PMTO in The Netherlands

Corine de Ruiter, Maastricht University

Ferko Öry, TNO Quality of Life

Parent Management Training Oregon model

PMTO

A research-based effective intervention aimed at strenghtening the parenting skills of parents with children with externalizing

behavior problems

PMTO

• Scientific foundation (Social Interaction Learning theory: Patterson, Reid, & Dishion)

• Certified as an effective program by SAMHSA in the US

Domains

• Family

• School

• Neighborhood

• Culture

PMTO

• For parents of children with serious externalizing behavior problems

• Outpatient treatment program of 20-25 sessions on average

Advantages PMTO

• Few parents dropout of the program

• Continuous monitoring of program integrity

• Program empowers parents and therapists

• Proven effectiveness in US

• International collaboration

The Netherlands- 2006: no effectiveness research on interventions for 4-12 yr old children with externalizing behavior problems

• Violent crime among adolescents show steady increase since the mid-90’s (Wittebrood, 2001).

• Systematic review by Trimbos-institute (2004): a lot of different interventions offered, but none are tested on effectiveness

• Interventions imported from abroad show program drift

Effects of PMTO

• Decrease of internalizing en externalizing problems in the children• Less criminal offending, substance use at

longer term follow up• Decrease in depression in parents; increase

in competence

Content of PMTO

Parents are taught 5 key parenting skills:

• Thuis samen problemen oplossen (problem solving)

• Kinderen discipline bijbrengen (discipline)

• Thuis een warme & liefdevolle omgeving scheppen

• Kinderen volgen (monitoring)

• Kinderen sociale vaardigheden leren (skill training)

Organisation and design for PMTO in The Netherlands

Partner institutions (1):• ISII Oregon/Oslo and Oregon Social Learning

Center: training of therapists, training in fidelity checks and assistance with implementation

• TNO Qaulity of Life (program management and implementation research)

• Maastricht University: fidelity checks; Randomized Controlled Trial (RCT), Cost-Utility Analysis (CUA) and Health Technology Assessment (HTA) study

Organisation and design for PMTO in The Netherlands

Partner institutions (2): • PI-Research (translation of PMTO material;

implementation research)• NIZW Youth: liaison with other “import”

programs• De Bascule, Cardea, Rivierduinen, Jeugdzorg

Drenthe: training, intervision and use of PMTO program

• Trimbos-institute & Erasmus University: participation in RCT, KEA and HTA

Financing

• Now: 3,6 million euro via public–private partnership• Government: Ministries of Health and Justice,

Provincies and City regions • Centraal Fonds RVVZ van de Zorgverzekeraars• Private funds: (o.a. Kinderpostzegels Nederland, VSB-

fonds, Rabobank Foundation en Fonds Psychische Gezondheid)

• In the future structural financing: via health insurance companies, (o.a. Diagnosis Behandel Combinaties DBC’s)

Research on effectiveness• Treatment integrity: behandelintegriteit with

fidelity checks

• Modification of PMTO training material for ethnic minorities

• Randomized Controlled Trial (RCT), Cost Utility Analysis (CUA of KEA) and Health Technology Assessment (HTA): vooraanmelding positief beoordeeld door Doelmatigheidsprogramma ZonMw

• Research on Implementation

Trainingplan for PMTO in The Netherlands

• PMTO conference 12 january 2006

• Training 12 – 15 therapists March 2006

• Training 12 – 15 therapists September 2006

• Training fidelity coders during 2006

• Research on implementation starts February 2006

• RCT, CUA (KEA) and HTA start in 2007

Concept Organisational structure PMTO in The Netherlands

T ra in ing Im p lem en ta tie O nderzoek F inanc ie ring

P M T O K e rn g ro e p

F e d e ra t ie E f fe c t ie v e J e u g d in te rv e n t ie s

PMTO as a strategy• Evidence-based and effective• Preventing program drift by fidelity checks and

intervision• Parents as partners, own strength based• Change in mentality of executing staff by using

impact measures as guiding principle• Increased professional identity of professionals

and managers of participatring institutions• New vision on implementation fed by research on

implementation guided by impact & outcome data• Maximal commitment of field staff by their

possibility to feed in the program content

And now …..let’s hit the road!