PMTO Presentation

Editor's Notes

• #3: Cartoon- Coercion- negative reinforcement Child learns to use coercive means to get what he/she wants- parent reacts in a coercive manner as well- but then finally gives in, giving the child what he/she wanted- reinforcing the behavior to continue in the future. Difference between PMTO and other PMT: PMTO is Theory based. coercion theory (created by Patterson) Gerald R. Patterson, Ph.D., OSLC founder and Senior Scientist Emeritus, is well known for his pioneering work in three major areas in psychology: a theory of aggression, parent-training forms of intervention, and multiple-method measurement with emphasis on direct observation of family interaction. onlineacademy.org/modules/a205/support/glossary/coercion.html‎ Books: Families, Living with Children, Coercive Family Process, Families with Aggressive Children, Parents and Adolescents, Antisocial Boys, and Antisocial Behavior.
• #4: Based on Reinforcement Theory: John Watson- Operant Conditioning Negative reinforcement- mother says no- child gets angry (tantrum); mother gives in- increases child’s aversive behavior next time But could also take away chores for one night for good behavior? FOCUS OF PMTO: Positive reinforcement: praise, treats, etc.
• #5: So- PMTO focuses on the use of Positive reinforcement and Negative punishment. Positive punishment (spanking, screaming, humiliation) Negative Punishment (take away affection, love) BUT- Less harsh discipline- Negative Punishment- Take away television time
• #6: Ages vary depending on source- some say 2-18; Manual says 4-12 since training involved only parents of these ages- can widen age gap after certification when customizing treatment Delinquency and deviant peer association Internalizing problems Often comes with multi-problem families: Parents with mental illness or legal issues Poverty, unsafe neighborhoods, Other stresses that can cause problems: Stressful changes such as Divorce, remarriage Moves, new births, deaths Focus can start with the children or with the parents- parents with problems PMTO has been successful for parents with chronic mental health problems (e.g. depression, anxiety or antisocial behaviour), parents living in poverty, parents undergoing a major transition, such as a divorce or close relative death, and domestic violence. Neglected or maltreated children
• #7: Reinforcement Theory: Negative reinforcement takes place within the family until No supervision- no monitoring; withdraw; consequences are withdrawn; kids fade away Positive reinforcement occurs in the peer context Anti social behaviors- Temper Tantrums/physical aggression. This behavior is typically not accepted by their peers. More time spent outside of family- Children drift to deviant peer groups who provide positive reinforcement PMTO emphasizes reducing resistance to change. Therapists must not teach or confront- this only increases resistance to changing behavior. - Intervention replaces pedantic teaching with active teaching (role play and problem solving) while delivering the core content
• #8: Parents are child’s best teachers Active teaching – avoids resistance to change First sessions: Intro to change- Typically, the practitioner will observe the child and parent interacting together with the Family Interaction Task. The child’s functioning is also assessed through the Child and Adolescent Functional Assessment Scale, which collects information on the child’s strengths and well as his or her difficulties. During the first session, parents identify goals for change and consider ways in which these goals can be achieved within the context of the family and child’s strengths and resources. The parents and practitioner then monitor the parent and child’s progress towards these goals throughout the duration of the programme. Also can just do a 2-day supplimentary parent group course
• #9: Skills Training: Using active teaching such as role play and problem solving- rather than pedantic teaching. Positive parenting skills- then terminating coercive interactions through effective discipline (may happen in reverse, however) Skill Encouragement: Teaching children new behavior through the use of praise and incentives. reinforcement and scaffolding- Break tasks down- give effective directions to your child - reinforce success, prompt desired behavior, correction in non-aversive way. 2) Limit Setting and emotional regulation: Responding to problem behavior with negative, nonphysical consequences (negative punishment). FLEXIBILITY- tailor intervention through wightin of the different components: More flexible skill components (vary from case to case): 3) Monitoring & Supervision: Checking on children’s behavior at home and away from home. 4) Family Problem Solving: An organized method of making decisions with family input., promoting school success 5) Positive Parent Involvement: Parents demonstrating interest, caring and attention. – empathy, support, affection, respect. http://www.northcare-up.org/pmto.html
• #10: Teach parents how to ID positive PMTO (Images) and use mild and consistent discipline to stop unwanted behavior. -Good Directions, ideas for Encouragement Token system of encouragement Components of PMTO: Observing and recording behavior Regulating emotions Fostering communication through cooperation Play with kids- with toys Then look at “Can do chart” with Goals: Pick up toys, ,make bed, etc beat the clock (time limit)Help kid clean Positive reinforcement when completed (hug, proud, etc) GROUP PMTO: Typically less severe cases Maximum number of 16 participants (caregivers of eight children) 12 weekly sessions, 2 ½ hours each Two group leaders (at least one PMTO therapist)
• #11: PMTO is based on the SIL model.
