Conan Gasque (Host): Welcome to Inside Pediatrics, a podcast brought to you by Children's Hospital of Alabama in Birmingham. I'm Conan Gasque. Thanks so much for joining us today. We're talking about a very important topic in the world of behavioral health. It's parent-child interaction therapy, also known as PCIT. It's something we've been offering here for quite a few years at Children's of Alabama, and we're joined by Dr. Arista Rayfield, the PCIT service line leader here at Children's of Alabama. Dr. Rayfield, thanks so much for your time.

Dr. Arista Rayfield: Thank you for having me.

Host: So as mentioned, this is a very important type of therapy that you and the behavioral health team at Children's offer. Can you explain just kind of on a very basic level, what exactly is PCIT?

Dr. Arista Rayfield: PCIT is an evidence-based therapy for young children with behavioral problems, and it was developed by Dr. Sheila Eyberg.

Host: And I guess it's targeted on kids who are really having a tough time with behavioral issues. Is that right?

Dr. Arista Rayfield: Yes. It can be for children with severe behavioral problems to more moderate problems. Children with ADHD or autism are often at high risk for behavioral problems.

Host: Are there particular types of behaviors that usually lead to, you know, a child to this program?

Dr. Arista Rayfield: The kind of behaviors like temper tantrums, not following directions, aggression, problems in school. It's also been demonstrated to help young children who have anxiety or other mood problems in very young ages.

Host: So, how does a parent know when it's time to pursue this kind of therapy? Is that something they learn through their typical therapy appointments?

Dr. Arista Rayfield: Well, I think that anytime there's a problem at school, if teachers are letting parents know, if it's disruptive to the family or if there's any kind of distressing behavior to the parent, it's always a good idea to get an assessment for PCIT, and your therapist can let you know if you think, if they think it's a good fit for your family, if you need that level of treatment, or if your kid's behaviors are in more typical ranges.

Host: So, you know, let's say a parent, you know, speaks to a therapist and they decide it's time to move forward with PCIT. How does the process work from there, and what should a parent and a child expect?

Dr. Arista Rayfield: Well, in PCIT, the therapist will be teaching the family a couple of different sets of skills, and then observing the family, implement these skills and give them live coaching so they can implement the skills with high fidelity and be very effective, and then be able to implement this in their home environment. So, coaching the skills you're learning is very central to PCIT.

Host: So, I guess, it's like the therapist kind of gets to take a look at the parent and the child interacting and kind of offer some instruction on do this a little better, do this a little differently, things kind of like that. Is that sort of what it is?

Dr. Arista Rayfield: Yes. It is conducted in the play situation because these are young children- Yeah ... and that's how children learn. And we are teaching them the skills. And so, we try to focus on when they're getting it right. We want to see more of this. You're doing a great job following their lead. So, we're really trying to focus on what the parent is doing well and help them make the changes sometimes that are pretty small and you're not aware of unless someone is observing you and helping give you feedback on your interactions.

Host: You mentioned very young ages. What are the ages?

Dr. Arista Rayfield: About three to seven.

Host: Okay.

Dr. Arista Rayfield: There are times that older children can be appropriate. There is a protocol for that, for adjusting it age up. And sometimes for younger there are protocols for working with younger children. It varies a little bit, of course, due to their developmental level, but around three to seven is the sort of sweet spot.

Host: How much of a difference can this make? How much potential does this have to really have a positive impact on the life of the parent or the child?

Dr. Arista Rayfield: It has a huge impact. Behavioral problems are decreased. Parent-child relationships are improved and very warm supportive relationships. Parents quit getting calls from teachers. That is a big improvement.

We expect most families to be able to get their child's behavior into the typical range. So, we see a big improvement in that. Improvement in social skills as well. So, we see a lot of improvements. And it's wonderful working with young children because you see the changes happening in the moment. I see the techniques working within the very session that we are in. I see children making changes based on how the parent is interacting with them. And so, it's really a wonderful kind of therapy to get to work with families with as well.

