Parent Management Training Oregon Model and Family-Based Services as Usual for Behavioral Problems in Youth: A National Randomized Controlled Trial in Denmark.

This randomized control trial used intent-to-treat analyses to compare parent management training-Oregon model (PMTO) (N = 64) to family-based services as usual (SAU) (N = 62) in 3.5-13-year-old children and their families in Denmark. Outcomes were parent report of child internalizing and externalizing problems, parenting efficacy, parenting stress, parent sense of coherence, parent-report of life satisfaction, and parental depressive symptoms. Outcomes were measured at pretreatment, post-treatment, and 18-20 months post-treatment. Results demonstrated that both PMTO and family-based SAU resulted in significant improvements in child externalizing and internalizing problems, parenting efficacy, as well as parent-reported stress and depressive symptoms, life satisfaction, and aspects of sense of cohesion. Effect sizes at post-treatment and follow-up were in the small to moderate range, consistent with prior PMTO evaluations. However, there were no significant differences between PMTO and family-based SAU. Further research on the process and content of family-based SAU is needed to determine how this approach overlaps with and is distinct from PMTO.

Examining the Emotional Experience of Mothers Completing an Evidence-Based Parenting Intervention: A Grounded Theory Analysis.

Parenting interventions are a well-established treatment for addressing child behavior problems that have also been shown to improve parent psychosocial health. Yet, little is known about how caregiver emotional experiences change over time during treatment. In response, the purpose of this study was to explore the emotional experiences of mothers following their participation in an evidence-based parenting intervention. Researchers conducted a secondary analysis of existing qualitative data. The study sample included semi-structured interview data from 17 mothers who previously completed the GenerationPMTO parenting intervention. Data analysis followed the grounded theory approach and included a sequential process of open, axial, and selective coding using the constant comparative method. Findings indicate mothers progressed through three distinct, yet interrelated stages of emotional experience: Before PMTO, their experiences were characterized by parenting through crisis (Stage 1); during PMTO, they transitioned to crisis stabilization (Stage 2); and following PMTO, they described experiences of emerging recovery and resilience (Stage 3). Maternal emotional experiences in each stage occurred across three contextual realms: (a) the individual (intrapersonal) level, (b) the parent-child relationship level, and the broader systemic level. Results highlight the dynamic and evolving nature of maternal emotional experience throughout various stages of the intervention process and suggest how these experiences may be associated with promoting effective parenting practices and positive child outcomes.

Las intervenciones en la crianza son un tratamiento firmemente consolidado para abordar los problemas de comportamiento de los niños y, a su vez, se ha comprobado que mejoran la salud psicosocial de los padres. Sin embargo, poco se sabe acerca de cómo las experiencias emocionales de los cuidadores cambian con el tiempo durante el tratamiento. En respuesta a esto, el propósito de este estudio fue analizar las experiencias emocionales de las madres después de su participación en una intervención factual en la crianza. Los investigadores llevaron a cabo un análisis secundario de los datos cualitativos actuales. La muestra del estudio incluyó datos de entrevistas semiestructuradas de 17 madres que anteriormente completaron la intervención en la crianza denominada GenerationPMTO. Los análisis de los datos siguieron el enfoque de teoría fundamentada e incluyeron un proceso secuencial de codificación abierta, axial y selectiva utilizando el método comparativo constante. Los resultados indican que las madres pasaron por tres estapas diferentes, pero interrelacionadas, de experiencia emocional: antes de la PMTO, sus experiencias estuvieron caracterizadas por la crianza durante la crisis (etapa 1), durante la PMTO, pasaron a la estabilización de la crisis (etapa 2) y después de la PMTO, describieron experiencias de surgimiento de recuperación y resiliencia (etapa 3). Las experiencias emocionales maternas de cada etapa se produjeron en tres ámbitos contextuales: a) el nivel individual (intrapersonal), b) el nivel de la relación entre padres e hijos y el nivel sistémico más amplio. Los resultados destacan la índole dinámica y cambiante de la experiencia emocional materna durante varias etapas del proceso de intervención y sugieren cómo estas experiencias pueden estar asociadas con el fomento de prácticas de crianza eficaces y resultados positivos en los niños.

Does Giving Parents Their Choice of Interventions for Child Behavior Problems Improve Child Outcomes?

