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The Hexagon: An Exploration Tool
The Hexagon can be used as a planning tool to guide selection and evaluate potential programs and practice for use.
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Core Components
Parent-Child Interaction Therapy (PCIT) is a manualised, dyadic intervention designed to treat behavioural problems in children aged 2-7 years. This individualised programme is composed of two treatment phases. Phase 1 is the Child-Directed Interaction (CDI) phase that teaches foundational PRIDE skills (praise, verbal reflection, imitation, behavioural description, and enjoyment), with the goal of establishing warm child-parent relationship. This phase promotes positive parenting skills in parents and helps children with behavioural regulation. Phase 2 is the Parent-Directed Interaction (PDI) phase. In this phase, parents are taught how to give effective commands; learn skills to manage challenging child behaviours; and learn how to set developmentally appropriate limits for their children. Mastery of the CDI phase is required before parents can proceed to the PDI phase. Family assessments are carried out at multiple time-points; during intake, through-out treatment, and at treatment completion. This is to ensure the intervention is tailored to meet the needs of the parent-child dyad; to determine if family treatment goals are being met; and to assess the family’s readiness for graduation.
PCIT sessions are delivered by trained PCIT practitioners in an outpatient clinic setting. Typically, one practitioner delivers the session per family. The first sessions in the CDI and PDI phases are delivered didactically, while subsequent sessions in both phases are delivered through direct coaching (coaching sessions). Parent(s) and child receive coaching sessions in a playroom fitted with a one way mirror. This allows the PCIT practitioner to observe parent-child interactions from the observation room that is adjoined to the playroom. Parents wear a “bug-in-the-ear” device that allows them receive real-time feedback from the PCIT practitioner regarding behaviour management skills. Alternatively, a video-feed room set up can be used. This allows practitioners watch parent-child interactions, and provide feedback from a video-feed room.
PCIT is typically delivered once a week, over 12-20 sessions, with each session lasting about 60 mins. The number of sessions delivered is dependent on individual families’ unique situations, such as the speed of parent mastery of taught skills, severity of child’s behavioural problems, and rate of parent reported reductions in child problem behaviours. The pocket PCIT interactive book, homework sheets and handouts are made available to parents to support them in practicing PCIT skills. The PCIT programme is considered complete when parents demonstrate mastery of the PCIT skills, and their child’s behaviour falls within normal range on a behaviour rating scale.
Fidelity
PCIT programme fidelity is maintained by adherence to the measures below;
• Ensuring practitioner PCIT training and promoting practitioner certification
• Ensuring the use of fidelity monitoring checklist for practitioner self-evaluation and for external evaluation
• Monthly remote consultation available to certified PCIT practitioners for additional support
Modifiable Components
PCIT is available in English, German, Japanese, Dutch and Spanish, and has been delivered in several countries including Australia, Canada, China, Japan, Taiwan, New Zealand, Netherlands, Norway, Switzerland, Denmark, France, Turkey, United Arab Emirates, and Germany. PCIT has been used in group format, has been adapted for use at home, and in children with conduct problems, anxiety disorders, ADHD, and autism. PCIT has also been adapted into the Teacher-Child Interaction Training (TCIT) programme that focuses on promoting teacher-student relationship, and effective classroom behaviour management strategies.
Support for Organisation/Practice
Implementation Support
Parent-Child Interaction Therapy (PCIT) is owned by PCIT International, Inc. USA. They also own the Teacher-Child Interaction Training programme (TCIT), a teacher adapted format of the PCIT programme.
Certified PCIT trainers conduct readiness assessments for organisations looking to implement the programme. They carry-out pre-training consultation, and provide training and implementation support consultation to practitioners and organisations implementing PCIT. This is to ensure that practitioners and organisations understand the scope of the training; and know the factors that enhance programme success. Consultation can be delivered face-to-face, via telephone, video chat, or in form of video reviews with feedback. Certified practitioners have access to monthly group consultation calls for additional support during programme delivery.
Licence Requirements
No agency licence is required to deliver PCIT
Start-up Costs
Start-up costs range between $4000-$5000/year/practitioner. Costs vary depending on number of practitioners to be trained, and the type of organisation rolling-out the programme. This payment covers the initial training, twice monthly consultation for a full year, and video reviews. This does not include travel.
Building Staff Competency
Qualifications Required
Practitioners usually have a Masters degree or higher in a mental health field, and must be registered providers of mental health services. Practitioners include family therapists, practitioner psychologists, registered counsellors, and psychiatrists. Doctoral psychology students who have completed their third year of training, and are undertaking clinical work under appropriate supervision can also deliver PCIT to families.
