Therapist Focused Articles
Comparing client outcomes for two evidence-based treatment consultation strategies
Funderburk, B., Chaffin, M., Bard, E., Shanley, J., Bard, D., & Berliner, L. (2015). Comparing client outcomes for two evidence-based treatment consultation strategies. Journal of Clinical Child & Adolescent Psychology, 44, 730-741.
Abstract: Posttraining expert case consultation is a key component of transporting and scaling up evidence-based treatments, and hopefully retaining their efficacy. Live practice observation and in vivo coaching is a strategy used in academic training environments, but is rarely feasible in field settings. Post hoc telephone consultation is a substitute strategy but does not approximate many aspects of live coaching. Live video technology offers a closer approximation but has not yet been sufficiently tested. Using a roll-out experimental design, this study compared client outcomes across doses of two posttraining expert consultation strategies-standard telephone consultation and live video coaching. The study was conducted during a two-state, 30-agency implementation involving 80 therapists and 330 cases receiving Parent-Child Interaction Therapy (PCIT). Child behavior problems fell from well above to below clinical cutoff values, with about a 1 standard deviation improvement in 14 sessions, which is within the range reported in laboratory efficacy trials. Symptom improvement was augmented by increased therapist dose of live video consultations. Phone consultation dose had no association with client level outcomes. PCIT benefits appear to be retained when the model is transported at scale into the field, and live video consultation appeared to offer small but significant advantages over telephone consultation as one element of an overall transport strategy.
Keywords: PCIT; General Outcome Studies; Post-training Expert Case Consultation; Efficacy Study; Telephone Consultation; Live Video; In Vivo; Coaching; Field Settings.
Protocol for a statewide randomized controlled trial to compare three training models for implementing an evidence-based treatment
Herschell, A. D., Kolko, D. J., Scudder, A. T., Taber-Thomas, S., Schaffner, K. F., Hiegel, S. A., Iyengar, S., Chaffin, M., & Mrozowski, S. (2015). Protocol for a statewide randomized controlled trial to compare three training models for implementing an evidence-based treatment. Implementation Science, 10, 133-149.
Abstract: Evidence-based treatments (EBTs) are available for treating childhood behavioral health challenges. Despite EBTs' potential to help children and families, they have primarily remained in university settings. Little empirical evidence exists regarding how specific, commonly used training and quality control models are effective in changing practice, achieving full implementation, and supporting positive client outcomes.|This study (NIMH RO1 MH095750; ClinicalTrials.gov Identifier: NCT02543359), which is currently in progress, will evaluate the effectiveness of three training models (Learning Collaborative (LC), Cascading Model (CM), and Distance Education (DE)) to implement a well-established EBT , Parent-Child Interaction Therapy, in real-world, community settings. The three models differ in their costs, skill training, quality control methods, and capacity to address broader implementation challenges. The project is guided by three specific aims: (1) to build knowledge about training outcomes, (2) to build knowledge about implementation outcomes, and (3) to test the differential impact of training clinicians using LC, CM, and DE models on key client outcomes. Fifty (50) licensed psychiatric clinics across Pennsylvania were randomized to one of the three training conditions: (1) LC, (2) CM, or (3) DE. The impact of training on practice skills (clinician level) and implementation/sustainment outcomes (clinic level) are being evaluated at four timepoints coinciding with the training schedule: baseline, 6 (mid), 12 (post), and 24 months (1 year follow-up). Immediately after training begins, parent-child dyads (client level) are recruited from the caseloads of participating clinicians. Client outcomes are being assessed at four timepoints (pre-treatment, 1, 6, and 12 months after the pre-treatment).|This proposal builds on an ongoing initiative to implement an EBT statewide. A team of diverse stakeholders including state policy makers, payers, consumers, service providers, and academics from different, but complementary areas (e.g., public health, social work, psychiatry), has been assembled to guide the research plan by incorporating input from multidimensional perspective.|ClinicalTrials.gov: NCT02543359.
Keywords: PCIT; Model Adaptation Studies; Implementation; Therapist Training; Learning Collaborative; Cascading Model; Train-the-trainer; Distance Education; Evidence-based Treatment; Follow-up Studies; Longitudinal Studies.
Successful therapist-parent coaching: How in vivo feedback relates to parent engagement in Parent-Child Interaction Therapy
Barnett, M. L., Niec, L. N., Peer, S. O., Jent, J. F., Weinstein, A., Gisbert, P., & Simpson, G. (2015). Successful therapist-parent coaching: How in vivo feedback relates to parent engagement in Parent-Child Interaction Therapy. Journal of Clinical Child & Adolescent Psychology, 1-8.
