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.     

Treatment effectiveness of PMTO for children's behavior problems in Iceland: Assessing parenting practices in a randomized controlled trial

Findings are presented from an Icelandic randomized control trial (RCT) evaluating parent management training – Oregon model (PMTO?), a parent training intervention designed to improve parenting practices and reduce child behavior problems. In a prior report from this effectiveness study that focused on child outcomes, children in the PMTO condition showed greater reductions in reported child adjustment problems relative to the comparison group. The present report focuses on observed parenting practices as the targeted outcome, with risk by treatment moderators also tested. It was hypothesized that mothers assigned to the PMTO condition would show greater gains in pre‐post parenting practices relative to controls. The sample was recruited from five municipalities throughout Iceland and included 102 participating families of children with behavior problems. Cases were referred by community professionals and randomly assigned to either PMTO (n = 51) or community services usually offered (n = 51). Child age ranged from 5 to 12 years; 73% were boys. Contrary to expectations, findings showed no main effects for changes in maternal parenting. However, evaluation of risk by treatment moderators showed greater gains in parenting practices for mothers who increased in depressed mood within the PMTO group relative to their counterparts in the comparison group. This finding suggests that PMTO prevented the expected damaging effects of depression on maternal parenting. Failure to find hypothesized main effects may indicate that there were some unobserved factors regarding the measurement and a need to further adapt the global observational procedures to Icelandic culture.     

An efficacious theory-based intervention for stepfamilies

This article evaluates the efficacy of the Oregon model of Parent Management Training (PMTO) in the stepfamily context. Sixty-seven of 110 participants in the Marriage and Parenting in Stepfamilies (MAPS) program received a PMTO-based intervention. Participants in the randomly assigned experimental group displayed a large effect in benefits to effective parenting practices with resultant decreases in child noncompliance and in home and school problem behaviors. MAPS findings replicate and extend those of the Oregon Divorce Study with single mothers while employing a similar multiple-method, multiple-measure randomized design, with Intent-to-Treat and structural equation modeling analyses. We discuss direct and indirect effects on distal outcomes and the generalizability of PMTO to differing family contexts.     

Examining the Emotional Experience of Mothers Completing an Evidence-Based Parenting Intervention: A Grounded Theory Analysis

Parenting interventions are a well-established treatment for addressing child behavior problems that have also been shown to improve parent psychosocial health. Yet, little is known about how caregiver emotional experiences change over time during treatment. In response, the purpose of this study was to explore the emotional experiences of mothers following their participation in an evidence-based parenting intervention. Researchers conducted a secondary analysis of existing qualitative data. The study sample included semi-structured interview data from 17 mothers who previously completed the GenerationPMTO parenting intervention. Data analysis followed the grounded theory approach and included a sequential process of open, axial, and selective coding using the constant comparative method. Findings indicate mothers progressed through three distinct, yet interrelated stages of emotional experience: Before PMTO, their experiences were characterized by parenting through crisis (Stage 1); during PMTO, they transitioned to crisis stabilization (Stage 2); and following PMTO, they described experiences of emerging recovery and resilience (Stage 3). Maternal emotional experiences in each stage occurred across three contextual realms: (a) the individual (intrapersonal) level, (b) the parent–child relationship level, and the broader systemic level. Results highlight the dynamic and evolving nature of maternal emotional experience throughout various stages of the intervention process and suggest how these experiences may be associated with promoting effective parenting practices and positive child outcomes.     

The competent psychoanalytic supervisor: Some thoughts about supervision competences for accountable practice and training

What are the competences required to satisfactorily practice effective or “good enough” psychoanalytic supervision? In this paper, I would like to consider that question. Over the past approximate 15-year period, increasing attention has been directed toward more specifically identifying and defining the components of competent psychoanalytic practice. But any parallel attention toward identifying and defining the components of competent psychoanalytic supervision practice has, in comparison, been sorely limited if not virtually absent. If we are to best practice competent psychoanalytic supervision and best train future psychoanalytic supervisors for competent practice, effort needs to be made to concretely delineate the competences that are requisite for such practice. In what follows, I present and adapt six broad-based families of internationally relevant supervision competence areas for use in psychoanalytic supervision: (1) knowledge about/understanding of psychoanalytic supervision models, methods, and intervention; (2) knowledge about/skill in attending to matters of ethical, legal, and professional concern; (3) knowledge about/skill in managing psychoanalytic supervision relationship processes; (4) knowledge about/skill in conducting psychoanalytic supervisory assessment and evaluation; (5) knowledge about/skill in fostering attention to difference and diversity; and (6) openness to/utilization of a self-reflective, self-assessment stance in psychoanalytic supervision. Although by no means an exhaustive list, 30 supervision competences (five per family) are proposed as significant for guiding competent psychoanalytic supervision practice and supervisor training, and a brief explanatory comment is offered in support of each broad-based family of competences.     

