Evidence-based treatments (EBTs) are available for treating Disruptive Behavior Disorders ( DBDs) including Parent-Child Interaction Therapy (PCIT). Despite EBTs' potential to help children and families, they have primarily remained in university settings. Recognized field leaders have expressed concern over the discrepancy between treatment research and clinical practice, and have indicated that EBT implementation is a priority. Little empirical evidence exists regarding how effective commonly used training models are in changing clinician behavior, achieving full implementation (e.g., increasing treatment fidelity, integrating into service settings), and supporting positive client outcomes. This novel application will evaluate the effectiveness of three training models (Learning Collaborative, Train-the-Trainer, and Web-Supported Self-Study) to implement a well-established EBT in real-world, community settings.

To accomplish this goal, the project will be guided by three specific aims:

1. to build knowledge about training outcomes,
2. to build knowledge about implementation outcomes, and
3. to understand the impact of training clinicians using LC, TTT, and SS models on key client outcomes.

Seventy-two of 243 possible (30%) licensed psychiatric clinics across Pennsylvania will be randomized to one of three training conditions:

1. Learning Collaborative (LC),
2. Train-the-Trainer (TTT), or
3. Web-Supported Self-Study (SS).

Data also will be collected on staff trained by clinicians in the TTT group given that the intention of a TTT model is for participants of that group to return to their organization and train others within the organization. The impact of training (clinician level) will be evaluated at 4 time-points coinciding with the training schedule: baseline, 6, 12, and 24-months. Immediately after training begins, parent-child dyads (client level) will be recruited from the caseloads of participating clinicians (N = 288). Client outcomes will be assessed at four timepoints (pre-treatment, 3, 6, and 12-months). Implementation outcomes (clinic level) will be assessed at baseline, 6, 12, and 24-months after training. This proposal builds on an ongoing state-led initiative to implement, and ultimately sustain, PCIT statewide. Lessons learned from this project will directly impact future EBT implementation efforts in Pennsylvania and other states, helping to increase the use of EBTs in community settings nationwide.

Inclusion Criteria:

Administrators group

• must be employed at an agency selected to participate in training as an Executive Director, Chief Financial Officer, or other person responsible for daily operations.

Clinicians/Supervisors group

• a masters or doctoral level professional in the human services field (e.g., social work, psychology, education),
• licensed in his/her field or receiving supervision from a licensed individual,
• actively seeing children and families who are appropriate for PCIT,
• receptive to training in PCIT but not previously trained in PCIT,
• amenable to study tasks (e.g., video-taping, completing assessments).

Parent-Child Dyads group

• Any parent-child dyad who a trained clinician enrolls in PCIT services

Exclusion Criteria:

Administrators group

• not employed at an agency selected to participate in training as an Executive Director, Chief Financial Officer, or other person responsible for daily operations.

Clinicians group

• a bachelors or lower level professional in the human services field,
• unlicensed in his/her field or not receiving supervision from a licensed individual,
• not actively seeing children and families who are appropriate for PCIT,
• not receptive to training in PCIT but not previously trained in PCIT, and/or
• not amenable to study tasks. Interns also will be excluded.

Parent-Child Dyads group

- if he/she is a ward of the state or living in state custody