Parent-Child Interaction Therapy Research Articles

The added value of virtual reality to parent–child interaction therapy: a qualitative study with parents and therapists

BackgroundVirtual reality (VR) is one of the most rapidly growing technological advancements being studied, developed, and implemented in mental health care. It offers a wide array of possibilities that go beyond the traditional ways of providing mental health care services. Many interventions require clients to learn new skills in order for change to occur. Relevant to this study, behavioral parent-training (BPT) interventions are focused on the acquisition of parenting skills in order to change child behavior. VR was added to the Parent–Child Interaction Therapy (PCIT) – a known BPT intervention — as an additional practice tool. In the present study, which is part of a larger study, the qualitative experiences of (PCIT-)VR from both parents’ and therapists’ perspectives are evaluated, as well as their suggestions for implementation.MethodSemi-structured interviews were conducted with eleven parents. Five therapists participated in a focus group and three additional semi-structured interviews were conducted with therapists. To analyze, a combination of deductive and inductive thematic analysis was used.ResultsResponses from interviews were divided into three categories: (1) parents’ evaluation, (2) therapists’ evaluation, and (3) suggestions for implementation from both parents and therapists. Next to a positive overall experience with PCIT, a large number of parents were also positive about the addition of VR to treatment. Both parents and therapists experienced VR as a useful additional practice tool. The additional practice in VR led to a boost in confidence in using positive parenting skills. There were mixed experiences regarding the ease and immersion of the tool. Suggestions for implementation from both parents and therapists were to make the tool more appealing and realistic, to vary more in VR modules and to improve certain practical aspects.ConclusionAdding VR to PCIT is still a pioneering piece of technology within PCIT. The value of this VR tool lies in the provision of the possibility to practice with skills outside of the therapeutic encounter, which has the potential to instill confidence in using those skills. Given the positive experiences regarding PCIT-VR, it is important to further develop the VR tool. We believe that ultimately, PCIT-VR can potentially serve as a customized way for parents to practice what they are taught during the treatment.

Treatment Engagement and Outcomes in Parent–Child Interaction Therapy with Mothers with a History of ADHD: A Case Series

Behavioral parent training is the recommended intervention for young children with disruptive behavior and/or attention-deficit/hyperactivity disorder (ADHD). Parent–child interaction therapy (PCIT) is an empirically supported behavioral parent-training program for families of children ages 3–6 years old. Behavioral parent-training programs, including PCIT, rely on parents as the primary agents of therapeutic change. Parents who face barriers to adequate engagement with these programs may also struggle to implement the changes necessary for children’s behavior to improve. Parental characteristics that may prevent treatment engagement, however, are seldom considered in the research literature or in clinical practice. The current case series describes engagement indicators in three mothers taking part in PCIT. Each mother has a history of diagnosed or suspected ADHD, and this series explores their ADHD-related symptoms as they relate to the treatment of their child’s behavior.

A naturalistic evaluation of parent-child interaction therapy (PCIT) and PCIT with trauma-directed interaction (PCIT with TDI) in Australian children exposed to abuse and neglect

BackgroundTo optimize PCIT treatment with children exposed to abuse and neglect, PCIT with Trauma-Directed Interaction (PCIT with TDI) was created. ObjectiveThe current study was a quasi-experimental cohort study (PCIT and PCIT with TDI treatment groups) with pre/post-treatment comparisons. The study was conducted in a statutory child protection agency and was a naturalistic evaluation of the outcomes achieved by this service. The outcomes under investigation included caregiver and child posttraumatic stress symptoms, child behavior problems, parenting stress, caregiver mental health, child protection notifications, and placement permanency goals. Participants and settingChildren were included in the study if they were aged between 2 and 7 years, had behavioral difficulties or trauma symptoms and/or their caregivers were experiencing parenting stress. MethodsFamilies were allocated to treatment group by clinician availability/preference (i.e., preference allocation). Caregivers were asked to report on child posttraumatic symptoms and behavioral issues; and to self-report on posttraumatic stress, general stress, parenting stress, and depression and anxiety at prescribed points in treatment. FindingsSixty-eight children and their caregivers were treated with either PCIT (n = 22) or PCIT with TDI (n = 46). Statistically significant changes were observed for both treatment conditions for some of the outcomes of interest for both children (i.e., child behavioral problems, posttraumatic stress) and their caregivers (i.e., general stress, posttraumatic stress). There was no significant main effect of treatment on any of the outcomes of interest. ConclusionFuture research should include a randomized controlled trial to adequately determine the efficacy of PCIT versus PCIT with TDI with this population.

