Running head: REACTIVE ATTACHMENT DISORDER IN CHILDREN
Reactive Attachment Disorder in Children: Evaluation Proposal: Part 1
Shelley Richardson
The Catholic University of America
National Catholic School of Social Service
February 10, 2019
1
REACTIVE ATTACHMENT DISORDER IN CHILDREN
2
This proposal seeks to examine the theoretical framework of social work and how it
correlates with the evidence-based practice intervention known as Attachment Theory. In
exploring the relationship of Attachment Theory and the discipline of social work, this paper also
poses a research question, literature review and hypothesis.
Statement of the Problem
Being that Social Work is a major discipline which influences many facets of life,
specifically this paper will illustrate the impact of social work as a system by examining the
major perspective of Attachment Theory. According to Steinhart, Scott and Barfield (2012),
attachment can only happen when an infant’s primary caregiver is consistently responsive to
their needs. Conversely, the absence of having the essential needs satisfied can certainly lead to
an unhealthy style of attachment (Steinhart et al., 2012). Needless to say, the basic needs include
feeding, and providing human touch while supplying a comfortable safe and nurturing
environment. Indeed, this theoretical perspective is not a new phenomenon in the study of Social
Work, but is a foundational perspective that was introduced initially by the Theory of Maslow’s
Hierarchy of Needs (Steinhart et al., 2012).
The Department of Social and Health Services is a widely-known system that often
removes children from their homes and provides placement into care of individuals who are
unfortunately, not known to the child who is at risk. While the intention of the Department of
Social and Health Services may be good, the transition can also be a negative contribution to the
life of a child. Unfortunately, situations that place children into the foster care system often
create extreme psychiatric consequences which may create significant and detrimental insecure
attachments (Steinhart et al., 2012). This unfortunate instance often leaves the child to deal with
a diagnosis known as Reactive Attachment Disorder (RAD) (Steinhart et al., 2012).
REACTIVE ATTACHMENT DISORDER IN CHILDREN
3
RAD can allow a child to fail to initiate or respond in developmentally appropriate ways
that are socially unacceptable within mainstream society (Hornor, 2008). Children often
demonstrate behaviors that are inhibited, hypervigilant, or highly ambivalent and contradictory
in response to social interactions (Hornor, 2008). These behaviors are certainly seen as
challenges for children as they are striving to develop new healthy and trusting relationships. In
addition, the child dealing with RAD often exhibits negative conduct behaviors (Hornor, 2008).
Steinhart et al. (2012) brought forth a study that was conducted in 2005 by Lake which indicated
that 38-40% of toddlers who experienced poor care-giving and were removed from their homes
showed signs of RAD.
Be that as it may, a greater understanding is needed to address the impact of the Social
and Health Services and how it functions as a system. In order to adequately assess the issue at
hand, one can turn to Social Work to address the fundamental delivery of service and its
implications as a system while further exploring the inner relationship of the individual, mother
to child. The discipline of Social Work offers the opportunity to not only view the situation from
a system perspective but to assess the situation from a client-centered perspective. Social Work
is truly a discipline that will recognize the client’s areas for growths and strengths. To ignore the
qualities of the client whether it be negative and/or positive, is to distract from the goal of
representing the consumer in hopes of advocating for change. By establishing a Single-Subject
Design (SSD) client -centered approach to address this problem will help better understand the
development and treatment of RAD, social workers can begin to support children who are placed
in foster care and provide their new care givers with the adequate tools to cope with and manage
symptoms of RAD. Sadly, in 2009, the Department of Health and Human Services (DHHS)
REACTIVE ATTACHMENT DISORDER IN CHILDREN
4
reported over 460,000 children who were placed into foster homes during the previous year
(DHHS, 2009).
Evidence–Based Practice Intervention
In order to affect positive change, a thorough and complete grasp of knowledge is needed
when seeking a comprehensive understanding of RAD. In terms of having a technique that will
address the issue of RAD, many treatment protocols have been introduced. However,
scientifically supported is Parent-Child Interaction Therapy (PCIT). This form of therapy has
been identified as an evidence-based treatment specifically to address RAD.
