Barriers to Treatment Engagement Among Minoritized, Low-Income Youth with Developmental Delay Receiving Internet-Delivered Parent-Child Interaction Therapy

Objective: Disruptive behavior problems (DBPs) are a top reason for referral to mental health clinics in young children, particularly those with developmental delays (DD). Yet, engagement in treatment is a major concern, especially for minoritized, low-income families. Internet-delivered Parent-Child Interaction Therapy (IPCIT) is effective for DBPs and offers a promising telehealth approach to support engagement. This study examined whether parent acculturation, technological problems, and stress predicted five IPCIT engagement indicators and whether the indicators formed a latent construct. Methods: Participants were 70 children with DD (M age = 34.3 months; 72.9% male) and their parents, primarily low-income and from racial/ethnic minoritized backgrounds (93.3%). Engagement indicators included session attendance, treatment retention, homework completion, therapeutic alliance, and treatment satisfaction. Regression and confirmatory factor analyses assessed predictors and engagement structure. Results: Higher parenting stress predicted lower attendance, weaker alliance, and reduced satisfaction. Lower parent acculturation predicted reduced homework completion. Technology problems were mostly non-significant, with one exception predicting attendance. The latent model of engagement could not be validated. An exploratory composite approach identified stress and acculturation variables as significant negative predictors of overall engagement. Conclusion: Engagement in IPCIT is presently best understood as a multidimensional construct, with stress as a key barrier, followed by acculturation. While most technology issues were non-significant, brief in-session disruptions appeared to hinder attendance. Findings highlight the need for stress-sensitive, culturally responsive strategies, while minimizing technology disruptions, to support engagement among underserved families in telehealth parent training.

Name thesis:degree_name

Ph.D.

Discipline thesis:degree_discipline

Clinical Child Psychology

Grantor dc:publisher

University of Kansas

Year dc:date.issued

2025

Author dc:creator

• Golik, Alexandra Michelle

Advisors dc:contributor.advisor

• Cushing, Christopher C
• Gudiño, Omar G

• barriers
• parent training
• PCIT
• telehealth
• treatment engagement

Language dc:language.iso

en

Dc Identifier Other

https://www.proquest.com/LegacyDocView/DISSNUM/32240550

OAI identifier oai:identifier

oai:kuscholarworks.ku.edu:1808/37786