A co-designed school-based early intervention involving parent-teacher collaboration to improve mental health and wellbeing in diverse children with disruptive disorders

The primary aim of this project is to improve the mental health and wellbeing of the most vulnerable Australian children by delivering an accessible, comprehensive school-based early intervention—iteratively co-designed with school endusers—to diverse children with disruptive behaviour disorders living in culturally and linguistically diverse (CALD) and rural communities. Standard PCIT Standard Parent Child Interaction Therapy (PCIT), is a highly efficacious ‘Parent Management Training’ (PMT) program—the first line and gold-standard intervention for disruptive child behaviour recommended by professional groups in Australia and worldwide. Mechanisms underpinning disruptive behaviour change in PMT are reduced harsh/inconsistent and increased positive parenting behaviours, which breaks the cycle of inadvertent maintenance of disruptive behaviour that occurs via coercive and inconsistent exchanges between parent and child. PCIT produces significant improvements in parent-reported and observed child disruptive behaviours with large effect sizes among children within our target age range (i.e., 7 and under), such that post-intervention disruptive behaviour returns to within normal limits and gains are sustained up to six years post-treatment. PCIT is identified as a transdiagnostic intervention that produces secondary improvements in children’s internalising problems (i.e., anxiety, depression), observed parenting skills, parent stress and mental health symptoms, and overall family functioning. PCIT’s efficacy is attributed to its intensive coaching method involving the parent-child dyad in most sessions. PCIT uses real-time, bug-in-ear technology to provide live coaching and immediate feedback to parents from a clinician observing the parent-child dyad from behind a one-way mirror. For these reasons, PCIT was selected for adaptation for School-based delivery and complex presentations. Treatment matching for complex conduct problems PCIT-CU is an adaptation of PCIT developed by CIA to target the unique treatment needs of children with callous unemotional traits and refined using researcher, clinician, and carer feedback over more than a decade. This matched v. non-matched design is based on: (a) meta-analytic research finding that children with CU traits start and end PMT with more severe conduct problems that do not normalise, and (b) post-treatment improvements in the conduct problems of clinic-referred children with CU traits deteriorated for those randomised to standard PCIT, but sustained to follow-up for children randomised to PCIT-CU in an RCT. School PCIT adaptation School-based PCIT/PCIT-CU addresses access barriers and enhances intervention effectiveness by improving teacher behaviour management skills and student-teacher relationships, ensuring better generalisation of benefits to the school setting. Targeted Intervention School PCIT involves the target student’s teaching team in PCIT/PCIT-CU sessions, where teachers or support staff receive real-time coaching via a bug-in-the-ear device while interacting with the student, fostering parent-teacher collaboration and consistency across home and school to support lasting behavioural change. Universal Teacher Workshop In response to advisory group feedback and aligning with national and state education priorities, our team developed an 8-hour professional learning workshop, delivered by a certified PCIT Trainer, with a pilot trial of its self-directed online format showing significant improvements in teachers’ mental health literacy on childhood disruptive behaviour. The workshops will be delivered across the school year, with the immediate treatment group participating in Year 1 and the waitlist control group in Year 2. Adapting treatment for non-English speaking CALD families This project builds on our proof-of-concept trial by testing an interpreter-assisted adaptation of School PCIT to overcome language barriers for non-English speaking families, where a trained interpreter relays real-time coaching from the therapist via a bug-in-ear device, ensuring accessibility, cultural sensitivity, and effective intervention delivery. Treatment procedure Children and parents will complete 14 (Standard ‘School PCIT’) to 21 (‘School PCIT-CU’ with a 7-session adjunctive module) weekly, one-hour sessions delivered by a PCIT clinician. The intervention consists of three phases: Child-Directed Interaction (CDI) to strengthen parent-child relationships through positive attention; Parent-Directed Interaction (PDI) to address chronic non-compliance, aggression, and destructiveness with effective discipline; and CARES to build prosocial behaviours and emotional skills like empathy and anger regulation. Teaching staff will join at least four sessions, receiving real-time coaching while interacting with the student, and will observe parents being coached, just as parents will observe teachers. Adherence will be assessed via attendance, homework completion, clinician alliance, and caregiver satisfaction. One primary caregiver will participate in assessments, but all caregivers are encouraged to attend, as father involvement enhances outcomes. The number of sessions completed by educators and parents will be recorded. If a family has multiple children with clinical conduct issues, the child causing the greatest distress will be enrolled, with parents encouraged to practise skills with all siblings in the PCIT age range (2.5–7 years).