Background This study was the first attempt to investigate the status of implementation and sustainability of early childhood positive behavior support (PBS) via the lens of implementation science for community-based child care centers in a Midwest state of the United States. Objective Obtain state-level data and gain insights on PBS implementation and sustainability in target child care centers. Method Through a total population sampling method, we recruited administrators (N=94, 12% of the full population) of target child care centers to participate in a survey. Results The results suggested that the majority of the responding centers (59.57%) had not received PBS professional development (PD) indicating PBS PD opportunities had not been disseminated in the majority of community-based child care centers in the target state. Nearly half of the programs were not implementing PBS practices after they received PBS PD, which raised questions about continuous use of PBS and the return on investment of PBS PD efforts. The results of ANOVA found that the scope of PBS training significantly affected the level of PBS implementation; the type of training significantly affected the level of PBS sustainability. Simple linear regression revealed programs that had a higher level of PBS implementation also had a higher level of PBS sustainability. Conclusions Using implementation science theories and tools, we developed two preliminary measures to obtain meaningful information about early childhood PBS implementation and sustainability in community-based child care centers. Understanding the factors associated with implementation can provide insights for the improvement of PD programs when disseminating the use of evidence-based PBS practices. (author abstract)