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The implementation of any evidence-based treatment (EBT) into community settings, especially at a broad scale, is a complex, dynamic process. Large-scale implementation requires consideration of factors at a variety of levels, including those related to the broader system, provider agencies, clinical and professional staff, as well as families. This chapter will explore the implementation of one EBT, parent–child interaction therapy (PCIT), across one state, the Commonwealth of Pennsylvania. The spread and implementation of the intervention will be discussed in light of the current literature related to dissemination and implementation. Specific examples and case discussions from the state will also be highlighted, including a review of specific facilitating factors and barriers, as well as strategies used to promote implementation with fidelity and ongoing sustainability of the model.