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Parent-Child Interaction Therapy: Advances toward Health Equity

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Adolescents".

Deadline for manuscript submissions: closed (28 February 2023) | Viewed by 33847

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Special Issue Editors

Dr. Larissa Niec

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Chief Guest Editor

Center for Children, Families, and Communities, Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, 48859 USA
Interests: parent-child relationships; prevention interventions for parents; in vivo therapeutic coaching; health equity

Dr. Beverly Funderburk

E-Mail Website
Assistant Guest Editor

Dept. of Developmental/Behavioral Pediatrics, University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma 73117 USA
Interests: parent-child interventions; implementation of evidence-based practices; cultural translations

Special Issue Information

Dear Colleagues,

The parent–child relationship is at the top of a developmental cascade that influences the long-term trajectory of children’s emotional, behavioral, and physical well-being. Increasing evidence demonstrates that nurturing and effective parenting provides a buffer against a number of types of adverse experiences at the individual (e.g., parent psychopathology), family (e.g., marital conflict), and systemic (e.g., poverty) levels. Parent–child interaction therapy (PCIT) is an evidence-based intervention that builds positive parenting skills and strengthens the parent–child relationship. PCIT has demonstrated the potential to prevent or ameliorate a wide range of developmental risk factors; it has been successfully transported across cultures, and shows lasting positive effects.

This Special Issue will include manuscripts that evaluate, conceptualize, or review PCIT and adaptations of PCIT that seek to address pressing public health issues. Submissions may be theoretical or empirical in nature. Below is a list of topics that may be appropriate for the Issue. This list is not exhaustive.

Innovations in the dissemination and implementation of PCIT to improve access to services among underserved populations or in low-income countries;
Evaluations of PCIT or adaptations of PCIT with families from marginalized communities;
Investigations of process variables/mechanisms of change that influence intervention outcomes, particularly outcomes for families underrepresented in previous research;
Evaluations of PCIT therapist or trainer training models;
Investigations of adaptations of PCIT to address child health problems;
Reviews of existing adaptations of PCIT;
Conceptualizations of tailoring/adaptation of PCIT for pressing health/mental health issues.

Submissions for full articles should be no more than 25 pages in length, and brief reports should not exceed 15 pages. Further details about submission will be forthcoming.

Dr. Larissa Niec
Dr. Beverly Funderburk
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Parent–child interaction therapy
Health disparities
Health equity
Family-focused prevention
Parent–child relationship
Parenting interventions
Parent management training
Child conduct problems

Published Papers (12 papers)

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Research

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20 pages, 381 KiB

Open AccessArticle

The Dissemination of Parent–Child Interaction Therapy in West Virginia during the Opioid Epidemic and COVID-19 Pandemic: A Qualitative Study

by Lindsay R. Druskin, Robin C. Han, Sharon T. Phillips, Erinn J. Victory, Emily Aman, Jennifer Tiano, Jocelyn Stokes and Cheryl B. McNeil

Int. J. Environ. Res. Public Health 2022, 19(22), 15085; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192215085 - 16 Nov 2022

Viewed by 1471

Abstract

The devastating impact of the opioid crisis on children and families in West Virginia was compounded by the COVID-19 pandemic and brought to light the critical need for greater mental health services and providers in the state. Parent–Child Interaction Therapy (PCIT) is an evidence-based treatment for child externalizing symptoms that teaches parents positive and appropriate strategies to manage child behaviors. The current qualitative study details barriers and facilitators to disseminating and implementing PCIT with opioid-impacted families across West Virginia during the COVID-19 pandemic. Therapists (n = 34) who participated in PCIT training and consultation through a State Opioid Response grant were asked to provide data about their experiences with PCIT training, consultation, and implementation. Almost all therapists (91%) reported barriers to telehealth PCIT (e.g., poor internet connection, unpredictability of sessions). Nearly half of therapists’ cases (45%) were impacted directly by parental substance use. Qualitative findings about the impact of telehealth and opioid use on PCIT implementation are presented. The dissemination and implementation of PCIT in a state greatly impacted by poor telehealth capacity and the opioid epidemic differed from the implementation of PCIT training and treatment delivery in other states, highlighting the critical importance of exploring implementation factors in rural settings. Full article

