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Parent Management Training

Blueprints Program Rating: Model

A group- or individual-based parent training program that teaches effective family management strategies and parenting skills, including skill encouragement, setting limits/positive discipline, monitoring, problem solving, and positive involvement, in order to reduce antisocial and behavior problems in children.

Program Outcomes

  • Antisocial-aggressive Behavior
  • Anxiety
  • Conduct Problems
  • Delinquency and Criminal Behavior
  • Externalizing
  • Illicit Drug Use
  • Internalizing
  • Mental Health - Other

Program Type

  • Parent Training

Program Setting

  • Community (e.g., religious, recreation)
  • Mental Health/Treatment Center

Continuum of Intervention

  • Selective Prevention (Elevated Risk)
  • Indicated Prevention (Early Symptoms of Problem)

Age

  • Early Childhood (3-4) - Preschool
  • Late Childhood (5-11) - K/Elementary
  • Early Adolescence (12-14) - Middle School
  • Late Adolescence (15-18) - High School

Gender

  • Male and Female

Race/Ethnicity

  • All Race/Ethnicity, Hispanic or Latino

Endorsements

  • Blueprints: Model
  • Coalition for Evidence-Based Policy: Near Top Tier

Program Information Contact

Anna Suski
Implementation Sciences International, Inc. (ISII)
10 Shelton McMurphey Blvd
Eugene OR 97401 USA
Phone: (541) 485-2711
Fax: (541) 338-9963
Email: annas@oslc.org
Website: www.isii.net

Program Developer/Owner

  • Marion Forgatch
  • Implementation Sciences International, Inc.

Brief Description of the Program

Parent Management Training – Oregon Model (PMTO™) is a group of theory-based parent training interventions that can be implemented in a variety of family contexts. The program aims to teach effective family management skills in order to reduce antisocial and problematic behavior in children who range in age from 3 through 16 years. PMTO is delivered in group and individual family formats, in diverse settings (e.g., clinics, homes, schools, community centers, homeless shelters), over varied lengths of time depending on families’ needs. Typically sessions are one week apart to optimize the opportunity for learning and rehearsing new practices. The number of sessions provided in parent groups ranges from 6 to 14; in clinical samples the mean number of individual treatment sessions is 25.

The central role of the PMTO therapist is to teach and coach parents in the use of effective parenting strategies, namely skill encouragement, setting limits or effective discipline, monitoring, problem solving, and positive involvement. In addition to the core parenting practices, PMTO incorporates the supporting parenting components of identifying and regulating emotions, enhancing communication, giving clear directions, and tracking behavior. Promoting school success is a factor that is woven into the program throughout relevant components.

See: Full Description

Outcomes

In a nine year study with divorced parents, parent training participants compared to controls experienced:

  • Posttest (12 months) reductions in coercive parenting and negative reinforcement (Forgatch & DeGarmo, 1999).
  • Posttest increases in positive parenting, effective parenting practices, and adaptive functioning.
  • Posttest decreases in boys' noncompliance.
  • Reduced maternal depression and child internalizing and externalizing at 30-month followup (DeGarmo et al., 2004; Martinez & Forgatch, 2001).
  • Reduction in poverty and greater rise out of poverty at 30 months follow-up (Forgatch & DeGarmo, 2007).
  • Lower levels and lower growth in teacher-rated delinquency at nine year follow-up (Forgatch et al., 2009).
  • Reduction in average levels (but not growth) of deviant peer association.
  • Lower rates of arrest and delayed age at first arrest at nine year follow-up (Forgatch et al., 2009).
  • Fewer police arrests among mothers at nine year follow-up (Patterson et al., 2010).
  • Increased socioeconomic status levels among mothers at nine year follow-up (Patterson et al., 2010, Forgatch & DeGarmo, 2007).

Bank et al., 1991:

  • Parent Training participants had faster decreases in rates and prevalence of juvenile arrests than community controls.

Patterson et al., 1982:

  • Significant reductions in deviant behavior among treatment children, compared to control group children (63% vs. 19%).
  • Significant differences in observations of aversive behaviors between groups, with 70% of treatment children testing within the normal range post-intervention, compared to 33% of control group children.

Martinez and Eddy, 2005:

  • Parent Training participants had reductions in 3 of 7 youth outcomes (aggression, externalizing behaviors, and likelihood of using tobacco) and 3 of 7 parenting outcomes (general parenting, skill encouragement, overall effective parenting).

