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

Margrét Sigmarsdóttir, Marion S. Forgatch, Edda Vikar Guðmundsdóttir, Örnólfur Thorlacius, Gøye Thorn Svendsen, Jolle Tjaden, Abigail Gewirtz

    Research output: Contribution to journalArticlepeer-review

    10 Scopus citations


    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.

    Original languageEnglish (US)
    Pages (from-to)S312-S325
    JournalJournal of Clinical Child and Adolescent Psychology
    Issue numbersup1
    StatePublished - Mar 29 2019

    Bibliographical note

    Funding Information:
    The full transfer approach may be an antidote for the decay in effect sizes frequently found following the scaling up of implementations (Weisz et al., 2014). A study of the Norwegian implementation of GenerationPMTO failed to find such a scale-up penalty (Tømmeraas & Ogden, 2017). The authors attributed the ongoing positive outcomes in part to the strong leadership within the local GenerationPMTO infrastructure and the support of Norwegian Center for Child Behavioral Development, the national implementation research center. Although data in the present study do not directly address effect sizes in child outcomes, findings indicate that community sites using the full transfer approach, even with small resources, can sustain practitioner fidelity across multiple generations of trainings and even when relatively independent of the program developer. The full transfer approach empowers sites offering GenerationPMTO to provide stable services with fully trained leadership, therapists/specialists, coaches, trainers, and fidelity raters. Once a site has this infrastructure in place, the high costs expended on the purveyor are transferred to the local community, reducing costs that can then be spent within the implementation site.

    Publisher Copyright:
    ©, Copyright © Society of Clinical Child & Adolescent Psychology.


    Dive into the research topics of 'Implementing an Evidence-Based Intervention for Children in Europe: Evaluating the Full-Transfer Approach'. Together they form a unique fingerprint.

    Cite this