What is PMTO?

1. PMTO: An Evidence-Based Program Marion S. ForgatchOregon Social Learning CenterEugene, 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.

7. 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

8. 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

9. 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

10. 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

11. 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

12. What is PMTO? Family intervention designed to empower parents • Skills training in effective parenting practices • 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

13. Social Interaction Learning Model

14. Sample Order of Topics Assessment Identifying Strengths & Challenges Giving Good Directions Encouragement Limit Setting (Problem Solving) (Monitoring and Supervision) (Positive Involvement) (Selected Topics Relevant for Family)

15. 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

16. PMTO INTERVENTION MODEL

17. Experimental Manipulation Apply theory-based intervention in randomized controlled designs. Contexts Parenting Child Practices Outcomes Address hypotheses: • Do parenting practices change? • Do child outcomes change? • Does change in parenting produce change in child outcomes?

18. Models of Mediated Effects Change in Outcome Group Change in Mediator Potential Covariates: Age/Grade Gender Socioeconomic status Baseline levels 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.

19. Preventing Noncompliance Marriage and Parenting in Stepfamilies PI: Marion Forgatch Stepfamilies: Boys & Girls; Kindergarten – 3rd Grade Selected Prevention: Recent Re-Marriage 1 year Change Noncompliance Group .29** -.66*** Couple Parenting Covariates Gender of Child Age of Child Baseline Couple Parenting Baseline Noncompliance

20. Preventing Noncompliance Parenting through Change PI: Marion Forgatch Single Mothers: Boys Kindergarten – 3rd Grade Selected Prevention: Recent Separation Growth Baseline-30 months 5 Assessments Noncompliance Observed Group -.19** -.54*** .20** -.19** N = 238 Coercive Parenting Positive Parenting Covariates Baseline Coercive Parenting Baseline Positive Parenting Baseline Noncomply Observed 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.

21. Preventing Substance Use Linking Interests of Families & Teachers PI: John Reid Mixed Family Structures; Fifth Grade Boys and Girls Universal Prevention: Schools in High-Crime Neighborhoods 5th- 11th Grade 6 Assessments 6-year Growth Substance Use Group Youth Report .12* -.21* BL-6 mos. Change Parent-Child Problem Solving Covariates Baseline Problem Solving Baseline Substance Use Social Disadvantage Child Gender Observed 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.

22. Treating Delinquency Multidimensional Treatment Foster Care PI: Patricia Chamberlain Sample: Chronically Delinquent Adolescent Boys Treatment: Court-Referred Offenders Placement to 1 year post-exit Change Delinquent Behavior Police Report Youth Report Group .88*** -.64** 3 months in treatment • Mediators • Deviant Peers • Supervision • Discipline • Adult-Youth • Relationships N = 53 AgentsMethods Caretaker Direct Interview Youth Phone Interview Covariate: Antisocial Behavior for 6 months pre-baseline 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.

23. Preventing Delinquency Parenting through Change PI: Marion Forgatch Single Mothers: Boys Kindergarten – 3rd Grade Selected Prevention: Recent Separation Growth Baseline-36 months 4 Annual Assessments Teacher Report Group Delinquent Behavior * * * * Growth Baseline – 30 Months Effective Parenting Deviant Peer Association Covariates Baseline Effective Parenting Baseline Deviant Peer Association Baseline Delinquent Behavior Observed Boy Report 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.

24. Group by Time Mean Trajectories TRF Delinquency T Score Teacher Delinquency T Score Years

27. Probability of Arrests by Group (HLM Bernoulli estimation) Probability of Arrests by Group Average (HLM Bernoulli estimation) Group × Time ß11 = -.34, p.031 Control Group Intervention Group

28. Probability of Arrests by Group Individuals (HLM Bernoulli estimation) Group × Time ß11 = -.34, p.031 Control Group Intervention Group

29. Univariate Effect Sizes of ODS II and III Cohen’s d DeGarmo, Patterson, & Forgatch, 2004

30. Univariate Effect Sizes of ODS II and III Cohen’s d DeGarmo, Patterson, & Forgatch, 2004

31. Univariate Effect Sizes of ODS II and III Cohen’s d DeGarmo, Patterson, & Forgatch, 2004

32. Univariate Effect Sizes of ODS II and III Cohen’s d DeGarmo, Patterson, & Forgatch, 2004

33. Univariate Effect Sizes of ODS II and III Cohen’s d DeGarmo, Patterson, & Forgatch, 2004

34. Univariate Effect Sizes of ODS II and III Cohen’s d

35. Univariate Effect Sizes of ODS II and III Cohen’s d

36. Univariate Effect Sizes of ODS II and III Cohen’s d

37. Univariate Effect Sizes of ODS II and III Cohen’s d

38. Univariate Effect Sizes of ODS II and III Cohen’s d

39. Univariate Effect Sizes of ODS II and III Cohen’s d

40. Univariate Effect Sizes of ODS II and III Cohen’s d

41. Norway certification ceremonies May 2000 • 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!

42. 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.

43. 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.

44. 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.

45. 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.

46. 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.

47. 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.

50. 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.