Using Technology to Augment the Implementation and Effectiveness of PCIT

Parent-Child Interaction Therapy (PCIT) is an empirically supported behavioral parent training program for reducing aggressive behavior in young children and for reducing future rates of child physical abuse. Prior research has found that an adapted version of PCIT developed specifically for violent parents in the child welfare system reduced future child physical abuse recurrence rates from 49% to 19%. OUHSC/CCAN researchers, in prior and ongoing studies, have found the benefits of PCIT to be durable over time and to generalize across settings and across children in the same family. Culturally-specific adaptations of PCIT and adaptations for older abused children and their abusive parents have been developed. A number of blue-ribbon panels have recommended PCIT for widespread dissemination in child abuse prevention and intervention service systems, but uptake of PCIT has been limited. One reason for this is that the traditional PCIT practitioner training models are not easily replicable in field settings. PCIT has historically been taught in University-based training programs (graduate programs, internships, etc.) and includes several months of co-therapy mentoring where trainers work directly with trainees during live sessions. In contrast, given the difficulties of conducting co-therapy mentoring in field settings, training for widespread implementation has generally involved initial training in the model followed by phone consultation.

OUHSC/CCAN researchers have pilot- and feasibility tested a system using internet-based telemedicine technology to deliver live, mentored PCIT training. OUHSC/CCAN researchers have piloted Remote Real-Time (RRT) training at sites in Utah, Seattle, Alaska, Oregon, and Oklahoma. Feasibility appears excellent, and the approach has been well received. Moreover, RRT implementation revealed misapplications of the model that had gone unaddressed in phone consultation. This research project will make use of planned, funded PCIT start-up implementations at 20-24 agency sites in Washington and Oklahoma. Study participants will include agency practitioners engaged in implementing the PCIT model and families receiving PCIT services at these community agencies. Using a multilevel interrupted time series randomized design; the study will compare the RRT implementation approach with standard phone consultation (PC). Outcomes will include practitioner fidelity and competency in implementing PCIT, practitioner acceptance and satisfaction with PCIT, and family outcomes of parental skill acquisition, parent satisfaction, child aggressive and oppositional behaviors, and rates of future child welfare abuse reports. A mediational model is proposed in which differences in client outcomes are mediated by improved practitioner fidelity and competency. Cost effectiveness and practitioner response to the implementation approach will be examined. The study thus will inform strategies for facilitating widespread dissemination and implementation with fidelity of the evidence-based PCIT model, thereby making the model available to a broader range of agencies and practitioners working with at-risk families.