pmto: an evidence-based program marion s. forgatch oregon social learning center eugene, oregon usa...
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PMTO: An Evidence-Based Program
Marion S. ForgatchOregon Social Learning Center
Eugene, Oregon USA
Paper presented at the PMTO Working Conference, January 12, 2006, De Eenhoorn in Amersfoort, the Netherlands.
Support for this project was provided by Grant Nos. R01 MH38318 and R01 MH54703 from the Child and Adolescent Treatment and Preventive Intervention Research Branch, DSIR, NIMH, U.S. PHS; Grant No. R01 DA16097 from the Prevention Research Branch, NIDA, U.S. PHS; and Grant No. P30 MH 46690 from the Prevention and Behavioral Medicine Research Branch, Division of Epidemiology and Services Research, NIMH & ORMH, U.S., PHS.
What is PMTO?
Grandfather of theoretically grounded evidence-based practices
Developed mid 1960s by Gerald R. Patterson
Lineage: John B. Reid
Patricia Chamberlain
Marion Forgatch
Thomas Dishion
What is PMTO?Theory Driven Interventions—Principle Based
Emphasizes Clinical & Teaching Skills
Manualized & Flexible
Family & Group applications
Prevention & Clinical Programs
Fidelity Evaluation (Competent Adherence)
Evidence Based: Published findings
Positive Outcomes for Youth & Parents
What is PMTO?Tailored for serious behavior problems for youth from preschool through adolescence Overt antisocial behavior (noncompliance, aggression, defiance, hyperactivity, fighting)
Covert antisocial behavior (lying, stealing, truancy, fire setting)
Internalizing problems (depressed mood, peer problems, deviant peer association)
Delinquency
Substance abuse
School Failure
What is PMTO?Family intervention designed to empower parents Parents as primary treatment agents
Parents practice skills through role play
Identify and build on strengths in family
Agendas yet responsive to needs of family
Intervenes with family members and subsystems
Couples
Youngsters
Siblings
What is PMTO?
Suitable for multi-problem families
Parents with psychopathology (depression, anxiety, antisocial)
Family contextual problems (poverty, poor neighborhoods)
Family structure transitions (divorce, repartnering)
Marital conflict
What is PMTO?
Family intervention designed to empower parents
Skill Encouragement: Teaching new behavior through positive contingencies
Limit Setting: Discouraging deviant behavior through negative noncorporal sanctions
Monitoring/Supervision: Attending to children’s behavior at home and away from home
Family Problem Solving: Interpersonal planning, troubleshooting, contingency agreements
Positive Involvement: Demonstrating interest, attention, caring
Skills training in effective parenting practices
Social Interaction Learning Model
Sample Order of Topics
AssessmentIdentifying Strengths & ChallengesGiving Good DirectionsEncouragementLimit Setting(Problem Solving)(Monitoring and Supervision)(Positive Involvement)(Selected Topics Relevant for Family)
Typical PMTO Session: General Outline
Prior to Session Midweek Call (Check in; encourage; troubleshoot) Call Night Before (Confirm appointment)
Agenda for 1-Hour Session Approx. Time Arrival, Greetings 5 minutes Debrief Home Practice 10-15 minutes Session Content 25-30 minutes
Review previous skills Troubleshoot & brainstorm Introduce new skills Role plays & exercises Address family issues
Home Practice Assignment 10 minutes Closing 5 minutes
PMTO INTERVENTION PMTO INTERVENTION MODELMODEL
Experimental Manipulation
Address hypotheses:
• Do parenting practices change?
• Do child outcomes change?
• Does change in parenting produce change in child outcomes?
Contexts Parenting Child Practices Outcomes
Apply theory-based intervention in randomized controlled designs.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182.
Group
Change in Mediator
Change in Outcome
Potential Covariates:Age/GradeGenderSocioeconomic statusBaseline levels
Models of Mediated Effects
Preventing NoncomplianceMarriage and Parenting in StepfamiliesPI: Marion ForgatchStepfamilies: Boys & Girls; Kindergarten – 3rd GradeSelected Prevention: Recent Re-Marriage
CovariatesGender of ChildAge of ChildBaseline Couple ParentingBaseline Noncompliance
Group Noncompliance
CoupleParenting
1 year Change
.29**-.66***
Martinez, C. R., Jr., & Forgatch, M. S. (2001). Preventing problems with boys' noncompliance: Effects of a parent training intervention for divorcing mothers. Journal of Consulting and Clinical Psychology, 69, 416-428.
