Implementing Parent Child Interaction Therapy (PCIT) in Community Clinics

CASE STUDY

Implementing Parent Child Interaction Therapy (PCIT) in Community Clinics

Authors: Katie Haupt Sean Snyder Sarah Tannenbaum Noemie Bechu Jessie Fitts

APRIL 2026

IMPROVING CARE. CHANGING LIVES.

53 Parker Hill Avenue, Boston, MA 02120 (617) 232-8390 | info@bakercenter.org bakercenter.org

Summary The Center for Traumatic Stress and Comorbidity (CTSC) was established by The Baker Center to address a critical national gap in training for trauma-informed, evidence-based practices (EBPs) that serve youth with co-occurring mental health conditions. Funded by the National Child Traumatic Stress Network (NCTSN), the CTSC strengthens agency capacity by equipping providers with Parent-Child Interaction Therapy (PCIT), a gold-standard, trauma-informed EBP for children ages 2 to 7. PCIT includes two structured phases, both of which focus on strengthening the caregiver–child attachment relationship. One phase does this by teaching caregivers effective positive behavioral support strategies to build connection with their child through play, while the other strengthens the relationship by teaching caregivers consistent, effective, and trauma-informed limit-setting strategies. Research consistently shows that PCIT improves child behavior problems, adaptive functioning, and prosocial skills, and research also shows how PCIT lowers caregiver stress and improves overall family functioning. For clinicians, it provides a clear, structured, skill-based approach to supporting young children and caregivers, particularly those impacted by trauma.

Through the CTSC Learning Collaborative (LC), trained clinicians delivered PCIT to over 200 children and families across eight states. The LC model acknowledges that implementing EBPs in mental health settings is inherently complex, requiring consideration of client needs, clinician readiness, organizational dynamics, policy constraints, and funding structures. To support agencies in navigating these factors, The Baker Center team provided hands-on training, ongoing clinical consultation during active implementation, fidelity monitoring, implementation coaching, and continuous quality improvement support. Despite expected challenges, most agencies successfully implemented PCIT and built the internal infrastructure needed to sustain the model over time.

Improvements emerged across multiple levels, including improved child functioning, increased caregiver skills, enhanced provider confidence, and strengthened organizational readiness. Collectively, these gains demonstrate the Learning Collaborative’s effectiveness in advancing trauma-informed care for young children with complex behavioral health needs

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Background PRESENTING PROBLEM A needs assessment conducted by The Baker Center with NCTSN Category III sites revealed that 94% of responding agencies expressed a need for additional training in EBPs that address co-occurring mental health conditions in the context of trauma. While all respondents were already implementing trauma-focused EBPs— 82 % were using Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)—they still reported gaps in their ability to fully meet the complex needs of youth and families affected by trauma, particularly when working with young children exposed to traumatic events, whose developmental needs often require additional relational, behavioral, and caregiver-focused interventions.

In response, The Baker Center established the Center for Traumatic Stress and Comorbidity (CTSC) with support from the National Child Traumatic Stress Network (NCTSN). CTSC supports agencies already delivering trauma-focused treatment by providing training and implementation assistance in complementary, trauma-informed EBPs. The initiative aims to:: • Improve youth and family outcomes related to traumatic stress and comorbid conditions • Build agency capacity to effectively treat comorbidities alongside trauma • Empower clinicians to confidently implement EBPs with complex trauma cases • Strengthen agency ability to collaborate with communities and policymakers to integrate complementary EBPs into trauma-informed systems of care

POPULATION SERVED CTSC supported eight NCTSN Category III agencies across eight states. In Cohort 1, four community mental health agencies in Alaska, North Carolina, Tennessee, and Missouri implemented PCIT. Cohort 2 included four additional agencies in Connecticut, Georgia, Massachusetts, and Maryland.

As of May 2025, participating clinicians have provided PCIT to over 200 children and their families.

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Implementation Process PHASE I

Preparation The Learning Collaborative begins with the preparation phase to engage the sponsoring agency in planning. Goals for the Learning Collaborative are developed, and potential participating organizations are identified. The requirements for participation are communicated to potential participants and selection and commitment of organizations is finalized.

PHASE II

Pre-Work Once the preparation phase is complete, the pre-work phase begins. The focus of this phase is on assessing organizational factors that might serve as opportunities or barriers to implementation. This phase also includes the design and installation of structural supports for implementation.

PHASE III

Active Implementation The active implementation phase includes the installation of the evidence based practise into the participating organizations and the initial implementation of EBP services. Participants engage in a number of structured and self-guided learning activities to deliver the EBP with high integrity.

