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Parents and Children Together (PACT)

Topic Areas
Scientific Rating
Child Welfare Relevance
Fetal Alcohol Spectrum Disorders (FASDs) Interventions (Child & Adolescent)
3  — Promising Research Evidence
High

About This Program

Target Population: Foster and adopted children 6 to 12 years of age with fetal alcohol spectrum disorders (FASD) and their parents/caregivers

For children/adolescents ages: 6 – 12

For parents/caregivers of children ages: 6 – 12

Program Overview

Parents and Children Together (PACT) is a group therapy intervention for foster and adopted children who were affected by prenatal exposure to alcohol and their parents/caregivers. PACT is based on the premise that difficulties with self-regulation contribute to the day-to-day challenges experienced by children with fetal alcohol spectrum disorders (FASDs), including executive functioning deficits and emotional dysregulation. The program is designed to teach children to recognize individual deficit areas and to develop strategies to compensate for areas of weakness, all while building upon existing skills and strengths. The development of this group treatment model integrated techniques and interventions utilized in therapy for traumatic brain injury (TBI) with components of the Alert Program®, curriculum that helps children improve self-regulatory skills by teaching children how to first identify their arousal level and then how to choose appropriate interventions to alter their arousal level based on situational demands.

Program Goals

The goals of Parents and Children Together (PACT) are:

For Parents:

  • Enhance understanding of changes in the brain of the child prenatally exposed to alcohol that are the source of learning and behavioral difficulties.
  • Improve ability to prevent and intervene in their children's behavioral difficulties.

For Children:

  • Improve executive functioning skills.
  • Improve emotional regulation.

Logic Model

The program representative did not provide information about a Logic Model for Parents and Children Together (PACT).

Essential Components

The essential components of Parents and Children Together (PACT) include:

  • 12 weeks of separate therapeutic group sessions that are run concurrently (i.e., at the same time) for children and parents/caregivers
  • Direct contact with parent/caregiver and child for 90 minutes each week. Parents and children participate in their respective groups for 45 minutes then come together to practice what they learned for the remaining 45 minutes.
  • The Children's Group:
    • Limited to four children at a time
    • Meets in a separate room than parents/caregivers for the first 45 minutes
    • Follows the following group therapy weekly curriculum:
      • Week 1: Invitation to Learn, Grow, and Share: Different Games for Different Brains
        • Learn to think of the human brain and body as an automobile engine to help understand self-regulation.
      • Week 2: Self-Regulation: Feelings and Behaviors
        • Learn to identify when their "engine" is running in low, just right, and high gear.
      • Week 3: Self-Regulation: Feelings and Behaviors, Part II
          • Learn to use the Engine Speed Chart to label their "engine levels" while participating in various activities throughout the course of a typical day.
      • Week 4: Memory, Planning, and Behavior
        • Learn steps for planning ahead and sequential thinking through active songs and movement.
      • Week 5: Sensation and Emotion
        • Learn progressive muscle relaxation techniques to help adjust arousal levels.
        • Learn to understand feelings by visually indicating with art where in the body they feel certain emotions..
      • Week 6: Review and Renew
        • Review and practice self-regulation, memory, and emotional awareness tasks that enhance skill areas and reinforce learning.
      • Week 7: Emotions and Planning
        • Learn about emotional awareness and expression by learning how to identify feelings visually and by acting out their feelings through various games.
      • Week 8: Social Skills and Problem Solving
        • Learn to increase self-awareness by participating in role-plays that use illustrate each of the various profiles. Via animal pictures that depict several different coping styles.
      • Week 9: Thinking and Planning
        • Work on strategies that promote emotional awareness and cause/effect reasoning through the use of comic strips and illustrated stories.
      • Week 10: Emotions and Self-Esteem
        • Increase emotional awareness skills and learn about self-esteem by exploring maladaptive or hurtful thoughts, including how to identify and stop Mr. Mean, the inner critic.
      • Week 11: Emotions and Self-Esteem, Part II
        • Learn about self-esteem through activities that highlight individual uniqueness, strengths, and positive qualities.
        • Practice strategies to enhance self-esteem.
        • Discuss the many feelings around saying goodbye.
      • Week 12: Conclusion and Graduation
        • Attend with caregivers and review and practice concepts learned over the course of the past 11 weeks.
        • Individually awarded a Master Mechanic Certificate to celebrate their growth and achievement
        • Presented with their strength book, which is a compilation of the learning exercises and art projects that they completed in each of the sessions.
    • The Caregivers/Parents' Group:
      • Limited to one or both of the participating children's caregivers/parents
      • Meets in a separate room than children for the first 45 minutes
      • Teaches parents about:
        • Effects of FASD
        • What the children are taught
        • The most common behaviors seen in children with prenatal alcohol exposure
        • Strategies to prevent and intervene in their child's inappropriate behaviors
        • Psychoeducational sessions that address the stressors faced by parents raising a child with FASD
      • Follows the following group psychoeducational weekly curriculum:
        • Week 1: Understanding the Effects of Alcohol Exposure & the Need for Intervention
        • Week 2: Understanding the Effects of Alcohol Exposure II
        • Week 3: Intervening with Emotional & Behavioral Effects of Sensory Integration Deficits
        • Week 4: Sensory Integration Deficits, Part II
        • Week 5: Caregiver Self-Care
        • Week 6: Memory Deficits in Alcohol-Exposed Children
        • Week 7: Helping Your Child Think Ahead and Solve Problems: Cause and Effect Thinking
        • Week 8: Problem Solving, Part II
        • Week 9: How to be an External Brain
        • Week 10: Understanding Self Esteem in Children with Developmental Disabilities
        • Week 11: Review of Discussion, Techniques, & At-Home Progress
        • Week 12: Conclusion and Graduation with the children