PCIT, as described by Thomas and Herschel (2013) states that the treatment can be
delivered into two phases. The first phase is identified as the Child Directed Interaction (CDI)
with the second being called the Parent Directed Interaction (PDI) (Thomas and Herschel, 2013).
In both phases, the main objective is to teach the parents how to communicate efficiently and
effectively. Communication is a skill that is highly valued because it will foster positive parentchild relationships. Furthermore, it will allow the parents to identify strategies of differential
reinforcement (Thomas and Herschel, 2013). PICT proves to be highly attractive to address RAD
due to the notion that PICT takes its foundation from attachment theory principles. In addition,
PICT has been studied to determine its effectiveness in preventing child maltreatment (Thomas
and Zimmer-Gembeck, 2011).
More in-depth observation is needed which would serve to provide a greater focus on the
foster families who are taking on the role as primary caregiver to children who display symptoms
of RAD. In order to gain more insightful knowledge, a client system would foster families and
children ages 5-10. Such a focus on the age would allow researchers opportunity to understand
how early intervention during development can reduce symptoms of RAD in adolescents.
REACTIVE ATTACHMENT DISORDER IN CHILDREN
5
Effective assessment and the use of the evidence-based treatment modality will be necessary for
researchers. The study would entail the client to attend a group meeting once a week for three
months. The goal is to reduce symptoms of Reactive Attachment Disorder in foster families and
children ages 5-10.
Literature Review
(Dickmann and Allen, 2017) in their article, “Parent-Child Interaction Therapy for the
Treatment of Disinhibited Social Engagement Disorder” argue that reactive attachment disorder
currently known as Disinhibited Social Engagement Disorder is a common condition that affects
millions of children around the world. The problem arises from a severe deprivation of the child
early in their life. In their analysis, they contend the idea that evidence-based parent-focused
behaviors such as parent-child interactions are one of the more efficient ways of treating the
condition in children. They argue that Parent-Child Interaction Therapy (PCIT) is a wellvalidated parent-focused behavior management training that can offer a direct result if explored.
However, a similar view as the one presented by (Dickmann and Allen, 2017) is also held
by (Hosogane, Kodaira, Kihara Saito, and Kamo, 2018) in their article “Parent-Child Interaction
Therapy (PCIT) for young children with Attention-Deficit Hyperactivity Disorder (ADHD)” and
(Suzuki and Tomoda, 2015) in their article, “Roles of attachment and self-esteem: impact of
early life stress on depressive symptoms among Japanese institutionalized children”. According
to (Hosogane et al., 2018) and (Suzuki and Tomoda, 2015), children experiencing Disinhibited
Social Engagement Disorder may be treated through Parent-Child Interaction Therapy (PCIT)
since this is an evidence-based intervention that offers a psychotherapy treatment for children
suffering some forms of disruptive behaviors.
REACTIVE ATTACHMENT DISORDER IN CHILDREN
6
(Cooley, Veldorale-Griffin, Petren, and Mullis, 2014) conducted a meta-analysis of
Parent-Child Interaction Therapy (PCIT) on child behavior outcomes and concluded that ParentChild Interaction Therapy (PCIT) is one of the most effective evidence-based intervention
therapies. The therapy provides an effective way to ensure a child-parent engagement which is
one of the key outcome measures of the treatment. According to them, Parent-Child Interaction
Therapy (PCIT) focuses on helping parents improve the quality of interaction with their children,
help in communicating behavioral expectations clearly and more importantly provide an
appropriate consequence for child behavior. (Graziano et al., 2015) contends to the fact that
parent-training intervention is a feasible and effective treatment for young children with
externalizing behavior.
The clinical implications of Parent-Child Interaction Therapy according to (Graziano et
al., 2015) is that it offers an effective way of improving a child’s behavioral impairment in a very
brief period. (Carpenter, Puliafico, Kurtz, Pincus, and Comer, 2014) in their articles, “Extending
parent-child interaction therapy for early childhood internalizing problems: New advances for an
overlooked population” and “Preventing maltreatment with a community-based implementation
of parent-child interaction therapy” respectively offers the same idea presented by (Graziano et
al., 2015). According to them, Parent-Child Interaction Therapy targets child symptoms by
directly reshaping the parent-child interaction patterns that are linked with the symptoms
identified.