Children With Conduct Problems and Co-occurring ADHD: Behavioral Improvements Following Parent Management Training

To scale up evidence-based treatment of conduct problems, parent management training, Oregon model (PMTO) has been disseminated throughout Norway. This study examined whether Attention Deficit Hyperactivity Disorder (ADHD) predicted the outcomes of PMTO. Of 253 children and families, 97 were reported to have an ADHD diagnosis. Although different at intake, the groups with and without ADHD had close to an equal change in behavioral status following treatment. Maternal depression and family income predicted the combined group's behavior following PMTO. The study indicates that reductions in conduct problems following PMTO are of the same magnitude in children with or without ADHD. However, some characteristics may differentially predict outcomes for children with combined problems.     

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.     

Observations of families in structured interactions: Parenting therapists provide reliable ratings of mothers' parenting

The reliability of observations of parenting by parenting therapists was assessed. An important predictor of externalizing behavior in children is quality of parenting. Data were videotapes of structured interactions in families with a child age 8–12 years referred to the evidence based Parent Management Training Oregon (PMTO) treatment program for child behavior problems. The therapists had clinical PMTO training but no training in systematic observation. PMTO observational coders with specific coder training were included as a reference for the therapists. Five therapists and two coders observed videotapes of 10 families and performed global evaluations of mothers' parenting skills. They used the coder's impression measure used in PMTO research. Scores were analyzed in a generalizability theory framework for the two groups of observers separately. Both observer types reliably rank‐ordered the mothers and assessed the level of parenting skills. PMTO therapists without coder training provided reliable ratings of parenting constructs relevant to the clinical PMTO program in a manner comparable to that of the trained reference coders.     

Patterns of Parental Adherence and the Association to Child and Parenting Outcomes Following a Multicomponent School-Home Intervention for Youth With ADHD

The goal of the present study was to evaluate the role of parent adherence in the Collaborative Life Skills (CLS) program, a multicomponent school-home intervention, for predicting child and parenting outcomes. A sample of 129 children (63% male; M age = 8.22, SD = 1.10; grades 2–5) with attention-deficit/hyperactivity disorder (ADHD) and their parents participated in CLS, which included 10 weekly behavioral parent training group sessions. Each week, parents provided information on their CLS skill use between sessions (at home) as part of the intervention. Outcome measures included parent and teacher ratings of child behavior and parenting at post-intervention and 6 months follow-up. Growth mixture models examining weekly parent skill use trajectories throughout the intervention significantly predicted parent- and teacher-reported outcomes including parent-rated child behavior, teacher-rated academic competence, and positive parenting behaviors. Fifty-two percent of parents displayed moderate skill use throughout the intervention, whereas the remaining parents had either low (20%) or high (28%) initial levels of use but demonstrated high skill utilization by the middle of the intervention. Results highlight the importance of examining individual differences in parents between session strategy use for behavioral parent training interventions targeting child and parenting outcomes.     

Predictors of changes in child behaviour following parent management training: Child,context, and therapy factors

This non‐randomised study examined a set of predictive factors of changes in child behaviour following parent management training (PMTO). Families of 331 Norwegian girls (26%) and boys with clinic‐level conduct problems participated. The children ranged in age from 3 to 12 years (M_age = 8.69). Retention rate was 72.2% at post‐assessment. Child‐, parent‐ and therapy‐level variables were entered as predictors of multi‐informant reported change in externalising behaviour and social skills. Behavioural improvements following PMTO amounted to 1 standard deviation on parent rated and ½ standard deviation on teacher rated externalising behaviour, while social skills improvements were more modest. Results suggested that children with higher symptom scores and lower social skills score at pre‐treatment were more likely to show improvements in these areas. According to both parent‐ and teacher‐ratings, girls tended to show greater improvements in externalising behaviour and social skills following treatment and, according to parents, ADHD symptomology appeared to inhibit improvements in social skills. Finally, observed increases in parental skill encouragement, therapists' satisfaction with treatment and the number of hours spent in therapy by children were also positive and significant predictors of child outcomes.     

