PMTO Eddy Rains 12-3-2010


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Powerpoint presentation from Mark Eddy and Laura Rains. Presented at the 2010 Research to Practice Conference

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PMTO Eddy Rains 12-3-2010

  1. 1. Parent Management Training – Oregon Model (PMTO™)<br />An Evidence-Based Practice Developed in Our Community<br />Mark EddyLaura Rains<br />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).<br />
  2. 2. Focus For Today<br />1. How This All Came About<br />2. Implementation History<br />3. Active Teaching<br />4. Summary<br />5. Conversation <br />
  3. 3. Eugene-Springfield Non-ProfitsOregon Social Learning CenterImplementation Sciences International, Inc.<br />
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  5. 5. A Typical Case<br />8 year old <br />Having trouble at home<br />Having trouble at school <br />Parent feels has tried everything<br />Don’t know what to do<br />
  6. 6. Eugene-Springfield, 1950s<br />Child Guidance Clinic<br />Child Study Center<br />Play therapy<br />Child focused<br />Wasn’t working for typical case<br />Needed new model<br />
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  8. 8. Jerry Patterson, 1960s<br />When things aren’t working, go back to the drawing board<br />Basic research<br />Conclusion that problem not just inside the child, but that what is going on around the child matters<br />What parents, teachers, and other adults do can change what a child does<br />
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  13. 13. Developing an Evidence-Base<br />1950s: Basic laboratory research<br />1960s: Outpatient clinical research<br />1970s: Longitudinal studies<br />1980s: Juvenile justice, child welfare, and mental health systems<br />1990s: School system, community-based non-profits:<br />2000s: Criminal justice system; early childhood intervention; communities, states, countries<br />
  14. 14. Child Outcomes<br />Treatment /Control<br />Parenting Practices<br />CHILD OUTCOMES<br />Arrest Rates / Severity of Crime<br />Substance Use<br />SAMPLES<br />Noncompliance<br />Divorced Mothers (PTC)<br />Delinquent Behaviors<br />Step-families (MAPS)<br />Academic Function<br />POSITIVE PARENTING PRACTICES<br />School in High Crime Neighborhoods (LIFT)<br />Out of Home Placement<br />Skills Encouragement<br />Deviant Peer Associations<br />Maltreated Children<br />Positive Involvement<br />Adjudicated Youth<br />Effective Discipline<br />Depression<br />Treatment Foster Care: Delinquents - Boys<br />Problem-solving<br />PARENT OUTCOMES<br />Monitoring / Supervision<br />Depression<br />Treatment Foster Care: Delinquents - Girls<br />NEGATIVE PARENTING PRACTICES<br />Standard of living<br />Negative Reciprocity<br />Foster Care: Mentally Ill (Hospitalized)<br />Arrest rates<br />Escalation<br />Marital adjustment<br />Early Intervention Treatment Care (2-4)<br />Negative Reinforcement<br />Marital satisfaction<br />Forgatch & Patterson, 2010<br />
  15. 15. Forgatch & Knutson, 2002<br />
  16. 16. Lifecourse Perspective<br />
  17. 17. Parent Management Training<br />Empowering parents with core strategies:<br />Skill Encouragement<br />Limit Setting<br />Monitoring/supervision<br />Family Problem Solving<br />Positive Involvement<br />Considered one of two “well established” treatments for conduct disorder (American Psychological Association)<br />
  18. 18. Family-Based Programs on 3 or More Federal Best Practice Lists<br />
  19. 19. Primary Target: Parent Behavior<br />Spending positive, quality time with children <br />Encouraging participation in normative behaviors/activities, teaching in small steps<br />Providing consistent, mild, small, nonviolent consequences for problem behaviors<br />Monitoring of daily activities in and outside home, supervising who, what, where, when<br />Goal setting, interpersonal planning, negotiating, trying out agreements<br />Separating child from delinquent peers, encouraging relationships with prosocial peers<br />
  20. 20. Key Intervention Targets<br />The presence and behavior of adults in parental roles<br />The presence and behavior of peers<br />
  21. 21. Social Interaction Learning Model<br />Forgatch & Patterson, 2010<br />
