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

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 the 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.

Acknowledgments

This study is funded by the National Institute of Mental Health R01MH100134 awarded to ASL and LBF. Further, the time and effort to prepare this manuscript was supported by K01MH110608 awarded to MLB. Funding for PCIT training was awarded to UC Davis CAARE Center and Los Angeles County Department of Mental Health by First 5 LA.

Administrative claims data were furnished by the Outcomes Management Division of the Los Angeles County Department of Mental Health. Additionally, the preparation of this article was supported in part by the Implementation Research Institute (IRI) at the Brown School, Washington University in St. Louis, through an award from the National Institute of Mental Health (R25 MH080916). MLB is a fellow of IRI and ASL and LBF are past fellows of IRI.

Disclosure statement

All procedures for this study were approved by the University of California, Los Angeles Institutional Review Board. The authors were provided de-identified data that were part of a county wide implementation effort.

Supplementary material

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Additional information

Funding

This work was supported by the National Institute of Mental Health [K01MH110608,R01MH100134].