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Empirically determining the components of evidence-based interventions contributing to positive change is a crucial, yet understudied area of research. In support of this aim, we describe the development and evaluation of an observational rating system for measuring fidelity to specific components of the evidence-based GenerationPMTO parenting intervention. A five-step process was employed to systematically develop the rating system, which included consultation with the intervention developer and input from additional GenerationPMTO experts. The rating system was then tested using 247 h of video data from 184 parenting group intervention sessions. Study findings support the psychometric properties of the new measure with regard to item performance, reliability (i.e., inter-rater reliability of items, dimensionality of components, internal consistency of component scales), and validity (i.e., content validity, convergent validity, discriminant validity, and predictive validity of the component scales) for seven of the eight scales evaluated. The seven components include clear directions, skill encouragement, emotion regulation, limit setting, effective communication, problem solving, and monitoring. Data did not support the psychometric properties of the positive involvement scale. Overall, the ability to assess component-specific fidelity allows for a more nuanced examination of change processes, with meaningful implications for research and practice. Electronic supplementary material The online version of this article (10.1007/s11121-020-01177-5) contains supplementary material, which is available to authorized users.

Empirically determining the active ingredients of evidence-based parenting interventions is a promising means for strengthening interventions and enhancing their public health impact. This study aimed to determine which distinct ingredients of the GenerationPMTO (GenPMTO) intervention were associated with subsequent changes in parenting practices. Using a sample of 153 participants randomly assigned to the GenPMTO condition, we employed multilevel modeling to identify intervention ingredients empirically linked with change trajectories in parenting practices observed across the 2 years following intervention exposure. Coercive parenting and positive parenting outcomes were examined. Study results indicated that emotion regulation, effective communication, problem solving, and monitoring each demonstrated a significant pattern of findings for coercive parenting. Differential exposure to each of these ingredients significantly predicted the level of coercive parenting immediately postintervention and/or trajectories of change in coercive parenting across the subsequent 2-year period, controlling for coercive parenting at baseline. No significant predictors were found for positive parenting trajectories. Our findings suggest four components as active ingredients of the GenPMTO intervention for coercive parenting. Identification of these active ingredients may lead to strengthening future iterations of GenPMTO by expanding the set of core components specified in the model, which may further improve public health benefits. Implications for further understanding change stemming from evidence-based parenting interventions are also discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effective implementation outcomes are necessary preconditions for effective service and positive treatment outcomes for children with behavioral problems. The aim of this study is to assess outcomes of the transfer of the empirically supported intervention GenerationPMTO from the developer in the USA to a nationwide implementation in Norway. Adoption, sustainability, reach, and fidelity are tested across seven generations of therapists in Norway. Participants in the study were 521 therapists who began training in the program. The developer’s team trained the first generation (G1) and the Norwegian team trained the next six generations (G2–G7). The mean rate of certification was 94.2% (n = 491). Intervention fidelity was assessed from 1964 video recordings of intervention sessions submitted for certification evaluation using the observation-based measure Fidelity of Implementation Rating System (FIMP). A small but significant drop in fidelity scores was previously observed from G1 to G2; however, fidelity scores recovered at or above G1 scores for G3 Forgatch and DeGarmo (Prevention Science 12, 235-246, 2011). Twenty years since the inception of implementation, 314 certified therapists practice the model today, a retention rate of 64%. The outcomes show sustained fidelity scores across seven generations, increasing heterogeneity among therapists trained, and a shift of focus in the target population from clinical to primary services. The present study contributes to the field with the systematic evaluation of outcomes for the full transfer implementation approach with continuing adoption and sustainability, increasing reach and sustained intervention fidelity across several generations of practitioners.

Background Despite the large number of evidence-based practices (EBPs) ready for implementation, they are the exception in usual care, especially for ethnic minority patients, who may not have access to trained health professionals. Providing EBP training as part of a graduate curriculum could help build the pipeline of professionals to provide quality care. Methods We conducted a before-after study to determine whether we could implement a blended learning strategy (BL; i.e., in vivo and online training) to teach an EBP in university settings. Feasibility in this pilot was operationalized as knowledge acquisition, satisfaction, fidelity, acceptability, and usability. Using GenerationPMTO as the EBP, our aim was to train graduate students enrolled in Psychology, Social Work, and Family Therapy programs in the EBP in one academic year. Two therapists from a community agency were also students in this pilot. A total of 13 students from five universities were trained in the intervention. Adaptations were made to the intervention and training strategy to optimize training fidelity. Focus groups were conducted with the students to capture their perspective about the training. Results Students demonstrated significant knowledge acquisition from baseline (Mean = 61.79, SD = 11.18) to training completion (Mean = 85.27, SD = 5.08, mean difference = − 23.48, 95% CI = − 29.62, − 17.34). They also reported satisfaction with the BL format, as measured by teaching evaluations at the end of the course. Instructors received acceptable fidelity scores (range of 7–9 in a 9-point scale). Qualitative findings from focus groups showed support for acceptability and usability of BL training. Conclusions BL training in university settings can be conducted with fidelity when provided by appropriately trained instructors. BL that integrates EBP and adaptations may be uniquely applicable for training providers in low-resource and ethnically diverse settings. The BL enhanced knowledge of GenerationPMTO was acceptable and usable to students, and was delivered with high instructor fidelity to the training model.

