Diverse Parents Decision-Making to Vaccinate Their Child under Five Attending Childcare Programs.

Background: On 18 June 2022, Moderna and Pfizer-BioNTech COVID-19 vaccines were authorized under an Emergency Use Authorization by the United States Food and Drug Administration to prevent severe coronavirus disease in children six months to four years of age. Despite approval of the COVID-19 vaccinations for young children, there remain ongoing challenges reaching widespread coverage due to parental decision-making. Parental decision-making plays a pivotal, yet understudied, role governing vaccine adoption among this priority demographic. Methods: This cross-sectional analysis examined COVID-19 vaccine intentions for 320 predominately Hispanic parents of two to five-year-olds attending Miami-Dade County childcare programs in Florida USA, several months following the June 2022 emergency authorization. Parent's self-reported survey data encompassed vaccine choices and rationales, social determinants of health, and parent immigrant status. Data analyses illustrate the associations between parent decision-making and these variables. Regression modeling and tests of independence identified predicting factors for parental vaccine decision-making. Results: Only 25% of parents intended to vaccinate their young child, while 34% resisted and 41% felt unsure, despite 70% personal vaccination rates. Household income under $25,000, identifying as a migrant, or testing COVID-19-positive significantly predicted unsure decision-making. The majority of hesitant groups expressed concerns around side effects (20%), safety (2.9%), and sufficiency of vaccine knowledge (3.3%). Conclusions: In this sample, the predominance of parents were unsure and resistant rather than accepting of having their child vaccinated despite emergency approval of the pediatric vaccine. Associations and predictive factors are examined.

New Therapy for a New Normal: Comparing Telehealth and in-Person Time-Limited Parent-Child Interaction Therapy.

Telehealth treatment for child disruptive behavior has the potential to overcome multiple barriers to access (e.g., transportation, therapist availability). Traditional Parent-Child Interaction Therapy (PCIT) has demonstrated efficacy via telehealth in randomized controlled trials. The current study extends this research by examining community-based effectiveness of time-limited (i.e., 18 week) telehealth PCIT, comparing intake and posttreatment child behavior and caregiver skills for both telehealth and in-person PCIT. Participants included predominantly racially, ethnically, linguistically, and socioeconomically diverse children aged 2 to 8 years, and their caregivers. Dyads (N = 380) received either telehealth (IPCIT) or in-person PCIT.Propensity score analyses were conducted to address potential selection bias due to the nonrandomized sample. Regression analyses revealed no difference between IPCIT and in-person treatment for child disruptive behaviors or compliance outcomes. However, caregivers who received IPCIT demonstrated fewer positive statements and greater corrective/directive statements at posttreatment than caregivers who received in-person treatment.This research demonstrated that time-limited IPCIT can effectively improve child disruptive behavior among a socioeconomically, linguistically, and culturally diverse population, and represents the largest sample to date demonstrating the effectiveness of PCIT via telehealth. Future research is warranted to document intervention sustainability on a more system-wide level, and balance prioritizing caregiver skill acquisition over family-derived treatment goals.

An 18-week model of Parent-Child Interaction Therapy: clinical approaches, treatment formats, and predictors of success for predominantly minoritized families.

