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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.

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Implementing Evidence- Based Practice on a Large Scale

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  1. 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.

  2. 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 )

  3. 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

  4. G1 Specialists N = 34 (85%)

  5. G2 Specialists N = 79 (95%)

  6. G3 Specialists N=69 (95%)

  7. Expected G4 Specialists N=73

  8. Adapt for Contexts & Culture Train Professionals Evaluate Effectiveness Evaluate Fidelity Make Sustainable Implementation Feedback Process Develop a Collaborative Partnership

  9. 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

  10. 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  

  11. PMTO Intervention Model

  12. 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)

  13. Norway G1 FIMP Across Training Early Mid Certification

  14. Norway G1 FIMP Across Training Early Mid Certification

  15. Training G2 Fidelity Training G3 Fidelity Fidelity Drift Across Generations G1 Fidelity Covariates: Agency Characteristics Therapist Characteristics Family Characteristics

  16. Fidelity Across Generations Certification G1 G2 G3

  17. Fidelity Across Generations All Available FIMPs G1 G2 G3

  18. Fidelity Model Fidelity Change Parenting Change Child Behavior

  19. 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)

  20. FIMP scores by Generation for Norwegian Model G1 G2 G3

  21. 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.

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