1
|
Peskin A, Barth A, Mansoor E, Farias A, Rothenberg WA, Garcia D, Jent J. Impact of parent child interaction therapy on child eating behaviors. Appetite 2024; 200:107544. [PMID: 38850640 DOI: 10.1016/j.appet.2024.107544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/08/2024] [Accepted: 06/04/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Picky eating commonly co-occurs with disruptive behaviors in young children. While feeding interventions exist, it remains unknown whether unmodified behavioral parent training (BPT) improves maladaptive child eating. As coercive feeding practices may exacerbate picky eating, BPT could ameliorate associated behaviors by increasing authoritative parenting. METHODS Caregiver-child dyads (N = 194, ages 2-8) received 18 weeks of Parent-Child Interaction Therapy (PCIT). Caregivers completed the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) at pre-, mid-, and post-treatment. The BPFAS overall picky eating frequency and number of problems was examined, as well as the subscale of mealtime misbehaviors, and overall caregiver feeding practices. RESULTS From pre-to post-treatment, reductions occurred in frequency/problems scales across overall BPFAS child behaviors. Mealtime misbehaviors significantly declined at all checkpoints - early skill acquisition may drive this early change, whereas changes in frequency/problem scales occurred after mid-treatment, suggesting later skill acquisition may be driving these changes. On the coercive caregiver feeding subscale, multivariate regression identified a significant race by time interaction (p = .02) - multiracial caregivers improved while others showed no difference. CONCLUSION Standard PCIT, not adapted for feeding concerns, decreased maladaptive child eating behaviors across all caregivers and coercive feeding practices in multiracial caregivers. Authoritative parenting principles may generalize to eating contexts for certain cultural groups. PCIT shows promise as an early upstream intervention potentially changing trajectories without needed feeding content modifications. Assessment of long-term maintenance is warranted. Coupling with nutrition education could optimize impact.
Collapse
Affiliation(s)
- Abigail Peskin
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1601 NW 12th Ave, Miami, FL, 33136, USA.
| | - Alex Barth
- University of California San Diego, USA.
| | - Elana Mansoor
- University of Miami Miller School of Medicine, Mailman Center for Child Development, USA.
| | - Alina Farias
- University of Miami Miller School of Medicine, Mailman Center for Child Development, USA.
| | - W Andrew Rothenberg
- University of Miami Miller School of Medicine, Mailman Center for Child Development, USA.
| | - Dainelys Garcia
- University of Miami Miller School of Medicine, Mailman Center for Child Development, USA.
| | - Jason Jent
- University of Miami Miller School of Medicine, Mailman Center for Child Development, USA.
| |
Collapse
|
2
|
Hennefield L, Gilbert K, Donohue MR, Tillman R, McCoy A, Diggs G, Paul ZA, Kohl PL, Luby JL. Early Emotion Development Intervention Improves Mental Health Outcomes in Low-Income, High-Risk Community Children. Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01639-1. [PMID: 38221601 PMCID: PMC11246493 DOI: 10.1007/s10578-023-01639-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 01/16/2024]
Abstract
Children living in poverty and facing related forms of adversity are at higher risk for experiencing concurrent and later psychopathology. Although negative psychological outcomes can be improved by enhancing sensitive and responsive caregiving early in development, interventions targeting the caregiver-child dyad are not readily accessible. The present study investigated the feasibility and effectiveness of delivering a shortened eight-session form of Parent-Child Interaction Therapy-Emotion Development (PCIT-ED) in-person or remotely as an early intervention for 3-6-year-old children (N = 62) at elevated risk for psychopathology who were growing up in low-income communities. Caregiver-child dyads were randomized to eight-sessions of PCIT-ED or online parenting education. Relative to parenting education, children receiving PCIT-ED exhibited lower externalizing symptoms and functional impairment and more positive peer relationships following the intervention. Findings support the effectiveness of this shortened form of PCIT-ED, delivered in-person or remotely, as an early intervention to improve symptoms of psychopathology and functioning in high-risk children living in poverty.Trial registration Clinicaltrials.gov; NCT04399629.
