Remotely Delivering Real-Time Parent Training to the Home: An Initial Randomized Trial of Internet-Delivered Parent-Child Interaction Therapy (I-PCIT)

Objective: Remote technologies are increasingly being leveraged to expand the reach of supported care, but applications to early child-behavior problems have been limited. This is the first controlled trial examining video-teleconferencing to remotely deliver behavioral parent training to the home setting with a live therapist. Method: Racially/ethnically diverse children ages 3-5 years with disruptive behavior disorders, and their caregiver(s), using webcams and parent-worn Bluetooth earpieces, participated in a randomized trial comparing Internet-delivered parent-child interaction therapy (I-PCIT) versus standard clinic-based PCIT (N = 40). Major assessments were conducted at baseline, midtreatment, posttreatment, and 6-month follow-up. Linear regressions and hierarchical linear modeling using maximum-likelihood estimation were used to analyze treatment satisfaction, diagnoses, symptoms, functioning, and burden to parents across conditions. Results: Intent-to-treat analyses found 70% and 55% of children treated with I-PCIT and clinic-based PCIT, respectively, showed "treatment response" after treatment, and 55% and 40% of children treated with I-PCIT and clinic-based PCIT, respectively, continued to show "treatment response" at 6-month follow-up. Both treatments had significant effects on children's symptoms and burden to parents, and many effects were very large in magnitude. Most outcomes were comparable across conditions, except that the rate of posttreatment "excellent response" was significantly higher in I-PCIT than in clinic-based PCIT, and I-PCIT was associated with significantly fewer parent-perceived barriers to treatment than clinic-based PCIT. Both treatments were associated with positive engagement, treatment retention, and very high treatment satisfaction. Conclusion: Findings build on the small but growing literature supporting the promising role of new technologies for expanding the delivery of behavioral parent training. What is the public health significance of this article? This study provides the first evidence from a controlled trial supporting the feasibility, acceptability, and preliminary efficacy of leveraging video-teleconferencing technology to remotely deliver live parent training to the home setting. With continued support, such a format may play an important role in improving the accessibility and scope of supported treatments for traditionally underserved populations by overcoming geographic barriers to quality mental health care and extending the reach of evidence-based treatment providers.