A Statewide Randomized Controlled Trial to Compare Three Models for Implementing Parent Child Interaction Therapy.

OBJECTIVE: This study (NIMH RO1 MH095750; ClinicalTrials.gov Identifier: NCT02543359) evaluated the effectiveness of three training models to implement a well-established evidence-based treatment, Parent-Child Interaction Therapy (PCIT). METHOD: Fifty licensed outpatient clinics, including 100 clinicians, 50 supervisors, and 50 administrators were randomized to one of three training conditions: 1) Learning Collaborative (LC), 2) Cascading Model (CM) or 3) Distance Education (DE). Data to assess training and implementation outcomes were collected at 4 time points coinciding with the training period: baseline, 6- (mid), 12- (post), and 24-months (1-year follow-up). RESULTS: Multi-level hierarchical linear growth modeling was used to examine changes over time in training outcomes. Results indicate that clinicians in CM were more likely to complete training, reported high levels of training satisfaction and better learning experiences compared to the other training conditions. However, supervisors in the LC condition reported greater learning experiences, higher levels of knowledge, understanding of treatment, and satisfaction compared to supervisors in other conditions. Although clinicians and supervisors in the DE condition did not outperform their counterparts on any outcomes, their performance was comparable to both LC and CM in terms of PCIT use, supervisor perceived acceptability, feasibility, system support, and clinician satisfaction. CONCLUSIONS: Through the use of a randomized controlled design and community implementation, this study contributes to the current understanding of the impact of training design on implementation of PCIT. Results also indicate that although in-person training methods may produce more positive clinician and supervisor outcomes, training is not a one-size-fits-all model, with DE producing comparable results on some variables.

Making Implementation Last: The Impact of Training Design on the Sustainability of an Evidence-Based Treatment in a Randomized Controlled Trial.

Although advances have been made in facilitating the implementation of evidence-based treatments, little is known about the most effective way to sustain their use over time. The current study examined the sustainability of one evidence-based treatment, Parent-Child Interaction Therapy (PCIT), following a statewide implementation trial testing three training methods: Cascading Model, Learning Collaborative, and Distance Education. Participants included 100 clinicians and 50 administrators from 50 organizations across Pennsylvania. Clinicians and administrators reported on sustainability at 24-months, as measured by the number of clients receiving PCIT and the continued use of the PCIT protocol. Multi-level path analysis was utilized to examine the role of training on sustainability. Clinicians and administrators reported high levels of sustainability at 24-months. Clinicians in the Cascading Model reported greater average PCIT caseloads at 24-months, whereas clinicians in the Learning Collaborative reported greater full use of the PCIT protocol at 24-months. Attending consultation calls was associated with delivering PCIT to fewer families. Implications for the sustainable delivery of PCIT beyond the training year as well as for the broader field of implementation science are discussed.

Understanding the Effectiveness of the Cascading Model to Implement Parent-Child Interaction Therapy.

Few community-based behavioral health clinicians are trained in evidence-based practices (EBPs). The Cascading Model (CM), a training model in which expert-trained clinicians train others at their agency, may help increase the number of EBP-trained clinicians. This study is one of the first to describe CM training methods and to examine differences between clinicians trained by an expert, and those trained through a within-agency training (WAT) by a fellow clinician. Results indicate that 56% of the 38 eligible clinicians chose to become trainers and 50% of the 56% conducted WATs to train others. This represents a 50% increase in EBP-trained clinicians within the study timeframe. Clinicians trained by an expert reported higher knowledge and training satisfaction than those trained through a WAT. Of note, clinicians trained through a WAT reported increases in EBP knowledge and were more diverse (race/ethnicity, employment status), suggesting that the CM may improve access to EBPs.

A mixed-methods study of system-level sustainability of evidence-based practices in 12 large-scale implementation initiatives.

BACKGROUND: In recent decades, evidence-based practices (EBPs) have been broadly promoted in community behavioural health systems in the United States of America, yet reported EBP penetration rates remain low. Determining how to systematically sustain EBPs in complex, multi-level service systems has important implications for public health. This study examined factors impacting the sustainability of parent-child interaction therapy (PCIT) in large-scale initiatives in order to identify potential predictors of sustainment. METHODS: A mixed-methods approach to data collection was used. Qualitative interviews and quantitative surveys examining sustainability processes and outcomes were completed by participants from 12 large-scale initiatives. RESULTS: Sustainment strategies fell into nine categories, including infrastructure, training, marketing, integration and building partnerships. Strategies involving integration of PCIT into existing practices and quality monitoring predicted sustainment, while financing also emerged as a key factor. CONCLUSIONS: The reported factors and strategies impacting sustainability varied across initiatives; however, integration into existing practices, monitoring quality and financing appear central to high levels of sustainability of PCIT in community-based systems. More detailed examination of the progression of specific activities related to these strategies may aide in identifying priorities to include in strategic planning of future large-scale initiatives. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT02543359 ; Protocol number PRO12060529.