This paper reviews the evolution of the Oregon model of family behavior therapy over the past four decades. Inspired by basic research on family interaction and innovation in behavior change theory, a set of intervention strategies were developed that were effective for reducing multiple forms of problem behavior in children (e.g., Patterson, Chamberlain, & Reid, 1982). Over the ensuing decades, the behavior family therapy principles were applied and adapted to promote children’s adjustment to address family formation and adaptation (Family Check-Up model), family disruption and maladaptation (Parent Management Training–Oregon model), and family attenuation and dissolution (Treatment Foster Care–Oregon model). We provide a brief overview of each intervention model and summarize randomized trials of intervention effectiveness. We review evidence on the viability of effective implementation, as well as barriers and solutions to adopting these evidence-based practices. We conclude by proposing an integrated family support system for the three models applied to the goal of reducing the prevalence of severe problem behavior, addiction, and mental problems for children and families, as well as reducing the need for costly and largely ineffective residential placements.

The present article employed a sample of 365 families of children in foster care to conduct a validation test of a newly developed instrument, the Parent Child Checklist (PCC). The PCC is a 54-item direct observation measure assessing parent–child interactions in the context of a family session. The PCC was developed to support the effective implementation of an evidence-based intervention, Parent Management Training-Oregon model, in the Kansas child welfare system. The PCC was designed to capture two scales of child behavior (prosocial and problem behavior) and five parenting domains (encouragement, positive involvement, problem solving, communication skill, and effective discipline). A combination of exploratory and confirmatory factor analysis was used in this first stage validation of the checklist. Results indicated the PCC scales obtained adequate internal consistency and interrater reliability. The confirmatory factor analysis supported 6 of the 7 expected scale domains; however, a two-factor solution was better - supported among the discipline items, labeled as effective and ineffective discipline. Test–retest reliability ranged from 0.45 to 0.80 across child behavior and parenting domains with alpha levels ranging from 0.65 to 0.88. A behavioral observation rating scale for clinicians that is reliable and feasible to implement can represent a significant improvement to practice-as-usual.

During the past decade, there have been increased efforts to implement evidence-based practices into child welfare systems to improve outcomes for children in foster care and their families. In this paper, the implementation and evaluation of a policy-driven large system-initiated reform is described. Over 250 caseworkers and supervisors were trained and supported to implement two evidence-based parent focused interventions in five private agencies serving over 2,000 children and families. At the request of child welfare system leaders, a third intervention was developed and implemented to train the social work workforce to use evidence-based principles in everyday interactions with caregivers (including foster, relative, adoptive, and biological parents). In this paper, we describe the policy context and the targeted outcomes of the reform. We discuss the theory of the interventions and the logistics of how they were linked to create consistency and synergy. Training and ongoing consultation strategies used are described as are some of the barriers and opportunities that arose during the implementation. The strategy for creating a path to sustainability is also discussed. The reform effort was evaluated using both qualitative and quantitative methods; the evaluation design, research questions and preliminary results are provided.

Objectives—This study evaluated implementation outcomes in three European countries of GenerationPMTO, an evidence-based parenting intervention for child and adolescent behavior problems. Method—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 six generations in Iceland, eight in Denmark, and four in the Netherlands. Therapist fidelity was measured at certification with an observation-based tool, Fidelity of Implementation Rating System (FIMP; Knutson, Forgatch, Rains, & Sigmarsdóttir, 2009). Results—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. Conclusions—Findings support full transfer as an effective implementation approach with longterm sustainability and fidelity.

This article describes the process of cultural adaptation at the start of the implementation of the Parent Management Training intervention-Oregon model (PMTO) in Mexico City. The implementation process was guided by the model, and the cultural adaptation of PMTO was theoretically guided by the cultural adaptation process (CAP) model. During the process of the adaptation, we uncovered the potential for the CAP to be embedded in the implementation process, taking into account broader training and economic challenges and opportunities. We discuss how cultural adaptation and implementation processes are inextricably linked and iterative and how maintaining a collaborative relationship with the treatment developer has guided our work and has helped expand our research efforts, and how building human capital to implement PMTO in Mexico supported the implementation efforts of PMTO in other places in the United States.

