Norway (initiated 1999)
Iceland (initiated 2000)
Netherlands (initiated 2006)
Denmark (initiated 2009)
State or Province-Wide
Michigan (initiated 2004)
Kansas (initiated 2010)
British Columbia (initiated 2015)
City or County-Wide
Detroit-Wayne County (initiated 2007)
New York City (initiated 2012)
Criando con Amor: Promoviendo Armonia y Superación (CAPAS), Utah (initiated 2006)
After Deployment: Adaptive Parenting Tools (ADAPT), Minneapolis, Minnesota(initiated 2010)
CAPAS, Mexico City (initiated 2009)
Minneapolis, Minnesota - Harriet Tubman Shelte r (initiated 2009) and Early Risers- Healthy Families Network (initiated 2013)
Padres Preparados (Prepared Parents)(initiated 2015)
PMTO Teaching Project (initiated 2015)
Implementation Sites, Projects, and Pilot Projects
Full Transfer or Training in Service Delivery
ISII contracts may provide for full transfer of GenerationPMTO to the community or a more limited model focused on training in service delivery. The goal is always for clinicians to practice GenerationPMTO with sustained method fidelity and for families to experience the positive outcomes attained in efficacy and effectiveness studies. (See box on right.)
Based at the Canadian Mental Health Association, British Columbia (CMHA BC), this implementation named Confident Parents: Thriving Kids (CPTK) is delivered via telephone by PMTO-trained clinicians throughout the province of British Columbia. CMHA, founded in 1918, is the oldest national mental health charity in Canada with the BC Division created in 1952. CPTK is designed for parents of children with mild to moderate behavior problems. The basic PMTO concepts and skills have been adapted for a 6, 10 or 14-week curriculum, allowing parents to access the most effective program for their needs. Only 12 months after implementation of CPTK began, CMHA BC reported 65% of parents' concerns resolved with an additional 79% of families reporting "very good or good improvements" in their child's behavior. (Results were measured by a standardized interview tool administered to parents at intake and at exit from the program.) The first PMTO specialist was certified exactly 1 year after the start of Workshop 1, which is a credit to the site’s readiness with access to families seeking services and its support of practitioner progress.
Initial PMTO training in Denmark was provided by PMTO trainers from the Norwegian Implementation Team. The ISII team then trained selected Danish PMTO therapists to become reliable fidelity raters and provided additional training for another select group of certified Danish PMTO therapists to become certified in leading PTC Groups. Over 2,000 families in Denmark have received the PMTO intervention from their team of almost 100 PMTO therapists.
Between 2002 when Iceland’s first 2 PMTO specialists completed certification and 2015, practitioners have been trained in several PMTO formats. There are now 51 therapists certified in individual family format, 18 facilitators trained to lead PTC groups, and 488 professionals trained in PMTO Brief. During this time, more than 1900 families have been served by PMTO in both child mental health and child welfare community agencies. Research completed seven years after PMTO implementation showed that schools receiving PMTO services reported a 31% decrease in student referrals for outside specialist services compared to increases in referrals ranging from 41% to 74% in communities that did not receive PMTO services. A nationwide randomized controlled trial showed medium effect size reductions in behavior problems for PMTO families compared to those receiving services as usual.
In 2010, the Children’s Bureau, a federal agency with the mission of improving child abuse prevention, foster care, and adoption, issued a $100 million funding initiative. They sought demonstration projects to test evidence-based strategies to improve outcomes for the children in foster care who face the most serious barriers to permanency. This call for proposals was addressed by a unique group in Kansas comprising professionals from the University of Kansas, a public child welfare agency, and four private foster care providers. The Kansas group won sponsorship with their proposal to conduct a randomized controlled trial (RCT) in which they offered GenerationPMTO to birth parents to strengthen their parenting skills and compared this group to families who received treatment as usual. The Kansas team focused on families of children in foster care between the ages 3-16 with severe emotional disturbance; these children tend to languish in foster care for years. In recent years there have been publications describing the process of the Kansas group as they identify this high-risk group, select GenerationPMTO as their evidence-based program, carry out their RCT with more than 900 families, and achieve positive outcomes for the children’s well-being.
This statewide implementation is a full transfer partnership between Michigan Department of Health and Human Services (MDHHS) and ISII. MDHHS serves families with children with Serious Emotional Disturbance (SED). Implemented in the Michigan public mental health system for over a dozen years, PMTO is delivered in 52 counties by 158 PMTO clinicians. A team of approximately 12 core trainers, 32 coaches, and 18 reliable FIMP raters provide a strong coaching structure that has sustained PMTO growth in the state. Early in their collaboration, Michigan and ISII developed a Matrix that outlines the roles and responsibilities for the PMTO infrastructure in the state. This model is supported by Federal Mental Health Block Grant funds from the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, contracted through MDHHS.
