Search

Empirically determining the components of evidence-based interventions contributing to positive change is a crucial, yet understudied area of research. In support of this aim, we describe the development and evaluation of an observational rating system for measuring fidelity to specific components of the evidence-based GenerationPMTO parenting intervention. A five-step process was employed to systematically develop the rating system, which included consultation with the intervention developer and input from additional GenerationPMTO experts. The rating system was then tested using 247 h of video data from 184 parenting group intervention sessions. Study findings support the psychometric properties of the new measure with regard to item performance, reliability (i.e., inter-rater reliability of items, dimensionality of components, internal consistency of component scales), and validity (i.e., content validity, convergent validity, discriminant validity, and predictive validity of the component scales) for seven of the eight scales evaluated. The seven components include clear directions, skill encouragement, emotion regulation, limit setting, effective communication, problem solving, and monitoring. Data did not support the psychometric properties of the positive involvement scale. Overall, the ability to assess component-specific fidelity allows for a more nuanced examination of change processes, with meaningful implications for research and practice. Electronic supplementary material The online version of this article (10.1007/s11121-020-01177-5) contains supplementary material, which is available to authorized users.

Empirically determining the active ingredients of evidence-based parenting interventions is a promising means for strengthening interventions and enhancing their public health impact. This study aimed to determine which distinct ingredients of the GenerationPMTO (GenPMTO) intervention were associated with subsequent changes in parenting practices. Using a sample of 153 participants randomly assigned to the GenPMTO condition, we employed multilevel modeling to identify intervention ingredients empirically linked with change trajectories in parenting practices observed across the 2 years following intervention exposure. Coercive parenting and positive parenting outcomes were examined. Study results indicated that emotion regulation, effective communication, problem solving, and monitoring each demonstrated a significant pattern of findings for coercive parenting. Differential exposure to each of these ingredients significantly predicted the level of coercive parenting immediately postintervention and/or trajectories of change in coercive parenting across the subsequent 2-year period, controlling for coercive parenting at baseline. No significant predictors were found for positive parenting trajectories. Our findings suggest four components as active ingredients of the GenPMTO intervention for coercive parenting. Identification of these active ingredients may lead to strengthening future iterations of GenPMTO by expanding the set of core components specified in the model, which may further improve public health benefits. Implications for further understanding change stemming from evidence-based parenting interventions are also discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effective implementation outcomes are necessary preconditions for effective service and positive treatment outcomes for children with behavioral problems. The aim of this study is to assess outcomes of the transfer of the empirically supported intervention GenerationPMTO from the developer in the USA to a nationwide implementation in Norway. Adoption, sustainability, reach, and fidelity are tested across seven generations of therapists in Norway. Participants in the study were 521 therapists who began training in the program. The developer’s team trained the first generation (G1) and the Norwegian team trained the next six generations (G2–G7). The mean rate of certification was 94.2% (n = 491). Intervention fidelity was assessed from 1964 video recordings of intervention sessions submitted for certification evaluation using the observation-based measure Fidelity of Implementation Rating System (FIMP). A small but significant drop in fidelity scores was previously observed from G1 to G2; however, fidelity scores recovered at or above G1 scores for G3 Forgatch and DeGarmo (Prevention Science 12, 235-246, 2011). Twenty years since the inception of implementation, 314 certified therapists practice the model today, a retention rate of 64%. The outcomes show sustained fidelity scores across seven generations, increasing heterogeneity among therapists trained, and a shift of focus in the target population from clinical to primary services. The present study contributes to the field with the systematic evaluation of outcomes for the full transfer implementation approach with continuing adoption and sustainability, increasing reach and sustained intervention fidelity across several generations of practitioners.

Parents and children exposed to war and relocation have high rates of negative relational and mental health outcomes. This study tested the feasibility of implementing an adapted evidence-based parenting intervention for contexts of trauma and relocation stress. Eleven Karen refugee caregivers from Burma participated in the intervention. Participants and a focal child completed ethnographic interviews as well as structured assessments at baseline and follow-up. Caregivers reported changes in their teaching, directions, emotional regulation, discipline, and child compliance. Children reported changes in these areas and in positive parent involvement. Caregivers reported higher mental health distress immediately after the intervention, potentially due to increased awareness. Researchers made personalized referrals for counseling services as needed. Children reported a decrease in mental health symptoms.

