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Assessing Therapist Competence in the Context of PCIT Training

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Handbook of Parent-Child Interaction Therapy

Abstract

Assessing therapist competence is an essential aspect of ensuring that parent–child interaction therapy (PCIT) services are delivered with fidelity. Currently PCIT International requires all PCIT therapists to complete a highly structured training process in which therapist competence is evaluated at several points. Pre- and post-training measures evaluating therapist knowledge of PCIT, observing therapist performance during role-plays and DPICS coding exercises, and review of therapist work samples during the year-long consultation period following a PCIT training are all useful techniques that are routinely used when assessing the competence of trainee PCIT therapists. Several “code the coach” systems are also gaining popularity as a way to offer structured feedback related to a therapist’s coaching style. Still, the specific methods used to assess therapist competence may vary between individual PCIT trainers. We discuss possible future directions in the assessment of therapist competence and present a case example of how the competence of one trainee therapist was assessed.

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Author information

Authors and Affiliations

  1. Department of Psychology, Auburn University, Auburn, AL, USA

    Richard F. Davis III & Elizabeth Brestan-Knight

Authors
  1. Richard F. Davis III
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  2. Elizabeth Brestan-Knight
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Corresponding author

Correspondence to Elizabeth Brestan-Knight .

Editor information

Editors and Affiliations

  1. Center for Children, Families, and Communities, Department of Psychology, Central Michigan University, Mount Pleasant, MI, USA

    Larissa N. Niec

Appendices

Figure 1: PCIT Therapist Competency Requirements (PCIT International, 2013)

  1. 1.

    Assessment Skills. By the end of the training process, the applicant should be able to:

    1. (a)

      Administer, score, and interpret the required standardized measures for use in assessment and treatment planning. (Required measures: ECBI, DPICS-IV; Recommended measures: TAI, PSI-SF, SESBI-R, and BASC or CBCL).

    2. (b)

      Administer behavioral observations from the DPICS-IV Coding System.

    3. (c)

      Achieve a minimum of 80% agreement with a PCIT Trainer using the DPICS-IV either during 5-min of live coding, or in continuous coding with a criterion video recording.

  2. 2.

    CDI-Related Therapist Skills. By the end of the training process, an applicant should be able to:

    1. (a)

      Conduct the CDI Teach session, adequately explaining all non-optional items on the treatment integrity checklist in the 2011 PCIT Protocol as observed by the PCIT Trainer.

    2. (b)

      Meet the parent criteria for CDI skills (ten labeled praises, ten behavioral descriptions, ten reflections; three or fewer negative talks, questions, plus commands) in a 5-min interaction with a child or a 5-min role-play with an adult portraying a child.

    3. (c)

      Demonstrate for the PCIT Trainer how to determine the coaching goals for a CDI session by interpreting the DPICS-IV Coding Sheet data gathered at the start of the session.

  3. 3.

    PDI-Related Therapist Skills. By the end of the training process, an applicant should be able to:

    1. (a)

      Present the PDI Teach Session, adequately explaining all non-optional items on the treatment integrity checklist in the 2011 PCIT Protocol as observed by the PCIT Trainer.

    2. (b)

      Effectively manage a PDI Coach session and accurately demonstrate the discipline sequence with a child in treatment. In the case when a full discipline sequence does not occur or cannot be video recorded, the applicant must demonstrate the skills through role-play.

    3. (c)

      Accurately explain the House Rules procedure as described in the 2011 PCIT Protocol. Accuracy can be assessed through role-play, and does not require observation of an actual session. However, the PCIT Trainer must observe the role-play in real time (e.g., live or online/telehealth) or by video recording.

    4. (d)

      Accurately explain the Public Behaviors procedure as described in the 2011 PCIT Protocol. Accuracy can be assessed through role-play, and does not require observation of an actual session. However, the PCIT Trainer must observe the role-play in real time (e.g., live or online/telehealth) or by video recording.

  4. 4.

    General Coaching Skills

    1. (a)

      By the end of the training process, an applicant is expected to demonstrate adequate and sensitive coaching as observed by the PCIT Trainer.

    2. (b)

      By the end of the training process, an applicant is expected to model CDI skills during all interactions with parents and children throughout the treatment.

Figure 2: Sample Items from the PCIT Quiz

  1. 1.

    PCIT is an acronym that stands for:

    1. (a)

      Parents and Teachers in Training

    2. (b)

      Proper Child Interaction Therapy

    3. (c)

      Parent–Child Interaction Therapy

    4. (d)

      Parent–Child Interest Test

  1. 2.