Family engagement in a behavioral parenting intervention: A randomized comparison of telehealth versus office-based treatment formats.

Despite effective treatment options, many families-especially those from marginalized backgrounds-lack access to quality care for their children's behavioral difficulties. Since the COVID-19 pandemic, telehealth has become a prominent format for the delivery of outpatient services, with potential to increase access to quality care. Although telehealth-delivered parenting interventions are associated with positive clinical outcomes, limited research has examined whether telehealth formats improve treatment engagement relative to office-based care. The present study is the first controlled comparison of engagement across office-based parent-child interaction therapy (PCIT) and internet-delivered PCIT (iPCIT). Children ages 3-5 years, and their caregiver(s) (N = 40) participated in a randomized trial comparing iPCIT to office-based PCIT in the treatment of behavioral problems. Analyses examined the effects of treatment format on engagement (i.e., missed sessions, premature treatment discontinuation, homework completion, therapeutic alliance, and treatment satisfaction). Logistic and linear regressions further explored whether treatment format moderated the effects of common predictors of treatment engagement (i.e., family economic means, racial/ethnic background, caregiver stress). iPCIT improved attendance rates relative to office-based PCIT, especially for families from minoritized racial/ethnic backgrounds. At the same time, among families with relatively higher levels of caregiver stress, office-based PCIT was associated with lower dropout rates and improved treatment alliance and satisfaction, relative to iPCIT. This study provides the first experimental support that telehealth formats can improve treatment attendance in behavioral parenting interventions. Findings highlight nuances in treatment engagement across treatment formats that reveal limits to the extent telehealth transcends engagement concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Caregiver Distress and Child Behavior Problems in Children with Developmental Delay from Predominantly Minoritized Backgrounds

ABSTRACT Importance Child behavior problems have been shown to contribute to caregiver distress and vice versa among youth with developmental delay (DD). However, studies have not examined these associations among children and caregivers from underrepresented ethnic/racial backgrounds. Furthermore, research has not explored how associations function differently following internet-delivered treatment or based on the level of acculturation and enculturation. Objective We examined bidirectional associations between caregiver distress (i.e. symptoms of depression, anxiety, and stress) and externalizing and internalizing behavior problems in 3- to 5-year-old children with DD from underrepresented ethnic/racial backgrounds. We also examined the impact of internet-delivered Parent–Child Interaction Therapy (iPCIT) and the moderating role of acculturation and enculturation on these bidirectional associations. Method Children aging out of early intervention services (n = 150) and their primary caregiver were randomized to receive iPCIT or referrals as usual (RAU) in the community. Results Findings provide support for bidirectional associations between child internalizing behavior problems and caregiver depressive symptoms, although there were fewer significant associations among families randomized to iPCIT compared to RAU. Weaker associations were observed among families with higher levels of enculturation, whereas stronger associations were observed among families with higher levels of acculturation. Conclusions Results highlight a sensitive period from age 3.5 to 4 years old for bidirectional associations between caregiver distress and child behavior problems and highlight the importance of addressing family cultural values during treatment. Findings also suggest the utility of internet-delivered behavioral parenting interventions in weakening the effect of child behavior problems on caregiver distress and vice versa.

The Efficacy of Parent-Child Interaction Therapy (PCIT) for Youth with Attention-Deficit/Hyperactivity Disorder (ADHD): A Meta-Analysis.

Attention-deficit/hyperactivity disorder (ADHD) is highly prevalent in early childhood and has long-term negative effects when left untreated. Parent-Child Interaction Therapy (PCIT) is an early intervention for children aged 2- to-7-years that has extensive evidence for treating child externalizing problems by teaching parents effective strategies to manage child behavior. However, the effect of PCIT for families with children diagnosed with ADHD is not completely understood. This meta-analysis aims to synthesize research on the use of PCIT for children with ADHD. Nine out of 711 identified studies were analyzed. Summary effect sizes were calculated using the standardized mean gain for child ADHD symptoms, child behaviors, parent stress, and parenting behaviors, and the Fail-Safe N was calculated to determine the robustness of the results. Overall, PCIT had a significant beneficial effect on child ADHD symptoms (g = 0.90), child behavior (g = 0.44), parent stress (g = 0.82), and parenting behaviors (g = 2.15). Results of this meta-analysis suggest that PCIT is an effective treatment for reducing core symptoms of ADHD.

