The Dissemination of Parent–Child Interaction Therapy in West Virginia during the Opioid Epidemic and COVID-19 Pandemic: A Qualitative Study
Abstract
:1. Introduction
1.1. The Need for Parent–Child Interaction Therapy in West Virginia
1.2. The State Opioid Response Grant
1.3. The Current Study
2. Materials and Methods
2.1. Trainers
2.2. Trainees
2.2.1. Recruitment
2.2.2. Description of Therapists
2.3. Training Description
2.3.1. Training of PCIT Therapists
2.3.2. Training of Within-Agency Trainers and Regional Trainers
2.4. Participants Included in Qualitative Analysis
2.5. Procedure
3. Results
3.1. Therapist Training Experiences
3.2. Shift to Telehealth Delivery of PCIT during the COVID-19 Pandemic
3.3. Families Treated through the SOR Grant
3.4. Impact of the Opioid Crisis on Families
4. Discussion
4.1. Strengths
4.2. Limitations
4.3. Future Directions
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | n (%) |
---|---|
Credentials | |
Doctoral | 13 (38%) |
Masters | 20 (59%) |
Student | 2 (6%) |
Licensed | 26 (76%) |
Years in profession (M = 10.47 years, SD = 8.03) | |
0–10 years | 19 (56%) |
11–20 years | 9 (26%) |
21–30 years | 4 (12%) |
31–40 years | 1 (3%) |
Not reported | 2 (6%) |
Therapist setting | |
Academic medical center | 1 (3%) |
Child advocacy center | 5 (15%) |
Community-based mental health center | 7 (21%) |
Early intervention | 1 (3%) |
Local health department | 1 (3%) |
Outpatient behavioral health clinic | 11 (32%) |
Private practice | 6 (18%) |
School-based mental health | 1 (3%) |
University-based training clinic | 5 (15%) |
Other | 5 (15%) |
Client payment format | |
Insurance | 25 (74%) |
Self-pay | 14 (41%) |
Sliding-scale fee | 13 (38%) |
Services are free of charge | 14 (41%) |
Not reported | 1 (3%) |
Code Theme | Theme Specification | Example Excerpt | % of Therapists Endorsed |
---|---|---|---|
Themes Related to Therapist Training Experiences | |||
Training Strengths Positive comments about or satisfaction with overall PCIT training | Experiential Components Positive comments about or satisfaction with role-play or volunteer family components of training | “I think practicing, so doing our own practice to reach the mastery criteria was really helpful.That way I knew what I am expecting of parents and how challenging it can be. But also, that just helps me to understan’d what I’m teaching as I’m going through the Teach sessions as well.” | 71% |
Trainer-related Strengths Positive comments that are inherent to the trainer or related to what the trainer has done; trainer expertise | “[The trainer] was really familiar with the ins-and-outs of practicing and providing. She was able to answer a lot of those really nuts and bolts questions and’ it wasn’t just content she knew, she knew the implementation of the craft and that doesn’t always happen. Some’times it’s just someone teaching you something new without having practiced it for a long time.” | 59% | |
Logistics and Organization Positive comments about the organization and format of the training (e.g., virtual or in-person format, group setting) | “Being able to talk to colleagues about what they were doing through this process as well and how they were implementing PCIT.” “It was smaller. Most of the ones I’ve attended have been big conferences. And I really appreciated that, just more personal aspect, more hands-on aspect.” | 68% | |
Thorough/Information Positive comments about the training being informative, training providing helpful information, the training being thorough/detailed | “We really did a good job of going through each part of it. How to prepare for it, the paperwork, how to introduce clients, parents, and children to how it works. And actually go through these scenarios. Now that was a strength.” “I didn’t feel like I was missing anything by the end of the training. I felt fully prepared to kind of jump into the actual practice by the end of it.” | 56% | |
Training Weaknesses Comments about weaknesses or areas for improvement related to the overall PCIT training | Experiential Components Suggestions or dissatisfaction with role-play or volunteer family components of training | “We would have done more, more role-play… It’s hard to know what issues you’re going to face just from taking in the information, so I think we would have done a little bit more, more role play.” “I feel like we had excellent support in that but it would have been nice to even have a follow-up with the same patients that we had seen in the first place.” | 32% |