Background Despite the large number of evidence-based practices (EBPs) ready for implementation, they are the exception in usual care, especially for ethnic minority patients, who may not have access to trained health professionals. Providing EBP training as part of a graduate curriculum could help build the pipeline of professionals to provide quality care. Methods We conducted a before-after study to determine whether we could implement a blended learning strategy (BL; i.e., in vivo and online training) to teach an EBP in university settings. Feasibility in this pilot was operationalized as knowledge acquisition, satisfaction, fidelity, acceptability, and usability. Using GenerationPMTO as the EBP, our aim was to train graduate students enrolled in Psychology, Social Work, and Family Therapy programs in the EBP in one academic year. Two therapists from a community agency were also students in this pilot. A total of 13 students from five universities were trained in the intervention. Adaptations were made to the intervention and training strategy to optimize training fidelity. Focus groups were conducted with the students to capture their perspective about the training. Results Students demonstrated significant knowledge acquisition from baseline (Mean = 61.79, SD = 11.18) to training completion (Mean = 85.27, SD = 5.08, mean difference = − 23.48, 95% CI = − 29.62, − 17.34). They also reported satisfaction with the BL format, as measured by teaching evaluations at the end of the course. Instructors received acceptable fidelity scores (range of 7–9 in a 9-point scale). Qualitative findings from focus groups showed support for acceptability and usability of BL training. Conclusions BL training in university settings can be conducted with fidelity when provided by appropriately trained instructors. BL that integrates EBP and adaptations may be uniquely applicable for training providers in low-resource and ethnically diverse settings. The BL enhanced knowledge of GenerationPMTO was acceptable and usable to students, and was delivered with high instructor fidelity to the training model.

This paper reviews the evolution of the Oregon model of family behavior therapy over the past four decades. Inspired by basic research on family interaction and innovation in behavior change theory, a set of intervention strategies were developed that were effective for reducing multiple forms of problem behavior in children (e.g., Patterson, Chamberlain, & Reid, 1982). Over the ensuing decades, the behavior family therapy principles were applied and adapted to promote children’s adjustment to address family formation and adaptation (Family Check-Up model), family disruption and maladaptation (Parent Management Training–Oregon model), and family attenuation and dissolution (Treatment Foster Care–Oregon model). We provide a brief overview of each intervention model and summarize randomized trials of intervention effectiveness. We review evidence on the viability of effective implementation, as well as barriers and solutions to adopting these evidence-based practices. We conclude by proposing an integrated family support system for the three models applied to the goal of reducing the prevalence of severe problem behavior, addiction, and mental problems for children and families, as well as reducing the need for costly and largely ineffective residential placements.

The present article employed a sample of 365 families of children in foster care to conduct a validation test of a newly developed instrument, the Parent Child Checklist (PCC). The PCC is a 54-item direct observation measure assessing parent–child interactions in the context of a family session. The PCC was developed to support the effective implementation of an evidence-based intervention, Parent Management Training-Oregon model, in the Kansas child welfare system. The PCC was designed to capture two scales of child behavior (prosocial and problem behavior) and five parenting domains (encouragement, positive involvement, problem solving, communication skill, and effective discipline). A combination of exploratory and confirmatory factor analysis was used in this first stage validation of the checklist. Results indicated the PCC scales obtained adequate internal consistency and interrater reliability. The confirmatory factor analysis supported 6 of the 7 expected scale domains; however, a two-factor solution was better - supported among the discipline items, labeled as effective and ineffective discipline. Test–retest reliability ranged from 0.45 to 0.80 across child behavior and parenting domains with alpha levels ranging from 0.65 to 0.88. A behavioral observation rating scale for clinicians that is reliable and feasible to implement can represent a significant improvement to practice-as-usual.

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.

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.