Long-term effects of parent-child interaction therapy: A mixed-methods follow-up study of three and nine years later

Parent management training (PMT) programs are commonly used for treatment of child disruptive behaviour at a young age. Intervening early and involving parents in the interventions is used to limit adverse outcomes later in life. Yet, there is a dearth of literature that regard the long-term effects of such interventions. Therefore, the current study aimed to uncover, the long-term effects are of the PMT-program Parent-Child Interaction Therapy (PCIT) from the perspective of parents. A mixed-method approach was used in order to find out how parents reflected back on the treatment and to find out how parents and their children were doing. Nineteen semi-structured interviews were conducted at three and nine years follow-up, and two questionnaires regarding child disruptive behaviour and parenting stress were filled out pre-, and post-treatment and at six-months, three years and nine years follow-up. Results showed that generally, parents were satisfied with PCIT. They were positive about the decrease in their child’s disruptive behaviour and their own parenting stress, the lasting effects of learning parenting skills, and bettered inter-family relationships. Parents also expressed dissatisfaction with the treatment. They were unsure about the suitability of PCIT for all children, disagreement with the time-out procedure was mentioned and parents lacked long-term contentment with learnt parenting skills. Quantitatively, an overall decrease in clinical reports of child disruptive behaviour and parenting stress was seen, although there was a peak of clinical reports at three years follow up. The current study is a steppingstone for uncovering parents’ thoughts on PCIT retrospectively. It contributes to the knowledge about the long-term effects of intervening early for disruptive behaviour in the Netherlands. The overall consensus on PCIT is positive, although most parents state to need further guidance a few years later. Future research is warranted to further uncover long-term effects of PCIT from the perspective of parents with a larger population.

Efficacy of parent-child interaction therapy for children born premature.

Premature children are known to be at a high risk of developing behavioral problems. This study examined the effectiveness of parent-child interaction therapy (PCIT) in reducing behavioral problems in young children born premature. The study included 18 child-parent pairs with children born at less than 35 weeks of gestation (range: 23-34 weeks, median: 31.0 weeks) and aged 27-52 months (median: 38.0 months). They were assigned to either the PCIT group (n = 7) or the non-PCIT group (n = 11) based on maternal desire for treatment. The study was designed to examine the effects of PCIT. Specifically, the Eyberg Child Behavior Inventory (ECBI) intensity score, ECBI problem score, and Parenting Stress Index Short Form (PSI-SF) scores were compared before treatment and after 6 months. In the PCIT group, the mean ECBI intensity score was 135.7 (SD = 13.5; T-score = 64) at baseline and 90.1 (SD = 15.5; T-score = 46) at post-assessment, the mean ECBI problem score was 9.8 (SD = 1.9; T-score = 54) at baseline and 4.4 (SD = 3.1; T-score = 44) at post-assessment, the mean PSI-SF total score was 60.1 (SD = 4.8; 95%tile) at baseline and 49.6 (SD = 5.6; 85%tile) at post-assessment, showing a significant improvement (ECBI intensity scores: p < 0.001, d = 2.03; ECBI problem scores: p < 0.001, d = 1.94; PSI-SF total scores: p = 0.004, d = 0.86). On the other hand, none of the scores showed significant change in the non-PCIT group. The PCIT can be considered as a potential treatment option for behavioral problems in young children born premature.

Effectiveness of Parent-Child Interaction Therapy for Maltreated Families: A Meta-Analysis of Randomized Controlled Trials.

This meta-analysis evaluated the effectiveness of Parent-Child Interaction Therapy (PCIT) for maltreated families and examined potential moderators associated with the intervention. Seven English electronic databases (PubMed, PsycINFO, Web of Science, MEDLINE, Scopus, Cochrane Library, and ProQuest Dissertations and Theses Global) were systematically searched to identify randomized controlled trials (RCTs) published before January 20, 2023. Eleven studies involving 1,069 maltreated or high-risk families were included in the meta-analysis. Our results showed that PCIT significantly reduced child externalizing behaviors, improved parenting skills, and decreased parenting stress and child abuse potential in maltreated families. Additionally, families with confirmed maltreatment history reported larger effect sizes across all outcomes than those at high risk of maltreatment; parenting skills outcomes were more effective in adapted PCIT versions, using per-protocol analysis, and American caregivers, whereas none of the outcomes were related to the number of sessions. These findings provide encouraging evidence for the use of PCIT as an intervention for families with a history of maltreatment, although more high-quality RCTs are required to confirm its effects.