(This article belongs to the Special Issue Parent-Child Interaction Therapy: Advances toward Health Equity)

15 pages, 807 KiB

Open AccessArticle

A Qualitative Analysis of Attrition in Parent–Child Interaction Therapy

by Amber Ufford, Tali Wigod, Joy Shen, Alec Miller and Lata McGinn

Int. J. Environ. Res. Public Health 2022, 19(21), 14341; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192114341 - 02 Nov 2022

Cited by 3 | Viewed by 1603

Abstract

Parent–child interaction therapy (PCIT) is one of the strongest evidence-based treatments for young children with behavior problems. Despite the efficacy of PCIT, many families fail to complete treatment, with attrition rates ranging from 30 to 69 percent. Preliminary research on attrition in PCIT treatment studies has linked maternal distress, negative verbal behavior (critical and sarcastic comments towards the child), lower socioeconomic status (SES), and fewer child major depressive disorder (MDD) diagnoses with premature termination from PCIT. However, more research is still needed to identify the range of reasons for treatment discontinuation. The purpose of the present study was to explore the range of reasons for premature termination from PCIT by conducting in-depth interviews with parents who discontinued PCIT using a qualitative design methodology. Results yielded eight themes, which were organized into three constructs: child-directed interaction (CDI) successes, difficulties with treatment, and the need for more clarity and orientation. Several existing treatment strategies that emerged from the data could be applied to PCIT to further enhance it and potentially reduce dropout (e.g., reconceptualizing dropout from PCIT, micro-orienting strategies used in other cognitive and behavioral therapies and dialectical behavior therapy). Understanding the reasons why parents drop out of PCIT and exploring different adaptations that can be made can further enhance this evidence-based treatment and increase its accessibility. Full article

(This article belongs to the Special Issue Parent-Child Interaction Therapy: Advances toward Health Equity)

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13 pages, 365 KiB

Open AccessArticle

Parent–Child Interaction Therapy Supports Healthy Eating Behavior in Child Welfare-Involved Children

by Emma R. Lyons, Akhila K. Nekkanti, Beverly W. Funderburk and Elizabeth A. Skowron

Int. J. Environ. Res. Public Health 2022, 19(17), 10535; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191710535 - 24 Aug 2022

Cited by 1 | Viewed by 1794

Abstract

Objective: We tested the efficacy of standard Parent–Child Interaction Therapy (PCIT), a live-coached, behavioral parent-training program, for modifying problematic eating behaviors in a larger effectiveness trial of PCIT for children involved in the child welfare system. Method: Children ages 3–7 years and their parents were randomly assigned to PCIT intervention (n = 120) or services as the usual control (SAU; n = 84) groups in a randomized clinical trial. Children’s eating behaviors were assessed pre- and post-intervention via the Child Eating Behaviors Questionnaire (CEBQ). Intention-to-treat analyses were conducted, followed by per-protocol analyses, on treatment-engaging families only. Results: PCIT led to reductions in child welfare-involved children’s food responsiveness, speed of food consumption, and tendency to engage in emotional overeating relative to children in the services-as-usual control condition. Standard PCIT may be an effective intervention to promote healthy child eating behaviors in families involved with child welfare, even when food-related behaviors are not directly targeted by the intervention. Public Health Significance: This clinical trial provides evidence that child welfare-involved children who received PCIT experienced significant reductions in maladaptive eating-related behaviors, namely food responsiveness, emotional overeating, and speed of eating. These findings were observed in relation to children in a comparison control group who had access to child welfare services-as-usual. Full article

(This article belongs to the Special Issue Parent-Child Interaction Therapy: Advances toward Health Equity)

