Understanding New Zealand therapist experiences of Parent-Child Interaction Therapy (PCIT) training and implementation, and how these compare internationally

Woodfield, Melanie J.; Cargo, Tania; Barnett, Daniel Bunout; Lambie, Ian

doi:10.1016/j.childyouth.2020.105681

Cited by 8 publications

(18 citation statements)

References 33 publications

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“…Survey items were informed by the earlier pilot study [ 13 ] and relevant research literature. As in the previous survey, we continued to include Likert items drawn from the ‘Clinician Use of and Satisfaction with PCIT’ (CUSP) interview schedule [ 14 , 15 , 34 ].…”

Section: Methodsmentioning

confidence: 99%

“…In New Zealand, invitations to participate were emailed by an administrator in June 2021 to members of a database of PCIT trainees held by Whāraurau, a Ministry of Health-funded workforce development agency, who are responsible for arranging training in PCIT in New Zealand. The invitation was also emailed by the first author (MJW) to members of a database compiled for a previous research study by the researchers [ 13 ]. Invitations to participate in the survey were emailed to Australian clinicians by Sue Morgan, National PCIT Trainer for Australia.…”

Section: Methodsmentioning

confidence: 99%

“…Direct training costs are approximately $NZD2500 per person. A 2019 anonymous online pilot survey of 84 PCIT-trained clinicians in New Zealand (response rate: 67%) suggested that between 24% and 45% of PCIT-trained clinicians in New Zealand were using PCIT in their practice, and for those who were using PCIT, it constituted a small proportion of their clinical work: an average of 2.4 clients per week, often co-worked with another clinician, so potentially ‘counted twice’ [ 13 ]. As such, PCIT was available to only a modest number of families in New Zealand at the time.…”

Section: Introductionmentioning

confidence: 99%

“…Responses suggested that clinicians felt positively towards PCIT, believing their training experience to have been worthwhile, and PCIT to be both an appropriate and effective treatment for childhood conduct problems [ 13 ]. However, many clinicians described having encountered barriers to PCIT use, which were broadly described as lacking support from colleagues, managers, or supervisors; limited availability of necessary equipment; and clients having difficulty accessing clinic-based sessions.…”

Section: Introductionmentioning

confidence: 99%

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Barriers to Clinician Implementation of Parent-Child Interaction Therapy (PCIT) in New Zealand and Australia: What Role for Time-Out?

Woodfield

Cargo

Merry

et al. 2021

IJERPH

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Background: Parent-Child Interaction Therapy (PCIT) is an effective parent training approach for a commonly occurring and disabling condition, namely conduct problems in young children. Yet, despite ongoing efforts to train clinicians in PCIT, the intervention is not widely available in New Zealand and Australia. Methods: We undertook a cross-sectional online survey of clinicians in New Zealand and Australia who had completed at least the 40-h initial PCIT training, to understand the barriers they encountered in their implementation efforts, and the extent to which attitudes toward time-out influenced implementation. The overall response rate was 47.5% (NZ: 60%; Australia: 31.4%). Results: Responses suggested that participants generally viewed PCIT as both acceptable and effective. Australian participants reported seeing significantly more clients for PCIT per week than those in NZ (Medians 0 and 2, respectively; χ2(1) = 14.08, p < 0.001) and tended to view PCIT as more effective in treating disruptive and oppositional behaviour (95% CI: −0.70, −0.13, p = 0.005). Participants currently seeing PCIT clients described it as more enjoyable to implement than those not using PCIT (95% CI: −0.85, −0.10, p = 0.01). Thirty-eight percent of participants indicated that they adapt or tailor the standardised protocol, primarily by adding in content relating to emotion regulation, and removing content relating to time-out. Participants generally felt that they had fewer skills, less knowledge, and less confidence relating to the Parent-Directed Interaction phase of PCIT (which involves time-out), compared with the Child-Directed Interaction phase. Conclusion: While we had hypothesised that time-out represented an intra-intervention component that detracted from implementation success, results suggested that clinician concern over the use of time-out was present but not prominent. Rather, the lack of access to suitable equipment (i.e., one-way mirror and ear-piece) and difficulties associated with clients attending clinic-based sessions were barriers most commonly reported by clinicians. We suggest that future research might consider whether and how PCIT might be “re-implemented” by already-trained clinicians, moving beyond simply training more clinicians in the approach.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Barriers to Clinician Implementation of Parent-Child Interaction Therapy (PCIT) in New Zealand and Australia: What Role for Time-Out?

