Implementing Group Parent Training in Telepsychology: Lessons Learned During the COVID-19 Pandemic

Abstract

Objective We recently transitioned from in-person delivery of a brief behavioral parent intervention to telepsychology delivery to meet families’ needs during the COVID-19 pandemic. In this topical review, we describe how we used treatment fidelity as a guiding principle to orient adaptations for telepsychology, as well as preliminary findings and early lessons learned in this implementation. Methods: Using rapid-cycle quality improvement methods, we adapted a brief parent training group (Bootcamp for Attention-Deficit/Hyperactivity Disorder; BC-ADHD) to three groups of caregivers (i.e., 5–7 families) of school-aged children with ADHD (n = 20; 85% males). Families were from the following ethnic backgrounds: 75% White non-Hispanic, 15% White Hispanic, and 10% Black. Clinicians completed measures on their implementation experience. Observers completed measures on content/process fidelity and attendance. Caregivers completed measures on demographics, treatment satisfaction, and telepsychology experience. Results Telepsychology BC-ADHD can be implemented with comparably high levels of content and process fidelity and treatment satisfaction to in-person groups; and it appears to be feasible and acceptable to caregivers. Caregiver and clinician qualitative feedback revealed themes of appreciating the convenience of telepsychology, while experiencing some challenges in relating to others and sharing over video. Conclusions When treatment fidelity is used as a guiding tool, telepsychology parent training groups can be delivered with high fidelity and appear to be acceptable and feasible to caregivers and clinicians. Future research using larger and more diverse samples, multimethod and multi-informant measurement approaches, and controlled designs is needed to further assess the generalizability and efficacy of telepsychology parent training groups.

Quality of Life Changes during the COVID-19 Pandemic for Caregivers of Children with ADHD and/or ASD

“…Behavioral parent training is a well-established psychosocial treatment with the strongest evidence base showing positive outcomes in children with ADHD and improvements in parenting [ 62 , 63 , 64 , 65 , 66 ]. A preliminary study implementing telepsychology group behavioral parent training for ADHD children during the COVID-19 pandemic resulted in mostly positive outcomes with efficacy, high treatment fidelity, and parental satisfaction comparable to in-person sessions [ 67 ], and a pilot study implementing a text-message based intervention with behavioral parent training principles for ADHD proved feasible and led to satisfaction in a proportion of the caregivers [ 54 , 66 , 68 ]. While remote parent-guided programs and interventions in families with children with ADHD and/or ASD show promising results in potentially improving caregivers’ quality of life [ 57 , 63 , 67 , 69 ], these virtual strategies and interventions are still in their infancy and require further exploration [ 54 , 57 , 59 , 60 , 67 ].…”

Pediatric behavioral telehealth in the age of COVID-19: Brief evidence review and practice considerations

“… 41 One study investigated a brief group parent training program for children newly diagnosed with ADHD, Bootcamp for ADHD (BC-ADHD), and utilized fidelity measures as tools to guide tele-adaptation during COVID-19. 42 Notably, these studies include remote delivery of the parenting interventions to a group of parents meeting at a more accesible location (e.g., regional medical center) with a remote therapist. Although this improves access for a number of families concurrently, the utility of this approach is limited during COVID-19 due to social distancing guidelines and stay at home orders.…”

Poor Mental Health in Caregivers of Children with Attention-Deficit/Hyperactivity Disorder and Its Relationships with Caregivers’ Difficulties in Managing the Children’s Behaviors and Worsened Psychological Symptoms during the COVID-19 Pandemic

“…Regarding health service provision, according to the special situations and needs encountered during the COVID-19 pandemic, modified models of health service provision should be developed. For example, intervention programs using telepsychiatry or telepsychology may provide feasible and convenient behavioral interventions for caregivers of children with ADHD [ 56 ]. Moreover, case management and active following of those who lost visiting outpatient units may provide timely assistance for the caregivers and their children with ADHD.…”