Filling potholes on the implementation highway: Evaluating the implementation of Parent-Child Interaction Therapy in Los Angeles County.

In October 2012, first 5 LA funded a unique collaboration between Los Angeles County Department of Mental Health (DMH) and UC Davis PCIT Training Center (UCD PCIT) to train county-contracted agencies to provide Parent-Child Interaction Therapy (PCIT). This $20 million dollar, 5-year grant represented the largest implementation effort of an empirically based treatment to date. The purpose of this paper was to describe the first 2 years of the implementation process of this project, beginning with project start up and pre-implementation phases, and to present agency training and client performance outcomes from our first year of training. Results presented in this evaluation suggest that it is possible to train LA County providers in PCIT, and that PCIT is an effective intervention for DMH-contracted providers in LA County. This evaluation also discusses challenges to successful implementation. Barriers to progress included unanticipated delays building county infrastructure, trainee attrition, and insufficient client referrals. We discuss the results of the current implementation with respect to theory, research, and others' training models, with the aim of evaluating and prioritizing different implementation drivers, noting the ongoing competition between knowing what to do and the need for action.

Challenging children in kin versus nonkin foster care: perceived costs and benefits to caregivers.

This study uses social exchange theory as a framework for examining 102 kin and 157 nonkin foster parents' perceptions of their foster children, their relationships with them, and their own functioning. The authors argue that these perceptions reflect perceived costs and benefits of parenting these children, which may influence their investment in them. All children in the study were referred to Parent-Child Interaction Therapy (PCIT) for treatment of the children's behavior problems, participating with their foster parents. Analyses showed that nonkin caregivers rated their foster children's behavior problems as significantly more severe than kin caregivers but rated themselves as significantly less stressed. Analyses predicting early treatment termination showed that kin caregivers were more likely than nonkin caregivers to complete the course of treatment in PCIT, particularly if they reported elevated levels of parental distress. The authors discuss the implications of these findings for foster children's placement stability and long-term success.