Empowering consumers to be active decision-makers in their own care is a core tenet of personalized, or precision medicine. Nonetheless, there is a dearth of research on intervention preferences in families seeking interventions for a child with behavior problems. Specifically, the evidence is inconclusive as to whether providing parents with choice of intervention improves child/youth outcomes (i.e., reduces externalizing problems). In this study, 129 families presenting to community mental health clinics for child conduct problems were enrolled in a doubly randomized preference study and initially randomized to choice or no-choice conditions. Families assigned to the choice condition were offered their choice of intervention from among three different formats of the Parent Management Training-Oregon Model/PMTO (group, individual clinic, home based) and services-as-usual (child-focused therapy). Those assigned to the no-choice condition were again randomized, to one of the four intervention conditions. Intent-to-treat analyses revealed partial support for the effect of parental choice on child intervention outcomes. Assignment to the choice condition predicted teacher-reported improved child hyperactivity/inattention outcomes at 6 months post-treatment completion. No main effect of choice on parent reported child outcomes was found. Moderation analyses indicated that among parents who selected PMTO, teacher report of hyperactivity/inattention was significantly improved compared with parents selecting SAU, and compared with those assigned to PMTO within the no-choice condition. Contrary to hypotheses, teacher report of hyperactivity/inattention was also significantly improved for families assigned to SAU within the no-choice condition, indicating that within the no-choice condition, SAU outperformed the parenting interventions. Implications for prevention research are discussed.

Treatment Fidelity during Therapist Initial Training is related to Subsequent Effectiveness of Parent Management Training-Oregon Model.

The present study examined the association between treatment fidelity during therapist initial training and subsequent treatment outcome of Parent Management Training - Oregon model (PMTO) in The Netherlands. Clinically referred children (N = 86) aged 4 to 11 years and their parents received PMTO and were assessed at four time points: at baseline, and after 6, 12, and 18 months. Difference scores between baseline and follow-up assessments of externalizing behavior problems, parenting practices, and parental psychopathology and parents' overall ratings of working alliance, were correlated with treatment fidelity scores measured prior to the intervention. Furthermore, differences in therapists' fidelity scores between treatment completers and drop-outs were examined. Results showed that higher fidelity scores of PMTO therapists during initial training were associated with larger improvements in externalizing behavior, parenting practices, and parental psychopathology, especially after 18 months. In addition, parents who completed the treatment had a significantly more adherent therapist than families who dropped out. However, the correlations between treatment fidelity and working alliance were non-significant. These findings indicate that therapists' high adherence to the PMTO treatment principles during initial training decreases the chance of treatment drop-out and positively affects the longterm effectiveness of PMTO.

Neurobiological stress responses predict aggression in boys with oppositional defiant disorder/conduct disorder: a 1-year follow-up intervention study.

To improve outcome for children with antisocial and aggressive behavior, it is important to know which individual characteristics contribute to reductions in problem behavior. The predictive value of a parent training (Parent Management Training Oregon; PMTO), parenting practices (monitoring, discipline, and punishment), and child neurobiological function (heart rate, cortisol) on the course of aggression was investigated. 64 boys with oppositional defiant disorder or conduct disorder (8-12 years) participated; parents of 22 boys took part in PMTO. All data were collected before the start of the PMTO, and aggression ratings were collected three times, before PMTO, and at 6 and 12 month follow-up. Parent training predicted a decline in aggression at 6 and 12 months. Child neurobiological variables, i.e., higher cortisol stress reactivity and better cortisol recovery, also predicted a decline in aggression at 6 and 12 months. Heart rate and parenting practices were not related to the course of aggression. These results indicate that child neurobiological factors can predict persistence or reduction of aggression in boys with ODD/CD, and have unique prognostic value on top of the parent training effects.

Parent Management Training-Oregon Model: Adapting Intervention with Rigorous Research.

Parent Management Training-Oregon Model (PMTO(®) ) is a set of theory-based parenting programs with status as evidence-based treatments. PMTO has been rigorously tested in efficacy and effectiveness trials in different contexts, cultures, and formats. Parents, the presumed agents of change, learn core parenting practices, specifically skill encouragement, limit setting, monitoring/supervision, interpersonal problem solving, and positive involvement. The intervention effectively prevents and ameliorates children's behavior problems by replacing coercive interactions with positive parenting practices. Delivery format includes sessions with individual families in agencies or families' homes, parent groups, and web-based and telehealth communication. Mediational models have tested parenting practices as mechanisms of change for children's behavior and found support for the theory underlying PMTO programs. Moderating effects include children's age, maternal depression, and social disadvantage. The Norwegian PMTO implementation is presented as an example of how PMTO has been tailored to reach diverse populations as delivered by multiple systems of care throughout the nation. An implementation and research center in Oslo provides infrastructure and promotes collaboration between practitioners and researchers to conduct rigorous intervention research. Although evidence-based and tested within a wide array of contexts and populations, PMTO must continue to adapt to an ever-changing world.

Implementation and evaluation of linked parenting models in a large urban child welfare system.

During the past decade, there have been increased efforts to implement evidence-based practices into child welfare systems to improve outcomes for children in foster care and their families. In this paper, the implementation and evaluation of a policy-driven large system-initiated reform is described. Over 250 caseworkers and supervisors were trained and supported to implement two evidence-based parent focused interventions in five private agencies serving over 2,000 children and families. At the request of child welfare system leaders, a third intervention was developed and implemented to train the social work workforce to use evidence-based principles in everyday interactions with caregivers (including foster, relative, adoptive, and biological parents). In this paper, we describe the policy context and the targeted outcomes of the reform. We discuss the theory of the interventions and the logistics of how they were linked to create consistency and synergy. Training and ongoing consultation strategies used are described as are some of the barriers and opportunities that arose during the implementation. The strategy for creating a path to sustainability is also discussed. The reform effort was evaluated using both qualitative and quantitative methods; the evaluation design, research questions and preliminary results are provided.