PHASE IV

Sustainability To ensure ongoing success of the EBP, the sustainability phase facilitates organization independence in the EBP through activities designed to eliminate barriers to practice utilization and create flexible plans for adapting to new challenges.

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IMPLEMENTATION NEEDS FOR AGENCIES The PCIT Learning Collaborative (LC) follows a structured four-phase model that guides agencies from early planning through sustained implementation. Each phase addresses the distinct needs that emerge as organizations adopt new practices, with lessons and tools from earlier phases serving as building blocks for long-term sustainability. Spanning roughly 24 months, the LC strengthens clinical competency, organizational readiness, and long-term sustainability through training, consultation, and continuous quality improvement activities. The implementation process is dynamic and phased, as outlined in the EPIS framework: Exploration, Preparation, Implementation and Sustainability.

In the Preparation phase, the Baker Center team engages prospective agencies through program announcements, application support, and pre-application Q&A sessions to clarify expectations and assess organizational fit. During Pre-Work, selected agencies are formally onboarded through welcome materials, kickoff calls, early data collection, and site visits, allowing teams to assess internal strengths and challenges and build foundational implementation structures. Active Implementation includes the core components of the LC—clinical training, consultation, learning sessions, implementation coaching, and senior leader engagement—while agencies begin using CQI tools to guide decision-making and make adaptive refinements. In the final Sustainability phase, support shifts toward agency independence, with consultation focused on refining workflows, strengthening internal training capacity through the Within Agency Trainer (WATer) model, and finalizing sustainability plans. By this stage, agencies are positioned to sustain PCIT with strengthened confidence and organizational alignment.

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Training and Capacity Building CLINICAL TRAINING AND CONSULTATION At the core of the NCTSN PCIT Learning Collaborative was a structured Therapist Training and Consultation model designed to build clinician capacity and support sustained implementation of the PCIT protocol.

The 40-hour training occurred in two parts: a three-day Child Directed Interaction (CDI) training followed approximately three months later by a two-day Parent Directed Interaction (PDI) training. Across both segments, clinicians learned the theoretical foundations of PCIT, practiced core CDI and PDI skills, and demonstrated proficiency in standardized tools such as the Eyberg Child Behavior Inventory (ECBI) and the Dyadic Parent-Child Interaction Coding System (DPICS). Training used adult learning strategies—including modeling, case vignettes, structured practice, and role-plays with feedback—and action-period assignments helped reinforce skills between sessions.

After completing CDI training, clinicians began implementing PCIT with families and joined biweekly small-group consultation calls (typically two agencies and six clinicians per call). These sessions blended individualized support with peer learning and addressed case enrollment, session logistics, fidelity challenges, measurement-based care software (“CHART”) integration, and clinician-identified concerns. CHART served as the real-time measurement and feedback system, tracking caregiver skill acquisition and client outcomes to guide treatment planning and data-driven decision-making.

Near Learning Session 3, each agency identified a Within-Agency Trainer (WATer) to build internal sustainability. Selected, fully certified therapists completed an eight-hour train-the-trainer workshop focused on teaching PCIT, maintaining fidelity, assessing coaching skills, and evaluating trainee competencies. WATers then participated in 12 monthly consultation calls while simultaneously training a new therapist through didactics and co-therapy, supporting them in completing at least one PCIT case to graduation. To become certified WATers, applicants were required to submit CDI and PDI coaching videos for review by a Global or Regional Trainer.

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LEARNING SESSIONS The Learning Collaborative was anchored by three structured Learning Sessions, each designed to support implementation of PCIT at different phases.

Learning Session I focused on building engagement and cohesion within and across teams, introducing PCIT and the CHART system, and launching cross-agency Affinity Groups to foster shared learning.

Learning Session II Centered on identifying and addressing early implementation challenges, with a strong emphasis on continuous quality improvement using tools like the Plan-Do-Study-Act (PDSA) cycle. Teams also explored adaptations to better fit MATCH with their client populations and agency structures.

Learning Session III Participating teams shared their clinical and organizational successes and highlighted strategies for sustaining MATCH over time. This final session reinforced advanced clinical competencies and allowed teams to present their sustainability plans, while Affinity Groups provided one last opportunity for role-specific collaboration and peer problem-solving.

IMPLEMENTATION LEADERSHIP Leading an agency-wide implementation initiative is a significant endeavor, even for agencies experienced in training staff in new EBPs. Each phase of implementationrequires agency leaders to think strategically about integrating the EBP into existing systems while building the infrastructure, relationships, and support necessary for long-term success.

