Podcast interview: Dr. Marion Forgatch of PMTO

Dr. Marion Forgatch is a key developer of Parent Management Training-Oregon Model (PMTO), a landmark parent-focused intervention based on more than 50 years of research.

In this discussion on the Center for Resilient Families podcast, Dr. Forgatch explains the basics of PMTO and why an organization may be interested in adopting it.

You can listen below, or listen on your phone via iTunes or Stitcher. A transcript of the interview is below.

The Center for Resilient Families’s mission is to spread the use of parent-focused interventions that have been proven to be effective. The Center trained a group of clinicians in PMTO this fall and is offering tuition-free training in several other proven interventions over the next four years. To learn more or apply, visit http://crf.umn.edu.

The Center is funded by a grant from from the Substance Abuse and Mental Health Services Administration and is housed within the Institute for Translational Research in Children’s Mental Health at the University of Minnesota.

Transcript:

What is PMTO and how did it come to be?

It’s a program originally developed by Gerald Patterson, who by the way is a Minnesotan, who worked originally from a psycho-dynamic perspective in a residential clinic for children. They could help the children sometimes when they were in the clinic, but when they sent them home, they bounced back. And he wanted to know: what happens in families? It’s not just in the child. It must be something going on in the family.

So, he began going into the families to observe what happens between parents and children. From that, he started to understand that parents are really important, and that what clinicians need to know is help parents be very effective in raising their children.

What are some examples of the things the program teaches parents to do?

It teaches parents to be good teachers. In fact, parents are their children’s best teachers. You can teach through encouragement: catching your child doing the right thing, and noticing it, and encouraging them to do more. Or you can teach through correction: that is, catch them doing it wrong and criticize them, correct them and tell them, “Don’t do that.” But one of the problems with that is that kids don’t necessarily know what to do when you tell them not to do something. So, we teach parents to do something like give a clear direction their kids, instead of, “Pick up your shoes! Don’t you know they’re not supposed to be there?” Which, anybody who’s a parent has done something like that.

Instead, when you see the shoes on the floor and they should be in the closet or by the side of the door, to take the time to calm yourself down and say, “What do I want?” I want the shoes picked up and put beside the door. So how can I do that? I’m going to get up, I’m going to walk over to my child, I’m going to put my hand on his shoulder and look in his eyes and smile. I’m going to say, “Sammy, pick up your shoes and put them by the door please.” And then I’m going to do what we call “stand and hold.” I’m going to hang out there for 10 seconds with a pleasant expression on my face, simply waiting.

PMTO is an intervention that is adopted organization-wide, usually bigger organizations like counties, states or provinces. What generally motivates an organization to approach you about adopting PMTO?

They have a caseload of families with children who may be out of control, hyperactive, aggressive, noncompliant, sad. What they’re using isn’t working. Families are disappointed, clinicians are leaving their jobs because they don’t have job satisfaction because what they’re doing doesn’t work. So, they’re organizations that want to help families and have a lot of families that need help.

Your team is really focused on sustainable implementation for the long-term. What things go into that?

We do what is called “full transfer.” That is, we train a group of practitioners. When agencies select practitioners for this training, they want to select people who are going to be with the organization for some time, who have some leadership skills, who are clinically gifted. This is because, from the group that we train, we help the agencies select leaders to now train future generations.

So for example, in Norway about 20 years ago, we trained the first generation. They were clinicians from all over the nation. We trained 30 to certification. Those 30, in the years since, have trained 1,300 active clinicians and they’re serving 20,000 families. So, we trained 30 and then we helped the agency or organization have what we call a “governance authority” to oversee the training, coaching and fidelity monitoring of the team. And so you pay us at first, but then you pay your own staff and they’re the ones that carry the program forward.

What kind of results do these organizations see?

We’ve done a number of clinical trials. We randomly assign people to PMTO or something else – treatment as usual. What we find is — by parent report, teacher report and direct observation — improvement in parenting practices, and that leads to improvement in child outcomes. Things like police arrests, teacher ratings of externalizing behavior, children’s ratings of their own depression and association with deviant peers. Several positive outcomes in study after study.

Say I am someone in an organization and I’m interested in adopting PMTO for my organization. What are my first steps in order to proceed?

You would contact us and we would tell you about what it would take. We have a readiness questionnaire that we can talk you through or give you to fill out that says what we expect of you in order for you to be able to do this. Then, if we both agree that this is something we both want to move forward with, you would want to have meetings with stakeholders. The kind of stakeholders you would have would be agency leaders, practitioners, and parents. One of the things that parents say is that they used to sit in the waiting room while the kid went in to see the therapist and then they would go home, and they didn’t know what happened and didn’t change anything they did. Now [with PMTO] the parents are going into the room and it’s not that we’re blaming the parents, we’re teaching the parents to be really effective teachers. They love going in and learning how they can be more effective in raising their kids.

Learn more about PMTO here.