE coding sheet (10 times: check off below)

SECTION 2: DIDACTIC COMPETENCE- Effectively deliver the following mini-didactics in a brief time frame.

2-1. Discuss possible catalyst behind child behavior problems and effects of caregiver-child relationship (e.g., trauma, developmental delays, parent illness)

2-2. Description of PC-CARE intervention and goals

2-3. Explain how to use and the value of doing “Daily CARE” (i.e., homework) for child & family

2-4. PRIDE & AVOID skills plus transitions (Session 1- 10 min)

2-5. Calming & coping skills, selective attention (what to ignore, how to ignore), redirect, modeling positive opposites (Session 2- 10 min)

2-6. Using rules and positive incentives (choices, when-then, or if-then statements) to get compliance and how to do it (Session 3- 10 min)

2-7. Giving effective commands and consistent consequences (Session 4- 10 min)

2-8. Recovery and “re-doing” (Session 5- 10 min)

2-9. Review PC-CARE strategies, identify strengths, problem solve behaviors and solutions (Session 6- 10 min)

SECTION 3: PROCESS COMPETENCE- Perform the following activities during treatment sessions

3-1. Collects and interprets pre- and post-treatment measures for clinical purposes, and discusses results with parent

3-2. Accurately delivers standard instructions for observational assessments

3-3. Provides feedback on parent skill use and child response from behavioral observation



A.3

3-4. Collect and interpret weekly WACBs and PC-CARE coding; graph results for parent

3-5. Coached the information scheduled to be covered in session

Sess. 1 Sess. 2 Sess. 3 Sess. 4 Sess. 5 3-6. Collect and review Daily CARE, addressing strengths and areas for improvement

3-7. Communicates with parent about their strengths and child responsiveness (i.e., what is working, achievements of session); administer and discuss “Strategies Learned – Will they work for us?” questionnaire

3-8. Communicates with child and incorporates child as needed – teaching and coaching child when indicated

SECTION 4: COACHING COMPETENCE- Conduct coaching during treatment sessions

4-1. Effectively directs parent to increase use of PRIDE skills and strategies to manage behavior (Level 1)

4-2. Follows and reinforces parent’s use of PRIDE skills and strategies to manage behavior (Level 2)

4-3. Explains to parent the positive effects of PRIDE skills and strategies to manage behavior (Level 3 – Explanations)

4-4. Makes goal-focused observations of child behavior, parent effects on child, and interaction quality for parent (Level 3 – Observation)

4-5. Helps parent generalize skills to daily life (Level 3 – Generalization)

4-6. Constructs real-life situations in coaching



A.4

Completed two cases with fidelity Verification of Training Completion: ______________________________ ______________________________ UCDMC PC-CARE Trainer Date ______________________________ ______________________________ PC-CARE Trainee Date

Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Armendariz, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE:

Course of Treatment Manual. Unpublished Manuscript. A.5

PC-CARE: A Brief intervention for caregivers and children together PROTOCOL

PRE-TREATMENT SESSION

GOALS: Assess, listen, teach about trauma, “sell” intervention

PRE-WORK • If they did not return questionnaires, have parent complete behavior measure, trauma screener, and Abbreviated Family Life Questionnaire

Make sure child is able to keep occupied for a few minutes, otherwise bring family into the therapy room and play with child while parent completes forms.

CHECK-IN • Administer WACB-N.

• Review Pre-Treatment measures with parent and child.

Make sure to explain the purpose of assessment measures.

BEHAVIORAL OBSERVATION

• Conduct the 12-minute behavioral observation (4-4-4).

Explain the purpose and process of doing the behavioral observation.

CATALYST DIDACTIC • Discuss why children develop difficult behaviors (e.g., effects of trauma, stressful events, temperament, etc.) and the importance of strong family relationships in building resilience

Tailor discussion to child or family’s experiences. Choose appropriate didactic handout.

ORIENT TO TREATMENT & SET GOALS

• Describe PC-CARE’s purpose to caregiver and child and how it will be helpful for this family.

