ruiterory

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
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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
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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:
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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, VSBfonds, 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
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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
Federatie Effectieve Jeugdinterventies
PMTO Kerngroep
Training
Implementatie
Onderzoek
Financiering
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!