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.
Highlights
Parent-Child Interaction Therapy (PCIT) is an effective parent training approach for a commonly occurring and disabling condition, namely conduct problems in young children
Our aims were to (1) primarily, more comprehensively and understand the barriers encountered by PCIT-trained clinicians in their attempts to implement the therapy after their training; (2) understand the extent to which time-out represents a barrier to implementation of PCIT; and (3) determine whether PCIT was generally acceptable to clinicians who had received training in the approach, and whether this acceptability differed between PCIT-trained clinicians in New Zealand and Australia
In New Zealand, invitations to participate were emailed by an administrator in June 2021 to members of a database of PCIT trainees held by Whāraurau, a Ministry of Health-funded workforce development agency, who are responsible for arranging training in PCIT in New Zealand
Summary
Behavioural difficulties are among the most common reasons children and families seek help from mental health services. Evidence-based treatments for childhood behavioural difficulties are some of the more effective psychological treatments we have available. Res. Public Health 2021, 18, 13116 one-way mirror using an ear-piece for the parent. This study surveyed clinicians who had received training in PCIT in New Zealand and Australia, to understand the reasons why they may not be using it as often as they could. We found that while clinicians generally liked PCIT and saw it as effective, lacking suitable equipment, such as a one-way mirror and ear-piece, was a common barrier to their use of PCIT. Exploring how to better implement an existing evidence-based treatment for childhood conduct problems will make PCIT, and other similar treatments, more available to families in New Zealand
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