Hybrid Effectiveness-Implementation Pilot of Personalized PCIT In Community Mental Health Settings

About This Grant

PROJECT SUMMARY/ABSTRACT Externalizing behavior disorders (EBDs) occur at high rates and have long term negative consequences for children, their families, and for society as a whole. There is robust empirical support for the efficacy of Behavioral Parent Training interventions (BPTs) such as Parent-Child Interaction Therapy (PCIT) for EBDs in children. However, BPT outcomes, including for PCIT, vary widely between controlled efficacy trials and community-based effectiveness trials, and there are variable rates of engagement across families, with dropout rates as high as 82%. Understanding mechanisms that affect parent engagement and treatment outcomes in BPTs is particularly important for services received in community mental health settings (CMHS), where families are most likely to access care. In addition, developing tools to increase engagement and outcome may have strong application in light of large-scale implementations of PCIT in CMHS. A personalized version of PCIT (called MY PCIT) has been developed, addressing key risk factors for low treatment engagement and poor outcomes in BPT that relate to differences between parent and treatment explanatory models. MY PCIT begins with a pre-treatment assessment of parent explanatory models, then provides therapists with a report with personalization guidance and a suite of personalization tools that may be deployed based on the pre-treatment assessment. While pilot data supports the successful development of MY PCIT and its potential to reduce targeted risk factors, more research is needed to prepare it for self-sustaining implementability in CMHS, and to compare engagement and outcomes to standard PCIT. This study is a pilot hybrid type 1 effectiveness-implementation trial designed to gather preliminary data to evaluate the effectiveness and the self-sustaining implementability of MY PCIT in CMHS through the following aims: 1) Engage representative CMHS therapists in mixed methods user testing sessions to identify barriers to/facilitators of implementing MY PCIT and inform areas for modifications to make it more feasible, usable, and appropriate in CMHS. 2) Conduct a randomized controlled trial in CMHS comparing PCIT as usual to MY PCIT to obtain pilot data on engagement, clinical outcomes and targeted mechanism change. 3) Gather therapist-level implementation outcomes data on MY PCIT from the clinical trial. Findings from this pilot study will inform and support a future R01 proposal for a fully powered trial of MY PCIT. This project directly supports the mission of NIMH by advancing research to improve how effective treatments are adapted and sustained in real-world care. It also advances several NIMH Strategic Plan objectives, including: tailoring interventions to increase effectiveness (3.2), testing interventions in real-world settings (3.3), developing innovative service models to improve outcomes (4.3), and promoting sustained implementation of evidence-based treatments (4.2).