Collapse
Affiliation(s)
- Laura Hennefield
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA.
- Department of Psychiatry, Washington University School of Medicine, 4444 Forest Park, Suite 2100, Saint Louis, MO, USA.
| | - Kirsten Gilbert
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Meghan Rose Donohue
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Rebecca Tillman
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Art McCoy
- Saint Louis University, The Jennings School District, Jennings, MO, USA
| | - Gwendolyn Diggs
- Head Start/Early Head Start at the Urban League of Metropolitan, Saint Louis, MO, USA
| | - Zori A Paul
- Department of Counselor Education and Counseling Psychology, College of Education, Marquette University, Milwaukee, WI, USA
| | - Patricia L Kohl
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
- The Brown School of Social Work, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| |
Collapse
|
3
|
Jent JF, Rothenberg WA, Peskin A, Acosta J, Weinstein A, Concepcion R, Dale C, Bonatakis J, Sobalvarro C, Chavez F, Hernandez N, Davis E, Garcia D. An 18-week model of Parent-Child Interaction Therapy: clinical approaches, treatment formats, and predictors of success for predominantly minoritized families. Front Psychol 2023; 14:1233683. [PMID: 37915519 PMCID: PMC10616824 DOI: 10.3389/fpsyg.2023.1233683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/01/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction 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. Methods 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. Results 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. Discussion 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.
Collapse
Affiliation(s)
- Jason F. Jent
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - William A. Rothenberg
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
- Center for Child and Family Policy, Duke University, Durham, NC, United States
| | - Abigail Peskin
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Juliana Acosta
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Allison Weinstein
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Raquel Concepcion
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Chelsea Dale
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
- Department of Psychology, Florida International University, Miami, FL, United States
| | - Jessica Bonatakis
- Department of Psychiatry and Behavioral Health, The Pennsylvania State University, University Park, PA, United States
| | - Cindy Sobalvarro
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Felipa Chavez
- School of Psychology, Florida Institute of Technology, Melbourne, FL, United States
| | - Noelia Hernandez
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Eileen Davis
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Dainelys Garcia
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| |
Collapse
|
4
|
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
| | | | | | | |
Collapse
|
5
|
Barnett ML, Salem H, Rosas YG, Feinberg E, Nunez-Pepen R, Chu A, Belmont-Ryu H, Matsuno E, Broder-Fingert S. Adapting Community Health Worker Care Models to Advance Mental Health Services Among LGBTQ Youth. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:658-672. [PMID: 37071315 PMCID: PMC10258167 DOI: 10.1007/s10488-023-01268-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/19/2023]
Abstract
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth of color experience high rates of mental health disorders, yet they experience challenges to accessing mental health services. Community health worker (CHW) models of care have potential to promote equitable mental health services among LGBTQ youth. Our aim was to understand how CHW models could be adapted to better support LGBTQ youth of color in accessing mental health services. Semi-structured qualitative interviews were conducted with LGBTQ youth of color (n = 16), caregivers of LGBTQ youth (n = 11), and CHWs (n = 15) in Massachusetts and California. Interviews were coded by 8 members of the research team. A Rapid Qualitative Analysis was conducted to identify themes. Caregivers, youth, and CHWs all endorsed the value of CHW models for this population. They also almost universally suggested multiple adaptations are needed for the model to be effective. Four main categories of themes emerged related to intervention adaptations: (1) Why adaptations are needed for LGBTQ youth, (2) Who should serve as CHWs providing care, (3) How CHWs should be trained, and (4) What content needs to be included in the intervention. Broadly, findings suggest the relevance of having CHW models for LGBTQ youth of color to address stigma and discrimination experienced, access to culturally and linguistically relevant services, and the need for caregiver support of LGBTQ youth. CHWs need increased training in these areas.