Training Requirements
Practitioner training prior to delivering PCIT is required, and certification is highly recommended. Practitioners receive 40 hours of face-to-face training from a PCIT Master trainer or PCIT level II trainer. This training includes the theoretical overview of PCIT, mastery of CDI and PDI skills, case observations, and coaching with families. Alternatively, the 40 hours could be delivered as 10 hours online training and 30 hours face-to-face training. PCIT level I trainers could also deliver the 40 hours training to practitioners, but this training must include at least 20 hours of co-therapy and/ or live case supervision. Practitioners must continue to receive consultation from a PCIT trainer at least twice monthly. This is to continue until the practitioner has delivered the programme to at least two families, and seen these cases to completion. Upon training completion, practitioners submit the certified PCIT therapist application, and complete the PCIT certification experience (a quiz that reviews the concepts taught during training). Certified practitioners can continue to receive monthly consultation, if they choose to do so, to maintain programme fidelity.
PCIT has a train-the-trainer model, hence certified PCIT practitioners can receive training and consultation to become certified trainers. To become a level I trainer, the certified PCIT practitioner must receive at least 8 hours of initial training and monthly supervision/ consultation for 12 months. Practitioners must also complete at least one therapist-in-training supervision. Additional training and supervision is required for practitioners who want to become level II trainers and master trainers.
Supervision Requirements
Certified PCIT master trainers, level II trainers and level I trainers provide 40 hours training, and provide consultation to practitioners as they deliver the programme to at least two families. Consultation could be carried out in real-time (e.g. face-to-face, telephone, video chat, etc.), or in form of video reviews with feedback. Certified trainers also conduct skills reviews when observing the two cases completed by practitioners.
Theory of Change
Parent-Child Interaction Therapy (PCIT) is guided by attachment theory, as one of the core goals of the programme is developing secure parent-child relationship. PCIT is also guided by social learning theory as the behavioural strategies taught in the programme are founded on social learning theory.
Infants and Toddlers: 0-36 months - Rating: 4+
Research Design & Number of Studies
The best evidence for children aged 0-36 months comes from four RCTs. Two of these studies involved researchers affiliated with PCIT (Bjørseth and Wichstrøm, 2016; Chaffin et al, 2004), while the remaining two studies were externally conducted (Leung et al, 2017; Leung et al, 2015). The studies included children aged 2–12 years, however separate data for the 0-36 month age group were not reported.
Outcomes Achieved
Compared to the control group that either received no treatment or treatment as usual, the following outcomes were observed:
Child Outcomes
Significant reduction in child behaviour problems (Leung et al, 2015; Bjørseth and Wichstrøm, 2016)
Significant reduction in child behaviour problems in children with ADHD (Leung et al, 2017)
Parent Outcomes
Significant reduction in parenting stress, and negative parenting practices (Leung et al, 2015; Leung et al, 2017)
Significant improvement in positive parenting practices (Leung et al, 2015; Leung et al, 2017)
Significant improvement in the use of taught parenting skills (Bjørseth and Wichstrøm, 2016)
Significant reduction in physical abuse recurrence (Chaffin et al, 2004)
Key References
Leung C., Tsang S., Ng G.S.H., Choi S.Y. (2017). Efficacy of Parent–Child Interaction Therapy With Chinese ADHD Children: Randomized Controlled Trial. Research on Social Work Practice, 27:1, 36-47
Bjørseth A., Wichstrøm L. (2016). Effectiveness of Parent-Child Interaction Therapy (PCIT) in the Treatment of Young Children’s Behavior Problems. A Randomized Controlled Study. PLoS ONE 11:9
Leung C., Tsang S., Sin T.C.S., and Choi S. (2015). The Efficacy of Parent–Child Interaction Therapy With Chinese Families: Randomized Controlled Trial. Research on Social Work Practice, 25(1) 117-128
Chaffin M., Silovsky J.F., Funderburk B., Valle L.A. Brestan, E. V., Balachova, T., and Bonner, B. (2004). Parent–Child Interaction Therapy With Physically Abusive Parents: Efficacy for Reducing Future Abuse Reports. Journal of Consulting and Clinical Psychology, 72:3, 500-510
Preschool: 3 to 5 years - Rating: 4+
Research Design & Number of Studies
The best evidence for children aged 3-5 years old comes from four RCTs. Two of these studies involved researchers affiliated with PCIT (Bjørseth and Wichstrøm, 2016; Chaffin et al, 2004), while the remaining two studies were externally conducted (Leung et al, 2017; Leung et al, 2015). The studies included children aged 2–12 years, however separate data for the 3-5 years old age group were not reported. Evidence outcomes for the age range 3-5 years is the same as for the 0-36-month evidence above.