(Niec, Barnett, Prewett., and Shanley, 2016) conducted a meta-analysis of the Group
Parent-Child Interaction Therapy with a view to evaluating the relevance of Parent-Child
Interaction Therapy as one of the most effective means of treating children with interaction
problem. According to them, Parent-Child Interaction Therapy is a parent management training
REACTIVE ATTACHMENT DISORDER IN CHILDREN
7
technique that focuses on identifying the unique behaviors of children and centers on aligning the
parent’s behavior towards nurturing child behavior. (Niec, et al., 2016) agrees to the fact that
children with behavior problems often have low self-esteem because they were exposed to an
environment of either neglect or abuse. (Ward, Theule, and Cheung, 2016) agree to the fact that
Parent-Child Interaction Therapy (PCIT) has a significant effect of improving the externalizing
behavior of children. According to them, children exposed to aggression or neglect in their early
life has a significant challenge when it comes to interaction. In other words, the primary
caregivers have the most significant responsibility of shaping the behavior or children in their
early life.
In light of the high prevalence rates of reactive attachment disorder and childhood
anxiety disorders, (Brendel, and Maynard,2014) argue that childhood anxiety disorders have
been linked to significant negative implications which in this case include low self-esteem,
academic and family problems, depression, substance abuse later in life, and other social
problems for children across social domains.
The same philosophy is echoed by (Buss, Warren, and Horton, 2015) who argue that
childhood trauma is a severe problem during childhood. According to them, family-based
therapies such as Parent-Child Interaction Therapy offer a useful evidence-based intervention
that is critical for the treatment of childhood conditions such as reactive attachment disorders or
anxiety. (Thomas, Webb, and Zimmer-Gembeck, 2017) however, argues that disorders of
attachment are consistently prevalent among children following their severe deprivation in their
early life. They say that although little is known about whether signs of this condition persist
until adolescent, it is essential to consider family-based interventions such as Parent-Child
REACTIVE ATTACHMENT DISORDER IN CHILDREN
8
Interaction Therapy as this center on the child behavior and aligns the parent’s action towards the
same.
Although many studies have pointed out the strengths of Parent-Child Interaction
Therapy as one of the psychological treatments for children with reactive attachment disorder, it
is imperative to understand that many studies have also pointed out some of the potentially
harmful psychological treatments for children with reactive attachment disorder and other related
psychological problems. (Mercer, 2017) pointed out that the psychological treatment should be
relevant and should address the intended psychological problem in children. However, there are
some psychological treatments that often than not are potentially harmful for use. Such
therapeutic psychological treatments have a potential harmful effect on the child’s mental
condition. Attachment Therapy is one of the evidence based psychological interventions that has
failed to provide psychological treatment for children who suffer from psychological conditions
such as reactive attachment disorder. This treatment modality according to (Mercer, 2017) has
been discredited due to its failure to provide a dynamic and effective intervention for children
who suffer from psychological problems. (Wendt Gone, and Nagata, 2015) shares the same
perspective and highlights Attachment Holding Therapy as another failed psychological
intervention. According to them, the attachment holding therapy has been implicated in many
child deaths around the country. The therapy has failed in its intervention and can no longer be
used as an effective intervention for children with behavioral or psychological problems.
(Grzanka and Miles,2016) in their study of intersecting identities evaluated the strengths
and weaknesses of affirmative therapy which is one of the psychological interventions and
concluded that the therapy does provide an effective intervention to help restore and treat
children/adolescents with psychological problems. They highlighted the potential harm of the use
REACTIVE ATTACHMENT DISORDER IN CHILDREN
9
of this therapy especially among children with reactive attachment problems as well as
adolescents with intersecting identities. Their conclusion was that affirmative therapy has some
discriminatory practices that can potentially harm the subject. Based on considerable research
and review of previous literature in their study, they contend to the idea of other researchers who
have discredited this therapeutic model as an evidence-based intervention.
Research Question and Hypothesis
It is hypothesized that the use of Parent-Child Interaction Therapy in foster families for
children ages 5-10 years old will reduce symptoms of Reactive Attachment Disorder. The
independent variable is the treatment modality – PCIT and the dependent variable is the change
in symptoms of RAD. The research question will be: Is the use of Parent-Child Interaction
Therapy able to reduce symptoms of the Reactive Attachment Disorder in foster families and
their children?
