Please support Telehealth.org’s ability to deliver helpful news, opinions, and analyses by turning off your ad blocker.
The January 2023 issue of JAMA carried a report of a study conducted by Daniel Bagner and colleagues who tested an Internet-delivered, parent-child interaction therapy (iPCIT) model for children aged up to three years with developmental delay (DD). Despite research and clinical support for the parent-child-interaction therapy (PCIT) model and other clinic-based parenting interventions, this telehealth-specific research team sought to bridge service delivery barriers that limit the accessibility and acceptability of children’s mental health services. Direct obstacles to reaching families in need include limited transportation, limited numbers of regional clinicians, unavailability of non-English language services, and stigma-related concerns about mental health clinic visits. Although research support for telehealth-specific interventions is beginning to appear for pediatric telehealth specialty areas such as autism, controlled studies of telehealth with young children with developmental disorders and their families are limited.
Pediatric Telehealth iPCIT Participants & Procedures
The pediatric telehealth researchers sought to test the use of video conferencing with families of children by conducting a randomized clinical trial of 150 children with DD and their primary caregivers. They worked with youth from marginalized, low-income, and remote communities who are particularly underserved. Such families tend to have lower session attendance and higher dropout rates. These underserved families are particularly at risk because behavior problems in young children with developmental delay (DD) represent a significant public health concern. Behavioral challenges are of concern, as children with DD show three times the risk of clinically significant externalizing problems than their typically developing counterparts. Externalizing problems in children with DD are associated with several functional impairments that can lead to high economic costs when untreated. Caregivers also are at risk of high levels of caregiving stress related to the severity of child behavior problems. Finding a way to deliver effective treatment to such families is important.
This study used videoconferencing to minimize access and other barriers. A randomized clinical trial was conducted from 3/17/16 to 12/15/2020. Children with DD and externalizing behavior problems were recruited from early intervention, randomly assigned to a telehealth parenting intervention or control group, and evaluated through a 12-month follow-up. More than 50% of the children lived in extreme poverty or low income-need ratio categories. Most children were from ethnic or racial minoritized backgrounds. The researchers explained the procedure using these words:
iPCIT draws on encrypted videoconferencing technology in which therapists provide live coaching of caregiver-child interactions via webcam and a caregiver-worn earpiece. As in clinic-based PCIT, iPCIT progresses through child-directed interaction and parent-directed interaction phases. During child-directed interaction, caregivers learn to follow their child’s lead in play by using PRIDE skills (ie, praising child behavior, reflecting child statements, imitating child play, describing child actions, and showing enjoyment) and avoiding questions, commands, and criticisms. They learn to use PRIDE skills in response to appropriate child behaviors and ignore undesirable behaviors.
During parent-directed interaction, caregivers learn to use effective commands and consistently follow through with timeouts to increase child compliance. Families received a tablet (and data plan for families without a wireless network) and wireless earpiece for treatment. Sessions were conducted weekly by a remote therapist and lasted 1 to 1.5 hours.
Families received 20 weeks of iPCIT (provided in English or Spanish) or a control group, which was given a referral. Measures of child and caregiver behaviors and caregiving stress were examined at five points during and after the five months of direct intervention, culminating in a 12-month follow-up.
iPCIT Study Outcomes
This iPCIT randomized pediatric telehealth trial led to improved child behavior maintained across follow-up visits. Results provide evidence that a telehealth-delivered parenting intervention with real-time therapist coaching led to significant and sustained improvements for young children with DD and their caregivers. The results of this pediatric telehealth study demonstrate the commitment of telehealth formats to broaden the reach and scope of care for underserved children with developmental delay and their families.
Pediatric Telemedicine, Telehealth & Teletherapy: Practicing with Children & Adolescents
This workshop aims to bring the pediatric telemedicine and telehealth evidence base to you in ways that are practical, predictable, and doable.