Logistics and Format Suggestions or negative comments related to the location or format of the training (e.g., virtual or in-person format, group size) | “More time in the lab with families. Maybe having a second or third family to work with so everybody got a little more time.” “The only thing I think, maybe, there were like a lot of people in our training. I wish there was a way to get it more scaled down. It was a lot harder to kind of get one on one time with the trainers. That’s a small complaint, nothing big.” | 65% | |
PDI Training A weakness or improvement related to the PDI portion of the training (e.g., wanting more PDI training, dissatisfaction of PDI training component) | “The second training was all about the PDI phase and I remembered wishing we could have had longer. We didn’t do too much PDI during the first five day training.” “I wish that we would have more training in PDI because that one you don’t get to very often, to be honest. You get CDI a lot, but you don’t get a lot of PDI. So having more training in the PDI would have been highly effective for future use.” | 14% | |
Consultation Call Strengths Positive comments about or satisfaction with the consultation call series | Expert Trainer Advice Positive comments about receiving consultation on their cases from a seasoned PCIT trainer (e.g., case-specific questions, difficult ethical questions) | “[Trainer] is so educated, she’s the master so it’s wonderful to get her eyes and her ideas on my cases to prepare me for when I’m working with family and things come up.” | 76% |
Group-based Format Therapist found the group-based nature of the consultation calls to be helpful (e.g., collegiality, support from the group) | “I think finding out how other people were implementing PCIT and being able to collaborate with peers throughout the state was very helpful.” | 53% | |
Experiential Components Therapists found the skills practice portion of consultation calls to be helpful | “Real life learning experience through the consultation calls.” | 21% | |
Consultation Call Weaknesses Comments about weaknesses or areas for improvement related to the overall consultation call series | Not Enough Cases Comments related to how a lack of PCIT cases made the consultation call experience less helpful for them | “I think the first thing I’m thinking of is that a lot of the people on my consultation calls haven’t had cases and that’s just kind of a bummer because there’s maybe two or three of us who do talk and get to troubleshoot a lot of things, but some other people haven’t had any cases at all, so they don’t get to participate as much so I don’t know that anything could be done about that.” | 18% |
Format Weaknesses or suggestions regarding the format of the consultation calls (e.g., group size) | “Having it as a call made it just too easy to throw a load of laundry in the washer or something like that, if you had to.” “Well in our consultation calls I think there was… 15 or 20 of us.” | 24% | |
Inconvenient Time Comments about when the consultation calls occurred within the week and day | “For my group, it worked best for everybody’s schedules but like for me I work more later day/evening… I wasn’t a fan of the 8:00 AM calls.” “The calls started to conflict with my schedule.” | 18% | |
Desire for More Time Dissatisfaction about the lack of time to go through cases and topics in consultation calls | “I think, perhaps, sometimes we ran out of time talking about really interesting cases” | 18% | |
Themes Related to Experiences with Telehealth Implementation of PCIT | |||
Telehealth Facilitators Comments related to factors that facilitated the use of telehealth- delivered PCIT | Convenience for Client Positive attributes about Telehealth in relation to convenience for families | “I think the positive piece is that families feel more comfortable in their home and it also fits for families who have resource needs. It fits their schedule, availability, timeline a little bit better, which are positives.” | 56% |
Reduced Transportation Barriers Telehealth eliminated obstacles associated with transportation | “I will continue to offer telehealth because we live in a very rural state, some people just aren’t close to one of our offices or don’t have transportation.” “I think it’s a really good option for a lot of families who have a hard time traveling or don’t have the means to.” | 44% | |
Agency Support Comments related to the agency for which the therapist works providing the support and infrastructure necessary to offer telehealth services | “We went straight to telehealth. I would say, maybe within a week or two. They did a really good job of helping us switch over quickly…” “Most of us already had access to webcams of some nature, whether it was in a laptop, a phone…if you didn’t have that, then they bought them for us…” | 38% | |
