UC Santa Barbara

Parent-Child Interaction Therapy (PCIT) is an evidence-based behavioral parent training intervention (BPT) that has been shown to significantly reduce externalizing behavior problems in young children, typically between the ages of 2-7. As a primary component of treatment, PCIT therapists coach caregivers in the use of specific behavioral skills during session. It has been found that different coaching styles impact both caregiver skill acquisition as well as treatment adherence, making it an important mechanism of change to study. Although PCIT has been demonstrated to be efficacious for families of diverse backgrounds, there is currently very little research examining how therapist coaching is implemented for Spanish-speaking families. Therefore, the current mixed-methods QUANT + qual study quantitatively examines therapist and caregiver moment-to-moment interactions and gathers qualitative information from PCIT providers in order to better understand how therapist and caregiver verbalizations are affecting one another during PCIT, as well as PCIT therapist experiences coaching Spanish-speaking caregivers. For the quantitative analyses, participants included 49 therapist-caregiver dyads from two previous PCIT clinical trials. Five-minute segments from the 49 therapist-parent dyads’ second coaching session were transcribed. Parent and therapist verbalizations were coded using the Dyadic Parent-Child Interaction Coding System (DPICS) and the Therapist-Parent Interaction Coding System, respectively. Sequential analysis was conducted using Noldus The Observer XT software to obtain transitional probabilities of caregiver skill use after therapist coaching verbalizations and vice versa. Independent Samples t Tests were used to examine differences in how caregivers responded to therapist coaching in English-speaking and Spanish-speaking sessions. For qualitative analyses, participants included ten PCIT providers (5 therapists and 5 supervisors/trainers). Therapists and trainers conducted a 1-hour semi-structured interview during which they discussed their experiences providing PCIT coaching to Spanish-speaking caregivers. Rapid Qualitative Analysis (RQA) was conducted, and themes were identified regarding therapist experiences, challenges, and facilitators working with Spanish-speaking families. Results from the current study found that Spanish-speaking caregivers do not significantly differ in their responses to therapist coaching, and that therapists are more likely to follow caregiver skill use with a directive for parents to use an additional skill use in sessions conducted in English (M = .01, SD = .02) than in sessions conducted in Spanish (M = .00, SD = .00; t(39) = 2.518, p = .016). Qualitative findings from therapist interviews converge with quantitative findings, highlighting discomfort that therapists may experience being directive with Spanish-speaking caregivers. Additional qualitative themes are presented, and training considerations are discussed.