Primary school: 6 to 12 years - Rating: 4+
Research Design & Number of Studies
The best available evidence for children aged 6-12 years comes from four randomised control trial (RCTs). Two of these studies involved researchers affiliated with PCIT (Bjørseth and Wichstrøm, 2016; Chaffin et al, 2004), while the remaining two studies were externally conducted (Leung et al, 2017; Leung et al, 2015). The studies included children aged 2–12 years, however separate data for children aged 6-12 years were not reported. Evidence outcomes for children aged 6-12 years are the same as for 0-36 month evidence above.
Need
Comparable Population
Parent-Child Interaction Therapy (PCIT) is an individualised programme designed to treat behavioural problems in children aged 2-7 years. The programme is delivered to child-parent dyads.
Is this comparable to the population your organisation would like to serve? Has your organisation identified families who may benefit from this programme? Is there a need for this programme?
Desired Outcome
Programme delivery is associated with significant improvements across several outcomes. These include reductions in child problem behaviours, parenting stress, negative parenting practices, as well as increases in child compliance and positive parenting practices.
Are the above outcomes priorities for your organisation? Are there other primary outcomes that your organisation would like to achieve, which are outside the premise of the PCIT programme? Does your organisation have other systems in place that effectively and efficiency address the above outcomes?
Need Score
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Fit
Values
Parent-Child Interaction Therapy (PCIT) is an individualised programme designed to treat behavioural problems in children aged 2-7 years. The programme is delivered to child-parent dyads with the goal of establishing warm child-parent relationships, and equipping parents with the skills to manage challenging child behaviours. PCIT is delivered in an outpatient clinic setting.
Is your organisation looking to implement a programme that addresses behavioural problems in young children?
Priorities
Is your organisation looking to implement an intervention that is delivered to parent(s) and child, parent(s) only, or child only? Would an intervention that is designed to treat behavioural problems be a good fit for your organisation? Or would an intervention that also addresses neurodevelopmental disorders be a better fit? Is your organisation looking to implement a programme that will be delivered in the home setting, clinic setting, or via telehealth? Is providing an individualised programme priority for your organisation, or would a group based programme be a better fit? Would your organisation prefer to deliver a preventive or treatment intervention?
Existing Initiatives
Does your agency have existing treatment programmes for young children with behavioural problems? Are the existing initiatives effective? Do the existing initiatives fit your current and anticipated future requirements? Do they address similar outcomes as PCIT? Are there components within the PCIT programme that are not met by existing programmes?
Fit Score
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Capacity
Workforce
Practitioners usually have a Masters degree or higher in a mental health field, and must be registered mental health professionals. As part of the training process, practitioners receive 40 hours of training, and also receive consultation on two Parent-Child Interaction Therapy (PCIT) cases. One PCIT practitioner delivers the intervention per family. There are additional time and training requirements for practitioners to become certified and to become trainers.
Does your organisation have practitioners with the qualifications and experience, who are interested in learning and delivering this programme? If not, does your organisation have the capacity to recruit qualified practitioners? How many families will your organisation support in the first year? Based on this number, how many practitioners will require training in the first year? Would your organisation also train certified PCIT practitioners and trainers? Can your organisation provide practitioners with the support needed during the training and certification process, bearing in mind the time commitment required?
Technology Support
Parents wear a “bug-in-the-ear” device that allows them receive real-time feedback from Parent-Child Interaction Therapy (PCIT) practitioners. Feedback is usually provided using a one-way mirror setup. Alternatively, a video feed room setup can be used. As part of the practitioner training process, video recordings of sessions can be reviewed by PCIT trainers in lieu of live or real-time consultation.
• Microphones
Does your organisation have these devices to allow live communication between parent and practitioner? Can these items be purchased? Will observation take place from an adjoining observation room or will a video feed room setup be used? Does your organisation have video recording cameras for live video feed of parent-child interaction? To support practitioner training, can your organisation provide the technology to record videos for review?
Administrative Support
The programme is usually delivered in a one way mirror room setup or a video feed room setup. Video recordings of sessions conducted by practitioners in training may be reviewed in lieu of live or real-time consultation.
Does your organisation have a facility to deliver this programme? Does the facility support a one way mirror room setup or a video feed room setup? Are there policies and procedures in place regarding the video recording and storing of these recordings?
Financial Support
Start-up costs range between $4000-$5000/year/practitioner. Costs vary depending on number of practitioners to be trained, and the type of organisation rolling-out the programme. There are additional time and training requirements for practitioners to become certified and to become trainers.
How many practitioners would your organisation like to train? Will your organisation be training practitioners as certified PCIT practitioners and trainers? Can this be supported financially? Can your organisation afford to purchase the technology required to deliver this programme?
Capacity Score
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