Assessing therapist competence in the context of PCIT training

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. Therapists play a critical role in maintaining the delivery of effective parent-child interaction therapy (PCIT; Eyberg & Funderburk, 2011) to families in need of services. In turn, PCIT supervisors are vital in helping new PCIT trainees learn to implement the PCIT protocol with fidelity. Providing effective supervision and training for PCIT trainees is of upmost importance for the continued dissemination and implementation of PCIT; however, we currently have relatively little empirical evidence to guide our definition of best practices in PCIT supervision. Research suggests that individual variations among therapists can function as key predictors of client outcomes and dropout (Harwood & Eyberg, 2004; Herschell, Capage, Bahl, & McNeil, 2008). Given the potential for individual differences among therapists to enhance or impede treatment progress, the assessment of therapist competence is essential during the PCIT training process. In this chapter, we outline a variety of assessment techniques and provide suggestions for tools that trainers can use to assess the competence of PCIT therapists. We offer a case study of the assessment of one trainee and provide recommendations for future research in the area of PCIT therapist training and assessment. As outlined by the PCIT Training Requirements (PCIT International, 2018), PCIT trainee competence is currently assessed using a checklist format to ensure that specific training activities and skill assessments are included in 320 PCIT training. Despite having a specific list of trainee skills to assess (e.g., Child-Directed Interaction (CDI)-based skills and Parent-Directed Interaction (PDI)-based skills), there is not yet a unified system for evaluating each of the PCIT therapist competencies. Currently, a checklist based on the PCIT Training Requirements would indicate whether or not an activity was conducted by a trainee or trainer at some point during training rather than provide details regarding the quality of the training activity. Additionally, the training requirements do not provide guidance on the best remediation or training activities to use should a trainee fail to complete a skill listed in the document. With the exception of the Therapist-Parent Interaction Coding System (TPICS; Barnett, Niec, & Acevedo-Polakovich, 2014), which is described in greater detail in the chapter "Therapist-Parent Interactions in PCIT: The Importance of Coach Coding" of this volume, the development and refinement of PCIT trainee competence assessment remains an understudied area in need of additional empirical evaluation.