Parenting through ChangePI: Marion ForgatchSingle Mothers: Boys Kindergarten – 3rd GradeSelected Prevention: Recent Separation
Group
CovariatesBaseline Coercive ParentingBaseline Positive ParentingBaseline Noncomply
Observed
.20**
-.54***
N = 238
Growth Baseline-30 months5 Assessments
Observed
Noncompliance
Positive Parenting
Coercive Parenting
-.19**
-.19**
Preventing Noncompliance
Preventing Substance UseLinking Interests of Families & TeachersPI: John ReidMixed Family Structures; Fifth Grade Boys and GirlsUniversal Prevention: Schools in High-Crime Neighborhoods
CovariatesBaseline Problem SolvingBaseline Substance UseSocial DisadvantageChild Gender
Group6-year
Growth Substance
Use
Change Parent-Child
Problem Solving
6 Assessments
.12*
-.21*
5th- 11th Grade
Observed
BL-6 mos.
Youth Report
DeGarmo, D. S., Eddy, J. M., & Reid, J. B. (in preparation). Preventing growth in substance use and delinquency: Testing intervening mechanisms across early and late adolescence.
Eddy, J. M., & Chamberlain, P. (2000). Family management and deviant peer association as mediators of the impact of treatment condition on youth antisocial behavior. Journal of Consulting and Clinical Psychology, 68(5), 857-863.
Group
Multidimensional Treatment Foster CarePI: Patricia ChamberlainSample: Chronically Delinquent Adolescent BoysTreatment: Court-Referred Offenders
Change Delinquent Behavior
Mediators•Deviant Peers•Supervision•Discipline•Adult-Youth Relationships
Police Report
Youth Report
.88***
-.64**
N = 53
Treating Delinquency
Placement to 1 year post-exit
3 months in treatment
Agents MethodsCaretaker Direct InterviewYouth Phone Interview
Covariate:Antisocial Behavior for 6 months pre-baseline
DeGarmo, D. S., & Forgatch, M. S. (submitted). Preventing the “Early Start” within transitional divorce families: An experimental test of developmental precursors of antisocial behavior and delinquency.
Parenting through ChangePI: Marion ForgatchSingle Mothers: Boys Kindergarten – 3rd GradeSelected Prevention: Recent Separation
Group
CovariatesBaseline Effective ParentingBaseline Deviant Peer AssociationBaseline Delinquent Behavior
Teacher Report
Growth Baseline-36 months4 Annual Assessments
Observed
Delinquent Behavior
Deviant Peer Association
Effective Parenting
Preventing Delinquency
Boy Report
Growth Baseline – 30 Months
*
* **
52
54
56
58
60
0 1 2 3 4 5 6 7 8 9
ControlIntervention
Te
ach
er D
elin
qu
en
cy T
Sc
ore
Group by Time Mean Trajectories TRF Delinquency T Score
Years
TRF DELTBL
TRF DELT1 Yr
TRF DELT3 Yrs
TRF DELT4 Yrs
9 YearAverage
Delinquency
9 YearGrowth
Delinquency
cmin =111.828, df =77, p =.006, cmindf =1.452, cfi = .991
D2
TRF DELT7 Yrs
Intent toTreat
TRF DELT8 Yrs
TRF DELT9 Yrs
Boy AgeBL
Boy Age 1Yr
Boy Age3 Yrs
Boy Age 4 Yrs
Boy Age7 Yrs
Boy Age 8 Yrs
Boy Age9 Yrs
D1
.64
TRF DELTBL
TRF DELT1 Yr
TRF DELT3 Yrs
TRF DELT4 Yrs
9 YearAverage
Delinquency
9 YearGrowth
Delinquency
cmin =131.063, df =89, p =.002, cmindf =1.473, cfi = .989
D2
TRF DELT7 Yrs
Intent toTreat
TRF DELT8 Yrs
TRF DELT9 Yrs
Boy AgeBL
Boy Age 1Yr
Boy Age3 Yrs
Boy Age 4 Yrs
Boy Age7 Yrs
Boy Age 8 Yrs
Boy Age9 Yrs
D1
ParentingChange
BL to 1 Yre8
.64
0
0.125
0.250
0.375
0.500
Pro
bab
ilit
y o
f A
rres
ts
0 2.24 4.49 6.73 8.98
Years Since ODS Baseline
E_GROUP = 0
E_GROUP = 1
Control Group
Intervention Group
Probability of Arrests by Group (HLM Bernoulli estimation)Probability of Arrests by Group Average (HLM Bernoulli estimation)Group × Time ß11 = -.34, p.031
0.002
0.248
0.494
0.740
0.986
Pro
bab
ilit
y o
f A
rres
tsProbability of Arrests: ODS Official Arrest Data
0 3.24 6.48 9.71 12.95
Years Since ODS Baseline
E_GROUP = 0E_GROUP = 1
Control Group
Intervention Group
Probability of Arrests by Group Individuals (HLM Bernoulli estimation)
Group × Time ß11 = -.34, p.031
Univariate Effect Sizes of ODS II and III Cohen’s d
PMTO Intervention
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0 1 2 3
Years from Baseline
Eff
ect
size
(d
)
Parenting