REACTIVE ATTACHMENT DISORDER IN CHILDREN
10
References
Brendel, K. E., & Maynard, B. R. (2014). Child–parent interventions for childhood anxiety
disorders: A systematic review and meta-analysis. Research on Social Work
Practice, 24(3), 287-295. [Google Scholar]
Buss, K. E., Warren, J. M., & Horton, E. (2015). Trauma and Treatment in Early Childhood: A
Review of the Historical and Emerging Literature for Counselors. Professional
Counselor: Research & Practice, 5(2). [Google Scholar]
Carpenter, A. L., Puliafico, A. C., Kurtz, S. M., Pincus, D. B., & Comer, J. S. (2014). Extending
parent–child interaction therapy for early childhood internalizing problems: New
advances for an overlooked population. Clinical child and family psychology
review, 17(4), 340-356. [Google Scholar]
Cooley, M. E., Veldorale-Griffin, A., Petren, R. E., & Mullis, A. K. (2014). Parent–Child
Interaction Therapy: A meta-analysis of child behavior outcomes and parent
stress. Journal of Family Social Work, 17(3), 191-208. [Google Scholar]
Dickmann, C. R., & Allen, B. (2017). Parent–Child Interaction Therapy for the Treatment of
Disinhibited Social Engagement Disorder: A Case Report. Evidence-Based Practice in
Child and Adolescent Mental Health, 2(1), 19-29. [Google Scholar]
Graziano, P. A., Bagner, D. M., Slavec, J., Hungerford, G., Kent, K., Babinski, D., & Pasalich,
D. (2015). Feasibility of intensive parent–child interaction therapy (I-PCIT): results from
an open trial. Journal of psychopathology and behavioral assessment, 37(1), 38-49.
[Google Scholar]
REACTIVE ATTACHMENT DISORDER IN CHILDREN
11
Grzanka, P. R., & Miles, J. R. (2016). The problem with the phrase “intersecting identities”:
LGBT affirmative therapy, intersectionality, and neoliberalism. Sexuality Research and
Social Policy, 13(4), 371-389. [Google Scholar]
Hornor, G., (2008). Reactive attachment disorder. Journal of Pediatric Health Care, 22(4), 234239.
Hosogane, N., Kodaira, M., Kihara, N., Saito, K., & Kamo, T. (2018). Parent–Child Interaction
Therapy (PCIT) for young children with Attention-Deficit Hyperactivity Disorder
(ADHD) in Japan. Annals of General Psychiatry, 17(1), 9. [Google Scholar]
Mercer, J. (2017). Evidence of potentially harmful psychological treatments for children and
adolescents. Child and adolescent social work journal, 34(2), 107-125. [Google Scholar]
Niec, L. N., Barnett, M. L., Prewett, M. S., & Shanley Chatham, J. R. (2016). Group parent–
child interaction therapy: A randomized control trial for the treatment of conduct
problems in young children. Journal of consulting and clinical psychology, 84(8), 682.
[Google Scholar]
Steinhart, M. A., Scott, D. A, and Barfield, H. G. (2012) Reactive attachment disorder in adopted
and foster care children: Implications for mental health professionals. The Family
Journal, 20(4), 355-360.
Suzuki, H., & Tomoda, A. (2015). Roles of attachment and self-esteem: impact of early life
stress on depressive symptoms among Japanese institutionalized children. BMC
psychiatry, 15(1), 8. [Google Scholar]
REACTIVE ATTACHMENT DISORDER IN CHILDREN
12
Thomas, R., Abell, B., Webb, H. J., Avdagic, E., & Zimmer-Gembeck, M. J. (2017). Parentchild interaction therapy: A meta-analysis. Pediatrics, 140(3), e20170352. [Google
Scholar]
Thomas, R., and Herschel, A. (2013). Parent-child interaction therapy: A manualized
intervention for the therapeutic child welfare sector. Child Abuse & Neglect, 37(8), 578584.
Ward, M. A., Theule, J., & Cheung, K. (2016, October). Parent–child interaction therapy for
child disruptive behavior disorders: A meta-analysis. In Child & Youth Care Forum (Vol.
