Assessing Long-Term Fidelity Outcomes Following Full Transfer Implementation of Generationpmto: International Perspective

Significance: Approximately 70% of families needing special services do not receive them, and of those who do, only a few receive an evidence based intervention (EBI). More than half of youngsters’ referrals are for behavior problems, making it important to provide wide-scale implementation of EBIs to treat and prevent behavior problems. System-wide implementation requires building an effective infrastructure to support initiation and maintenance of EBI’s with method fidelity. This study evaluates wide-scale implementation of an EBI for youngsters’ behavior problems using a valid measure of method fidelity. Sustained method fidelity ensures quality service to families in need.

Innovation: Not all EBI programs provide validity or sustainability data following implementation. Some EBIs use peer and self-evaluation with little validity or sustainability information. This study provides data on the sustainability of GenerationPMTO (earlier referred to as Parent Management Training – Oregon Model/PMTO) using direct observation of intervention sessions over multiple generations of practitioners with a valid measure. We present data across several generations of practitioners in three European countries.

Approach: GenerationPMTO is a progenitor parent training program that addresses youngsters’ behavior problems. This EBI uses a full transfer implementation approach in which the program purveyors train the first generation of practitioners and subsequently train infrastructure roles for sustained fidelity within the implementation site. This approach can enhance system-wide reach. However, it raises the question: is there drift in method fidelity over time? We address this question in the three European countries; Iceland, Denmark, and the Netherlands. We provide data on fidelity scores of candidates’ certification sessions, numbers of practitioners within generations, and years of sustained program practice in each nation. Fidelity is scored using the Fidelity of Implementation Rating System/FIMP, which evaluates model adherence and competent delivery. The predictive validity of FIMP has been demonstrated for pre/post changes in observed parenting practices and parent-reported child outcomes in efficacy, effectiveness, and implementation trials.

Results/Implications for Optimizing Prevention Science: Findings show that following the full transfer approach from the program purveyor to the adopting community, the pool of practitioners grows and fidelity is sustained. An effective infrastructure requires maintaining a team of trainers, coaches and reliable fidelity raters. This systematic approach to system-wide change may extend reach within community service systems and make EBIs more accessible to families in need.