• On the “What is PC-CARE?” handout: o Develop positively stated goals with

caregiver and child to accomplish together in PC-CARE

• Talk about skills taught in each session, structure of each session (check-in, teaching, assess, coaching, wrap-up), and plan for graduation

Give What is “PC-CARE?” flyer, PC-CARE syllabus. Use Pre-Tx measures and WACB to help identify goals. Specific goals should match parent’s concerns.

CHECK OUT • Explain importance of daily positive time with child & parent to improve relationship and child behaviors.

• Encourage parent to find 5 minutes every day to spend in play with child.

Give “How & Why” Daily CARE Handout. Make sure to focus on importance of quality time for CHILD.



SESSION 1 GOALS: Teach PRIDE skills, adjusting Environment to promote compliance, Transitions

CHECK-IN (7 min)

• Find out how parent and child are doing

• Administer and review WACB-N & “Strategies: Did They Work?” questionnaire

• Put toys out; allow child to play with toys during check-in

MINI-DIDACTIC (10 min)

• BRIEFLY review PRIDE skills, AVOID negative- Describe how behavior management skills are only effective when the child receives plenty of attention for being good, following rules, listening.

• Show parent Strategies to Manage Behavior handouts and discuss how the ENVIRONMENT CAN BE CHANGED to promote compliance; teach about children’s need for TRANSITION TIME to new activities. Show how to do it.

Forms needed:

• PRIDE skill handout

• Strategies to Manage Behavior

* Make sure to involve child in the didactic if age appropriate.

CODE (4 min)

• Conduct 4- minute behavioral observation. Code using PC-CARE coding.

Use PC-CARE Coding Sheet

COACH (15-20 min)

• Have parent play with child and practice PRIDE skills. If parent has trouble engaging with child, try a toy requiring joint attention.

• Practice transition by having parent give a warning 5 minutes and again 2 minutes before the end of special play time.

• Reminder: Do not coach parent to have child clean up. Let parent know the child can keep playing during check out.

Pick toys the child is interested in. If the child gets bored with your toy choice, take others in.

CHECK OUT (5-7 min)

Discuss when the parent can use transitions and PRIDE skills at home. Make a plan for them to try it daily. (Use the “Strategies Learned – Will they work for us?” questionnaire.)

Present graph of PC-CARE Progress.

Tell parent and child about Daily CARE handout. Talk about it as a way for them to generalize skills learned in the clinic to the home and other settings. Emphasize importance of child receiving positive attention and hearing PC-CARE skills daily. Daily CARE Week 1:

• 5-minute Special Playtime daily

• Use PRIDE skills all day long

• Transitions as planned

Make sure to leave some toys on the table for child to play with.

Remember to include child if age appropriate. Child can ask parent for transition time.



SESSION 2 GOALS: Teach Selective Attention, Modeling, Redirect, Calming, PRIDE Skills

CHECK-IN (7 min)


• Collect Daily CARE handout- find out how transitions went, what kinds of changes PRIDE skills made. Review PRIDE skills if needed.


Listen, but bring discussion back to how PC-CARE skills might help. If parent/ child issues are outside the scope of PC-CARE, offer to call later to discuss more thoroughly.

MINI-DIDACTIC* (10 min)

• Show parent Strategies to Manage Behavior handouts and teach about SELECTIVE ATTENTION as a way to cut down low-level negative child behaviors, possibly accompanied by MODELING and REDIRECTING the child’s attention to more appropriate play.

• Talk about the need for parents to keep CALM during SELECTIVE ATTENTION. Talk about the importance for kids of keeping calm (emotionally regulated). Show parent & child coping handout and teach them one or two CALMING strategies. Show parent & child COREGULATION handout and encourage them to try 1 or 2 skills at home.

Forms needed:


• Calming Strategies for young children

• Calming Strategies for older children

• Coregulation handout * Make sure to involve child in the didactic if age appropriate. Child can use selective attention with sibs

CODE & FEEDBACK (5 min)



COACH (20 min)

• Coach parent to play with child and practice PRIDE skills.

