Testing telemethods to expand the availability of Parent-Child Interaction Therapy (PCIT) for disruptive young children

Participating families will be randomly allocated to either standard, in-clinic Parent-Child Interaction Therapy (PCIT) or Internet-delivered Parent-Child Interaction Therapy. Standard PCIT: Standard PCIT is a clinic-based protocol, which draws on real-time, wireless technology to provide in vivo coaching of parent-child interactions by a therapist observing the parent-child dyad from behind a one-way mirror. Treatment is divided into 2 phases: (1) Child-Directed Interaction (CDI) and (2) Parent-Directed Interaction (PDI). During CDI, parents are coached in traditional play therapy skills, including following the child’s lead, describing the actions of the child, and reflecting and imitating the child’s appropriate speech and play. Parents are taught to consistently attend to and reinforce positive child behaviours via praise, descriptions, reflections, and imitations, while simultaneously withdrawing their attention from negative, inappropriate behaviours. During CDI, the overall purpose of applying these skills is to improve the quality of the parent-child relationship. During PDI, , parents are coached to set limits and provide appropriate, consistent consequences for inappropriate behaviour (e.g., time-out). The overall purpose of PDI is to reduce the frequency and intensity of disruptive child behaviour, and to allow parents to effectively manage disruptive behaviour if/when it does occur. The first treatment session of each phase begins with a Teach session during which parents are taught specific skills, which are then practiced in the following 6 coaching sessions. Since transition between phases and to graduation from treatment depends on parents reaching a prescribed level of the phase-specific skills (‘mastery criteria’), the dosage of treatment varies between families. However, prior research indicates improved outcomes and lower attrition rates using a fixed approach to dosage, whereby transition through and from treatment occurs after completing a pre-specified number of sessions, rather than a variable approach that requires reaching skill mastery. The current protocol utilises this fixed approach, with all families receiving 14 weekly, one-hour treatment sessions in total (one CDI Teach session and six CDI Coach sessions, and one PDI Teach sessions and six PDI Coach sessions). This treatment dose is consistent with the average number of PCIT sessions completed in prior research (i.e., 12-16 sessions). The therapy will be delivered by a therapist certified in PCIT, one-on-one in a research clinic setting. I-PCIT: I-PCIT is an Internet-delivered format of PCIT, drawing on real-time, interactive technology. Unlike standard PCIT, I-PCIT uses real-time videoconferencing for sessions, delivering live coaching to parents wearing cordless headsets to afford mobility to provide live and evidence-based coaching of parent-child interactions directly to a family’s home setting. Although the delivery format differs from standard PCIT, the contents of I-PCIT directly follow the standard protocol, with the minor exception that the initial session also includes an introduction to technological aspects of treatment. To maintain relative control of the in-home setting during treatment, parents are told their appointment should be treated just as any in-clinic appointment (e.g., direct phones to voicemail) and pets should be locked in other rooms. During sessions, I-PCIT families broadcast parent-child interactions live from their home via webcam over an encrypted connection, and therapists provide instantaneous feedback from a remote site to a wireless headset worn by the parent. Also, whereas handouts are given in standard PCIT after sessions throughout treatment, I-PCIT session handouts are made available online and only for the session in which the principles are introduced. As in the standard PCIT protocol, I-PCIT will be delivered in a total of 14 weekly, one hour treatment sessions (one CDI Teach session and six CDI Coach sessions, and one PDI Teach sessions and six PDI Coach sessions). The therapy will be delivered by a therapist certified in PCIT, one-on-one, with the therapist situated at the research clinic and the family situated in their own home. Adherence to the protocol will be monitored via the number of sessions that participating families attend and adherence to homework requirements (i.e., five minutes of daily skill practice).