A Delphi consensus among experts on assessment and treatment of disruptive mood dysregulation disorder.

The aim of this study was to explore consensus among clinicians and researchers on how to assess and treat Disruptive Mood Dysregulation Disorder (DMDD). The Delphi method was used to organize data collected from an initial sample of 23 child psychiatrists and psychologists. Three rounds of closed/open questions were needed to achieve the objective. Fifteen experts in the field completed the whole study. Finally, 122 proposals were validated and 5 were rejected. Globally, consensus was more easily reached on items regarding assessment than on those regarding treatment. Specifically, experts agreed that intensity, frequency, and impact of DMDD symptoms needed to be measured across settings, including with parents, siblings, peers, and teachers. While a low level of consensus emerged regarding optimal pharmacological treatment, the use of psychoeducation, behavior-focused therapies (e.g., dialectical behavior therapy, chain analysis, exposure, relaxation), and systemic approaches (parent management training, family therapy, parent-child interaction therapy) met with a high degree of consensus. This study presents recommendations that reached a certain degree of consensus among researchers and clinicians regarding the assessment and treatment of youths with DMDD. These findings may be useful to clinicians working with this population and to researchers since they also highlight non-consensual areas that need to be further investigated.

Parent-Child Interaction Therapy for Muslim-American Parents and Young Children

There are limited data available regarding early childhood mental health in the Muslim American population. Nevertheless, the literature has shown that American Muslims are more likely to experience mental health disorders, including being twice as likely to report a history of suicide attempt1 compared to other religious communities.2 Despite these challenges, Muslims in America are often underserved and tend to underutilize mental health services, compared to other minority groups.2-5 The combination of Muslim children with significant mental health challenges and caregivers who underutilize mental health services reduces the likelihood that effective treatments will be used and increases risk of long-term harm for Muslim American children. Research has shown that Muslim American populations may be hesitant in seeking mental health treatment for a variety of reasons, including associated stigma behind mental illness within the community, fears related to past experiences of racism and discrimination in a post-9/11 world, differing way of conceptualizing mental illness and psychological distress that may lead to seeking alternative supports within family and community instead of mental health providers, and lack of knowledge about how to access formal mental health services.6,7 Another plausible reason for the underutilization of mental health services in this population is the concern that mental health treatment may not align with religious or cultural values.3

Pilot evaluation of the Fiscal Mapping Process for sustainable financing of evidence-based youth mental health treatments: A comparative case study analysis.

Sustained delivery of evidence-based treatments (EBTs) is essential to addressing the public health impacts of youth mental health problems, but is complicated by the limited and fragmented funding available to youth mental health service agencies. Supports are needed that can guide service agencies in accessing sustainable funding for EBTs. We conducted a pilot evaluation of the Fiscal Mapping Process, an Excel-based strategic planning tool that helps service agency leaders identify and coordinate financing strategies for their EBT programs. Pilot testing of the Fiscal Mapping Process was completed with 10 youth mental health service agencies over a 12-month period, using trauma-focused cognitive-behavioral therapy or parent-child interaction therapy programs. Service agency representatives received initial training and monthly coaching in using the tool. We used case study methods to synthesize all available data (surveys, focus groups, coaching notes, document review) and contrast agency experiences to identify key findings through explanation building. Key evaluation findings related to the process and outcomes of using the Fiscal Mapping Process, as well as contextual influences. Process evaluation findings helped clarify the primary use case for the tool and identified the importance-and challenges-of engaging external collaborators. Outcome evaluation findings documented the impacts of the Fiscal Mapping Process on agency-reported sustainment capacities (strategic planning, funding stability), which fully explained reported improvements in outcomes (extent and likelihood)-although these impacts were incremental. Findings on contextual factors documented the influence of environmental and organizational capacities on engagement with the tool and concerns about equitable impacts, but also the view that the process could usefully generalize to other EBTs. Our pilot evaluation of the Fiscal Mapping Process was promising. In future work, we plan to integrate the tool into EBT implementation initiatives and test its impact on long-term sustainment outcomes across various EBTs, while increasing attention to equity considerations.