Introduction: Disruptive behavior disorders are among the most prevalent pediatric mental health referrals for young children. However, families from historically minoritized social identities have experienced disparities in treatment access, retention, and outcomes. Evidence-based interventions such as Parent-Child Interaction Therapy (PCIT) have been found to be effective in reducing children's disruptive behaviors in minoritized families. However, variable treatment length as a result of skill-based graduation criteria (e.g., observed caregiver verbalizations) may slow and/or hinder treatment progress, particularly for families where expected treatment verbalizations are less linguistically relative (e.g., no exact English to Spanish translations) and/or culturally familiar. Time-limited PCIT has been proposed as a strategy for promoting equity in treatment completion and outcomes amongst minoritized families, because treatment progression and/ or completion is not contingent upon caregiver linguistic skill demonstration. Methods: The current study evaluated the overall effectiveness of an 18-week model of PCIT and examined predictors of retention and treatment outcomes. Participants (N = 488 dyads) included predominantly racially, ethnically, linguistically, and socioeconomically diverse children aged two to eight years, and their caregivers. Results: Overall findings indicate that the 18-week PCIT model is an effective intervention for reducing children's externalizing and internalizing behaviors and improving caregiver parenting skills for most treatment completers. Despite advances in treatment completion, some caregiver social identities and PCIT treatment characteristics were predictive of lower completion rates and/or less optimal treatment outcomes. Discussion: Overall, this study provides strong support for widely disseminating use of the 18-week model of PCIT for most families served. Clinical implications and considerations for continued treatment inequity are discussed.

Universal Teacher-Child Interaction Training in early childhood special education: A cluster randomized control trial.

Growing evidence suggests that Teacher-Child Interaction Training-Universal (TCIT-U) is effective for increasing teachers' use of strategies that promote positive child behavior, but more rigorous research with larger, diverse samples is needed to understand the effects of TCIT-U on teacher and child outcomes in early childhood special education. Using a cluster randomized control trial, we evaluated the effects of TCIT-U on (a) teacher skill acquisition and self-efficacy and (b) child behavior and developmental functioning. Teachers in the TCIT-U group (n = 37) exhibited significantly greater increases in positive attention skills, increased consistent responding, and decreased critical statements relative to teachers in the waitlist control group (n = 36) at post and 1-month follow-up (d's range from 0.52 to 1.61). Teachers in the TCIT-U group also exhibited significantly fewer directive statements (d's range from 0.52 to 0.79) and greater increases in self-efficacy compared to waitlist teachers at post (d's range from 0.60 to 0.76). TCIT-U was also associated with short-term benefits for child behavior. Frequency (d = 0.41) and total number of behavior problems (d = 0.36) were significantly lower in the TCIT-U group than in the waitlist group at post (but not follow-up), with small-to-medium effects. The waitlist group, but not the TCIT-U group, demonstrated an increasing trend in number of problem behaviors over time. There were no significant between-group differences in developmental functioning. Current findings build support for the effectiveness of TCIT-U as universal prevention of behavior problems with an ethnically and racially diverse sample of teachers and children, including children with developmental disabilities. Implications for implementation of TCIT-U in the early childhood special education setting are discussed.

A Natural Helper Intervention to Address Disparities in Parent Child-Interaction Therapy: A Randomized Pilot Study.

OBJECTIVE: Parent-child interaction therapy (PCIT) is an effective intervention to address child externalizing behaviors. However, disparities in access and retention are pervasive, which relate to the availability of PCIT in low-income communities, inadequate workforces to provide culturally appropriate care, and distrust in services due to systemic discrimination. This study incorporated natural helpers who had been trained as community health workers into PCIT delivery to improve disparities in engagement and outcomes. METHOD: Families from three low-income, predominately Latino/a/x and Black neighborhoods in Miami qualified for services if they had a child aged 2-8 with clinically elevated externalizing behaviors. Families were randomly assigned into either Standard-PCIT group (N = 30 families; 80% boys, 57% Latino/a/x, 27% Black) or a PCIT plus Natural helper (PCIT+NH) group (N = 51 families; 66% boys, 76% Latino/a/x, 18% Black). Families in the PCIT+NH group received home visits and support addressing barriers to care from a natural helper. Path analyses within an intention-to-treat framework examined group-differences in treatment engagement, child behavior, and parenting skills and stress. RESULTS: Families in both groups demonstrated large improvements in child externalizing behavior, caregiver stress, and parenting skills from pre-to-post-treatment. Externalizing behavior improved significantly more in the PCIT+NH group compared to the Standard-PCIT group. There were no significant group differences in parenting skills or caregiver stress. Though differences in engagement were not significant, the PCIT+NH group had a small effect on treatment retention. CONCLUSIONS: Natural helpers may help to address structural barriers that systematically impact communities of color, apply treatment in naturalistic environments, and promote improved treatment outcomes.