Abstract: 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.
Keywords: PCIT; Parental Factors.
Dissemination of an evidence-based parenting program: Clinician perspectives on training and implementation
Christian, A. S., Niec, L. N., Acevedo-Polakovich, I. D., & Kassab, V. A. (2014). Dissemination of an evidence-based parenting program: Clinician perspectives on training and implementation. Children and Youth Services Review, 43, 8-17.
Abstract: The present study used a qualitative approach to examine clinicians' experiences as trainees of an evidence based parenting program, parent–Child interaction therapy (PCIT). In order to explore factors related to successful implementation and maintenance of the PCIT program in a community setting, twenty-nine community clinicians completed phone interviews six months to four years after an initial forty-hour PCIT training workshop. Clinicians reported positive experiences with the training, but also described barriers related to agency, client, program, and training factors. Findings suggest that (1) trainees view the core components of PCIT as acceptable and valuable, (2) training costs and problems with third-party reimbursement can impede implementation, (3) clinicians may benefit fromtraining that includes skills inmotivation enhancement, and (4) ongoing consultation is valuable to clinicians, although trainees differ in their preferences regarding the manner of delivery (e.g., teleconference, live). This study brings clinicians into the conversation regarding barriers to and facilitators of evidence-based training and implementation.
Keywords: PCIT; General Outcome Studies; Treatment Dissemination; Qualitative Methods.
Teaching to improve parent-child interaction: An educational case study
Hall, S., & Warren, M. E. (2012). Teaching to improve parent-child interaction: An educational case study. Academic Psychiatry, 36, 465-467.
Keywords: PCIT; General Outcome Studies; Clinical Disorders; Attention Deficit and Disruptive Behavior Disorders; Behavior Therapy; Child; Child Behavior Disorders; Child Psychiatry; Child, Preschool; Curriculum; Humans; Internship and Residency; Parent-Child Relations; Parents.
Therapists’ attitudes toward evidence-based practices and implementation of Parent–Child Interaction Therapy
Nelson, M. M., Shanley, J. R., Funderburk, B. W., & Bard, E. (2012). Therapists’ attitudes toward evidence-based practices and implementation of Parent–Child Interaction Therapy. Child Maltreatment, 17, 47-55.
Abstract: Child abuse and neglect affects many families each year, but evidence-based parent training programs can be instrumental in reducing maltreatment. Parent-Child Interaction Therapy, a parent training program developed for treatment of disruptive child behavior, has demonstrated effectiveness with families at risk of or exposed to child maltreatment. However, methods for disseminating this evidence-based intervention in community settings are not well understood. This study examined the association between community-based therapists' attitudes toward evidence-based practices (EBP's) and their participation in an implementation research project in which they received two forms of consultations. Results showed that therapists' self-reported unwillingness to degrees to which therapists found EBP's can be improved, if changing attendance for online consultation. The next step in this line of research is to examine how therapists' attitude toward EBP's can be improved, if changing attitudes affects therapist acquisition of treatment skills, and if such improvements enhance implementation efforts.
Keywords: PCIT; Therapist Factors; Abusive Parents; Child Abuse; Child Maltreatment; Dissemination; Evidence-based Practice; Parenting.
Using an online viewing system for Parent-Child Interaction Therapy consulting with professionals
Wilsie, C. C., & Brestan-Knight, E. (2012). Using an online viewing system for Parent-Child Interaction Therapy consulting with professionals. Psychological Services, 9, 224-226. 10.1037/a0026183
Abstract: Parent–Child Interaction Therapy (PCIT) training was provided to therapists working with parents of children with disruptive behavior problems. Therapists uploaded video-recordings of selected sessions using a web-based tool for video sharing and review, the Video Analysis Tool (VAT). Trainers utilized the VAT for consultation to improve treatment fidelity. Clinical practice benefits include the ability to provide targeted, specific feedback to the trainees soon after a session and to disseminate PCIT to a larger, global audience.
Keywords: PCIT; Model Adaptation Studies; Internet-Based PCIT; iPCIT; Consultation; Dissemination; Fidelity; Web-based.