SYNOPSISObjective. Guided by a social interaction learning model, this study investigated potential risk and protective factors related to fathers’ early parenting behaviors. Design. Parenting behaviors in 726 Norwegian fathers with their 1-year olds (51.7% boys) were assessed by both micro social coding and global ratings from direct observation of structured interactions. Father and child factors were reported by fathers when the child was 6 months and 1 year old. Results. Fathers’ positive involvement was associated with children’s observed sustained attention, and lack of positive involvement was associated with children’s communicative risk and fathers’ lower education. Fathers’ negative reinforcement was associated with children’s developmental difficulties and communicative risk. Positive involvement and negative reinforcement were not correlated and were predicted by different factors, indicating they are separate dimensions of parenting. Conclusion. Multiple predictors relate to different parenti...

Objectives—This study evaluated implementation outcomes in three European countries of GenerationPMTO, an evidence-based parenting intervention for child and adolescent behavior problems. Method—The implementation approach was full transfer, in which purveyors train a first generation (G1) of practitioners; adopting sites assume oversight, training, certification, and fidelity assessment for subsequent generations (Forgatch & DeGarmo, 2011; Forgatch & Gewirtz, 2017). Three hundred therapists participated in trainings in GenerationPMTO in Iceland, Denmark, and the Netherlands. Data are from the implementation’s initiation in each country through 2016, resulting in six generations in Iceland, eight in Denmark, and four in the Netherlands. Therapist fidelity was measured at certification with an observation-based tool, Fidelity of Implementation Rating System (FIMP; Knutson, Forgatch, Rains, & Sigmarsdóttir, 2009). Results—Candidates in all generations achieved fidelity scores at or above the required standard. Certification fidelity scores were evaluated for G1 candidates, who were trained by the purveyor, and subsequent generations trained by the adopting implementation site. In each country, certification fidelity scores declined for G2 candidates compared with G1 and recovered to G1 levels for subsequent generations, partially replicating findings from a previous Norwegian study (Forgatch & DeGarmo, 2011). Recovery to G1 levels of fidelity scores was obtained in Iceland and the Netherlands by G3; in Denmark, the recovery was obtained by G5. The mean percentage of certification in each country was more than 80%; approximately 70% of certified therapists remained active in 2017. Conclusions—Findings support full transfer as an effective implementation approach with longterm sustainability and fidelity.

In this article, we discuss the successful implementation of an adapted evidence-based parenting intervention for families affected by two decades of war in Northern Uganda. The adaptation and adoption of such interventions to support mental health and family functioning is widely endorsed by prevention scientists and considered a priority in global mental health. The preparation and early adoption phases of engaging with a highly vulnerable community affected by war trauma are documented in this paper along with a discussion of the steps taken to adapt a parenting intervention for cultural and contextual fit. This study is a component of an overall program of research aimed at reducing the long-term negative effects of war on parenting practices and childhood outcomes, which have considerable implications for preventing mental, neurological, and substance-use disorders. The processes described here cover a 4-year period culminating in the implementation of the nine-session Enhancing Family Connection intervention piloted with a group of 14 mothers. The lessons in cultural adaptation have been valuable and the feasibility results promising for further testing the intervention.

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.

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. Language: en

Parent management training (PMT) has beneficial effects on child and parent adjustment that last for 5 to 10 years. Short-term changes in parenting practices have been shown to mediate these effects, but the manner in which changes in specific components of parenting are sequenced and become reciprocally reinforcing (or mutually entrained) to engender and sustain the cascade of long-term beneficial effects resulting from PMT has received modest empirical attention. Long-term changes in parenting resulting from the Oregon model of PMT (PMTO) over a 2-year period were examined using data from the Oregon Divorce Study-II in which 238 recently separated mothers and their 6- to 10-year-old sons were randomly assigned to PMTO or a no treatment control (NTC) group. Multiple indicators of observed parenting practices were used to define constructs for positive parenting, monitoring and discipline at baseline, and at 6-, 12-, 18- and 30-months postbaseline. PMTO relative to NTC resulted in increased positive parenting and prevented deterioration in discipline and monitoring over the 30-month period. There were reliable sequential, transactional relationships among parenting practices; positive parenting supported better subsequent monitoring, and positive parenting and better monitoring supported subsequent effective discipline. Small improvements in parenting resulting from PMTO and small deteriorations in parenting in the NTC group may be sustained and amplified by mutually entrained relationships among parenting practices. These data about the change processes engendered by PMTO may provide information needed to enhance the power, effectiveness, and efficiency of behavioral parent training interventions.