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  26. 26. 23,020<br />Norway<br />912<br />29<br />Forgatch, 2010<br />
  27. 27. Iceland<br />680<br />290<br />2<br />Forgatch, 2010<br />
  28. 28. The Netherlands<br />1081<br />63<br />26<br />Forgatch, 2010<br />
  29. 29. Michigan<br />1056<br />157<br />24<br />Forgatch, 2010<br />
  30. 30. Denmark<br />48<br />24<br />4<br />Forgatch, 2010<br />
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  38. 38. Role Play as a PMTO Teaching Tool<br />Teaching is active!<br />Learning is kinesthetic<br />Engages family in the change process<br />Decreases time spent in “talk”<br />Parents practice skill before using at home with children<br />
  39. 39. Active Teaching: The 3-D Approach<br />Demonstrate: Model appropriate and sufficient information. Engage family quickly and effectively with RP. Be theatrical.<br />Differentiate: Help parents specify characteristics that differentiate effective and less effective action.<br />Debrief: Punctuate and frame effective actions. Guide parents to recognize and reinforce their own and each other’s successes.<br />
  40. 40. PMTO Role Play: 3-Step Dance<br />RP Setup<br />Models/demonstrates <br />Draws family in quickly and effectively <br />Provides direction (who is to do exactly what) <br />RP Practice<br />Guides (exactly how)<br />Uses theatrical strategies<br />Breaks role play into small steps<br />RP Debrief<br />Punctuates, reinforces, supports, encourages <br />Weaves in instructional material<br />Differentiates effective and less effective action <br />
  41. 41. Spotlight: Wrong Way / Right Way RP<br />Wrong way demonstration normalizes the parenting experience, increases session comfort and introduces humor into the situation<br />Dramatic wrong way RP ushers in surprise and insight<br />Wrong way/right way RPs are used to compare and contrast <br />Emphasis is spent on practicing the right way<br />
  42. 42. Let’s <br /> try <br /> it <br /> out!<br />
  43. 43. Let’s try it out!Role Play #1: Practice as parent<br />Practice 2 wrong way, 2 right way directions<br />Roles: Parent, Child<br />“Put your shoes in the closet now, please.”<br />“Use an inside voice now, please.”<br />“Put your toys away in the toy box now, please.”<br />(Name), do (________) now, please.”<br />
  44. 44. Let’s try it out!Role Play #2: Practice as therapist<br />Practice demonstrating “wrong way/right way” directions and debriefing role plays<br />Roles: Therapist, Parent<br /> Model wrong way directions<br /> Debrief<br /> Engage parent in building better direction<br /> Model right way direction<br /> Debrief<br />
  45. 45. PMTO at a Glance<br />Core belief: Parents are their children’s best teachers <br />Strength-based: Strengthening skills via coaching<br />Implementation strategy: Teach therapists to teach parents to teach children<br />Teaching: Engaging, active, fun!<br />Based on 40 years of research and practice*<br />* Forgatch, M.S., & Patterson, G.R. (2010)<br />
  46. 46. Shine the light on what you want to grow!<br />
  47. 47. Sigmarsdóttir, Rains, Knutson, & Forgatch, 2009 <br />
  48. 48. Fidelity of Implementation Rating System (FIMP)<br /><ul><li>Rating system that evaluates competent adherence to PMTO.
  49. 49. Based on direct observation of therapy.
  50. 50. Video recordings uploaded to portal.
  51. 51. Used to certify PMTO therapists, coaches, group leaders </li></ul>Knutson, Forgatch, Rains, & Sigmarsdóttir, 2009 <br />
  52. 52. Fidelity of Implementation Rating System (FIMP): <br />The manual for PMTO™<br />(Revised: Knutson, Forgatch, Rains, & Sigmarsdóttir, 2009)<br />9-Point Likert Scale Good work = 7-9; Acceptable = 4-6; Needs Work = 1-3  <br />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)<br />
  53. 53. Uses of FIMP<br />● 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? <br />
  54. 54. Fidelity To Intervention Model<br />Fidelity<br />Change<br />Parenting<br />Change<br />Child<br />Behavior<br />
  55. 55. Stress<br />Conflict<br />Divorce<br />Unemploy-<br />ment<br />Poverty<br />PARENT<br />Low<br />Education<br />Culture<br />Substance<br />Use<br />Neighbor-<br />hood<br />Psycho-<br />pathology<br />Deviant<br />Peers<br />
  56. 56. The Parking Lot<br />
  57. 57. The Parking Lot<br />