Parent Management Training-the Oregon Model Research Articles

General and specific factors of working alliance in parent training: A bifactor exploratory structural equation modelling approach

The Working Alliance Inventory Short form (WAI-S) comprises 12 items that measure 3 subdomains (goal, task, and bond). In the present study, we evaluated the factor structure of WAI-S in a parent management training (PMT) context, by investigating a series of different factor models, including standard confirmatory factor analyses (CFA) models and more recent alternatives, like the exploratory structural equation model (ESEM), the bifactor-CFA, and the bifactor exploratory structural equation model (B-ESEM). The study sample consisted of 259 Norwegian parents receiving PMT – the Oregon model (PMTO). Alliance was rated by parents of children with emerging or present conduct problems after the first therapy session. Results showed that the B-ESEM model provided best model fit to the data. Estimated sources of variance and omega reliabilities supported a strong general alliance factor, but revealed poor quality of the specific factors. Overall, the present study implies that specific factors of working alliance should be interpreted with caution; rather one should rely on a general working alliance construct.Clinical or methodological significance of this article: Findings suggest that working alliance, as measured by WAI-S in a PMT context, is best reflected by a general construct that also take into account multidimensionality. However, only the general factors provide acceptable reliability. Consequently, practitioners should use the specific factors with caution. The indicators of the specific factors should be improved.

Observed callousness as a predictor of treatment outcomes in parent management training.

The goal of this study was to examine how observed Callous-Unemotional (CU) behavior influenced change in externalized and internalized problems, hyperactivity, social competence, and treatment satisfaction following parent management training. Three hundred twenty-three children and their families received Parent Management Training-the Oregon model (PMTO). They were compared at intake and after treatment in order to examine differences in 14 treatment outcomes using hierarchical regression analyses. Children with low levels of observed CU showed the greatest gains after PMTO treatment. This was evident in parent, therapist, self, and teacher reports. The results indicate that it is possible to observe CU behavior among children with conduct problems, and that children with elevated levels of observed CU behavior may be in need of additional treatment or components of treatment or more intense versions of parent management treatment.

A Balancing Act: Integrating Evidence-Based Knowledge and Cultural Relevance in a Program of Prevention Parenting Research with Latino/a Immigrants.

Family therapists have a unique opportunity to contribute toward the reduction of widespread mental health disparities impacting diverse populations by developing applied lines of research focused on cultural adaptation. For example, although evidence-based prevention parent training (PT) interventions have been found to be efficacious with various Euro-American populations, there is a pressing need to understand which specific components of PT interventions are perceived by ethnic minority parents as having the highest impact on their parenting practices. Equally important is to examine the perceived cultural relevance of adapted PT interventions. This qualitative investigation had the primary objective of comparing and contrasting the perceived relevance of two culturally adapted versions of the efficacious parenting intervention known as Parent Management Training, the Oregon Model (PMTO). According to feasibility indicators provided by 112 Latino/a immigrant parents, as well as findings from a qualitative thematic analysis, the core parenting components across both adapted interventions were identified by the majority of research participants as relevant to their parenting practices. Participants exposed to the culturally enhanced intervention, which included culture-specific sessions, also reported high satisfaction with components exclusively focused on cultural issues that directly impact their parenting practices (e.g., immigration challenges, biculturalism). This investigation illustrates the relevant contributions that family therapy scholars can offer toward addressing mental health disparities, particularly as it refers to developing community-based prevention interventions that achieve a balance between evidence-based knowledge and cultural relevance.

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.

Examining the Process of Change in an Evidence-Based Parent Training Intervention: A Qualitative Study Grounded in the Experiences of Participants

While strong research evidence demonstrates that parent training interventions are capable of preventing child behavioral problems, much less is known about how the participants in these programs experience the change process. The purpose of this study was to provide a better understanding of how parents' experiences in an evidence-based parent training intervention led to change in their parenting practices, based on the first-person accounts of program participants. Qualitative data were collected through in-depth, individual interviews with parents who had completed the intervention known as Parent Management Training-the Oregon Model (PMTO™). Data were analyzed according to principles of the grounded theory approach, using the constant comparative method and a sequential process of open, axial, and selective coding. Study findings suggest that parents make active and intentional efforts to attempt, appraise, and apply the intervention material within their various life contexts, contributing to change in their parenting practices. Aspects of intervention content, method of delivery, and the role of the interventionist were also found to be important. This study can guide further prevention research into the mechanisms of change operating in parent training interventions and has the potential to inform continued efforts to adapt and implement evidence-based parent training interventions.

Implementation of Parent Management Training—Oregon Model (PMTOTM) in Iceland: Building Sustained Fidelity

Bringing empirically supported treatments (ESTs) into community settings is a challenge because of threats to therapy adherence. The nationwide implementation of Parent Management Training-the Oregon Model (PMTO) in Iceland was studied by comparing therapists' competent adherence to PMTO across three generations of therapists. To assess therapists' competence and adherence to the PMTO method, the Fidelity of Implementation Rating System (FIMP) was used as the measuring device. Of 16 therapists across three generations who entered training, 12 completed with certification. As expected, each of the three generations obtained adequate FIMP scores. Generations 1 and 3 showed equivalent levels of performance on FIMP scores at certification. A small drop in FIMP scores for Generation 2 was explained in terms of translating and culturally adjusting materials and strengthening training procedures. Results are parallel to earlier findings from the nationwide PMTO implementation in Norway and support the idea that PMTO can be implemented in community settings with high fidelity even when resources are scarce.