This report uses 6-year outcomes of the Oregon Divorce Study to examine the processes by which parenting practices affect deviant peer association during two developmental stages: early to middle childhood and late childhood to early adolescence. The participants were 238 newly divorced mothers and their 5- to 8-year-old sons who were randomly assigned to Parent Management Training—Oregon Model (PMTO®) or to a no-treatment control group. Parenting practices, child delinquent behavior, and deviant peer association were repeatedly assessed from baseline to 6 years after baseline using multiple methods and informants. PMTO had a beneficial effect on parenting practices relative to the control group. Two stage models linking changes in parenting generated by PMTO to children's growth in deviant peer association were supported. During the early to middle childhood stage, the relationship of improved parenting practices on deviant peer association was moderated by family socioeconomic status (SES); effective parenting was particularly important in mitigating deviant peer association for lower SES families whose children experience higher densities of deviant peers in schools and neighborhoods. During late childhood and early adolescence, the relationship of improved parenting to youths' growth in deviant peer association was mediated by reductions in the growth of delinquency during childhood; higher levels of early delinquency are likely to promote deviant peer association through processes of selective affiliation and reciprocal deviancy training. The results are discussed in terms of multilevel developmental progressions of diminished parenting, child involvement in deviancy producing processes in peer groups, and increased variety and severity of antisocial behavior, all exacerbated by ecological risks associated with low family SES.

Latinos constitute the largest ethnic minority group in the United States. However, the cultural adaptation and dissemination of evidence-based parenting interventions among Latino populations continues to be scarce despite extensive research that demonstrates the long-term positive effects of these interventions. The purpose of this article is threefold: (1) justify the importance of cultural adaptation research as a key strategy to disseminate efficacious interventions among Latinos, (2) describe the initial steps of a program of prevention research with Latino immigrants aimed at culturally adapting an evidence-based intervention informed by parent management training principles, and (3) discuss implications for advancing cultural adaptation prevention practice and research, based on the initial feasibility and cultural acceptability findings of the current investigation.

This report describes three studies from the nationwide Norwegian implementation of Parent Management Training – Oregon Model (PMTO™), an empirically supported treatment for families of children with behavior problems (Forgatch and Patterson 2010). Separate stages of the implementation were evaluated using a fidelity measure based on direct observation of intervention sessions. Study 1 assessed growth in fidelity observed early, mid, and late in the training of a group of practitioners. We hypothesized increased fidelity and decreased variability in practice. Study 2 evaluated method fidelity over the course of three generations of practitioners trained in PMTO. Generation 1 (G1) was trained by the PMTO developer/purveyors; Generation 2 (G2) was trained by selected G1 Norwegian trainers; and Generation 3 (G3) was trained by G1 and G2 trainers. We hypothesized decrease in fidelity with each generation. Study 3 tested the predictive validity of fidelity in a cross-cultural replication, hypothesizing that higher fidelity scores would correlate with improved parenting practices observed in parent-child interactions before and after treatment. In Study 1, trainees' performance improved and became more homogeneous as predicted. In Study 2, a small decline in fidelity followed the transfer from the purveyor trainers to Norwegian trainers in G2, but G3 scores were equivalent to those attained by G1. Thus, the hypothesis was not fully supported. Finally, the FIMP validity model replicated; PMTO fidelity significantly contributed to improvements in parenting practices from pre- to post-treatment. The data indicate that PMTO was transferred successfully to Norwegian implementation with sustained fidelity and cross-cultural generalization.

