Five-year fidelity assessment of an evidence-based parenting program (GenerationPMTO): inter-rater reliability following international implementation.

BACKGROUND: Implementing evidence-based programs in community service settings introduces the challenge of ensuring sustained fidelity to the original program. We employ a fidelity measure based on direct observation of practitioners' competence and adherence to the evidence-based parenting program (EBPP) GenerationPMTO following installation in national and international sites. Fidelity monitoring is crucial, especially when the program purveyor transfers administration of the program to the community as was done in this case. In previous studies, the Fidelity of Implementation rating system (FIMP) was used to evaluate practitioners' fidelity to the GenerationPMTO intervention in six countries following implementation showing high levels of adherence up to 17 years post certification. Other studies showed FIMP to have predictive validity. The present study provides inter-rater reliability data for this fidelity tool across teams of the purveyor, Implementation Sciences International, Inc./ISII, and national and international sites over a five-year period. METHODS: Data assess inter-rater reliability in terms of percent agreement and intraclass correlation (ICC) for the purveyor's two fidelity teams and the fidelity teams in seven implementation sites. RESULTS: Results report stable good to excellent levels of inter-rater reliability and ICCs as well as good attendance at fidelity meetings for all fidelity teams. CONCLUSIONS: This observational method of assessing fidelity post implementation is a promising approach to enable EBPPs to be transferred safely from purveyors to communities while maintaining reliable fidelity to the intervention.

Mental health, risk and resilience among refugee families in Europe.

Refugee children and families are at high risk of developing mental health conditions. The objective of this systematic review was to examine the current empirical literature on refugee mental health in Europe with a focus on children and families. A systematic search was conducted between January 2022 to June 2022 in PsychInfo, CINAHIL and PubMed. The search produced 2385 results and 62 articles met the selection criteria. Results showed that children had high rates of trauma exposure and were at higher risk of psychopathology than their host peers. Post-migration stressors impact mental health outcomes in adolescents and adults. However, most studies were self-report and cross-sectional and there were very few studies on refugee parenting or dyadic relationships.

Implementing an Evidence-Based Intervention for Children in Europe: Evaluating the Full-Transfer Approach.

This study evaluated the implementation outcomes of GenerationPMTO, an evidence-based parenting intervention for child and adolescent behavior problems, in three European countries. The implementation approach was full transfer, in which purveyors train a first generation (G1) of practitioners; adopting sites assume oversight, training, certification, and fidelity assessment for subsequent generations (Forgatch & DeGarmo, 2011; Forgatch & Gewirtz, 2017). Three hundred therapists participated in trainings in GenerationPMTO in Iceland, Denmark, and the Netherlands. Data are from the implementation's initiation in each country through 2016, resulting in 6 generations in Iceland, 8 in Denmark, and 4 in the Netherlands. Therapist fidelity was measured at certification with an observation-based tool, the Fidelity of Implementation Rating System (Knutson, Forgatch, Rains, & Sigmarsdóttir, 2009). Candidates in all generations achieved fidelity scores at or above the required standard. Certification fidelity scores were evaluated for G1 candidates, who were trained by the purveyor, and subsequent generations trained by the adopting implementation site. In each country, certification fidelity scores declined for G2 candidates compared with G1 and recovered to G1 levels for subsequent generations, partially replicating findings from a previous Norwegian study (Forgatch & DeGarmo, 2011). Recovery to G1 levels of fidelity scores was obtained in Iceland and the Netherlands by G3; in Denmark, the recovery was obtained by G5. The mean percentage of certification in each country was more than 80%; approximately 70% of certified therapists remained active in 2017. Findings support full transfer as an effective implementation approach with long-term sustainability and fidelity.

Treatment Effectiveness of PMTO for Children's Behavior Problems in Iceland: Child Outcomes in a Nationwide Randomized Controlled Trial.