• Look for opportunities to try selective attention, modeling, redirecting, and calming.

• Have parent give a transitional warning for switching toys half way through session; ask parent to model the CALMING skills by saying, “Sometimes I don’t want to change toys and get a little frustrated. When that happens, I take a deep breath.” [models]; switch toys; if child whines or protests, have parent ignore and point out cool qualities of new toy.

• Reminder: Do not coach parent to have child clean up. Let parent know the child can keep playing during check out.

Pick toys the child is interested in. Make sure child is happy to switch toys- make sure the parent makes it sound REALLY fun! If you haven’t had enough time with the first toy (for one reason or another), don’t switch toys.



CHECK OUT (5-7 min)

Discuss when the parent (and child, if appropriate) can use selective attention, redirecting, and calming at home or school. Work out plans with them to try it. (Use the “Strategies Learned – Will they work for us?” questionnaire.)


• Remind parent and child about Daily CARE. Discuss toys they like to play with and what time of day they like to play.

• If they did Daily CARE in Week 1, praise, talk about what a big difference it makes.

• If no Daily CARE or little buy in, talk about how this is an important part of their therapy, foundation of their commitment to change

Daily CARE Week 2:

• 5-minutes of Special Playtime daily

• PRIDE skills

• Selective attention & Redirect as planned

• Calming

Make sure to leave some toys on the table for child to play with. Remember to include child if age appropriate.



SESSION 3 GOALS: Using Rules, Positive Incentives, PRIDE Skills

CHECK-IN (7 min)


• Collect Daily CARE handout- find out how selective attention and redirect went, what kinds of changes PRIDE skills made. Review PRIDE skills if needed.


Put toys on the table and allow child to play with toys during your check-in


• Show parent Strategies to Manage Behavior handouts and teach about USING RULES and POSITIVE INCENTIVES (CHOICES, WHEN-THEN, IF-THEN statements) to set up compliance. Refer to the WACB-N and see how you can use positive incentives to improve problem behaviors. (Always add PRIDE skills!)

• Make sure you do not use Special Playtime (or anything you really want the child to do) as the positive incentive.

Forms needed:


* Make sure to involve child in the didactic if age appropriate. Child can use these with friends or sibs




COACH (20 min)

• Have parent give a RULE for Special Playtime. For 3 – 10 year olds, give RULE (plus consequence for breaking rule). No rules for 1 - 2 year olds except safety rules.


• Have parent state choices for toys to play with. Look for opportunities to try when-then, if-then statements.

• Have parent give a transitional warning for switching toys half way through session; have parent state “when we put the toys away we can get a new toy out”; if child whines or protests, have parent ignore and point out cool qualities of new toy. **

• Use transition, positive incentives at end of Special Playtime (e.g., sticker)

Pick toys the child is interested in. Make sure child is happy to switch toys- make sure the parent makes it sound REALLY fun! If you haven’t had enough time with the first toy (for one reason or another), don’t switch toys. ** If family has specific concerns, incorporate here (e.g., homework, trying new food, etc.)



CHECK OUT (5 - 7 min)

Discuss when the parent (and child, if appropriate) can use rules and positive incentives at home or school. Work out plans to try it. (Use the “Strategies Learned – Will they work for us?” questionnaire.)


• Remind parent and child about Daily CARE. Discuss how they make it work (e.g., Schedule? Who reminds whom?).

• If they did Daily CARE past weeks, praise (be specific).

• If no Daily CARE or little buy in, talk about what parent and child can do to make more time for Special Playtime.

Daily CARE Week 3:

• 5-minutes of Special Playtime daily

• PRIDE skills- Use all day long

• Use Positive incentives and Rules as planned




SESSION 4 GOALS: Giving Effective Commands and getting compliance, Removal of Privileges, PRIDE Skills

CHECK-IN (7 min)


• Collect Daily CARE handout- find out how using positive incentives went (and other strategies), what kinds of changes PRIDE skills made. Review PRIDE skills if needed.



