Delivering Parent-Child Interaction Therapy Via Telehealth

Telehealth is here to stay. Consequently, experts are exploring how well existing therapies for mental health care translate to a virtual, remote treatment setting.

Psych Congress Network spoke with Daniel Bagner, PhD, professor of psychology and director of clinical training in Child and Adolescent Psychology at Florida International University about his study, “Telehealth Treatment of Behavior Problems in Young Children With Developmental Delay: A Randomized Clinical Trial,” recently published in JAMA Pediatrics.

In Part 1 of this video Q&A, Dr Bagner explains the study aims, methods, and results of practicing Parent-Child Interaction Therapy via telehealth. He discusses the study’s most surprising takeaways, and their implications for mental health care clinicians.

Find Part 2: Using Telehealth to Deliver Behavioral Interventions for Children here. Visit our Telehealth Excellence Forum for more expert insights on how to improve patient outcomes remotely.

Daniel Bagner, PhD, is Professor of Psychology and Director of Clinical Training and the Clinical Science Doctoral Program in Child and Adolescent Psychology at Florida International University (FIU). A licensed and board-certified clinical child psychologist, Dr Bagner studies interventions for at-risk infants and young children and their families and etiological models of early childhood behavior problems. He has published more than 90 scientific papers and chapters on these topics and has been continuously funded by the National Institutes of Health (NIH) for the past 19 years to conduct his research. Dr Bagner currently serves on the editorial board for five journals and was a member of the Psychosocial Development, Risk, and Prevention (PDRP) study section at the National Institutes of Health. He is involved in several professional and community organizations, including his role as the FIU representative to the board of directors for The Children’s Trust, an organization with a dedicated source of revenue to fund strategic investments that improve the lives of children and families in Miami-Dade County, Florida.

Read the Transcript:

Daniel Bagner, PhD: I'm Dr. Daniel Bagner. I'm a professor of psychology at Florida International University, and also at the Center for Children and Families. I'm also the director of the Clinical Science Doctoral Training Program.

We know that behavior problems such as aggression and defiance and oppositional behavior are very, very common in children with developmental delays and they can be highly problematic and cause a lot of challenges for the children and their families. But multiple barriers exist for these kids to get the right services for these problems, including things like transportation to a clinic or even stigma going to a clinic. That could impact them receiving the services that they need for their care.

So we were interested in taking an approach that we know can be effective for treating these problems in children with developmental delay and testing it being delivered via telehealth. That is, delivering the intervention over webcams and working with families and children while they're in the comfort of their own home.

This study was a randomized controlled trial. Families either were randomized to receive the intervention, which is called Parent-Child Interaction Therapy, an internet delivered version of that, or iPCIT, or referrals as usual as a control condition. They were referred to other places to get services, and they may or may not have received those services.

Some of our most significant findings are that we found that iPCIT, our treatment that we were testing, led to significant improvements in behavior in the child and also in significant changes in the parenting practices among the caregivers during their interactions with their child.

In this treatment approach, in PCIT, the focus is on improving the interactions or the relationship between the parent and the child. One of the main features of the sessions involve the therapist providing live feedback and coaching to the parent while their child is interacting with them. Even when we deliver this intervention in the clinic, the therapist is typically behind a one-way mirror coaching the parent through a wireless headset device. It made a lot of sense in this particular study to do this remotely because in clinic you're not actually in the same room as the parent anyway, so this was an ideal treatment to test the telehealth delivery of this approach.

We thought that the treatment would also lead to improvements in parenting or caregiver stress. We actually found that all of our caregivers in this study reported decreases in stress, but we didn't find that the treatment led to more decreases in stress than the control condition. This was somewhat surprising, although we know that it can be very, very stressful to have a child with a developmental delay and with a child with behavioral problems. This might suggest that we may need additional support for families, especially for those caregivers who have higher levels of stress.

I think the message for providers is that in this new day and age after COVID, where treatments are provided via telehealth, that we know that this type of treatment in particular can be very effective for children with developmental delay. We're actually working with families in their home, in the environment that they're trying to resolve any challenges in their child's behavior. And so if clinicians are aware of programs like that in their community, they can feel confident that by referring children to those services, that they can get the right support that they need.