    You and a child are playing with toy animals and the child says, “I’ve got a moo cow.” An example of a reflection you could say is:

    1. (a)

      You are playing so nicely with your moo cow

    2. (b)

      What comes from cows

    3. (c)

      I have a goat

    4. (d)

      You do have a brown and white cow

  1. 3.

    Which of the following is an example of an effective command?

    1. (a)

      “Don’t put the airplane on the table.”

    2. (b)

      “Why don’t you put the blocks in the cabinet?”

    3. (c)

      “Hand me the red block.”

    4. (d)

      “Let’s play with Mr. Potato head.”

    5. (e)

      “Watch out.”

  2. 4.

    Which of the following should you avoid doing when playing with a child:

    1. (a)

      Doing what the child is doing

    2. (b)

      Asking the child about what they are doing

    3. (c)

      Describing what the child is doing

    4. (d)

      Being enthusiastic

  3. 5.

    Which is not a benefit of PDI play sessions?

    1. (a)

      Teaches children to obey parents in a fun environment

    2. (b)

      Teaches parents how to consistently discipline their child

    3. (c)

      Allows the parents to use their PRIDE skills with their child

    4. (d)

      Increasing the child’s creativity

  4. 6.

    When playing with a child during a CDI session it is important for you to:

    1. (a)

      Lead the play

    2. (b)

      Make sure the focus is on what you are doing

    3. (c)

      Show you are interested by asking questions

    4. (d)

      Let the child know what they are doing is interesting

Figure 3: PDI Flow Chart

PDI Quiz (Day 3)

  1. 1.

    Jane is playing in a playroom. There are several toys strewn about on the floor (books, blocks, and Legos). Jane’s mother tells her to put the blocks in the container. Jane pouts and begins to throw the blocks across the room. Five seconds have elapsed and Jane has not complied with the command. Jane needs to be put in time-out. Assume that in time-out Jane behaves appropriately for the full 3 min. After sitting in the chair, she complies with the original command. Be sure to include the procedure(s) that should follow including all parent verbalizations. Began the diagram with the parent giving the command. You can write along the arrows and use the boxes.

figure a

Figure 4: Integrity Checklist for DPICS Set-Up Task (Courtesy of Jessica Bonatakis)

Room Set-Up Fidelity

Item Number

Yes

No

1. One table present in the therapy room

  

2. Two chairs at the table in the therapy room

  

3. One time-out chair facing the corner in the therapy room

  

4. Toy box or toy shelf present

  

5. Two sets of toys spread out/strewn on the table

  

6. Five sets of toys strewn out on the floor

  

7. No extraneous furniture/items present in the therapy room

  

TOTAL

  

Fidelity [(# Yes/7 × 100)]

 

Figure 5: Treatment Integrity Checklist for House Rules

ID #: _____ Session Title: House RulesCoder Initials: _____ Date Reviewed: _______

Integrity Checklist

ITEM NUMBER

✓

N/A

X

1. Types of behaviors that need a house rule

   

2. How to set up a house rule

   

3. Explaining the house rule to your child

   

4. How to use the house rule

   

5. Beginning another house rule

   

TOTALS

   

Integrity = Yes’s (✓’s) = ______

Yes’s (✓’s) + No’s (X’s)

Integrity Checker Comments about Session

•

Figure 6: Treatment Integrity Checklist for Public Behavior

ID #: _____ Session Title: Public Behavior Coder Initials: _____ Date Reviewed: ________

Integrity Checklist

ITEM NUMBER

✓

N/A

X

1. Plan a practice outing

   

2. Tell your child where you are going and how you want him/her to act

   

3. Explain to your child that you will use time-out in public if needed

   

4. Praise your child for appropriate behavior

   

5. Don’t push your child too hard

   

6. Make the trip fun

   

7. How to do time-out in public

   

TOTALS

   

Integrity = Yes’s (✓’s) = _____

Yes’s (✓’s) + No’s (X’s)

Integrity Checker Comments about Session

•

Figure 7: Sample Treatment Integrity Checklist for CDI Coach 1

ID #: 9999 Session: CDI Coach 1 Rater Initials: SOS Date Reviewed: XX/XX/XX

As you review the session, place a checkmark under the appropriate column.

List the totals in the appropriate blanks below the table. See expanded session outlines for more information on each item.