Ogden and Hagen, 2008; Hagen et al., 2011:

  • Children in the PMTO group scored significantly lower than Regular Service (RS) group children at end of treatment on parent-rated externalizing behavior problems and had significantly lower scores on the CBCL total problem scale.
  • Parent Daily Report scores across 3 days indicated that significantly fewer problems were reported for PMTO children younger than 8 compared with the RS group, and younger PMTO children scored significantly lower on the TRF externalizing and total problem scales than did younger RS children.
  • Children of families assigned to the PMTO group were rated as significantly more socially competent by their teachers at the end of treatment than RS children.
  • Parents who received PMTO scored significantly higher on effective discipline than did their counterparts in the RS group at the end of treatment as rated by coders.
  • PMTO parents with younger children scored significantly higher on parental monitoring than did the parents of younger children in the RS group.
  • Long-term results showed benefits only for total aversive behavior in two-parent families.

Forgatch et al, 2005; DeGarmo & Forgatch, 2007; Bullard et al., 2010; Wachlarowicz et al., 2012

  • Stepparent families receiving PTMO showed a significant increase in positive parenting and stepfathering practices, and a significant decline in child behavior problems and depression.
  • Parents reported improved marital interaction and mothers' marital satisfaction (but not fathers')
  • Significant decline in coercive parenting.

Bjørknes et al., 2012; Bjørknes & Manger, 2012:

  • Among immigrant mothers from Pakistan and Somalia now living in Norway, the program improved positive parenting practices and child conduct problems.

Sigmarsdóttir et al., 2014

  • Significant program effects on child adjustment problems, compared to families who received Services as Usual.

Kjobli & Ogden, 2012 (Brief Parent Training):

  • Parents reported that their children in the intervention group had fewer behavioral problems, externalizing, and Anxiety/Depression and improved social competence.
  • Intervention parents, relative to control parents, reported more positive parenting practices, and lower scores on harsh discipline, harsh for age, and inconsistent discipline.

Kjøbli, et al., 2013:

  • Two of the five variables of parent-reported child outcomes (intensity and social competence) and one variable of parent-reported parenting practices (harsh discipline) were significantly improved in the intervention group compared to the control group at posttest and 6-month follow-up.
  • The parent distress measure was significantly different between groups at posttest.
  • One of the three teacher-report measures (social competence) was significantly improved in the intervention group compared to the control group at posttest but not at 6-month follow-up.

Ollendick et al., 2015 found that, compared to a waitlist control group, Parent Management Training and another parent-training program (Collaborative & Proactive Solutions) similarly improved posttest:

  • Oppositional defiant disorder (clinically rated and parent reported).
  • Parent-reported aggression.

Rabbitt et al., 2016 found no differences on three behavioral outcomes between two online versions of the program and traditional in-person PMT, though a comparison between the online programs showed:

  • Greater decreases in parent-reported child internalizing symptoms for Full Contact PMT than Reduced Contact PMT.

Race/Ethnicity/Gender Details

Evaluations have been conducted in the U.S. with White samples and Spanish-speaking, Latino families, as well as in Norway and Iceland with Scandinavian families (one of which targeted immigrant Pakistani and Somali families).

Risk and Protective Factors

Risk Factors
  • Peer: Interaction with antisocial peers*
  • Family: Low socioeconomic status*, Parent stress*, Poor family management*
Protective Factors
  • Individual: Clear standards for behavior, Prosocial behavior, Prosocial involvement, Rewards for prosocial involvement, Skills for social interaction*
  • Peer: Interaction with prosocial peers
  • Family: Attachment to parents, Opportunities for prosocial involvement with parents, Parental involvement in education, Rewards for prosocial involvement with parents

*Risk/Protective Factor was significantly impacted by the program.

See also: Parent Management Training Logic Model (PDF)

Training and Technical Assistance

A typical training program for PMTO specialists includes five workshops for a total of 18 workshops days.

During the 18-day workshop training, active teaching techniques provide abundant opportunity for practice (e.g., modeling, video demonstrations, role play, experiential exercises, and video recording of practice followed up with direct feedback).

Participants receive a comprehensive set of materials for practitioners providing PMTO and parents receiving PMTO services. Manuals contain foundational information, explanations and experiential exercises of core and supporting PMTO content and strategies, session outlines, sample dialogue and raps, parent materials, and all other necessary intervention and assessment tools.

Throughout the course of training, candidates are required to record their sessions with training families. These video materials are uploaded to a secure portal so that training mentors and coaches can view their sessions and provide detailed coaching.