45, No. 5, pp. 675-690). Springer US. [Google Scholar]
U.S. Department of Health and Human Services. (2009). The AFCARS Report: Preliminary FY
2008 Estimates as of October 2009 (16). Retrieved January 7, 2010, from
www.acf.hhs.gov/programs/cb/stats_research/afcars/tar/report16.htm
Wendt, D. C., Gone, J. P., & Nagata, D. K. (2015). Potentially harmful therapy and multicultural
counseling: Bridging two disciplinary discourses. The Counseling Psychologist, 43(3),
334-358. [Google Scholar]
Running Head: REACTIVE ATTACHMENT DISORDER IN CHILDREN
1
Reactive Attachment Disorder in Children: Evaluation Proposal: Part II
Shelley Richardson
The Catholic University of America
National Catholic School of Social Service
February 24, 2019
EVALUATION PROPOSAL PART II
2
Introduction
The aim of this proposal is to examine the theoretical framework of social work and its
correlation with the evidence-based practice intervention known as Parent-Child Interaction
Therapy PCIT. In exploring the relationship of Attachment Theory and the discipline of social
work, this paper also discusses the research question and hypothesis, methodology, data
collection plan, human subject concerns, data analysis plan, implications, and recommendations
for future SSD.
Research Question and Hypothesis
It is hypothesized that the use of Parent-Child Interaction Therapy (PCIT) in foster
families for children ages 5-10 years old will reduce symptoms of Reactive Attachment Disorder.
The independent variable is the treatment modality–PCIT, and the dependent variable is the
change in symptoms of RAD. The research question will be: Is the use of Parent-Child
Interaction Therapy able to reduce symptoms of the Reactive Attachment Disorder in foster
families and their children?
Methodology
Evaluation Design
The Single-Subject Design (SSD) that will be used to test the stated hypothesis is the
reversal design, also known as the A-B-A design. The A-B-A design is the most appropriate
design to test the hypothesis because it will determine whether or not the utilization of ParentChild Interaction Therapy in foster families for children ages 5-10 years will minimize
symptoms of Reactive Attachment Disorder. Fundamentally, the reversal design uses three
phases. In phase A, which is the first phase, a baseline is determined for the dependent variable.
EVALUATION PROPOSAL PART II
3
This is the phase of responding before any form of treatment is introduced, and thus the baseline
stage serves as a form of control condition. Regarding the context of this study, in Phase A, the
baseline is ascertained for the level and symptoms of RAD. In other words, the symptoms of
RAD are determined before PCIT is introduced (Bloom & Orme, 2009).
When a stable level responding is determined, the researcher initiates Phase B, where the
treatment is introduced. In this phase, PCIT is introduced to the participants. There may be a
stage of modification to the treatment during which the behavior of interest becomes more
flexible and starts to decrease or increase. Like Phase A, in Phase B, the researcher waits until
the dependent variable is steady to determine whether it (dependent variable) has changed. In
other words, in this stage, the PCIT is introduced, and the researcher observes whether the
treatment impacts/changes the symptoms of RAD.
The final phase is Phase A. In the last phase, the researcher eliminates the treatment and
waits until the dependent variable is steady. Within the context of the study, the researcher
removes the PCIT and waits until the symptoms of RAD are steady. It is in this phase that the
researcher determines whether or not treatment alternative was effective (Brendel, & Maynard,
2014).
The three threats pertaining to A-B-A’s internal validity are history, testing, and
instrumentation. The threat of history may occur when the institution of the independent
variable, in this case, the treatment alternative of PCIT, may overlap with other events in the
participant’s life. Furthermore, regarding the threat of testing, changes in the dependent variable,
in this case, the symptoms of RAD may have been caused by repeated exposure to the
experimental schedules. Lastly, the internal validity threat of instrumentation may occur when
EVALUATION PROPOSAL PART II
4
changes depict alterations in the measurement framework instead of the independent variable
(treatment module- PCIT) (Buss, Warren, & Horton, 2015).