Motivational Interviewing Promotes Adherence and Improves Wellbeing in Pre-Dialysis Patients with Advanced Chronic Kidney Disease

Low rates of adherence to medical treatments and adverse emotional states are a widespread problem in advanced chronic kidney disease (ACKD). Motivational interviewing using the stages of change model is an effective combination in promoting behavior modifications. The objective of the present study was to determine the effectiveness of an individual, pre-dialysis intervention program (monthly sessions of 90 min over a 6-month period) in terms of adherence, emotional state and health-related quality of life (HRQL). Forty-two patients were evaluated for adherence, depression, anxiety and HRQL with standardized self-report questionnaires. Biochemical markers were also registered. The results show that after the intervention, patients reported significantly higher levels of adherence, lower depression and anxiety levels, and better HRQL (i.e., general health and emotional role domains). Biochemical parameters were controlled significantly better after the intervention, except for iPTH. These findings highlight the potential benefit of applying individual psycho-educational intervention programs based on motivational interviewing and using the stages of change model to promote adherence and wellbeing in ACKD patients.     

An information-motivation-behavioral skills model of adherence to antiretroviral therapy.

HIV-positive persons who do not maintain consistently high levels of adherence to often complex and toxic highly active antiretroviral therapy (HAART) regimens may experience therapeutic failure and deterioration of health status and may develop multidrug-resistant HIV that can be transmitted to uninfected others. The current analysis conceptualizes social and psychological determinants of adherence to HAART among HIV-positive individuals. The authors propose an information-motivation-behavioral skills (IMB) model of HAART adherence that assumes that adherence-related information, motivation, and behavioral skills are fundamental determinants of adherence to HAART. According to the model, adherence-related information and motivation work through adherence-related behavioral skills to affect adherence to HAART. Empirical support for the IMB model of adherence is presented, and its application in adherence-promotion intervention efforts is discussed.     

Perception and Help-Seeking Intention of Intimate Partner Violence in Later Life: An International Perspective

This study examines whether elderly Koreans recognize a scenario of intimate partner violence as such and whether they would seek help in the given situation of elder mistreatment (EM). Two cohorts of Korean elders (one immigrant and one Korea-based), each numbering 124 participants, were recruited using a quota sampling strategy. The study used a mixed method approach, employing a hypothetical scenario, and patriarchy theory informed the study. Findings revealed low perception of the vignette as EM and low help-seeking intention in both cohorts. Among the immigrant cohort, intention to seek help was greater among respondents who were female, demonstrated lower adherence to traditional values, and perceived the vignette as EM. Among the Korea-based cohort, the only significant factor was recognition of the scenario as EM. Development of culturally competent and geographically specific practice and intervention is urgently needed, particularly among elders who have greater adherence to traditional cultural values.     

Therapist Self-disclosure and Culturally Competent Care with Mexican–American Court Mandated Clients: A Phenomenological Study

Therapist self-disclosure (TSD) is a skill with numerous potential benefits and risks for the therapeutic alliance. While its effects have been established, little empirical research has examined the impact of TSD in cross-cultural treatment settings with court-mandated clients, a context with unique considerations. In an effort to help fill this gap, results of a phenomenological study examining the effects of TSD on Mexican–American men working with Anglo American therapists in a mandated treatment setting are presented. The results of this study indicate that TSD is a culturally competent intervention with several benefits for mandated clients, including strengthening the therapeutic alliance, normalizing client problems, lessening the therapist-client hierarchy, and modeling the acceptability of self-disclosure. Clinical and marriage and family therapy educational implications are also discussed.     

Helping military families through the deployment process: Strategies to support parenting

Recent studies have highlighted the impact of deployment on military families and children and the corresponding need for interventions to support them. Historically, however, little emphasis has been placed on family-based interventions in general, and parenting interventions in particular, with returning service members. This paper provides an overview of research on the associations between combat deployment, parental adjustment of service members and spouses, parenting impairments, and children's adjustment problems, and provides a social interaction learning framework for research and practice to support parenting among military families affected by a parent's deployment. We then describe the Parent Management Training-Oregon model (PMTO(?)), a family of interventions that improves parenting practices and child adjustment in highly stressed families, and briefly present work on an adaptation of PMTO for use in military families (After Deployment: Adaptive Parenting Tools, or ADAPT). The article concludes with PMTO-based recommendations for clinicians providing parenting support to military families.     

Community implementation of PMTO™: Impacts on referrals to specialist services and schools

Sigmarsdóttir, M. & Björnsdóttir, A. (2012). Community implementation of PMTO?: Impacts on referrals to specialist services and schools. Scandinavian Journal of Psychology 53, 506–511. In 2000, the city of Hafnarfjörður, Iceland, implemented Parent Management Training – Oregon Model (PMTO^?) to prevent and treat behavioral problems among children. This paper describes the implementation and findings regarding impacts in the community. As hypothesized, findings showed that the number of referrals to specialist services decreased in Hafnarfjörður following PMTO implementation and increased in two comparison communities not implementing the method. Within the Hafnarfjörður community, recorded instances of behavior problems reduced in elementary schools working in line with PMTO. The results presented are the first such findings in Iceland and suggest the kinds of systematic changes communities may experience following the implementation of an evidence‐based program.     