To support agency leaders and build organizational capacity throughout the Learning Collaborative, CTSC facilitated regular coordinator consultation calls and cross-site senior leadership calls. These meetings provided dedicated space for agency leaders and program champions to reflect on their site-specific implementation progress, troubleshoot challenges, and share best practices with peers. Discussion topics included strategies for increasing caregiver enrollment through targeted marketing, integrating CHART into existing data systems, establishing realistic timelines for internal PCIT training, and planning for sustainability beyond the Learning Collaborative.

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FAMILY ENGAGEMENT AND EDUCATION Family engagement is critical for PCIT, as it is a dyadic treatment requiring participation from the caregiver.

Beginning in Learning Session 1, agencies received a sample PCIT flyer and began developing their “PCIT pitch,” adapting the base materials for their own marketing needs and community contexts. To strengthen outreach efforts in Cohort 2, the Community Outreach and Engagement (COE) Toolkit—developed collaboratively by Baker Center staff and the Parent Professional Advocacy League of Massachusetts—was introduced. This toolkit provides practical language, messaging strategies, and community-engagement tips to help agencies welcome families into their services and connect evidence-based services like PCIT to the families who can benefit from them. Building on these resources, each agency created tailored materials, including family-facing and referral-focused flyers as well as elevator pitch scripts.

Agencies also tested new approaches to sustain caregiver engagement. At one site, a Family Partner developed a caregiver survey and conducted regular follow-up calls to support ongoing participation and address barriers; this tool has since been shared with other organizations for wider use. To expand awareness and strengthen referral networks, agencies engaged in community events, coalition meetings, and outreach to primary care providers, while also increasing collaboration with Family Support Specialists across cohorts.

Hybrid learning sessions and instructional videos were added to improve accessibility and promote consistent uptake of resources among staff. Finally, CTSC developed a PCIT “Myths and Facts” and FAQs resource to help Family Partners and agency staff address common caregiver questions and concerns during the referral and engagement process.

ONGOING SUPPORT AND QUALITY IMPROVEMENT NCTSN established a continuous feedback loop to monitor progress and refine implementation throughout the Learning Collaborative. Clinicians received regular case consultation while also benefiting from additional implementation support provided by Baker Center staff. Beyond clinical training, Baker Center faculty delivered multi-level implementation consultation to guide agencies through both installation and long-term sustainability of PCIT. Each agency formed an implementation team composed of therapists, supervisors, administrators, senior leaders, and family support specialists (including community liaisons or care coordinators when applicable). These teams met weekly or biweekly to coordinate planning, address barriers, and align organizational processes with PCIT requirements. Baker Center faculty supported these efforts through scheduled consultation sessions, ad hoc technical assistance, and co-facilitated site-based meetings designed to strengthen implementation infrastructure across agencies.

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Outcomes The implementation of PCIT across participating NCTSN Category III agencies led to measurable improvements in access, provider capacity, and client outcomes, despite workforce and infrastructure challenges.

INCREASED ACCESS TO CARE Agencies reported that offering PCIT helped expand access to trauma-informed, evidence-based care for young children ages 2 to 7. Some sites, particularly those in rural or under-resourced areas, noted that PCIT provided a structured, family-centered option for children who previously lacked access to developmentally appropriate behavioral health services. Additionally, internal tracking showed an increase in the number of caregivers actively participating in services over time, especially when outreach and engagement strategies were tailored to local communities.

CLIENT OUTCOMES Outcome data suggests improvements in child behavior and family functioning for families who engaged in PCIT. Across participating sites, clinicians reported decreases in scores on the ECBI, reflecting reductions in child externalizing behaviors. Anecdotal caregiver feedback also pointed to stronger parent-child relationships, increased caregiver confidence, and greater consistency in parenting strategies.

PROVIDER KNOWLEDGE, ATTITUDES, AND SKILLS Across the four quarters of PCIT Cohort 1, clinicians demonstrated steady growth in their competencies, reporting a 9% improvement in general therapy skills, a 34% increase in general behavioral therapy skills, and a 121% increase in PCIT-specific skills. Early results from Cohort 2 showed similar upward trends: during the first two quarters, clinicians reported a 6% improvement in general therapy skills, a 25% increase in general behavioral skills, and a 90% increase in PCIT-specific skills. Agencies also reported a increases in PCIT-specific capacity and an 11% improvement in their ability to identify an internal PCIT program champion. From Q1 to Q3, Cohort 2 providers showed an even more substantial 144% increase in PCIT self-efficacy, along with continued gains in general therapy (4%) and general behavioral skills (25%). Overall, agencies reported a 16.5% increase in PCIT-specific capacity, reflecting both clinician growth and expanding organizational readiness to support the model.

