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Implementing Evidence- Based Practice on a Large Scale. Marion S. Forgatch Zintars G. Beldavs Oregon Social Learning Center.

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implementing evidence based practice on a large scale

Implementing Evidence- Based Practice on a Large Scale

Marion S. Forgatch

Zintars G. Beldavs

Oregon Social Learning Center

Presented at the Intervening Early: Progress and Opportunities in Child Service Settings meeting sponsored by the National Institute on Drug Abuse, National Institutes of Health (NIH), September 18-19, 2007.

Support for this project was provided by Grant No. R01 DA16097 from the Prevention Research Branch, NIDA, U.S. PHS, and support from the Behavior Center in Oslo, Norway.

nationwide implementation study in norway
Nationwide Implementation Study in Norway
  • International Collaboration
    • OSLC (Forgatch, Patterson, DeGarmo)
    • Norwegian Center for the Study of Behavioral Problems and Innovative Practices (Atferdsenterret) (Ogden)
    • University of Michigan (Price)
  • Nationwide Implementation of PMTO
  • Study factors contributing to
    • Implementation
    • Adoption
    • Adaptation
    • Fidelity through successive generations
  • Successive Generations of Norwegian Professionals
    • Generation 1 (G1): certified by OSLC professionals (N=34)
    • Generation 2 (G2): certified by G1 (N=79)
    • Generation 3 (G3): certified by G1 & G2 (N=69)
    • Generation 4 (G4): in process (N=74 )
system wide implementation in norway ogden forgatch et al 2005
System-wide Implementation in Norway (Ogden, Forgatch et al., 2005)
  • Establish National Implementation and Research Center
  • Develop Plans @ County & Municipal Levels
  • Conduct Therapist Recruitment, Training, & Maintenance Program
  • Conduct Clinical Outcome Research
  • Conduct Implementation Research
slide5

G1 Specialists

N = 34

(85%)

slide6

G2 Specialists

N = 79

(95%)

slide9

Adapt for Contexts & Culture

Train Professionals

Evaluate Effectiveness

Evaluate Fidelity

Make Sustainable

Implementation Feedback Process

Develop a Collaborative Partnership

slide10

Fidelity of Implementation Rating System (FIMP)

Knutson, Forgatch, & Rains (2003)

  • Rating system: evaluates competent application of PMTO principles
  • Ratings based on direct observation of intervention sessions (DVD recordings)
  • Sessions scored: Encouragement & Discipline
  • Session segments rated: 10-35 minute samples
slide11

Principal Component Analysis: Alpha = .947; 1 component extracted; 82.85% of variance explained 9-Point Likert Scale: Good work = 7-9; Acceptable = 4-6; Needs Work = 1-3

FIMP Content

5 categories: Knowledge: Proficiency in understanding and application of core principles

Structure: Session management, pacing, leads without dominating

Teaching: Interactive approach to promote parents’ mastery and independent use of PMTO skills & tools

Process: Proficiency in use of clinical and strategic skills, provides safe context in which to learn

Overall (Integration): Growth during session, family satisfaction, likelihood to continue & use, sensitive to context  

does training increase fidelity g1
Does Training Increase Fidelity?G1

Early Training

Training Cases

88 (2.6)

Mid Training

Training Cases

81 (2.4)

Certification

New Cases

70 (2.3)

slide14

Norway G1 FIMP Across Training

Early Mid Certification

slide15

Norway G1 FIMP Across Training

Early Mid Certification

fidelity drift across generations

Training

G2

Fidelity

Training

G3

Fidelity

Fidelity Drift Across Generations

G1

Fidelity

Covariates:

Agency Characteristics

Therapist Characteristics

Family Characteristics

slide18

Fidelity Across Generations

All Available FIMPs

G1 G2 G3

fidelity model
Fidelity Model

Fidelity

Change

Parenting

Change

Child

Behavior

slide20

Fidelity Effects on Change in Observed Effective Parenting: OSLC Stepfamily Sample

Baseline

Maternal

-.46

Parenting

2

.26

R =

.53

12 mo.

Change

Encouragement

e3

Maternal

.83***

.51*

Sessions

Parenting

.84**

Intervention

Fidelity

.52***

.70*

.49*

Discipline

Sessions

2

.66

R =

.20

12 mo.

Change

e4

Stepfather

Parenting

-.71**

Baseline

Stepfather

Parenting

Child

Age

-.42t

chi-square =9.113, df = 12, P =.693, CFI = 1.000, cmindf =.759, rmsea =.000

Child

Gender

tp < .10; *p < .05; **p < .01; ***p < .001

(Forgatch, Patterson, & DeGarmo, 2005)

references
References

Forgatch, M. S., Patterson, G. R., & DeGarmo, D. S. (2005). Evaluating fidelity: Predictive validity for a measure of competent adherence to the Oregon model of parent management training (PMTO). Behavior Therapy, 36, 3-13.

Knutson, N. M., Forgatch, M. S., & Rains, L. A. (2003). Fidelity of Implementation Rating System (FIMP): The training manual for PMTO. Eugene: Oregon Social Learning Center.

Ogden, T., Forgatch, M. S., Askeland, E., Patterson, G. R., & Bullock, B. M. (2005). Implementation of parent management training at the national level: The case of Norway. Journal of Social Work Practice, 19(3), 317-329.