Participant Criteria
Random sampling will be used to select participants from the population. With this
approach, everyone in the target population has an equal opportunity of being selected. Random
sampling is appropriate for this study because it will assist in representing the target population
as well as remove sampling bias. Moreover, the criteria that will be used to determine eligibility
for participants in the research study include age, medical history, and residential system (foster
homes). Essentially, eligible participants for the study must be children between the ages of 5
and 10, must present symptoms of Reactive Attachment Disorder, and the participants must be
raised up by foster families (Carpenter, et al. 2014).
The two threats regarding the design’s external validity that are most applicable to the
context of this study are the interaction effect of testing and reactive effects of experimental
arrangements. With the interaction effect of testing, this threat occurs when the pre-test hints the
participants to react in a particular manner to the experimental treatment that would not occur in
the absence of the pre-test. Reactive effects of experimental arrangements occur when the
participants are aware that they are partaking in an experiment and feeling the novelty of it.
“This threat is also known as the Hawthorne effect” (Cooley, Veldorale-Griffin, Petren, &
Mullis, 2014, para 3). With the Hawthorne effect, the participants (children ages 5-10) modify
their behaviors because they are aware they are being experimented on (Cooley, VeldoraleGriffin, Petren, & Mullis, 2014).
EVALUATION PROPOSAL PART II
5
Based on the generalizability of the SSD’s potential findings, it is determined after a
comprehensive study that the use of Parent-Child-Interaction Therapy in foster families for the
selected participants will minimize symptoms of Reactive Attachment Disorder. The abovementioned external validity threats minimize the generalizability of the results. For instance, it
will be difficult for the researcher to determine whether or not the PCIT treatment works
effectively in reducing RAD with the presence of external validity threats. In other words, threats
to external validity will likely impact the outcome and findings of the research study
significantly (Dickmann, & Allen, 2017).
Dependent Variable
The dependent variable for this study is the changes in symptoms of RAD. Conceptual
variables are essentially the facets that need to be measured. In this case, the conceptual
definition of the research’s dependent variable is changes in symptoms of Reactive Attachment
Disorder. A RAD is a form of disorder whereby a child fails to develop healthy, firm affections
to a caregiver because he/she endured emotional and/or physical neglect. The operational
definition, on the other hand, informs the researcher how to measure the concept. Behavioral
observation and individual rating scale will be used to measure the changes in symptoms of
RAD. Some of the symptoms that will be analyzed to determine whether or not they have
changed include unexplained withdrawal and sadness, minimum or no social interaction, failure
to smile, and failure to seek assistance or support (Graziano, et al. 2015).
The researcher will use an individualized rating scale to measure the dependent variable.
Typically, this scale will be utilized to monitor the reaction of the participants regarding the
changes in symptoms of RAD. For instance, a Likert scale will be used to elicit responses from
EVALUATION PROPOSAL PART II
6
the participants and can range between 1 and 5: 1 signifying strongly agree, and 5 meaning
strongly disagree. Each participant will be given a questionnaire with a list of questions that
he/she is supposed to answer using the Likert scale criteria. Additionally, behavior observation
will be used by the researcher to assess the behaviors of the participants. This approach involves
observing the participants in typical environments and recording how they respond to the
treatment as far as changes in the symptoms of RAD are concerned. For instance, the researcher
may observe the children in the foster family setting and assess how PCIT impacts symptom
changes of RAD (Suzuki, & Tomoda, 2015).
With behavioral observation, the validity and reliability of this measure that can be
established are content validity and interrater reliability. Content validity assesses how
behavioral observation represented all the components of a construct. For instance, content
validity will reflect how the researcher measured the behavioral changes of the participants with
respect to changes in symptoms of RAD. Interrater reliability, on the other hand, measures the
consistency of the judgment that is concluded on the same stimulus. In other words, this form of
reliability entails the observation that the researcher makes when he/she collects observational
information about the participants (Steinhart, Scott, & Barfield, 2012).
Internal consistency reliability and construct validity will be established with the use
individualized rating scale. With internal consistency reliability, the consistency of results across
elements within the test will be assessed. With construct validity, the cause and effect of the
constructs will be measured to determine how they align with the real-world scenario they ate
projected to model. Particularly, convergent validity will be ascertained to determine how
measures of constructs correlate (Niec, Barnett, Prewett, M. & Shanley Chatham, 2016).