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IMPLEMENTATION BARRIERS ADDRESSED IN THE LEARNING COLLABORATIVE Participating agencies encountered a range of challenges that CTSC worked to address through training, technical assistance, and tailored implementation support. These challenges reflected both broader systemlevel constraints and agency-specific barriers to delivering trauma-informed care through PCIT. Workforce Limitations and Turnover: Persistent workforce shortages and high staff turnover presented significant, system-level obstacles to PCIT implementation. Across cohorts, agencies experienced substantial clinician turnover that disrupted training continuity and challenged service sustainment. In Cohort 2 alone, nine clinicians exited participating agencies during the implementation period, with only four remaining active. Turnover often occurred between the two training phases or after certification, resulting in the loss of designated within-agency trainers and reduced internal training capacity. In several instances, agencies withdrew from the Learning Collaborative or were left without an eligible internal trainer despite prior investment in training. In response, The Baker Center supported remaining trainees at affected sites to complete certification and maintain service capacity where possible, while also facilitating pathways for trained clinicians who changed organizations to continue delivering PCIT in new settings Provider Fit and Clinical Philosophy: Many clinicians entered the Learning Collaborative with preconceptions or misunderstandings about PCIT, particularly regarding its use of time-out and it’s fit within trauma-informed care. This was especially common among providers trained in non-directive and play therapy approaches, leading some to initially question PCIT’s alignment with their therapeutic philosophy. These concerns significantly impacted the initial training experience. A considerable portion of didactic time was spent addressing clinician hesitations and correcting misinformation, which reduced time available for skill-building activities such as role-plays and practice coding. As a result, some participants experienced delays in completing skill check-offs and beginning full implementation. CTSC responded by embedding education and dialogue throughout the Learning Collaborative. For example, Dr. Gurwitch led a dedicated presentation during Learning Session 2 on how PCIT aligns with trauma-informed principles, creating space for open discussion among both clinical and non-clinical staff. The team also developed and shared family-facing “Myths and Facts” and FAQ resources to help agencies engage caregivers and address common concerns. Additional materials, including a research summary and caregiver testimonials, are in development to further support provider and stakeholder buyin. Despite these efforts, philosophical misalignment led to attrition: two clinicians from Cohort 1 and one agency from Cohort 2 ultimately chose not to continue with PCIT implementation.

Technology: PCIT’s use of real-time coaching and AV technology created significant logistical hurdles. Agencies faced challenges identifying the right equipment for their site(s), coordinating setup with internal IT teams, and ensuring systems functioned smoothly during sessions and for required recordings. Additionally, PCIT requires two therapy rooms for in-person delivery, which was difficult for some sites to accommodate.

Access and Engagement: Engaging caregivers in a structured, time-intensive intervention like PCIT posed challenges, particularly in rural and under-resourced areas. CTSC supported agencies in adapting materials and outreach strategies to improve engagement. This included updating marketing flyers and tailoring messaging to ensure cultural responsiveness and accessibility for diverse populations.

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Key Takeaways For agencies and systems wanting to implement PCIT, consider how trust-building must underpin all technical implementation strategies. This trust building includes how technical assistance is tailored and how implementation workplans are co-developed with agencies. Relationship-building—particularly through face-to-face interactions—plays a central role in establishing strong, durable partnerships. We find that adaptability and trust are closely linked; maintaining model fidelity while allowing thoughtful, site-specific Lessons Learned from the adaptations is critical to sustaining engagement.

Shared decision-making further strengthens trust by ensuring NCTSN MATCH Learning that implementation solutions reflect each site’s needs and priorities. Finally, transparent communication and Collaborative consistent follow-through can help to reinforce trust throughout all phases of implementation, building the foundation for long-term collaboration.

DESIGN INFRASTRUCTURE WITH CERTIFICATION IN MIND Since the previous collaboratives focused on MATCH and TF-CBT, the team needed to develop new tracking workflows and materials tailored to PCIT. This included updating CHART to monitor caregiver PRIDE skills and creating tools to support fidelity tracking and certification progress. A consistent barrier for is the setup and use of audiovisual (AV) equipment, an essential component for live coaching and video review. Account for this in implementation planning. In response to challenges observed in Cohort 1, the Baker Center team created an Implementation Guide with equipment recommendations, room setup examples, recording timelines, and troubleshooting tips. The team also began sending monthly progress reports to agencies, detailing video submission status, skill checkoffs, and consult attendance (which must remain at 80% or higher). Real-time tracking tools, for example, noting the date of submission, pass/fail status, and remaining review attempts, helped reduce clinician uncertainty and enabled more targeted support.

