Anecdotal observations suggest that engagement and treatment response is comparable to that seen in traditional,

in-clinic PCIT, although parents in a brief I-PCIT open pilot series took somewhat longer than our traditional PCIT cases to meet PCIT mastery criteria. Several other process matters merit comment. First, I-PCIT presents greater obstacles to limiting distractions and interruptions in the treatment environment. Family members unexpectedly enter the treatment room, telephones ring, play activities can be more difficult to manage, and despite the best room setup efforts, children elope from the treatment room with fewer opportunities for the therapist to proactively or reactively intervene. As such, whereas the therapist prepares the treatment/play room in traditional PCIT, I-PCIT requires the therapist to train parents to set up the treatment/play room to reduce the likelihood of interruptions CDK phosphorylation and ensure proper play activities during sessions (e.g., removing toys/objects that are not indicated for CDI “special time,”

removing objects that present potential Tofacitinib mw safety concerns when coaching parents to actively ignore problem behavior, coordinating family members and child care for siblings to reduce interruptions). For the duration of each session, we routinely ask parents to turn off cellular phones or to place them on vibrate mode, and to unplug landlines or direct them to go straight to voicemail. We have asked parents to place “do not disturb” signs on their front door prior to each session to indicate that they are unable to answer the door for the following hour. For parents with multiple young children, it is important to have a childcare plan for siblings during session—whether it is leaving siblings with a Niclosamide neighbor during session, or, in two-parent homes, rotating off the care of the untreated sibling for half of the session at a time while the other parent is being coached. While these obstacles can present additional challenges for the family and therapist, they also give families an opportunity to receive concrete feedback on ways in

which their home spaces can be better tailored to CDI and PDI. While in traditional clinic-based PCIT, the therapist attempts to provide similar feedback with only parents’ verbal descriptions of the home space, I-PCIT allows for a more thorough survey of the home environment and increased opportunities for troubleshooting. In addition, the quantity and quality of therapist-child interactions differ between I-PCIT and traditional clinic-based PCIT. While the frequency and quality of therapist-parent interactions is roughly consistent, I-PCIT presents fewer opportunities for the therapist to interact with the child. In clinic-based PCIT, planned and unplanned transitions allow the therapist to build rapport with the child as well as model skill use and effectiveness to parents.