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Al-Beltagi M, Saeed NK, Bediwy AS, Elbeltagi R. Breaking the cycle: Psychological and social dimensions of pediatric functional gastrointestinal disorders. World J Clin Pediatr 2025; 14:103323. [DOI: 10.5409/wjcp.v14.i2.103323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 12/14/2024] [Accepted: 01/02/2025] [Indexed: 03/18/2025] Open
Abstract
BACKGROUND Functional gastrointestinal disorders (FGIDs) in children present with chronic symptoms like abdominal pain, diarrhea, and constipation without identifiable structural abnormalities. These disorders are closely linked to gut-brain axis dysfunction, altered gut microbiota, and psychosocial stress, leading to psychiatric comorbidities such as anxiety, depression, and behavioral issues. Understanding this bidirectional relationship is crucial for developing effective, holistic management strategies that address physical and mental health.
AIM To examine the psychiatric impacts of FGIDs in children, focusing on anxiety and depression and their association with other neurodevelopmental disorders of childhood, such as attention-deficit/hyperactivity disorder, emphasizing the role of the gut-brain axis, emotional dysregulation, and psychosocial stress. Key mechanisms explored include neurotransmitter dysregulation, microbiota imbalance, central sensitization, heightening stress reactivity, emotional dysregulation, and symptom perception. The review also evaluates the role of family dynamics and coping strategies in exacerbating FGID symptoms and contributing to psychiatric conditions.
METHODS A narrative review was conducted using 328 studies sourced from PubMed, Scopus, and Google Scholar, covering research published over the past 20 years. Inclusion criteria focused on studies examining FGID diagnosis, gut-brain mechanisms, psychiatric comorbidities, and psychosocial factors in pediatric populations. FGIDs commonly affecting children, including functional constipation, abdominal pain, irritable bowel syndrome, gastroesophageal reflux, and cyclic vomiting syndrome, were analyzed concerning their psychological impacts.
RESULTS The review highlights a strong connection between FGIDs and psychiatric symptoms, mediated by gut-brain axis dysfunction, dysregulated microbiota, and central sensitization. These physiological disruptions increase children’s vulnerability to anxiety and depression, while psychosocial factors - such as chronic stress, early-life trauma, maladaptive family dynamics, and ineffective coping strategies - intensify the cycle of gastrointestinal and emotional distress.
CONCLUSION Effective management of FGIDs requires a biopsychosocial approach integrating medical, psychological, and dietary interventions. Parental education, early intervention, and multidisciplinary care coordination are critical in mitigating long-term psychological impacts and improving both gastrointestinal and mental health outcomes in children with FGIDs.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Paediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
- Department of Pediatric, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
| | - Nermin K Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Governmental Hospitals, Manama 26671, Bahrain
- Medical Microbiology Section, Department of Pathology, The Royal College of Surgeons in Ireland - Bahrain, Busaiteen 15503, Muharraq, Bahrain
| | - Adel S Bediwy
- Department of Pulmonology, Faculty of Medicine, Tanta University, Tanta 31527, Alghrabia, Egypt
- Department of Pulmonology, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
| | - Reem Elbeltagi
- Department of Medicine, Royal College of Surgeons in Ireland - Bahrain, Busaiteen 15503, Muharraq, Bahrain
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Eadie K, Zahir SF, Chapman JA, Bergh W, Withington T. A 15-year outcome study of children and young people in care attending a tertiary level specialist mental health service. CHILD ABUSE & NEGLECT 2025; 161:107297. [PMID: 39919623 DOI: 10.1016/j.chiabu.2025.107297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 01/21/2025] [Accepted: 01/22/2025] [Indexed: 02/09/2025]
Abstract
BACKGROUND Children and young people (C/YP) exposed to abuse and neglect can experience complex mental health problems. Examining interventions and outcomes for C/YP in care receiving mental health treatment could help optimise service delivery to this population. OBJECTIVE The aim of the study was to investigate functioning and mental health outcomes of C/YP in care attending a tertiary level specialist mental health service in Queensland, Australia. In addition, outcomes were explored with Aboriginal and/or Torres Strait Islander status, length of stay (LOS) and age as potential contributing factors. PARTICIPANTS AND SETTING This 15-year retrospective cohort study consisted of a sample of 1561C/YP with pre- and post-treatment data attending the mental health service. METHODS The Children's Global Assessment Scale (CGAS) and the Health of the Nations Outcome Scale for Children and Adolescents (HoNOSCA) were used to examine C/YP's functioning and mental health outcomes. Generalised linear mixed model, linear mixed model and McNemar's test were conducted. RESULTS Overall, C/YP improved in mental health concerns and functioning on all domains post-intervention (p < 0.001). Non-Aboriginal and/or Torres Strait Islander C/YP had a greater improvement post-intervention in disruptive/aggressive behaviour, scholastic/language skills, and poor school attendance compared to Aboriginal and/or Torres Strait Islander C/YP (p < 0.05). A reduced length of stay resulted in a greater improvement post-intervention in overall functioning, overactivity/attentional difficulties, peer relationships and poor school attendance (p < 0.05). Younger children had a greater improvement post-intervention in overall functioning, scholastic/language skills, emotional symptoms, peer relationships, self-care/independence and poor school attendance compared to older children (p < 0.05). CONCLUSIONS Findings from this study demonstrate that the tertiary level specialist mental health service is an effective treatment program for C/YP in care who have experienced severe and complex trauma. There were some differences in outcomes based on Aboriginal and/or Torres Strait Islander status, LOS and age that need to be considered to enhance service delivery for all C/YP. Implications and further research were explored.
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Affiliation(s)
- Kathryn Eadie
- Evolve Therapeutic Services, Child and Youth Mental Health Services, Children's Health Queensland Hospital and Health Service, 289 Wardell Street, Enoggera, Qld 4051, Australia.
| | - Syeda Farah Zahir
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Building 33, Princess Alexandra Hospital Campus, Woolloongabba, Qld 4102, Australia.
| | - Jo-Anne Chapman
- Community Mental Health & Specialised Services, West Moreton Health, Ipswich Health Plaza, 21 Bell St, Ipswich, Qld 4305, Australia.
| | - Warren Bergh
- Evolve Therapeutic Services, Child and Youth Mental Health Services, Children's Health Queensland Hospital and Health Service, 289 Wardell Street, Enoggera, Qld 4051, Australia.
| | - Tania Withington
- Child and Youth Mental Health Services, Children's Health Queensland Hospital and Health Service, 34 Curd Street, Greenslopes, Qld 4120, Australia.
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Calderone A, Piccolo A, Latella D, De Luca R, Corallo F, Quartarone A, Militi A, Cucinotta F, Calabrò RS. Parent-Child Interaction Therapy for Disruptive Behavior: A Systematic Review of Effectiveness in Different Settings. J Clin Med 2025; 14:856. [PMID: 39941526 PMCID: PMC11818805 DOI: 10.3390/jcm14030856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Revised: 01/23/2025] [Accepted: 01/25/2025] [Indexed: 02/16/2025] Open
Abstract
Background: Parent-child interaction therapy (PCIT) is an evidence-based intervention for children with behavioral problems. This systematic review assesses the efficacy of PCIT in reducing disruptive behavior problems (DBPs) by analyzing outcomes across diverse populations and settings. Methods: Studies were identified through an online search of the PubMed, Web of Science, Cochrane Library, and Embase databases, with a search period ranging from 2014 to 2024. This review was registered on Open OSF (n) TVFQ5. Results: Research studies demonstrate that PCIT is effective across a variety of DBP conditions, showing significant reductions in child behavioral problems and parenting stress. PCIT's adaptability, effectiveness, and potential for widespread use have been validated in both specialized and community settings, including diverse and high-risk populations. Conclusions: This systematic review highlights PCIT's overall effectiveness in reducing disruptive behaviors and improving parent-child relationships across diverse settings and populations. It emphasizes the need for further research into its long-term efficacy, adaptability in multicultural contexts, and potential integration with technology for enhanced dissemination and effectiveness.
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Affiliation(s)
- Andrea Calderone
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy;
| | - Adriana Piccolo
- IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (D.L.); (R.D.L.); (F.C.); (A.Q.); (F.C.); (R.S.C.)
| | - Desirèe Latella
- IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (D.L.); (R.D.L.); (F.C.); (A.Q.); (F.C.); (R.S.C.)
| | - Rosaria De Luca
- IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (D.L.); (R.D.L.); (F.C.); (A.Q.); (F.C.); (R.S.C.)
| | - Francesco Corallo
- IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (D.L.); (R.D.L.); (F.C.); (A.Q.); (F.C.); (R.S.C.)
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (D.L.); (R.D.L.); (F.C.); (A.Q.); (F.C.); (R.S.C.)
| | - Angela Militi
- Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, 98100 Messina, Italy;
| | - Francesca Cucinotta
- IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (D.L.); (R.D.L.); (F.C.); (A.Q.); (F.C.); (R.S.C.)
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (D.L.); (R.D.L.); (F.C.); (A.Q.); (F.C.); (R.S.C.)
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Furuzawa A, Yoshinaga N, Hattori K. Internet Parent-Child Interaction Therapy for Maternal Guilt in a Child Abuse Case: A Single Case Study. Cureus 2024; 16:e70904. [PMID: 39376977 PMCID: PMC11457898 DOI: 10.7759/cureus.70904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2024] [Indexed: 10/09/2024] Open
Abstract
This single case study explored the effectiveness of Internet Parent-Child Interaction Therapy (I-PCIT) for addressing maternal guilt in a case of child abuse. I-PCIT was implemented because traditional PCIT was challenging due to the family's geographical constraints and the mother's professional commitments. The study utilized multiple assessment tools, including the Eyberg Child Behavior Inventory (ECBI) and the Beck Depression Inventory-II (BDI-II), to measure the therapy's impact on the child's behavior and the mother's depressive symptoms. The case conceptualization highlighted the mother's emotional regulation difficulties and dissociative symptoms under stress that contributed to the abusive incidents. I-PCIT sessions, conducted via videoconferencing software, focused on enhancing the mother-son relationship through Child-Directed Interaction (CDI) and Parent-Directed Interaction (PDI) phases. Through 19 sessions of I-PCIT (with one session conducted face-to-face), the mother's mastery of positive skills improved, and follow-up sessions indicated sustained positive outcomes. This case study underscores the potential of I-PCIT in preventing the recurrence of abuse, enhancing parental skills, and facilitating positive parent-child interaction. It also highlights the importance of therapist-parent collaboration in mitigating dropout risks and promoting therapy adherence.
