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IMPLEMENTATION OF PMTO IN ICELAND EVIDENSEKONFERENCE DENMARK 2012 Margrét Sigmarsdóttir

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Page 1: IMPLEMENTATION OF PMTO IN ICELAND - Socialstyrelsen · The PMTO implementation in Iceland was a success in terms of demonstrating that the method could be transferred fully from the

IMPLEMENTATION OF PMTO IN ICELAND

EVIDENSEKONFERENCE – DENMARK 2012 Margrét Sigmarsdóttir

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AGENDA Introduction to the Implementation

Results from the implementation study

Method of the implementation study

Discussions and experiences

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INTRODUCTION

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

Builds on Gerald Patterson´s theory about the development of antisocial behavior

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REACHING MORE THAN HALF OF THE POPULATION

2012

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SUCCESSFUL IMPLEMENTATION

Building base

Recruiting professionals

Ongoing training/coaching

Infrastructure

Many critical steps

Fidelity *

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INFRASTRUCTURE

A small department in the community of Hafnarfjördur

Serves as the central department for the PMTO nationwide

implementation infrastructure

PMT-FORELDRAFÆRNI

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FIDELITY

Fidelity 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)

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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)

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Child adjustment

Parenting practices

Therapist behavior FIMP (Fidelity of Implementation Rating System)

Adapted in Iceland from Marion Forgatch by Margrét Sigmarsdóttir 2011

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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

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METHOOD

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Competent Adherence to the PMTO Method

FIMP

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

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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)

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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)

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TEACH

Therapists’ ways of balancing instructional

strategies to focus on active rather than

didactic approaches

(Knutson et al.,2009)

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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

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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)

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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)

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EXAMPLES

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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

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PROCEDURE

Reliable FIMP coders rated certification

sessions, which consisted of four video-

recorded sessions of therapist and parents

in PMTO individual therapy

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PROCEDURE

These sessions addressed the following

required content: introducing

encouragement, troubleshooting

encouragement, introducing discipline and

troubleshooting discipline

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RESULTS

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5,6

5,8

6,0

6,2

6,4

6,6

6,8

7,0

7,2

7,4

7,6

Knowledge Structure Teach Process Overall Total FIMP

FIM

P S

CO

RE

S

FIMP DIMENSIONS

G1

G2

G3

Sigmarsdóttir & Guðmundsdóttir, 2012

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CHILD OUTCOME; SEM structural equation model

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

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DISCUSSION

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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

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FIMP score patterns were similar to data

from the Norwegian implementation

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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

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In our study we assessed fidelity at

certification only

Assessing maintenance over time is

equally important for future studies

FUTURE

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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

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Margrét Sigmarsdóttir [email protected]