PMTO Presentation

Alison Cox & Miriam Holbrook

PARENT MANAGEMENT TRAINING: OREGON MODEL (PMTO)

WHAT IS PMTO?Created by Gerald R. Patterson, Research scientist;

Founder of Oregon Social Learning Center

PMTO is THEORY-BASED:

Social Interaction Learning Theory:

Emphasizes the influence of the social

environment on behavioral outcomes.

http://www.youtube.com/watch?v=YI5Tylind9E

Coercion Theory

Hypothesis:

One person engages in a negative behavior to get what he/she wants

The other person responds in an equally negative fashion.

The exchange between the two individuals increases in intensity-

Until one of them finally gives in.

REINFORCEMENT A consequence following a behavior that

attempts to increase that behavior

Positive Reinforcement (PMTO): Presenting something goodfollowing a behavior you want to increase

Negative Reinforcement: Removing something badfollowing behavior you want to increase

PUNISHMENTA consequence followed by a behavior that

attempts to decrease that behavior

Positive Punishment: Presenting something bad following a behavior you want to decrease

Negative Punishment:Removing something goodfollowing a behavior you want to decrease

WHO IS PMTO FOR?TARGET POPULATION:

Parents (caregivers) of children 2-18 years of age with disruptive behaviors:

• Conduct Disorder• Substance Abuse• Oppositional Defiant Disorder• School Failure• Anti Social Behaviors• Covert/overt anti-social behaviors• Neglected/maltreated children• Parents with anti social issues

• http://www.cebc4cw.org/program/the-oregon-model-parent-management-training-pmto/

WHAT’S SO SPECIAL ABOUT PMTO?

Based on these theories, PMTO addresses two social contexts:

Negative reinforcement (within the family)- Family coercive behaviors overt antisocial behaviors. Not accepted by peers

Positive Reinforcement (from deviant peer

groups) Covert behaviors such as lying, stealing and truancy.

PARENT MANAGEMENT TRAININGEMPOWERING PARENTS AS AGENTS OF

CHANGE FOR THEIR CHILDREN

Group ( Michigan: Parenting Through Change) 14 weeks, standard

Individual PMTO: 18-22 sessions (more flexible, customized)

Active (not pedantic) teaching

Role-play; home practice assignments

Based on simple routine tasks, then move on to limit setting behaviors

First sessions- Intro to Change:

Identify and build on family strengths and resources

Practitioner observation

Assessment of child’s functioning

Parent’s goals for change

•

PMTO OVERVIEWFIVE CORE PARENTING SKILLS:

1) Skill Encouragement through positive reinforcement

Pro social behavior

2) Limit Setting

decrease deviant behavior 3) Monitoring &

Supervision to ensure behavior stays on track4) Family Problem Solving prevent conflict/manages stress 5) Positive Parent Involvement

CHANGING OLD PARENTING HABITSParents- learn to identify positive parenting, use mild and consistent discipline and identify / avoid harsh discipline:

Avoid negative reinforcement- identify coercion- no “giving in” to child after initiating discipline.

No negative reciprocity- aversive response to child’s aversive behavior

No more inept discipline- anger, coercive discipline, irritability,indecisiveness, inconsistent discipline.

ROLE PLAYTherapist with Mom, Dad (children are Carl and Liv)

CASCADING EFFECTS of PMTONine Year Follow-up study (Patterson, Forgatch & DeGarmo, 2010)

Possible enduring effects of PMTO intervention that generalize through and beyond the family:

• Less deviant peer association

• Positive maternal adjustment: Improved parenting Increase in standard of living (education, income, occupation)

• These effects increased throughout 9-year follow up

Reduced deviant behavior = reduced maternal depression?

