Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021;6(2):262-276.
doi: 10.1080/23794925.2020.1855613. Epub 2021 Jan 8.

Train-to-Sustain: Predictors of Sustainment in a Large-Scale Implementation of Parent-Child Interaction Therapy

Miya L Barnett  1 , Lauren Brookman-Frazee  2   3 , Stephanie H Yu  4 , Teresa Lind  2   3 , Joyce H L Lui  4 , Susan Timmer  5 , Deanna Boys  5 , Anthony Urquiza  5 , Debbie Innes-Gomberg  6 , Daphne Quick-Abdullah  6 , Anna S Lau  4
Affiliations

Train-to-Sustain: Predictors of Sustainment in a Large-Scale Implementation of Parent-Child Interaction Therapy

Miya L Barnett et al. Evid Based Pract Child Adolesc Ment Health. 2021.

Abstract

Sustainment of evidence-based practices is necessary to ensure their public health impact. The current study examined predictors of sustainment of Parent-Child Interaction Therapy (PCIT) within a large-scale system-driven implementation effort in Los Angeles County. Data were drawn from PCIT training data and county administrative claims between January 2013 and March 2018. Participants included 241 therapists from 61 programs. Two sustainment outcomes were examined at the therapist- and program-levels: 1) PCIT claim volume and 2) PCIT claim discontinuation (discontinuation of claims during study period; survival time of claiming in months). Predictors included therapist- and program-level caseload, training, and workforce characteristics. On average, therapists and programs continued claiming to PCIT for 17.7 and 32.3 months, respectively. Across the sustainment outcomes, there were both shared and unshared significant predictors. For therapists, case-mix fit (higher proportions of young child clients with externalizing disorders) and participation in additional PCIT training activities significantly predicted claims volume. Furthermore, additional training activity participation was associated with lower likelihood of therapist PCIT claim discontinuation in the follow-up period. Programs with therapists eligible to be internal trainers were significantly less likely to discontinue PCIT claiming. Findings suggest that PCIT sustainment may be facilitated by implementation strategies including targeted outreach to ensure eligible families in therapist caseloads, facilitating therapist engagement in advanced trainings, and building internal infrastructure through train-the-trainer programs.

Keywords: community implementation; evidence-based practice; parent-child interaction therapy; survival analysis; sustainment.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Flow of therapists through the training, initiation, and discontinuation of PEI PCIT claiming
Note. PEI = Prevention and Early Intervention; PCIT = Parent-Child Interaction Therapy.
Figure 2
Figure 2
Kaplan-Meier survival curve for program PCIT claiming survival by group (internal trainer vs. no internal trainer)
See this image and copyright information in PMC

References

    1. Aarons GA, Green AE, Willging CE, Ehrhart MG, Roesch SC, Hecht DB & Chaffin MJ (2014). Mixed-method study of a conceptual model of evidence-based intervention sustainment across multiple public-sector service settings. Implementation Science, 9, 183. 10.1186/s13012-014-0183-z - DOI - PMC - PubMed
    1. Barnett ML, Bernal NA & Sanchez BEL (2020). Direct-to-consumer marketing for parent-child interaction therapy: Impact of language and messenger. Journal of Child and Family Studies, 29, 71–81. 10.1007/s10826-019-01575-6 - DOI - PMC - PubMed
    1. Barnett ML, Lau AS, Lind T, Wright B, Stadnick NA, Innes-Gomberg D, Pesanti K. & Brookman-Frazee L. (2019). Caregiver attendance as a quality indicator in the implementation of multiple evidence-based practices for children. Journal of Clinical Child & Adolescent Psychology. Advance online publication. 10.1080/15374416.2019.1683851 - DOI - PMC - PubMed
    1. Becan JE, Bartkowski JP, Knight DK, Wiley TRA, DiClemente R, Ducharme L, Welsh WN, Bowser D, McCollister K, Hiller M, Spaulding AC, Flynn PM, Swartzendruber A, Dickson MF, Fisher JH, & Aarons GA (2018). A model for rigorously applying the Exploration, Preparation, Implementation, Sustainment (EPIS) framework in the design and measurement of a large scale collaborative multi-site study. Health and Justice, 6, 9. 10.1186/s40352-018-0068-3 - DOI - PMC - PubMed
    1. Beidas RS, Marcus S, Wolk CB, Powell B, Aarons GA, Evans AC, Hurford MO, Hadley T, Adams DR, Walsh LM, Babbar S, Barg F, & Mandell DS (2016). A prospective examination of clinician and supervisor turnover within the context of implementation of evidence-based practices in a publicly-funded mental health system. Administration and Policy in Mental Health and Mental Health Services Research, 43(5), 640–649. 10.1007/s10488-015-0673-6 - DOI - PMC - PubMed