Clinical Round Table 7 - Attending to Social Determinants of Health to Optimize Delivery of Evidence-based Treatment for Early Childhood Externalizing Behaviors: A Parent-child Interaction Therapy (PCIT) Illustration

Parent-Child Interaction Therapy (PCIT) is an empirically-supported treatment to address behavioral concerns among young children and has many benefits for children with externalizing difficulties, including those with developmental delays and at risk for early-life adversity. Despite these benefits, many families encounter challenges accessing PCIT or experience barriers to care that increase the likelihood of early termination. Social determinants of health (SDH) are social factors that influence health and include regional policies, food and housing availability, systemic racism/discrimination, immigration status, neighborhood characteristics, English proficiency, religious affiliation, social support, and social benefits eligibility. SDH are also associated with child health and mental health outcomes including but not limited to: risk of trauma, exposure to community violence, premature birth and developmental risks, risk of family separation, insurance coverage, housing and food quality and stability, and access to clinical sites offering evidence-based treatments. Thus, families most in need of PCIT to help alleviate and buffer against deleterious effects of systemic failures that predicate a variety of health and mental health risks may simultaneously encounter the greatest barriers to treatment engagement and retention.

There is a growing body of research that focuses on capturing the extent to which families are impacted by SDH that place them at risk for encountering barriers to care and how providers are adapting their PCIT practices to reflect these impacts. This round table is designed for providers to learn how these research recommendations are being applied practically, how clinical observations may be leveraged to facilitate future scientific inquiry and who are curious to learn examples of efforts made to enroll, successfully retain, and complete treatment with SDH in mind. Panelists in this clinical roundtable will share specific practice recommendations and examples of how these challenges were ameliorated in their clinics. Panelists have prepared clinical case and research examples to highlight how different phases of treatment may require unique cultural and social considerations with families in PCIT.