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Alison Cox & Miriam Holbrook PARENT MANAGEMENT TRAINING: OREGON MODEL (PMTO)

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Page 1: PMTO Presentation

Alison Cox & Miriam Holbrook

PARENT MANAGEMENT TRAINING: OREGON MODEL (PMTO)

Page 2: PMTO Presentation

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.

Page 3: PMTO Presentation

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

Page 4: PMTO Presentation

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

Page 5: PMTO Presentation

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/

Page 6: PMTO Presentation

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.

Page 7: PMTO Presentation

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

Page 8: PMTO Presentation

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

Page 9: PMTO Presentation

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.

Page 10: PMTO Presentation
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ROLE PLAYTherapist with Mom, Dad (children are Carl and Liv)

Page 13: PMTO Presentation

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?

Page 14: PMTO Presentation

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

Page 15: PMTO Presentation

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

Page 16: PMTO Presentation

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”

Page 17: PMTO Presentation

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?

Page 18: PMTO Presentation

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

Page 19: PMTO Presentation

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

Page 20: PMTO Presentation

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)

Page 21: PMTO Presentation

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.