16 pages, 399 KiB

Open AccessArticle

Treatment Readiness among Primarily Latine Families Seeking Parent–Child Interaction Therapy (PCIT) in an Urban Setting

by Allison Hatley-Cotter, Georgette Saad and Elizabeth Brestan-Knight

Int. J. Environ. Res. Public Health 2022, 19(8), 4784; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19084784 - 14 Apr 2022

Cited by 1 | Viewed by 1969

Abstract

(1) Background: Given the high prevalence of childhood mental health problems and their long-lasting negative consequences if left untreated, it is important to investigate factors that affect family engagement in psychological interventions such as Parent–Child Interaction Therapy (PCIT), including caregiver treatment readiness and readiness for change (RFC). Specifically, Latine families experience greater mental health disparities and have unique cultural factors that affect engagement. The current project examined caregiver pretreatment readiness among primarily Latine Spanish- and English-speaking families. (2) Methods: Participants were 100 caregivers (96% female) of young children ages 2 to 7 who sought PCIT services from a community mental health center in Washington, D.C. Families completed written and observational assessment measures at pretreatment and throughout PCIT, which were used for the current study. (3) Results: Caregivers reported high readiness and importance of treatment at intake, with higher RFC among Spanish-speaking caregivers. Regardless of language, caregivers who reported more frequent and problematic child misbehavior and who were from a multi-caregiver household tended to report more RFC and treatment importance at intake. Pretreatment RFC also predicted family completion of the first phase of PCIT although there was a high attrition rate for the sample as only 18% of families completed treatment. (4) Conclusions: These findings provide insight into the implementation of standard PCIT among Spanish- and English speaking families and highlight the benefits of assessing pretreatment caregiver readiness to inform clinical decision-making. Full article

(This article belongs to the Special Issue Parent-Child Interaction Therapy: Advances toward Health Equity)

19 pages, 1309 KiB

Open AccessFeature PaperArticle

A Cohort Study on the Effect of Parental Mind-Mindedness in Parent−Child Interaction Therapy

by Merlijn Meynen, Cristina Colonnesi, Mariëlle E. Abrahamse, Irma Hein, Geert-Jan J. M. Stams and Ramón J. L. L. Lindauer

Int. J. Environ. Res. Public Health 2022, 19(8), 4533; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19084533 - 09 Apr 2022

Viewed by 2503

Abstract

Parent−child interaction therapy (PCIT) is a short-term, evidence-based intervention for caregivers with children aged between 2 and 7 who exhibit behavioral problems. PCIT is effective, but has a high attrition rate ranging from 27% to 69%. We hypothesize that a low level of parental mind-mindedness—the parent’s propensity to treat the child as an intentional agent with its own thoughts and emotions—might contribute to premature attrition or cause families to profit less from treatment. To test these hypotheses, we performed a retrospective cohort study in a time-limited, home-based PCIT sample (n = 19) and in a clinic-based PCIT sample (n = 25), to investigate whether parents with a medium-high level of mind-mindedness differ from parents with a medium-low level of mind-mindedness in the outcome measures of PCIT (child’s behavioral problems, parenting skills and stress and mothers’ anxious and depressed symptoms). Furthermore, we examined if mind-mindedness was related to attrition and (for clinic-based PCIT only) number of sessions. Repeated measures ANOVA showed that mothers with a medium-high level of mind-mindedness displayed more improvement in two parenting skills benefiting a positive parent−child interaction. Furthermore, we found a group effect of mind-mindedness in the PCIT-home sample, with mothers with a medium-high level of mind-mindedness showing better results on most outcome measures. Our findings suggest that adding a mind-mindedness improving intervention prior to or during PCIT could benefit mothers with a medium to low level of mind-mindedness. Full article

(This article belongs to the Special Issue Parent-Child Interaction Therapy: Advances toward Health Equity)

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12 pages, 348 KiB

Open AccessArticle

Examining English- and Spanish-Speaking Therapist Behaviors in Parent–Child Interaction Therapy

by Yessica Green Rosas, Kristen M. McCabe, Argero Zerr, May Yeh, Kristine Gese and Miya L. Barnett