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Affiliation(s)
| | | | - Kie Hattori
- Nursing, Nihon Fukushi University, Tokai, JPN
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Ramos G, Woller M, Quetsch L, Girard E, Barnett M, Montoya A, Le K, Reyes Y, Chavira D, Villodas M, Lau A. Trajectories of Change in Parent-Child Interaction Therapy Outcomes in Latinx Families: Implications for Cultural Adaptation. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024:1-15. [PMID: 39287980 DOI: 10.1080/15374416.2024.2395272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
OBJECTIVE Parent-Child Interaction Therapy (PCIT) is a parenting program in which caregivers must achieve "skill criteria" in using Do Skills and avoiding Don't Skills to complete treatment. Despite PCIT's emphasis on these skills, little is known about how Latinx caregivers acquire these Western-based parenting practices and whether cultural mismatches lead to inequities in outcomes. This study compared the trajectories of change in PCIT skills and treatment outcomes of Latinx and non-Latinx White families. METHOD We analyzed weekly treatment data from 64 families (20.3% Spanish-speaking Latinx, 51.6% English-speaking Latinx, 28.1% non-Latinx White) served in community clinics. Caregivers were mostly females (95.3%), on average 35.13 years old, and lived in poverty (77.6%). PCIT skills were coded using the Dyadic Parent-Child Interaction Coding System, and child behavior problems were reported using the Eyberg Child Behavior Inventory. RESULTS Latinx and non-Latinx White caregivers acquired Do Skills similarly during treatment. In contrast, some Latinx caregivers began treatment using significantly more Don't Skills and needed more sessions to achieve some aspects of PCIT skill criteria compared with non-Latinx White caregivers. Latinx families also experienced similar or even more pronounced reductions in child behavior problems than non-Latinx White families. There were no significant differences in the percentage of caregivers who achieved PCIT skill criteria or left treatment prematurely. CONCLUSIONS This study provides evidence that strictly defined PCIT skill criteria may lead to inequities in treatment length for some Latinx families. Informed by these findings, we propose data-driven adaptations to improve the cultural fit of PCIT for Latinx groups.
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Affiliation(s)
- Giovanni Ramos
- Department of Psychological Science, University of California, Irvine
| | - Michael Woller
- Department of Psychology, University of California, Los Angeles
| | | | - Emma Girard
- School of Medicine, University of California, Riverside
| | - Miya Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara
| | - Amanda Montoya
- Department of Psychology, University of California, Los Angeles
| | - Kenny Le
- Department of Psychology, University of Central Florida
| | - Yazleen Reyes
- Department of Psychological Science, University of California, Irvine
| | - Denise Chavira
- Department of Psychology, University of California, Los Angeles
| | | | - Anna Lau
- Department of Psychology, University of California, Los Angeles
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Tan Y, Lyu R, Lu S. Reducing parenting stress in Chinese parents of children with learning disabilities with a mindful parenting program: A randomized controlled trial. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 151:104794. [PMID: 38964212 DOI: 10.1016/j.ridd.2024.104794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/13/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Parents raising children with Learning Disabilities (LDs) often face multiple challenges and high levels of parenting stress, especially in societies with intense academic competitions. Mindful parenting (MP) is an emerging approach that brings mindful awareness to parent-child interactions and is found effective in reducing parenting stress in various parent populations. AIMS This study examined the effectivenesss of an 8-week online MP program on Chinese parents of children with LDs. METHODS AND PROCEDURES A MP program was adapted and implemented in an online format with 69 parents of children with LDs. A randomized controlled trial design was used to examine the efficacy of the mindful parenting group compared with a wait-list control group. Parenting stress, mindful parenting and self-compassion were assessed pre- and post-intervention. OUTCOMES AND RESULTS Compared with the wait-list control group, the MP group participants showed decreased parenting stress (d = 0.62, p < 0.05), improved mindful parenting (d = 0.63, p < 0.05), and increased self-compassion (d = 0.61, p < 0.05). CONCLUSIONS AND IMPLICATIONS These findings support the effectiveness of an online MP intervention in reducing parenting stress and increasing mindful parenting and self-compassion among Chinese parents of children with LDs. The behavioral and intrapersonal aspects of MP are more amenable to improvement, whereas the attitudinal and interpersonal aspects, particularly non-judgmental acceptance and compassion towards the child, are resistant to change. Future studies should explore strategies to enhance these attitudinal aspects and interpersonal processes of MP.
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Affiliation(s)
- Yaqian Tan
- Beijing Normal University-Hong Kong Baptist University United International College, 2000 Jintong Road, Tangjiawan, Zhuhai 519087, Guangdong, China; Department of Counselling and Psychology, Hong Kong Shue Yan University, 10 Wai Tsui Crescent, Braemar Hill, North Point, Hong Kong, China.
| | - Renhui Lyu
- School of Humanities and Social Sciences, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing 100083, China.
| | - Shuang Lu
- School of Social Work, University of Central Florida, 12805 Pegasus Drive, Orlando, FL, USA.
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Nobakht HN, Steinsbekk S, Wichstrøm L. Reciprocal relations between interparental aggression and symptoms of oppositional defiant and conduct disorders: a seven-wave cohort study of within-family effects from preschool to adolescence. J Child Psychol Psychiatry 2024; 65:753-763. [PMID: 37786360 DOI: 10.1111/jcpp.13903] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Interparental aggression is believed to increase the risk of behavioral disorders in offspring, and offspring behavioral problems may forecast interparental aggression. However, these assumptions have yet to be put to a strong test. This study, therefore, examined whether increased interparental aggression predicted increased symptoms of oppositional defiant disorder (ODD) and conduct disorder (CD) from preschool to adolescence and vice versa. METHODS A sample (n = 1,077; 49.6% girls) from two birth cohorts of children in Trondheim, Norway, was assessed biennially from age 4 to 16. Children's symptoms of ODD and CD were assessed using semi-structured clinical interviews of parents (from age 4) and children (from age 8). One of the parents reported on their own and their partner's verbal and physical aggression. A random intercept cross-lagged model was estimated to test the within-family relations between interparental aggression, CD, and ODD symptoms. RESULTS Across development, increased interparental aggression predicted increased CD symptoms 2 years later, whereas an increased number of ODD symptoms forecasted increased interparental aggression. CONCLUSIONS The argumentative/defiant, aggressive, and vindictive behaviors seen in ODD are often directed toward parents and may take a toll on their relationship and possibly foster interparental aggression, whereas aggression between parents may promote symptoms of CD in their offspring, which commonly extend beyond the home. Incorporating effective and non-aggressive means to solve interparental conflict into parental management programs may reduce the development of symptoms of CDs in children.
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Affiliation(s)
- Habib Niyaraq Nobakht
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Silje Steinsbekk
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lars Wichstrøm
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St Olavs Hospital, Trondheim, Norway
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Fortuna LR, Porche MV. Upholding the Human Rights and Well-Being of Refugee Children Through Effective Clinical Care. Child Adolesc Psychiatr Clin N Am 2024; 33:111-124. [PMID: 38395499 PMCID: PMC10894321 DOI: 10.1016/j.chc.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Refugee children are often exposed to adversities and traumatic experiences that can harm the mental health and well-being of refugee children. These include human trafficking and exploitation and dangers in detention centers and refugee camps. All these adverse events can be traumatic and contribute to poor mental health, including posttraumatic stress, anxiety, depression, and substance use disorders. Therefore, the assessment of refugee children and adolescents should include screening and identification for these experiences, provision of evidence-based trauma treatment, and social supports to promote their well-being and thriving.
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Affiliation(s)
- Lisa R Fortuna
- University of California Riverside, School of Medicine Education Building 2, 5th Floor, Psychiatry and Neurosciences, 900 University Avenue, Riverside, CA 92521, USA.
| | - Michelle V Porche
- University of California, Psychiatry and Behavioral Sciences, 1001 Potrero Avenue, Building 5, 7M10, San Francisco, CA 94110, USA
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Belanger K, Gennis H, Ottenbreit N, Racine N. Enhancing attachment-based aspects of PCIT for young children with a history of maltreatment. Front Psychol 2023; 14:1229109. [PMID: 38023060 PMCID: PMC10655231 DOI: 10.3389/fpsyg.2023.1229109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Disruptive behavior difficulties, such as aggression, non-compliance, and emotional outbursts, are common among children exposed to maltreatment. Parent-Child Interaction Therapy (PCIT) is an effective parenting intervention for addressing child behavior difficulties, however, treatment retention and engagement among parents remain a concern in the clinical setting. This paper describes how the delivery of an intervention that teaches attachment theory concepts (Circle of Security-Parenting, COS-P) prior to PCIT can increase engagement and retention among parents of maltreated children and inform new coaching practices. A detailed description of how to extend and integrate COS-P concepts with PCIT for maltreated families using specific strategies is provided. Recommendations, limitations, and next steps for research are presented.
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Affiliation(s)
- Kristine Belanger
- Child Abuse Service, Alberta Children’s Hospital, Calgary, AB, Canada
- Luna Child and Youth Advocacy Centre, Calgary, AB, Canada
| | | | - Nicole Ottenbreit
- Child Abuse Service, Alberta Children’s Hospital, Calgary, AB, Canada
- Luna Child and Youth Advocacy Centre, Calgary, AB, Canada
| | - Nicole Racine
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
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Woodfield MJ, Phillips ST, Cargo T, Merry SN, McNeil CB, Hetrick SE. Applying the Theoretical Domains Framework to Develop an Intervention to 'Re-implement' Parent-Child Interaction Therapy (PCIT). ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:976-998. [PMID: 37691065 PMCID: PMC10543774 DOI: 10.1007/s10488-023-01298-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/12/2023]
Abstract
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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Affiliation(s)
- Melanie J. Woodfield
- Te Ara Hāro-Centre for Infant, Child and Adolescent Mental Health, Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142 New Zealand
- Te Whatu Ora (Health New Zealand), Te Toka Tumai Auckland, Auckland, New Zealand
| | | | - Tania Cargo
- Te Ara Hāro-Centre for Infant, Child and Adolescent Mental Health, Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142 New Zealand
- Department of Psychology, University of Auckland, Auckland, New Zealand
| | - Sally N. Merry
- Te Ara Hāro-Centre for Infant, Child and Adolescent Mental Health, Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142 New Zealand
| | - Cheryl B. McNeil
- Department of Psychology, West Virginia University, Morgantown, USA
- Department of Psychiatry, University of Florida, Gainesville, USA
| | - Sarah E. Hetrick
- Te Ara Hāro-Centre for Infant, Child and Adolescent Mental Health, Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142 New Zealand
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Sanchez BEL, Klein CC, Tremblay M, Rastogi M, Corcoran F, Barnett ML. Adapting to Unprecedented Times: Community Clinician Modifications to Parent-Child Interaction Therapy during COVID-19. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2023; 8:348-363. [PMID: 37981955 PMCID: PMC10656036 DOI: 10.1080/23794925.2023.2238741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Parent-Child Interaction Therapy (PCIT) is an evidence-based practice that effectively prevents and treats child disruptive behaviors and child physical maltreatment and reduces parenting stress. PCIT was adapted for telehealth delivery, internet-delivered PCIT (iPCIT), before the COVID-19 pandemic but was not widely implemented until the rapid transition to telehealth during stay-at-home orders. To understand how clinicians adapted PCIT during COVID-19, we followed up on a previous study investigating community clinician adaptations of PCIT pre-COVID-19 using the Lau et al. (2017) Augmenting and Reducing Framework. Clinicians (N = 179) who responded to the follow-up survey and reported delivering PCIT remotely completed a quantitative measure of adaptations at both time points (Fall 2019; Summer 2020) to assess how adaptations to PCIT changed following lockdown measures. Clinicians (n = 135) also provided qualitative descriptions of adaptations made early in the COVID-19 pandemic. Clinicians in the full sample were 74.3% Non-Hispanic White and 14% Latinx. Most clinicians had a master's degree (66.5%), were licensed (80.4%), and were PCIT-certified (70.4%). Paired samples t-tests showed that clinicians reported similar levels of augmenting t(179) = -0.09, p=.926) and reducing adaptations t(179) = -0.77, p=.442) at both time points. Unlike quantitative findings, qualitative findings indicated that clinicians described engaging in many types of adaptations in response to the pandemic. Clinicians discussed engaging in augmenting adaptations by extending treatment length and integrating other practices into treatment. Clinicians also discussed engaging in reducing adaptations. Implications and future directions will be discussed.