Michigan offers families a range of PMTO services, including individual delivery of PMTO for families in the office or at home, Parenting through Change (PTC) groups, Parenting through Change – for Reunification (PTC-R) groups, Informed PMTO (basic skills training for professionals), and Informed PTC (a 2-day skills-focused training). The state program relies on its Michigan PMTO Portal and website to keep track of fidelity, levels of satisfaction from families, and program outcomes.
“This experience reframed the needs of the parents – it took into account adversity, history, trauma.”
– Certified PTC-R group leader, Detroit, MI
“Parents took encouragement and rolled with it!”
- Certified PTC-R group leader, Lansing, MI
Michigan: Detroit – Wayne County
ISII began PMTO training in the largest population center of Michigan in 2007 to supplement the Michigan statewide implementation, providing services to families with SED children. Three cohorts of therapists from several agencies were trained to certification. As Michigan PMTO continued building its infrastructure, ISII recommended that these therapists join the statewide effort already in place. Detroit-Wayne County therapists made a smooth transition to joining the Michigan PMTO network and adding to the statewide capacity to serve children and families.
ISII began training the first generation of 26 certified PMTO specialists here in 2006. Since then, PMTO in the Netherlands has grown to more than 88 active clinicians and served more than 1,000 families. This full transfer program has created a strong nationwide infrastructure and continues to train its own leaders, trainers, coaches and fidelity raters.
New York City
This implementation delivers PMTO in a parenting group format for birth parents working towards reunification with their children – Parenting through Change for Reunification (PTC-R). In this unique project, PMTO was linked with another evidence-based parenting practice provided for foster parents, Keeping Foster and Kin Parents Supported and Trained (KEEP), and with a casework practice model, R3. These are all based on the same foundation of the social interaction learning principles of reinforcing effort, relationships and small steps toward success. Initiated in 2012, over 250 caseworkers and supervisors in five child welfare agencies serving over 2000 children and families in the five boroughs of the city – Manhattan, Bronx, Brooklyn, Staten Island, and Queens – have been trained in all three models (PTC-R, KEEP, and R3). Approximately 9 months after training for this program began, an independent evaluation of outcomes showed a 20% increase in permanent exits from foster care and a 14% decrease in placement moves. These agencies continue to strengthen their programs as ISII provides ongoing consultation, support, and fidelity review for PTC-R.
In this first PMTO implementation, initiated nationwide in child welfare and child mental community clinics, 29 community practitioners were certified as PMTO Specialists in 2001 as the first generation of this full transfer program. Ten years later, 92% of this first generation had maintained PMTO certification and continued to provide PMTO services to families in their communities. As of 2014, there were over 600 registered PMTO practitioners in more than 300 workplaces throughout the nation. More than 20,000 families were estimated to have received PMTO-related services in Norway during its first 14 years. Cultural adaptations have been made to provide services to the ethnic minorities of immigrant Somali and Pakistani mothers in Norway. This community of PMTO professionals continues to train its own leaders, trainers, coaches, and fidelity raters for future generations of PMTO clinicians.
“It has given me hope on behalf of the children of Norway, … and it’s so much more fun to work with these families.”
“I’ve worked with young human beings for 14 years, and I’ve really been looking for a method that works, and I think I’ve found it.”
(statements by PMTO therapists working towards certification, speaking at the Norwegian PMTO certification ceremony, 2000)
After Deployment: Adaptive Parenting Tools (ADAPT)
Minneapolis, MN (initiated 2010)
This trauma-informed project, developed by Dr. Abigail Gewirtz and colleagues at the University of Minnesota in collaboration with Marion Forgatch at OSLC and ISII, is being tested in clinical trials funded by NIH (completed) and the Department of Defense (ongoing). The goal of ADAPT is to promote resilience among military parents and their children and to provide support for military families coping with the stress of deployment and reintegration. Originally developed as a web-enhanced group-based program, ADAPT has reached 336 Minnesota military families and is showing improvements in observed parenting, parenting efficacy, parents’ mental health (reduced suicidality, depression, and PTSD symptoms) and children’s adjustment (per teacher, child, and parent report) over a 1-2 year period. Four new PMTO-informed versions – self-directed online, tele-health with facilitator coach, workshop-based, and individual face-to-face – have recently been developed to reach additional families and are now being tested. http://www.cehd.umn.edu/fsos/projects/adapt/default.asp
“We have been through two deployments and hope that is all we do. But I feel if another one happens I can rely on the teachings that I received through ADAPT to ease the burden."
– Spouse of Army National Guardsman, participant in ADAPT
Criando con Amor: Promoviendo Armonia y Superación (CAPAS)
Utah (initiated 2006)
The first adaptation of PMTO for Spanish-speaking families, adapted by Melanie Domenech Rodríguez in collaboration with Marion Forgatch, CAPAS-Utah was implemented in a rural community in Utah for Latino/a families. As in all PMTO cultural adaptations, the process was led by a cultural adaptation specialist (CAS), a PMTO-trained expert with direct knowledge of the target population. It was further adapted as a new project in Detroit, Michigan (CAPAS-Enhanced) and as a pilot project in Mexico City (CAPAS-Mx). See separate descriptions for these projects on this page.