MINI-DIDACTIC (10 min)

• Show parent Calmly Tell Your Child Exactly What to Do & Two-Choice Removal of Privileges handouts and teach about GIVING EFFECTIVE COMMANDS followed by LOGICAL CONSEQUENCES or REMOVAL OF PRIVILEGES in case of non-compliance (Hand Over Hand & ReDo for young children). Refer to the WACB-N and see when you would use an effective commands to improve problem behaviors.

• Make sure parent understands the difference between using effective commands (needs follow-through if no compliance) and positive incentive (if positive incentive is not chosen, you do not force compliance).

Forms needed:

• Calmly Tell Your Child Exactly What to do Handout

• Two-Choice Removal of Privileges (on back of Calmly)

• YOUNG CHILDREN: HandOverHand/ReDo is on back of Calmly





COACH (20 min)


• Have parent state their RULE FOR SPECIAL PLAYTIME.

• Have parent state choices for toys to play with. Look for opportunities to give effective commands. Have parents practice play commands.

• Have parent give a transitional warning for switching toys half way through session; have parent give an effective command to clean up the toys when it is time. **

• Use transitional warnings, have parent tell the child that Special Playtime is ending and give effective command to get the child to clean up (or help clean up). If the child does not comply, have parent give warning for removing a privilege (e.g., sticker)

Pick toys the child is interested in. If you want to use stickers for positive incentives, make sure you have 2 handy (let the child choose one). When switching to a new toy, make sure the parent makes it sound fun! Parents need to practice giving effective commands and see them work. If you haven’t had enough time with the first toy (for one reason or



another), don’t switch toys. ** If family has specific concerns, incorporate here (e.g., homework, trying new food, etc.)


Only parents should use EFFECTIVE COMMANDS at home. It is helpful for children to understand what the parent means when giving them and what will happen with compliance (Praise!!) and non-compliance (Consequences). Discuss when the parent can use effective commands. Work out plans to try it. (Use the “Strategies Learned – Will they work for us?” questionnaire.)

Explain that child may use EFFECTIVE COMMANDS at school etc. if they feel threatened or need something (e.g., leave me alone, please pass the water).


• Remind parent and child about Daily CARE. Discuss how they made it work (or not) the last week (e.g., Schedule? Who reminds whom?).

• If they did Daily CARE past weeks, praise (be specific).


Daily CARE Week 4:


• PRIDE skills

• Effective Commands and consistent consequences




SESSION 5 GOALS: Using RE-DOING (Hand-over-Hand for very young children), RECOVERY, PRIDE Skills

CHECK-IN (7 min)


• Collect Daily CARE handout- find out what skills the parent used, what was most helpful & when, what kinds of changes PRIDE skills made. Review PRIDE skills if needed.




• Talk to the parent about the importance of being calm and emotionally regulated for traumatized children. Review CALMING (from Session 2) if needed. Introduce concepts of RECOVERY, and RE-DOING and how to do it. Discuss how much harder it is to follow directions when it makes you unhappy, or when you have to stop doing fun things. Talk about the importance of using all the strategies they have learned to make it easier for the child to comply with commands.

• Refer to the WACB-N and see how you can use CALMING, RECOVERY, and RE-DOING to improve problem behaviors.

Forms needed:






COACH (20 min)


• Have parent give a rule for Special Playtime; state choices for toys to play with. Look for opportunities to give effective commands (play commands). For RECOVERY: Make sure to have the parent give 10 PRIDE skills for every command they give. Point out how child returns to a more mellow state using recovery skills.

• Have parent give a transitional warning for switching toys half way through session, cleaning up first toys before starting to play with second set of toys. If child puts toys away too roughly or throws toys, you can RE-DO more gently and carefully.

