Abstract
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.