Youth Internalizing
Deviant Peer Association
Teacher Report Delinquency
Maternal Depression
DeGarmo, Patterson, & Forgatch, 2004
Univariate Effect Sizes of ODS II and III Cohen’s d
PMTO Intervention
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0 1 2 3
Years from Baseline
Eff
ect
size
(d
)
Parenting
Youth Internalizing
Deviant Peer Association
Teacher Report Delinquency
Maternal Depression
DeGarmo, Patterson, & Forgatch, 2004
Univariate Effect Sizes of ODS II and III Cohen’s d
PMTO Intervention
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0 1 2 3
Years from Baseline
Eff
ect
size
(d
)
Parenting
Youth Internalizing
Deviant Peer Association
Teacher Report Delinquency
Maternal Depression
DeGarmo, Patterson, & Forgatch, 2004
Univariate Effect Sizes of ODS II and III Cohen’s d
PMTO Intervention
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0 1 2 3
Years from Baseline
Eff
ect
size
(d
)
Parenting
Youth Internalizing
Deviant Peer Association
Teacher Report Delinquency
Maternal Depression
DeGarmo, Patterson, & Forgatch, 2004
Univariate Effect Sizes of ODS II and III Cohen’s d
PMTO Intervention
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0 1 2 3
Years from Baseline
Eff
ect
size
(d
)
Parenting
Youth Internalizing
Deviant Peer Association
Teacher Report Delinquency
Maternal Depression
DeGarmo, Patterson, & Forgatch, 2004
Univariate Effect Sizes of ODS II and III Cohen’s d
PMTO Intervention
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0 1 2 3 4 5 6 7 8 9
Years from Baseline
Eff
ect
Siz
e (d
)
Parenting
Youth Internalizing
Youth Externalzing
Deviant Peer Association
Teacher Report Delinquency
Maternal Depression
Univariate Effect Sizes of ODS II and III Cohen’s d
PMTO Intervention
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0 1 2 3 4 5 6 7 8 9
Years from Baseline
Eff
ect
Siz
e (d
)
Parenting
Youth Internalizing
Deviant Peer Association
Teacher Report Delinquency
Maternal Depression
Univariate Effect Sizes of ODS II and III Cohen’s d
PMTO Intervention
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0 1 2 3 4 5 6 7 8 9
Years from Baseline
Eff
ect
Siz
e (d
)
Parenting
Youth Internalizing
Deviant Peer Association
Teacher Report Delinquency
Maternal Depression
Univariate Effect Sizes of ODS II and III Cohen’s d
PMTO Intervention
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0 1 2 3 4 5 6 7 8 9
Years from Baseline
Eff
ect
Siz
e (d
)
Parenting
Youth Internalizing
Deviant Peer Association
Teacher Report Delinquency
Maternal Depression
Youth Substance
Univariate Effect Sizes of ODS II and III Cohen’s d
PMTO Intervention
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0 1 2 3 4 5 6 7 8 9
Years from Baseline
Eff
ect
Siz
e (d
)
Parenting
Youth Internalizing
Deviant Peer Association
Teacher Report Delinquency
Maternal Depression
Youth Substance
Maternal Substance
Univariate Effect Sizes of ODS II and III Cohen’s d
PMTO Intervention
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0 1 2 3 4 5 6 7 8 9
Years from Baseline
Eff
ect
Siz
e (d
)
Parenting
Youth Internalizing
Deviant Peer Association
Teacher Report Delinquency
Maternal Depression
Youth Substance
Maternal Substance
Univariate Effect Sizes of ODS II and III Cohen’s d
PMTO Intervention
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0 1 2 3 4 5 6 7 8 9
Years from Baseline
Eff
ect
Siz
e (d
) Parenting
Youth Internalizing
Deviant Peer Association
Teacher Report Delinquency
Maternal Depression
Youth Substance
Maternal Substance
Per Capita Yearly Income
• When I was asked to join this program, I didn’t know much of what I was saying yes to. But today I’m very happy.
• I’ve learned the importance of being supportive and encouraging.
• Well, the first thing that came into my mind is this role play! And I still can’t believe that I’ve done that!
Norway certification ceremonies May 2000
• I’ve learned it’s important to have fun while you do therapy. I’ve never had so much fun as I have now.
