Implementation of Virtual Reality to Parent-Child Interaction Therapy for Enhancement of Positive Parenting Skills: The Study Protocol

Background: Disruptive behaviour is a common reason that young children are referred to child and adolescent mental health care services worldwide. Research indicates that treatments for child disruptive behaviour where parents are the primary agents of change are most impactful. Parent-Child Interaction Therapy (PCIT) is an effective parent management training program, currently implemented in therapeutic settings within the Netherlands. If parenting skills have been mastered, PCIT has shown to make impactful long-term improvements on parental warmth, responsiveness and effectiveness. The current study aims to increase the proven effectiveness of PCIT by increasing accessibility and impact of the treatment with a focus on strengthening positive parenting skills. To enhance the skills from the therapy, the current study will implement a Virtual Reality (VR) element for additional practice in the home-setting. We expect that if the positive parenting skills are trained by implementing the VR-element, skill mastery will be achieved sooner, treatment completion rates will increase and the parent-child relationship will better, whilst parental stress and child disruptive behaviour will decrease.Methods: Fifteen children (ages 2 to 7 years old) with disruptive behaviour and their parents will followed throughout their PCIT-VR treatment. Using a non-concurrent multiple baseline Single-Case Experimental Design (SCED) with three phases, fifteen families will fill out questionnaires weekly, in addition to having pre-, and post-treatment and follow-up measurements to monitor their positive parenting skills, child disruptive behaviour, parenting stress and VR progress. Moreover, the quantitative information and qualitative interviews will be analysed visually and statistically and summarised to provide a complete picture of experiences from both parents and therapists. Discussion: The SCED - with its phased design, randomisation and the opportunity to replicate and assess both individual and group treatment effects - and adaptability of the VR technology are the strengths of the study. The risks of increased type I errors, maturation effects or technological failure will be mitigated with the right statistical support. The current study aims to enhance the scope of the treatment through the additional skill training, ultimately in support of routinely implementing VR at scale within PCIT.