EVALUATION PROPOSAL PART II
7
Independent Variable
The independent variable is the treatment modality-PCIT. The conceptual definition of
this independent variable is Parent-Child Interaction Therapy. PCIT entails the combination of
behavioral and plays therapy for children and their caregivers. The PCIT treatment can be
delivered into two stages. The first stage is known as the Child-Directed Interaction (CDI)
whereas the second stage is referred to as the Parent-Directed Interaction (PDI). It should be
noted that in both stages, the major goal is to teach the parents and caregivers how to
communicate effectively. Moreover, the application of PCIT would be measured with respect to
its length and timing based on the pattern and quality of parent-child interaction before, during,
and after the intervention (Niec, Barnett, Prewett, M. & Shanley Chatham, 2016).
Data Collection Plan
The data for both baseline and intervention phases will be collected using in-depth
observation. As mentioned, the participants will include children, and therefore data will be
collected from these participants. The researcher will physically observe the participants and in
some instances will video-record them for documentation purposes. The data will be collected
for 6 hours per day for one week. In Phase A (baseline), 5 data will be included, and in Phase B
(intervention) and Phase C, 3 and 1 data points will be included respectively. Furthermore,
special training and assistance will be given as part of the data collection process. Since the
participants are children, they will require guidance and additional help from their caregivers and
members of the research team (Bloom & Orme, 2009).
EVALUATION PROPOSAL PART II
8
Human Subject Concerns
Since the participants will be children, the researcher will obtain informed consent from
their caregivers and foster parents. Some of the information that will be included in the informed
consent form includes benefits and risks of participating in the research, the purpose of the
research, experimental procedures, and duration of the study (Niec, Barnett, Prewett, M. &
Shanley Chatham, 2016).
Data Analysis
Regarding operational definition 1 of the dependent variable, the data analysis method
that will be used to analyze the collected data is descriptive statistics. This method offers simple
outlines regarding the sample and the measures, and it utilizes graphics analysis. This method is
appropriate because it describes what the data shows. In order to test the hypothesis, several
procedures must be followed. First, an alternative and a null hypothesis will be set followed by
the determination of the test criterion. The information obtained from the samples will then be
analyzed using descriptive statistics and plotted in graphs (Hosogane, Kodaira, Kihara, Saito, &
Kamo, 2018).
For operational definition 2 of the dependent variable, the visual analysis will be used to
analyze the data. This data analysis approach is appropriate because it utilizes analytical
reasoning as well as visual interfaces to present data. To test the hypothesis to determine whether
or not it was accurate and resulted in the desired outcome, several steps must be followed. The
first step involves setting a null and alternative hypothesis and ascertaining the test criteria. The
next procedure is to collect the desired data and then analyze them using visual analysis
approach. The heterogeneous data sources will then be incorporated before applying visual
EVALUATION PROPOSAL PART II
9
analysis. It should be noted that visualizations enable the researcher to interact with automatic
approaches by altering factors or choosing other analysis processes (Hornor, 2008).
Implications for Social Work Practice
The aspects presented in this study may inform social work practice from both
knowledge-building and knowledge-using perspectives. With information about Reactive
Attachment Disorder, social workers may understand the nature, causes, symptoms, and
treatment alternatives of this disorder. In other words, information about RAD provides an
insight into social workers on how to handle this disorder and also how to manage and prevent it.
The mentioned facets will build not only social work practice knowledge but also allow social
workers to adopt them practically (Bloom & Orme, 2009).
In addition to the problem, the intervention also shapes social work practice theoretically
and practically. According to Bloom, Fischer, & Orme (2009), the clinical implication of PCIT is
that it offers a suitable alternative for improving a child’s behavioral impairment in a very brief
period. The authors further claim that this intervention method targets child symptoms by
directly reshaping the parent-child interaction patterns that are linked with the symptoms. In
other words, the field of social work is impacted significantly by the information regarding the
problem and the solution (treatment alternative). Theoretically, based on this data, social workers
have sufficient information to build their knowledge about RAD and PCIT. Practically, they can
apply this knowledge to their profession and tackle real-life situations (Bloom & Orme, 2009).
