Behavior problems in young children, especially among families from disadvantaged backgrounds (e.g., facing greater risk of poverty, social exclusion, discrimination, and violence), often result in referrals to mental health clinics. However, low‐income families from historically marginalized racial and ethnic backgrounds disproportionately experience barriers to accessing, engaging, and completing treatment. This study examined the recruitment and referral network of a parenting program providing Parent‐Child Interaction Therapy (PCIT) in a large urban academic medical center and affiliated community‐embedded clinics, as well as the impact of recruitment/referral sources on screening paperwork completion, intake attendance, and treatment completion. Data from 2510 families referred between 2018 and 2022 were analyzed, considering demographic factors and recruitment adaptations during COVID‐19. Referral sources included but were not limited to community agencies, social media, and healthcare providers. Logistic regression analyses determined the likelihood of completing the screening paperwork, attending intake, and completing treatment based on recruitment/referral sources. Every recruitment/referral source increased the likelihood of screening paperwork completion (except community outreach). Every source increased the likelihood of attending intake (except previously enrolled families). Treatment completion was significantly more likely for those referred from pediatricians, friends, behavioral health, and Google. After COVID‐19 (post March 2020), families were more likely to complete the screening paperwork, attend intake, and complete treatment compared to families screened before COVID‐19. Effective recruitment and retention strategies are crucial for engaging families in mental health services. Findings emphasize the role of community and healthcare providers, word‐of‐mouth, and Google and the benefits of telehealth (indicated by post‐COVID‐19 results), in improving treatment access and retention, highlighting the need for flexible service delivery methods.

Background: Parent-Child Interaction Therapy (PCIT) is an evidence-based treatment for child disruptive behavior problems, but access barriers historically limit its reach. Objective: This study examined the reach, effectiveness, adoption, and implementation of Pocket PCIT Online, a self-directed web-based adaptation of PCIT. Methods: In an open trial, 1480 caregivers accessed the free 4-week Pocket PCIT Online intervention. Measures of child behavior, parenting stress, and family conflict were collected pre- and postintervention. Reach, effectiveness, adoption, and implementation were assessed using an implementation science framework. Results: Significant improvements were observed across all outcome measures for intervention completers (n=204). Caregivers reported increased positive child behaviors (Cohen’s d=0.87) and decreased parenting distress (Cohen’s d=−0.3) following completion of Pocket PCIT Online. Of note, approximately 35.8% (73/204) of caregivers reported clinically significant improvements in their children’s frequency of disruptive behaviors. However, only 16.5% (204/1234) of participants completed postintervention measures. Caregivers completed Pocket PCIT Online at a significantly higher rate prior to the COVID-19 national emergency (21/74, 28%) than during or after the onset of COVID-19 (183/1158, 15.8%). Conclusions: While Pocket PCIT Online demonstrates potential as a low-cost, accessible, and scalable public health intervention for child disruptive behaviors, strategies to enhance retention and broaden reach to historically underserved populations are needed.

Background Objectives: Parental anxiety and depression demonstrate bidirectional connections with child developmental outcomes (e.g., disruptive behavior). Directly targeting child development through behavioral parent training (BPT) has potential for reversing this cycle. Parent–Child Interaction Therapy (PCIT), a BPT with robust research evidence for decreasing child disruptive behaviors, has demonstrated promise in also decreasing caregiver anxiety and depression. However, the mechanisms that explain this relationship are less understood. Methods: The current study examined whether caregivers (N = 840) completing time-limited PCIT experienced significant reductions in depression and anxiety symptoms and improvements in child disruptive behaviors at each time point. Generalized estimate equation analyses assessed whether caregiver anxiety and depression moderated changes in child disruptive behavior. Mediation analyses explored the extent that changes in caregiver–child interactions over time explained changes in family outcomes. Results: Child disruptive behavior and caregiver depression and anxiety symptoms improved significantly at each time point of PCIT. Change in child behavioral outcomes was significantly moderated by caregiver race. Caregivers with higher anxiety reported fewer improvements in child disruptive behavior compared to other caregivers. Changes in caregiver anxiety and depression over the course of treatment were partially mediated by improvement in caregiver–child interaction skills. Changes in child disruptive behavior were not mediated by improvement in caregiver–child interaction skills. Conclusions: Results demonstrate that time-limited PCIT could significantly improve caregiver anxiety and depression, and some PCIT-taught parenting skills are direct drivers of this process. Further research is needed to understand other mechanisms underlying the relationship between PCIT and improved family outcomes.

Introduction: Clinics providing mental health treatment to children and families experience a multitude of barriers shepherding patients from their first clinic contact through to graduation from treatment, including difficulty retaining families, getting families to complete screening forms, and finding patients who are eligible for the services offered. This study describes the iterative strategies used by a mental health clinic for child behavior management training to increase families' likelihood of completing their screening forms, attending sessions, and graduating from treatment. Methods: Over the course of five years, this clinic implemented four subsequent strategies to improve intake, including introducing a structured follow-up to get patients to complete screening forms, shortening the screening forms to reduce family time burden, moving screening procedures online, and distributing a public survey link where the intake forms could be accessed without an initial phone screen. Results: Results of logistic regression analyses indicate that, although none of the screening interventions was successful for increasing a child's likelihood of attending intake or graduating from treatment, the addition of the public survey link significantly increased families' chances of completing their initial screening forms. Discussion: Findings indicate that, while other interventions are needed to improve chances of child intake attendance and graduation, it appears that the combination of screening strategies described in this study may begin to overcome barriers to families accessing treatment.