• You may want to practice CALMING again. (Ask parent to model the CALMING skills by saying,

Pick toys the child is interested in. If you want to use stickers for positive incentives, make sure you have 2 handy (let the child choose one). When switching to a new toy, make sure the parent makes it sound fun! Real-life commands are easier for child if given in a context of positive emotion. If you haven’t had enough time with the first toy (for one reason



“Sometimes I don’t want to change toys and get a little frustrated. When that happens, I take a deep breath.” [models].

• Have parent practice when-then statements when taking a new toy out; if child whines or protests, have parent ignore and point out cool qualities of new toy. **

• Use transitional warnings, have parent tell the child that Special Playtime is ending and give effective command to get the child to clean up (or help clean up). If the child does not comply, have parent give warning for removing a privilege (e.g., sticker, juice, crackers).

or another), don’t switch toys. ** If family has specific difficult behaviors or situations, incorporate here (e.g., homework, trying new food, etc.)


Discuss when the parent (and child, if appropriate) can use calming, recovery, and re-do at home or school. Work out plans to try it. (Use the “Strategies Learned – Will they work for us?” questionnaire.)


Prepare for session 6/graduation, including assessing for ongoing issues.

• Remind parent and child about Daily CARE. Discuss how they make it work (e.g., Schedule? Who reminds whom?).

• If they did Daily CARE past weeks, praise, talk about what a big difference it makes (be specific).


Daily CARE Week 5:


• PRIDE skills all day long

• All Strategies to Manage Behaviors as needed

• Give parent ECBI, PSI4-SF, ECTSS, and TAI to complete and return next week.




SESSION 6 GOALS: Putting it all together PRIDE Skills + Strategies to Improve Compliance

PRE-WORK • If they did not return questionnaires, have parent complete behavior measure, trauma screener, and TAI

Make sure child is able to keep occupied for a few minutes, otherwise bring family into the therapy room and play with child while parent completes forms.

CHECK-IN (7 min)

• Administer and review WACB-N & “Strategies: Which work the best?” questionnaire


• Collect Daily CARE handout- find out what they skills they used, what worked/what was a problem, and what kinds of changes PRIDE skills made.



• Referring to the “Strategies” questionnaire, BRIEFLY review PRIDE skills and the Strategies to Manage Behavior handouts. Briefly review what they’ve learned. Discuss which skills have been most useful, which were not useful, and which the family still need to work on.

• Referring to the WACB-N, review the Problem Behaviors & Solutions handout to troubleshoot remaining difficult behaviors.

Forms needed:


• WACB Problem Behaviors & Solutions handout



• Conduct 12- minute behavioral observation (4-4-4). Code first 4 minutes. Use coding sheet to take notes.

Use 12 minute PC-CARE Coding Sheet

COACH (10 min)


• Have parent give a rule for special playtime, state choices for toys to play with. Look for opportunities to try all skills. Incorporate real life situations that continue to be problematic if possible.

• Use transition, positive incentives to get the child to clean up (or help clean up) at end of Special Playtime (e.g., sticker)

Pick toys the child is interested in.


• Discuss when the parent (and child, if appropriate) uses the different skills. Refer to the WACB-N and ask how they manage each




type of behavior problem. If needed, help plan a more optimal strategy. Encourage them to stick with their behavior management plan.

• Encourage them to continue Special Playtime at home.

• Tell parent that you will be calling to schedule a Follow-Up (Booster) Session in a month’s time.

• Present graduation certificate and encourage child and caregiver to be proud of accomplishments.

• Discuss transition to different treatment (if appropriate) or to no treatment.



1 MONTH AFTER POST PC-CARE

GOALS: FOLLOW UP call or visit to find out how family is doing.

CHECK-IN & ASSESS (15-min)

• Ask parent and child how they are doing.

• Use WACB-N to find out what child’s behavior is like.

• Ask what skills they are using to manage any difficult behaviors mentioned on the WACB-N (any behavior with a score above “2”)

Listen to the parent, ask questions to get a full picture of how their life is. Make sure to include the child (if appropriate).