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Raudenska J, Gumančík J, Raudenský M, Pasqualucci A, Moka E, Varrassi G, Paladini A, Javurkova A. Cognitive-Behavioral Play Therapy and COVID-19 Pandemic Trauma in Preschool Children. Cureus 2023; 15:e44249. [PMID: 37772203 PMCID: PMC10524805 DOI: 10.7759/cureus.44249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Traumatic life events, such as the ongoing COVID-19 pandemic, can be a challenging health emergency, among others. The pandemic can also affect young preschoolers. They can experience negative emotions and behavioral and social difficulties. It can be hard for children to understand on their own what is going on, as well as for their families. This narrative review summarizes the role of psychotherapeutic approaches in working with trauma and aims to manage trauma, such as COVID-19, in preschool children. It focuses on the possibilities of applying cognitive-behavioral play therapy (CBPT) in preschool children who suffer from trauma during the COVID-19 pandemic period. The therapeutic approaches are tailored to specific development in preschoolers. Furthermore, the article provides insights into the relationship between negative emotions, thinking, and behavior, and COVID-19 as a threat, by describing a cognitive model in preschool-aged children. Finally, the article offers possible ways of applying play-based cognitive-behavioral therapy programs in preschool children who are victims of trauma.
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Affiliation(s)
- Jaroslava Raudenska
- Department of Nursing, Second Medical Faculty of Charles University, Prague, CZE
| | - Jiří Gumančík
- Department of Psychology, Faculty of Health and Life Sciences, University of Northumbria in Newcastle, Newcastle upon Tyne, GBR
| | | | - Alberto Pasqualucci
- Department of Anesthesia and Critical Care, University of Perugia, Perugia, ITA
| | - Eleni Moka
- Department of Anesthesiology, Creta InterClinic, Heraklion, GRC
| | | | - Antonella Paladini
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, ITA
| | - Alena Javurkova
- Department of Clinical Psychology, University Hospital Královské Vinohrady, Prague, CZE
- Department of Nursing, Second Medical Faculty of Charles University and Motol University Hospital, Prague, CZE
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13
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Ramos G, Lorenzo NE, Garcia D, Bagner DM. Skill Change Among Latinx Families in a Behavioral Parenting Intervention: The Interactive Effect of Caregiver Language Preference and Acculturation. JOURNAL OF LATINX PSYCHOLOGY 2023; 11:175-188. [PMID: 37810445 PMCID: PMC10557956 DOI: 10.1037/lat0000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Affiliation(s)
- Giovanni Ramos
- Department of Psychology, University of California, Los Angeles
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14
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Deotto A, Fabiano GF, Chung BYT, Wade SL, Anagnostou E, Crosbie J, Kelley E, Nicolson R, Andrade BF, Miller SP, Williams TS. Stepping up to COVID-19: A Clinical Trial of a Telepsychology Positive Parenting Program Targeting Behavior Problems in Children With Neurological Risk. J Pediatr Psychol 2023:jsad032. [PMID: 37316980 DOI: 10.1093/jpepsy/jsad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/19/2023] [Accepted: 05/19/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE To evaluate the feasibility, acceptability, and preliminary efficacy of a stepped-care parenting program implemented during COVID-19 among families of behaviorally at-risk children with neurological or neurodevelopmental disorders aged 3-9 years. METHODS Stepped-care I-InTERACT-North increased psychological support across 3 steps, matched to family needs: (1) guided self-help (podcast), (2) brief support, and (3) longer-term parent support. The intervention was provided by clinicians at The Hospital for Sick Children. Recruitment occurred via hospital and research cohort referral. A single-arm trial using a pragmatic prospective pre-post mixed-method design was utilized to assess accrual, engagement, acceptability, and preliminary efficacy. RESULTS Over 15 months, 68 families enrolled (83% consent rate) and 56 families completed stepped-care (Step 1 = 56; Step 2 = 39; Step 3 = 28), with high adherence across Steps (100%, 98%, and 93%, respectively). Parents reported high acceptability, reflected in themes surrounding accessibility, comprehension, effectiveness, and targeted care. Positive parenting skill increases were documented, and robust improvement in child behavior problems was apparent upon Step 3 completion (p =.001, d = .390). Stepped-care was as effective as traditional delivery, while improving consent and completion rates within a pandemic context. CONCLUSIONS This stepped-care telepsychology parenting program provides a compelling intervention model to address significant gaps in accessible mental health intervention while simultaneously balancing the need for efficient service. Findings inform program scalability beyond COVID-19 and emphasize the value of stepped-care intervention in delivering and monitoring mental health treatment.
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Affiliation(s)
- Angela Deotto
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
| | - Giulia F Fabiano
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Beryl Y T Chung
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Shari L Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Evdokia Anagnostou
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, The Hospital for Sick Children Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Elizabeth Kelley
- Department of Psychology, Queens University, Kingston, ON, Canada
| | - Rob Nicolson
- Department of Psychiatry, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Brendan F Andrade
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Steven P Miller
- Faculty of Medicine, BC Children's Hospital, Vancouver, BC, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tricia S Williams
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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15
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Ulaş S, Seçer İ, Victory EJ, McNeil CB. Scientific collaborations and research trends in Parent-Child Interaction Therapy: a bibliometric analysis. Front Psychol 2023; 14:1167937. [PMID: 37251036 PMCID: PMC10213549 DOI: 10.3389/fpsyg.2023.1167937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Parent-child interaction therapy (PCIT) is considered to be an effective intervention for children aged 2-7 years with conduct problems. PCIT research has been conducted for approximately 50 years; however, an analysis of general research patterns has not been published. In this context, the present study outlines a bibliometric analysis of scientific collaborations, prevalence across locations on the basis of countries and organizations, leading researchers, and trends within PCIT research. Findings demonstrate that PCIT is an area in which international scientific collaborations are intense and current, and collaborations continue to be formed around the world. Additionally, results indicate that dissemination of intercultural PCIT adaptations are continuous.
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Affiliation(s)
- Sümeyye Ulaş
- Laboratory Department of Psychological Counseling and Guidance, Atatürk University, Erzurum, Türkiye
| | - İsmail Seçer
- Laboratory Department of Psychological Counseling and Guidance, Atatürk University, Erzurum, Türkiye
| | - Erinn J. Victory
- Department of Psychology, West Virginia University, Morgantown, WV, United States
| | - Cheryl B. McNeil
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
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16
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Woodfield MJ, Cargo T, Merry S, Hetrick SE. Protocol for a randomised pilot study of a novel Parent-Child Interaction Therapy (PCIT) 're-implementation' intervention. Pilot Feasibility Stud 2023; 9:73. [PMID: 37138334 PMCID: PMC10155153 DOI: 10.1186/s40814-023-01309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/21/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Despite a number of clinicians having been trained in Parent-Child Interaction Therapy (PCIT) in Aotearoa/New Zealand, few are regularly delivering the treatment, with barriers to use including a lack of suitable equipment and lack of professional support. This pragmatic, parallel-arm, randomised, controlled pilot trial includes PCIT-trained clinicians who are not delivering, or only rarely utilising, this effective treatment. The study aims to assess the feasibility, acceptability and cultural responsivity of study methods and intervention components and to collect variance data on the proposed future primary outcome variable, in preparation for a future, larger trial. METHODS The trial will compare a novel 're-implementation' intervention with a refresher training and problem-solving control. Intervention components have been systematically developed to address barriers and facilitators to clinician use of PCIT using implementation theory, and a draft logic model with hypothesised mechanisms of action, derived from a series of preliminary studies. The intervention includes complimentary access to necessary equipment for PCIT implementation (audio-visual equipment, a 'pop-up' time-out space, toys), a mobile senior PCIT co-worker and an optional weekly PCIT consultation group, for a 6-month period. Outcomes will include the feasibility of recruitment and trial procedures; acceptability of the intervention package and data collection methods to clinicians; and clinician adoption of PCIT. DISCUSSION Relatively little research attention has been directed at interventions to resurrect stalled implementation efforts. Results from this pragmatic pilot RCT will refine and shape knowledge relating to what it might take to embed the ongoing delivery of PCIT in community settings, providing more children and families with access to this effective treatment. TRIAL REGISTRATION ANZCTR, ACTRN12622001022752, registered on July 21, 2022.
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Affiliation(s)
- Melanie J Woodfield
- Centre for Infant, Child and Adolescent Mental Health, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
- Te Toka Tumai Auckland (Health New Zealand), Auckland, New Zealand.
| | - Tania Cargo
- Centre for Infant, Child and Adolescent Mental Health, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
- Department of Psychology, University of Auckland, Auckland, New Zealand
| | - Sally Merry
- Centre for Infant, Child and Adolescent Mental Health, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Sarah E Hetrick
- Centre for Infant, Child and Adolescent Mental Health, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
- Centre for Youth Mental Health, University of Melbourne, Melbourne, USA
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17
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Martinez K, Chlebowski C, Roesch S, Stadnick NA, Villodas M, Brookman-Frazee L. Psychometric Assessment of the Eyberg Child Behavior Inventory in Children with Autism in Community Settings. J Autism Dev Disord 2023; 53:1693-1705. [PMID: 35278165 PMCID: PMC9464797 DOI: 10.1007/s10803-022-05427-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 10/18/2022]
Abstract
The Eyberg Child Behavior Inventory (ECBI) is a frequently used measure to assess interfering behaviors in children and psychometric properties have recently been examined in children with autism spectrum disorder (ASD). There is a need to confirm the identified factors and examine the factor structure in a racially/ethnically diverse, community-based sample. The current study conducts a psychometric analysis of the ECBI in a sample of children with ASD receiving publicly-funded mental health services. Data were collected from 201 children with ASD ages 5-13 years (60% Hispanic/Latinx) participating in a community effectiveness trial. Confirmatory factor analysis indicated poor model fit using previously identified factors and a new four-factor solution was identified. Clinical and research implications of these findings are discussed.
