Awarded Cooperative Agreement to Prevent Violence and Violence-Related Injury
Parent-Child Interaction Therapy (PCIT) is an empirically well-supported behavioral parent training program for reducing aggressive behavior in young children, and for reducing future rates of child physical abuse. Prior randomized trial research conducted by the applicant Center has found that an adapted version of PCIT we developed specifically for violent parents in the child welfare system reduced future child physical abuse recurrence rates from 49% to 19%. Our prior and ongoing studies have found the benefits of PCIT to be durable over time, to generalize across settings and across children in the same family, and we have developed culturally-specific adaptations of PCIT as well as adaptations for older abused children and their abusive parents. A number of blue-ribbon panels have recommended PCIT for scaled-up implementation in child abuse prevention and intervention services systems, but uptake of PCIT has been limited. One reason for this is that traditional PCIT training modes are a poor fit with field settings. PCIT has historically been taught in University-based training programs (graduate programs, internships, etc.) and includes several months of co-therapy mentoring where trainers work directly with trainees in live sessions. Replicating this mentored implementation approach is not feasible in most scaled-up field settings. Over the past six months, our Center has pilot and feasibility tested a system using internet-based telemedicine technology to deliver live, mentored PCIT training. We have piloted Remote Real Time (RRT) training at sites in Utah, Seattle, Alaska, Oregon and within Oklahoma. Feasibility appears excellent, and the approach has been well received. Moreover, RRT implementation revealed misapplications of the model that had gone unaddressed in phone consultation. The proposed research project will make use of planned, funded PCIT start-up implementations at 23 agency sites in Oklahoma and Washington. Using a multilevel interrupted time series randomized design; the proposed study will compare the RRT implementation approach with standard phone consultation (PC). Outcomes will include practitioner fidelity and competency and rates of future child welfare abuse reports. A mediational model is proposed wherein differences in downstream client outcomes are mediated by improved practitioner fidelity and competency. Cost effectiveness and practitioner response to the implementation approach will be examined.