IF CONDUCTING BOOSTER SESSION:




COACH (20 min) • Coach parent to play with child and practice

PRIDE skills.

• Have parent give a rule for special playtime, state choices for toys to play with. Look for opportunities to try all skills. Have parent give a transitional warning for switching toys half way through session; have parent state “when we put the toys away we can get a new toy out”; if child whines or protests, have parent ignore and point out cool qualities of new toy.

• Use transition, positive incentives to get the child to clean up (or help clean up) at end of Special Playtime (e.g., sticker)

Pick toys the child is interested in.

WRAP UP (10 min) • Discuss when the parent (and child, if

appropriate) uses the different skills. Refer to the WACB-N and ask how they manage each type of behavior problem. If needed, help plan a more optimal strategy. Encourage them to stick with their behavior management plan.

• Encourage them to continue Special Playtime at home.




Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Armendariz, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. A.19

Non-Standard Protocol: Multiple Children Pre-Treatment Session with TWO CHILDREN

Session Component Adjustments for Two Children Pre-Work Parent completes all measures for each child separately. Assess Child 1 Explain 12-minute observation with parent and both children together.

Conduct 12-minute observation with one child. Assess Child 2 Switch children, and conduct 12-minute observation with the second

child. Bring parent and both children together for observation feedback. Didactic Give trauma/ASD/etc. didactic with parents and both children together.

You may need to use more than one handout depending on the children’s ages. If so, focus most on the symptoms you observe with these children. Discuss how children can present differently due to age and personality.

Describe PC-CARE With parent and both child together. Ensure that both children will attend all sessions.

Set Goals Set goals for each child separately. Prepare for Daily CARE With parent and both children together. Explain the importance of 5-min

of play with each child separately.

Sessions 1-5 with TWO CHILDREN Session Component Adjustments for Two Children

Check-In (10 min) Parent completes WACB-N and returns Daily CARE separately for both children. Behavioral focus of session should be child-specific.

Mini-Didactic (10 min) With parent and both children. May need more than one handout depending on children’s ages and presenting concerns. Discuss how the same skills can serve different purposes based on children’s needs.

Code Child 1 (5 min) Choose one child to play with parent first. Coach Child 1 (15 min) Coach the parent with the first child. Follow session coaching protocol,

but total coaching time is reduced to 15 minutes. Code Child 2 (5 min) Switch children. Coach Child 2 (15 min) Coach the parent with the second child. Follow session coaching

protocol, but total coaching time is reduced to 15 minutes. *Optional: Coach Both Children

If clinical judgment indicates children should be coached together, add joint coaching time. Ensure that each child receives at least 5-10 minutes of individual coaching and that each child’s total coaching (individual + combined) is at least 15 minutes.

Wrap-Up (5 min) With parent and both children together. Use two separate progress graphs (one for each child).

Closing Session (5 min) Give two Daily CARE handouts to parent. Complete ‘Strategies: Will They Work’ sheet with parent for each child.

Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Armendariz, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. A.20

Non-Standard Protocol: Multiple Children

Session 6 with TWO CHILDREN Session Component Adjustments for Two Children

Pre-Work Parent completes all measures for each child separately. Check-In (7 min) Parent completes WACB-N and returns Daily CARE for both children.

Behavioral focus of session is child-specific. Mini-Didactic (10 min) With parent and both children together. May have multiple handouts

depending on ages and presenting concerns. Code Child 1 (15 min) Choose one child to play with parent first. Complete 12-minute

observation with first child. Code Child 2 (15 min) Switch children. Complete 12-minute observation with second child. Coach Both Children (10 min)

Coach the parent with both children together, unless clinical judgment indicates that children need additional separate coaching.

Wrap-Up (7-10 min) With parent and both children together.

*Modifications for >2 Children: Use the same protocol, but code and coach child 3 after child 2.

