implementing evidence- based practice on a large scale marion s. forgatch zintars g. beldavs oregon...
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Implementing Evidence- Based Practice on a Large
Scale
Marion S. ForgatchZintars G. Beldavs
Oregon Social Learning CenterPresented 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.
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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 )
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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
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G1 Specialists
N = 34
(85%)
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G2 SpecialistsN = 79(95%)
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G3 SpecialistsN=69(95%)
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Expected G4 Specialists
N=73
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Implementation Feedback Process
Develop a Collaborative Partnership
Adapt for Contexts & Culture
Train Professionals
Evaluate Effectiveness
Evaluate FidelityEvaluate Fidelity
Make SustainableMake Sustainable
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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
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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
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PMTO Intervention Model
S
T
PMTO INTERVENTION MODEL
S
PARENTINGPRACTICES
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Does Training Increase Fidelity?
G1
Mid Training
Training Cases
81 (2.4)
Early Training
Training Cases
88 (2.6)
Certification
New Cases
70 (2.3)
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Estimated Marginal Means of AVERAGE
TIME
321
Est
imat
ed M
argi
nal M
eans
7.2
7.0
6.8
6.6
6.4
6.2
6.0
5.8
5.6
Early Mid Certification
Norway G1 FIMP Across Training
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Norway G1 FIMP Across Training
Early Mid Certification
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Fidelity Drift Across Generations
G1Fidelity
Covariates:Agency CharacteristicsTherapist CharacteristicsFamily Characteristics
G2Fidelity
Training
G3Fidelity
Training
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Fidelity Across Generations Certification
G1 G2 G3
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34
56
78
9
131 729 321N=
fimpmn1 fimpmn2 fimpmn3
Fidelity Across Generations All Available FIMPs
G1 G2 G3
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Fidelity Model
FidelityChange
Parenting
ChangeChild
Behavior
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BaselineMaternalParenting
.53
12 mo.ChangeMaternalParenting
e3
BaselineStepfatherParenting
.66
12 mo.Change
StepfatherParenting
e4
.70
*
chi-square =9.113, df = 12, P =.693, CFI = 1.000, cmindf =.759, rmsea =.000
tp < .10; *p < .05; **p < .01; ***p < .001
DisciplineSessions
EncouragementSessions
.84
**
ChildAge
-.46
.20
ChildGender
-.71**
.26
-.4
2t
InterventionFidelity
.51*
.49*.52***
.83***
R =2
R =2
Fidelity Effects on Change in Observed Effective Parenting: OSLC Stepfamily Sample
(Forgatch, Patterson, & DeGarmo, 2005)
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BaselineMother
Parenting
.31
ChangeMother
Parentinge3
BaselineFather
Parenting
.39
ChangeFather
Parentinge4
chi-square =10.882, df = 8, P =.208, CFI = .990, cmindf =1.360, rmsea =.053tp < .10; *p < .05; **p < .01; ***p < .001
Fidelity Effects on Pre/Post Treatment Change in Effective Parenting: Norwegian Sample
.56
DisciplineSessions
e2
.53
EncouragementSessions
e1
InterventionFidelity
R =2
R =2
Generation
-.19*
-.17*
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56
78
13 50 51N=
fimpmn1 fimpmn2 fimpmn3
FIMP scores by Generation for Norwegian Model
G1 G2 G3
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ReferencesForgatch, 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.