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Affiliation(s)
- Kassandra Martinez
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
| | - Colby Chlebowski
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Scott Roesch
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Nicole A Stadnick
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA
| | - Miguel Villodas
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA
- Rady Children's Hospital, San Diego, CA, USA
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18
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Setiyowati E, Hanik U, Juliasih NN, Chanifah A. The Impact of Parent Child Interaction Therapy on Temper Tantrums in Pre-school. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Temper tantrum behavior is a child's emotional behavior which is shown by explosive anger and some parents consider this behavior to be bad behavior. Temper tantrums can occur in children aged 3-6 years or more. This literature review aims to determine the impact of PCIT (Parent Child Interaction Therapy) on temper tantrums in preschool. In finding this literature review used four databases (ProQuest, Scopus, Pubmed, and Sains Direct) for the design of the study used cross sectional, True Experimental, Observational and Systematic Reviews published in the last five years. The protocol and evaluation of the literature review used the PRISMA checklist to determine the selection of studies that were found and adapted to the objectives of the literature review. The results of literature review analysis of several parents in group and individual PCIT reported that the application of parent-child-based interventions was proven to be effective and has the potential to bring significant and lasting changes in increasing positive behavior in children with external behavior problems. The frequency of problematic child relationship behavior significantly decreased with increasing age of the child. In addition, assessing both positive and negative child relationship behavior could assist parents in understanding the relevance of different aspects for the development of parent-child relationships.
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19
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Studts CR, Jacobs JA, Bush ML, Lowman J, Westgate PM, Creel LM. Behavioral Parent Training for Families With Young Deaf or Hard of Hearing Children Followed in Hearing Health Care. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3646-3660. [PMID: 35985319 PMCID: PMC9802658 DOI: 10.1044/2022_jslhr-22-00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE It is well established that individuals with a communication disability, including being deaf or hard of hearing (DHH), experience inequities in health services and outcomes. These inequities extend to DHH children's access to psychosocial evidence-based interventions (EBIs). Behavioral parent training is an EBI that can be used to improve caregiver and child outcomes. Despite being supported by decades of effectiveness research, this EBI is rarely accessed by, or studied with, caregivers of DHH children. The purpose of this article is to describe a program of stakeholder-engaged research adapting and assessing behavioral parent training with caregivers of young DHH children followed in hearing health care, aimed at reducing inequities in access to this EBI. METHOD The first section briefly summarizes the literature on disruptive behavior problems in young children, with a focus on preschool-age DHH children. The evidence base for behavioral parent training is described. Next, the gaps in knowledge and practice regarding disruptive behaviors among DHH children are highlighted, and the potential integration of behavioral parent training into the standard of care for this population is proposed. CONCLUSIONS Young DHH children who use hearing aids and/or cochlear implants experience disruptive behavior problems at rates at least as high as typically hearing children, but their access to EBIs is limited, and behavioral parent training programs tailored to this population have not been rigorously tested. Caregivers and hearing health care service providers affirm the potential benefits of behavioral parent training and were partners in adapting this EBI. This research highlights several principles and approaches essential for reducing inequities and improving the quality of life not only for DHH children and their families but also for individuals with communication disabilities more broadly: engagement of key stakeholders in research, collaboration across disciplines, and using implementation science methods and models to design for implementation, dissemination, and sustainment. Presentation Video: https://doi.org/10.23641/asha.21215900.
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Affiliation(s)
- Christina R. Studts
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
| | - Julie A. Jacobs
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington
| | - Matthew L. Bush
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington
| | - Joneen Lowman
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | | | - Liza M. Creel
- Department of Health Management and Systems Sciences, University of Louisville, KY
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20
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Luis Sanchez BE, Klein CC, Corcoran F, Barnett ML. A Mixed-Methods Study of Clinician Adaptations to Parent-Child Interaction Therapy - What about Culture? EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 8:269-285. [PMID: 37456065 PMCID: PMC10348697 DOI: 10.1080/23794925.2022.2070883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Parent-Child Interaction Therapy (PCIT) is an evidence-based practice (EBP) for young children with challenging behaviors. PCIT has been adapted to treat varying presentations and culturally diverse families. Although efforts have been made to disseminate PCIT into community settings, which often serve clinically complex, socio-culturally diverse, and marginalized communities, barriers to disseminating adapted models remain. An alternative strategy to understanding how to increase access to appropriately adapted PCIT is to learn from community clinicians' practice-based adaptations to meet their clients' diverse needs related to clinical presentation, culture, and language. This mixed-method study investigated community clinician adaptations of PCIT. Clinicians (N = 314) were recruited via PCIT listservs to complete a survey collecting background information, and adaptations to PCIT. Most clinicians had a master's degree (72.1%), were licensed (74.2%), and were PCIT-certified (70.7%). Qualitative interviews were conducted with a purposeful sample of 23 community clinicians, who were 39% Spanish-speaking, were 30% Latinx, and 30% reported serving a ≥50% Latinx clientele. Clinicians reported engaging in adaptations aimed at augmenting PCIT more extensively than adaptations involving removing core components. Themes from qualitative interviews converged with quantitative findings, with clinicians most frequently describing augmenting adaptations, and highlighted reasons for adapting PCIT. Clinicians primarily augmented treatment to address clients' clinical presentations. Clinicians rarely adapted treatment specifically for culture, but when mentioned, clinicians discussed tailoring idioms and phrases to match clients' culture for Spanish-speaking clients. Implications for training PCIT clinicians in intervention adaptations will be discussed.
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Affiliation(s)
| | | | | | - Miya L Barnett
- University of California Santa Barbara, Santa Barbara, CA
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21
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Building I-INTERACT-North: Participatory Action Research Design of an Online Transdiagnostic Parent-Child Interaction Therapy Program to Optimize Congenital and Neurodevelopmental Risk. J Clin Psychol Med Settings 2022; 30:204-215. [PMID: 35505202 PMCID: PMC9063871 DOI: 10.1007/s10880-022-09875-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 11/16/2022]
Abstract
To adapt an existing virtual family-based mental health intervention learning platform (I-InTERACT-North), using participatory action research design, to meet the needs of parents and children with congenital, neonatal, and neurodevelopmental conditions that impact development. A purposive sample of parent knowledge users recruited from a large pediatric hospital (n = 21) and clinician stakeholders (n = 16) participated in one interview. An iterative process was adopted to implement feedback in the adaption of the learning platform. Qualitative thematic analysis was used to examine themes across participant feedback. Initial satisfaction with the adapted website was high. Qualitative results revealed four themes: acceptability, usability, recommendations, and dissatisfaction. Addressed with iterations, technical difficulties, wanting more information on content, resources, and intended audience were areas of dissatisfaction. This study reflects the importance of participatory action research methods in informing virtual mental health interventions. Future directions to improve the learning platform are discussed.
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22
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Preston R, Halpin M, Clarke G, Millard S. Palin parent-child interaction therapy with children with autism spectrum disorder and stuttering. JOURNAL OF COMMUNICATION DISORDERS 2022; 97:106217. [PMID: 35594755 DOI: 10.1016/j.jcomdis.2022.106217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 03/18/2022] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION It is estimated that 8% of children who stutter (CWS) have autism spectrum disorder (ASD) Briley & Ellis (2018). There is evidence that interventions for CWS and interventions for children with ASD can be effective, but there is little evidence to guide clinical decision making when working with CWS with a co-existing diagnosis of ASD. Palin Parent-Child Interaction (PCI) therapy Kelman & Nicholas (2020) is an evidence-based intervention for CWS, with the authors suggesting that the approach may be beneficial for CWS with ASD. The aim of this study was to examine outcomes for three CWS with ASD who received Palin PCI at a specialist centre for stuttering in London. METHOD The participants were three CWS with ASD aged 4;5, 6;7 and 7;7. Assessments were administered before therapy, and then at three, six and twelve months after therapy began. Outcome measures included stuttering frequency, child's communication attitude, parents' perception of the impact of stuttering on the child, the severity of stuttering and its impact on the parents, and parents' knowledge and confidence in managing stuttering. RESULTS All three children showed improvement in three or more variables. Four out of five parents reported reduced impact of stuttering on the child and themselves following therapy, and change was maintained one year post-therapy. All five parents reported increased knowledge of stuttering and confidence in managing it after therapy, and four parents maintained these changes for a year. CONCLUSIONS Over a one year period, these CWS with ASD who received Palin PCI showed change across multiple variables. The observed increases in parent knowledge and confidence were comparable to previously published data. These preliminary findings suggest that CWS with ASD and their parents can benefit from Palin PCI therapy and that further experimental evaluation of this approach with this client group is indicated.
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Affiliation(s)
- Rachel Preston
- City, University of London, Northampton Square, Clerkenwell, London EC1V 0HB, United Kingdom.
| | - Marie Halpin
- Michael Palin Centre, 13-15 Pine St, Farringdon, London EC1R 0JG, United Kingdom
| | - Gemma Clarke
- Michael Palin Centre, 13-15 Pine St, Farringdon, London EC1R 0JG, United Kingdom
| | - Sharon Millard
- City, University of London, Northampton Square, Clerkenwell, London EC1V 0HB, United Kingdom; Michael Palin Centre, 13-15 Pine St, Farringdon, London EC1R 0JG, United Kingdom
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23
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Dawson-Squibb JJ, Davids EL, Chase R, Puffer E, Rasmussen JDM, Franz L, de Vries PJ. Bringing Parent-Child Interaction Therapy to South Africa: Barriers and Facilitators and Overall Feasibility-First Steps to Implementation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084450. [PMID: 35457315 PMCID: PMC9031323 DOI: 10.3390/ijerph19084450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/24/2022] [Indexed: 12/26/2022]
Abstract
There is a large assessment and treatment gap in child and adolescent mental health services, prominently so in low- and middle-income countries, where 90% of the world's children live. There is an urgent need to find evidence-based interventions that can be implemented successfully in these low-resource contexts. This pre-pilot study aimed to explore the barriers and facilitators to implementation as well as overall feasibility of Parent-Child Interaction Therapy (PCIT) in South Africa. A reflective and consensus building workshop was used to gather South African PCIT therapist (N = 4) perspectives on barriers, facilitators, and next steps to implementation in that country. Caregiver participants (N = 7) receiving the intervention in South Africa for the first time were also recruited to gather information on overall feasibility. Facilitators for implementation, including its strong evidence base, manualisation, and training model were described. Barriers relating to sustainability and scalability were highlighted. Largely positive views on acceptability from caregiver participants also indicated the promise of PCIT as an intervention in South Africa. Pilot data on the efficacy of the treatment for participating families are a next step. These initial results are positive, though research on how implementation factors contribute to the longer-term successful dissemination of PCIT in complex, heterogeneous low-resource settings is required.
