The effectiveness of parent-child interaction therapy in the Netherlands: Preliminary results of a randomized controlled trial.

Objective.– This presentation provides preliminary results from a randomized controlled trial (RCT) examining the effectiveness of Parent-Child Interaction Therapy (PCIT) for Dutch families. Method.– Although data collection is not finished already, fifty families were eligible for treatment in a community mental health setting. Children's mean age was 4.8 years and 33 children were boys (62%). Most of them were randomly assigned to PCIT or Creative Family Therapy (treatment as usual; TAU). The standard, non-time limited PCIT was conducted by the trained therapists. Pre and post-treatment measures included questionnaires (Child Behavior Checklist, Eyberg Child Behavior Inventory) and observations from the Dyadic Parent Child Interaction Coding System. Results.– Pre and post-treatment data of 20 families and six-month follow-up data of 15 families were analyzed. So far, eight families dropped out. Conclusion.– Though preliminary, results of the ongoing RCT will be discussed and will indicate if PCIT is an effective treatment modality for families in the Netherland

Treating Child Disruptive Behavior in High-Risk Families: A Comparative Effectiveness Trial from a Community-Based Implementation

Parent management training programs have proven the most effective way to treat child behavior problems. This study reports on an effectiveness trial of a community-based implementation of Parent–Child Interaction Therapy (PCIT) in comparison with the Dutch-developed Family Creative Therapy (FCT). Forty-five children (58 % boys) aged between 32 and 102 months (M = 67.7, SD = 15.9) were referred for treatment, and they and their parent(s) were randomly assigned to PCIT or FCT. Treatment effectiveness was measured primarily by the degree of improvement on child behavior problems, using the Eyberg Child Behavior Inventory. Secondary outcomes included parent and teacher report data and independent observations of parenting skills and child behavior. During the trial, randomization was violated by treatment crossovers (from FCT to PCIT). Intention-to-treat analyzes revealed no significant differences in the primary outcome at 6-month follow-up, but interpretation was hampered by the crossovers. Subsequent treatment-received analyzes revealed significant interaction effects between time and treatment condition, with greater improvements in child behavior and parenting skills for PCIT families compared to FCT families. Analyzes on families that fully completed the PCIT protocol also showed higher treatment maintenance at follow-up. The treatment-received analyzes indicated promising results for the effectiveness of PCIT in treating young children’s disruptive behavior problems in a high-risk population. However, caution in generalizing the conclusions is needed in view of the design difficulties in this study. Suggestions are made for enhancing treatment delivery in daily practice, and clinical implications are noted

Transporting PCIT around the world

Pathogenic parenting and childhood conduct problems are an international concern; thus, a need exists for evidence-based parenting interventions around the globe. In part because of the large treatment effects associated with parent-child interaction therapy, the model has been transported to many countries outside of the United States (e.g., Australia, Germany, Japan, Korea, Netherlands, New Zealand, Norway). Through its inherent flexibility, PCIT may be an intervention of choice because of its sensitivity and responsiveness to cultural variations in child-rearing that can be readily implemented in international samples. In this chapter, we review the characteristics and results of international effectiveness research on PCIT and provide a case example of the dissemination of PCIT in the Netherlands

Home-based parent–child interaction therapy to prevent child maltreatment: A randomized controlled trial

High treatment attrition and limited reach of mental health services for at-risk families remains an important problem in order to effectively address the global concern of child maltreatment and child disruptive behavior problems. This study evaluated the effectiveness of a home-based and time-limited adaptation of Parent–Child Interaction Therapy (PCIT). Twenty families with children (70% boys) aged between three and seven years were randomly assigned to an immediate treatment group (IT, n = 10) or a waitlist control group (WL, n = 10). After receiving treatment and compared to mothers in the WL group, mothers in the IT group reported fewer child behavior problems and more improved parenting skills. Although initial analyses revealed no significant differences, additional analyses showed a significant decrease in the primary outcome of the study, namely child abuse potential, between the baseline and follow-up assessment for the total treated sample. A low treatment attrition rate (15%) was found, indicating higher accessibility of treatment for families. Findings suggest that the brief home-based PCIT is a potentially effective intervention to prevent child maltreatment and disruptive behavior problems in at-risk families. Results also reinforce the importance of addressing the specific needs of these families to increase treatment effectiveness

Risk factors for attrition from an evidence-based parenting program: Findings from the Netherlands

