Implementing an Evidence-Based Intervention for Children in Europe: Evaluating the Full-Transfer Approach

Objectives—This study evaluated implementation outcomes in three European countries of GenerationPMTO, an evidence-based parenting intervention for child and adolescent behavior problems. Method—The implementation approach was full transfer, in which purveyors train a first generation (G1) of practitioners; adopting sites assume oversight, training, certification, and fidelity assessment for subsequent generations (Forgatch & DeGarmo, 2011; Forgatch & Gewirtz, 2017). Three hundred therapists participated in trainings in GenerationPMTO in Iceland, Denmark, and the Netherlands. Data are from the implementation’s initiation in each country through 2016, resulting in six generations in Iceland, eight in Denmark, and four in the Netherlands. Therapist fidelity was measured at certification with an observation-based tool, Fidelity of Implementation Rating System (FIMP; Knutson, Forgatch, Rains, & Sigmarsdóttir, 2009). Results—Candidates in all generations achieved fidelity scores at or above the required standard. Certification fidelity scores were evaluated for G1 candidates, who were trained by the purveyor, and subsequent generations trained by the adopting implementation site. In each country, certification fidelity scores declined for G2 candidates compared with G1 and recovered to G1 levels for subsequent generations, partially replicating findings from a previous Norwegian study (Forgatch & DeGarmo, 2011). Recovery to G1 levels of fidelity scores was obtained in Iceland and the Netherlands by G3; in Denmark, the recovery was obtained by G5. The mean percentage of certification in each country was more than 80%; approximately 70% of certified therapists remained active in 2017. Conclusions—Findings support full transfer as an effective implementation approach with longterm sustainability and fidelity.Peer Reviewe

Evidence-based Kernels: Fundamental Units of Behavioral Influence

This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior–influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of its components would render it inert. Existing evidence shows that a variety of kernels can influence behavior in context, and some evidence suggests that frequent use or sufficient use of some kernels may produce longer lasting behavioral shifts. The analysis of kernels could contribute to an empirically based theory of behavioral influence, augment existing prevention or treatment efforts, facilitate the dissemination of effective prevention and treatment practices, clarify the active ingredients in existing interventions, and contribute to efficiently developing interventions that are more effective. Kernels involve one or more of the following mechanisms of behavior influence: reinforcement, altering antecedents, changing verbal relational responding, or changing physiological states directly. The paper describes 52 of these kernels, and details practical, theoretical, and research implications, including calling for a national database of kernels that influence human behavior

Five-year fidelity assessment of an evidence-based parenting program (GenerationPMTO): inter-rater reliability following international implementation

Abstract Background Implementing evidence-based programs in community service settings introduces the challenge of ensuring sustained fidelity to the original program. We employ a fidelity measure based on direct observation of practitioners’ competence and adherence to the evidence-based parenting program (EBPP) GenerationPMTO following installation in national and international sites. Fidelity monitoring is crucial, especially when the program purveyor transfers administration of the program to the community as was done in this case. In previous studies, the Fidelity of Implementation rating system (FIMP) was used to evaluate practitioners’ fidelity to the GenerationPMTO intervention in six countries following implementation showing high levels of adherence up to 17 years post certification. Other studies showed FIMP to have predictive validity. The present study provides inter-rater reliability data for this fidelity tool across teams of the purveyor, Implementation Sciences International, Inc./ISII, and national and international sites over a five-year period. Methods Data assess inter-rater reliability in terms of percent agreement and intraclass correlation (ICC) for the purveyor’s two fidelity teams and the fidelity teams in seven implementation sites. Results Results report stable good to excellent levels of inter-rater reliability and ICCs as well as good attendance at fidelity meetings for all fidelity teams. Conclusions This observational method of assessing fidelity post implementation is a promising approach to enable EBPPs to be transferred safely from purveyors to communities while maintaining reliable fidelity to the intervention

Clinicians\u27 observations of family interactions in the reunification process: The Parent Child Checklist

The present article employed a sample of 365 families of children in foster care to conduct a validation test of a newly developed instrument, the Parent Child Checklist (PCC). The PCC is a 54-item direct observation measure assessing parent–child interactions in the context of a family session. The PCC was developed to support the effective implementation of an evidence-based intervention, Parent Management Training-Oregon model, in the Kansas child welfare system. The PCC was designed to capture two scales of child behavior (prosocial and problem behavior) and five parenting domains (encouragement, positive involvement, problem solving, communication skill, and effective discipline). A combination of exploratory and confirmatory factor analysis was used in this first stage validation of the checklist. Results indicated the PCC scales obtained adequate internal consistency and interrater reliability. The confirmatory factor analysis supported 6 of the 7 expected scale domains; however, a two-factor solution was better - supported among the discipline items, labeled as effective and ineffective discipline. Test–retest reliability ranged from 0.45 to 0.80 across child behavior and parenting domains with alpha levels ranging from 0.65 to 0.88. A behavioral observation rating scale for clinicians that is reliable and feasible to implement can represent a significant improvement to practice-as-usual