The potential challenges and mental health consequences of war-time deployments to service members and veterans are considerable, and increasing evidence suggests that families face diverse stressors at different periods in the deployment cycle (Pincus, House, Christenson, & Adler, 2005). Family members of deployed personnel are often the “unsung heroes” of a combat deployment, supporting service members before, during, and after a deployment. Consequently, the psychological consequences of deployment also apply to families. Partners of service members who are deployed, for example, face the challenge of worrying about and supporting a loved one for an extended period without knowing if or when they will return (Faber, Willerton, Clymer, MacDermid, & Weiss, 2008). Children face a variety of challenges at all stages of deployment, as they prepare for the absence of one of their parents, adapt to the changes in the home that are inevitable parts of that absence, and then re-adjust to the return of their parents months or even a year or more later. Service members themselves may face a range of challenges in reintegrating to civilian life following return from a combat deployment, including posttraumatic stress disorder (PTSD), depression, substance abuse, or simply transitioning back to work and family life. In this article, deployment related stressors and their impact on parents’ wellbeing are conceptualized as interrelated factors influencing parenting and children’s adjustment. We review the literature on relationships among deployment and related stressors, family relationships, and child adjustment with an explicit focus on parenting because research and practice show parenting is a key mechanism through which relationships operate to protect children, or place them at risk for maladjustment. We then discuss the Parent Management Training-Oregon model (PMTO™) and our efforts at adapting PMTO for work with military families. Finally, we discuss strategies and recommendations for clinicians providing parenting support to military families.

Four different sources for cascade effects were examined using 9-year process and outcome data from a randomized controlled trial of a preventive intervention using the Parent Management Training—Oregon Model (PMTO™). The social interaction learning model of child antisocial behavior serves as one basis for predicting change. A second source addresses the issue of comorbid relationships among clinical diagnoses. The third source, collateral changes, describes events in which changes in one family member correlate with changes in another. The fourth component is based on the long-term effects of reducing coercion and increasing positive interpersonal processes within the family. New findings from the 9-year follow-up show that mothers experienced benefits as measured by standard of living (i.e., income, occupation, education, and financial stress) and frequency of police arrests. It is assumed that PMTO reduces the level of coercion, which sets the stage for a massive increase in positive social interaction. In effect, PMTO alters the family environment and thereby opens doors to healthy new social environments.

Effects of intervention with the Oregon model of Parent Management Training (PMTO™) on marital relationship processes and marital satisfaction in recently married biological mother and stepfather couples were examined. Sixty-seven of the 110 participating families were randomly assigned to PMTO, and 43 families to a non-intervention condition. Intervention had reliable positive indirect effects on marital relationship processes 24 months after baseline which in turn were associated with higher marital satisfaction. These indirect effects were mediated by the impact of PMTO on parenting practices 6 months after baseline. Enhanced parenting practices resulting from PMTO prevented escalation of subsequent child behavior problems at school. Consistent with a family systems perspective and research on challenges to marital quality in stepfamilies, improved co-parenting practices were associated with enhanced marital relationship skills and marital satisfaction as well as with prevention of child behavior problems.

OBJECTIVE: The primary goal of this paper was to evaluate independent effects of stepfather parenting behaviors within the context of a parent training efficacy trial designed for recently married couples with children exhibiting behavior problems. A secondary goal was to examine measurement properties of a multiple-method, multiple-source construct of effective stepfathering including direct observation. Stepfather hypotheses were derived from a social interaction learning model of child adjustment and specifically evaluated the Oregon model of Parent Management Training (PMTO) intervention DESIGN: In a randomized control trial, 110 recently married families consisting of an early-elementary-school-aged focal child, biological mother, and stepfather were assessed over 2 years. Assessment included direct observation of stepfather - stepchild interactions. Analyses first tested intervention effects on change in stepfathering and second tested independent effects of stepfathering on change in children's depression and noncompliance at follow-ups. RESULTS: The intervention produced medium effect sizes at 6 and 12 months for improved stepfathering with parenting effects diminishing at 24 months. Hierarchical regression models showed that intervention group improvements in stepfathering predicted greater reductions in children's depression and noncompliance at 2 years relative to controls, controlling for change in mothering. CONCLUSIONS: These findings underscore the preventive utility of the PMTO intervention for stepfathers. Implications for research, translation, timing of intervention, and implementation are discussed.

This study evaluated benefits of a preventive intervention to the living standards of recently separated mothers. In the Oregon Divorce Study's randomized experimental design, data were collected 5 times over 30 months and evaluated with Hierarchical Linear Growth Models. Relative to their no-intervention control counterparts, experimental mothers had greater improvements in gross annual income, discretionary annual income, poverty threshold, income-to-needs ratios, and financial stress. Comparisons showed the intervention to produce a greater increase in income-to-needs and a greater rise-above-poverty threshold. Benefits to income-to-needs were statistically independent of maternal depressed mood, divorce status, child support, and repartnering. Financial stress reductions were explained by the intervention effect on income-to-needs. The importance of helping disadvantaged families with evidence-based programs is discussed.

