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PMTO Eddy Rains 12-3-2010
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Transcript of PMTO Eddy Rains 12-3-2010
Parent Management Training – Oregon Model (PMTO™)
An Evidence-Based Practice Developed in Our Community
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).
Mark EddyLaura Rains
Focus For Today
1. How This All Came About2. Implementation History3. Active Teaching4. Summary5. Conversation
Eugene-Springfield Non-Profits
Oregon Social Learning Center
Implementation Sciences International, Inc.
A Typical Case
• 8 year old • Having trouble at home• Having trouble at school • Parent feels has tried everything• Don’t know what to do
Eugene-Springfield, 1950s
• Child Guidance Clinic• Child Study Center• Play therapy
– Child focused– Wasn’t working for typical case– Needed new model
Jerry Patterson, 1960s
• When things aren’t working, go back to the drawing board
• Basic research– Conclusion that problem not just inside the
child, but that what is going on around the child matters
– What parents, teachers, and other adults do can change what a child does
Developing an Evidence-Base
• 1950s: Basic laboratory research• 1960s: Outpatient clinical research• 1970s: Longitudinal studies• 1980s: Juvenile justice, child welfare, and
mental health systems• 1990s: School system, community-based non-
profits:• 2000s: Criminal justice system; early childhood
intervention; communities, states, countries
Treatment /Control
Parenting Practices
Child Outcomes
Divorced Mothers (PTC)
Adjudicated Youth
Step-families (MAPS)
School in High Crime Neighborhoods (LIFT)
Treatment Foster Care: Delinquents - Boys
SAMPLES
Foster Care: Mentally Ill (Hospitalized)
Maltreated Children
Treatment Foster Care: Delinquents - Girls
Early Intervention Treatment Care (2-4)
Arrest Rates / Severity of Crime
Substance Use
Noncompliance
Delinquent Behaviors
Academic Function
CHILD OUTCOMES
Out of Home Placement
Deviant Peer Associations
Depression
PARENT OUTCOMES
Depression
Standard of living
Arrest rates
Marital satisfaction
Marital adjustment
POSITIVE PARENTING PRACTICES
Skills Encouragement
Positive Involvement
Effective Discipline
Problem-solving
Monitoring / Supervision
Negative Reinforcement
Escalation
Negative Reciprocity
NEGATIVE PARENTING PRACTICES
Forgatch & Patterson, 2010
Forgatch & Knutson, 2002
Lifecourse Perspective
Parent Management Training
• Empowering parents with core strategies:– Skill Encouragement– Limit Setting– Monitoring/supervision– Family Problem Solving– Positive Involvement
• Considered one of two “well established” treatments for conduct disorder (American Psychological Association)
Family-Based Programs on 3 or More Federal Best Practice Lists
Classification Percent Cumulative Percent
Developed at OSLC 23%
Derived from OSLC 23% 56%
Includes many OSLC elements
33% 81%
Few or no OSLC elements
19%
Primary Target: Parent Behavior• Spending positive, quality time with children • Encouraging participation in normative
behaviors/activities, teaching in small steps• Providing consistent, mild, small, nonviolent
consequences for problem behaviors• Monitoring of daily activities in and outside
home, supervising who, what, where, when• Goal setting, interpersonal planning,
negotiating, trying out agreements• Separating child from delinquent peers,
encouraging relationships with prosocial peers
Key Intervention Targets
• The presence and behavior of adults in parental roles
• The presence and behavior of peers
Social Interaction Learning Model
Child AdjustmentPositive Involvem
ent
Skill E
ncou
rage
men
t
Mon
itorin
gP
roblem solving
Lim
it S
ettin
g
Aversive Behavior
Negative R
eciprocity Escal
atio
nNeg
ative
Rei
nfor
cem
ent
Coercive
Positive
Disrupted parentingAdverse Contexts Child AdjustmentPositive Involvem
ent
Skill E
ncou
rage
men
t
Mon
itorin
gP
roblem solving
Lim
it S
ettin
g
Aversive Behavior
Negative R
eciprocity Escal
atio
nNeg
ative
Rei
nfor
cem
ent
Coercive
Positive
Disrupted parentingAdverse Contexts
Forgatch & Patterson, 2010
23,020912
Norway
29
Forgatch, 2010
680290
Iceland
2
Forgatch, 2010
108163
The Netherlands
26
Forgatch, 2010
1056157
Michigan
24
Forgatch, 2010
Denmark
24
48
4
Forgatch, 2010
Role Play as a PMTO Teaching Tool
• Teaching is active!• Learning is kinesthetic• Engages family in the change process• Decreases time spent in “talk”• Parents practice skill before using at home
with children
Active Teaching: The 3-D Approach
• Demonstrate: Model appropriate and sufficient information. Engage family quickly and effectively with RP. Be theatrical.
• Differentiate: Help parents specify characteristics that differentiate effective and less effective action.
• Debrief: Punctuate and frame effective actions. Guide parents to recognize and reinforce their own and each other’s successes.
PMTO Role Play: 3-Step DanceRP Setup• Models/demonstrates • Draws family in quickly and effectively • Provides direction (who is to do exactly what)
RP Practice• Guides (exactly how)• Uses theatrical strategies• Breaks role play into small steps
RP Debrief• Punctuates, reinforces, supports, encourages • Weaves in instructional material• Differentiates effective and less effective action
Spotlight: Wrong Way / Right Way RP
• Wrong way demonstration normalizes the parenting experience, increases session comfort and introduces humor into the situation
• Dramatic wrong way RP ushers in surprise and insight
• Wrong way/right way RPs are used to compare and contrast
• Emphasis is spent on practicing the right way
Let’s
try
it
out!
Let’s try it out!Role Play #1: Practice as parent
Practice 2 wrong way, 2 right way directionsRoles: Parent, Child
“Put your shoes in the closet now, please.”•“Use an inside voice now, please.”•“Put your toys away in the toy box now, please.”•(Name), do (________) now, please.”
Let’s try it out!Role Play #2: Practice as therapist
Practice demonstrating “wrong way/right way” directions and debriefing role plays
Roles: Therapist, Parent
1. Model wrong way directions2. Debrief3. Engage parent in building better direction4. Model right way direction5. Debrief
PMTO at a Glance
1.Core belief: Parents are their children’s best teachers
2.Strength-based: Strengthening skills via coaching
3. Implementation strategy: Teach therapists to teach parents to teach children
4.Teaching: Engaging, active, fun!
5.Based on 40 years of research and practice*
* Forgatch, M.S., & Patterson, G.R. (2010)
Shine the light on what you want to grow!
Sigmarsdóttir, Rains, Knutson, & Forgatch, 2009
Fidelity of Implementation Rating System (FIMP)
• Rating system that evaluates competent adherence to PMTO.
• Based on direct observation of therapy.
• Video recordings uploaded to portal.
• Used to certify PMTO therapists, coaches, group leaders
Knutson, Forgatch, Rains, & Sigmarsdóttir, 2009
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)
Fidelity of Implementation Rating System (FIMP): The manual for PMTO™
(Revised: Knutson, Forgatch, Rains, & Sigmarsdóttir, 2009)
9-Point Likert Scale Good work = 7-9; Acceptable = 4-6; Needs Work = 1-3
● 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?
Uses of FIMP
Fidelity To Intervention Model
FidelityChange
Parenting
ChangeChild
Behavior
PARENT
Divorce
Neighbor-hood
Unemploy-ment
Stress
Poverty
SubstanceUse
DeviantPeers
Conflict
LowEducation
Psycho-pathology
Culture
The Parking Lot
The Parking Lot