History and Implementation of PMTO

• Created by Dr. Gerald Patterson (1960s) and his colleagues at Oregon Social Learning Center (OSLC)

• Implemented in:• Norway: First wide range implementation

(national), 1999

• Later (2001) Iceland, the Netherlands, Denmark

• Statewide programs in Michigan and Kansas• Some implementations in Utah• Military families in Minnesota• Prevention program in Mexico City

PMTO: CULTURAL ADAPTATIONS

• Latino families-( Mexico City) Utah, Minnesota, Michigan)• Norway- Studies with Somali and Pakistani immigrant and refugee populations

Adaptations:• Translation of all materials• Cultural adaptations of PMTO

handbook • Use of trained bilingual • “link workers” from the population• Gender separation

Somali/Pakistani- no fathers

• Results show fidelity across cultures

ENSURING FIDELITYFidelity of Implementation Rating System (FIMP)

Team of PMTO specialists – reliability checks

Database used by all PMTO sites

Used across all implementation sites

Certification – every three years

Trainees -narrow range of excellence

- more homogeneous as they

work toward certification

Monitored by ISII coaches

to be sure standard is sustained

Regular meetings in supervision

Fidelity should cross generations- linger to their children, etc.

“Competent adherence”

LIMITATIONS and FUTURE RESEARCH

Managing fidelity in large-scale implementation

Better efficiency with older children

Need additional recruitment

strategies to reach ethnic minorities

Need more research with

ethnic minority families

(Pakistani/Somali- validity?)

Cascading Effects:

Why? Can we do more?

PMTO in MICHIGAN2004 SED population only- referred to CMH

Training/certification is only for CMH agency employees (Free)

Funded through block grants 50,000.00 per region

In long run, saves money

2013: 35agencies with PMTO

practitioners in the state community mental health system

83 certified PMTO practitioners

97 currently in training and providing services to families on individual basis

CERTIFICATION and TRAINING• Advancement to PMTO certification candidacy is based on ISII

and onsite mentor feedback• Free (must be CMH agency worker)• 12-18 months, workshops• Practice with real and simulated cases

with feedback- children age 4-12• Coaching- at least 12 sessions based on

video observation of therapy • Must achieve passing scores when

tested each session• Certification period- 3 years• Must renew certification through documentation of

cases, seminars,

observation and supervision

FURTHER INFORMATION ON THE WEB:

• Implementation Sciences International, Inc. (ISII):http://www.isii.net

• Oregon Social Learning Center:http://www.oslc.org

• PMTO in MICHIGAN: https://michiganpmto.com

•Two day workshops- informational, for anyone (parents)•State seminar coaching day- End of March: Lansing, MI.•Five-day training sessions (February, January)

ReferencesBjorknes, R., Kjobli, J., Manger T., & Jakobsen, R. (2012). Parent training among ethnic minorities: Parenting practices as mediators of change in child conduct problems. Family Relations, 61, 101-114,

Forgatch, M. S., Patterson, G. R., & Gewirtz, A. H. (2013). Looking forward: The promise of widespread implementation of parent training programs. Perspective on Psychological Science, 8(6), 682-694.

Kjobli, J., Hukkelberg, S., & Ogden, T. (2013). A randomized trial of group parent training: Reducing child conduct problems in read-world settings. Behaviour Research and Therapy, 51, 113-121.

Ogden T., Hagen, A. K., Askeland E., & Christensen, B. (2009). Implementing and evaluating evidence-based treatments of conduct problems in children and youth in Norway. Research on Social Work Practice, 19 (5), 582-591.

Patterson, G. R., Forgatch, M. S., & DeGarmo, D. S. (2010). Cascading effects following intervention. Development and Psychopathology, 22, 949-970.

Reed, A., Snyder, Staats, S., Forgatch, M. S., DeGarmo, D. S., Patterson, G. R., . . . Schmidt, N. (2013). Duration and mutual entrainment of changes in parenting practices engendered by behavioral parent training targeting recently separated mothers. Journal of Family Psychology, 27(3), 343-354.

Solholm, R., Kjobli, J., & Christiansen, T. (2013). Early initiative for children at risk: Development of a program for the prevention and treatment of behavior

problems in primary services. Prev Science, 14, 535-544.