PMTO training is supported with regular coaching. Coaching takes place by phone, through videoconferencing, in written format, or in person. Coaching is structured to give the practitioner strong support for improving strategies in terms of content and therapeutic process as well as teaching strategies. Candidates receive a minimum of 12 coaching sessions based on direct observation of their therapy sessions with training families.

Coaching feedback is based on five categories within the Fidelity of Implementation Rating System (FIMP) (Knutson, Forgatch, & Rains, 2003; Knutson, Forgatch, Rains, & Sigmarsdóttir, 2009). The FIMP categories follow. Knowledge: demonstrated understanding and practice of PMTO principles, practice, and theoretical model; Structure: proficiency in session management, leading without dominating, responsive to family issues; Teaching: skill in balancing specific instructional strategies to promote parental mastery of PMTO practices; Process: proficiency in use of therapeutic process skills that promote a safe and supportive learning environment; and Overall Development: engagement of family in PMTO practice incorporating contextual and family circumstances that may interfere. Feedback is provided to strengthen existing skills and support practitioners in shaping new skills in mastery.

Training Certification Process

Candidates see a minimum of three training families who are referred for treatment at their agency. Given that candidates show effective incorporation of coaching feedback into their practice and competent application of PMTO techniques, they are advanced to certification candidacy by invitation. They then begin work with a minimum of two new certification families. Candidates submit four video recordings of full treatment sessions from their work with these certification families. The sessions must be on each of the following topics: introducing encouragement, troubleshooting encouraging, introducing discipline, and troubleshooting discipline. These sessions are then viewed by Implementation Sciences International, Inc. (ISII) Mentors, who rate the sessions using the FIMP manual to evaluate candidates' fidelity to the method. To achieve a passing score, the mean score for each session must be no less than 6.0 (on a 9-point scale), with no scores below 4.

Practitioners must complete the certification process to be qualified to implement PMTO interventions independent of ISII coaching. Following certification, coaching within the local PMTO community is required at a minimum of once monthly. ISII coaching is strongly recommended and provided to community coaches at regular intervals to sustain fidelity over time in the community.

The amount of time to certification is variable; from initial training workshop to certification typically ranges from 18 – 24 months.

Brief Evaluation Methodology

The Forgatch and DeGarmo (1999) and related studies utilized an experimental longitudinal design, which included random assignment into the PMT group or a non-intervention control group. The participants were 238 recently separated mothers and their sons in grades 1-3. Mothers in the experimental group (n = 153) received the PMT intervention and mothers in the control group (n = 85) received no intervention. In this study the participants received extensive multiple-method, -setting, and -agent assessment at several time points: baseline, 6 months, 12 months, 18 months, 30 months (DeGarmo et al., 2004; Forgatch & DeGarmo, 2007; Martinez & Forgatch, 2001), and 6, 7, 8, & 9 years (Forgatch et al., 2009; Patterson et al., 2010).

The Bank et al. (1991) study, conducted in the 1970's, used a randomized trial of Parent Training (PT), which included 60 boys referred by the Lane County (Oregon) Juvenile Court. Participants were assigned to either the Oregon Social Learning Center OSLC) PT Intervention (n = 28) or Community Control (n = 27) treatment conditions. Offense data were collected for the year prior to intake, the treatment year, and the three years following treatment.

The Patterson, Chamberlain, and Reid (1982) study utilized a randomized design in which 46 families were referred to OSLC by pediatricians, school or mental health personnel, or parents. Nineteen families that were not excluded and did not drop from the study were randomly assigned to experimental treatment (n = 10) or a comparison group (n = 9). Observations were conducted during baseline (2 week duration) and when experimental families were terminated (after an average of 17 hours of therapy time).

The Martinez and Eddy (2005) study randomized 73 Spanish-speaking, Latino families to a treatment or control condition and the program was adapted to meet the needs of this specific cultural population.

The study by Ogden and Hagen (2008) and Hagen, Ogden, and Bjornebekk (2011) utilized a randomized design in which 59 Norwegian families were assigned to the PMTO group and 53 families were assigned to a regular services (RS) comparison group. Data were collected at intake (baseline) and at post-treatment (approximately 11 to 12 months later), and one year follow-up.

The Forgatch, DeGarmo, and Beldavs (2005) and related studies (Bullard et al., 2010; DeGarmo & Forgatch, 2007; Wachlarowicz, Snyder, Low, Forgatch, & DeGarmo, 2012) examined the effects of the PMTO program to prevent conduct problems in children in 110 families whose mother was recently married using randomized controlled assignment. Added components to the program included material addressing stepfamily issues and measures were collected at 6-, 12-, and 24-months post baseline.

