Parent-Child Interaction Therapy:International Spotlight

Anthony Urquiza, Ph.D.

6th Annual PCIT Conference

University of Florida

Gainesville, FL

International Spotlight: Hong Kong

PCIT in Hong Kong

PCIT in Hong Kong

PCIT in Hong Kong

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

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)

PCIT in Hong Kong

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

Hong Kong PCIT Protocol

The Chinese Version of PCIT treatment & DPICS

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.

PCIT in Hong Kong