Theses and Dissertations

Date of Award

2021

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

College of Psychology

First Advisor

Diana Formoso

Second Advisor

Jason Jent

Third Advisor

Christian DeLucia

Fourth Advisor

Lourdes Suarez-Morales

Keywords

behavior intervention, disruptive behaviors, early childhood, Parent coaching, parent-child interaction therapy, telehealth

Abstract

Despite the rich evidence for early intervention to prevent/treat emotional and behavioral disorders, a gap continues to exist between research and practice, and multitudinous barriers prevent families from accessing vital evidence-based services. Telehealth is an emerging area of research and clinical practice, often proposed as a solution for multiple barriers to service provision. However, despite scattered promising evidence translating in-person treatments to telehealth, many treatments still lack established effectiveness in a virtual format. Parent-child interaction therapy (PCIT) is a traditionally in-person behavioral parenting intervention uniquely well-suited to telehealth, as during typical clinic practice the clinician is not in the clinic room, but rather coaching caregivers from behind a one-way mirror. Translating to the home setting via telehealth allows the clinician to increase the potential for generalization while simultaneously decreasing treatment barriers for both clinician and family.

In this study, investigators examined change in child behaviors, caregiver stress, and caregiver child-directed statements for 58 families who completed internet-based PCIT and 140 families who completed clinic-based PCIT. Caregivers self-selected into either clinic or telehealth treatment, so propensity scores were computed to control for pre-existing variability between groups due to selection bias. Paired t tests confirmed that all caregiver and child outcome variables changed significantly from pre- to post-treatment, including child disruptive, externalizing, adaptive behavior and compliance, caregiver stress, and caregiver positive and directive/corrective child-directed statements. Then, hierarchical linear regressions were conducted to examine the effect of treatment group (i.e., IPCIT or clinic) on the variability in each outcome. Outcomes did not significantly differ across treatment modalities for child disruptive, externalizing, adaptive behaviors and compliance and for caregiver stress. However, caregivers in the IPCIT modality demonstrated smaller increases in positive child-directed statements and smaller decreases in directive/corrective child-directed statements compared to the clinic-based group, exhibiting small effect sizes for both outcomes. These findings replicate previous research establishing IPCIT as effective at improving child behavior and caregiver stress and extend such findings to a wider group of children using a larger, more diverse sample who received a shorter course of treatment than previous IPCIT studies. Implications and directions for future research are discussed.

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