EVALUATION PROPOSAL PART II
10
Recommendation for Future SSD
One of the advanced SSDs outlined by Bloom et al. (2009) is the multiple baseline design
(A-B). Multiple baseline design can be used to address the limitations of the reversal design. In
one form of the design, a baseline is identified for each of the multiple participants, and the
treatment is initiated for each participant. Essentially, the A-B design is used to test each
participant. The major concept with this approach is that the treatment is initiated at a different
period for each participant (Bloom & Orme, 2009).
The underlying notion with multiple baseline design is that if the DV changes when the
treatment is initiated for one participant, it may happy by chance or luck. However, if the DV
changes when the treatment is given to multiple participants, then it is improbable to be
coincidentally. Therefore, since the A-B-A SSD design has several limitations, the next logical
design to be utilized is the A-B design. With the utilization of the A-B design, the PCIT will be
introduced at a different period for each participant. If symptoms of RAD changes when PCIT is
introduced for one participant, then the outcome will be regarded coincidentally. Nonetheless, if
symptoms of RAD changes when PCIT is introduced for various participants, then the outcome
will not be considered to be a coincident. In other words, if symptoms of RAD changes when the
treatment is given to several participants, it means that the treatment can be considered effective
(Bloom & Orme, 2009).
EVALUATION PROPOSAL PART II
11
References
Bloom, F. Orme (2009) Evaluating practice. Guidelines for the accountable professional.
Brendel, K. E., & Maynard, B. R. (2014). Child–parent interventions for childhood anxiety
disorders: A systematic review and meta-analysis. Research on Social Work
Practice, 24(3), 287-295. [Google Scholar]
Buss, K. E., Warren, J. M., & Horton, E. (2015). Trauma and Treatment in Early Childhood: A
Review of the Historical and Emerging Literature for Counselors. Professional
Counselor: Research & Practice, 5(2). [Google Scholar]
Carpenter, A. L., Puliafico, A. C., Kurtz, S. M., Pincus, D. B., & Comer, J. S. (2014). Extending
parent–child interaction therapy for early childhood internalizing problems: New
advances for an overlooked population. Clinical child and family psychology
review, 17(4), 340-356. [Google Scholar]
Cooley, M. E., Veldorale-Griffin, A., Petren, R. E., & Mullis, A. K. (2014). Parent–Child
Interaction Therapy: A meta-analysis of child behavior outcomes and parent
stress. Journal of Family Social Work, 17(3), 191-208. [Google Scholar]
Dickmann, C. R., & Allen, B. (2017). Parent–Child Interaction Therapy for the Treatment of
Disinhibited Social Engagement Disorder: A Case Report. Evidence-Based Practice in
Child and Adolescent Mental Health, 2(1), 19-29. [Google Scholar]
Graziano, P. A., Bagner, D. M., Slavec, J., Hungerford, G., Kent, K., Babinski, D., ... & Pasalich,
D. (2015). Feasibility of intensive parent–child interaction therapy (I-PCIT): results from
EVALUATION PROPOSAL PART II
12
an open trial. Journal of psychopathology and behavioral assessment, 37(1), 38-49.
[Google Scholar]
Hornor, G., (2008). Reactive attachment disorder. Journal of Pediatric Health Care, 22(4), 234239.
Hosogane, N., Kodaira, M., Kihara, N., Saito, K., & Kamo, T. (2018). Parent–Child Interaction
Therapy (PCIT) for young children with Attention-Deficit Hyperactivity Disorder
(ADHD) in Japan. Annals of General Psychiatry, 17(1), 9. [Google Scholar]
Niec, L. N., Barnett, M. L., Prewett, M. S., & Shanley Chatham, J. R. (2016). Group parent–
child interaction therapy: A randomized control trial for the treatment of conduct
problems in young children. Journal of consulting and clinical psychology, 84(8), 682.
[Google Scholar]
Steinhart, M. A., Scott, D. A, and Barfield, H. G. (2012) Reactive attachment disorder in
adopted and foster care children: Implications for mental health professionals. The
Family Journal, 20(4), 355-360.
Suzuki, H., & Tomoda, A. (2015). Roles of attachment and self-esteem: impact of early life
stress on depressive symptoms among Japanese institutionalized children. BMC
psychiatry, 15(1), 8. [Google Scholar]
Purchase answer to see full
attachment