Home-Based vs. Clinic-Based Parent–Child Interaction Therapy: Comparative Effectiveness in the Context of Dissemination and Implementation

Abstract

Disruptive child behavior disorders remain a major public health issue despite the proliferation of several strong Evidence-Based Practices (EBPs) for these children and their families. This may stem from barriers to treatment facing many families in need, particularly families with low resources. Home-based treatment may be best suited for this population; however, EBPs are not always available or tested as home-based interventions. The current study compares an intensive home-based adaptation of Parent Child Interaction Therapy (PCIT) to the standard clinic-based model in the context of a statewide implementation. As part of the statewide implementation, therapists entered archival data into an online system. Data was gathered for 314 families receiving PCIT, with 181 children in clinic-based PCIT and 133 in intensive home-based PCIT. Consistent with other trials of PCIT, results of the current study indicate that both versions of the therapy were effective in reducing child-behavior problems and increasing parenting skills; however, there were marked differences in attrition. Intensive home-based participants were twice as likely to complete treatment (64.66%) compared to clinic-based participants (33.15%) despite facing more adversity. These results underscore the importance of scientifically-sound adaptations of EBPs, as well as the role of comparative effectiveness studies as a critical tool in the integrative model of intervention science.