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IMPLEMENTATION OF PMTO IN ICELAND

IMPLEMENTATION OF PMTO IN ICELAND. EVIDENSE KONFERENCE – DENMARK 2012 Margrét Sigmarsdóttir. AGENDA. Introduction to the Implementation. Method of the implementation study. Results from the implementation study. Discussions and experiences. INTRODUCTION.

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IMPLEMENTATION OF PMTO IN ICELAND

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  1. IMPLEMENTATION OF PMTO IN ICELAND EVIDENSEKONFERENCE – DENMARK 2012 Margrét Sigmarsdóttir

  2. AGENDA Introduction to the Implementation Method of the implementation study Results from the implementation study Discussions and experiences

  3. INTRODUCTION

  4. Builds on Gerald Patterson´s theory about the development of antisocial behavior PMTO was developed by Gerald Patterson, Marion Forgatch and colleagues at the Oregon Social Learning Center

  5. REACHING MORE THAN HALF OF THE POPULATION 2012

  6. SUCCESSFUL IMPLEMENTATION Many critical steps Fidelity * Infrastructure Building base Ongoing training/coaching Recruiting professionals

  7. INFRASTRUCTURE A small department in the community of Hafnarfjördur PMT-FORELDRAFÆRNI Serves as the central department for the PMTO nationwide implementation infrastructure

  8. 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)

  9. FIDELITY Earlier findings have shown that high FIMP scores predict greater improvement in outcomes (Forgatch & DeGarmo, 2011; Forgatch, Patterson & DeGarmo, 2005; Ogden & AmlundHagen, 2008)

  10. Therapist behavior FIMP (Fidelity of Implementation Rating System) Parenting practices Child adjustment Adapted in Iceland from Marion Forgatch by Margrét Sigmarsdóttir 2011

  11. 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

  12. METHOOD

  13. FIMP Competent Adherence to the PMTO Method • Knowledge • Structure • Teaching • Process skills • Overall development FIVE DIMENSIONS • 1-3 needs work • 4-6 acceptable work • 7-9 good work Rated on a 9-Point Liker Scale (Knutson et al.,2009)

  14. 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)

  15. 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)

  16. TEACH Therapists’ ways of balancing instructional strategies to focus on active rather than didactic approaches (Knutson et al.,2009)

  17. TEACH 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)

  18. 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)

  19. 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)

  20. EXAMPLES

  21. PARTICIPANTS 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 There were 3.9 therapists in Norway per 100.000 from the first three groups

  22. PROCEDURE Reliable FIMP coders rated certification sessions, which consisted of four video-recorded sessions of therapist and parents in PMTO individual therapy

  23. PROCEDURE These sessions addressed the following required content: introducing encouragement, troubleshooting encouragement, introducing discipline and troubleshooting discipline

  24. RESULTS

  25. Sigmarsdóttir & Guðmundsdóttir, 2012

  26. CHILD OUTCOME; SEM structural equation model (Sigmarsdóttir, Thorlacius, Guðmundsdóttir, DeGarmo & Forgatch, 2012)

  27. DISCUSSION

  28. 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

  29. FIMP score patterns were similar to data from the Norwegian implementation

  30. 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

  31. FUTURE In our study we assessed fidelity at certification only Assessing maintenance over time is equally important for future studies

  32. 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

  33. Margrét Sigmarsdóttir margret@hafnarfjordur.is

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