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Affiliation(s)
- John-Joe Dawson-Squibb
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa; (E.L.D.); (L.F.); (P.J.d.V.)
- Correspondence:
| | - Eugene Lee Davids
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa; (E.L.D.); (L.F.); (P.J.d.V.)
| | - Rhea Chase
- Judge Baker Children’s Center, Harvard Medical School, Boston, MA 02115, USA;
| | - Eve Puffer
- Department of Psychology & Neuroscience, Duke Global Health Institute, Duke University, Durham, NC 27708, USA; (E.P.); (J.D.M.R.)
| | - Justin D. M. Rasmussen
- Department of Psychology & Neuroscience, Duke Global Health Institute, Duke University, Durham, NC 27708, USA; (E.P.); (J.D.M.R.)
| | - Lauren Franz
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa; (E.L.D.); (L.F.); (P.J.d.V.)
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioural Sciences, Duke Global Health Institute, Duke University, Durham, NC 27708, USA
| | - Petrus J. de Vries
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa; (E.L.D.); (L.F.); (P.J.d.V.)
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Chung MR, Jun M, Lee SY. A Narrative Study into the Experience of a Mother Using Child Art Therapy Services for an Extended Time. HUMAN ARENAS 2022. [DOI: 10.1007/s42087-021-00266-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Levinson AR, Szenczy A, Nelson BD, Hajcak G, Bernard K. A biomarker of maternal vicarious reward processing and its association with parenting behavior. Biol Psychol 2022; 167:108240. [PMID: 34875364 PMCID: PMC10575693 DOI: 10.1016/j.biopsycho.2021.108240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 10/14/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022]
Abstract
Parenting styles play a critical role in child well-being, yet the neural bases of parenting behaviors remain nebulous. Understanding the neural processes associated with parenting styles can both clarify etiological mechanisms underlying parenting behaviors and point us toward new targets for intervention. A novel electrocortical biomarker called the observational reward positivity (oRewP) that occurs in response to observing another receive a reward has been linked to self-reported authoritarian parenting behavior. The current study sought to replicate associations between the oRewP and self-reported and observationally-coded parenting in a sample of mothers selected to be at elevated risk for problematic parenting. Self-reported authoritarian parenting was associated with observationally-coded problematic discipline, while no other self-reported parenting scales were associated with observationally-coded scores. We replicated the previously reported association between a blunted oRewP and increased self-reported authoritarian parenting. We additionally found that an attenuated oRewP was associated with greater permissive parenting, and that only the relationship with permissive parenting was conserved after adjusting for other parenting styles and other relevant covariates. We did not find significant associations between the oRewP and observationally-coded parenting. The current findings suggest that the neural process indexed by the oRewP are relevant to parenting behavior. Further research is needed to better understand the discrepancy between self-reported and observed parenting.
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Affiliation(s)
- Amanda R Levinson
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA.
| | - Aline Szenczy
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA
| | - Brady D Nelson
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA
| | - Greg Hajcak
- Department of Psychology, Florida State University, Tallahassee, FL, USA; Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Kristin Bernard
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA
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Rosas YG, Sigal M, Park A, Barnett ML. Predicting a Rapid Transition to Telehealth-Delivered Parent-Child Interaction Therapy Amid COVID-19: A Mixed Methods Study. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2022; 2:293-304. [PMID: 36105665 PMCID: PMC9462633 DOI: 10.1007/s43477-022-00057-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 08/29/2022] [Indexed: 12/31/2022]
Abstract
The sudden onset of COVID-19 forced mental health therapists to rapidly transition to telehealth services. While some therapists and organizations were able to achieve an expeditious transition, others struggled. Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, which outlines key phases that guide the implementation process, the current mixed methods study examined what factors predicted the transition to internet-based Parent-Child Interaction Therapy (iPCIT), a telehealth-delivered evidence-based practice (EBP). We investigated two areas related to the transition: (1) if PCIT therapists transitioned to provide iPCIT and (2) if they made this transition quickly. In Fall 2019, 324 therapists completed a survey about implementing PCIT. After stay-at-home orders, 223 of those therapists completed a follow-up survey about their transition to telehealth, organizational characteristics, their caseloads, and telehealth training. The majority of therapists (82%) transitioned to provide iPCIT, with 48% making the transition in less than a week. Open-ended responses indicated that therapists who did not transition-faced challenges related to limited client resources, a lack of training, and organizational delays. Qualitative findings informed predictors for two logistic regression models that are statistical models that predict the probability of an event occurring, with criterion variables (1) whether therapists transitioned to provide iPCIT and (2) whether they transitioned in less than a week. Results showed that caseload in Fall 2019 and receipt of iPCIT training were associated with iPCIT transition. Organizational setting, resiliency, and baseline caseload predicted rapid transition to iPCIT. Implications regarding supporting the implementation of telehealth delivery of EBPs are discussed.
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Affiliation(s)
- Yessica Green Rosas
- grid.133342.40000 0004 1936 9676Department of Counseling, Clinical, and School Psychology, Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA 93106-9490 USA
| | - Marika Sigal
- grid.27860.3b0000 0004 1936 9684Department of Human Ecology, University of California, Davis, Davis, CA USA
| | - Alayna Park
- grid.170202.60000 0004 1936 8008Department of Psychology, University of Oregon, Eugene, OR USA
| | - Miya L. Barnett
- grid.133342.40000 0004 1936 9676Department of Counseling, Clinical, and School Psychology, Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA 93106-9490 USA
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Woodfield MJ, Cargo T, Merry SN, Hetrick SE. Barriers to Clinician Implementation of Parent-Child Interaction Therapy (PCIT) in New Zealand and Australia: What Role for Time-Out? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13116. [PMID: 34948725 PMCID: PMC8700887 DOI: 10.3390/ijerph182413116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 12/22/2022]
Abstract
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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Affiliation(s)
- Melanie J. Woodfield
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland 1023, New Zealand; (T.C.); (S.N.M.); (S.E.H.)
- Auckland District Health Board, Auckland 1023, New Zealand
| | - Tania Cargo
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland 1023, New Zealand; (T.C.); (S.N.M.); (S.E.H.)
- Department of Psychology, University of Auckland, Auckland 1023, New Zealand
| | - Sally N. Merry
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland 1023, New Zealand; (T.C.); (S.N.M.); (S.E.H.)
| | - Sarah E. Hetrick
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland 1023, New Zealand; (T.C.); (S.N.M.); (S.E.H.)
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC 3010, Australia
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Wang C, Hu Y, Nakonezny PA, Melo V, Ale C, Athreya AP, Shekunov J, Lynch R, Croarkin PE, Romanowicz M. A Retrospective Examination of the Impact of Pharmacotherapy on Parent-Child Interaction Therapy. J Child Adolesc Psychopharmacol 2021; 31:685-691. [PMID: 34319785 PMCID: PMC8721494 DOI: 10.1089/cap.2021.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: Parent-child interaction therapy (PCIT) is an evidence-based approach for children aged 2-7 years with disruptive behavior problems. This study examined the effectiveness of PCIT with and without concurrent pharmacotherapy. Methods: A convenience sample was collected from a retrospective chart review of preschool-aged children treated with PCIT at the Mayo Clinic Young Child Clinic between 2016 and 2020. Quantitative and qualitative data were abstracted from all patients. The sample was divided into two groups based on psychotropic medications status (medicated and unmedicated) at the initiation of PCIT. Effectiveness of treatment was assessed with the change in Eyberg Child Behavior Inventory (ECBI) score. The change over time in ECBI score was compared between the two PCIT groups with and without concurrent pharmacotherapy using a linear mixed model. Results: Of the 62 youth, 38.71% were females. Mean age was 4.71 ± 1.17 years. The mean baseline ECBI score was 148.74 ± 30.86, indicating clinically significant disruptive behaviors. The mean number of PCIT sessions was 6.59 ± 3.82. There was no statistically significant difference in ECBI scores between the two groups at pre-PCIT (medication group: 149.68, standard error [SE] = 11.61 vs. unmedicated group: 147.92, SE = 10.93, p = 0.8904) and at post-PCIT (medication group: 116.27 [SE = 11.89] vs. unmedicated group: 128.86 [SE = 11.57], p = 0.3464). There was a statistically significant improvement in ECBI scores for both groups after completing therapy (medication group = -33.41 [-22.32%], SE = 6.27, p < 0.0001; d = 1.144; unmedicated group = -19.06 [-12.88%], SE = 5.78, p = 0.0022; d = 1.078). Conclusions: PCIT reduced disruptive behaviors in this sample of young children regardless of concurrent pharmacotherapy. Future prospective studies should consider one particular pharmacological agent and long-term outcomes of treatment. PCIT and certain pharmacological treatments could have complex and important bidirectional priming effects for both treatments.
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Affiliation(s)
- Chris Wang
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yuliang Hu
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul A. Nakonezny
- Department of Psychiatry and University of Texas Southwestern, Dallas, Texas, USA
- Department of Population and Data Sciences, University of Texas Southwestern, Dallas, Texas, USA
| | - Valeria Melo
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Chelsea Ale
- Department of Psychiatry and Psychology, Mayo Clinic, La Crosse, Wisconsin, USA
| | - Arjun P. Athreya
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Julia Shekunov
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel Lynch
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul E. Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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Barnett ML, Sigal M, Green Rosas Y, Corcoran F, Rastogi M, Jent JF. Therapist Experiences and Attitudes About Implementing Internet-Delivered Parent-Child Interaction Therapy During COVID-19. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:630-641. [PMID: 33994769 PMCID: PMC8112899 DOI: 10.1016/j.cbpra.2021.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 03/19/2021] [Indexed: 12/01/2022]
Abstract
It has been widely recognized that access to mental health treatment is imperative to address current and long-term stressors for children and parents during COVID-19. Internet-delivered Parent-Child Interaction Therapy (iPCIT, previously referred to as I-PCIT) is a strong model for remote service delivery during social distancing restrictions due to its empirical base. However, this treatment modality was not widely implemented before COVID-19, likely due to barriers to providing telehealth services. This mixed methods study conducted a follow-up survey to gather therapist experiences (N = 223) in delivering iPCIT during COVID-19, including qualitative data on the benefits and challenges to delivering iPCIT. The vast majority of therapists (82%) indicated that they transitioned to deliver PCIT via telehealth in response to COVID-19. PCIT caseloads decreased slightly from the first survey to the COVID-19 follow-up survey, but the racial and ethnic composition of caseloads were not significantly different between the two surveys. Of the 183 therapists who transitioned to deliver PCIT via telehealth, 82% expressed interest in continuing to provide iPCIT following the COVID-19 pandemic. Reported benefits of iPCIT included decreased barriers to access and the ability to practice skills within the naturalistic home environment. Challenges to iPCIT were primarily issues with technology as well as other logistical barriers, which could limit engagement for some families. Findings from this study may be beneficial in improving future implementation of iPCIT during and post-COVID-19.
