parent-child interaction therapy: international spotlight anthony urquiza, ph.d. 6th annual pcit...
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Parent-Child Interaction Therapy:International Spotlight
Anthony Urquiza, Ph.D.
6th Annual PCIT Conference
University of Florida
Gainesville, FL
PCIT in Hong Kong
But PCIT in Hong Kong is the end of the story, this is our most recent international training agency.
I think it is best to start at the beginning
When we started training, these were the questions…
What are the barriers to overcome?What training model is most effective?
What leads to leads to success?(What is training success?)
What are the barriers to overcome?
• Therapists wouldn’t like PCIT because of it’s behavioral theoretical foundation
• Therapists wouldn’t like a protocol-driven treatment– Therapists as technicians– Manual/protocol rigid, can’t adjust to change– Non-authentic interactions with clients– Protocol undermines the therapeutic relationship– Protocols rule out clinical judgment, innovation
• Therapists would refuse to do 5-minute coding• PCIT was too difficult to learn
What are the barriers to overcome?
• Therapist instability– Therapists would get trained, then leave
• Organizational instability/commitment– Administrators would not see the value– Agency would accept a new treatment
• That ‘Effect Size’ thing
Estimating the Effect Size:X4 meta-analyses on child therapy
• EBPs have ‘medium’ to ‘large’ effect sizes
‘EBP treatment works’
• Specific tx better than broad-based tx
• Tx effect sustains over time
This is really a good thing… right?
• Well, yes, except these are mostly university-based treatment outcome studies (including PCIT)
• ES in community MH clinics are not as good
What do we need to do to effectively train?
Successful training = adherence to protocol + fidelity (Competence)
Good Training ModelGood Trainers/Training
Committed TraineesOngoing Relationship
Agency Support$
Good Training Model
Parent is to Therapist as Therapist is to Trainer
And PCIT is very robust!
Information Theory/contentSkill Acquisition/Practice Role playsMastery Coached coachingGeneralization How many clients?
InformationSkill Acquisition/Practice Mastery Generalization
Good Training Model
The role of praise in Hong Kong…
Give me the model! -------------------------------------------------------------------------------
Hong Kong February 2004 (multiple days of training)
March/April 2004 (case consultation)
Sacramento February 2005 (multiple CA site visits)
Hong Kong June 2005 (Symposium and additional training)
It’s good that it is hard
Good Training Model – Hong Kong
Identified three Tung Wah staff to be TOTsHeung Yin Kwan(Kitty) Choi Ka Yan(Trian) Chan Kai Wai(Monique)
Good Trainers/Training
Because we have good trainers…
Training Staff
Tanda Almont Alissa Porter Michelle Culver
Shalila Douglas Georganna Sedlar Lareina Ho
Susan Timmer Jean McGrath Lisa Ware
Leslie Whitten Nancy Zebell
UCDavis CAARE Center: 100-112 clients/week
Committed Trainees
UCDMC-trained staff at PCIT6Russ Decker Emma Girard Cheryl Goldberg-Diaz Audra Hirsch Mary Linscomb Tiffany MassonSharon Mellar Elisa Nevius Lori Pack Mary Pratt Naomi Perry Erica PearlRyan Quist Araceli Salazar Janae Tucker
+Agency Stability (OES stable funding)+Leadership within the agency
You are not normal!
Committed Trainees: Hong Kong
+Strong institutional support
TOTs
Heung Yin Kwan
(Kitty)
Choi Ka Yan
(Trian)Chan Kai Wai
(Monique)
Committed Trainees: Hong Kong
+Ivan Yi – Administrative Leadership+Heung Yin Kwan – Program Leadership
TOTs
Heung Yin Kwan
(Kitty)
Choi Ka Yan
(Trian)Chan Kai Wai
(Monique)
Ongoing Relationship
Because we’ve maintained contact…• Conferences (PCIT conferences 1 through 5)• Frequent site visits• Advanced training seminars• Web-based information (www.pcittraining.tv)• Refinements in program development• Ongoing consultation (‘Dear Nancy’)• Training products
– Handouts, sample tx objectives, etc.– Training video series– The Spanish PDI video is just now done!
Ongoing Relationship: Hong Kong
All of the regular training materials and connections
We’re continuing our relationship with Hong Kong
And you will see Hong Kong present at a future PCIT conference
Tung Wah Group of Hospitals
Parent-Child Interaction Therapy Pilot Project in Hong Kong
(Sharing & Demonstration)
Presented for Symposium on New Initiatives of Child Abuse PreventionJune 23, 2005 Tung Wah Group of Hospitals
Heung Yin Kwan, Kitty Centre Supervisor
Lui Wing Cheung Children Centre
0
50
100
150
200
ECBI intensity 154 99
ECBI problem 20 5
Pre Post
The treatment result of PCIT pilot project in H.K.
Change of Children’s behavior problem (ECBI pre & post score)
ECBI intensity clinical cut 131
ECBI problem clinical cut off 15
04080
120160
PSI Total 121 82
Pre Post
The result of PCIT pilot project in H.K.
Change of parents’ stress level (PSI pre & post score)
Clinical range 85% or above
99% less 85%
The result of PCIT pilot project in H.K.
Change of Parenting Behavior (DPICS: pre & post score)
0.00
10.00
20.00
30.00
40.00
PRETEST 0.73 11.55 18.36
POST 16.64 31.55 1.27
Praise Reflective & Descriptive StatementsQuestion, Command & Critical
Statements
mastery criteria 15
mastery criteria less than 3
mastery criteria: 25
Issues and Key Learning from the Project
• Extra-counseling sessions (eg. Telephone counseling & home visit) are provided for individual mental health problems and family crisis to avoid non-attendance and attrition rate.
• Liaison with school professionals to facilitate the case progress.
• Regular professional meetings to enhance treatment integrity and PCIT skill mastery.
• Ongoing staff-training to enhance staff competencies.
Future Development of PCIT Project at TWGHs
• Train of Trainer (TOT) scheme to respond to the increased number of referrals.
• Provide PCIT training to pre-school & primary teachers.
• Expand services to different child clinical problems.
• Conduct research on the project.