ITEM

✓

N/A

X

1. Spend a few minutes addressing parent stressors unrelated to the child’s behavior

  

X

2. Review homework

X

  

3. Orient the child to CDI

X

  

With one parent in treatment

4. Code parent and child in CDI for 5 minutes

X

  

5. Give parent feedback on skills and set goals for coaching

  

X

6. Coach parent with child for at least 20 minutes

X

  

With two parents in treatment

4. Code one parent and child in CDI for 5 minutes

   

5. Give first parent feedback on skills and set goals for coaching

   

6. Coach first parent for at least 10 minutes

   

7. Code second parent for 5 minutes

   

8. Give second parent feedback on skills and set goals for coaching

   

9. Coach second parent with child for at least 5 minutes

   

With each parent

7 or 10. Show CDI Skills Progress sheet data to parent(s)

X

  

8 or 11. Introduce ECBI graph and show parents ratings

  

X

9 or 12. Give homework sheet and discuss what to emphasize

X

  

TOTALS

   
  1. Note: Omit items not applicable (i.e. 1-parent items for 2-parent family and vice versa)

Integrity = Yes’s (✓’s)= ______ 66 ______ %

Yes’s (✓’s) + No’s (X’s)

Length of session = ___45___ minutes

Evaluation of Coaching

  1. 1.

    Timing or frequency of coaching

Not Observed

Needs Improvement

Adequate

Very Good

Excellent

1

2

3

4

5

  1. 2.

    Therapist Enthusiasm

Not Observed

Needs Improvement

Adequate

Very Good

Excellent

1

2

3

4

5

  1. 3.

    Accurate Labeling of Pride Skills

Not Observed

Needs Improvement

Adequate

Very Good

Excellent

1

2

3

4

5

  1. 4.

    Appropriate ignoring of “don’t skills”

Not Observed

Needs Improvement

Adequate

Very Good

Excellent

1

2

3

4

5

  1. 5.

    Provided appropriate redirection

Not Observed

Needs Improvement

Adequate

Very Good

Excellent

1

2

3

4

5

  1. 6.

    Appropriate Level of Guidance (specific vs. general)

Not Observed

Needs Improvement

Adequate

Very Good

Excellent

1

2

3

4

5

  1. 7.

    Correct Follow-Through for PDI Procedure (if applicable) Mark if N/A

Not Observed

Needs Improvement

Adequate

Very Good

Excellent

1

2

3

4

5

Integrity Checker Comments about Session

  • This mother looks like she is having trouble processing this information about homework. I don’t see a lot of head nodding or buy-in from mom—no questions about how to best do it. The girl, on the other hand, is really into this! She seems quite interested and invested!

  • During check-in be sure to place a lot of emphasis on how the homework went the previous week. Bring out a blank sheet if mom didn’t bring her sheet from last week and re-create it. Talk about what they did each day, what skill was easiest, what skill was harder, and how the girl liked the playtime. Guide mom through a discussion of how to problem solve the issue of other children wanting to be a part of the playtime.

  • After you complete your DPICS coding, be sure to give mom a summary of her skills. “You did a great job with Labeled Praise today, we are going to really focus on Behavior Descriptions since they were on the low side today.”

  • Mom doesn’t notice all her questions! You are doing a good job ignoring them during this CDI Coach 1.

  • Be careful with your tone of voice—you used a question when you modeled a RF. Also, later you praised her for reflecting when she used a question a few times.

  • Be sure to increase the frequency of your coaching statements. It is hard when the mom is not using the skills frequently—just find something positive that you still can comment on (tone of voice, following child’s lead, sharing, sitting close to the child) after almost every parent statement.

  • You can praise mom for ignoring the child’s sassiness/bossiness when you see it in session. This was really the only misbehavior that I saw during the session.

  • Also, try labeling your coaching statements. You said “great job” every so often. Be sure to tell mom what was a great job (i.e., label your coaching statements).

  • Be sure to praise mom when she does follow your coaching directions. So if you say “find something to describe” and mom complies, be sure to say enthusiastically “Great description!!” as though she was the one who came up with it : )

  • When you end the coaching, you want to be really positive. “What a great interaction!” You two are really having a great time in there! (insert the ending statement from the protocol) I’ll be there in just a minute or two.” Basically, you want to end on a high note and have that parent feeling really confident when you finish the coaching.