Program Delivery

Child/Adolescent Services

Parents and Children Together (PACT) directly provides services to children/adolescents and addresses the following:

  • Diagnosed with fetal alcohol spectrum disorders (FASD) or has behaviors that fall into that classification such as difficulties with self-regulation (both behavioral and emotional); significant attention deficits; high levels of hyperactivity; learning deficits; emotional rages; and other out-of-control behaviors.

Parent/Caregiver Services

Parents and Children Together (PACT) directly provides services to parents/caregivers and addresses the following:

  • Care for a child whose brain has been changed due to prenatal alcohol exposure that is the cause of the child's behavioral difficulties

Recommended Intensity:

One weekly 90-minute session

Recommended Duration:

12 weeks

Delivery Settings

This program is typically conducted in a(n):

  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Group or Residential Care
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

Parents and Children Together (PACT) includes a homework component:

Parents/caregivers keep a diary in between weekly sessions, documenting frequency and duration of use of strategies they learned through the treatment program.

Resources Needed to Run Program

The typical resources for implementing the program are:

  • One room for children's group
  • One room for parent/caregiver psychoeducation programming
  • Common art supplies

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Supervisor: Clinician with a Master's degree or higher and experience in providing treatment to children and families

Group leaders/direct delivery staff: Clinicians with a Bachelor's degree who co-lead group sessions – there should be 2 to 3 group leaders per session

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Chasnoff I. J., Schmidt C. A., Telford E., & Bailey, L. (2011). Parents and Children Together. Children's Research Triangle.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

PACT training is conducted onsite at the trainee's organization. Under certain circumstances, training can be delivered online as a virtual training program.

Number of days/hours:

Training is 18 hours conducted over 3 days.

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Parents and Children Together (PACT).

Formal Support for Implementation

There is formal support available for implementation of Parents and Children Together (PACT) as listed below:

PACT training team provides ongoing technical assistance and support, leadership coaching, and evaluation for a minimum of one year following the initial training. This is usually provided through telephone or online support (e.g., live case reviews, helping address specific clinical difficulties, etc.); although in some cases, the training team is asked to return to the trainee site to provide follow-up training, clinical consultation, and support.