Woodfield

Cargo

Merry

et al. 2021

IJERPH

View full text Add to dashboard Cite

show abstract

“…“I come from an attachment framework and struggle with some of the aspects of PCIT” (PCIT Practitioner) [ 26 ].…”

Section: Therapist Cognitions Emotions Experiences and Behaviourmentioning

confidence: 99%

Time-Out with Young Children: A Parent-Child Interaction Therapy (PCIT) Practitioner Review

Woodfield

Brodd

Hetrick

2021

IJERPH

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Time-out is a component of many evidence-based parent training programmes for the treatment of childhood conduct problems. Existing comprehensive reviews suggest that time-out is both safe and effective when used predictably, infrequently, calmly and as one component of a collection of parenting strategies—i.e., when utilised in the manner advocated by most parent training programmes. However, this research evidence has been largely oriented towards the academic community and is often in conflict with the widespread misinformation about time-out within communities of parents, and within groups of treatment practitioners. This dissonance has the potential to undermine the dissemination and implementation of an effective suite of treatments for common and disabling childhood conditions. The parent-practitioner relationship is integral to the success of Parent-Child Interaction Therapy (PCIT), an evidence-based treatment which involves live coaching of parent(s) with their young child(ren). Yet this relationship, and practitioner perspectives, attitudes and values as they relate to time-out, are often overlooked. This practitioner review explores the dynamics of the parent-practitioner relationship as they apply to the teaching and coaching of time-out to parents. It also acknowledges factors within the clinical setting that impact on time-out’s use, such as the views of administrators and professional colleagues. The paper is oriented toward practitioners of PCIT but is of relevance to all providers of parent training interventions for young children.

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Applying the Theoretical Domains Framework to Develop an Intervention to ‘Re-implement’ Parent–Child Interaction Therapy (PCIT)

Woodfield,

Phillips,

Cargo

et al. 2023

Adm Policy Ment Health

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Parent–Child Interaction Therapy (PCIT) is an empirically supported treatment for childhood conduct problems, with increasing numbers of clinicians being trained in Aotearoa/New Zealand. However, ensuring sustained delivery of effective treatments by trained clinicians in routine care environments is notoriously challenging. The aims of this qualitative study were to (1) systematically examine and prioritise PCIT implementation barriers and facilitators, and (2) develop a well specified and theory-driven ‘re-implementation’ intervention to support already-trained clinicians to resume or increase their implementation of PCIT. To triangulate and refine existing understanding of PCIT implementation determinants from an earlier cross-sectional survey, we integrated previously unanalysed qualitative survey data (54 respondents; response rate 60%) with qualitative data from six new focus groups with 15 PCIT-trained clinicians and managers in Aotearoa/New Zealand. We deductively coded data, using a directed content analysis process and the Theoretical Domains Framework, resulting in the identification of salient theoretical domains and belief statements within these. We then used the Theory and Techniques Tool to identify behaviour change techniques, possible intervention components, and their hypothesised mechanisms of action. Eight of the 14 theoretical domains were identified as influential on PCIT-trained clinician implementation behaviour (Knowledge; Social/Professional Role and Identity; Beliefs about Capabilities; Beliefs about Consequences; Memory, Attention and Decision Processes; Environmental Context and Resources; Social Influences; Emotion). Two of these appeared to be particularly salient: (1) ‘Environmental Context and Resources’, specifically lacking suitable PCIT equipment, with (lack of) access to a well-equipped clinic room appearing to influence implementation behaviour in several ways. (2) ‘Social/Professional Role and Identity’, with beliefs relating to a perception that colleagues view time-out as harmful to children, concerns that internationally-developed PCIT is not suitable for non-Māori clinicians to deliver to Indigenous Māori families, and clinicians feeling obligated yet isolated in their advocacy for PCIT delivery. In conclusion, where initial implementation has stalled or languished, re-implementation may be possible, and makes good sense, both fiscally and practically. This study suggests that re-implementation of PCIT in Aotearoa/New Zealand may be facilitated by intervention components such as ensuring access to a colleague or co-worker who is supportive of PCIT delivery, access to suitable equipment (particularly a time-out room), and targeted additional training for clinicians relating to the safety of time-out for children. The feasibility and acceptability of these intervention components will be tested in a future clinical trial.

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Understanding New Zealand therapist experiences of Parent-Child Interaction Therapy (PCIT) training and implementation, and how these compare internationally

Cited by 8 publications

References 33 publications

Barriers to Clinician Implementation of Parent-Child Interaction Therapy (PCIT) in New Zealand and Australia: What Role for Time-Out?

Barriers to Clinician Implementation of Parent-Child Interaction Therapy (PCIT) in New Zealand and Australia: What Role for Time-Out?

Time-Out with Young Children: A Parent-Child Interaction Therapy (PCIT) Practitioner Review

Applying the Theoretical Domains Framework to Develop an Intervention to ‘Re-implement’ Parent–Child Interaction Therapy (PCIT)

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