  • This is really hard to do—but try to use just PRIDE skills with the girl. A few questions snuck in, but overall great PRIDE skills with her : )

  • For #7 above (giving feedback on the DPICS) you really want to go into great detail here. Show her the numbers for each skill, compare them to her baseline numbers, and praise her for any changes that you notice. Same thing with the ECBI graph. You want to make a big deal about the number coming down (if it did) and then talk about why it didn’t (if that is what happened).

  • This girl is a real firecracker. I am looking forward to seeing what she does with time-out in PDI. Although the session was missing some key elements, you provided mom with a very nice CDI Coach 1 session!

Exercise 8a: Common CDI Coach Session Questions/Themes to Look for in Supervision

  • Does the trainee spend too much time talking to the parent about nonessential topics?

  • Is the trainee using only PRIDE skills during interactions with the child?

  • Does the trainee help the parent to generalize behavioral principles during check in and check out?

  • How does the trainee deal with parental homework noncompliance?

  • Does the trainee convey confidence and hope in the parent’s ability to effect behavior change?

  • Is the trainee talking to both caregivers equally (if there are two caregivers)?

  • How does the trainee deal with a disruptive child during check in and check out?

  • What is the rate/frequency of coaching statements?

  • What feedback can be given about the quality of coaching statements?

  • Is there too much line feeding or misapplication of coaching statements?

  • How well does the trainee go over ECBI data and DPICS coding data in session?

Exercise 8b: Common PDI Coach Session Questions/Themes to Look for in Supervision

  • Are the toys appropriate for this child during PDI?

  • Does the therapist redirect coaching statements quickly, if needed?

  • Does the parent provide praise to the parent for correct follow-through?

  • Is the therapist giving no more than 5 s for compliance?

  • Is the therapist following the PDI flow chart?

  • Does the therapist talk to the parent during a time-out?

  • Is the therapist watching whether or not the child gets off the chair and providing guidance to the parent?

  • Is the homework given after a PDI session appropriate for the caregiver’s skill level?

Figure 9: Sample PDI Feedback

Integrity Checker Comments About Session

  • Good ignoring of that kiddo at the beginning…just as he was starting to escalate, he stopped briefly, and you slipped in a praise (so good!). He is really pushing buttons.

  • She had complaints about the ECBI—that doesn’t happen so much with other parents, but I see her point that he still needing a warning after praises and so she doesn’t know how to rate him. Great ignoring while he is yelling “shut up!”

  • He definitely needs a house rule for sassy talk….

  • Your new sound system is really awesome, by the way.

  • Your coaching is very good through some very challenging situations. Your timing was great and you provided just enough direction to mom as you helped her through the command sequence.

  • Mom keeps talking even when he is yelling at her to “shut up”—I would have her move her body away a bit and really give a big ignore (make it really obvious when she is ignoring him—it isn’t so obvious right now). This kid isn’t getting a lot of praise for the positive opposite and when he does he is still sassy back to her.

  • He seems to really like the teaching parts of the play—or at least parts where he is learning something or has something to consider. I also heard him say “thank you” somewhere in there!

  • Your feedback to her was so sensitive and nice. It was a hard interaction to watch in a way because he was so disrespectful to her.

  • Good idea to focus on reflections during the coaching.

  • The only problem with her first command sequence was that it was two commands together (take that off the mirror and bring it to me). You would want to give her some feedback on that—but he did comply and she did follow up with a LP.

  • For the second command she actually just used two UPs instead of a LP after the compliance. She started the command by giving an IC (I need you to give me the X. Please hand me the X).

  • Mom has a good mix of giving commands and then using PRIDE skills.

  • She did not give LPs after the third compliance. Her habit it to give a string of Ups.

  • “I want you to put the man on top…” is an IC rather than a DC (mom thinks it is DC).

  • Things for mom to work on in PDI

    • Be sure to give one DC.

    • Use the specific Warning words.

    • Don’t count to 5 out loud/No extra words after the command.

  • For all his sassy talk, this boy is actually quite compliant! He was much more appropriate by the end of the session. I hope that mom is able to make the connection that her positive attention leads to more appropriate behavior for this boy.

  • Excellent modeling the skills for mom during the checkout!!

  • One small point about house rules…and this would help mom with her desire to have some response to the child after going to the chair for a house rule…she needs to watch him carefully afterwards and then give a huge praise when he is using respectful/nice language. This way he knows what she likes and it changes the contingencies.

  • Wonderful session!

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Davis III, R.F., Brestan-Knight, E. (2018). Assessing Therapist Competence in the Context of PCIT Training. In: Niec, L. (eds) Handbook of Parent-Child Interaction Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-97698-3_20

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