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Home-Based vs. Clinic-Based Parent–Child Interaction Therapy: Comparative Effectiveness in the Context of Dissemination and Implementation

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Abstract

Disruptive child behavior disorders remain a major public health issue despite the proliferation of several strong Evidence-Based Practices (EBPs) for these children and their families. This may stem from barriers to treatment facing many families in need, particularly families with low resources. Home-based treatment may be best suited for this population; however, EBPs are not always available or tested as home-based interventions. The current study compares an intensive home-based adaptation of Parent Child Interaction Therapy (PCIT) to the standard clinic-based model in the context of a statewide implementation. As part of the statewide implementation, therapists entered archival data into an online system. Data was gathered for 314 families receiving PCIT, with 181 children in clinic-based PCIT and 133 in intensive home-based PCIT. Consistent with other trials of PCIT, results of the current study indicate that both versions of the therapy were effective in reducing child-behavior problems and increasing parenting skills; however, there were marked differences in attrition. Intensive home-based participants were twice as likely to complete treatment (64.66%) compared to clinic-based participants (33.15%) despite facing more adversity. These results underscore the importance of scientifically-sound adaptations of EBPs, as well as the role of comparative effectiveness studies as a critical tool in the integrative model of intervention science.

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Acknowledgements

We acknowledge the tremendous contribution of Dr. Cheryl McNeil to this implementation. Her home-based adaptation provided a foundation for our model. She also trained some of the providers herself. Overall, we owe her a great deal for ongoing support, consultation, and encouragement. We also thank the implementation team members, therapists, and families that made this work possible.

Author Contributions

T.R.F.: designed and executed the study, wrote major parts of the manuscript, coordinated the analyses and writing of the manuscript. J.J.M.: oversaw training and implementation of community and HB models collaborated with the design and writing of the study, wrote several key sections. L.M.: collaborated with the design, execution, and writing of the study, analyzed data, wrote several key sections, assisted with the submission of the paper. R.M.B.: collaborated with the design, execution and writing of the study, wrote several key sections. A.A.W.: analyzed the data, wrote part of the results, and collaborated in the editing of the final manuscript. M.A.S.: assisted with the execution of the study, created and implemented the coding system for attrition/completion, analyzed data. B.P.P.: assisted with the execution of the study, analyses, and editing of the manuscript.

Funding

This study was funded by Grant Number SM58493 from the Substance Abuse and Mental Health Services Agency (SAMHSA) and administered by the State of Delaware’s Division of Prevention and Behavioral Health Services. The content of the publication reflects only the views of the authors and not necessarily of funders or stakeholders.

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Authors and Affiliations

  1. University of Delaware, Newark, DE, 19716, USA

    Timothy R. Fowles, Ryan M. Beveridge & Marissa A. Smith

  2. Boston Child Study Center, Boston, MA, USA

    Joshua J. Masse

  3. University of Massachusetts - Dartmouth, North Dartmouth, MA, USA

    Joshua J. Masse

  4. Wayne State University, Detroit, MI, USA

    Lucy McGoron

  5. Perelman School of Medicine, University of Pennsylvania, Children’s Hospital of Philadelphia (CHOP), Philadelphia, PA, USA

    Ariel A. Williamson

  6. University California - San Diego, San Diego, CA, USA

    Brendt P. Parrish

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  1. Timothy R. Fowles
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Correspondence to Timothy R. Fowles.

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Fowles, T.R., Masse, J.J., McGoron, L. et al. Home-Based vs. Clinic-Based Parent–Child Interaction Therapy: Comparative Effectiveness in the Context of Dissemination and Implementation. J Child Fam Stud 27, 1115–1129 (2018). https://doi.org/10.1007/s10826-017-0958-3

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