Treatment Effectiveness of PMTO for Children's Behavior Problems in Iceland: Child Outcomes in a Nationwide Randomized Controlled Trial.

Well-documented treatment methods must be tested following their implementation in community service agencies and across different cultures to ensure continuing effectiveness. This study was a randomized controlled trial (RCT) of Parent Management Training-the Oregon model (PMTO), conducted within a nationwide implementation in Iceland. Families of 102 clinically referred children with behavior problems were recruited from five municipalities throughout Iceland. Child age ranged from 5 to 12; 73% were boys. Families were randomly assigned to either PMTO or services usually offered in the communities (SAU). Child adjustment was measured with a latent construct based on parent, child, and teacher reports of externalizing and internalizing problems and social skills. Prepost intent-to-treat analyses showed that PMTO treatment led to greater reductions in child adjustment problems relative to the comparison group, obtaining a modest to medium effect size based on the construct score. Only one indicator (parent-rated Social Skills) showed significant change independently and information on amount and kind of treatment in the SAU was limited. Overall, findings indicate that PMTO is an effective method to treat children's behavior problems in a Northern European culture and supply evidence for the method's successful implementation in community settings in Iceland. This is one of few nationwide implementation studies of PMTO outside the United States and the first RCT in Iceland to test a treatment model for children's behavior problems.

Parent Management Training-Oregon Model (PMTO™) in Mexico City: Integrating Cultural Adaptation Activities in an Implementation Model.

This article describes the process of cultural adaptation at the start of the implementation of the Parent Management Training intervention-Oregon model (PMTO) in Mexico City. The implementation process was guided by the model, and the cultural adaptation of PMTO was theoretically guided by the cultural adaptation process (CAP) model. During the process of the adaptation, we uncovered the potential for the CAP to be embedded in the implementation process, taking into account broader training and economic challenges and opportunities. We discuss how cultural adaptation and implementation processes are inextricably linked and iterative and how maintaining a collaborative relationship with the treatment developer has guided our work and has helped expand our research efforts, and how building human capital to implement PMTO in Mexico supported the implementation efforts of PMTO in other places in the United States.

Looking Forward: The Promise of Widespread Implementation of Parent Training Programs.

Over the past quarter century, researchers have developed a body of parent training programs that have proven effective in reducing child behavior problems, but few of these have made their way into routine practice. This article describes the long and winding road of implementation as applied to children's mental health. Adopting Rogers' (1995) diffusion framework and Fixsen and colleagues' implementation framework (Fixsen, Naoom, Blase, Friedman, & Wallace, 2005), we review more than a decade of research on the implementation of Parent Management Training-Oregon Model (PMTO). Data from U.S. and international PMTO implementations are used to illustrate the payoffs and the challenges of making empirically supported interventions routine practice in the community. Technological advances that break down barriers to communication across distances, the availability of efficacious programs suitable for implementation, and the urgent need for high quality mental health care provide strong rationales for prioritizing implementation. Over the next quarter of a century, the challenge is to reduce the prevalence of children's psychopathology by creating science-based delivery systems to reach families in need, everywhere.

Treatment effectiveness of PMTO for children's behavior problems in Iceland: assessing parenting practices in a randomized controlled trial.

Findings are presented from an Icelandic randomized control trial (RCT) evaluating parent management training - Oregon model (PMTO™), a parent training intervention designed to improve parenting practices and reduce child behavior problems. In a prior report from this effectiveness study that focused on child outcomes, children in the PMTO condition showed greater reductions in reported child adjustment problems relative to the comparison group. The present report focuses on observed parenting practices as the targeted outcome, with risk by treatment moderators also tested. It was hypothesized that mothers assigned to the PMTO condition would show greater gains in pre-post parenting practices relative to controls. The sample was recruited from five municipalities throughout Iceland and included 102 participating families of children with behavior problems. Cases were referred by community professionals and randomly assigned to either PMTO (n = 51) or community services usually offered (n = 51). Child age ranged from 5 to 12 years; 73% were boys. Contrary to expectations, findings showed no main effects for changes in maternal parenting. However, evaluation of risk by treatment moderators showed greater gains in parenting practices for mothers who increased in depressed mood within the PMTO group relative to their counterparts in the comparison group. This finding suggests that PMTO prevented the expected damaging effects of depression on maternal parenting. Failure to find hypothesized main effects may indicate that there were some unobserved factors regarding the measurement and a need to further adapt the global observational procedures to Icelandic culture.