• #12: From 2011 Presentation Terje Ogden, U of Oslo Forgatch, Eugene (OSLC- oregon social learning center) Flexibility (may not include) Can be tailored for specific clinical problems, such as antisocial behavior, conduct problems, theft, delinquency, substance abuse, and child neglect and abuse. Returning Military families dealing with the effects of PTSD Stepfamilies Single parents Can be used as a preventative program and a treatment program Formats vary widely- can include parent groups, individual family treatment, books, audiotapes and video recordings. http://www.cebc4cw.org/program/the-oregon-model-parent-management-training-pmto/
• #14: Not just reducing anti-social behavior- but other benefits- why? Decreasing rigidity/ coercive interactions (The longer the time after PMTO, greater the difference between experimental and control groups) Reduced deviant behavior- and also reduced maternal depression Helping children through parent training can impact a mother’s world outside the family and thus lead to spread of intervention effects that go behond the home? -- one person changes and that change leads to change in another- happier; less depression on both sides-
• #15: OSLC- research center of anti-social behavior in children Oregon Social Learning Center (founded by Patterson) International program implementation in Norway: to reduce long-term foster care- children 3-12 with conduct problems- psychiatric health care and child welfare Kansas: Statewide child welfare system implementation Michigan- statewide in the children’s community mental health system (SED – severly emotionally disabled) Detroit- for parents who have lost custody due to abuse Other PMTO Researchers: John Reid Patricia Chamberlan Marion Forgatch Thomas Dishion
• #16: Cultural adaptations- to consider/show more ethnically homogeneous groups LINK WORKERS: function both as translators and culture builders- strengthen relationship between therapist and participants Expansion of other components- large sibling groups and emotion control Role playing- versions of the parent material Harsh discipline and positive parenting may have differential effects on child conduct problems in different ethnic groups-varies But here, the adaptation seems to work- was effective in reducing conduct problems- reduced harsh discipline and increased positive parenting was linked to this. Mothers who attended more than 50% had best results Seems flexible- can adapt without sacrificing the core components of PMTO Seems to generalize well across cultures Somali/ Pakistani populations- change in deviant behavior at home; not at school- why? Perhaps school still using coercive measures of discipline? --future: combined parent training with teacher training Based on Parents self-report of behavior outcomes (biased?)
• #17: Database- for adherence to PMTO based on direct observation FIMP is also observation based. FIMP reliability checks – against the ISII FIMP raters- also involved in cultural adaptations- in these cases- idea is to achieve “competent adherance” rather than 100% fidelity Implementation Sciences International, Inc. (ISII) is a research-based, non-profit organization providing training for community practitioners in Parent Management Training – the Oregon Model (PMTO™). An affiliate organization of Oregon Social Learning Center (OSLC) based in Eugene, Oregon. Shown to work across generations with little drift- Even when adapted for diverse groups High fidelity rates- with coaching and better when implemented across the child’s institutions
• #18: Moving interventions from controlled settings to community implementation is always a challenge. Fidelity Norway/Iceland some drift after 8 years- harder to manage in large-scale implementation, but WEB technology helps Need to better understand what policy changes are required to install evidenced based implementations in communities When service system could break down- or sustainability changes due to changes in policy, how can we monitor the outcomes of implementation? Encourage organizational use of evidence based practice- can promote fidelity within organizations- reward like additional funding, services, free training opportunities OLDER CHILDREN: PMTO most successful when children are below 8 years of age - need to develop a design of PMTO interventions better suited for older chlldren- Future research More research on group PMTO to consider more group intervention in the future CULTURAL adaptations- Somali/Pak studies– self report- no check of translations a way to include fathers? Cascading effects- we don’t know exactly why mothers do better after PMTO- and the longer they go, the better- we don’t know why peer deviant behavior goes down- Perhaps if we knew more, we could do more in these directions and learn more ways to expand the research that we may not have thought about.
• #19: Luann Gray- State rep for PMTO 2004 PTMO in Michigan: Need for change for children in the mental health system (SED SED- Severely emotionally disabled CMH- Community of Mental Health Norway first- they put tons of money into their children Michigan- shoe string budget Long run- reduced crisis calls, etc- saving money 27 practitioners providing Group PMTO families are seen in community treatment centers or at home 20 trainers 30 coaches 13 reliable fidelity raters Medicaid accepted Successfully implemented program- were initially some political and logistical issues Some angry about the behavioral theory (rewarding children for what they ought to do in the first place) Other problems- pitching the program to parents (experimental therapy) childcare arrangements at the treatment centers Policy issues: child has to receive direct services in order for agencies to receive third party payments- had to change this policy Source: #4 Website: Michiganpmto.com lgray@kazoocmh.org Hegira Westland, MI    http://www.hegira.net/ChildrenSED.htm   Programs Outpatient Therapy Case Management Home-Based Wraparound   We feature the following evidence-based treatment interventions: Parent Management Training-Oregon (PMTO) Adolescent Multi-Family Group (MFG) ALSO: Arab American and Chaldean Council Detroit (Not specifically on the website, however) In LANSING: Several other evidence-based practices are also used by specially-trained FGS (Family guidence services) therapists to address specific emotional and behavioral needs of children. Parent Management Training – Oregon Model: a structured in-home intervention to help parents manage their children’s behavior COSTS:Our services may be covered by health insurance, including Medicaid. Fees are assessed based on the client’s ability to pay. A coverage determination will identify a person's ability to pay along with any public funding that might be available. No one is ever denied services due to their inability to pay. Arbor Circle, Grand Rapids: Arbor Circle provides many services for children, families and teens. Home Based services are offered in your home and other convenient locations. Services are often free of charge. Certain income levels require some ability to pay based on a sliding fee scale.
• #20: Typical training program includes six three-day workshops (18 workshop days) Covering essential and supporting components, practice with cases Candidates for certification required to video record their sessions with families Coaching based on FIMP (Fidelity of Implementation Rating System): Knowledge of PMTO principles, practice and theoretical models Structure proficiency, leading without dominating Teaching: verbal and active teaching strategies that promote parents mastery of PMTO skills Process: proficiency of sophisticated therapeutic skills Overall development- incorporating contextual and family circumstances that may interfere with the intervention of PMTO Assessment of your local agency, funding, caseload, target pop, - have to assess all to achieve sustained implementation with high fidelity FIMP: NO scores below four on a nine-point scale. Following certification, monthly PMTO coaching within local community is required Coaching from ISII at regular intervals to sustain fidelity Need an additional 2 family PMTO cases- not training families