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. Language: en

Latinos constitute the largest ethnic minority group in the United States. However, the cultural adaptation and dissemination of evidence-based parenting interventions among Latino populations continues to be scarce despite extensive research that demonstrates the long-term positive effects of these interventions. The purpose of this article is threefold: (1) justify the importance of cultural adaptation research as a key strategy to disseminate efficacious interventions among Latinos, (2) describe the initial steps of a program of prevention research with Latino immigrants aimed at culturally adapting an evidence-based intervention informed by parent management training principles, and (3) discuss implications for advancing cultural adaptation prevention practice and research, based on the initial feasibility and cultural acceptability findings of the current investigation.

This report describes three studies from the nationwide Norwegian implementation of Parent Management Training – Oregon Model (PMTO™), an empirically supported treatment for families of children with behavior problems (Forgatch and Patterson 2010). Separate stages of the implementation were evaluated using a fidelity measure based on direct observation of intervention sessions. Study 1 assessed growth in fidelity observed early, mid, and late in the training of a group of practitioners. We hypothesized increased fidelity and decreased variability in practice. Study 2 evaluated method fidelity over the course of three generations of practitioners trained in PMTO. Generation 1 (G1) was trained by the PMTO developer/purveyors; Generation 2 (G2) was trained by selected G1 Norwegian trainers; and Generation 3 (G3) was trained by G1 and G2 trainers. We hypothesized decrease in fidelity with each generation. Study 3 tested the predictive validity of fidelity in a cross-cultural replication, hypothesizing that higher fidelity scores would correlate with improved parenting practices observed in parent-child interactions before and after treatment. In Study 1, trainees' performance improved and became more homogeneous as predicted. In Study 2, a small decline in fidelity followed the transfer from the purveyor trainers to Norwegian trainers in G2, but G3 scores were equivalent to those attained by G1. Thus, the hypothesis was not fully supported. Finally, the FIMP validity model replicated; PMTO fidelity significantly contributed to improvements in parenting practices from pre- to post-treatment. The data indicate that PMTO was transferred successfully to Norwegian implementation with sustained fidelity and cross-cultural generalization.

The potential challenges and mental health consequences of war-time deployments to service members and veterans are considerable, and increasing evidence suggests that families face diverse stressors at different periods in the deployment cycle (Pincus, House, Christenson, & Adler, 2005). Family members of deployed personnel are often the “unsung heroes” of a combat deployment, supporting service members before, during, and after a deployment. Consequently, the psychological consequences of deployment also apply to families. Partners of service members who are deployed, for example, face the challenge of worrying about and supporting a loved one for an extended period without knowing if or when they will return (Faber, Willerton, Clymer, MacDermid, & Weiss, 2008). Children face a variety of challenges at all stages of deployment, as they prepare for the absence of one of their parents, adapt to the changes in the home that are inevitable parts of that absence, and then re-adjust to the return of their parents months or even a year or more later. Service members themselves may face a range of challenges in reintegrating to civilian life following return from a combat deployment, including posttraumatic stress disorder (PTSD), depression, substance abuse, or simply transitioning back to work and family life. In this article, deployment related stressors and their impact on parents’ wellbeing are conceptualized as interrelated factors influencing parenting and children’s adjustment. We review the literature on relationships among deployment and related stressors, family relationships, and child adjustment with an explicit focus on parenting because research and practice show parenting is a key mechanism through which relationships operate to protect children, or place them at risk for maladjustment. We then discuss the Parent Management Training-Oregon model (PMTO™) and our efforts at adapting PMTO for work with military families. Finally, we discuss strategies and recommendations for clinicians providing parenting support to military families.

Four different sources for cascade effects were examined using 9-year process and outcome data from a randomized controlled trial of a preventive intervention using the Parent Management Training—Oregon Model (PMTO™). The social interaction learning model of child antisocial behavior serves as one basis for predicting change. A second source addresses the issue of comorbid relationships among clinical diagnoses. The third source, collateral changes, describes events in which changes in one family member correlate with changes in another. The fourth component is based on the long-term effects of reducing coercion and increasing positive interpersonal processes within the family. New findings from the 9-year follow-up show that mothers experienced benefits as measured by standard of living (i.e., income, occupation, education, and financial stress) and frequency of police arrests. It is assumed that PMTO reduces the level of coercion, which sets the stage for a massive increase in positive social interaction. In effect, PMTO alters the family environment and thereby opens doors to healthy new social environments.

