1. Parent-Child Interaction Therapy: International Spotlight Anthony Urquiza, Ph.D. 6th Annual PCIT Conference University of Florida Gainesville, FL

2. International Spotlight: Hong Kong

3. PCIT in Hong Kong

7. But PCIT in Hong Kong is the end of the story, this is our most recent international training agency. I think it is best to start at the beginning When we started training, these were the questions… What are the barriers to overcome? What training model is most effective? What leads to leads to success? (What is training success?)

8. What are the barriers to overcome? Therapists wouldn’t like PCIT because of it’s behavioral theoretical foundation Therapists wouldn’t like a protocol-driven treatment –Therapists as technicians –Manual/protocol rigid, can’t adjust to change –Non-authentic interactions with clients –Protocol undermines the therapeutic relationship –Protocols rule out clinical judgment, innovation Therapists would refuse to do 5-minute coding PCIT was too difficult to learn

9. What are the barriers to overcome? Therapist instability –Therapists would get trained, then leave Organizational instability/commitment –Administrators would not see the value –Agency would accept a new treatment That ‘Effect Size’ thing

10. Estimating the Effect Size: X4 meta-analyses on child therapy EBPs have ‘medium’ to ‘large’ effect sizes ‘EBP treatment works’ Specific tx better than broad- based tx Tx effect sustains over time This is really a good thing… right? Well, yes, except these are mostly university-based treatment outcome studies (including PCIT) ES in community MH clinics are not as good

11. What do we need to do to effectively train? Successful training = adherence to protocol + fidelity (Competence) Good Training Model Good Trainers/Training Committed Trainees Ongoing Relationship Agency Support $

12. Good Training Model Parent is to Therapist as Therapist is to Trainer And PCIT is very robust! InformationTheory/content Skill Acquisition/PracticeRole plays MasteryCoached coaching GeneralizationHow many clients? Information  Skill Acquisition/Practice  Mastery  Generalization

13. Good Training Model The role of praise in Hong Kong… Give me the model! ------------------------------------------------------------------------------- Hong KongFebruary 2004 (multiple days of training) March/April 2004 (case consultation) SacramentoFebruary 2005 (multiple CA site visits) Hong KongJune 2005 (Symposium and additional training) It’s good that it is hard

14. Good Training Model – Hong Kong

15. Identified three Tung Wah staff to be TOTs Heung Yin Kwan(Kitty) Choi Ka Yan (Trian) Chan Kai Wai(M onique)

16. Good Trainers/Training Because we have good trainers… Training Staff Tanda AlmontAlissa PorterMichelle Culver Shalila DouglasGeorganna SedlarLareina Ho Susan TimmerJean McGrathLisa Ware Leslie WhittenNancy Zebell UCDavis CAARE Center: 100-112 clients/week

17. Committed Trainees UCDMC-trained staff at PCIT6 Russ Decker Emma Girard Cheryl Goldberg-Diaz Audra Hirsch Mary Linscomb Tiffany Masson Sharon Mellar Elisa NeviusLori Pack Mary PrattNaomi PerryErica Pearl Ryan Quist Araceli Salazar Janae Tucker +Agency Stability (OES stable funding) +Leadership within the agency You are not normal!

18. Committed Trainees: Hong Kong +Strong institutional support TOTs Heung Yin Kwan (Kitty) Choi Ka Yan (Trian) Chan Kai Wai (Monique)

19. Committed Trainees: Hong Kong +Ivan Yi – Administrative Leadership +Heung Yin Kwan – Program Leadership TOTs Heung Yin Kwan (Kitty) Choi Ka Yan (Trian) Chan Kai Wai (Monique)

20. PCIT in Hong Kong

21. Ongoing Relationship Because we’ve maintained contact… Conferences (PCIT conferences 1 through 5) Frequent site visits Advanced training seminars Web-based information (www.pcittraining.tv)www.pcittraining.tv Refinements in program development Ongoing consultation (‘Dear Nancy’) Training products –Handouts, sample tx objectives, etc. –Training video series –The Spanish PDI video is just now done!

22. Ongoing Relationship: Hong Kong All of the regular training materials and connections We’re continuing our relationship with Hong Kong And you will see Hong Kong present at a future PCIT conference

23. Tung Wah Group of Hospitals Parent-Child Interaction Therapy Pilot Project in Hong Kong (Sharing & Demonstration) Presented for Symposium on New Initiatives of Child Abuse Prevention June 23, 2005 Tung Wah Group of Hospitals Heung Yin Kwan, Kitty Centre Supervisor Lui Wing Cheung Children Centre

24. Hong Kong PCIT Protocol The Chinese Version of PCIT treatment & DPICS

25. The treatment result of PCIT pilot project in H.K. Change of Children’s behavior problem (ECBI pre & post score) ECBI intensity clinical cut 131 ECBI problem clinical cut off 15

26. The result of PCIT pilot project in H.K. Change of parents’ stress level (PSI pre & post score) Clinical range 85% or above 99% less 85%

27. The result of PCIT pilot project in H.K. Change of Parenting Behavior (DPICS: pre & post score) mastery criteria 15 mastery criteria less than 3 mastery criteria: 25

28. Issues and Key Learning from the Project Extra-counseling sessions (eg. Telephone counseling & home visit) are provided for individual mental health problems and family crisis to avoid non-attendance and attrition rate. Liaison with school professionals to facilitate the case progress. Regular professional meetings to enhance treatment integrity and PCIT skill mastery. Ongoing staff-training to enhance staff competencies.

29. Future Development of PCIT Project at TWGHs Train of Trainer (TOT) scheme to respond to the increased number of referrals. Provide PCIT training to pre-school & primary teachers. Expand services to different child clinical problems. Conduct research on the project.

30. PCIT in Hong Kong