The Bjørknes et al. (2012) and Bjørknes and Manger (2012) studies used an RCT method to determine the effect of PMTO on parent practices as mediators of change on child conduct problems among 96 Pakistani and Somali immigrant families in Norway. Cultural adaptations (translations) were made to the program to accommodate the needs of the targeted population.

The Sigmarsdóttir et al. (2013, 2014) study was a randomized controlled trial of 102 families in Iceland. Cultural adaptations (translations) were made to the program to accommodate the needs of the targeted population. Results for treatment families were compared to a group that received usual services for children with behavioral problems.

Kjobli and Ogden (2012) conducted a randomized trial of brief parent training (3-5 sessions) in primary care settings among 216 Norwegian families whose children were exhibiting signs of problem behaviors.

Kjøbli et al. (2013) used a randomized controlled trial of group-based PMTO with 137 families assigned to PMTO or a comparison group. Twelve 2.5-hour group sessions were provided to parents in the PMTO group to promote parenting skills in families whose children exhibited conduct problems in Norway.

Ollendick et al. (2015) used a U.S.-based randomized control trial that compared the program (N= 63) to both a similar parent training intervention, Collaborative & Proactive Solutions (N=60), and a waitlist control group (N=11). Participants assigned to these 3 groups were assessed at baseline (N=134) and posttest (N=100; 75%), 6 weeks later. Relatively few in the full baseline sample were retained at 6-month follow-up (N=55; 41%) to compare longer-term outcomes of the two programs.

The Rabbitt et al. (2016) study used a U.S.-based QED with some randomization to compare two new online versions of the program, “Full Contact PMT” (N=40) and “Reduced Contact PMT” (N=46), to a separate, matched sample that had previously received the traditional in-person delivery model. Only families that completed treatment were included in the study, so while 86 were initially enrolled in the online versions of the program, only the 60 (70%) that completed posttest measures were compared to those that had previously received traditional PMT (N=60).

Peer Implementation Sites

Kansas
Becci A. Akin, PhD, MSW
Assistant Professor
University of Kansas
School of Social Welfare
Phone: 785-864-2647
Email: becciakin@ku.edu

Latino populations in the U.S.
J. Ruben Parra-Cardona, Ph.D.
Associate Director, MSU Research Consortium on Gender-Based Violence
Associate Professor, Couple and Family Therapy Program Human Development and Family Studies
552 W. Circle Drive, 3 D Human Ecology
Michigan State University
East Lansing, MI, 48824
Phone: 517-432-2269
Email: parracar@msu.edu
http://vaw.msu.edu/people/parra

Iceland
Margrét Sigmarsdóttir
margret@bvs.is

Mexico City, CAPAS
CAPAS-MX "Criando con Amor Promoviendo Armonía y Superación en México"
Nancy Gigliola Amador Buenabad
Medical Science Research
National Institute of Psychiatry "Ramón de la Fuente Muñiz"
nagy@imp.edu.mx
naagy14@yahoo.com.mx
011 52 55 4160 5139 (office)
011 521 55 40116159 (movil)

References

Bank, L., Marlowe, J. H., Reid, J. B., Patterson, G. R., & Weinrott, M. R. (1991). A comparative evaluation of parent-training interventions for families of chronic delinquents. Journal of Abnormal Child Psychology, 19(1), 15-33.

Bjørknes, R., Kjøbli, J., Manger, T., & Jakobsen, R. (2012). Parent training among ethnic minorities: Parenting practices as mediators of change in child conduct problems. Family Relations, 61, 101-114.

Bjørknes, R., & Manger, T. (2012). Can parent training alter parent practices and reduce conduct problems in ethnic minority children? A randomized controlled trial. Prevention Science,  published online.

Bullard, L., Wachlarowicz, M., DeLeeuw, J., Snyder, J., Low, S., Forgatch, M., & DeGarmo, D. (2010). Effects of the Oregon Model of Parent Management Training (PTMO) on marital adjustment in new stepfamilies: A randomized trial. Journal of Family Psychology, 24(4), 485-496.

DeGarmo, D. S., & Forgatch, M. S. (2007). Efficacy of parent training for stepfathers: From playful spectator and polite stranger to effective stepfathering. Parenting Science and Practice, 7(4), 331-353.

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, 73-89.