Designing a virtual mental health consultation program to support and strengthen childcare centers impacted by COVID-19: A randomized controlled trial protocol.

BACKGROUND: The COVID-19 pandemic has had negative psychosocial impacts on young children; teachers in childcare centers continue to be overwhelmed by how to address the downstream psychological effects children are experiencing. This randomized controlled trial will study the role of a community-based, childcare center-support system in improving resilience and mitigating the long-term impacts of COVID-19 on children's development. METHODS: This study will be modeled on a successful Early Childhood Mental Health Consultation (ECMHC) intervention which utilizes mental health consultants to deliver a Jump Start+: COVID 19 Support (JS + CS) virtual toolkit to childcare centers in Miami-Dade County via a Kubi robot. The toolkit comprises four strength-based strategies likely to be effective in improving resiliency following disasters: Safety Planning, Effective Communication, Adult Self-Care, and Trauma-Informed Behavior Support. Our first aim will utilize a cluster randomized trial to examine the effectiveness of JS + CS on improving the psychosocial functioning of young children, as compared to an obesity prevention intervention control group. Children will be followed at 6, 12, 18, and 24 months. The second aim will examine the mechanisms that contribute to effective uptake by teachers of the JS + CS support strategies on child outcomes. The third aim will explore implementation barriers/facilitators as well as potential societal contextual factors (e.g., vaccine uptake) to help centers serving disproportionately affected minority communities recover from and prepare for future crises. CONCLUSION: This design will inform the refinement and scaling of JS + CS and generalize impacts to other childcare center interventions in the context of disasters.

A Preliminary Analysis of Parent-Child Interaction Therapy Plus Natural Helper Support to Increase Treatment Access and Engagement for Low-Income Families of Color.

Disparities in care for low-income children of color call for innovative culturally and linguistically responsive solutions to better engage marginalized populations in evidence-based interventions. In partnership with a community organization, the addition of natural helper support as an adjunct to Parent-Child Interaction Therapy (PCIT+NH) was examined as a strategy to increase recruitment, engagement, and retention in PCIT for families historically unreached by a university-based clinic. Natural helpers provided home-based skills practice and support for forty-two families whose parents were more racially and linguistically diverse and had lower income and lower caregiver education than the typical population served by the same program (i.e., program population). Families who received PCIT+NH had comparable or higher rates of engagement and improvements in clinical outcomes (i.e., decreased child externalizing and internalizing behaviors, increased child compliance, decreased caregiver stress, increased caregiver parenting skills) relative to the program population. Furthermore, higher doses of natural helper support were associated with higher rates on most measures of treatment engagement (i.e., treatment completion, completion of the Child Directed Interaction phase of treatment, PCIT sessions, homework in the Parent Directed Interaction phase of treatment), with the exception of homework in the Child Directed Interaction phase of treatment and overall session attendance rate. Next steps for testing the treatment engagement and clinical outcome effects of the PCIT+NH model are discussed.

Aiming High: Monitoring Population Level Indicators of Child Wellbeing as a Goal of Community-Academic Partnerships.