A Randomized Effectiveness Trial of Brief Parent Training in Primary Care Settings

Brief Parent Training (BPT) is a short-term intervention (3-5 sessions) delivered by regular staff in municipal child and family services. BPT is based on social interaction learning theory and Parent Management Training, the Oregon model (PMTO) and promotes parenting skills in families with children who either are at an early stage of problem behavior development or have developed conduct problems. This study examined the effectiveness of BPT compared to regular services in primary care settings at post assessment. Participants were 216 children (3-12years) and their parents who were randomly assigned to BPT or the comparison group. Data were collected from parents and teachers. Significant intervention effects emerged for caregiver assessments of parenting practices, child conduct problems, and social competence. The results suggested that BPT had beneficial effects for families, although the generalization of the effects to school was limited.

Measurement of implementation components ten years after a nationwide introduction of empirically supported programs – a pilot study

BackgroundTen years after the nationwide dissemination of two evidence-based treatment programs, the status of the implementation components was evaluated in a cross-sectional study. The aim of the study was to pilot a standardized measure of implementation components by examining the factor structure, the reliabilities of the scores, and their association with implementation outcome variables. The aim was also to compare implementation profiles of the two evidence-based programs based on multi informant assessments.MethodsThe 218 participants in the study were therapists, supervisors, and agency leaders working with Parent Management Training, the Oregon model (PMTO), and Multisystemic Therapy (MST) in Norway. Interviewers filled in an electronic version of the Implementation Components Questionnaire during a telephone interview.ResultsThe factor analysis of the eight one-dimensional subscales resulted in an individual clinical-level factor and an organizational system-level factor. Age, experience, and number of colleagues in the workplace were negatively correlated with positive ratings of the implementation process, but the number of colleagues working with the same program predicted positive ratings. MST and PMTO had different implementation profiles and therapists, supervisors, and managers evaluated some of the implementation drivers significantly differently.ConclusionsThe psychometric quality of the questionnaire was supported by measures of internal consistency, factor analyses of the implementation components, and the comparisons of implementation profiles between programs and respondent groups. A moderate, but consistent association in the expected direction was found with the implementation outcome variables.

Implementing and Evaluating Evidence-Based Treatments of Conduct Problems in Children and Youth in Norway

This article sums up 8 years of experience with evidence-based programs in the treatment of conduct problems in children and youth. A conceptual model describing the implementation components relevant to the Norwegian project is presented and discussed. Next, we describe a case study of the implementation strategy accompanied by outcomes from the clinical trials of Multisystemic Therapy (MST) and Parent Management Training—the Oregon model (PMTO). The national implementation strategy for evidence-based treatment programs is a combination of a ‘‘top-down’’ and ‘‘bottom-up’’ approach to implementation based on collaborative efforts of a national center for dissemination, implementation, and research and the public child and adolescent service system operating in the municipalities. The strategy further includes recruitment of candidates for training through the various service systems and the establishment of permanent networks for collaboration, supervision, and support.

Gender differences in intake characteristics and behavior change among children in families receiving parent management training

Participants were 323 families with children (aged 4–12 years), among whom 87 (26.9%) were girls. Gender differences before treatment with Parent Management Training—the Oregon model (PMTO) and pre–post gender differences in behavioral change (regression analyses) were examined. At pre treatment, girls demonstrated less externalizing problem behavior according to parents and teachers, but more internalizing problems according to parents. Teachers reported girls to be more socially competent than boys and they reported more comorbidity among boys than girls. At post treatment, girls had more likely changed in a positive direction according to teacher ratings of externalizing behavior and social competence, but not according to any of the parent-reported variables. In sum, girls were not more at risk than boys at intake to treatment and PMTO appeared to be an equally effective intervention for girls and boys. The few gender differences in outcomes indicated that girls benefited more from PMTO than boys. The limitations and practical implications of the findings are discussed.

Treatment effectiveness of parent management training in Norway: A randomized controlled trial of children with conduct problems.

This study was a randomized control trial (RCT) of Parent Management Training--The Oregon Model (PMTO) in Norway. A sample representing all health regions of Norway and consisting of 112 children with conduct problems and their families participated in the study. Families were randomly assigned to either PMTO or a regular services comparison group. PMTO was delivered via existing children's services, and families were recruited using the agencies' regular referral procedures, making this the first effectiveness study of PMTO and the first RCT of PMTO conducted outside of the United States. Using a multiagent-multimethod approach, results showed that PMTO was effective in reducing parent-reported child externalizing problems, improving teacher-reported social competence, and enhancing parental discipline. Age level and gender modified the effects of PMTO treatment on other outcomes. In a path model, participation in PMTO was associated with improved parental discipline, and effective discipline predicted greater child compliance, fewer child-initiated negative chains, and lower levels of child externalizing problems. Findings are presented along with a discussion of the implications for practice and research and the challenges accompanying effectiveness trials.