Strengthening Latino/a Families by Enhancing Parenting Practices
Lansing and Detroit (initiated 2007)
This randomized controlled trial, led by Rubén Parra-Cardona in close collaboration with Melanie Domenech Rodríguez, Marion Forgatch and Detroit community leaders, provided PTC 12-week parenting groups to low-income Latino/a immigrant families with children ages 4-12. This adaptation was enhanced from the original adaptation of PTC (CAPAS) carried out by Domenech-Rodriguez and her colleagues. The expanded intervention, known as "CAPAS-Enhanced", included sessions addressing parenting as a Latino family, immigration, coping with racism, and becoming a bicultural family. The focus of the intervention was preventive in nature as only families with children exhibiting moderate behavioral problems were recruited in the study. An 87% overall retention rate of participating families was achieved including a retention rate of 85% for fathers, considerably higher than rates reported in other community-based studies with underserved Latinos/as. Central to this work was the training of community leaders as parenting interventionists. This exploratory study, funded by the National Institute of Mental Health, showed that rigorous evidence-based preventive parenting interventions can be successfully disseminated among low-income Latino populations exposed to multiple stressors. Results also indicate that both parents in these families reported significant improvements in child internalizing behaviors such as sadness and withdrawn behaviors, with fathers reporting the highest improvements in externalizing behaviors such as rule-breaking.
A separate randomized controlled trial has just been funded by the National Institute on Drug Abuse. The curriculum for this exploratory study integrated PTC-R materials from our New York City implementation project. The focus of this investigation is also preventative in nature and targets low-income Latino families with adolescent children ages 12-14. Similar themes focused on culture are integrated into the intervention, with a strong focus on addressing cultural conflicts in families, as well as the promotion of biculturalism. (See articles describing this project.)
Padres Preparados (Prepared Parents)
This PMTO-informed multi-media Spanish language intervention supports Latino/a families with children who attend Head Start, teaching parenting skills to help improve children’s school readiness. Funded by the National Institutes of Health, Padres Preparados is the result of a collaboration between Dr. Melanie Domenech Rodríguez, a PMTO Mentor and an expert in the cultural adaptation of research-based parenting interventions for Latino populations, and IRIS Educational Media, a research firm in Eugene, Oregon.
CAPAS, Mexico City – Adaptation and Trial of a Training Model in Positive Parenting Practices in Mexican Families with Children with Behavior Problems
Extensive and detailed collaboration between ISII and ISII-trained clinicians in the US and Mexico as well as a graphic artist in Mexico City resulted in this beautiful cultural adaptation of the intervention and training manual for families in Mexico City. This project, led by Nancy Amador Buenabad, later incorporated new components of updated PMTO/PTC manuals from Kansas and New York City projects. As in all PMTO cultural adaptations, the process was led by a cultural adaptation specialist (CAS), a PMTO-trained expert with direct knowledge of the target population.
Harriet Tubman Shelter (initiated 2009) — This pilot project, developed by Dr. Abigail Gewirtz in collaboration with ISII, provided a Parenting through Change (PTC) group (a 14-week group delivery of the PMTO model) for mothers temporarily housed in shelters due to homelessness or domestic violence. Groups retained 90% of the mothers over the 14 weeks despite the fact that the number of mothers living at the shelter dropped from 80% to 30%. Mothers participating in the project expressed a high level of satisfaction.
Early Risers-Healthy Families Network (initiated 2013) — This program funded by NIMH and NIDA, involved a partnership between the University of Minnesota and the Family Housing Fund and its partners in the Twin Cities Metro area. The pilot project provided PTC groups to families in family supportive housing sites as part of an empirically supported family-based prevention program. Outcomes from the randomized controlled trial showed significant decreases in children’s depression and externalizing behavior as well as maternal reports of increased confidence and improved parenting.
Northern Uganda – Jingo Kupe I Dog Gang (Enhancing Family Connection in Northern Uganda)
This adaptation and further development of Parenting through Change (PTC), a group delivery of PMTO, was developed by Dr. Elizabeth Wieling in collaboration with ISII for families affected by psychological trauma related to war, organized violence, and disaster. Modifications in the curriculum address cross-cultural variations in family/community parenting values and practices. Parenting materials were made accessible for non-literate populations by creating pictorial depictions of PMTO parenting concepts and tools.
PMTO Teaching Project
Introducing PMTO training in a university setting for the first time, two of our PMTO leaders, Drs. Ana Bauman and Melanie Domenech Rodríguez, are using blended learning (face-to-face and web-based instruction) to train 12 doctoral and post-doctoral students from five universities (Washington University in St. Louis, Utah State, Michigan State, Florida State, and University of Minnesota) in PTC. With support from Washington University’s Institute for Public Health – Center for Dissemination and Implementation Pilot Program and ISII, this project also aims to assess the implementation outcomes and fidelity to the PMTO model of this blended learning platform.