# Incorporating Evidence-Based Parenting Practices into Home-Based Behavioral Health: A PCIT-Informed Approach for Training Paraprofessionals

## TL;DR

Training paraprofessionals to teach parenting skills at home leads to significant improvements in caregiver behavior and child behavior.

## Contribution

Demonstrates that paraprofessionals can effectively deliver PCIT-informed parenting training in home settings.

## Key findings

- Caregivers showed large improvements in positive parenting behaviors during child-led play.
- Child disruptive behaviors significantly decreased as reported by caregivers.
- BSF shows promise as a scalable model for delivering behavioral health services in community settings.

## Abstract

What are the main findings?
Paraprofessional-delivered, PCIT-informed Child-Directed Interaction (CDI) skills practice was associated with large, clinically meaningful improvements in observed caregiver parenting behaviors within a brief intervention window.Caregiver-reported child disruptive behaviors decreased significantly during early Behavioral Skills Training for Families (BSF) program, indicating early behavior change in real-world, home-based services.

Paraprofessional-delivered, PCIT-informed Child-Directed Interaction (CDI) skills practice was associated with large, clinically meaningful improvements in observed caregiver parenting behaviors within a brief intervention window.

Caregiver-reported child disruptive behaviors decreased significantly during early Behavioral Skills Training for Families (BSF) program, indicating early behavior change in real-world, home-based services.

What are the implications of the main findings?
Structured, PCIT-informed parenting skills can be effectively delivered by bachelor’s-level workers under supervision, expanding access to evidence-based practices in community settings.Behavioral Skills Training for Families (BSF) shows promise as a scalable workforce model that preserves core behavioral mechanisms while reducing common barriers to traditional clinic-based parent training.

Structured, PCIT-informed parenting skills can be effectively delivered by bachelor’s-level workers under supervision, expanding access to evidence-based practices in community settings.

Behavioral Skills Training for Families (BSF) shows promise as a scalable workforce model that preserves core behavioral mechanisms while reducing common barriers to traditional clinic-based parent training.

Background/Objectives: Disruptive behavior problems are common in early childhood, yet access to evidence-based parent training remains limited in many communities due to workforce shortages and service delivery barriers. Behavioral Skills Training for Families (BSF) is a Parent–Child Interaction Therapy (PCIT)-informed, home-based behavioral skills practice model designed to be delivered by bachelor’s-level paraprofessionals under close supervision. This pilot study evaluated the feasibility and preliminary caregiver and child outcomes associated with the Child-Directed Interaction (CDI) module of BSF to inform refinement of training and implementation protocols and guide future evaluation. Methods: Using a non-randomized pre–post design embedded within routine services, caregiver–child dyads (children ages 2–10 years) receiving BSF CDI across community-based agencies in Minnesota were included. Outcomes were assessed using observational coding of caregiver skills (Dyadic Parent–Child Interaction Coding System; DPICS) and caregiver-reported child behavior measures (Eyberg Child Behavior Inventory [ECBI]; Weekly Assessment of Child Behavior–Positive [WACB-P]). Paired-sample t-tests with intent-to-treat analyses examined changes from the baseline to the last attended CDI session. Results: Caregivers demonstrated statistically significant and large increases in observed positive parenting skills and reductions in negative verbalizations during child-led play. Children showed significant reductions in disruptive behavior intensity and problem scores on the ECBI, reflecting movement toward clinically meaningful improvement. No significant change was observed in caregiver-reported positive child behaviors on the WACB-P. Post hoc analyses were conducted to further explore these differences and found consistent changes in the ECBI for cases, regardless of no reported changes in positive child behaviors on the WACB. Conclusions: The results provide preliminary evidence that a structured, PCIT-informed CDI skills practice model can be feasibly implemented by paraprofessionals and is associated with meaningful improvements in caregiver behavior and child behavior outcomes in the first 2–3 months following service initiation. The findings support BSF as a promising workforce-embedded approach and inform future controlled studies examining effectiveness, sustainability, and broader implementation outcomes.