Readers will gain knowledge about the Parent Management Training-Oregon model (PMTO®):1. PMTO as a theoretical model and practice. 2. Specific criteria EBT programs need to fulfill. 3. The theoretical background of PMTO. 4. The core elements of positive parenting practices. 5. Important training methods that set up PMTO practitioners to learn and polishskills. 6. Why method fidelity is important and how it can be measured. 7. Existing evidence supporting PMTO and randomized controlled trial (RCTs)that have been conducted. 8. Important implementation strategies that need to be in place when a methodis transferred from program developers to adopting sites. 9. Where and how PMTO has been implemented with high fidelity to themodel.

The Oregon Model of Parent Management Training (PMTO) is an intervention based on the social interaction learning model, which posits coercion as a disruptor for family processes and outcomes. This chapter examines the role that coercion plays in the context of theory-based intervention, reviewing two randomized, controlled trials that evaluated coercive and positive parenting practices as mediators of outcomes. The studies examined the differential effects of changes on coercive and positive parenting as well as the orderly sequence of these changes and their mediating effects in short-term and longer term follow-up data. The chapter considers family contextual factors and their impact on change processes during intervention and includes a discussion of factors such as parental adjustment (depression, antisocial qualities) and stressful circumstances and their relationship to parental resistance during intervention. Practitioner variables and practices are examined as contributors to the change process. Some findings of resistance observed during therapy are discussed.

Current measures of implementer fidelity often fail to adequately measure core constructs of adherence and competence, and their relationship to outcomes can be mixed. To address these limitations, we used observational methods to assess these constructs and their relationships to proximal outcomes in a randomized trial of a school-based preventive intervention (Rochester Resilience Project) designed to strengthen emotion self-regulation skills in first–third graders with elevated aggressive–disruptive behaviors. Within the intervention group (n = 203), a subsample (n = 76) of students was selected to reflect the overall sample. Implementers were 10 paraprofessionals. Videotaped observations of three lessons from year 1 of the intervention (14 lessons) were coded for each implementer–child dyad on adherence (content) and competence (quality). Using multilevel modeling, we examined how much of the variance in the fidelity measures was attributed to implementer and to the child within implementer. Both measures had large and significant variance accounted for by implementer (competence, 68 %; adherence, 41 %); child within implementer did not account for significant variance indicating that ratings reflected stable qualities of the implementer rather than the child. Raw adherence and competence scores shared 46 % of variance (r = .68). Controlling for baseline differences and age, the amount (adherence) and quality (competence) of program delivered predicted children’s enhanced response to the intervention on both child and parent reports after 6 months, but not on teacher report of externalizing behavior. Our findings support the use of multiple observations for measuring fidelity and that adherence and competence are important components of fidelity which could be assessed by many programs using these methods.

This article describes early aspects of the nationwide implementation of an evidence‐based program (EBP) in Norway and the design for studying program fidelity over time. The EBP is the Parent Management Training, Oregon Model (PMTO). The project is a combination of a ‘top down’ initiative at the governmental and ministry level, and a ‘bottom up’ initiative from practitioners seeking effective interventions in the prevention and remediation of behavior problems in children and youth. The main components of the implementation strategy were to (a) establish a national implementation and research center; (b) provide for regional and local participation at county and municipal levels; (c) establish a comprehensive therapist recruitment, training, and maintenance program; (d) create a network for collaboration, supervision, and quality control; (e) conduct clinical outcome research; and (f) study the implementation process. Following the training of three successive generations of PMTO specialists, a study was...

This paper reports on an experimental test of coercion theory early onset model of delinquency. Results are from the Oregon Divorce Study-II, a randomized preventive intervention trial with a sample of 238 recently separated mothers and their sons in early elementary school. The objective was to experimentally manipulate parenting variables hypothesized to influence development of delinquent behaviors. Multiple-method assessment spanned 36 months. Because the intervention focused on parent training, we expected that any intervention effects on changes in child outcomes would be mediated by hypothesized intervening mechanisms. Linear growth models showed significantly greater reduction in boys' delinquency and deviant peer affiliation in the experimental group relative to the controls. Subsequent models using no method overlap in constructs demonstrated that the intervention effect on delinquency operated through growth in parenting and reduction in deviant peer affiliation.

