Although behavioral parent training is considered efficacious treatment for childhood conduct problems, not all families benefit equally from treatment. Some parents take longer to change their behaviors and others ultimately drop out. Understanding how therapist behaviors impact parental engagement is necessary to improve treatment utilization. This study investigated how different techniques of therapist in vivo feedback (i.e., coaching) influenced parent attrition and skill acquisition in parent-child interaction therapy (PCIT). Participants included 51 parent-child dyads who participated in PCIT. Children (age: M = 5.03, SD = 1.65) were predominately minorities (63% White Hispanic, 16% African American or Black). Eight families discontinued treatment prematurely. Therapist coaching techniques during the first session of treatment were coded using the Therapist-Parent Interaction Coding System, and parent behaviors were coded with the Dyadic Parent-Child Interaction Coding System, Third Edition. Parents who received more responsive coaching acquired child-centered parenting skills more quickly. Therapists used fewer responsive techniques and more drills with families who dropped out of treatment. A composite of therapist behaviors accurately predicted treatment completion for 86% of families. Although group membership was correctly classified for the treatment completers, only 1 dropout was accurately predicted. Findings suggest that therapist in vivo feedback techniques may impact parents' success in PCIT and that responsive coaching may be particularly relevant.
Health agencies call for the immediate mobilization of existing interventions in response to numerous child and family mental health concerns that have arisen as result of the COVID-19 pandemic. Answering this call, this pilot study describes the rapid, full-scale change from a primarily clinic-based Parent–Child Interaction Therapy (PCIT) model to a virtual service model (i.e., I-PCIT) in an academic and community-based program in Miami, Florida. First, we describe the virtual service training model our program developed and its implementation with 17 therapists (
M
Age
= 32.35, 88.2% female, 47.1% Hispanic) to enable our clinic to shift from providing virtual services to a small portion of the families served (29.1%) to all of the families served. Second, we examine the effect of I-PCIT on child and caregiver outcomes during the 2-month stay-at-home period between March 16, 2020, and May 16, 2020, in 86 families (
M
ChildAge
= 4.75, 71% Hispanic). Due to the rapid nature of the current study, all active participants were transferred to virtual services, and therefore there was no comparison or control group, and outcomes represent the most recently available scores and not treatment completion. Results reveal that I-PCIT reduced child externalizing and internalizing problems and caregiver stress, and increased parenting skills and child compliance with medium to large effects even in the midst of the COVID-19 pandemic. Finally, the study examined components of our virtual service training model associated with the greatest improvements in child and caregiver outcomes. Preliminary findings revealed that locally and collaboratively developed strategies (e.g., online communities of practice, training videos and guides) had the strongest association with child and caregiver outcomes. Implications for virtual service delivery, implementation, and practice in the midst of the COVID-19 pandemic are discussed.
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