INTRODUCTION: Community-academic partnerships (CAPs) aim to improve neighborhood population health. Though measuring the impact of partnership activities at a population level can be difficult, evaluating indicators of wellbeing may increase understanding of how communities benefit from CAPs. This study examined child health indicators over time in two low-income, predominantly Black/African American and Hispanic communities where partnerships between an academic child development center and community coalitions were formed with the intention of improving child well-being. METHODS: Trends in three child wellbeing indicators (graduation rates, kindergarten readiness, and proportion of youth in school and/or employed) were compared between two CAP communities and several neighboring comparison communities. Data between 2011 and 2017 were analyzed to calculate percent change from baseline and mapped using ArcGIS to visualize trends by zip code. Proportions of youth meeting benchmarks were also determined. RESULTS: Kindergarten readiness and high-school graduation rates improved in CAP communities but not in geographically proximal and socioeconomically similar comparison communities. No improvements were found in the proportion of youth in school or employed. DISCUSSION: This study revealed population-level indicators improved over time in CAP communities. Because community-level child health and wellbeing are influenced by many factors, this correlation is not proof of a causal relationship. Assessing population level indicators can nonetheless provide insight into the benefit of CAPs, and the commitment to monitoring such outcomes can itself advance how academic and community partners plan activities and set long-term goals.

Person-Centered Cultural Assessment Can Improve Child Mental Health Service Engagement and Outcomes.

OBJECTIVE: Disparities in child mental health service engagement suggest traditional evidence-based practices do not properly consider cultural and contextual factors relevant for marginalized families. We propose a person-centered approach to improve the cultural responsiveness of services. Preliminary research supports broadening standard assessments to include a person-centered evaluation of patient cultural factors, however, controlled studies have not been conducted in the context of children's mental health care. METHODS: Participants included families (N = 89; 89% racial/ethnic minority) receiving services for child externalizing problems. Prior to intake, caregivers were randomized to receive either Assessment as Usual (AAU) or AAU augmented with the Cultural Formulation Interview (CFI+AAU), a brief caregiver assessment of cultural factors affecting their child's problems and family help-seeking. RESULTS: Implementation data showed strong provider fidelity and clinical utility. Following assessments, CFI+AAU caregivers (relative to AAU caregivers) reported feeling better understood by their provider, and providers reported better understanding CFI+AAU families' values. Caregiver satisfaction was rated highly overall, yet providers reported being more satisfied with the assessment when the CFI was incorporated. Engagement outcomes found CFI+AAU families were significantly more likely than AAU families to subsequently complete the first phase of treatment. Further, among families receiving services in Spanish, CFI+AAU, relative to AAU, was associated with significantly higher treatment attendance, homework completion, and treatment response. CONCLUSIONS: The results underscore the utility of incorporating a brief cultural assessment in pretreatment assessments. To improve the cultural responsiveness of services, efforts may do well to promote the uptake of person-centered approaches such as cultural assessment into usual care. Registered at clinicaltrials.gov (NCT03499600).

Psychometric Properties of the Behavior Assessment System for Children Student Observation System (BASC-3 SOS) with Young Children in Special Education.

Measuring classroom behavior among young children is important to guide assessment and intervention decisions, yet there is limited literature on appropriate direct observation tools for this purpose. This article describes the psychometric properties of the Behavior Assessment System for Children, Student Observation System (BASC-3 SOS) with 135 children ages 20 to 67 months (M = 35 months, 64% Latinx, 78% with an established developmental disability) and their teachers (N = 36) as part of a larger randomized control trial of a teacher training intervention. Inter-rater reliability on individual BASC-3 SOS behaviors ranged from poor to good. Correlations between BASC-3 SOS scores across time indicated low to moderate developmental test-retest reliability. Significant correlations between BASC-3 SOS scores and teacher ratings provided evidence for convergent, divergent, and predictive validity. Differences between BASC-3 SOS scores for children with versus without disabilities supported the tool's discriminant validity. There were no significant pre- to post-treatment changes in BASC-3 SOS scores. Overall, results provide mixed evidence for the psychometric properties of the BASC-3 SOS when used with young, diverse children with and without disabilities. Implications for clinical and research purposes are discussed. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10864-021-09458-x.

Comparing Traditional and Ebook-Augmented Parent-Child Interaction Therapy (PCIT): A Randomized Control Trial of Pocket PCIT.