Ebeveyn-Çocuk Etkileşim Terapisi

Parent-child interaction therapy is a parent-mediated therapy approach that focuses on solving internalization-externalization problems observed in children aged 2-7. The approach based on parenting styles, attachment theory, behavioral theory, and social learning theories aims to teach play therapy skills to parents. In this direction, each stage was organized as teaching and coaching sessions in an approach that included two phases: a child-directed interaction phase and parent-directed interaction. The first stage, which is the child-directed stage, it is aimed to developing a sincere and warm relationship between the parent and the child by following the child's lead.. In the second phase, the parent-directed interaction phase, effective discipline methods are taught to parents and coached at the point of use, depending on the goal of increasing their child's adaptation skills. Therapy is not time-limited and is performance-oriented. In this study, the general characteristics of parent-child interaction therapy, its historical development, theoretical foundations, the structure of therapy sessions, the intervention process, and parent-child interaction therapy research are included. As a result of the review, depending on the international literature, can be said to be parent-child interaction therapy is an early-term, parent-oriented and evidence-based approach that is effective on early childhood compliance and behavior problems, including children with neurodevelopmental problems, parenting stress, parental efficacy perception, and family harmony.

PCIT: How to help the parent interact with their child

The biggest fear of parents when referred to Parent‐Child Interaction Therapy (PCIT) is that the therapists will validate that the parent isn't good at parenting, so if the parent ever thinks the therapist is judging or blaming him or her, the therapy won't go well, said Melanie M. Nelson, Ph.D., presenting this topic at the AACAP last fall. “How would if feel if you were told you should go to parent training?” she said. “The message is that you need to go to remedial classes. So, we emphasize that we are working on specialized parenting, or therapeutic parenting.”

Internet‐delivered Parent–Child Interaction Therapy increases positive parenting behaviors that maintain over time

AbstractYoung children's display of emotional and behavioral difficulties is relatively commonplace. However, if left unaddressed, these challenging behaviors have potential to develop into more serious problems. Furthermore, parents often report feeling unprepared to prevent and address their young children's emotional and behavioral difficulties. Fortunately, behavioral parent training strategies, such as Parent–Child Interaction Therapy, have been found to be effective for helping parents learn to effectively improve young children's behavior. Although effective, there are barriers to accessing behavioral parent training, such as cost, lack of transportation, and living in rural areas with limited mental and behavioral health care. Therefore, the purpose of this pilot study was to evaluate the effects of internet‐delivered PCIT (iPCIT) on parents' use of praise, reflections, imitations, descriptions, and enjoyment/enthusiasm (PRIDE skills) with children referred for disruptive behavior. Participants in this study included three parents and their 2‐year‐old children. We used a concurrent multiple probe across participants' design to test the effects of iPCIT on parents' use of PRIDE skills and maintenance of treatment effects. Results indicated that all three parents increased their use of PRIDE skills and maintained them following termination of treatment. Results, implications, and future directions are discussed.

Reliability and Validity of the Therapy Attitude Inventory in Caregivers Receiving Internet-Delivered Parent Child Interaction Therapy for Young Children with Developmental Delay

Reliability and Validity of the Therapy Attitude Inventory in Caregivers Receiving Internet-Delivered Parent Child Interaction Therapy for Young Children with Developmental Delay

Enhancing attachment-based aspects of PCIT for young children with a history of maltreatment.

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.

