Dataset Information

Barriers to Clinician Implementation of Parent-Child Interaction Therapy (PCIT) in New Zealand and Australia: What Role for Time-Out?

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.

SUBMITTER: Woodfield MJ

PROVIDER: S-EPMC8700887 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundParent-Child Interaction Therapy (PCIT) is a parent training intervention for childhood conduct problems, distinctive in its use of live clinician coaching of the parent-child dyad via a one-way mirror and discrete earpiece. However, despite a compelling evidence base, uptake of evidence-based parent training programmes such as PCIT by clinicians in routine care settings remains poor. This systematic review aimed to identify and synthesise implementation interventions that have sought to increase clinician adoption of PCIT in usual care settings.MethodsWe searched MEDLINE (Ovid), Embase (Ovid), PsycInfo (Ovid), CINAHL (EBSCO), Science Citation Index and Social Sciences Citation Index, and Web of Science Core Collection from inception to October 2020. Articles were included if they tested (by way of randomised controlled trials, controlled clinical trials, interrupted time series and controlled before and after trials) implementation interventions across any and all of the patient, clinician, clinic, system or policy domains. Two independent reviewers screened and selected studies, assessed risk of bias and extracted data - summarising implementation intervention components according to items from the Template for Intervention Description and Replication (TIDieR) checklist ( Hoffmann et al., 2014).ResultsOf the 769 articles identified once duplicates were removed, 13 papers relating to three studies met the inclusion criteria - all were quantitative or mixed-methods examinations of the effectiveness of different PCIT clinician training or training-related consultation methods. A narrative description of interventions was provided, as quantitative synthesis was not possible.ConclusionsResearch attention has to date been focussed on the establishment of an evidence-base for PCIT's effectiveness, with relatively little attention to the dissemination, implementation and sustainment of this treatment. Those studies that do exist have focused on training methods and training-related expert consultation. Research attention could usefully turn to both adoption and sustainment of this effective treatment in usual care settings.Plain language summaryIn this review, we aimed to summarise what is already known about how to implement PCIT in community settings after clinicians have received training in the approach. While research relating to the implementation of other parent training programmes is interesting and informative, implementation efforts are most effective when tailored to a specific programme in a specific context. As such, it was important to review published studies relating to PCIT specifically. We identified three relevant studies, one of which is yet to publish its main implementation findings. The three studies have focused on how best to train clinicians in PCIT, including how best to provide post-training support from expert trainers. We concluded that a fruitful line for future research would be to focus on the post-training period, particularly how best to support clinicians to adopt and sustain PCIT in their practice.Systematic review registrationThe study was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 01/10/2020 (CRD42020207118).

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