Disruptive behavior in young children is one of the most common referrals to behavioral health providers. While numerous effective parenting programs, such as parent-child interaction therapy (PCIT), exist for improving children's behaviors, challenges with treatment engagement and retention limit the intended positive impact on child and caregiver outcomes, particularly for racial and ethnic minority families. In an effort to address barriers contributing to poor engagement and retention in traditional PCIT service delivery and among ethnic and racial minority families, a multimedia PCIT ebook was developed and evaluated. In a sample of the general public that utilized the ebook, users were found to be more engaged in viewing embedded videos within the ebook that were related to expert skill explanations and skill demonstrations than caregiver testimonies. A randomized controlled trial was also conducted to evaluate the extent that the ebook + PCIT improved treatment engagement, retention, parenting skills, skill acquisition efficiency, and child behavior above and beyond traditional PCIT. Participating families were randomly assigned to either the traditional PCIT (n = 71) or ebook + PCIT (n = 107) group using an online random number generator. Forty-nine caregivers (traditional PCIT n = 24, ebook + PCIT n = 25) were excluded from analyses because they were lost to follow-up during the intervention. Families in both the traditional PCIT and ebook + PCIT groups demonstrated generally equivalent positive outcomes in treatment engagement (i.e., attendance, treatment length, completion rate) and caregiver skill acquisition efficiency at midtreatment, posttreatment, and 3-month follow-up. The addition of the ebook to PCIT also reduced child disruptive behavior at midtreatment, above and beyond traditional PCIT, but not at posttreatment or follow-up. Clinical implications and future directions are discussed.

Therapist Experiences and Attitudes About Implementing Internet-Delivered Parent-Child Interaction Therapy During COVID-19.

It has been widely recognized that access to mental health treatment is imperative to address current and long-term stressors for children and parents during COVID-19. Internet-delivered Parent-Child Interaction Therapy (iPCIT, previously referred to as I-PCIT) is a strong model for remote service delivery during social distancing restrictions due to its empirical base. However, this treatment modality was not widely implemented before COVID-19, likely due to barriers to providing telehealth services. This mixed methods study conducted a follow-up survey to gather therapist experiences (N = 223) in delivering iPCIT during COVID-19, including qualitative data on the benefits and challenges to delivering iPCIT. The vast majority of therapists (82%) indicated that they transitioned to deliver PCIT via telehealth in response to COVID-19. PCIT caseloads decreased slightly from the first survey to the COVID-19 follow-up survey, but the racial and ethnic composition of caseloads were not significantly different between the two surveys. Of the 183 therapists who transitioned to deliver PCIT via telehealth, 82% expressed interest in continuing to provide iPCIT following the COVID-19 pandemic. Reported benefits of iPCIT included decreased barriers to access and the ability to practice skills within the naturalistic home environment. Challenges to iPCIT were primarily issues with technology as well as other logistical barriers, which could limit engagement for some families. Findings from this study may be beneficial in improving future implementation of iPCIT during and post-COVID-19.

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.

Rapid, Full-Scale Change to Virtual PCIT During the COVID-19 Pandemic: Implementation and Clinical Implications.

Health agencies call for the immediate mobilization of existing interventions in response to numerous child and family mental health concerns that have arisen as result of the COVID-19 pandemic. Answering this call, this pilot study describes the rapid, full-scale change from a primarily clinic-based Parent-Child Interaction Therapy (PCIT) model to a virtual service model (i.e., I-PCIT) in an academic and community-based program in Miami, Florida. First, we describe the virtual service training model our program developed and its implementation with 17 therapists (MAge = 32.35, 88.2% female, 47.1% Hispanic) to enable our clinic to shift from providing virtual services to a small portion of the families served (29.1%) to all of the families served. Second, we examine the effect of I-PCIT on child and caregiver outcomes during the 2-month stay-at-home period between March 16, 2020, and May 16, 2020, in 86 families (MChildAge = 4.75, 71% Hispanic). Due to the rapid nature of the current study, all active participants were transferred to virtual services, and therefore there was no comparison or control group, and outcomes represent the most recently available scores and not treatment completion. Results reveal that I-PCIT reduced child externalizing and internalizing problems and caregiver stress, and increased parenting skills and child compliance with medium to large effects even in the midst of the COVID-19 pandemic. Finally, the study examined components of our virtual service training model associated with the greatest improvements in child and caregiver outcomes. Preliminary findings revealed that locally and collaboratively developed strategies (e.g., online communities of practice, training videos and guides) had the strongest association with child and caregiver outcomes. Implications for virtual service delivery, implementation, and practice in the midst of the COVID-19 pandemic are discussed.