Therapist verbal behavior early in treatment: Relation to successful completion of Parent-Child Interaction Therapy
Harwood, M. D., & Eyberg, S. M. (2004). Therapist verbal behavior early in treatment: Relation to successful completion of Parent-Child Interaction Therapy. Journal of Clinical Child and Adolescent Psychology, 33, 601-612.
Abstract: We examined the role of specific therapist verbal behaviors in predicting successful completion of Parent–Child Interaction Therapy (PCIT) in 22 families, including 11 families that successfully completed treatment and 11 that discontinued treatment prematurely. The children were 3 to 6 years old and diagnosed with oppositional defiant disorder (ODD). Chamberlain et al.’s (1986) Therapy Process Code (TPC) was used to measure therapist verbalizations during therapist–parent interactions during the initial clinical interview and the second treatment session. Results indicated that therapists’ use of the categories Question, Facilitate, and Support during these sessions accurately predicted treatment dropout versus completion for 73% of families. Findings suggest that the early therapist–parent relationship in PCIT may be critical to successful treatment completion.
Keywords: PCIT; Therapist Factors; Clinical Disorder; Oppositional Defiant Disorder.
Effect of therapist process variables on treatment outcome for Parent-Child Interaction Therapy (PCIT)
Harwood, M. D. (2003). Effect of therapist process variables on treatment outcome for Parent-Child Interaction Therapy (PCIT). (Masters) University of Florida, Tampa, FL.
Abstract: The role of specific therapist process variables in predicting treatment outcome for Parent-Child Interaction Therapy (PCIT) was examined in 22 families, including 11 families that completed treatment and 11 that discontinued treatment prematurely. The children were 3 to 5 years old and diagnosed with Oppositional Defiant Disorder (ODD). Chamberlain’s Therapy Process Code was used to measure therapist verbalizations during therapist-parent interactions at the clinical intake interview and the second treatment session. Results indicated that therapists’ use of the categories Question, Facilitate, and Support during these sessions accurately predicted treatment dropout versus completion for 73% of families. Findings indicate that an early therapist-parent alliance is essential for successful treatment outcome in PCIT.
Keywords: PCIT; Therapist Factors; Thesis; Clinical Disorder; Oppositional Defiant Disorder
Assessment of a new procedure to prevent timeout escape in preschoolers
McNeil, C. B., Clemens-Mowrer, L., Gurwitch, R. H., & Funderburk, B. W. (1994). Assessment of a new procedure to prevent timeout escape in preschoolers. Children & Family Behavior Therapy, 16, 27-35.
Abstract: Hanf-model parent training programs (e.g., Forehand, Eyberg, Barkley) include a spank as the primary consequence for timeout escape. Because many agencies provide services to groups for whom a spank is not an option (e.g., foster parents), an alternative back-up was developed, the "two-chair hold" technique. Children referred for treatment of behavior problems (n = 22) were assessed using the Eyberg Child Behavior Inventory, parent interview, and behavioral observations in the clinic. Related measures t-tests comparing pre- and post-treatment scores indicate that the two-chair technique was successful for decreasing timeout escape and improving overall behavior. However, a greater number of therapy sessions was required to obtain the desired effects than is typical in interventions using a spank as the escape consequence. Clinical issues regarding the use of the two-chair hold technique with defiant preschoolers are discussed.
Keywords: PCIT; Enhancement Studies.
The effect of training procedures on the maintenance of parental relationship building skills
Packard, T., Robinson, E. A., & Grove, D. C. (1983). The effect of training procedures on the maintenance of parental relationship building skills. Journal of Clinical Child Psychology, 12, 181-186.
Abstract: This study was a follow‐up comparison of the effect of parent‐training method on the relationship building skills of 18 mothers and their normal children (X age = 39.7 mos.). Laboratory observations during child‐directed play 11 weeks after training indicated that mothers who were coached via a bug‐in‐the‐ear following self‐instruction continued to make gains in nondirective skills after training was discontinued and issued more descriptive statements (p<.01), fewer indirect commands (p<.05), and less negative behavior at follow‐up (p<.01) than did placebo‐control mothers. Those trained via self‐instruction only did not differ from a placebo‐control group at follow‐up. Uniformly high efficacy and competency ratings suggested that the results were not attributable to differential expectations. The authors concluded that coached practice enhanced the. maintenance of parental relationship building skills.
Keywords: PCIT; Child-Adult Relationship Enhancement; CARE; Training Procedures; Parental Relationships; Follow-up; Comparison; Relationship Skills; Children.