Parent-Child Interaction Therapy PCIT Across PA Team Amy D. Herschell, Ph.D. Shelley A. Hiegel, MEd, MSCP, NCC Kristen F. Schaffner, Ph.D., NCSP Ashley T. Scudder, Ph.D. Sarah Taber-Thomas, Ph.D. Collaborating Partners Susan Dougherty, Ph.D. Psychologist and Implementation Scientist, formerly at Children s Hospital of Philadelphia Denise Namowicz, LCSW, BCD Vice President of Clinical Services at Children s Service Center Priscilla Zorichak, LPC PCIT Coordinator at Children s Service Center April 28, 2015
Overview Parent-Child Interaction Therapy (PCIT) - BRIEF Overview Current Implementation of PCIT in Pennsylvania Where are we now? How did we get here? Where are we heading? Discussion Items Feedback on Future Directions What would be interesting to you?
What is PCIT? Work with the parent (birth, kin, foster, adoptive) and child together Designed to treat children age 2.5 to 7 years exhibiting disruptive behaviors Use of coaching with a bug-in-the-ear from a one-way mirror Consists of two phases of treatment: Child Directed Interactions (CDI) or relationship enhancement Parent Directed Interactions (PDI) or child behavior management McNeil, C.B., & Hembree-Kigin, T. (2010). Parent-Child Interaction Therapy. Second edition. New York: Springer.
Current PCIT in PA
2014 Pennsylvania Agencies Providing Parent-Child Interaction TherapyTherapy Last Updated March 2, 2015
PCIT in PA Summary (study + non-study) 60 Counties 100 Agencies 238 Clinicians All Clinicians: are in or have completed training are now able to see families using PCIT
A Statewide Trial to Compare Three Training Models for Implementing an EBT Funder: NIMH R01 MH095750 Pittsburghbased Team PCIT Experts Pennsylvania Stakeholders and Steering Committee Science Experts Start Date: 9/18/12 Project Length: 5 years Budget: 3.3 million Project PI: Amy Herschell, Ph.D. Project Coordinator: Shelley Hiegel, M.Ed. Project Trainers: Ashley T. Scudder, Ph.D. Sarah Taber-Thomas, Ph.D. Kristen F. Schaffner, Ph.D. NCSP
Current Team
PCIT Across PA Alumni
Specific Aims 1) to build knowledge about training outcomes 2) to build knowledge about implementation outcomes 3) to understand the impact of training clinicians using different training methods on key child and family outcomes
PCIT Across PA: Counties Randomized to Condition Cascading Hierarchical training process. Strong and specific focus on two clinicians. Distance Education Use of technology to facilitate learning. Potential broad public health impact. Learning Collaborative Addresses multiple organization levels. Emphasizes cross-site sharing across teams. Integrates a quality improvement process. NIMH R01 MH095750; A Statewide Trial to Compare Three Training Models for Implementing an EBT. PI: Herschell
Data Collection Administrators (baseline, 6, 12, & 24 months) Cost, Acceptability, Feasibility, Penetration, Sustainability Supervisors (baseline, 6, 12, & 24 months) Acceptability, Fidelity, Skill, Knowledge, Satisfaction Clinicians (baseline, 6, 12, & 24 months) Fidelity, Acceptability, Feasibility, Skill, Knowledge, Satisfaction Families (baseline, 3, 6, & 12 months) Treatment Outcome (child, parent), Perceived Barriers, Service Utilization, Satisfaction Proctor, E.K., et al. (2010) Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health, DOI: 10.1007/s10488-010-0319-7.