Generalizability Comments related to telehealth aiding in the generalizability of therapy skills to the family’s home environment | “I think sometimes it’s a little more realistic for families to practice these skills at home because that’s where the behaviors are happening.” “One thing that I really have appreciated about telehealth with PCIT is that you can see kind of where the parents are doing special time, you can see more of… what the home environment looks like which is really helpful to have that direct view instead of relying on their explanations of what things look like…” | 32% | |
Telehealth Barriers Comments related to factors that hindered telehealth treatment accessibility or implementation | Therapist-Family Connection Comments related to telehealth impairing the therapist’s ability to connect with families | “I think I have less of a connection with the client. I mean the parent or the child with telehealth. And it’s not because I’m afraid of it or I haven’t gotten used to it, the connection is just not the same. Not as personal.” “Just because in my experience with telehealth it’s been harder to engage them [children] than it has been adults.” | 65% |
Technology Comments related to either the family or therapist not having the necessary technology to support telehealth sessions | “I did not have any success delivering PDI sessions virtually, simply because of the internet capabilities or lack thereof of my patients.” “There are technical problems, there’s lagging, there’s volume issues with the technology… You might be in the middle of something really important with a client, and in person it wouldn’t be an issue, but all of a sudden something cuts out or ‘can you repeat that,’ it kind of just disrupts the flow of therapy.” | 44% | |
Low Family Resources Comments related to telehealth treatment not being accessible or as successful as in-person treatment due to low family resources | “They simply didn’t have the bandwidth to be video conferencing with me and for me to be coaching them using a bug in the ear.” “...Trying to figure out how to get a parent equipment that they might need like earbuds or headphones that we would have for them automatically in the clinic.” | 9% | |
Lack of Agency Support Comments related to treatment not being accessable or as successful as in-person treatment due to lack of support from the therapist’s agency (e.g., not providing the appropriate platforms or supplies) | “… And my agency tried to keep us doing therapy, but they weren’t prepared at all for telehealth sessions… essentially everyone was just kind of laid off and then brought back in September.” “It was basically, ‘Go figure this out’, ‘Go do this’, … and there was no ability to do that. You just had to keep going and figure [telehealth] out.” | 5% | |
PCIT Confidence Comments about factors that contributed to the therapist’s confidence in delivering the PCIT model | General Experience Comments related to high levels of therapist confidence due to their previous experience in the field | “Because I feel like those are a lot of skills that I use in therapy anyway with children and adults so I feel pretty confident with skills that I’m trying to teach the parents.” | 14% |
PCIT-specific Experience Comments related to high levels of therapist confidence due to their experience providing PCIT | “I feel really confident that I know the model and that I can provide high fidelity PCIT treatment, that I’ve studied it, that I’ve practiced it, that I’ve got good consultation and supervision. And I see the results in my cases.” | 67% | |
Predictability and Control Comments related to high levels of therapist confidence due to the predictable and consistent nature of therapy or feelings of control over the session | “I have the skills and I have the manual, and I have a curriculum that I could follow to be successful at sticking to the integrity of the curriculum.” | 47% | |
Lack of PCIT Confidence Comments about factors that contributed to the therapist’s lack of confidence in delivering the PCIT model | General Experience Comments related to decreased levels of therapist confidence due to their lack of experience in the field | “I always have room to grow, I’m not perfect in everything and there’s always new things to learn. There’s always children that are gonna come in and throw your game off.” | 15% |
PCIT-specific Experience Comments related to decreased levels of therapist confidence due to their lack of experience providing PCIT | “I just don’t know if I can effectively portray the PCIT curriculum to the clients and they can understand and get it.” “I’m not as comfortable with [PDI] delivery because I’ve had a lot of dropouts … after things get successful.” | 71% | |