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Melo V, Zaccariello M, Girard E, Croarkin P, Romanowicz M. Internet parent-child interaction therapy (I-PCIT) in medically ill child: A case report. Medicine (Baltimore) 2021; 100:e27547. [PMID: 34731157 PMCID: PMC8519228 DOI: 10.1097/md.0000000000027547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/01/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION This case illustrates the feasibility, benefit, and putative enhanced ecological validity of performing internet-parent-child interaction therapy (I-PCIT) in the parent-child dyad's home for the treatment of behavior problems in medically ill children in the context of a global pandemic. PATIENT CONCERNS Parents of a 5-year-old girl initially presented with concerns regarding inattentiveness, physical and verbal fighting with her siblings, and getting kicked out of daycare for hitting another child. Patient also had difficulties sleeping at night. DIAGNOSES Patient was diagnosed with electrical status epilepticus in sleep, frontal lobe executive function deficit, and attention deficit hyperactivity disorder. INTERVENTIONS Patient received a course of I-PCIT. Equipment included a cell phone with video capabilities connected to a videotelephony software program and set-up in the child's home by the parents. The treatment course included 8, 1-hour, weekly teaching/coaching sessions (7 of which were performed using I-PCIT) plus 1 follow-up booster session 6 months later. OUTCOMES Home-based I-PCIT implementation greatly improved disruptive behaviors in a young child with electrical status epilepticus in sleep and attention deficit hyperactivity disorder. CONCLUSION A combination of I-PCIT and methylphenidate allowed her to be successful at home and in a school setting. More research is needed on PCIT adaptations, such as home-based and internet-based PCIT, for medically ill children as well as treatment protocols for combined therapies.
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Affiliation(s)
- Valeria Melo
- Mayo Clinic Alix School of Medicine, Mayo Clinic Rochester, MN
| | | | - Emma Girard
- Department of Health Sciences, UC Riverside School of Medicine Riverside, CA
| | - Paul Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic Rochester, MN
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31
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O'Toole C, Lyons R, Houghton C. A Qualitative Evidence Synthesis of Parental Experiences and Perceptions of Parent-Child Interaction Therapy for Preschool Children With Communication Difficulties. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:3159-3185. [PMID: 34289311 DOI: 10.1044/2021_jslhr-20-00732] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose Parent-child interaction therapy refers to a number of interventions mediated by trained parents to treat developmental difficulties, including speech, language, and communication. Understanding the experiences of parents who take part in parent-child interaction therapy is a key aspect of determining how this intervention can be implemented successfully. However, to date, there has been limited work on synthesizing parental views of this intervention. Method We used qualitative evidence synthesis that involved searching the literature for qualitative studies addressing the experiences and perceptions of parent-child interaction therapy for parents of preschool children with communication difficulties. We identified 27 studies (from 32 publications) and synthesized the data using thematic synthesis. We appraised the quality of included studies using Critical Appraisal Skills Programme (CASP) and assessed our confidence in the review findings using GRADE Confidence in the Evidence from Reviews of Qualitative research (CERQual). Results At the beginning of this intervention, parents may have competing demands and varied expectations about the intervention. Their engagement is facilitated when the intervention is tailored to their individual family, their preferences for learning, and when they have a trusting relationship with the clinician. At the end of the intervention, although most parents perceive an improvement in their child's communication and feel empowered to facilitate this, they have concerns about their child's future needs. Conclusions It is important that clinicians explore parents' readiness for this intervention by discussing their needs and preferences openly, and that they facilitate their engagement through a supportive relationship. They also need to consider how parents will transition out of the intervention and continue to support their child's language development. Supplemental Material https://doi.org/10.23641/asha.14978454.
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Affiliation(s)
- Ciara O'Toole
- Department of Speech and Hearing Sciences, University College Cork, Ireland
| | - Rena Lyons
- Discipline of Speech and Language Therapy, National University of Ireland Galway
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Improving the Quality of Children's Mental Health Care with Progress Measures: A Mixed-Methods Study of PCIT Therapist Attitudes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:182-196. [PMID: 34363566 PMCID: PMC8850255 DOI: 10.1007/s10488-021-01156-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
Progress measures are an evidence-based technique for improving the quality of mental health care, however, clinicians rarely incorporate them into treatment. Research into how measure type impacts clinician preference has been recommended to help improve measure implementation. Parent–Child Interaction Therapy (PCIT) is an assessment-driven treatment that serves as an ideal intervention through which to investigate measure preferences given its routine use of two types of assessments, a behavioral observation (the Dyadic Parent–Child Interaction Coding System) and a parent-report measure (the Eyberg Child Behavior Inventory). This study investigated PCIT therapist attitudes towards progress measures used within PCIT and children’s mental health treatment generally. A mixed-method (QUAN + QUAL) study design examined PCIT therapist attitudes towards two types of progress measures and measures used in two contexts (PCIT and general practice). Multi-level modeling of a survey distributed to 324 PCIT therapists identified predictors of therapist attitudes towards measures, while qualitative interviews with 23 therapists expanded and clarified the rationale for differing perceptions. PCIT therapists reported more positive attitudes towards a behavioral observation measure, the DPICS, than a parent-report measure, the ECBI, and towards measures used in PCIT than in general practice. Clinician race/ethnicity was significantly related to measure-specific attitudes. Qualitative interviews highlighted how perceptions of measure reliability, type of data offered, ease of use, utility in guiding sessions and motivating clients, and embeddedness in treatment protocol impact therapist preferences. Efforts to implement progress monitoring should consider preferences for particular types of measures, as well as how therapists are trained to embed measures in treatment.
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Wimer C, Marti M, Brooks-Gunn J, Waldfogel J. Early Impacts of Room to Grow: A Multifaceted Intervention Supporting Parents and Children Age Zero to Three. CHILDREN AND YOUTH SERVICES REVIEW 2021; 126:106041. [PMID: 34149135 PMCID: PMC8208596 DOI: 10.1016/j.childyouth.2021.106041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Children experiencing poverty or low incomes fare worse than their more advantaged peers on a host of developmental and educational outcomes. Interventions have focused on strengthening parenting in families with young children, when supports appear to be most critical. But most parenting programs for low-income families fail to address parents' economic needs, which almost always take precedence relative to broader educational or developmental goals. In this article, we describe the early results of a multifaceted intervention aimed at supporting parents, infants, and toddlers in the first three years of life. The Room to Grow program provides parents, primarily mothers, with support from a clinical social worker, connections to community referrals, and up to $10,000 in material support for the baby in the form of in-kind assistance such as clothes, books, toys, strollers, and other necessities. The current study examines proximal outcomes of the intervention after one year using a randomized controlled trial evaluation design. The study finds that early impacts on proximal outcomes are uniformly positive, especially with regards to the presence of books and developmental goods in the home, developmentally-oriented parenting outcomes, and reduced stress and aggravation in the domain of parenting.
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Merianos AL, Nabors LA, Fiser KA, Mahabee-Gittens EM. Exposure to Tobacco Smoke and Temperament among U.S. Children 0-5 Years Old. J Pediatr Psychol 2021; 46:454-464. [PMID: 33355348 PMCID: PMC8056209 DOI: 10.1093/jpepsy/jsaa123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study examined the association between tobacco smoke exposure (TSE) and temperament among children 0-5 years old overall and within age groups: 0-2 and 3-5 years. METHODS Data were obtained from the 2017-2018 NSCH (N = 14,345). TSE status was defined as whether children lived with a smoker who: does not smoke inside the home (no home TSE) or smokes inside the home (home TSE). We conducted logistic regression analyses while controlling for covariates. RESULTS Overall, 12.5% of children lived with a smoker with no home TSE and 1.1% had home TSE. Children with home TSE were at increased odds to not always: be affectionate and tender (aOR = 1.74, 95% CI = 1.18-2.58), show interest and curiosity (aOR = 1.81, 95% CI = 1.23-2.68), and smile and laugh (aOR = 1.77, 95% CI = 1.13-2.77) than those with no TSE. Among 0- to 2-year-olds, those with home TSE were more likely to not always be affectionate and tender (aOR = 1.97, 95% CI = 1.04-3.74). Among 3- to 5-year-olds, those who lived with a smoker with no home TSE were more likely to not always: bounce back quickly (aOR = 1.21, 95% CI = 1.05-1.40) and smile and laugh (aOR = 1.26, 95% CI = 1.03-1.54), and those with home TSE were more likely to not always: show interest and curiosity (aOR = 2.24, 95% CI = 1.40-3.59) and smile and laugh (aOR = 2.43, 95% CI = 1.43-4.11). CONCLUSIONS Tobacco smoke-exposed children were at increased odds of not always demonstrating positive early childhood temperament behaviors, with 3- to 5-year-olds having more pronounced odds.
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Affiliation(s)
| | | | | | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati
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35
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PCIT engagement and persistence among child welfare-involved families: Associations with harsh parenting, physiological reactivity, and social cognitive processes at intake. Dev Psychopathol 2021; 34:1618-1635. [PMID: 33766186 DOI: 10.1017/s0954579421000031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Parent-Child interaction therapy (PCIT) has been shown to improve positive, responsive parenting and lower risk for child maltreatment (CM), including among families who are already involved in the child welfare system. However, higher risk families show higher rates of treatment attrition, limiting effectiveness. In N = 120 child welfare families randomized to PCIT, we tested behavioral and physiological markers of parent self-regulation and socio-cognitive processes assessed at pre-intervention as predictors of retention in PCIT. Results of multinomial logistic regressions indicate that parents who declined treatment displayed more negative parenting, greater perceptions of child responsibility and control in adult-child transactions, respiratory sinus arrhythmia (RSA) increases to a positive dyadic interaction task, and RSA withdrawal to a challenging, dyadic toy clean-up task. Increased odds of dropout during PCIT's child-directed interaction phase were associated with greater parent attentional bias to angry facial cues on an emotional go/no-go task. Hostile attributions about one's child predicted risk for dropout during the parent-directed interaction phase, and readiness for change scores predicted higher odds of treatment completion. Implications for intervening with child welfare-involved families are discussed along with study limitations.
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Davidson BC, Davis E, Cadenas H, Barnett M, Sanchez BEL, Gonzalez JC, Jent J. Universal Teacher-Child Interaction Training in Early Special Education: A Pilot Cluster-Randomized Control Trial. Behav Ther 2021; 52:379-393. [PMID: 33622507 DOI: 10.1016/j.beth.2020.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 11/30/2022]
Abstract
Using a pilot matched-pairs cluster-randomized control trial, we evaluated the acceptability and preliminary outcomes of universal Teacher-Child Interaction Training (TCIT-U) with students with disabilities in early special education programs. Twelve classrooms (clusters) were paired by age and type and then randomly assigned within pairs to either TCIT-U (81 students, 20 teachers) or wait-list control (63 students, 16 teachers) with services as usual. We analyzed the effects of TCIT-U on (a) teachers' skills acquisition via masked observational coding and (b) students' behavior and developmental functioning via teacher questionnaires. For child-directed interaction skills, teachers receiving TCIT-U exhibited significantly greater increases in behavior descriptions and labeled praise than teachers who did not receive TCIT-U at posttreatment and follow-up. No significant group differences were observed in use of teacher-directed interaction skills. Qualitative data from teachers expanded on these findings, suggesting that teachers found child-directed interaction skills more acceptable than teacher-directed interaction skills. Teachers receiving TCIT-U reported small but significant improvements in student behavior problems and socioemotional functioning at posttreatment and follow-up, as compared to wait-list students. We discuss considerations for future implementation and tailoring of TCIT for young students with disabilities, which may have positive impacts on future cohorts of students beyond teachers' initial training.