Host: And I know you provide this therapy yourself, but you also have a certification to teach this therapy, and how has that made a difference in the state of Alabama as a whole that you've been able to provide instruction for other therapists?

Dr. Arista Rayfield: That has made a huge difference in access for children across our state. Everybody can't drive to Birmingham to get treatment, so the Children's Behavioral Health, the PATHS Grant, and Alabama Department of Mental Health have partnered to train over 60 therapists across the state to be able to provide PCIT. And so, that means that families can get access to treatment without a long wait list and closer to their home.

Host: And I think you got a unique certification yourself. You're one of not very many people around the world that has it. Can you tell me what that is?

Dr. Arista Rayfield: Yes. I am a regional trainer through PCIT International. And there are, at last count, about 43 regional trainers in the United States. So, I have done a lot of PCIT and had the privilege of training under Dr. Iberg at the University of Florida.

Host: And that the person who created this? Is that correct?

Dr. Arista Rayfield: Yes.

Host: And when, how long has this type of therapy been around?

Dr. Arista Rayfield: It was first developed in the '70s and then through the '80s and early '90s really got a lot of traction with research and documenting the effectiveness. And I would say the research continues to work on the most difficult aspects and some of the technical aspects to help therapists implement this in the most effective manner.

Host: And I know Children's, as we mentioned, has been offering this for a long time. But in the last few years, we've kind of advanced the ways that we implement this, right?

Dr. Arista Rayfield: Absolutely. In one way we have added other providers who provide PCIT within our own department. We have developed and gotten to create space that's really great for providing PCIT and just the emphasis on training across the state has really been going on about the past four or five years to really increase access for our young kids.

Host: So, you have all these people across the state who have the right training to be able to provide this therapy, but then you have, even those among them, who can also provide the training themselves, right?

Dr. Arista Rayfield: Absolutely. One of the things we wanted to do was to be able to sustain the therapists we have trained, that sustain our numbers. And so, we have trained other therapists to be within agency trainers, meaning they can teach therapists within their own agency PCIT and get them certified as well. We've had one group of those and we have four or five trainers across the state who within their own agency can train a therapist and hopefully to sustain our numbers.

Host: Yeah. And I guess that just helps to multiply the number of people who can provide this and the amount of help that can be provided throughout the state.

Dr. Arista Rayfield: Absolutely.

Host: I understand y'all had an event related to PCIT recently. Can you tell me about that?

Dr. Arista Rayfield: Yes. We were able to have a conference, a continuing education conference, for our PCIT therapist, certified or in the process or interested. And we provided additional education on PCIT, and to also try to build that community here in our state. There's a wonderful community internationally really with PCIT, and we're trying to build that in our state to help people feel supported and to be able to continue to provide this therapy for young children.

Host: How important is it right now when mental health providers and their services are in such high demand, how important is it to be able to offer this in so many places across the state right now?

Dr. Arista Rayfield: I think it is so important. One of the things about PCIT is that it is designed to treat the problems and help the child graduate so that they're not continuing to be in therapy. It is a short-term therapy, about 12 to 16 weeks, depending on the family and the practice level at home. So, it really helps be able to get kids treatment and then more kids access because families are graduating and their kids are getting better so that they're not having to continue to come to therapy.

Host: Very interesting topic, and it's good to hear about the great work that you and your team are doing in making a difference in the lives of not only children, but their parents and and the way they interact. Any other details that you want to add for parents who you know, maybe may have this on the horizon for their kids?

Dr. Arista Rayfield: I think recognizing that PCIT is a commitment from the family because we do want the parent and child there. They learn wonderful skills, and we're asking them to practice them for a few minutes every day. But the benefits and the outcome is really wonderful in terms of improved behavior, but even more than that, the warm relationship that parents can develop with their children that really carry on through a lifetime.

Host: All right. Once again, Dr. Arista Rayfield, with our behavioral health team at Children's of Alabama, thanks so much for your time.

Dr. Arista Rayfield: Thank you.

Host: Thanks for listening to Inside Pediatrics. For more podcasts like this one, go to childrensal.org or wherever you download podcasts.