亲子互动疗法(PCIT)是一种有效的家长培训方法,用于治疗常见和致残的疾病,即幼儿的行为问题。然而,尽管正在努力培训PCIT临床医生,这种干预措施在新西兰和澳大利亚并不普遍。
我们对新西兰和澳大利亚的临床医生进行了一项横断面在线调查,这些医生至少完成了40小时的初始PCIT培训,了解他们在实施工作中遇到的障碍,以及对超时的态度在多大程度上影响了实施。总反应率为47.5%(新西兰:60%;澳大利亚:31.4%)。
答复表明,与会者普遍认为PCIT既可接受又有效。澳大利亚参与者报告说,每周PCIT的客户明显多于新西兰的客户(分别为Medians0和2;χ2(1)=14.08,p<0.001),并且倾向于认为PCIT在治疗破坏性和对立行为方面更有效(95%CI:-0.70,-0.13,p=0.005)。目前看到PCIT客户的参与者描述它比不使用PCIT的参与者更令人愉快(95%CI:-0.85,-0.10,p=0.01)。38%的参与者表示他们适应或调整标准化协议,主要是通过增加与情绪调节相关的内容,并删除与超时相关的内容。参与者通常认为他们的技能较少,知识较少,与PCIT的家长导向互动阶段(涉及超时)相关的信心降低,与儿童导向互动阶段相比。
虽然我们假设超时代表了干预中的一个因素,影响了实施的成功,结果表明,临床医生对超时使用的担忧存在,但并不突出.相反,无法获得合适的设备(即,单向镜和耳机)和与患者参加诊所会议相关的困难是临床医生最常报告的障碍。我们建议未来的研究可能会考虑PCIT是否以及如何由受过训练的临床医生“重新实施”,不仅仅是简单地培训更多的临床医生。
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.
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%).
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.
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.