Well-documented treatment methods must be tested following their implementation in community service agencies and across different cultures to ensure continuing effectiveness. This study was a randomized controlled trial (RCT) of Parent Management Training-the Oregon model (PMTO), conducted within a nationwide implementation in Iceland. Families of 102 clinically referred children with behavior problems were recruited from five municipalities throughout Iceland. Child age ranged from 5 to 12; 73% were boys. Families were randomly assigned to either PMTO or services usually offered in the communities (SAU). Child adjustment was measured with a latent construct based on parent, child, and teacher reports of externalizing and internalizing problems and social skills. Prepost intent-to-treat analyses showed that PMTO treatment led to greater reductions in child adjustment problems relative to the comparison group, obtaining a modest to medium effect size based on the construct score. Only one indicator (parent-rated Social Skills) showed significant change independently and information on amount and kind of treatment in the SAU was limited. Overall, findings indicate that PMTO is an effective method to treat children's behavior problems in a Northern European culture and supply evidence for the method's successful implementation in community settings in Iceland. This is one of few nationwide implementation studies of PMTO outside the United States and the first RCT in Iceland to test a treatment model for children's behavior problems.

Implementation of Parent Management Training-Oregon Model (PMTO(TM) ) in Iceland: building sustained fidelity.

Bringing empirically supported treatments (ESTs) into community settings is a challenge because of threats to therapy adherence. The nationwide implementation of Parent Management Training-the Oregon Model (PMTO) in Iceland was studied by comparing therapists' competent adherence to PMTO across three generations of therapists. To assess therapists' competence and adherence to the PMTO method, the Fidelity of Implementation Rating System (FIMP) was used as the measuring device. Of 16 therapists across three generations who entered training, 12 completed with certification. As expected, each of the three generations obtained adequate FIMP scores. Generations 1 and 3 showed equivalent levels of performance on FIMP scores at certification. A small drop in FIMP scores for Generation 2 was explained in terms of translating and culturally adjusting materials and strengthening training procedures. Results are parallel to earlier findings from the nationwide PMTO implementation in Norway and support the idea that PMTO can be implemented in community settings with high fidelity even when resources are scarce.

Treatment effectiveness of PMTO for children's behavior problems in Iceland: assessing parenting practices in a randomized controlled trial.

Findings are presented from an Icelandic randomized control trial (RCT) evaluating parent management training - Oregon model (PMTO™), a parent training intervention designed to improve parenting practices and reduce child behavior problems. In a prior report from this effectiveness study that focused on child outcomes, children in the PMTO condition showed greater reductions in reported child adjustment problems relative to the comparison group. The present report focuses on observed parenting practices as the targeted outcome, with risk by treatment moderators also tested. It was hypothesized that mothers assigned to the PMTO condition would show greater gains in pre-post parenting practices relative to controls. The sample was recruited from five municipalities throughout Iceland and included 102 participating families of children with behavior problems. Cases were referred by community professionals and randomly assigned to either PMTO (n = 51) or community services usually offered (n = 51). Child age ranged from 5 to 12 years; 73% were boys. Contrary to expectations, findings showed no main effects for changes in maternal parenting. However, evaluation of risk by treatment moderators showed greater gains in parenting practices for mothers who increased in depressed mood within the PMTO group relative to their counterparts in the comparison group. This finding suggests that PMTO prevented the expected damaging effects of depression on maternal parenting. Failure to find hypothesized main effects may indicate that there were some unobserved factors regarding the measurement and a need to further adapt the global observational procedures to Icelandic culture.

Community implementation of PMTO(™): impacts on referrals to specialist services and schools.

In 2000, the city of Hafnarfjörður, Iceland, implemented Parent Management Training--Oregon Model (PMTO(™)) to prevent and treat behavioral problems among children. This paper describes the implementation and findings regarding impacts in the community. As hypothesized, findings showed that the number of referrals to specialist services decreased in Hafnarfjörður following PMTO implementation and increased in two comparison communities not implementing the method. Within the Hafnarfjörður community, recorded instances of behavior problems reduced in elementary schools working in line with PMTO. The results presented are the first such findings in Iceland and suggest the kinds of systematic changes communities may experience following the implementation of an evidence-based program.