A randomized trial was conducted to test the efficacy and sufficiency of parent-child interaction therapy (PCIT) in preventing re-reports of physical abuse among abusive parents. Physically abusive parents (N=110) were randomly assigned to one of three intervention conditions: (a) PCIT, (b) PCIT plus individualized enhanced services, or (c) a standard community-based parenting group. Participants had multiple past child welfare reports, severe parent-to-child violence, low household income, and significant levels of depression, substance abuse, and antisocial behavior. At a median follow-up of 850 days, 19% of parents assigned to PCIT had a re-report for physical abuse compared with 49% of parents assigned to the standard community group. Additional enhanced services did not improve the efficacy of PCIT. The relative superiority of PCIT was mediated by greater reduction in negative parent-child interactions, consistent with the PCIT change model.

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Findings demonstrate that previous laboratory results can be replicated in a field implementation setting and among parents with chronic and severe child welfare histories, supporting a synergistic SM + PCIT benefit. Methodological considerations for analyzing child welfare event history data complicated by differential risk deprivation are also emphasized.

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A motivational orientation intervention designed to improve parenting program retention was field tested versus standard orientation across two parenting programs, Parent-Child Interaction Therapy (PCIT) and a standard didactic parent training group. Both interventions were implemented within a frontline child welfare parenting center by center staff. Participants had an average of six prior child welfare referrals, primarily for neglect. A double-randomized design was used to test main and interaction effects. The motivational intervention improved retention only when combined with PCIT (cumulative survival = 85% vs. around 61% for the three other design cells). Benefits were robust across demographic characteristics and participation barriers but were concentrated among participants whose initial level of motivation was low to moderate. There were negative effects for participants with relatively high initial motivation. The findings suggest that using a motivational intervention combined with PCIT can improve retention when used selectively with relatively low to moderately motivated child welfare clients.

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This brief report discusses the use and feasibility of telemedicine technology in the dissemination of Parent-Child Interaction Therapy (PCIT). PCIT is an empirically supported behavioral parent training program for reducing disruptive behavior in young children and for reducing future rates of child physical abuse. The positive impact PCIT has demonstrated in reducing child maltreatment has galvanized interest in widespread dissemination of the PCIT model into child service systems. PCIT has traditionally been taught in university-based training programs in a mentored cotherapy model. By contrast, in field settings, PCIT training typically consists of workshop training supplemented by a period of telephone consultation (PC). Given concerns with the level of practitioner competency and fidelity yielded by the PC model, PCIT training programs have begun to examine Internet-based telemedicine technology to deliver live, mentored PCIT training to trainees at remote locations (Remote Real-Time or RRT) to better approximate the university-based training model. Challenges of disseminating evidence-based practices are discussed, using PCIT as a model of how these challenges are being addressed by telemedicine technology.