Adapting to Unprecedented Times: Community Clinician Modifications to Parent-Child Interaction Therapy during COVID-19.

Parent-Child Interaction Therapy (PCIT) is an evidence-based practice that effectively prevents and treats child disruptive behaviors and child physical maltreatment and reduces parenting stress. PCIT was adapted for telehealth delivery, internet-delivered PCIT (iPCIT), before the COVID-19 pandemic but was not widely implemented until the rapid transition to telehealth during stay-at-home orders. To understand how clinicians adapted PCIT during COVID-19, we followed up on a previous study investigating community clinician adaptations of PCIT pre-COVID-19 using the Lau et al. (2017) Augmenting and Reducing Framework. Clinicians (N = 179) who responded to the follow-up survey and reported delivering PCIT remotely completed a quantitative measure of adaptations at both time points (Fall 2019; Summer 2020) to assess how adaptations to PCIT changed following lockdown measures. Clinicians (n = 135) also provided qualitative descriptions of adaptations made early in the COVID-19 pandemic. Clinicians in the full sample were 74.3% Non-Hispanic White and 14% Latinx. Most clinicians had a master's degree (66.5%), were licensed (80.4%), and were PCIT-certified (70.4%). Paired samples t-tests showed that clinicians reported similar levels of augmenting t(179) = -0.09, p=.926) and reducing adaptations t(179) = -0.77, p=.442) at both time points. Unlike quantitative findings, qualitative findings indicated that clinicians described engaging in many types of adaptations in response to the pandemic. Clinicians discussed engaging in augmenting adaptations by extending treatment length and integrating other practices into treatment. Clinicians also discussed engaging in reducing adaptations. Implications and future directions will be discussed.

Universal Teacher-Child Interaction Training in Early Special Education: A Pilot Cluster-Randomized Control Trial.

Using a pilot matched-pairs cluster-randomized control trial, we evaluated the acceptability and preliminary outcomes of universal Teacher-Child Interaction Training (TCIT-U) with students with disabilities in early special education programs. Twelve classrooms (clusters) were paired by age and type and then randomly assigned within pairs to either TCIT-U (81 students, 20 teachers) or wait-list control (63 students, 16 teachers) with services as usual. We analyzed the effects of TCIT-U on (a) teachers' skills acquisition via masked observational coding and (b) students' behavior and developmental functioning via teacher questionnaires. For child-directed interaction skills, teachers receiving TCIT-U exhibited significantly greater increases in behavior descriptions and labeled praise than teachers who did not receive TCIT-U at posttreatment and follow-up. No significant group differences were observed in use of teacher-directed interaction skills. Qualitative data from teachers expanded on these findings, suggesting that teachers found child-directed interaction skills more acceptable than teacher-directed interaction skills. Teachers receiving TCIT-U reported small but significant improvements in student behavior problems and socioemotional functioning at posttreatment and follow-up, as compared to wait-list students. We discuss considerations for future implementation and tailoring of TCIT for young students with disabilities, which may have positive impacts on future cohorts of students beyond teachers' initial training.