Feasibility and Effectiveness of Parent-Child Interaction Therapy with Victims of Domestic Violence: A Pilot Study.

Parent-Child Interaction Therapy (PCIT) is an evidence-based treatment for young children (aged 2.5 to 7 years) with externalizing behavior problems. Since its development, PCIT has been applied to a wide array of childhood problems and has a significant evidence base for families with histories of child physical abuse. The current study extended the existing literature by testing the effectiveness and feasibility of PCIT in an urban domestic violence shelter with community-based clinicians delivering the treatment. Seven clinicians implemented PCIT with parent-child dyads which included 21 preschool (M = 4.57 years; SD = 1.50) children. Families completed assessments at baseline, mid-treatment, and post-treatment. Nine families completed PCIT (43%). Completion of PCIT was associated with improved child behavior, parenting practices, and mental health symptoms. Considerations for treatment delivery and future directions are discussed.

Training Community-Based Clinicians in Parent-Child Interaction Therapy: The Interaction Between Expert Consultation and Caseload.

Professional psychologists are increasingly encouraged to utilize evidence-based treatments (EBTs), and therefore have a need to participate and provide the most efficient training methods for these treatments. Multicomponent trainings, which commonly include ongoing support, are more effective than brief methods such as 1-day workshops or reading treatment manuals. The present study examined the effectiveness of 1 form of ongoing support, consultation, as part of a multicomponent training protocol. Thirty-two community-based clinicians were trained in Parent-Child Interaction Therapy (PCIT) as part of a statewide implementation effort, and data were collected on clinician and implementation outcomes at pre-, mid-, and posttraining. Simple and multiple linear regression analyses were conducted to predict posttraining knowledge, skill, acceptability, and feasibility, as well as to examine clinician variables that might moderate these relations. Greater consultation call attendance significantly predicted higher posttraining skill; however, this association was qualified by a significant interaction with PCIT caseload. Implications for training guidelines are discussed.

Protocol for a statewide randomized controlled trial to compare three training models for implementing an evidence-based treatment.

BACKGROUND: Evidence-based treatments (EBTs) are available for treating childhood behavioral health challenges. Despite EBTs' potential to help children and families, they have primarily remained in university settings. Little empirical evidence exists regarding how specific, commonly used training and quality control models are effective in changing practice, achieving full implementation, and supporting positive client outcomes. METHODS/DESIGN: This study (NIMH RO1 MH095750; ClinicalTrials.gov Identifier: NCT02543359), which is currently in progress, will evaluate the effectiveness of three training models (Learning Collaborative (LC), Cascading Model (CM), and Distance Education (DE)) to implement a well-established EBT , Parent-Child Interaction Therapy, in real-world, community settings. The three models differ in their costs, skill training, quality control methods, and capacity to address broader implementation challenges. The project is guided by three specific aims: (1) to build knowledge about training outcomes, (2) to build knowledge about implementation outcomes, and (3) to test the differential impact of training clinicians using LC, CM, and DE models on key client outcomes. Fifty (50) licensed psychiatric clinics across Pennsylvania were randomized to one of the three training conditions: (1) LC, (2) CM, or (3) DE. The impact of training on practice skills (clinician level) and implementation/sustainment outcomes (clinic level) are being evaluated at four timepoints coinciding with the training schedule: baseline, 6 (mid), 12 (post), and 24 months (1 year follow-up). Immediately after training begins, parent-child dyads (client level) are recruited from the caseloads of participating clinicians. Client outcomes are being assessed at four timepoints (pre-treatment, 1, 6, and 12 months after the pre-treatment). DISCUSSION: This proposal builds on an ongoing initiative to implement an EBT statewide. A team of diverse stakeholders including state policy makers, payers, consumers, service providers, and academics from different, but complementary areas (e.g., public health, social work, psychiatry), has been assembled to guide the research plan by incorporating input from multidimensional perspective. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02543359.