Forgatch, M., & DeGarmo, D. (1999). Parenting Through Change: An effective prevention program for single mothers. Journal of Consulting and Clinical Psychology, 67(5), 711-724.

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., & DeGarmo, D. S. (2007). Accelerating recovery from poverty: Prevention effects for recently separated mothers. Journal of Early and Intensive Behavioral Intervention, 4(4), 681-702.

Forgatch, M. S., DeGarmo, D. S., & Beldavs, Z. G. (2005). An efficacious theory-based intervention for stepfamilies. Behavior Therapy, 36(4), 357-365.

Forgatch, M. S., Patterson, G. R., DeGarmo, D. S., & Beldavs, Z. (2009). Testing the Oregon delinquency model with 9-year follow-up of the Oregon Divorce Study. Development and Psychopathology,  21(5), 637-660.

Hagen, K. A., Ogden, T., & Bjørnebekk, G. (2011). Treatment outcomes and mediators of parent management training: A one-year follow-up of children with conduct problems. Journal of Clinical Child and Adolescent Psychology, 40(2), 165-178.

Kjøbli, J., & Ogden, T. (2012). A randomized effectiveness trial of brief parent training in primary care settings. Prevention Science, 13,  616-626.

Kjøbli, J., Hukkelberg, S., & Ogden, T. (2013). A randomized trial of group parent training: Reducing child conduct problems in real-world settings. Behavior Research and Therapy, 51, 113-121.

Martinez, C., & Eddy, M. (2005). Effects of culturally adapted Parent Management Training on Latino youth behavioral health outcomes. Journal of Consulting and Clinical Psychology, 73(4), 841-851.

Martinez, C., & Forgatch, M. (2001) Preventing problems with boys' noncompliance: Effects of a parent training intervention for divorcing mothers. Journal of Consulting and Clinical Psychology, 69(3), 416-428.

Ogden, T., & Hagen, K. A. (2008). Treatment effectiveness of parent management training in Norway: A randomized controlled trial of children with conduct problems. Journal of Consulting and Clinical Psychology, 76, 607-623.

Ollendick, T. H., Greene, R. W., Austin, K. E., Fraire, M. G., Halldorsdottir, T., Allen, K. B., ... Wolff, J. C. (2015). Parent Management Training and Collaborative & Proactive Solutions: A randomized control trial for oppositional youth. Journal of Clinical Child and Adolescent Psychology, 0(0), 1-14.

Parra Cardona, J. R., Domenech-Rodriguez, M., Forgatch, M., Sullivan, C., Bybee, D., Holtrop, K., ... Bernal, G. (2012). Culturally adapting an evidence-based parenting intervention for Latino immigrants: The need to integrate fidelity and cultural relevance. Family Process, 51(1), 56-72.

Patterson, G. R., Chamberlain, P., & Reid, J. B. (1982). A comparative evaluation of a parent-training program. Behavior Therapy 13, 638-650.

Patterson, G. R., Forgatch, M. S., & DeGarmo, D. S. (2010). Cascading effects following intervention. Development and Psychopathology, 22,  949-970.

Rabbit, S. M., Carrubba, E., Lecza, B., MacWhinney, E., Pope, J., & Kazdin, A. E. (2016). Reducing therapist contact in parenting programs: Evaluation of internet-based treatments for child conduct problems. Journal of Child and Family Studies, 25, 2001-2020.

Reed, A., Snyder, J., Staats, S., Forgatch, M., DeGarmo, D., Patterson, G., ... Schmidt, N. (2013). Duration and mutual entrainment of changes in parenting practices engendered by behavioral parent training targeting recently separated mothers. Journal of Family Psychology, 27(3), 343-354.

Sigmarsdóttir, M., Thorlacius, O., Guõmundsdóttir, E. V., & DeGarmo, D. S. (2014). Treatment effectiveness of PMTO for children's behavior problems in Iceland: Child outcome in a nationwide randomized controlled trial. Family Process, 54, 498-517.

Sigmarsdóttir, M., DeGarmo, D. S., Forgatch, M. S., & Guõmundsdóttir, E. V. (2013). Treatment effectiveness of PMTO for children's behavior problems in Iceland: Assessing parenting practices in a randomized controlled trial. Scandinavian Journal of Psychology, 54, 468-476.

Wachlarowicz, M., Snyder, J., Low, S., Forgatch, M. S., & DeGarmo, D. A. (2012). The moderating effects of parent antisocial characteristics on the effects of Parent Management Training - Oregon (PMTO), Prevention Science, 13,  229-240.