History of ISII and PMTO

Since the 1970s, colleagues at the Oregon Social Learning Center (OSLC) have developed and tested theory-based interventions to treat and prevent conduct and associated problems in children and youth. This research, which has been supported by the National Institutes of Health (NIH), has generated a set of intervention programs that are now recognized as evidence-based programs (EBP). The basic model underlying these methods is called Parent Management Training - Oregon Model (PMTO®). PMTO provides preventive and clinical interventions for families of youngsters with behavioral problems in the externalizing spectrum (e.g., aggression, antisocial behavior, conduct problems, conduct disorder, oppositional defiance, delinquency, and substance use) as well as associated problems (depression, academic problems, and deviant peer association).

In order to extend these programs to the families who need help, a network of OSLC-affiliated organizations was established. ISII is a nonprofit member of this network. (For a list of references, e.g., peer-reviewed journal articles and book chapters, go to our publications page.

First Nationwide Implementation of PMTO

The first nationwide implementation of PMTO began in 1999 in Norway with a request from the Norwegian government to train a set of PMTO specialists. The goal was to establish a sustainable EBP to serve families in need in every municipality throughout the nation in both the child welfare and child mental health systems of care. This project led to the birth of ISII with the goal of providing professional training in PMTO and PMTO-associated methods to mental health and child welfare professionals, both nationally and internationally.

Since 2001, ISII has become the driving force behind PMTO training for child mental health and child welfare professionals. Leaders in Iceland, the Netherlands, Denmark, the States of Michigan and Kansas, the province of British Columbia (Canada), Wayne County Michigan, and New York City have contracted with ISII for system-wide trainings of professionals. Pilot programs have tested PMTO services for parents whose children have been placed in care (Detroit), mothers in supportive housing and in shelters because of domestic violence or homelessness (Minnesota), and Somali immigrant parents (Minnesota). Scientists have been funded to adapt and test the program for service members returning home from the wars in Iraq and Afghanistan, and for Latina/o families in Utah, Minnesota, and Michigan. PMTO studies have fostered the testing of a prevention program for parents in Mexico City and a feasibility study for war-displaced mothers in Northern Uganda.

Introducing PMTO training in a university setting for the first time, PMTO leaders are using a blended approach using face-to-face and web-based instruction to train doctoral and post-doctoral students from five universities (Washington University in St. Louis, Utah State, Michigan State, Florida State, and University of Minnesota) in PMTO and will assess the implementation outcomes and fidelity of this blended learning platform.

Full Program Transfer

ISII provides full program transfer from the purveyor to the community. This approach entails training a progenitor generation (Generation 1) and selecting leaders from this group to build an infrastructure to carry out training, coaching, fidelity checks, certification, and further tailoring within their site. Approximately two to four years of support is required to complete full transfer. Data from the Norwegian project, which began more than 15 years ago, provide strong support that fidelity to the PMTO model can be sustained (Forgatch, Patterson, & Gewirtz, 2013). For example, in Norway, ISII trained and certified 29 G1 PMTO therapists. In the 10 years following their certification, 92% were still certified and practicing PMTO. As of 2014 there are more than 900 registered PMTO practitioners in more than 300 workplaces throughout the nation. We have also successfully employed this full-transfer approach in wide-scale implementations in Iceland, The Netherlands, Denmark, Michigan, Kansas, and British Columbia. What sets us apart from many programs is that we elicit local involvement, help their leaders select and train, and then we let go. As communities establish their own infrastructure and trained leaders, the ISII team becomes less involved and provides consultation upon request. Our continued connection with full program-transfer sites is based on fidelity ratings.

Ensuring sustained fidelity to the PMTO model is of great importance to ISII. Our fidelity measure has been validated in three studies showing that competent adherence to the PMTO model predicts improvements before and after treatment in parenting practices and child outcomes (Forgatch & DeGarmo, 2011; Forgatch, Patterson, & DeGarmo, 2005; Hukkelberg & Ogden, 2013). As part of the full transfer PMTO program, certified PMTO practitioners receive training in our observation-based measure, Fidelity of Implementation Rating System (FIMP: Knutson, Forgatch, Rains, & Sigmarsdóttir, 2009), and then they become part of our international FIMP network. To ensure sustained fidelity and prevent drift in current and future generations, we conduct periodic reliability checks between community and ISII FIMP rating teams.