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Fukuya Y, Fujiwara T, Isumi A, Doi S, Ochi M. Association Between Parenting and School Refusal Among Elementary School Children in Japan: Results From A-CHILD Longitudinal Study. Front Pediatr 2021; 9:640780. [PMID: 33842410 PMCID: PMC8032934 DOI: 10.3389/fped.2021.640780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/10/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: The aim of this study was to examine the association between parenting, including the parent-child interaction and child maltreatment in the first grade (6-7 years old), and school refusal in the second (7-8 years old) and fourth (9-10 years old) grades among elementary school children in Japan. Methods: Data were from the Adachi Child Health Impact of Living Difficulty (A-CHILD) longitudinal study conducted in 2015, 2016, and 2018 in Adachi City, Tokyo, Japan. A questionnaire was distributed to all the first-grade school children (N = 5,355) in 2015. Of the total 4,291 valid children (response rate: 80.1%), 3,590 and 3,070 children were followed up to the second and fourth grades, respectively. Caregivers responded to the questionnaire on the parent-child interaction and child maltreatment, including neglect, physical abuse, and psychological abuse in the first grade and school refusal in the second and fourth grades. We conducted multiple imputation for missing data. Multivariate logistic regression model was used for this analysis adjusting for child mental health in the first grade and sociodemographic characteristics. Results: Prevalence of school refusal was 1.8% (n = 64) in the second grade and 2% (n = 60) in the fourth grade. We found no association of the parent-child interaction and child maltreatment in the first grade and with school refusal in the second and fourth grades, respectively, after adjusting for covariates. Conclusions: Parenting, such as the parent-child interaction and child maltreatment, may not be associated with school refusal among elementary school children. Further longitudinal research is needed to elucidate other factors, such as peer relationships and school environment, which can affect school refusal.
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Affiliation(s)
- Yoshifumi Fukuya
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Aya Isumi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satomi Doi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Manami Ochi
- Department of Health and Welfare Services, National Institute of Public Health, Saitama, Japan
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Childress AC, Beltran N, Supnet C, Weiss MD. Reviewing the role of emerging therapies in the ADHD armamentarium. Expert Opin Emerg Drugs 2020; 26:1-16. [PMID: 33143485 DOI: 10.1080/14728214.2020.1846718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder that can be treated with both pharmacologic and nonpharmacologic modalities. Effective drug treatments for ADHD have been available for more than six decades. However, initial treatments had limitations in duration of effect, need for multiple daily doses, requirement for patients to swallow intact tablets, adverse effects and risk for abuse and diversion. During the past 20 years, more than two dozen stimulant and nonstimulant drugs have been developed. Nonetheless, there remain unmet needs in the treatment of ADHD.Areas covered: New stimulant and nonstimulant formulations in development are reviewed with emphasis on drugs in phase II and III trials. Efficacy, mechanism of action and adverse effect data are described where available. Abuse liability studies are described for abuse-deterrent formulations in development.Expert opinion: The review found a robust pipeline of stimulants and nonstimulants. Medications in development are formulated to optimize onset and duration of effect, alter the time of administration, obviate the need to swallow whole capsules or tablets and to deter abuse. While each of these formulations may fill a unique niche, these incremental improvements based on new drug delivery technologies may lead to very significant clinical effects.
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Affiliation(s)
- Ann C Childress
- Center for Psychiatry and Behavioral Medicine, Inc., Las Vegas, NV, USA
| | - Nathalie Beltran
- Touro University Nevada, College of Osteopathic Medicine, Henderson, NV, USA
| | - Carl Supnet
- Touro University Nevada, College of Osteopathic Medicine, Henderson, NV, USA
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Peterson RK, Williams T, Dlamini N, Westmacott R. Parent experiences and developmental outcomes following neonatal stroke. Clin Neuropsychol 2020; 35:973-987. [PMID: 32924802 DOI: 10.1080/13854046.2020.1815855] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Parents of children with neonatal stroke offer critical insight into potential avenues to direct neuropsychological care from the time of diagnosis through the early years. The aims of this study were to (1) describe what parents remember about early prognostic discussions with the medical team and (2) to examine the relationships between initial prognoses and the child's current neurodevelopmental status and parents' mental health. Method: Thirty parents of children with neonatal stroke completed the Depression Anxiety Stress Scales (DASS) and Parent Experiences Questionnaire (PEQ). The children of these parents were also seen for neurodevelopmental/neuropsychological assessments. Results: Parents recalled discussions with the medical team about motor, language, cognitive, and academic outcomes, with fewer discussions about the impact of neonatal stroke on their child's social skills, behavior, attention, mental health, and adaptive functioning. Many parents recalled poor initial prognoses following their child's diagnosis, with better than expected outcomes 3 years later. Parent self-reported depression, anxiety, and stress were associated with higher ratings of externalizing symptoms in their child. There were no significant correlations between parent mental health and their perception of their child's internalizing symptoms, neurodevelopmental functioning, or any of the child's medical/demographic factors. Conclusions: This study highlights the role of the neuropsychologist in the child's care in educating families and monitoring outcomes, emphasizes mental health support for parents of children with a history of neonatal stroke, and reiterates how environmental factors outside of the neonatal stroke itself can impact the child's functioning.
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Affiliation(s)
- Rachel K Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Tricia Williams
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, USA
| | - Nomazulu Dlamini
- Department of Neurology, The Hospital for Sick Children, Toronto, ON, USA
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, USA
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O'Toole C, Lyons R, Ó'Doibhlín D, O'Farrell F, Houghton C. Stage 1 Registered Report: The experiences and perceptions of parent-child interaction therapy for parents of young children with communication difficulties: A qualitative evidence synthesis protocol. HRB Open Res 2020; 2:36. [PMID: 32566893 PMCID: PMC7281664 DOI: 10.12688/hrbopenres.12974.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Parent-child interaction therapy refers to a group of interventions mediated by trained parents to address areas of developmental difficulties in children. In the field of speech and language therapy it is used in early intervention for children with speech, language and communication difficulties. The intervention involves training parents and caregivers on the importance of responsivity and language input in daily interactions and coaches them on strategies to implement these with the children. As the success of the intervention is heavily influenced by caregiver engagement, understanding and acceptance, it is important to consider their views. However, to date there has been limited work on synthesising parental views of this intervention. Methods: This is a protocol for a qualitative evidence synthesis of peer-reviewed qualitative papers addressing the experiences and perceptions of parent-child interaction therapy for parents of children with communication difficulties. We will complete a systematic search of 11 databases, review the reference lists and complete a cited reference search of all included studies. Two authors will independently screen tests for inclusion, initially by title and abstract, with full-text screening as necessary. Thematic synthesis will be used for all included studies. We will appraise the quality of included studies using CASP and confidence in the review findings using GRADE CERQual. Discussion: As the views of parents are pivotal in the success of this intervention, the findings from this synthesis should help to guide best practice and policy for the future implementation of parent child interaction therapy for children with communication difficulties..
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Affiliation(s)
- Ciara O'Toole
- Department of Speech and Hearing Sciences, University College Cork, Cork, Ireland
| | - Rena Lyons
- Discipline of Speech and Language Therapy, National University of Ireland, Galway, Galway, Ireland
| | - Donna Ó'Doibhlín
- Boston Scientific Library, University College Cork, Cork, Ireland
| | | | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
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Factors Influencing Implementation of Evidence-Based Mental Health Interventions for Infants and Young Children. J Behav Health Serv Res 2020; 47:493-508. [PMID: 32367263 DOI: 10.1007/s11414-020-09694-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Large-scale efforts have been made to adopt evidence-based practices (EBPs) for young children within community mental health settings. The current study investigated the implementation of Parent-Child Interaction Therapy and Child-Parent Psychotherapy using an online survey of 20 program managers representing 16 birth-to-five mental health agencies serving an ethnically diverse Medicaid population throughout a large urban county. Survey questions addressed intake and referral processes, training and supervision in EBPs, treatment fidelity, and patient outcomes/satisfaction. Results indicated that both clinical judgment and established decision-trees were used to select treatment approaches and that supervision, consultation, and fidelity monitoring were used to support fidelity to the models. Participants cited intensive EBP training processes, staff turnover, and patient attrition as barriers to sustainability. Implications regarding implementation of EBPs for infants and young children are discussed, including issues related to patient care, training and supervision, treatment fidelity, program sustainability, and barriers to system change.
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Barnett ML, Bernal NA, Luis Sanchez BE. Direct-to-Consumer Marketing for Parent-Child Interaction Therapy: Impact of Language and Messenger. JOURNAL OF CHILD AND FAMILY STUDIES 2020; 29:71-81. [PMID: 33311965 PMCID: PMC7728243 DOI: 10.1007/s10826-019-01575-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVES Parent-Child Interaction Therapy (PCIT) is an effective therapy to treat early onset disruptive behavior problems and child physical maltreatment. In order to support the successful implementation and sustainment of PCIT, strategies are needed to recruit parents into care, especially for racial and ethnic minority families, who often have lower rates of access and utilization of mental health services. METHODS This study investigated the impact of direct-to-consumer advertisements on parents' attitudes towards PCIT. Advertisements were delivered in Spanish and English, with either a parent testimony or therapist explaining the treatment. Participants were parents of children between the ages of 2 and 7, who were recruited through Amazon Mechanical Turk. Participants (N = 204) were 38.2% female and 49.5% Spanish speaking. RESULTS There were no main effects for language or messenger related to PCIT Help-Seeking Intentions, Attitudes, or Stigmatization. However, there was an interaction effect for language and messenger for PCIT Help-Seeking Intentions. Specifically, Spanish-speaking participants had higher intentions when the messenger was a therapist rather than a parent, and had lower intentions than English-speaking parents when the messenger was a parent. CONCLUSIONS These findings are promising for direct-to-consumer advertising strategies that may help recruit more Spanish-speaking families into PCIT, which could help address disparities in access to mental health services.