Int. J. Environ. Res. Public Health 2022, 19(8), 4474; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19084474 - 08 Apr 2022

Cited by 2 | Viewed by 1550

Abstract

Parent–child interaction therapy (PCIT) is a best-practice treatment for behavior problems in young children. In PCIT, therapists coach parents during in-vivo interactions to strengthen the parent–child relationship and teach parents effective ways of managing difficult child behaviors. Past research has found that different therapist coaching styles may be associated with faster skill acquisition and improved parent engagement. However, most research examining therapist behaviors has been conducted with English-speaking families, and there is limited research examining therapist behaviors when working with Spanish-speaking clients. In this study, English- and Spanish-speaking therapists’ coaching behaviors (e.g., directive versus responsive) were examined, as well as their association with client outcomes, including speed of parental skill acquisition and treatment completion. Results suggested that coaching styles varied significantly between sessions conducted in Spanish versus English. In Spanish sessions, therapists had more total verbalizations than in English sessions and demonstrated higher rates of both total directive and responsive coaching. Responsive coaching was found to predict treatment completion across groups, while directive coaching was not. Directive and responsive coaching were not found to predict the rate of parental skill acquisition. Implications regarding the training of therapists and emphasizing cultural considerations are discussed. Full article

(This article belongs to the Special Issue Parent-Child Interaction Therapy: Advances toward Health Equity)

20 pages, 1371 KiB

Open AccessArticle

Bringing Parent–Child Interaction Therapy to South Africa: Barriers and Facilitators and Overall Feasibility—First Steps to Implementation

by John-Joe Dawson-Squibb, Eugene Lee Davids, Rhea Chase, Eve Puffer, Justin D. M. Rasmussen, Lauren Franz and Petrus J. de Vries

Int. J. Environ. Res. Public Health 2022, 19(8), 4450; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19084450 - 07 Apr 2022

Cited by 5 | Viewed by 2693

Abstract

There is a large assessment and treatment gap in child and adolescent mental health services, prominently so in low- and middle-income countries, where 90% of the world’s children live. There is an urgent need to find evidence-based interventions that can be implemented successfully in these low-resource contexts. This pre-pilot study aimed to explore the barriers and facilitators to implementation as well as overall feasibility of Parent–Child Interaction Therapy (PCIT) in South Africa. A reflective and consensus building workshop was used to gather South African PCIT therapist (N = 4) perspectives on barriers, facilitators, and next steps to implementation in that country. Caregiver participants (N = 7) receiving the intervention in South Africa for the first time were also recruited to gather information on overall feasibility. Facilitators for implementation, including its strong evidence base, manualisation, and training model were described. Barriers relating to sustainability and scalability were highlighted. Largely positive views on acceptability from caregiver participants also indicated the promise of PCIT as an intervention in South Africa. Pilot data on the efficacy of the treatment for participating families are a next step. These initial results are positive, though research on how implementation factors contribute to the longer-term successful dissemination of PCIT in complex, heterogeneous low-resource settings is required. Full article

(This article belongs to the Special Issue Parent-Child Interaction Therapy: Advances toward Health Equity)

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17 pages, 2467 KiB

Open AccessArticle

Barriers to Clinician Implementation of Parent-Child Interaction Therapy (PCIT) in New Zealand and Australia: What Role for Time-Out?

by Melanie J. Woodfield, Tania Cargo, Sally N. Merry and Sarah E. Hetrick

Int. J. Environ. Res. Public Health 2021, 18(24), 13116; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182413116 - 12 Dec 2021