• I’ve done therapy for many years, and have wanted to help these families. But it’s difficult and you get burned out. One of the things I’ve learned is the inspiration of these persons. It brings my inspiration and focus back. Actually, I was thinking of retiring as a therapist, and I’ve very glad I didn’t.
• It has given me hope on behalf of the children of Norway, especially this conduct disordered group, and it’s so much more fun to work with these families
• I’ve learned that no family is hopeless.
• It’s changed the way I am with my nearest family. I’m more encouraging.
• I’ve learned that this has been a very safe group of people. I have been a participant in very many groups in my life, but I have never felt so secure.
• Your method has challenged my thinking from backward to forward. I’m taking small steps, but I’m on the road to develop. And the reason for that is the way it’s been done and the beautiful support of the group.
• Using role play has really opened up a new world for me as a therapist. And I like the way PMT has allowed us to have answers and set up the families to discover those answers.
• The first workshop was overwhelming. I could barely breathe. But we went on.
• I had to climb down from the abstract and work with concrete details. Perhaps it has to do with role plays. I never used them before. It has been amazing.
• Well, let’s take the role play first. It’s very difficult for a serious person, but I’m trying and going along slowly.
• This therapy is in a humane frame, a very realistic frame.
• I like the role plays and having fun with the parents. I think I do a much better job with the kids I work with (in a residential center) and also being a mother.
• This therapy is hard work. I think I had a little resistance and was resistant. But we, all these beautiful people from Norway, we have learned a lot and we share this optimistic confidence and respect for you.
• It’s strange to be a student of 50 and come in to a new classroom. And it’s such a lovely class. There’s a focus on details, a focus on performance, a focus on patience, and persistence. I would also like to say it has helped me in my personal life. In this area I’ve had many losses.
• There is no shortcut to create a symphony.
References
Achenbach, T. M. (1991). Manual for the Teacher's Report Form and 1991 Profile. Burlington: University of Vermont.
Asher, S. R., & Wheeler, V. A. (1985). Children's loneliness: A comparison of rejected and neglected peer status. Journal of Consulting and Clinical Psychology, 53(4), 500-505.
Capaldi, D. M., & Dishion, T. J. (1985). Describing Friends Questionnaire.
Capaldi, D. M., Dishion, T. J., & Patterson, G. R. (1991). Assessment of families for the Oregon Youth Study (Technical report). Eugene, OR: Oregon Social Learning Center.
DeGarmo, D. S., & Forgatch, M. S. (2005). Early development of delinquency within divorced families: Evaluating a randomized preventive intervention trial. Developmental Science.
DeGarmo, D. S., Patterson, G. R., & Forgatch, M. S. (2004). How do outcomes in a specified parent training intervention maintain or wane over time? Prevention Science, 5(2), 73-89.
Dishion, T. J., & Owen, L. D. (2002). A longitudinal analysis of friendships and substance use: Bidirectional influence from adolescence to adulthood. Developmental Psychology, 38, 480-491.
Duncan, G. J., Brooks-Gunn, J., & Klebanov, P. K. (1994). Economic deprivation and early childhood development. Child Development, 65, 296-318.
Forgatch, M. S. (1994). Parenting through change: A programmed intervention curriculum for groups of single mothers. Eugene: Oregon Social Learning Center.
References
Forgatch, M. S., & DeGarmo, D. S. (2002). Extending and testing the social interaction learning model with divorce samples. In J. B. Reid, G. R. Patterson & J. Snyder (Eds.), Antisocial behavior in children and adolescents: A developmental analysis and model for intervention (pp. 235-256). Washington DC: American Psychological Association.
Forgatch, M. S., Knutson, N. M., & Mayne, T. (1992). Coder impressions of ODS lab tasks. Eugene: Oregon Social Learning Center.
Kovacs, M. (1985). The children's depression inventory (CDI). Psychopharmacology Bulletin, 21(4), 995-998.
Martinez, C. R., Jr., & Forgatch, M. S. (2001). Preventing problems with boys' noncompliance: Effects of a parent training intervention for divorcing mothers. Journal of Consulting and Clinical Psychology, 69, 416-428.
Patterson, G. R., DeGarmo, D. S., & Forgatch, M. S. (2004). Systematic changes in families following prevention trials. Journal of Abnormal Child Psychology, 32(6), 621-633.
Pearlin, L. I., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19, 2-21.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401.
Rusby, J. C., Estes, A., & Dishion, T. (1991). The Interpersonal Process Code (IPC) (unpublished manuscript): Oregon Social Learning Center, Eugene, OR.