A selective prevention design was applied to 238 recently separated families. Of these, 153 mothers randomly assigned to the experimental (E) group participated in 14 group sessions focused on Parent Management Treatment (PMT). Prior analyses showed that, over time, the group of families in the untreated group deteriorated in both parenting practices and in child outcomes. In keeping with the classic prevention pattern, families in the E group showed modest improvements in parenting and in child outcomes. Improvements in parenting were associated with significant reductions in problem behavior. The data showed that those mothers who improved their parenting skills during the first 12 months also showed significant reductions in maternal depression during that same interval. A cross-lagged panel analysis showed that a reduction in maternal depression during the first year of the study was a significant predictor of maintenance or improvements over the next 18 months. The findings are consistent with the concept of the family as a system.

In a randomized prevention trial, 238 recently separated mothers and their young sons were assigned to either Parent Management Training (PMT) or a comparison group. Families were intensively assessed at baseline and at each 6-month interval through 30 months. To understand the effects of PMT, we first evaluated effect sizes among family variables over time. Second, because observed parenting was the target of PMT, we hypothesized a sequential pattern of structured changes within and between individuals. Using constructs with mismatched sources of data, we conducted a set of latent growth mediational analyses to test hypothesized mechanisms explaining change. Effect sizes indicated that parenting changed first within 12 months, followed by changes in boy behaviors and finally changes in maternal depression within 30 months. Unique follow-up findings indicated that intervention effects on reductions in maternal depression were mediated by reductions in boy externalizing; intervention effects on externalizing were mediated by reductions in boy depression. As expected, increases in effective parenting predicted reductions in child behavior problems. PMT effects on internalizing were direct and indirect, partially mediated by parenting practices. Results are discussed from a system's perspective on PMT amplifiers.

After a marital break up parents may make efforts to find new romantic partners, although little is known about how the process of repartnering unfolds. This study consisted of surveying by phone two samples of divorcing custodial parents who had been identified from court records (N = 39 for recent filers, N = 39 for one-year post filers). Results indicate that repartnering happened fairly quickly, with 50% having had some dating experience even prior to the divorce filing. At one-year post filing, typically parents had dated two new partners (range = 0-7) and their children had witnessed 2.5 new relationship transitions (range = 0-9). Among recent filers, younger parents, those with greater time since separation, and those in households containing other (nonromantic adults) were significantly more likely to have dated. While there were no differences in dating by ethnic group, African American parents reported significantly longer times since separation. Parental strategies for handling childre...

This study provided a randomized, experimental test of the efficacy of a parent training intervention on coercive discipline, positive parenting practices, and child noncompliance in a sample of 238 divorcing mothers and their sons in Grades 1-3. Intervention effects were evaluated 5 times from baseline to 30 months. The intervention produced enduring benefits to coercive discipline, positive parenting, and boys' noncompliance. These benefits followed a classic prevention effect: Mothers and sons in the experimental group maintained stable outcome trajectories, whereas those in the control group deteriorated. The intervention's impact on boys' noncompliance was mediated independently by its impact on coercive discipline and positive parenting. Change in positive parenting was more strongly associated with change in noncompliance than was change in coercive discipline, although each explained unique variance in change in noncompliance.

Following divorce, mothers may seek support for their parenting efforts. This study investigates confidant support from friends, family, and intimate partners, along with maternal distress, as predictors of parenting practices for divorced women. In a multimethod study of 138 mothers and their support confidants, we employed a measure of observed support that included emotional support, supportive behaviors, and likability of the support provider. These qualities were scored from dyadic problem-solving discussions of the mother's personal and parenting problems. Our main hypothesis was supported: Controlling for maternal distress and confidant negativity, observed confidant support predicted higher levels of effective parenting practices. Confidant negativity was associated with maternal distress, and we found a marginal relationship between maternal distress and parenting. Confidant negativity had an indirect association with parenting by predicting lower levels of observed support. Overall, 36% of the variance in parenting practices and 24% of the variance in observed support was explained in a multimethod structural equation model specified with minimal overlap.