Questions and reflections: the use of motivational interviewing microskills in a peer-led brief alcohol intervention for college students

The purpose of this study was to examine the association between peer facilitator adherence to motivational interviewing (MI) microskills and college student drinking behavior. First year students (N=67) took part in a Brief Alcohol Screening and Intervention for College Students (BASICS) led by peer facilitators trained in MI and BASICS. Participants were assessed pre- and 2 weeks post-intervention on contemplation to change, as well as, pre- and 3 months post- intervention on drinking quantity. Independent coders used the Motivational Interviewing Treatment Integrity scale (MITI, Moyers, Martin, Manuel, & Miller, 2003) to evaluate therapist MI adherence. Peer facilitators met beginning proficiency in MI on scores of empathy, the ratio of MI adherent behaviors to non-adherent behaviors and the ratio of open questions to total questions as defined by the MITI. Results indicated that a higher number of closed questions was related to less contemplation and a higher number of open questions was related to more contemplation post intervention. A higher number of simple reflections was associated with increased drinking at the 3 month assessment, however, complex reflections were found to attenuate the effect of simple reflections on changes in drinking. These findings highlight the importance of competent reflective listening skills and the need for continual training and supervision for peer facilitators.     

Adherence predictors in an Internet-based Intervention program for depression

Internet-delivered psychotherapy has been demonstrated to be effective in the treatment of depression. Nevertheless, the study of the adherence in this type of the treatment reported divergent results. The main objective of this study is to analyze predictors of adherence in a primary care Internet-based intervention for depression in Spain. A multi-center, three arm, parallel, randomized controlled trial was conducted with 194 depressive patients, who were allocated in self-guided or supported-guided intervention. Sociodemographic and clinical characteristics were gathered using a case report form. The Mini international neuropsychiatric interview diagnoses major depression. Beck Depression Inventory was used to assess depression severity. The visual analogic scale assesses the respondent’s self-rated health and Short Form Health Survey was used to measure the health-related quality of life. Age results a predictor variable for both intervention groups (with and without therapist support). Perceived health is a negative predictor of adherence for the self-guided intervention when change in depression severity was included in the model. Change in depression severity results a predictor of adherence in the support-guided intervention. Our findings demonstrate that in our sample, there are differences in sociodemographic and clinical variables between active and dropout participants and we provide adherence predictors in each intervention condition of this Internet-based program for depression (self-guided and support-guided). It is important to point that further research in this area is essential to improve tailored interventions and to know specific patients groups can benefit from these interventions.     

Effect of simultaneous model observation and self-modeling of volleyball skill acquisition

This study examined the effect of feedback with simultaneous skilled model observation and self-modeling on volleyball skill acquisition. 53 pupils 12 to 15 years old formed two experimental groups and one control group who followed an intervention program with 12 practice sessions for acquisition and retention of how to receive a ball. Groups received different types of feedback before and in the middle of each practice session. Reception performance outcome (score) and technique in every group were assessed before and at the end of the intervention program and during the retention phase. A 3 (Group) x 3 (Measurement Period) multivariate analysis of variance with repeated measures was applied to investigate differences. Results showed equivalent improvement in all three groups at the end of the intervention program. In conclusion, types of augmented feedback from the physical education teacher are effective in acquisition and retention of the skill for reception in volleyball.     

A Task-Shifting Problem-Solving Therapy Intervention for Depression and Barriers to Antiretroviral Therapy Adherence for People Living With HIV in Zimbabwe: Case Series

HIV is prevalent in Sub-Saharan Africa, and depression frequently co-occurs. Depression is one of the most important predictors of poor adherence to antiretroviral therapy (ART). Little has been done to develop integrated interventions that are feasible and appropriate for task-shifting to nonspecialists that seek to address both depression and barriers to ART adherence in Sub-Saharan Africa.This case series describes an integrated intervention for depression and ART adherence delivered by a lay adherence counselor and supervised by a local psychologist. The 6-session intervention was based on problem-solving therapy for depression and for barriers to adherence (PST-AD), with stepped care for those whose depression did not recover with PST-AD. Primary outcomes were acceptability and depression. Acceptability was measured by participant attendance to the 6 sessions.Three case studies illustrate the structured intervention, solutions identified to adherence barriers and to problems underlying low mood, and changes seen in the participant's psychological symptoms. Acceptability of the intervention was high and common mental disorder symptoms scores measured using the SRQ-8 decreased overall.An integrated intervention for depression and adherence to ART appeared feasible in this low-income setting. An RCT of the intervention versus an appropriate comparison condition is needed to evaluate clinical and cost-effectiveness.