Risk and resilience of well-being in caregivers of young children in response to the COVID-19 pandemic.

The COVID-19 pandemic is impacting communities worldwide, with direct effects of illness and mortality, and indirect effects on economies, workplaces, schools/daycares, and social life. However, we understand very little about the effects of this pandemic on families of young children. We used a risk and resilience model to evaluate the effects of the pandemic on mental health in diverse caregivers (N = 286) with children ages birth to 5. We evaluated the hypotheses that (a) pandemic stress and caregiver-reported child psychosocial concerns correlate with caregivers' mental health symptoms and (b) caregivers' pandemic-related self-efficacy and coping mediate these relationships. Caregivers completed surveys in April-May 2020 assessing pandemic stress (e.g., health, finances, and housing), child psychosocial problems, coping strategies, and self-efficacy to manage family needs. Our primary outcome was caregivers' self-reported changes in mental health symptoms since the outbreak. Path analysis revealed that higher pandemic stress was associated with caregivers' reduced confidence in meeting their family's needs related to COVID-19, which correlated with worse caregiver mental health symptoms. Greater child psychosocial problems also predicted worse caregiver mental health symptoms. Findings suggest that pandemic stress, child psychosocial problems, and caregiver self-efficacy are interrelated in their influence on caregivers' mental health. While further research is needed to examine strategies to foster resilience and buffer the pandemic's effects on caregiver mental health, this is a first step in evaluating the psychosocial effects of this pandemic in families of young children. Clinical implications are discussed for a tiered response to mitigate the pandemic's impacts on family functioning.

Parent-Child Interaction Therapy for children with autism spectrum disorder and a matched case-control sample.

Parent-Child Interaction Therapy is an empirically based, behavioral parent training program for young children exhibiting disruptive behaviors. Parent-Child Interaction Therapy shows promise for treating disruptive behaviors in children with autism spectrum disorder. Treatment processes (i.e. treatment length and homework compliance), parenting skills, parenting stress, and behavioral outcomes (i.e. disruptive and externalizing behaviors and executive functioning) were compared in 16 children with autism spectrum disorder and 16 children without autism spectrum disorder matched on gender, age, and initial intensity of disruptive behaviors. Samples were statistically similar in terms of child receptive language, child race and ethnicity, parent age, gender and education, and number of two-parent families in treatment. Families received standard, mastery-based Parent-Child Interaction Therapy. Both groups demonstrated significant and clinically meaningful improvements in child disruptive and externalizing behavior and executive functioning, parenting skills, and parenting stress. Length of treatment, homework compliance, and parent and child outcomes did not differ significantly between groups. A subset of children with autism spectrum disorder also showed significant improvements in social responsiveness, adaptive skills, and restricted/repetitive behaviors. This study replicates and extends prior research by demonstrating that children with and without autism spectrum disorder experience similar benefits following Parent-Child Interaction Therapy. Findings may expand the availability and dissemination of time-limited, evidence-based interventions for autism spectrum disorder and comorbid disruptive behaviors.

Successful Therapist-Parent Coaching: How In Vivo Feedback Relates to Parent Engagement in Parent-Child Interaction Therapy.