*Modifications for 2 Children AND 2 Parents: Use the 2 child protocol, but match one child with one parent. That parent should always complete measures for that child and complete coding and coaching with that child. Check-in, mini-didactic, wrap-up, and closing session should occur with both parents and both children together.

Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Armendariz, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. A21

Non-Standard Protocol: Multiple Caregivers

OPTION 1. Complete the full course of PC-CARE (7 sessions) with one parent. After treatment is ended, complete the full course of PC-CARE (7 sessions) with the other parent.

OPTION 2. Conduct 2 separate treatment sessions each week: one with each parent so that each participates in a full course of treatment (14 total sessions).

OPTION 3. Choose 1 parent to be the primary caregiver. That parent must complete measures and have coding and coaching at every session. The second parent may participate in check-in, didactic, and check-out. Depending on session location, you may have the second parent observe coding and coaching.

Pre-Treatment Session with TWO PARENTS Session Component Adjustments for Two Parents

Pre-Work Both parents complete all measures independently. Assess Parent 1 Explain 12-minute observation with both parents and child together.

Conduct 12-minute observation with one parent. Assess Parent 2 Switch parents, and conduct 12-minute observation with the second

parent. Bring both parents and child together for observation feedback. Didactic Give trauma/ASD/etc. didactic with both parents and child together. Describe PC-CARE With both parents and child together. Ensure that both parents will

attend all sessions. Set Goals Goals can be general or parent-specific depending on the family. Prepare for Daily CARE With both parents and child together. Explain the importance of 5-min

of play with each parent separately. Ideal is 7 days each, but it is ok for each parent to choose 1-2 days to take off from play as long as the other parent does Daily CARE.

Sessions 1-5 with TWO PARENTS Session Component Adjustments for Two Parents

Check-In (10 min) Both parents complete WACB-N and return Daily CARE. Behavioral focus of session can be the same for both parents or parent-specific.

Mini-Didactic (10 min) With both parents and child together. Have handouts for both parents. Code Parent 1 (5 min) Choose one parent to play with child first. Coach Parent 1 (15 min) Coach the first parent with child. Follow session coaching protocol, but

total coaching time is reduced to 15 minutes. Code Parent 2 (5 min) Switch parents. Coach Parent 2 (15 min) Coach the second parent with the child. Follow session coaching

protocol, but total coaching time is reduced to 15 minutes. Wrap-Up (5 min) With both parents and child together. Either use two separate progress

graphs or include both parents’ scores on the same graph. Closing Session (5 min) Give Daily CARE handouts to both parents. Complete ‘Strategies: Will

They Work’ sheet with both parents.

Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Armendariz, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. A22

Session 6 with TWO PARENTS Session Component Adjustments for Two Parents

Pre-Work Both parents complete all measures independently. Check-In (7 min) Both parents complete WACB-N and return Daily CARE. Behavioral focus

of session can be the same for both parents or parent-specific. Mini-Didactic (10 min) With both parents and child together. Have handouts for both parents. Code Parent 1 (15 min) Choose one parent to play with child first. Complete 12-minute

observation with first parent. Coach Parent 1 (5-10 min) Coach the first parent with child. Use observation to inform coaching. Code Parent 2 (15 min) Switch parents. Complete 12-minute observation with second parent. Coach Parent 2 (5-10 min) Coach the second parent with the child. Use observation to inform

coaching Wrap-Up (7-10 min) With both parents and child together.

Timmer, S., Hawk, B., Lundquist, K., Forte, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished

Manuscript. A.21

PC-CARE

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Funding • There is a funding source to serve the family

Age • Child is interested in playing with toys (see pg. 1.9, “Selecting

the Right Toys”) o Approximately between the ages of 2 and 10 years

Child & Family Factors

• Child is exhibiting low-level difficult to manage behaviors according to referring party (i.e. school authorities, social worker, self-referred parent, pediatrician, therapist, etc.)