Fidelity Measures

There are fidelity measures for Parents and Children Together (PACT) as listed below:

  • To track family compliance and completion, PACT recommends recording family attendance. In addition, the program recommends specific measures to evaluate fidelity to the following core elements of the treatment. These measures are completed by the supervisor through observation of the clinicians delivering the intervention.
  • Use of multiple sensory inputs is monitored through a set of leader report questions in which co-leaders reported on each other, and through observation by raters.
  • The degree to which groups are interactive is monitored through a set of child and parent report questions and through observation by trained raters.
  • The completion of key activities and realization of goals is monitored through a set of leader and parent report questions and through observation by trained raters.
  • Completion of Strength Book exercises at each session and whether or not it was given to children at graduation is monitored.
  • The use of parent/child interaction time is monitored through a set of parent and child report questions and through observation by trained raters.
  • The group leaders' adherence to transition recommendations is monitored through a set of leader report questions in which co-leaders reported on each other and through observations by trained raters.
  • The group leaders' use of modeling is monitored through a set of child and parent report questions and through observation by trained raters.
  • Management of group behaviors – in order for the program to work, group leaders must maintain comparison of their groups. Both children and parents may demonstrate behaviors and interaction styles that can disrupt the group process. These behaviors must be actively addressed on an ongoing basis. The behavior management techniques used by group leaders and the length and degree of group process disruption are monitored through a set of leader and child report questions and through observations by trained raters.

Implementation Guides or Manuals

There are no implementation guides or manuals for Parents and Children Together (PACT).

Implementation Cost

There are no studies of the costs of Parents and Children Together (PACT).

Research on How to Implement the Program

Research has not been conducted on how to implement Parents and Children Together (PACT).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Wells, A. M., Chasnoff, I. J., Schmidt, C. A., Telford, E., & Schwartz, L. D. (2012). Neurocognitive habilitation therapy for children with fetal alcohol spectrum disorders: An adaptation of the Alert Program®. American Journal of Occupational Therapy, 66(1), 24–34. https://doi.org/10.5014/ajot.2012.002691

Type of Study: Randomized controlled trial
Number of Participants: 78

Population:

  • Age — 6–11 years
  • Race/Ethnicity — 42% African American, 36% White, 15% Mixed Race, 8% Hispanic, and 3% Native American
  • Gender — 53 Male and 25 Female
  • Status — Participants were children in the foster care system of the Illinois Department of Children and Family Services that were seeking evaluation for fetal alcohol syndrome (FAS) and alcohol-related neurodevelopmental disorder (ARND) and their caregivers.

Location/Institution: Illinois

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effectiveness of a neurocognitive habilitation program [now called Parents and Children Together] for foster and adoptive caregivers and their children who were prenatally exposed to alcohol. Participants were randomly assigned to treatment and no-treatment control groups. Measures utilized include the Behavior Rating Inventory of Executive Function (BRIEF), the Roberts Apperception Test for Children (RATC), and the Wechsler Intelligence Scale for Children –Third Edition (WISC–III). Results indicate that significant differences between the treatment and control groups were demonstrated on the BRIEF and on the RATC, suggesting that the intervention improved executive functioning and emotional problem-solving skills. Limitations include results cannot be generalized to all school-age children with prenatal alcohol exposure because the study participants resided in foster or adoptive homes; differences in outcomes between the treatment and control groups may have been muted by the extensive feedback and comprehensive recommendations the assessment psychologist provided following the initial screening to both treatment and control group parents; and length of follow-up.

Length of controlled postintervention follow-up: Approximately 2 to 3 months.

Additional References

Bertrand, J., Floyd, R. L., O'Connor, M. J., Frankel, F., Paley, B., Coles, C. D., Kable, J., Taddeo, E., Dent, D., Chasnoff I., Wells A., Bailey G., Gurwitch, R., Mulvhill, J., Chaffin, M., Grim, M., Carmichael Olson, H., & Astley, S. (2009). Interventions for children with fetal alcohol spectrum disorders (FASDs): Overview of findings for five innovative research projects. Research in Developmental Disabilities, 30(5), 986–1006. https://doi.org/10.1016/j.ridd.2009.02.003

Contact Information

Ira J. Chasnoff
Title: MD
Agency/Affiliation: NTI Upstream
Email:
Phone: (312) 560-1436

Date Research Evidence Last Reviewed by CEBC: July 2023

Date Program Content Last Reviewed by Program Staff: February 2021

Date Program Originally Loaded onto CEBC: February 2021