Abstract
Effective implementation outcomes are necessary preconditions for effective service and positive treatment outcomes for children with behavioral problems. The aim of this study is to assess outcomes of the transfer of the empirically supported intervention GenerationPMTO from the developer in the USA to a nationwide implementation in Norway. Adoption, sustainability, reach, and fidelity are tested across seven generations of therapists in Norway. Participants in the study were 521 therapists who began training in the program. The developer’s team trained the first generation (G1) and the Norwegian team trained the next six generations (G2–G7). The mean rate of certification was 94.2% (n = 491). Intervention fidelity was assessed from 1964 video recordings of intervention sessions submitted for certification evaluation using the observation-based measure Fidelity of Implementation Rating System (FIMP). A small but significant drop in fidelity scores was previously observed from G1 to G2; however, fidelity scores recovered at or above G1 scores for G3 Forgatch and DeGarmo (Prevention Science 12, 235-246, 2011). Twenty years since the inception of implementation, 314 certified therapists practice the model today, a retention rate of 64%. The outcomes show sustained fidelity scores across seven generations, increasing heterogeneity among therapists trained, and a shift of focus in the target population from clinical to primary services. The present study contributes to the field with the systematic evaluation of outcomes for the full transfer implementation approach with continuing adoption and sustainability, increasing reach and sustained intervention fidelity across several generations of practitioners.
Highlights
Effective implementation outcomes are necessary preconditions for effective service and positive treatment outcomes for children with behavioral problems
Can an intervention created and tested in a research context produce equivalent outcomes when employed in community settings with diverse cultures and populations? Can training programs produce substantial numbers of certified therapists to practice the program, Prev Sci (2019) 20:1189–1199 use it with fidelity with their clientele, and maintain quality assurance? Can the services be provided by practitioners with diverse professional backgrounds within a variety of service agencies? Are communities able to expand their reach to serve all families who seek services? Is it possible for an intervention to adapt to local contexts yet retain fidelity to the core components that produce positive outcomes? These questions direct attention to the need for adoption at community, agency, practitioner, and client levels
We focus on longer-term outcomes of adoption, sustainability, reach, and fidelity
Summary
Effective implementation outcomes are necessary preconditions for effective service and positive treatment outcomes for children with behavioral problems. The present study contributes to the field with the systematic evaluation of outcomes for the full transfer implementation approach with continuing adoption and sustainability, increasing reach and sustained intervention fidelity across several generations of practitioners. In the twenty-first century, we must install ESIs within community service agencies using strategies that ensure extended reach with sustained intervention fidelity and positive outcomes for families (Forgatch et al 2013; Weisz et al 2014). The strategy involved a combination of “top-down” and “bottom-up” approaches: The governmental initiative and long-term funding led from the top, while local services chose whether to adopt the program, recruit and train therapists, and maintain them as certified practitioners in their agencies. The present study evaluates long-term implementation outcomes of the full transfer approach of GenerationPMTO in Norway
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