Parent management training programs for the treatment of childhood conduct problems are increasingly being transported from their country of origin to international settings. Family interactions, however, may be influenced by different cultural expectations and children's mental health problems may be addressed within different systems. Demonstrating reductions in symptoms within the new population is insufficient to support the wide-scale transport of a treatment model. Implementation outcomes such as the rates of treatment retention and factors related to treatment attrition must also be considered. We explored predictors of attrition in families from the Netherlands referred to the evidence-based parenting program Parent–Child Interaction Therapy (PCIT). Participants included 40 children with conduct problems (2–7 years; 68% boys) and their caregivers. Attrition (40%) was somewhat lower than findings with similar community samples in the US. Significant predictors of attrition were child age and maternal levels of internalizing symptoms. Low parental demandingness and high child compliance before start of treatment were related to early attrition within twelve treatment sessions. Meeting the needs of families at risk for attrition is an important goal for parent management training programs within and outside the US if families in need of services are to benefit from them

Psychometric Properties of the Dyadic Parent-Child Interaction Coding System in The Netherlands

The current study explored the psychometric properties of a parent-child interaction observation system, the Dyadic Parent-Child Interaction Coding System (DPICS) in the Netherlands. Participants included 31 Dutch mother-child dyads and 86 U.S. mother-child dyads for a community sample (2–7 years; 50% boys). Good one-week test-retest reliability was demonstrated among the Dutch sample. Similarities were found between Dutch and U.S. samples on most interaction codes, but mothers in the U.S. sample used more directive behaviors (e.g., commands) in some situations. Findings suggest that the DPICS is a reliable measure of mother-child interactions in the Dutch population. Cultural issues regarding the use of the DPICS are discussed

Global dissemination of parent-child interaction therapy: The perspectives of Dutch trainees

Robust evidence of the efficacy of behavioral parent training (BPT) programs for the treatment of childhood conduct problems has led to increasing international dissemination. As BPT programs are transported out of the countries in which they were developed, it is important to consider how barriers to therapist training vary—or do not vary—across countries and cultures in order to determine how the training process may need to be adapted. Using a systematic qualitative approach, we interviewed 75% (18) of all Dutch therapists trained in the BPT program parent-child interaction therapy (PCIT) to explore their perceptions of the PCIT model, training, and acceptability in the Netherlands. Dutch therapists reported numerous positive experiences with PCIT training and the treatment model, but also described significant barriers related to family, therapist, protocol, and agency factors. Therapists’ perceptions of barriers to training and implementation overlapped substantially, though not comprehensively, with a sample of PCIT therapists in the US, suggesting that while PCIT training may be transported from the US to the Netherlands, some barriers exist that are not being addressed in the global dissemination

Implementation of Virtual Reality to Parent-Child Interaction Therapy for Enhancement of Positive Parenting Skills: Study Protocol for Single-Case Experimental Design With Multiple Baselines

Background: Disruptive behavior is a common reason for young children to be referred to mental health care services worldwide. Research indicates that treatments for child disruptive behavior where parents are the primary agents of change are most impactful. Parent-Child Interaction Therapy (PCIT) is an effective parent management training program currently implemented in therapeutic settings within the Netherlands. Ongoing research into improving the effectiveness of PCIT is being done within these settings. To further promote the key elements of PCIT, this study focuses on creating the opportunity for parents to practice positive parenting skills more outside of the clinical setting by adding virtual reality (VR) as an additional homework element. PCIT has shown to make impactful long-term improvements in parental warmth, responsiveness, and the parent-child relationship. Through VR, parents practice the taught parenting skills out loud in the comfort of their own homes in VR scenarios. We expect that VR addition will innovatively increase the effectiveness of PCIT. Objective: This study aimed to evaluate the added value of VR to PCIT by using a multiple baseline single-case experimental design (SCED). We expect to find that PCIT-VR will ameliorate positive parenting skills. By implementing the VR element, we secondarily expected that meeting the skill criteria will be achieved sooner, treatment completion rates will increase, and the parent-child relationship will be better, whereas parental stress and child disruptive behavior will decrease. Methods: A total of 15 children (aged 2-7 years) with disruptive behavior and their parents will be followed throughout the PCIT-VR treatment. Using a multiple baseline SCED with 3 phases, 15 families will fill out questionnaires weekly, in addition to having pre- and posttreatment and follow-up measurements to monitor their positive parenting skills, child disruptive behavior, parenting stress, and VR progress. Moreover, quantitative information and qualitative interviews will be analyzed visually and statistically and summarized to provide a complete picture of experiences. Results: As of February 2021, 6 families have been enrolled in the study at the moment of submission. Data collection is projected to be completed in 2023. Quantitative and qualitative results are planned to be published in peer-reviewed journals, as well as being presented at national and international conferences. Conclusions: The SCED-with its phased design, randomization, and the opportunity to replicate and assess both individual and group treatment effects-and adaptability of the VR technology are the strengths of the study. The risks of increased type I errors, maturation effects, or technological failure will be mitigated with the right statistical support. This study aims to magnify the scope of the treatment through additional skill training, ultimately in support of routinely implementing VR within PCIT