Although behavioral parent training is considered efficacious treatment for childhood conduct problems, not all families benefit equally from treatment. Some parents take longer to change their behaviors and others ultimately drop out. Understanding how therapist behaviors impact parental engagement is necessary to improve treatment utilization. This study investigated how different techniques of therapist in vivo feedback (i.e., coaching) influenced parent attrition and skill acquisition in parent-child interaction therapy (PCIT). Participants included 51 parent-child dyads who participated in PCIT. Children (age: M = 5.03, SD = 1.65) were predominately minorities (63% White Hispanic, 16% African American or Black). Eight families discontinued treatment prematurely. Therapist coaching techniques during the first session of treatment were coded using the Therapist-Parent Interaction Coding System, and parent behaviors were coded with the Dyadic Parent-Child Interaction Coding System, Third Edition. Parents who received more responsive coaching acquired child-centered parenting skills more quickly. Therapists used fewer responsive techniques and more drills with families who dropped out of treatment. A composite of therapist behaviors accurately predicted treatment completion for 86% of families. Although group membership was correctly classified for the treatment completers, only 1 dropout was accurately predicted. Findings suggest that therapist in vivo feedback techniques may impact parents' success in PCIT and that responsive coaching may be particularly relevant.

Does Practice Make Perfect? The Relationship Between Self-Reported Treatment Homework Completion and Parental Skill Acquisition and Child Behaviors.

The purpose of the current study was to examine whether the rate and type of parent-reported homework completion is associated with parent-report of child behavior outcomes, number of sessions to master parental skills as measured by therapist observation, and length of treatment in Parent-child Interaction Therapy (PCIT). Sixty-two parent-child dyads (primary caregiver: Mage=36.35years, female 95.20%, 81.60% White, 59.57% Hispanic; child Mage=4.22years; child gender male 64.50%) who completed PCIT were included in the study. A within-subjects hierarchical regression statistical design was used to examine the impact of parent report of homework completion on treatment processes and outcomes. A higher rate of self-reported homework completion was predictive of parental mastery of skill acquisition in fewer sessions and treatment completion in fewer sessions. Parent report of homework completion rate was not related to changes in child disruptive behavior after controlling for child behavior at baseline. Current study findings reinforce the importance of having parents regularly practice PCIT skills outside of session in order to decrease treatment length and facilitate the acquisition of parenting skills, which may reduce family burdens associated with attending a weekly treatment.

Improving behavior using child-directed interaction skills: A case study determining cochlear implant candidacy.

OBJECTIVE AND IMPORTANCE: Children with hearing loss (HL) are at increased risk of developing externalizing behavior problems (e.g., hyperactivity, attention problems). These problems can lead to cascading effects on children's overall development. However, few studies have identified evidence-based interventions for this population. CLINICAL PRESENTATION: A 6-year-old boy with bilateral HL presented to the clinic with significant behavioral challenges. These challenges (e.g., fatigued quickly, poor attention, and hyperactivity) were affecting the reliability of audiological testing to determine cochlear implant candidacy. Thus, the child was referred for Parent-Child Interaction Therapy (PCIT) to address these behavioral challenges. INTERVENTION AND TECHNIQUE: PCIT is an evidence-based intervention that has been shown to significantly improve externalizing behavior problems. This study describes how the Child-Directed Interaction phase of PCIT was tailored for a child with bilateral HL. The goal of the intervention was to reduce externalizing behaviors in order to reliably complete a cochlear implant evaluation. Post-intervention, significant improvements were noted in behavior, including a decrease in disruptive behavior to normal levels. This led to completion of previously unsuccessful audiological testing and determination of cochlear implant candidacy. CONCLUSION: This study illustrates how PCIT was successfully tailored to one child with an HL. This is critical as children with HL are at risk for behavior problems, and effective interventions for disruptive behaviors in children with HL may lead to significant improvements in medical and psychosocial outcomes for children with HL and their families.