Collapse
Affiliation(s)
- Miya L Barnett
- Department of Counseling, Clinical, and School Psychology, Gervitz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA.
| | - Hanan Salem
- Department of Counseling, Clinical, and School Psychology, Gervitz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA
| | - Yessica Green Rosas
- Department of Counseling, Clinical, and School Psychology, Gervitz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA
| | - Emily Feinberg
- Boston University School of Medicine, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
| | | | | | - Hana Belmont-Ryu
- Department of Counseling, Clinical, and School Psychology, Gervitz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA
| | - Em Matsuno
- Arizona State University, Tempe, AZ, USA
| | | |
Collapse
|
6
|
Barnett ML, Puffer ES, Ng LC, Jaguga F. Effective training practices for non-specialist providers to promote high-quality mental health intervention delivery: A narrative review with four case studies from Kenya, Ethiopia, and the United States. Glob Ment Health (Camb) 2023; 10:e26. [PMID: 37854408 PMCID: PMC10579690 DOI: 10.1017/gmh.2023.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/06/2023] [Accepted: 04/29/2023] [Indexed: 10/20/2023] Open
Abstract
Mental health needs and disparities are widespread and have been exacerbated by the COVID-19 pandemic, with the greatest burden being on marginalized individuals worldwide. The World Health Organization developed the Mental Health Gap Action Programme to address growing global mental health needs by promoting task sharing in the delivery of psychosocial and psychological interventions. However, little is known about the training needed for non-specialists to deliver these interventions with high levels of competence and fidelity. This article provides a brief conceptual overview of the evidence concerning the training of non-specialists carrying out task-sharing psychosocial and psychological interventions while utilizing illustrative case studies from Kenya, Ethiopia, and the United States to highlight findings from the literature. In this article, the authors discuss the importance of tailoring training to the skills and needs of the non-specialist providers and their roles in the delivery of an intervention. This narrative review with four case studies advocates for training that recognizes the expertise that non-specialist providers bring to intervention delivery, including how they promote culturally responsive care within their communities.
Collapse
Affiliation(s)
- Miya L. Barnett
- Department of Counseling, Clinical, and School Psychology, Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Eve S. Puffer
- Department of Psychology and Neuroscience, Global Health Institute, Duke University, Durham, NC, USA
| | - Lauren C. Ng
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Florence Jaguga
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| |
Collapse
|
7
|
Garcia D, Barnett ML, Rothenberg WA, Tonarely NA, Perez C, Espinosa N, Salem H, Alonso B, Juan JS, Peskin A, Davis EM, Davidson B, Weinstein A, Rivera YM, Orbano-Flores LM, Jent JF. A Natural Helper Intervention to Address Disparities in Parent Child-Interaction Therapy: A Randomized Pilot Study. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:343-359. [PMID: 36524764 PMCID: PMC10213097 DOI: 10.1080/15374416.2022.2148255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Parent-child interaction therapy (PCIT) is an effective intervention to address child externalizing behaviors. However, disparities in access and retention are pervasive, which relate to the availability of PCIT in low-income communities, inadequate workforces to provide culturally appropriate care, and distrust in services due to systemic discrimination. This study incorporated natural helpers who had been trained as community health workers into PCIT delivery to improve disparities in engagement and outcomes. METHOD Families from three low-income, predominately Latino/a/x and Black neighborhoods in Miami qualified for services if they had a child aged 2-8 with clinically elevated externalizing behaviors. Families were randomly assigned into either Standard-PCIT group (N = 30 families; 80% boys, 57% Latino/a/x, 27% Black) or a PCIT plus Natural helper (PCIT+NH) group (N = 51 families; 66% boys, 76% Latino/a/x, 18% Black). Families in the PCIT+NH group received home visits and support addressing barriers to care from a natural helper. Path analyses within an intention-to-treat framework examined group-differences in treatment engagement, child behavior, and parenting skills and stress. RESULTS Families in both groups demonstrated large improvements in child externalizing behavior, caregiver stress, and parenting skills from pre-to-post-treatment. Externalizing behavior improved significantly more in the PCIT+NH group compared to the Standard-PCIT group. There were no significant group differences in parenting skills or caregiver stress. Though differences in engagement were not significant, the PCIT+NH group had a small effect on treatment retention. CONCLUSIONS Natural helpers may help to address structural barriers that systematically impact communities of color, apply treatment in naturalistic environments, and promote improved treatment outcomes.
