Remotely Delivering Real-Time Parent Training to the Home: An Initial Randomized Trial of Internet-Delivered Parent-Child Interaction Therapy (I-PCIT) Objective: Remote technologies are increasingly being leveraged to expand the reach of supported care, but applications to early child-behavior problems have been limited. This is the first controlled trial examining video-teleconferencing to remotely deliver behavioral parent training to the home setting with a live therapist. Method: Racially/ethnically diverse children ages 3–5 years with disruptive behavior disorders, and their caregiver(s), using webcams and parent-worn Bluetooth earpieces, participated in a randomized trial comparing Internet-delivered parent–child interaction therapy (I-PCIT) versus standard clinic-based PCIT (N = 40). Major assessments were conducted at baseline, midtreatment, posttreatment, and 6-month follow-up. Linear regressions and hierarchical linear modeling using maximum-likelihood estimation were used to analyze treatment satisfaction, diagnoses, symptoms, functioning, and burden to parents across conditions. Results: Intent-to-treat analyses found 70% and 55% of children treated with I-PCIT and clinic-based PCIT, respectively, showed “treatment response” after treatment, and 55% and 40% of children treated with I-PCIT and clinic-based PCIT, respectively, continued to show “treatment response” at 6-month follow-up. Both treatments had significant effects on children’s symptoms and burden to parents, and many effects were very large in magnitude. Most outcomes were comparable across conditions, except that the rate of posttreatment “excellent response” was significantly higher in I-PCIT than in clinic-based PCIT, and I-PCIT was associated with significantly fewer parent-perceived barriers to treatment than clinic-based PCIT. Both treatments were associated with positive engagement, treatment retention, and very high treatment satisfaction. Conclusion: Findings build on the small but growing literature supporting the promising role of new technologies for expanding the delivery of behavioral parent training. 

Rationale and Considerations for the Internet-Based Delivery of Parent-Child Interaction Therapy (Comer et al., 2015) This article discusses the traditional barriers to effective care for those using Parent-Child Interaction Therapy and ways that technological innovations can break down obstacles like availability, accessibility and acceptability. A detailed description of a current Internet-delivered PCIT treatment program (I-PCIT) is discussed. 

Addressing Barriers to Care Among Hispanic Youth: Telehealth Delivery of Trauma-Focused Cognitive Behavioral Therapy (Stewart et al., 2017) This article addresses the barriers that Hispanic youth face when receiving mental health services and provides an illustration of the feasibility of delivering TF-CBT through telehealth services in a school setting. A multiple-case study design was used to discover that TF-CBT via telemental health is a feasible option for hispanic youth with multiple barriers to care.

A Pilot Study of Trauma-Focused Cognitive-Behavioral Therapy Delivered via Telehealth Technology (Stewart et al., 2017) This study used telehealth technology to deliver trauma-focused cognitive behavioral therapy (TF-CBT) to underserved trauma-exposed youth. Researchers found significant symptom change posttreatment and reduction in caregiver-reported PTSD symptoms, with a 0% attrition rate. 

Delivering an Evidence-Based Mental Health Treatment to Underserved Populations Using Telemedicine: The Case of a Trauma-Affected Adolescent in a Rural Setting (Shealy et al., 2015) Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychological treatment that can effectively ameliorate symptoms of depression and anxiety that are common responses to trauma exposure. However, access to high-quality mental health services can be problematic, especially for traditionally underserved populations such as rural/remote residents, racial/ethnic minorities, and those from low socioeconomic strata. Individuals living in remote areas encounter additional obstacles to care, including long travel distances to reach services, increased time out of work or school, lack of access to transportation, and childcare difficulties. Many rural/remote communities struggle with scarcity of resources in general, and specialized mental health resources specifically, which may inadvertently exclude patients from obtaining the most appropriate health care. Telemedicine, or the use of Internet-based video conferencing, allows a patient live and direct virtual access to specialized mental health care providers. This article examines the application of TF-CBT via telemedicine to treat trauma exposure in a teenager living in a rural setting. Though this case example originates in the rural southeastern United States, the barriers and concepts addressed are generalizable to other remote areas in the United States and worldwide. Specific attention is given to evidence-based treatments for trauma, the merits of the telemedicine modality, and confidentiality considerations when using Internet-based teleconferencing for the application of psychological services.

Guidelines for Establishing a Telemental Health Program to Provide Evidence-Based Therapy for Trauma-Exposed Children and Families (Jones et al., 2014) This article reviews the set-up, use and utility of a telemental health program in an existing clinic that is using trauma-focused cognitive-behavioral therapy. The guidelines that are addressed include: 1. Establishing and utilizing community partnerships 2. Memoranda of Understanding (MOU) 3. Equipment setup and technological resources 4. Video Conferencing software 5. Physical setup 6. Clinic administration 7. Service reimbursement and start-up costs 8. Therapy delivery modifications and 9. Delivering culturally competent services to rural and remote areas.

Delivering TF-CBT via Tele-Mental Health (Webinar) Regan Stewart and Meg Wallace (Medical University of South Carolina) Part 1 Learn how Trauma-Focused Cognitive Behavioral Therapy has been used via tele-health with underserved youth and youth in rural and frontier communities. Part 2 Engaging Schools in TF-CBT How to form relationships with schools and practical considerations for delivering tele-mental health in schools.

Telehealth Used to Treat Rural North Dakota Child Abuse Victims   Rural North Dakota is getting a digital solution to the lack of mental-health resources for children who’ve been victims of abuse. Children’s Advocacy Centers of North Dakota launched telehealth therapy services this week for kids handling trauma. Interim director of the centers, Paula Condol, says the method is based on University of South Carolina research on cognitive behavioral therapy, which she calls the “gold standard” for treating traumatized kids.

Feasibility and Effectiveness of a Telehealth Service Delivery Model for Treating Childhood Posttraumatic Stress: A Community-Based, Open Pilot Trial of Trauma-Focused Cognitive–Behavioral Therapy (Stewart et al., 2020)This study found that completion rates for telehealth are significantly higher than for in-person services. In this study, “[c]lose to nine out of every 10 youth (88.6%) completed a full course of telehealth delivered TF-CBT, and 96.8% of these treatment completers no longer met diagnostic criteria for a trauma-related disorder at posttreatment. Although 2.9% (or two individuals) did not exhibit full treatment response, both youths showed substantial treatment response in the form of symptom reduction….”  The telehealth provision of TF-CBT has broad application.

TF-CBT Teleboxes These “teleboxes” developed by the Children’s Advocacy Centers of North Dakota (CACND) contain all the tools that a client needs to participate in telehealth, including an iPad that is restricted-use but data-enabled, headphones, and the materials used during the course of treatment.  The contents of the teleboxes are modeled on the supplies used in TF-CBT, but can be modified and adapted to other treatment modalities. The boxes are age-appropriate and divided into age groups (7-9, 10-12, and 13-18 years old), and the materials are placed in separate envelopes and labeled by session, so that the participants have something to look forward to opening as treatment progresses. The sample list of telebox contents linked here was shared by CACND in May 2020. For more information on this innovative program, contact Paula Condol or Dr. Nicola Herting.