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.

Despite the widespread availability of evidence-based parenting programs, population-level improvements in child mental health remain limited, partly due to persistent challenges recruiting, engaging, and retaining families in services. Intermediary organizations have increasingly invested in implementation support systems to address these challenges, yet evaluations often focus on provider satisfaction rather than organizational outcomes. This study evaluated a county-wide, two-tiered implementation support system delivered by University of Miami Team COACH to strengthen parenting programs funded by The Children’s Trust of Miami-Dade County. The current investigation used a quasi-experimental pre-post design and conducted descriptive analyses, paired-samples t -tests, and multiple regression analyses to examine program reach, provider satisfaction, changes in organizational outcomes, and associations between implementation support participation and program performance. The implementation support system included a universal voluntary tier available to all funded programs and an indicated tier providing additional targeted support to programs experiencing implementation challenges. Across 78 parenting programs, 88.5% participated in at least one implementation support strategy, averaging 11.8 hours of support during the contract year. Provider satisfaction ranged from 89% to 100% across support types. Relative to the pre-implementation year, programs participating in the implementation support system saw recruitment increased from 90.3% to 95.7% of contracted families and retention increased from 61.1% to 67.7%, a statistically significant improvement, t (64) = -1.97, p = .05. In regression analyses controlling for prior-year performance and participation in other supports, Communities of Practice participation was positively associated with increased recruitment rates ( B = 0.02, p = .04), whereas live trainings ( B = -0.06, p = .01) and asynchronous online courses ( B = -0.01, p < .01) were negatively associated with recruitment rates. Similar negative associations were observed for retention. Findings suggest that implementation support systems can achieve broad reach and high provider satisfaction and may be associated with improvements in organizational outcomes, particularly when supports emphasize active, ongoing, collaborative engagement.