IMPLEMENTATION OF PMTO IN ICELAND

EVIDENSEKONFERENCE – DENMARK 2012Margrét Sigmarsdóttir

AGENDAIntroduction to the Implementation

Results from the implementation study

Method of the implementation study

Discussions and experiences

INTRODUCTION

PMTO was developed by Gerald Patterson, Marion Forgatch and colleagues at the Oregon Social Learning Center

Builds on Gerald Patterson´s theory aboutthe development of antisocial behavior

REACHING MORE THAN HALF OF THE POPULATION

2012

SUCCESSFUL IMPLEMENTATION

Building baseRecruiting

professionals

Ongoing training/coaching

Infrastructure

Many critical steps

Fidelity *

INFRASTRUCTURE

A small department in the community of Hafnarfjördur

Serves as the central department for the PMTO nationwide

implementation infrastructure

PMT-FORELDRAFÆRNI

FIDELITYFidelity measures provide information about the manner in which practitioners adhere to

content and practices of a given method

The Fidelity of Implementation Rating System (FIMP) is an observation-based

measure assessing therapist’s competence and adherence to PMTO

(Knutson, Forgatch, Rains & Sigmarsdóttir 2009)

FIDELITY

Earlier findings have shown that high FIMP scores predict greater improvement in

outcomes

(Forgatch & DeGarmo, 2011; Forgatch, Patterson & DeGarmo, 2005; Ogden & Amlund Hagen, 2008)

Child adjustment

Parenting practices

Therapist behavior FIMP(Fidelity of Implementation Rating System)

Adapted in Iceland from Marion Forgatch by Margrét Sigmarsdóttir 2011

GOAL WITH THE STUDY

To explore if fidelity will sustain by

comparing and assessing therapists´

competence and adherence to PMTO

between the first three groups of therapists

trained in the country

METHOOD

Competent Adherence to the PMTO MethodFIMP

FIVE DIMENSIONS

Rated on a 9-Point Liker Scale

(Knutson et al.,2009)

• Knowledge• Structure • Teaching• Process skills• Overall development

• 1-3 needs work • 4-6 acceptable work • 7-9 good work

KNOWLEDGE

Evaluates therapists’ understanding of the

PMTO model and principles, taking into

account accuracy of technical details,

integration of core and supportive

components and application of the model

(Knutson et al.,2009)

STRUCTURE

Measures use of a PMTO agenda

followed with relevant phasing and

timing while, at the same time, being

responsive to families’ needs

(Knutson et al.,2009)

TEACH

Therapists’ ways of balancing instructional

strategies to focus on active rather than

didactic approaches

(Knutson et al.,2009)

Examples include use of short, specific raps

(verbal summaries that give key information)

balanced with role play and other exercises to

practice procedures as well as problem solving

strategies that engage participants in the

learning process

(Knutson et al.,2009)

TEACH

PROCESS SKILLS

Therapists´ skills to create a safe and balanced

environment for learning to take place.

Therapists’ support, effective use of the

questioning process, and sophisticated clinical

tools are factors measured on this dimension

(Knutson et al.,2009)

OVERALL DEVELOPMENT

A dimension that measures how therapists

manage to engage families, create growth in

their PMTO skills, motivate them to use the

principles and come back to next session

(Knutson et al.,2009)

EXAMPLES

PARTICIPANTS

There were 3.9 therapists in Norway per 100.000 from the first three groups

16 therapists from the first three groups of PMTO therapists trained to certification in IS

All candidates held graduate degrees from different academic disciplines

From the first three groups there were 3.8 therapists in Iceland per 100.000

PROCEDURE

Reliable FIMP coders rated certification

sessions, which consisted of four video-

recorded sessions of therapist and parents

in PMTO individual therapy

PROCEDURE

These sessions addressed the following

required content: introducing

encouragement, troubleshooting

encouragement, introducing discipline and

troubleshooting discipline

RESULTS

Knowledge Structure Teach Process Overall Total FIMP5.6

5.8

6.0

6.2

6.4

6.6

6.8

7.0

7.2

7.4

7.6

G1

G2

G3

FIMP DIMENSIONS

FIM

P S

CO

RE

S

Sigmarsdóttir & Guðmundsdóttir, 2012

CHILD OUTCOME; SEM structural equation model

(Sigmarsdóttir, Thorlacius, Guðmundsdóttir, DeGarmo & Forgatch, 2012)

DISCUSSION

The PMTO implementation in Iceland was a

success in terms of demonstrating that the

method could be transferred fully from the

purveyor to the community without loss of

fidelity to the method

FIMP score patterns were similar to data

from the Norwegian implementation

A drop in fidelity for G2 is likely due to an

adapting period where material needed

translation and coaching and training

methods needed to be transferred to the

adopting nation

In our study we assessed fidelity at

certification only

Assessing maintenance over time is

equally important for future studies

FUTURE

FUTURE

It is necessary to have a sophisticated

assessment tool to measure therapists’

competence and adherence to the

method when implementing an EST in

the real world

Margrét Sigmarsdóttirmargret@hafnarfjordur.is