Rural families gain access to childhood behavioural support

For the first time, parents living in regional and remote NSW can gain access to vital early childhood behavioural support through an online help program, with UNSW researchers leading the push for permanent services.


UNSW's Dr Jane Kohlhoff holding a parent child therapy session with Shannon Murphy, mother of two from Armidale. Photo: Peter Rae

Parents in regional and rural areas may soon have access to specialised support services for severe behavioural problems in young children, with a trial of a government funded online toddler clinic underway across NSW.

UNSW Sydney’s Dr Jane Kohlhoff, who is working with parenting service Karitane, is running an Australian-first parent training program via the internet that will give access to specialist mental health therapy for families in remote areas.

Clinical psychologists will use a live video link to coach parents as they play with their children, then give support based on the interactions and behaviour they have witnessed.

The play-based program, known as Parent Child Interaction Therapy (PCIT), is an extension of Karitane’s Toddler Clinic, a service that launched more than 10 years ago to fulfil the demand from families in Sydney’s metropolitan areas seeking help for toddlers with aggressive behaviour, persistent tantrums, hyperactivity, defiance and separation anxiety. Almost 2500 families have been referred to Karitane’s Toddler Clinics since 2005.

“This is the first time that parents who don’t have easy access to specialist help in their community can receive live video-based coaching in parenting strategies while the parent and child are playing,” says Dr Kohlhoff, from UNSW Medicine’s School of Psychiatry.


UNSW's Dr Jane Kohlhoff at the Karitane offices in Sydney. Photo: Peter Rae

PCIT is an evidence-based method of treating consistent and disruptive behaviour in children aged 2 to 4, says Dr Kohlhoff. It is shown to be crucial in improving symptoms of maternal depression and stress by boosting parents’ confidence and ability.

The PCIT therapy program provides up to 6 to 12 sessions over a three month period, with clinicians using specialised Bluetooth headset technology and live video, similar to Skype, to deliver active treatment sessions.

Clinicians follow the same principles as when working with families in-person at the Toddler Clinic, where they coach the parent through a one-way mirror while the parent and child play. The aim of PCIT is to improve the child’s behaviour by strengthening the parent-child relationship and teaching positive limit-setting strategies.

Helping to mitigate behaviour problems early is key in improving family dynamics, preventing chronic problems emerging later in life, says Dr Kohlhoff.

“The whole program in based on the knowledge that children need warmth and sensitivity, combined with positive discipline," she said.

“This type of access to specialist services is especially crucial for parents who are geographically isolated in rural towns or farms. There shouldn’t be stigma for parenting help, but there often is. This program allows parents to access support from a psychologist in their home and should help ease the burden on other mental health services.”

In a 2017 study published in the Journal of Consulting and Clinical Psychology, a randomised control trial of 40 children, examined the use of real-time video teleconferencing to deliver behavioural therapy to children aged 3 to 5 in their homes. Up to 70% of children treated with internet-based PCIT had improvement scores of 1 (very much improved) or 2 (much improved). About half of the children in the study no longer met the diagnostic criteria for disruptive behaviour disorder.

Dr Kohlhoff and her team intend to treat up to 50 families this year, with those already in the program showing a significant improvement in outcomes.

“We’ve treated families from Armidale, Dubbo, Bega and Byron Bay, with all showing dramatic changes in the children’s behaviour, and parents reporting a reduction in disobedience, hurting parents and siblings and extreme tantrums.

“Mothers are enjoying their children more, having closer relationships and seeing improvements in behaviour at pre-school.”

The project intends to use improving broadband infrastructure and video technology to deliver the program in coordination with the family’s local healthcare networks and GP.

For more information on how to access the service visit