Cited by 5 | Viewed by 2971

Abstract

Background: Parent-Child Interaction Therapy (PCIT) is an effective parent training approach for a commonly occurring and disabling condition, namely conduct problems in young children. Yet, despite ongoing efforts to train clinicians in PCIT, the intervention is not widely available in New Zealand and Australia. Methods: We undertook a cross-sectional online survey of clinicians in New Zealand and Australia who had completed at least the 40-h initial PCIT training, to understand the barriers they encountered in their implementation efforts, and the extent to which attitudes toward time-out influenced implementation. The overall response rate was 47.5% (NZ: 60%; Australia: 31.4%). Results: Responses suggested that participants generally viewed PCIT as both acceptable and effective. Australian participants reported seeing significantly more clients for PCIT per week than those in NZ (Medians 0 and 2, respectively; χ²(1) = 14.08, p < 0.001) and tended to view PCIT as more effective in treating disruptive and oppositional behaviour (95% CI: −0.70, −0.13, p = 0.005). Participants currently seeing PCIT clients described it as more enjoyable to implement than those not using PCIT (95% CI: −0.85, −0.10, p = 0.01). Thirty-eight percent of participants indicated that they adapt or tailor the standardised protocol, primarily by adding in content relating to emotion regulation, and removing content relating to time-out. Participants generally felt that they had fewer skills, less knowledge, and less confidence relating to the Parent-Directed Interaction phase of PCIT (which involves time-out), compared with the Child-Directed Interaction phase. Conclusion: While we had hypothesised that time-out represented an intra-intervention component that detracted from implementation success, results suggested that clinician concern over the use of time-out was present but not prominent. Rather, the lack of access to suitable equipment (i.e., one-way mirror and ear-piece) and difficulties associated with clients attending clinic-based sessions were barriers most commonly reported by clinicians. We suggest that future research might consider whether and how PCIT might be “re-implemented” by already-trained clinicians, moving beyond simply training more clinicians in the approach. Full article

(This article belongs to the Special Issue Parent-Child Interaction Therapy: Advances toward Health Equity)

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15 pages, 561 KiB

Open AccessArticle

Home-Based Parent–Child Interaction Therapy to Prevent Child Maltreatment: A Randomized Controlled Trial

by Mariëlle E. Abrahamse, Vionna M. W. Tsang and Ramón J. L. Lindauer

Int. J. Environ. Res. Public Health 2021, 18(16), 8244; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18168244 - 04 Aug 2021

Cited by 4 | Viewed by 2818

Abstract

High treatment attrition and limited reach of mental health services for at-risk families remains an important problem in order to effectively address the global concern of child maltreatment and child disruptive behavior problems. This study evaluated the effectiveness of a home-based and time-limited adaptation of Parent–Child Interaction Therapy (PCIT). Twenty families with children (70% boys) aged between three and seven years were randomly assigned to an immediate treatment group (IT, n = 10) or a waitlist control group (WL, n = 10). After receiving treatment and compared to mothers in the WL group, mothers in the IT group reported fewer child behavior problems and more improved parenting skills. Although initial analyses revealed no significant differences, additional analyses showed a significant decrease in the primary outcome of the study, namely child abuse potential, between the baseline and follow-up assessment for the total treated sample. A low treatment attrition rate (15%) was found, indicating higher accessibility of treatment for families. Findings suggest that the brief home-based PCIT is a potentially effective intervention to prevent child maltreatment and disruptive behavior problems in at-risk families. Results also reinforce the importance of addressing the specific needs of these families to increase treatment effectiveness. Full article

(This article belongs to the Special Issue Parent-Child Interaction Therapy: Advances toward Health Equity)

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Review

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17 pages, 1334 KiB

Open AccessReview

Time-Out with Young Children: A Parent-Child Interaction Therapy (PCIT) Practitioner Review

by Melanie J. Woodfield, Irene Brodd and Sarah E. Hetrick

Int. J. Environ. Res. Public Health 2022, 19(1), 145; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19010145 - 23 Dec 2021

