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IMPLEMENTATION OF PMTO IN ICELAND
EVIDENSEKONFERENCE – DENMARK 2012 Margrét Sigmarsdóttir
AGENDA Introduction to the Implementation
Results from the implementation study
Method of the implementation study
Discussions and experiences
INTRODUCTION
PMTO was developed by Gerald Patterson, Marion Forgatch and colleagues at the Oregon Social Learning Center
Builds on Gerald Patterson´s theory about the development of antisocial behavior
REACHING MORE THAN HALF OF THE POPULATION
2012
SUCCESSFUL IMPLEMENTATION
Building base
Recruiting professionals
Ongoing training/coaching
Infrastructure
Many critical steps
Fidelity *
INFRASTRUCTURE
A small department in the community of Hafnarfjördur
Serves as the central department for the PMTO nationwide
implementation infrastructure
PMT-FORELDRAFÆRNI
FIDELITY
Fidelity measures provide information about the manner in which practitioners adhere to
content and practices of a given method
The Fidelity of Implementation Rating System (FIMP) is an observation-based
measure assessing therapist’s competence and adherence to PMTO
(Knutson, Forgatch, Rains & Sigmarsdóttir 2009)
FIDELITY
Earlier findings have shown that high FIMP scores predict greater improvement
in outcomes
(Forgatch & DeGarmo, 2011; Forgatch, Patterson & DeGarmo, 2005; Ogden & Amlund Hagen, 2008)
Child adjustment
Parenting practices
Therapist behavior FIMP (Fidelity of Implementation Rating System)
Adapted in Iceland from Marion Forgatch by Margrét Sigmarsdóttir 2011
GOAL WITH THE STUDY
To explore if fidelity will sustain by
comparing and assessing therapists´
competence and adherence to PMTO
between the first three groups of therapists
trained in the country
METHOOD
Competent Adherence to the PMTO Method
FIMP
FIVE DIMENSIONS
Rated on a 9-Point Liker Scale
(Knutson et al.,2009)
• Knowledge • Structure • Teaching • Process skills • Overall development
• 1-3 needs work • 4-6 acceptable work • 7-9 good work
KNOWLEDGE
Evaluates therapists’ understanding of the
PMTO model and principles, taking into
account accuracy of technical details,
integration of core and supportive
components and application of the model
(Knutson et al.,2009)
STRUCTURE
Measures use of a PMTO agenda
followed with relevant phasing and
timing while, at the same time, being
responsive to families’ needs
(Knutson et al.,2009)
TEACH
Therapists’ ways of balancing instructional
strategies to focus on active rather than
didactic approaches
(Knutson et al.,2009)
Examples include use of short, specific raps
(verbal summaries that give key information)
balanced with role play and other exercises to
practice procedures as well as problem solving
strategies that engage participants in the
learning process
(Knutson et al.,2009)
TEACH
PROCESS SKILLS
Therapists´ skills to create a safe and balanced
environment for learning to take place.
Therapists’ support, effective use of the
questioning process, and sophisticated clinical
tools are factors measured on this dimension
(Knutson et al.,2009)
OVERALL DEVELOPMENT
A dimension that measures how therapists
manage to engage families, create growth in
their PMTO skills, motivate them to use the
principles and come back to next session
(Knutson et al.,2009)
EXAMPLES
PARTICIPANTS
There were 3.9 therapists in Norway per 100.000 from the first three groups
16 therapists from the first three groups of PMTO therapists trained to certification in IS
All candidates held graduate degrees from different academic disciplines
From the first three groups there were 3.8 therapists in Iceland per 100.000
PROCEDURE
Reliable FIMP coders rated certification
sessions, which consisted of four video-
recorded sessions of therapist and parents
in PMTO individual therapy
PROCEDURE
These sessions addressed the following
required content: introducing
encouragement, troubleshooting
encouragement, introducing discipline and
troubleshooting discipline
RESULTS
5,6
5,8
6,0
6,2
6,4
6,6
6,8
7,0
7,2
7,4
7,6
Knowledge Structure Teach Process Overall Total FIMP
FIM
P S
CO
RE
S
FIMP DIMENSIONS
G1
G2
G3
Sigmarsdóttir & Guðmundsdóttir, 2012
CHILD OUTCOME; SEM structural equation model
(Sigmarsdóttir, Thorlacius, Guðmundsdóttir, DeGarmo & Forgatch, 2012)
DISCUSSION
The PMTO implementation in Iceland was a
success in terms of demonstrating that the
method could be transferred fully from the
purveyor to the community without loss of
fidelity to the method
FIMP score patterns were similar to data
from the Norwegian implementation
A drop in fidelity for G2 is likely due to an
adapting period where material needed
translation and coaching and training
methods needed to be transferred to the
adopting nation
In our study we assessed fidelity at
certification only
Assessing maintenance over time is
equally important for future studies
FUTURE
FUTURE
It is necessary to have a sophisticated
assessment tool to measure therapists’
competence and adherence to the
method when implementing an EST in
the real world
Margrét Sigmarsdóttir [email protected]