This cross-sectional study extends child outcome models by focusing on factors in the adult social domain as contributors to parenting. The sample included 138 divorced mothers, their focal sons, and their support confidants assessed approximately 5 years after marital separation. The multimethod latent variable analysis tested a hypothesized progression stating observed confidant support would enhance problem solving outcomes achieved by mothers and confidants. Resolving parenting and personal issues for the mother was expected to benefit parenting practices (i.e., monitoring, discipline, and mother/child problem solving), which in turn would predict a macro level measure of child antisocial behavior. Analysis of the simplex model supported the progression. The final model explained 36% of the variance in antisocial behavior, 15% of the variance in parenting, and 53% of the variance in problem solving outcome. Dyads with cohabiting partners scored higher on problem solving outcomes than did dyads with friends or family members. The model is discussed in the context of social interactional and social learning theory.

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.

General issues relating to the use of outcome and process data from the treatment of antisocial children to predict future childhood adjustment are examined. For outcome measures, it was assumed that variables based on direct observation of child behavior would provide a better predictor of long-term adjustment than would ratings by participant adults. Long-term adjustment measures consisted of police arrest and out-of-home placement data collected 2 years after treatment termination. Observation data collected at termination predicted future police arrest, but parent and teacher ratings did not. It was also hypothesized that measures of the processes thought to produce the changes in child antisocial behavior would serve as predictors of future adjustment. The data supported this hypothesis. How do researchers measure change brought about by interventions designed to alter children's antisocial behavior problems? In keeping with the current Zeitgeist, we assumed that the most generalizable procedure would be based on multipleagent, multiple-method assessments (Bank, Dishion, Skinner, & Patterson, 1990). Combining this with modern techniques for analyzing change (e.g., Collins & Horn, 1991) should provide an elegant approach to the problem of evaluating treatment outcome. The necessary groundwork for creating such constructs is missing, however. From this perspective, the need for information relating to both short-term and long-term clinical outcomes becomes apparent. Each treatment should specify its expected long-term clinical outcomes, which may become one means of validating the short-term outcome measures. In addition to studying outcome, treatment programs must assess the theoretical models underlying the intervention. This calls for evaluating the processes hypothesized as causal mechanisms. To the extent that the theoretical model is well specified and assessed, changes in the process variables would also predict the long-term clinical outcomes. Thus, measures of adjustment, process, or both may serve as predictors of long-term outcomes. This article provides a detailed examination of treat

The degree to which parent antisocial characteristics moderated the effects of the Oregon model of Parent Management Training (PMTO™) on observed parenting practices over 2 years after baseline was assessed in a sample of recently married biological mother and stepfather couples with at-risk children. Sixty-seven of the 110 participating families were randomly assigned to PMTO, and 43 families to a non-intervention condition. Using an intent-to-treat analysis, PMTO was reliably related to growth in positive parenting and to decreases in coercive parenting. Parent antisocial characteristics moderated the effect of PMTO on coercive but not on positive parenting practices. PMTO resulted in greater reductions in coercive parenting as parent antisocial histories were more extensive, and this moderator effect was found for both mothers and stepfathers. The findings support the effectiveness of PMTO as a preventive intervention for child conduct problems, and indicate that the parenting behaviors of antisocial parents are malleable and serve as important mediators of their impact on child conduct problems.

This study examined effects of a self-administered video tape intervention designed to improve students' homework quality, promote parental involvement and support for children's homework efforts, ...

Families who fail to stay problem-focused and instead resort to the exchange of negatively charged emotions during family problem-solving discussions tend to have more distressed adolescents and also fail to solve their disputes. The current study examined the role of 10 affects observed during family problem solving for an at-risk sample of approximately 200 boys and their parent(s). Affects were assessed at Grade 8 and at Grade 10 as part of an ongoing longitudinal study with extensive multimethod, multi-agent assessments. Stability of affect over the 2-year period as well as the relation of affect to problem-solving outcome, parent-adolescent relationship, and adolescent self-esteem was examined. Analyses were conducted by family structure (intact, single-mother, stepfather). Results provided evidence for the value of studying the role of a range of affects in family interaction andfor the predictive validity of observed affects duringfamily process.