Parent Management Training – Oregon Model (PMTO™) An Evidence-Based Practice Developed in Our Community Mark EddyLaura Rains Presented at ORI’s 8th Annual Research to Practice Conference, Supporting Families Through Evidence-Based Approaches: Meeting Diverse Levels of Need, Eugene, OR (December 3, 2010).
Focus For Today 1. How This All Came About 2. Implementation History 3. Active Teaching 4. Summary 5. Conversation
Eugene-Springfield Non-ProfitsOregon Social Learning CenterImplementation Sciences International, Inc.
Jerry Patterson, 1960s When things aren’t working, go back to the drawing board Basic research Conclusion that problem not just inside the child, but that what is going on around the child matters What parents, teachers, and other adults do can change what a child does
Developing an Evidence-Base 1950s: Basic laboratory research 1960s: Outpatient clinical research 1970s: Longitudinal studies 1980s: Juvenile justice, child welfare, and mental health systems 1990s: School system, community-based non-profits: 2000s: Criminal justice system; early childhood intervention; communities, states, countries
Child Outcomes Treatment /Control Parenting Practices CHILD OUTCOMES Arrest Rates / Severity of Crime Substance Use SAMPLES Noncompliance Divorced Mothers (PTC) Delinquent Behaviors Step-families (MAPS) Academic Function POSITIVE PARENTING PRACTICES School in High Crime Neighborhoods (LIFT) Out of Home Placement Skills Encouragement Deviant Peer Associations Maltreated Children Positive Involvement Adjudicated Youth Effective Discipline Depression Treatment Foster Care: Delinquents - Boys Problem-solving PARENT OUTCOMES Monitoring / Supervision Depression Treatment Foster Care: Delinquents - Girls NEGATIVE PARENTING PRACTICES Standard of living Negative Reciprocity Foster Care: Mentally Ill (Hospitalized) Arrest rates Escalation Marital adjustment Early Intervention Treatment Care (2-4) Negative Reinforcement Marital satisfaction Forgatch & Patterson, 2010
Parent Management Training Empowering parents with core strategies: Skill Encouragement Limit Setting Monitoring/supervision Family Problem Solving Positive Involvement Considered one of two “well established” treatments for conduct disorder (American Psychological Association)
Family-Based Programs on 3 or More Federal Best Practice Lists
Primary Target: Parent Behavior Spending positive, quality time with children Encouraging participation in normative behaviors/activities, teaching in small steps Providing consistent, mild, small, nonviolent consequences for problem behaviors Monitoring of daily activities in and outside home, supervising who, what, where, when Goal setting, interpersonal planning, negotiating, trying out agreements Separating child from delinquent peers, encouraging relationships with prosocial peers
Key Intervention Targets The presence and behavior of adults in parental roles The presence and behavior of peers
Social Interaction Learning Model Forgatch & Patterson, 2010
Role Play as a PMTO Teaching Tool Teaching is active! Learning is kinesthetic Engages family in the change process Decreases time spent in “talk” Parents practice skill before using at home with children
Active Teaching: The 3-D Approach Demonstrate: Model appropriate and sufficient information. Engage family quickly and effectively with RP. Be theatrical. Differentiate: Help parents specify characteristics that differentiate effective and less effective action. Debrief: Punctuate and frame effective actions. Guide parents to recognize and reinforce their own and each other’s successes.
PMTO Role Play: 3-Step Dance RP Setup Models/demonstrates Draws family in quickly and effectively Provides direction (who is to do exactly what) RP Practice Guides (exactly how) Uses theatrical strategies Breaks role play into small steps RP Debrief Punctuates, reinforces, supports, encourages Weaves in instructional material Differentiates effective and less effective action
Spotlight: Wrong Way / Right Way RP Wrong way demonstration normalizes the parenting experience, increases session comfort and introduces humor into the situation Dramatic wrong way RP ushers in surprise and insight Wrong way/right way RPs are used to compare and contrast Emphasis is spent on practicing the right way
Let’s try it out!Role Play #1: Practice as parent Practice 2 wrong way, 2 right way directions Roles: Parent, Child “Put your shoes in the closet now, please.” “Use an inside voice now, please.” “Put your toys away in the toy box now, please.” (Name), do (________) now, please.”
Let’s try it out!Role Play #2: Practice as therapist Practice demonstrating “wrong way/right way” directions and debriefing role plays Roles: Therapist, Parent Model wrong way directions Debrief Engage parent in building better direction Model right way direction Debrief
PMTO at a Glance Core belief: Parents are their children’s best teachers Strength-based: Strengthening skills via coaching Implementation strategy: Teach therapists to teach parents to teach children Teaching: Engaging, active, fun! Based on 40 years of research and practice* * Forgatch, M.S., & Patterson, G.R. (2010)
Used to certify PMTO therapists, coaches, group leaders
Knutson, Forgatch, Rains, & Sigmarsdóttir, 2009
Fidelity of Implementation Rating System (FIMP): The manual for PMTO™ (Revised: Knutson, Forgatch, Rains, & Sigmarsdóttir, 2009) 9-Point Likert Scale Good work = 7-9; Acceptable = 4-6; Needs Work = 1-3 Knowledge: Proficiency in understanding theoretical model, core and supporting principles and practices, details and proceduresStructure: Session management, leads without dominating, responsive, sensitive pacing/timing Teaching: Promotes mastery, elicits goal behavior, teaching is active (e.g., role play) and engagingProcess: Proficient clinical & strategic skills, safe learning context Overall: Promotes growth, satisfaction, likely return, adjusts for context, difficulty Sessions scored: Encouragement and Limit Setting (intro & troubleshooting)
Uses of FIMP ● Teaching tool for coaching● Evaluation of Training & Certification● Evaluation of Drift across generations● Evaluation of drift within a generation● Evaluation of theoretical mechanisms: Does PMTO Fidelity result in improved parenting?
Fidelity To Intervention Model Fidelity Change Parenting Change Child Behavior
Stress Conflict Divorce Unemploy- ment Poverty PARENT Low Education Culture Substance Use Neighbor- hood Psycho- pathology Deviant Peers