Unpredictability and Lack of Control Comments related to decreased levels of therapist confidence due to the unpredictable and inconsistent nature of therapy or lack of control over the session | “Because of the PDI component and the lack of being able to really support a parent if they get into a difficult situation. It’s not like you can press the stop button or really assist them when you’re virtual. And you don’t have much control over the environment that they have.” “There is just a lack of control in PDI and not having eyes on a kiddo could potentially be dangerous and that is anxiety producing.” | 79% | |
Poor Internet Connection Comments related to decreased levels of therapist confidence due to poor internet connectivity | “I feel less confident because, you know, technology in that situation is a little bit trickier to navigate, and technology is always going to raise its ugly head at some point or another [such as] the internet cutting out.” “I did have a situation where the phone that they were using died in the middle of a time-out and I was like ‘ahh,’ but it just feels like more is needed of me and technology sometimes works great and sometimes doesn’t.” | 18% | |
Themes Related to the Impact of the Opioid Crisis on Therapist Delivery of PCIT | |||
Opioid Case Differences Comments about the ways in which PCIT cases with opioid use in the family differed from cases without opioid use in the family | Frequent Crises Comments related to frequent crises experienced by PCIT families impacted by family member opioid use | “... and at the same time there was a lot of instability. The [grandparents who were the child’s caregivers] would come in one week and they would be confident that their child [who was the child’s mother] was going to rehab and then the next week that plan had kind of flipped upside down. So I would kind of say … there was a lot of instability or inconsistency in kind of what our plans were from week to week.” “a lot more instability as far as like placement and visits.” | 47% |
Inconsistent Attendance Comments about how cases affected by opioid use had more inconsistent attendance than those not affected by opioid use | “Probably the commitment of the families, sometimes it was challenging to keep them committed if there was opioid issues in part of the treatment” “much, much more higher percentage of dropout and like length of time between sessions.” | 21% | |
Strained Family Relationships Comments about how cases affected by opioid use had greater strain in family relationships than those not affected by opioid use | “Providing more psychoeducation how if that client themselves weren’t struggling with addiction, how addiction impacts that individual and affects the whole family.” | 21% | |
Low Family Resources Comments about how families impacted by opioid use were lower resourced than other families | “I would say [these cases] became more complicated because some people who were in the midst of recovery had difficulty maintaining all the resources they needed.” | 18% |
Characteristic | n (%) |
---|---|
Child diagnoses 1 | |
ADHD 2 | 37 (25%) |
Anxiety | 8 (5%) |
Autism | 9 (6%) |
Cognitive/developmental delay | 20 (14%) |
CD/DMDD/ODD 3,4,5 | 26 (18%) |
Caregiver role involved in treatment 1 | |
Adoptive parents | 13 (9%) |
Foster parents | 12 (8%) |
Biological parents | 100 (68%) |
Grandparents | 21 (14%) |
Other relatives | 18 (12%) |
Single caregiver involved in treatment | 88 (60%) |
Multiple caregivers involved in treatment | 59 (40%) |
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Druskin, L.R.; Han, R.C.; Phillips, S.T.; Victory, E.J.; Aman, E.; Tiano, J.; Stokes, J.; McNeil, C.B. The Dissemination of Parent–Child Interaction Therapy in West Virginia during the Opioid Epidemic and COVID-19 Pandemic: A Qualitative Study. Int. J. Environ. Res. Public Health 2022, 19, 15085. https://doi.org/10.3390/ijerph192215085
Druskin LR, Han RC, Phillips ST, Victory EJ, Aman E, Tiano J, Stokes J, McNeil CB. The Dissemination of Parent–Child Interaction Therapy in West Virginia during the Opioid Epidemic and COVID-19 Pandemic: A Qualitative Study. International Journal of Environmental Research and Public Health. 2022; 19(22):15085. https://doi.org/10.3390/ijerph192215085
Chicago/Turabian StyleDruskin, Lindsay R., Robin C. Han, Sharon T. Phillips, Erinn J. Victory, Emily Aman, Jennifer Tiano, Jocelyn Stokes, and Cheryl B. McNeil. 2022. "The Dissemination of Parent–Child Interaction Therapy in West Virginia during the Opioid Epidemic and COVID-19 Pandemic: A Qualitative Study" International Journal of Environmental Research and Public Health 19, no. 22: 15085. https://doi.org/10.3390/ijerph192215085