87 Suitability of the I-InTERACT-North Parenting Program for families with autistic children

Objective:I-InTERACT-North is a stepped-care telepsychological parenting intervention designed to promote positive parenting skills and improve child behaviour. Initially developed for children with traumatic brain injury, our pilot study has shown efficacy in increasing positive parenting skills and reducing problem behaviours for children with early brain injury (e.g., stroke, encephalopathy). Recently, the program has expanded to include children with neurodevelopmental disorders, including Autism Spectrum Disorder. Although positive parenting programs (e.g., Parent-Child Interaction Therapy) can be effective for autistic children, it is unknown whether the goals most important to these families can be addressed with IInTERACT-North program. An examination of suitability and preliminary efficacy was conducted.Participants and Methods:Parent participants of autistic children between 3 and 9 years (n= 20) were recruited from the neonatal, neurology, psychiatry, or cardiology clinics at The Hospital for Sick Children and the Province of Ontario Neurodevelopmental Disorders (POND) Network. Top problems, as reported by parents at baseline, were analyzed qualitatively through a cross-case analysis procedure in order to identify common themes and facilitate generalizations surrounding concerning behaviours. Parent-reported intensity of their children’s top problem behaviours on a scale from 1 (“not a problem”) to 8 (“huge problem”) were quantified. To explore preliminary program efficacy, t-tests were used to compare pre- and post-intervention problems and intensity on the Eyberg Child Behavior Inventory (ECBI) (n=16).Results:A total of 56 top problem data units were examined, with convergent thematic coding on 53 of 56 (94.6% inter-coder reliability). Four prevalent, high-agreement themes were retained: emotion dysregulation (19; 33.9%), non-compliance (12; 21.4%), sibling conflict (7; 12.5%), and inattention and hyperactivity (7; 12.5%). Average problem intensity for these themes ranged from 5.85 to 6.53 (where 8 is greatest impairment) with emotion dysregulation having the highest intensity (6.53) compared to the others. Scores on the ECBI were lower post-intervention (Intensity scale: M= 59.06, SD= 8.1; Problem scale: M= 60.69, SD= 11.5) compared to pre-intervention (Intensity scale: M= 61.19, SD= 10.4; Problem scale: M= 64.31, SD= 11.7), but small sample size precluded detecting statistical significance (p’s = .16 and .07, respectively).Conclusions:Thematic analysis of top problems identified by parents of autistic children suggested that concerns were transdiagnostic in nature, and represent common treatment targets of the I-InTERACTNorth program. Though challenging behaviours related to restricted interests or repetitive behaviours may exist in our sample, parental behavioural goals appeared to align with the types of concerns traditionally raised by participants of the program, supporting a transdiagnostic approach. Preliminary data point to positive treatment outcomes in these families.

Improving Behavioural and Social Skills in Children with Down Syndrome through Parent-Child Interaction Therapy: Effects on Parenting Skills and Stress in Caregivers

This study aimed to shed light on the available intervention tools for children with Down syndrome and their caregivers. Based on evidence gathered from past research, four hypotheses were formed which were tested by four different standardized tests along with Dyadic Parent-Interaction Coding System (DPICS). The research is based on a randomized experimental design checking the pre-post efficacy of the treatment. Out of all of the hypotheses, two showed statistical significance, which showed the impact of Parent-Child Interaction Therapy (PCIT) on the disruptive behaviour of children with Down syndrome and the caregiver skills of their parents. However, it showed statistical significance in the subscales of autonomy and empathy in the social skills of Down syndrome and showed no statistical significance on parental stress.

An 18-week model of Parent-Child Interaction Therapy: clinical approaches, treatment formats, and predictors of success for predominantly minoritized families.

Disruptive behavior disorders are among the most prevalent pediatric mental health referrals for young children. However, families from historically minoritized social identities have experienced disparities in treatment access, retention, and outcomes. Evidence-based interventions such as Parent-Child Interaction Therapy (PCIT) have been found to be effective in reducing children's disruptive behaviors in minoritized families. However, variable treatment length as a result of skill-based graduation criteria (e.g., observed caregiver verbalizations) may slow and/or hinder treatment progress, particularly for families where expected treatment verbalizations are less linguistically relative (e.g., no exact English to Spanish translations) and/or culturally familiar. Time-limited PCIT has been proposed as a strategy for promoting equity in treatment completion and outcomes amongst minoritized families, because treatment progression and/ or completion is not contingent upon caregiver linguistic skill demonstration. The current study evaluated the overall effectiveness of an 18-week model of PCIT and examined predictors of retention and treatment outcomes. Participants (N = 488 dyads) included predominantly racially, ethnically, linguistically, and socioeconomically diverse children aged two to eight years, and their caregivers. Overall findings indicate that the 18-week PCIT model is an effective intervention for reducing children's externalizing and internalizing behaviors and improving caregiver parenting skills for most treatment completers. Despite advances in treatment completion, some caregiver social identities and PCIT treatment characteristics were predictive of lower completion rates and/or less optimal treatment outcomes. Overall, this study provides strong support for widely disseminating use of the 18-week model of PCIT for most families served. Clinical implications and considerations for continued treatment inequity are discussed.