Despite these improvements, some Cohort 2 sites still experienced delays. To address this, future cohorts may benefit from a two-step AV readiness process: first, a “space tour” during the site visit to receive feedback; second, a follow-up deadline to confirm full AV functionality. Reinforcing these expectations early and tying them directly to certification timelines can help minimize disruptions and promote a smoother training process.

ENHANCE PRE-SCREENING AND PRE-EDUCATION FOR SITES Enhancing pre-screening and pre-education emerged as a key lesson, as additional preparation—such as targeted pre-reading, PCIT video clips, and dedicated Q&A sessions—could have reduced early resistance and freed more time for active skill-building during formal training. Clinician perceptions of PCIT and of its use with families who experience trauma played a central role in training engagement and implementation success. The PCIT Attitudes Survey, used in Cohort 2 to track changes in confidence and alignment with the model, provided valuable insight into shifting perceptions over time. Administering the survey at three points in future cohorts (pre-CDI, pre-PDI, and near certification) would offer a more complete picture of how attitudes develop across the learning cycle. Synthesizing site-level responses and sharing themes with trainers can help tailor training content and consultation to address specific concerns earlier. When sites show signs

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of hesitancy—such as philosophical concerns before PDI—proactive, targeted support (e.g., presentations on PCIT and trauma) may prevent resistance from derailing progress. Broader use of the survey, including distribution through the PCIT listserv, could also generate comparative data to strengthen training strategies across the field.

STRENGTHEN EARLY IMPLEMENTATION PLANNING AND INTERNAL COORDINATION Agencies with strong internal implementation teams and invested senior leadership (e.g., meeting regularly to review cases, consult feedback, and video submission status) were more successful in troubleshooting barriers. Embedding structured agendas or checklists and clarifying expectations during initial calls (e.g., expected caseloads, licensing requirements, co-therapy options) helped align roles and foster consistency.

SUPPORT WATER DEVELOPMENT AND ROLE CLARITY Agencies benefited from flexibility in identifying WATers over time rather than at the outset. Clear guidance on selecting appropriate trainees, strategic case selection, and realistic time estimates helped WATers prepare effectively. This included offering clear criteria for selecting appropriate trainees, such as ensuring alignment with PCIT’s behavioral orientation, interest in early childhood work, and availability to fully engage in training.

Additional support in case selection is also critical, for example, avoiding cases involving complex trauma or high instability, and instead prioritizing families likely to attend consistently and engage with the model.

Scheduling recommendations (e.g., front-loading CDI didactics, staggering co-therapy) and leadership support were critical to success. Providing realistic time estimates for the WATer role, and guidance on how senior leaders can support protected time for supervision and training, can further reduce burden and promote success.

ENHANCE CONSULTANT-SPECIALIST COORDINATION Regular, structured communication between implementation specialists and clinical consultants helped prevent silos and misalignment. Weekly check-ins allowed teams to share updates from both clinical and leadership perspectives, monitor progress, and identify emerging barriers early.

CREATE MORE OPPORTUNITIES FOR PEER SUPPORT Clinicians expressed interest in optional monthly “drop-in” office hours for discussion and peer support, particularly around topics like cultural adaptations, caregiver engagement, and managing dropouts. These peer spaces can complement formal consultation and build a sense of community among participants.

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Conclusion The implementation of PCIT through the two NCTSN Learning Collaborative demonstrated that, with the right structure, support, and leadership, community-based mental health agencies can successfully adopt and sustain trauma-informed, evidence-based care for young children and their families. Despite workforce shortages, infrastructure limitations, and philosophical concerns about fit, agencies made meaningful progress in building internal capacity, strengthening caregiver engagement, and improving clinical outcomes.

CTSC played a critical role in guiding this process, offering targeted training, consultation, and implementation support that addressed both clinical skill development and organizational readiness. The success of this initiative illustrates the importance of pairing high-quality clinical models like PCIT with structured implementation strategies rooted in collaboration, continuous quality improvement, and relationship-building.

As the mental health field continues to confront rising demand and a strained workforce, initiatives like this one highlight the potential of learning collaboratives to accelerate the uptake of EBPs, reduce disparities in access, and improve the well-being of children and families across diverse settings.

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