Collapse
Affiliation(s)
- Dainelys Garcia
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Miya L. Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA 93106-9490
| | - W. Andrew Rothenberg
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
- Duke University Center for Child and Family Policy, 302 Towerview Rd, Durham, NC, USA 27708
| | - Niza A. Tonarely
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Camille Perez
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Natalie Espinosa
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Hanan Salem
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Betty Alonso
- ConnectFamilias, 1111 SW 8 Street, Miami, FL, USA 33130
| | | | - Abigail Peskin
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Eileen M. Davis
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Bridget Davidson
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Allison Weinstein
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | | | | | - Jason F. Jent
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| |
Collapse
|
8
|
Andrade BF, Aitken M, Brodkin S, Sawrikar V. Multiple needs and multiple treatments. What's a clinician to do? Update on the psychosocial treatment of disruptive behaviours in childhood. Curr Opin Psychiatry 2022; 35:409-416. [PMID: 36125210 PMCID: PMC9594137 DOI: 10.1097/yco.0000000000000823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
PURPOSE OF REVIEW There are a wide range of psychosocial treatment options, delivered in different modalities, for children with disruptive behaviour. However, clinicians face many challenges in ensuring the empirically supported treatments (ESTs) they select will be effective for their patient. This has prompted studies to generate knowledge on how to improve treatment outcomes for children with disruptive behaviour. This review identifies the major challenges in treatment selection as well as emerging research seeking to improve outcomes. RECENT FINDINGS This review emphasizes the salience of the research-practice gap associated with establishing ESTs using narrow definitions of clinical problems. Recent research is reviewed considering the complex determinants of disruptive behaviours, including parent and family factors that influence outcomes. The review subsequently outlines recent advances in research and clinical practice guidelines aiming to surmount these challenges. Key advances discussed include examining the most impactful components of ESTs, personalizing interventions by targeting core dysfunction underlying behaviour, and addressing parent factors including mental health and cultural relevance to improve outcomes. SUMMARY Thorough assessment of patients' needs, combined with knowledge of treatment response predictors, are recommended to determine the most suitable treatment plan. Recent advances have focused on developing and designing interventions that meet needs in a way that is flexible and tailored.
Collapse
Affiliation(s)
- Brendan F. Andrade
- Margaret and Wallace McCain Centre for Child Youth and Family Mental Health, Centre for Addiction and Mental Health
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health
- Ontario Institute for Studies in Education, University of Toronto, Toronto Canada
| | - Madison Aitken
- Margaret and Wallace McCain Centre for Child Youth and Family Mental Health, Centre for Addiction and Mental Health
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health
| | - Sabrina Brodkin
- Margaret and Wallace McCain Centre for Child Youth and Family Mental Health, Centre for Addiction and Mental Health
- Ontario Institute for Studies in Education, University of Toronto, Toronto Canada
| | - Vilas Sawrikar
- School of Health in Social Science, University of Edinburgh, UK
| |
Collapse
|
9
|
Phillips ST, Mychailyszyn MP. Parent-Child Interaction Therapy for Preschool Aged Youth: A Meta-Analysis of Developmental Specificity. CHILD & YOUTH CARE FORUM 2022. [DOI: 10.1007/s10566-022-09694-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
10
|
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.
Collapse
Affiliation(s)
| | | | | | - Miya L Barnett
- University of California Santa Barbara, Santa Barbara, CA
| |
Collapse
|