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Applying the Theoretical Domains Framework to Develop an Intervention to 'Re-implement' Parent-Child Interaction

Melanie J Woodfield1,2, Sharon T Phillips3, Tania Cargo4,5

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Summary

Re-implementing Parent-Child Interaction Therapy (PCIT) in New Zealand requires addressing environmental resources and social identity barriers. Interventions should focus on supportive colleagues, suitable equipment, and targeted training for clinicians.

Keywords:
COM-BPCITParent–child interaction therapySustainabilitySustainmentTheoretical domains framework

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Area of Science:

  • Implementation Science
  • Clinical Psychology
  • Childhood Conduct Problems Treatment

Background:

  • Parent-Child Interaction Therapy (PCIT) is an effective treatment for childhood conduct problems.
  • Sustaining PCIT delivery by trained clinicians in routine care settings presents significant challenges.
  • Clinician training in PCIT is increasing in Aotearoa/New Zealand.

Purpose of the Study:

  • To systematically identify and prioritize barriers and facilitators for PCIT implementation.
  • To develop a theory-driven intervention for re-implementing PCIT among trained clinicians.
  • To refine understanding of PCIT implementation determinants using integrated qualitative data.

Main Methods:

  • Qualitative study integrating previously unanalyzed survey data (n=54) with new focus group data (n=15).
  • Deductive content analysis using the Theoretical Domains Framework (TDF).
  • Application of the Theory and Techniques Tool to identify behavior change techniques.

Main Results:

  • Eight of 14 TDF domains influenced PCIT implementation; 'Environmental Context and Resources' and 'Social/Professional Role and Identity' were most salient.
  • Key barriers included lack of suitable PCIT equipment/clinic rooms and concerns about time-out efficacy and cultural suitability for Māori families.
  • Clinicians reported isolation and obligation in advocating for PCIT.

Conclusions:

  • Re-implementation of stalled PCIT programs is feasible and practical.
  • Intervention components should include peer support, access to appropriate facilities (e.g., time-out rooms), and targeted training on time-out safety.
  • Future trials will assess the feasibility and acceptability of these re-implementation strategies.