Cited by 4 | Viewed by 4902

Abstract

Time-out is a component of many evidence-based parent training programmes for the treatment of childhood conduct problems. Existing comprehensive reviews suggest that time-out is both safe and effective when used predictably, infrequently, calmly and as one component of a collection of parenting strategies—i.e., when utilised in the manner advocated by most parent training programmes. However, this research evidence has been largely oriented towards the academic community and is often in conflict with the widespread misinformation about time-out within communities of parents, and within groups of treatment practitioners. This dissonance has the potential to undermine the dissemination and implementation of an effective suite of treatments for common and disabling childhood conditions. The parent-practitioner relationship is integral to the success of Parent-Child Interaction Therapy (PCIT), an evidence-based treatment which involves live coaching of parent(s) with their young child(ren). Yet this relationship, and practitioner perspectives, attitudes and values as they relate to time-out, are often overlooked. This practitioner review explores the dynamics of the parent-practitioner relationship as they apply to the teaching and coaching of time-out to parents. It also acknowledges factors within the clinical setting that impact on time-out’s use, such as the views of administrators and professional colleagues. The paper is oriented toward practitioners of PCIT but is of relevance to all providers of parent training interventions for young children. Full article

(This article belongs to the Special Issue Parent-Child Interaction Therapy: Advances toward Health Equity)

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Other

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16 pages, 1142 KiB

Open AccessCase Report

Adapting PCIT-Health for Telehealth Delivery: A Case Study

by Sarah E. Domoff, Mikaela M. Overton, Aubrey L. Borgen and Larissa N. Niec

Int. J. Environ. Res. Public Health 2022, 19(14), 8352; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19148352 - 08 Jul 2022

Cited by 2 | Viewed by 1935

Abstract

During the COVID-19 pandemic, children’s physical health and access to mental health resources have been two critical concerns. Parent-Child Interaction Therapy-Health (PCIT-Health) is a treatment model aimed at helping parents manage children’s general behavior and their behavior in obesogenic contexts (screen time and mealtime). Due to social distancing guidelines, PCIT-Health was adapted for remote delivery through video conferencing. In this article, we describe the experience of implementing virtual PCIT-Health with a family. The family’s progress through treatment is described, along with the challenges associated with remote service delivery and how those challenges were addressed. Progress through treatment was measured with questionnaires administered to caregivers and with observational measures of parent-child interactions. The results from these measures indicate that caregivers experienced a reduction in stress and improvements in their child’s behavior after PCIT-Health completion. They also reported engaging in healthier management of their child’s screen time and mealtime behaviors. As coded from observational assessments, parents increased their use of positive parenting practices. Telehealth-delivered PCIT-Health is a promising treatment modality for increasing parenting skills and improving child behavior. Full article

(This article belongs to the Special Issue Parent-Child Interaction Therapy: Advances toward Health Equity)

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19 pages, 429 KiB

Open AccessHypothesis

Trauma-Directed Interaction (TDI): An Adaptation to Parent-Child Interaction Therapy for Families with a History of Trauma

by Robin H. Gurwitch and Christina M. Warner-Metzger

Int. J. Environ. Res. Public Health 2022, 19(10), 6089; https://doi.org/10.3390/ijerph19106089 - 17 May 2022

Cited by 10 | Viewed by 3986

Abstract

Parent-Child Interaction Therapy (PCIT) is one of the strongest evidence-based treatments available for young children and their families. Research has supported the use of PCIT for children with a history of trauma; however, the treatment does not directly address trauma in the child. PCIT is a dyadic treatment; yet, the impact of the carer’s trauma on the carer-child relationship is not assessed or incorporated into treatment. For these reasons, therapists, families, agencies, and funders tend to view PCIT as a trauma treatment with skepticism. PCIT therapists who currently address trauma within the intervention do so without a standardized approach. Trauma-Directed Interaction (TDI) is an adaptation developed to directly address these concerns. TDI maintains the key elements and theoretical underpinnings of PCIT while adding sessions to cover psychoeducation about trauma, carer response to a child’s trauma reactions (SAFE skills), and coping skills to aid both the child and the carer to manage trauma activators (COPE skills). The TDI module creates a consistent strategy for PCIT therapists to address trauma, thus allowing research and replication which will advance the dual fields of PCIT and family trauma. The theoretical conceptualization of TDI is presented along with next steps in its evaluation. Full article

(This article belongs to the Special Issue Parent-Child Interaction Therapy: Advances toward Health Equity)

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