The impact of incentives on treatment adherence and attrition: A randomized controlled trial of Parent-Child Interaction Therapy with a primarily Latinx, low-income population

Advancements in the implementation of evidence-based family therapies have yielded successful reductions in child disruptive behavior. Unfortunately, effective interventions such as Parent-Child Interaction Therapy (PCIT) are plagued with high rates of attrition and low rates of homework completion in community clinics. Objective: To evaluate the use of low-cost incentives on attendance and homework adherence in PCIT in a community mental health center. Method: Families referred for PCIT (N = 84; 63.1% Latinx) were randomly assigned to receive PCIT as usual or PCIT plus incentives. Families were able to earn incentives for attendance, homework completion, and therapeutic skill mastery. Results: Attrition rates (59.5%) were reflective of other community-based intervention studies, with a significant reduction in no-show rates for families receiving incentives. No significant changes were found between groups on attainment of therapeutic skill mastery or number of sessions prior to termination. Families completed homework at low rates with no differences between groups. Conclusions: Low-cost incentives largely did not impact meaningful outcomes for attendance in parent training, although no-shows were less likely. These findings suggest that adherence is a complex phenomenon requiring multi-faceted solutions.