Effects of intervention with the Oregon model of Parent Management Training (PMTO™) on marital relationship processes and marital satisfaction in recently married biological mother and stepfather couples were examined. Sixty-seven of the 110 participating families were randomly assigned to PMTO, and 43 families to a non-intervention condition. Intervention had reliable positive indirect effects on marital relationship processes 24 months after baseline which in turn were associated with higher marital satisfaction. These indirect effects were mediated by the impact of PMTO on parenting practices 6 months after baseline. Enhanced parenting practices resulting from PMTO prevented escalation of subsequent child behavior problems at school. Consistent with a family systems perspective and research on challenges to marital quality in stepfamilies, improved co-parenting practices were associated with enhanced marital relationship skills and marital satisfaction as well as with prevention of child behavior problems.

OBJECTIVE: The primary goal of this paper was to evaluate independent effects of stepfather parenting behaviors within the context of a parent training efficacy trial designed for recently married couples with children exhibiting behavior problems. A secondary goal was to examine measurement properties of a multiple-method, multiple-source construct of effective stepfathering including direct observation. Stepfather hypotheses were derived from a social interaction learning model of child adjustment and specifically evaluated the Oregon model of Parent Management Training (PMTO) intervention DESIGN: In a randomized control trial, 110 recently married families consisting of an early-elementary-school-aged focal child, biological mother, and stepfather were assessed over 2 years. Assessment included direct observation of stepfather - stepchild interactions. Analyses first tested intervention effects on change in stepfathering and second tested independent effects of stepfathering on change in children's depression and noncompliance at follow-ups. RESULTS: The intervention produced medium effect sizes at 6 and 12 months for improved stepfathering with parenting effects diminishing at 24 months. Hierarchical regression models showed that intervention group improvements in stepfathering predicted greater reductions in children's depression and noncompliance at 2 years relative to controls, controlling for change in mothering. CONCLUSIONS: These findings underscore the preventive utility of the PMTO intervention for stepfathers. Implications for research, translation, timing of intervention, and implementation are discussed.

This study evaluated benefits of a preventive intervention to the living standards of recently separated mothers. In the Oregon Divorce Study's randomized experimental design, data were collected 5 times over 30 months and evaluated with Hierarchical Linear Growth Models. Relative to their no-intervention control counterparts, experimental mothers had greater improvements in gross annual income, discretionary annual income, poverty threshold, income-to-needs ratios, and financial stress. Comparisons showed the intervention to produce a greater increase in income-to-needs and a greater rise-above-poverty threshold. Benefits to income-to-needs were statistically independent of maternal depressed mood, divorce status, child support, and repartnering. Financial stress reductions were explained by the intervention effect on income-to-needs. The importance of helping disadvantaged families with evidence-based programs is discussed.

Current measures of implementer fidelity often fail to adequately measure core constructs of adherence and competence, and their relationship to outcomes can be mixed. To address these limitations, we used observational methods to assess these constructs and their relationships to proximal outcomes in a randomized trial of a school-based preventive intervention (Rochester Resilience Project) designed to strengthen emotion self-regulation skills in first–third graders with elevated aggressive–disruptive behaviors. Within the intervention group (n = 203), a subsample (n = 76) of students was selected to reflect the overall sample. Implementers were 10 paraprofessionals. Videotaped observations of three lessons from year 1 of the intervention (14 lessons) were coded for each implementer–child dyad on adherence (content) and competence (quality). Using multilevel modeling, we examined how much of the variance in the fidelity measures was attributed to implementer and to the child within implementer. Both measures had large and significant variance accounted for by implementer (competence, 68 %; adherence, 41 %); child within implementer did not account for significant variance indicating that ratings reflected stable qualities of the implementer rather than the child. Raw adherence and competence scores shared 46 % of variance (r = .68). Controlling for baseline differences and age, the amount (adherence) and quality (competence) of program delivered predicted children’s enhanced response to the intervention on both child and parent reports after 6 months, but not on teacher report of externalizing behavior. Our findings support the use of multiple observations for measuring fidelity and that adherence and competence are important components of fidelity which could be assessed by many programs using these methods.