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Affiliation(s)
- Miya L Barnett
- Department of Counseling, Clinical and School Psychology University of California Santa Barbara
| | - Natalie A Bernal
- Department of Counseling, Clinical and School Psychology University of California Santa Barbara
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Yu D, Hsu H. Mother–child verbal communication and preschoolers' inhibitory control. INFANT AND CHILD DEVELOPMENT 2019. [DOI: 10.1002/icd.2146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Dian Yu
- Department of Human Development and Family ScienceUniversity of Georgia Athens Georgia
| | - Hui‐Chin Hsu
- Department of Human Development and Family ScienceUniversity of Georgia Athens Georgia
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Abstract
As increasing resources are now being directed towards addressing the growing U.S. opioid epidemic, the long-term care of children from opioid-affected families has been relatively neglected. While an array of evidence suggests long-term negative developmental, medical, and social impacts to children related to their parents' opioid use, there remains much to be learned about how best to support children and families to promote healthy outcomes. Here, we report on the launch of an innovative family-centered pediatric medical home for opioid-affected families in Boston. We describe the program, the patient cohort, and early lessons learned. Important themes include the vulnerability of families with infants whose parents are in early recovery, and the need for compassionate, high-touch, high-continuity, team-based care that views the needs of the family as a whole. We recommend a future emphasis on non-stigmatizing, trauma-informed care; centering the needs of the family by addressing social and logistics barriers and by expanding models of parent-child dyadic care; investing in attachment and mental health interventions; developing strategies for prevention of opioid use disorder (OUD) in the next generation; and grounding our advocacy and actions in a social justice approach.
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Lieneman CC, Quetsch LB, Theodorou LL, Newton KA, McNeil CB. Reconceptualizing attrition in Parent-Child Interaction Therapy: "dropouts" demonstrate impressive improvements. Psychol Res Behav Manag 2019; 12:543-555. [PMID: 31413647 PMCID: PMC6660625 DOI: 10.2147/prbm.s207370] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/07/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: Behavior disorders in early childhood are linked to a variety of negative outcomes for both children and families. Parent-Child Interaction Therapy (PCIT), an evidence-based parent-training program, demonstrates large effect sizes in reducing child problem behavior for dyads who complete treatment; however, a high number of families seeking treatment in community-based settings terminate from PCIT prior to meeting the protocol's strict graduation criteria. The purpose of this study was to examine the impact of PCIT on child behavior problems for families who received at least a small dose of PCIT but not enough to meet the strict mastery criteria required for graduation. Patients and methods: This study employed one of the largest community research samples conducted with PCIT (2,787 children and their families across the state of Oregon, 1,318 with usable data) to determine how PCIT impacts both graduates and early terminators. Results: While families who graduated from PCIT (17.7% of the sample) demonstrated a very large effect size in problem behavior intensity improvements (d=1.65), families who terminated treatment early, but after attending at least four treatment sessions (51.7% of the sample), still showed significant improvements in behavior problems with a medium-to-large effect size (d=0.70). In contrast, very early terminators (those attending fewer than four treatment sessions, 0.3% of the sample), demonstrated little improvement at the time of dropout from services (d=0.12). Conclusion: Though early terminators in PCIT have previously been identified as treatment failures, the present study discusses the reconceptualization of "dropouts" in relation to some positive evidence of treatment outcomes, the implications for community-based service delivery, and possible future directions.
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Affiliation(s)
- Corey C Lieneman
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Lauren B Quetsch
- Department of Psychology, West Virginia University, Morgantown, WV, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | - Cheryl B McNeil
- Department of Psychology, West Virginia University, Morgantown, WV, USA
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Brabson LA, Herschell AD, Kolko DJ, Mrozowski SJ. Associations Among Job Role, Training Type, and Staff Turnover in a Large-Scale Implementation Initiative. J Behav Health Serv Res 2019; 46:399-414. [PMID: 30607527 PMCID: PMC8006068 DOI: 10.1007/s11414-018-09645-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Staff turnover is problematic for behavioral health agencies implementing evidence-based practices (EBPs), which are costly and time-consuming. The current study examined the association between EBP training methods and turnover and explored predictors of turnover for different types of staff. Participants (100 clinicians, 50 supervisors, 50 administrators) were randomized to one of three training conditions for an EBP. Results indicated low annual rates of turnover for clinicians, supervisors, and administrators. However, contrary to hypothesis, no statistically significant differences were found in rates of turnover across training conditions. Partially consistent with prior research, organizational climate was a significant predictor of supervisor and administrator turnover at 24 months, but was not a significant predictor of clinician turnover. Implications and future directions for research are discussed.
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Affiliation(s)
- Laurel A Brabson
- Department of Psychology, West Virginia University, 1124 Life Sciences Building, P.O. Box 6040, Morgantown, WV, 26506-6040, USA.
| | - Amy D Herschell
- Department of Psychology, West Virginia University, 1124 Life Sciences Building, P.O. Box 6040, Morgantown, WV, 26506-6040, USA
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - David J Kolko
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, USA
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Gross D, Belcher HME, Budhathoki C, Ofonedu ME, Dutrow D, Uveges MK, Slade E. Reducing Preschool Behavior Problems in an Urban Mental Health Clinic: A Pragmatic, Non-Inferiority Trial. J Am Acad Child Adolesc Psychiatry 2019; 58:572-581.e1. [PMID: 30768419 PMCID: PMC8745406 DOI: 10.1016/j.jaac.2018.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 08/23/2018] [Accepted: 09/13/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This pragmatic, randomized, non-inferiority trial compared the effectiveness and cost of group-based parent management training with mastery-based individual coaching parent management training in a low-income, predominantly African American sample. METHOD Parents seeking treatment for their 2- to 5-year-old children's behavior problems in an urban fee-for-service child mental health clinic were randomized to the Chicago Parent Program (CPP; n = 81) or Parent-Child Interaction Therapy (PCIT; n = 80). Consent followed clinic intake and diagnostic assessment and parent management training was delivered by clinicians employed at the clinic. Primary outcome measures were externalizing child behavior problems, assessed at baseline and postintervention follow-up, using the Child Behavior Checklist (CBCL) and average per-participant treatment cost. RESULTS Data from 158 parents were analyzed. Most were mothers (75.9%), African American (70.3%), and economically disadvantaged (98.7% Medicaid insured). Of children, 58.2% were boys, and mean age was 3.6 years (SD 1.03). Based on CBCL scores, behavior problems improved in the 2 conditions (Cohen d = 0.57 for CPP and 0.50 for PCIT). CPP was not inferior to PCIT (90% CI -1.58 to 4.22) at follow-up, even after controlling for differences in treatment length (90% CI -1.63 to 4.87). Average per-participant treatment cost was higher for PCIT (mean $2,151) than for CPP (mean $1,413, 95% CI -1,304 to -170). CONCLUSION For parents of young children living in urban poverty, CPP is not inferior to PCIT for decreasing child behavior problems. CPP requires less time to complete and costs a third less than PCIT. CLINICAL TRIAL REGISTRATION INFORMATION Early Parenting Intervention Comparison (EPIC); https://clinicaltrials.gov/; NCT01517867.
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Affiliation(s)
| | | | | | - Mirian E Ofonedu
- Kennedy-Krieger Institute; Maryland Center for Developmental Disabilities, Windsor Mill
| | | | | | - Eric Slade
- Johns Hopkins School of Nursing, Baltimore, MD; University of Maryland School of Medicine, Baltimore; US Department of Veteran Affairs VISN5 MIRECC, Baltimore
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Jimenez‐Gomez C, McGarry K, Crochet E, Chong IM. Training behavioral technicians to implement naturalistic behavioral interventions using behavioral skills training. BEHAVIORAL INTERVENTIONS 2019. [DOI: 10.1002/bin.1666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Corina Jimenez‐Gomez
- The Scott Center for Autism TreatmentFlorida Institute of Technology Melbourne Florida USA
| | - Kacie McGarry
- The Scott Center for Autism TreatmentFlorida Institute of Technology Melbourne Florida USA
| | - Emily Crochet
- The Scott Center for Autism TreatmentFlorida Institute of Technology Melbourne Florida USA
| | - Ivy M. Chong
- The Scott Center for Autism TreatmentFlorida Institute of Technology Melbourne Florida USA
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Abstract
OBJECTIVE Sleep problems are common and associated with externalizing behavior problems in young children, particularly among young children with developmental delay (DD). The aims of the current study, which was a secondary data analysis of 2 previously conducted randomized controlled trials, were to assess whether parent-child interaction therapy (PCIT) led to decreases in child sleep problems and whether initial sleep problems moderated the effect of PCIT on child behavior. METHODS The study participants were 44 children (M = 49.19 months, SD = 13.1) with DD or borderline DD and with co-occurring clinically significant levels of externalizing behavior problems and their mothers (M = 35.9 years, SD = 7.3). These participants were randomly assigned to either an immediate treatment group or a waitlist control group. RESULTS Findings revealed a significant direct effect of PCIT on decreases in sleep problems. Additionally, moderation analyses revealed that lower levels of child sleep problems at pretreatment were associated with greater improvements in observed child compliance compared with higher levels of child sleep problems at pretreatment. CONCLUSION This study extends previous findings by providing support for the preliminary efficacy of PCIT in reducing sleep problems in children with DD and borderline DD and highlighting the role of sleep problems as a factor associated with differential treatment effects in behavioral parenting intervention research.
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Shafi RMA, Bieber ED, Shekunov J, Croarkin PE, Romanowicz M. Evidence Based Dyadic Therapies for 0- to 5-Year-Old Children With Emotional and Behavioral Difficulties. Front Psychiatry 2019; 10:677. [PMID: 31620029 PMCID: PMC6759941 DOI: 10.3389/fpsyt.2019.00677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 08/21/2019] [Indexed: 11/13/2022] Open
Abstract
As many as one in four preschool-aged children are estimated to struggle with psychosocial stress and social-emotional issues; yet, interventions are often postponed until older ages when change is actually more difficult. Reasons for this include limited interventions, paucity of FDA approved medications for young children, as well as the dearth of clinicians adequately trained in psychotherapeutic approaches for young children. This commentary outlines indications of the four most commonly used evidence-based dyadic psychotherapies for young children: Child-Parent Psychotherapy (CPP) and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), used primarily for young children with trauma, and Parent-Child Interaction Therapy (PCIT) and Child Parent Relationship Therapy (CPRT), used mostly for children with behavioral issues. Rooted in attachment theory and further supported by the premise that the quality of the child-caregiver dyad is paramount to psychological wellbeing, these therapies focus on strengthening this relationship. Literature indicates that insecure or disorganized early attachments adversely affect an individual's lifelong trajectory. These therapies have demonstrated efficacy leading to positive behavioral changes and improved parent-child interactions. The major challenges of clinical practice focused on young children and their families include proper diagnosis and determining the best therapeutic strategy, especially for families who have not benefited from prior interventions. At this time, it is still unclear which therapy is best indicated for which type of patients and it mostly has been driven by convenience and provider preference or training. Further research is required to tailor treatments more successfully to the child's needs.
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Affiliation(s)
- Reem M A Shafi
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Ewa D Bieber
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Julia Shekunov
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Magdalena Romanowicz
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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