Counties approached for PCIT Across PA Waves 1-4
Statewide Steering Committee Membership Considerations Child Serving Systems Child Welfare Education Juvenile Justice Mental Health Regions of the State Urban/Rural Ultimate Goal - Representative from any group affected by PCIT Implementation including Consumers
Steering Committee Members Parent of children with BH concerns Communications Consultant State OMHSAS President & CEO Behavior Health MCO Statewide Child Psychiatric Consultant OMHSAS Clinician Community-based MH Agency Senior Medical Director Behavioral Health MCO Parent who has completed PCIT Practice Improvement Specialist, The Pennsylvania Child Welfare Resource Center Program Specialist Supervisor State Child Welfare Service Systems Specialist Behavioral Health Alliance of Rural Pennsylvania Professor of Psychiatry, Psychology & Pediatrics Director of Pupil Services & Special Programs School District Director Penn State EPIS Center Executive Director Community-based MH Agency Children s Policy Specialist Pennsylvania Community Providers Association ECMH Project Manager Pennsylvania Key Director, Evidence-based Practice and Innovation Center (EPIC)
Sample Discussion Topics Project Name & Logo Assessment Protocols Recruitment Procedures Randomization Regular Study Updates Credentialing & Certification in PA Statewide Referral List PCIT International Convention Planning Infrastructure Development Sustainability
Past PCIT in PA
Milestones Date Fall 2008 January 2009 January 2010 March 2010 April 2010 Milestone Discussions & Stakeholder meetings being in Pittsburgh CHOP awarded grant from The Annie E. Casey Foundation Pittsburgh group awarded grant from the Clinical Translational Science Institute at Pitt Pittsburgh group awarded grant from the Staunton Farms Foundation Berks County awarded grant from the Heinz Endowments
Milestones (continued) Date Summer 2010 Milestones Fayette County begins PCIT Training through System of Care support December 2010 Southwestern Behavioral Management Inc starts a training group June 2011 October 2011 Pittsburgh group awarded grant from Allegheny County System of Care Starting Early Together Community Care to start a training group
Milestones (continued) Date January 2012 June 2012 September 2012 Milestones Northwestern Behavioral Management Inc starts a training group Additional groups fund training (e.g., Lancaster County) National Institute of Mental Health Grant (3.3 million) awarded SAMHSA Level III Grant (1.5 million) awarded 2 nd annual Statewide Networking Meeting
2011 Pennsylvania Agencies Providing Parent-Child Interaction Therapy
2012 Pennsylvania Agencies Providing Parent-Child Interaction Therapy
2013 Pennsylvania Agencies Providing Parent-Child Interaction Therapy
2014 Pennsylvania Agencies Providing Parent-Child Interaction TherapyTherapy Last Updated March 2, 2015
Future PCIT in PA
What s Next? The Not-too-Distant Future Building Infrastructure Steering Committee PA Agency Referral List Ongoing Data Collection to Inform Practice PA PCIT Implementation Study (NIMH R01) Sustainability Large-Scale PCIT Initiatives Study
Sustaining the Work Maintenance and growth after initial training 12 Large-Scale PCIT Initiatives (across United States) Participants: Key stakeholders involved in each initiative Training and Implementation Survey Sustainability Discussion Outcomes: Training and Implementation Characteristics Barriers for Sustainability Strategies for Sustainability Lessons Learned
Initiative Characteristics Presence of a PCIT Champion/s Training Support Center In-State Trainer System Service Reimbursement Changes in Policies/Regulations Public Roster of Trained Clinicians/Agencies Large-scale Clinical Monitoring Outcomes Funding Diversity Clinician Connectedness Limited/Variability in Skills with early childhood
Barriers Sustainability Fluctuation Over Time Competing Services or Programs Workforce Instability/Turnover (from agency) Clinician Attrition (no longer providing) False Advertising by Untrained Professionals Agency Intake/Caseload Structure Availability of Referrals for Trainees Moving towards PCIT certification Ongoing Costs (setups, equipment) One-year Fiscal Cycle (State, Private Insurance)
Strategies to Sustain Building a Clinician Network Building a Referral Source Network Building a Within Agency Trainer Network Training a Selective/Qualified Workforce Providing Implementation and Sustainability Training System-Level Infrastructure Development Strategic Marketing Regional or State PCIT Conference and Network Meetings Continued Training and Ongoing Consultation Continuing Education Opportunities
Parent Feedback
What Pennsylvania Parents Say About PCIT Participants articulated that they and their child enjoyed going to PCIT sessions. When he got it with the PCIT, he was like, Wow. I love this. And so, he wants to do it all the time. He always calls me, asking me like, Can we go to play therapy? So that was the biggest thing for me. He was looking forward to it every week so it really became a time that we bonded. That was definitely my favorite part.
What Pennsylvania Parents Say About PCIT I just wish it were available to everyone. It was just so helpful. I mean so positive. I wish I had known about it awhile ago because I ve had these behaviors in the house since my oldest [was my] only child and my youngest. Because I have never been able stop it that. Where I didn t find out about it until my fourth child and I think the behaviors would have been gone awhile ago.
Clinician & Administrator Feedback
What Pennsylvania Clinicians and Administrators say about PCIT Please welcome some of our collaborative partners Susan Dougherty, Ph.D. Psychologist and Implementation Scientist, formerly at Children s Hospital of Philadelphia Denise Namowicz, LCSW, BCD Vice President of Clinical Services at Children s Service Center Priscilla Zorichak, LPC PCIT Coordinator at Children s Service Center
Questions? 38
Thank you for your time and interest! Shelley Hiegel, MEd, MSCP, NCC Western Psychiatric Institute & Clinic University of Pittsburgh School of Medicine 3811 O'Hara Street - 505 Bellefield Towers Pittsburgh, PA 15213 Phone: 412-246-5886 Fax: 412-246-5341 hiegelsa@upmc.edu