• Caregiver is able to participate in play time with child at home at least 4 times per week as part of homework

• Child is participating in other trauma treatments (e.g., TF-CBT) and needs more intensive parenting component

• Child has chronic medical problems and family needs brief parenting support

• Child has other mental health problems (e.g., ASD, IDD) and family needs brief parenting support

• Families struggling with situational life problems (e.g., separation, divorce)

Assessment/ Behavioral

Observation*

• Caregiver reports difficult to manage behaviors on WACB or other screener

and/or

• Child displays difficult to manage behaviors during 12 Minute Behavioral Observation

* Defensive reporting: Caregiver may report lower scores and/or child behavioral problems during clinical interview, pre-measurements and behavioral observation which may reflect defensive reporting (i.e. involvement with CPS, custody issues, court ordered treatment, fear that child may be removed from home, etc, or, the parent and child would benefit from PC-CARE even though the measures are not elevated).

Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Forte, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. A.22

PC-CARE

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Child & Family Factors

• Child is outside of the 2-10 year age range

• Child does not live with caregiver who will receive services

• Child’s difficult behaviors are too severe or intense and require other services

• In the clinical interview, the caregiver indicates an inability to consistently participate in PC-CARE for the 6 week duration (i.e., medical problems, transportation difficulties, day care arrangements of other children, etc.)

• The child has a diagnosis that contraindicates a referral to PC-CARE (e.g., psychosis, severe mental delay, severe developmental disorder, physical limitation to participate in play activities, etc.)

• The caregiver has a diagnosis that contraindicates the decision to provide PC-CARE (e.g., active chemical dependency, psychosis, severe mental delay, personality disorder, severe depression, physical limitation to participate in play activities, etc.)

• Background history or clinical interview indicates that the child is a victim of sexual abuse and the caregiver is alleged perpetrator, or if non-offending caregiver does not support/believe the sexual abuse allegations

• Other mental health treatment interventions are being recommended prior to initiating PC-CARE


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When selecting toys for your session, think about your client and what you want to accomplish. The toys you choose will help you achieve your goals.

• Think about how old children are, their motor coordination, and their taste in toys. You may also consider whether a toy poses a safety hazard (e.g., choking).

• Think about toys that will help the parent and child to play together. • Think about really fun toys that help the parents to keep children interested in

playing with them. • Think about whether the child might have a meltdown or require a time out.

While it is all right to use other toys, the toys listed below have traditionally been successful for PC-CARE sessions.

You may also consider selecting the following toys as exercises to achieve coaching goals if needed:

• Games like Candy Land or Chutes & Ladders, or puzzles • Homework from school • Play family figures, all ages and ethnicities • Fischer-Price school house and playground • Play furniture, with beds, toilets, and bathtubs • Cars and trucks, esp. police cars, ambulances, and fire trucks

Toys for Most 3 – 7 yr. olds Toys for Younger Children (< 3 yrs.)

Toys for Older Children (7 – 10 yrs.)

Foam blocks Pop-beads Small Legos

Little People toys Duplo blocks (large Legos) Gears (building gears)

Play-Doh with molds, shapes, & cutters Megga blocks (giant Legos) Magnetix, Magna Tiles

Play food, dishes, pots, & pans Ring stacker with sounds Tinker Toys (plastic), Playstix

Potato Heads (at least two so that both parent & child can play)

Xylophone, or other musical instruments that do not go in the mouth

Matchbox or Hotwheels cars

Wooden train & track Pop-up toy Kid Kinex

Plastic play figures with terrain/play mats: farm animals, dinosaurs, jungle animals

Toys with a small amount of sound, music, or lights

Motorworks (cars to build)

Bristle Blocks (Krinkles brand with wheels and figures) Soft toys, or small plush animals Marble Toy

Washable crayons and paper Sorting blocks, nesting toys Simple, non-directive arts and crafts


Documents

COURSE of TREATMENT MANUAL: PC-CARE Version: 1.2 1/2019 · M INIMUM R EQUIREMENTS FOR B ECOMING A PC-CARE P ROVIDER Trainee must: 1) Be able to enroll at least two families in PC-CARE