Over the past quarter century, researchers have developed a body of parent training programs that have proven effective in reducing child behavior problems, but few of these have made their way into routine practice. This article describes the long and winding road of implementation as applied to children’s mental health. Adopting Rogers’ (1995) diffusion framework and Fixsen and colleagues’ implementation framework (Fixsen, Naoom, Blase, Friedman, & Wallace, 2005), we review more than a decade of research on the implementation of Parent Management Training—Oregon Model (PMTO). Data from U.S. and international PMTO implementations are used to illustrate the payoffs and the challenges of making empirically supported interventions routine practice in the community. Technological advances that break down barriers to communication across distances, the availability of efficacious programs suitable for implementation, and the urgent need for high quality mental health care provide strong rationales for prioritizing implementation. Over the next quarter of a century, the challenge is to reduce the prevalence of children’s psychopathology by creating science-based delivery systems to reach families in need, everywhere.

This study tested a hypothesized social interaction learning (SIL) model of confidant support and paternal parenting. The latent growth curve analysis employed 230 recently divorced fathers, of which 177 enrolled support confidants, to test confidant support as a predictor of problem solving outcomes and problem solving outcomes as predictors of change in fathers’ parenting. Fathers’ parenting was hypothesized to predict growth in child behavior. Observational measures of support behaviors and problem solving outcomes were obtained from structured discussions of personal and parenting issues faced by the fathers. Findings replicated and extended prior cross-sectional studies with divorced mothers and their confidants. Confidant support predicted better problem solving outcomes, problem solving predicted more effective parenting, and parenting in turn predicted growth in children’s reduced total problem behavior T scores over 18 months. Supporting a homophily perspective, fathers’ antisociality was associated with confidant antisociality but only fathers’ antisociality influenced the support process model. Intervention implications are discussed regarding SIL parent training and social support.

When efficacious interventions are implemented in real-world conditions, it is important to evaluate whether or not the programs are practiced as intended. This article presents the Fidelity of Implementation Rating System (FIMP), an observation-based measure assessing competent adherence to the Oregon model of Parent Management Training (PMTO). FIMP evaluates 5 dimensions of competent adherence to PMTO (i.e., knowledge, structure, teaching skill, clinical skill, and overall effectiveness) specified in the intervention model. Predictive validity for FIMP was evaluated with a subsample of stepfamilies participating in a preventive PMTO intervention. As hypothesized, high FIMP ratings predicted change in observed parenting practices from baseline to 12 months. The rigor and scope of adherence measures are discussed.

This article evaluates the efficacy of the Oregon model of Parent Management Training (PMTO) in the stepfamily context. Sixty-seven of 110 participants in the Marriage and Parenting in Stepfamilies (MAPS) program received a PMTO-based intervention. Participants in the randomly assigned experimental group displayed a large effect in benefits to effective parenting practices with resultant decreases in child noncompliance and in home and school problem behaviors. MAPS findings replicate and extend those of the Oregon Divorce Study with single mothers while employing a similar multiple-method, multiple-measure randomized design, with Intent-to-Treat and structural equation modeling analyses. We discuss direct and indirect effects on distal outcomes and the generalizability of PMTO to differing family contexts.

Socialization theories posit parenting practices as mechanisms linking socioeconomic status (SES) and children's academic outcomes. A mediational parenting model was tested examining separate effects of maternal education, occupation, and income for a sample of 238 divorced or recently separated mothers of 6- to 9-year-old sons. For the SEM path models, each indicator of SES was associated with better parenting, and parenting in turn had indirect effects on achievement through home skill-building activities and school behavior. The direct effect of maternal education on achievement was mediated by home skill-building activities, the direct effect of maternal occupation on achievement was not mediated, and income measures had no direct effects on achievement. These findings underscore the importance of unpacking the effects of SES and the relevance of effective parenting practices as a protective factor in the home and school environment for young boys' school success during postdivorce adjustment.

Using 115 couples from stepfather families, we tested the hypothesis that identity salience would moderate effects of threatening or enhancing family interaction on psychological and marital distress. Data were taken from structured interaction tasks at two separate visits to the center: a couple and a family assessment. Measures included observed behaviors directed from one spouse toward another and behaviors directed from a child to mother or stepfather. Five of eight hypothesized moderation effects were supported. Negative engagement from a mother to a stepfather with high spousal salience predicted higher levels of stepfather distress. For both spouses, negative interactions were moderated in the couple interaction tasks, and positive interactions were moderated in family tasks. Contrary to expectations, parental salience did not moderate children's behavior toward parents. Predictors in the couple interaction tasks but not in the family tasks explained within-couple distress. Finally, stepfather stress showed spillover effects predicting mother distress, but not vice versa.

Etude des pratiques educatives des meres divorcees en direction de leur(s) fils en bas-âge. Plusieurs hypotheses sont construitent en fonction de l'âge du fils et du contexte familial (notions de qualites maternelles antisociales, desavantage socio-economique, problemes de comportement antisocial)