Woodfield Melanie J, Merry Sally, Hetrick Sarah E
The Werry Centre, Department of Psychological Medicine, University of Auckland, New Zealand.
Centre for Youth Mental Health, University of Melbourne, Australia.
Implement Res Pract. 2022 Mar 7;3:26334895221082330. doi: 10.1177/26334895221082330. eCollection 2022 Jan-Dec.
Parent-Child Interaction Therapy (PCIT) is a parent training intervention for childhood conduct problems, distinctive in its use of live clinician coaching of the parent-child dyad via a one-way mirror and discrete earpiece. However, despite a compelling evidence base, uptake of evidence-based parent training programmes such as PCIT by clinicians in routine care settings remains poor. This systematic review aimed to identify and synthesise implementation interventions that have sought to increase clinician adoption of PCIT in usual care settings.
We searched MEDLINE (Ovid), Embase (Ovid), PsycInfo (Ovid), CINAHL (EBSCO), Science Citation Index and Social Sciences Citation Index, and Web of Science Core Collection from inception to October 2020. Articles were included if they tested (by way of randomised controlled trials, controlled clinical trials, interrupted time series and controlled before and after trials) implementation interventions across any and all of the patient, clinician, clinic, system or policy domains. Two independent reviewers screened and selected studies, assessed risk of bias and extracted data - summarising implementation intervention components according to items from the Template for Intervention Description and Replication (TIDieR) checklist ( Hoffmann et al., 2014).
Of the 769 articles identified once duplicates were removed, 13 papers relating to three studies met the inclusion criteria - all were quantitative or mixed-methods examinations of the effectiveness of different PCIT clinician training or training-related consultation methods. A narrative description of interventions was provided, as quantitative synthesis was not possible.
Research attention has to date been focussed on the establishment of an evidence-base for PCIT's effectiveness, with relatively little attention to the dissemination, implementation and sustainment of this treatment. Those studies that do exist have focused on training methods and training-related expert consultation. Research attention could usefully turn to both adoption and sustainment of this effective treatment in usual care settings.
In this review, we aimed to summarise what is already known about how to implement PCIT in community settings after clinicians have received training in the approach. While research relating to the implementation of other parent training programmes is interesting and informative, implementation efforts are most effective when tailored to a specific programme in a specific context. As such, it was important to review published studies relating to PCIT specifically. We identified three relevant studies, one of which is yet to publish its main implementation findings. The three studies have focused on how best to train clinicians in PCIT, including how best to provide post-training support from expert trainers. We concluded that a fruitful line for future research would be to focus on the post-training period, particularly how best to support clinicians to adopt and sustain PCIT in their practice.
The study was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 01/10/2020 (CRD42020207118).
亲子互动疗法（PCIT）是一种针对儿童行为问题的家长培训干预方法，其独特之处在于通过单向镜和独立听筒对亲子二元组进行现场临床指导。然而，尽管有令人信服的证据基础，但在常规护理环境中，临床医生对诸如PCIT等循证家长培训项目的采用率仍然很低。本系统评价旨在识别和综合那些试图提高临床医生在常规护理环境中采用PCIT的实施干预措施。
我们检索了MEDLINE（Ovid）、Embase（Ovid）、PsycInfo（Ovid）、CINAHL（EBSCO）、科学引文索引和社会科学引文索引以及Web of Science核心合集，检索时间从创刊至2020年10月。如果文章通过随机对照试验、对照临床试验、中断时间序列和前后对照试验测试了患者、临床医生、诊所、系统或政策领域中任何和所有方面的实施干预措施，则纳入研究。两名独立评审员筛选并选择研究、评估偏倚风险并提取数据——根据干预描述与复制模板（TIDieR）清单（Hoffmann等人，2014年）中的项目总结实施干预措施的组成部分。
在去除重复项后识别出的769篇文章中，与三项研究相关的13篇论文符合纳入标准——所有这些都是对不同PCIT临床医生培训或培训相关咨询方法有效性的定量或混合方法研究。由于无法进行定量综合，因此提供了干预措施的叙述性描述。
迄今为止，研究重点一直集中在为PCIT的有效性建立证据基础上，而对这种治疗方法的传播、实施和维持关注相对较少。现有的那些研究主要集中在培训方法和与培训相关的专家咨询上。研究关注点可以有益地转向在常规护理环境中采用和维持这种有效治疗方法。
在本综述中，我们旨在总结在临床医生接受该方法培训后，关于如何在社区环境中实施PCIT的已知情况。虽然与其他家长培训项目实施相关的研究很有趣且信息丰富，但实施工作在针对特定背景下的特定项目进行调整时最为有效。因此，专门回顾与PCIT相关的已发表研究很重要。我们识别出三项相关研究，其中一项尚未发表其主要实施结果。这三项研究主要关注如何以最佳方式对临床医生进行PCIT培训，包括如何从专家培训师那里获得最佳的培训后支持。我们得出结论，未来研究的一个富有成效的方向将是关注培训后阶段，特别是如何以最佳方式支持临床医生在实践中采用和维持PCIT。
该研究于2020年10月1日在国际前瞻性系统评价注册库（PROSPERO）上进行了前瞻性注册（CRD42020207118）。
