Parent Management Training Oregon®

An intervention to help parents and caregivers manage the behaviour of their children in order to promote prosocial skills and cooperation.

The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness from this review. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest. 

Overview

Evidence Rating

Well-supported+

Pathway

  • Early help
  • Targeted and specialist

Australian Study

Not included

Risk of Bias

Low concerns

Cost

No cost information available

Target Age Group

Age 4 to 12

About

Parent Management Training Oregon® (PMTO®) is a parent management training intervention to help parents and caregivers manage the behaviour of their children. PMTO® is designed to promote pro-social skills and cooperation and to prevent, reduce and reverse the development and maintenance of mild to severe conduct problems in children aged 4 to 12. PMTO® empowers parents as primary treatment agents to promote and sustain positive change in families. The basic model underlying these methods is called GenerationPMTO.

Aims

  • Improve child-parent interaction
  • Reduce child behavioural problems
  • Improve social competency and peer relations
  • Reduce and prevent delinquency and police arrests
  • Reduce depression and anxiety
  • Prevent out of home placement in youth
  • Prevent substance use and abuse in youth.

Impact

Evidence is mixed for parent and child mental health. There is evidence that PMTO® improved parenting skills in positive disciplining and setting clear expectations.

Direction of effect
Outcome domain Outcome measured Positive effect No effect Negative effect
Child Mental health/behaviour Yes Not found Yes
Parent/caregiver Mental health/functioning Yes Not found Yes
Parent/caregiver Parenting skills Yes Not found Not found
Parent/caregiver Wellbeing Yes Not found Yes

How to read the table:

When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page. 

PMTO® has an evidence rating of Well-supported+.

This means that PMTO® has evidence from at least 2 randomised controlled trials (RCT) and/or quasi-experiments (QE) demonstrating positive, long-term impact on at least one child and family outcome.

This assessment is based on 6 research outputs from 5 RCTs and 1 QE. Another 9 RCTs were identified but did not count towards the evidence due to concerns with study quality. PMTO® has not received a Very well-supported rating as a rigorous systematic review with meta-analysis has not been conducted.

Included research by design and outputs
Study design Number of research outputs included
Systematic review with meta-analysis Not identified or included
Randomised controlled trial 5
Quasi-experiment 1

The evidence has low concerns with risk of bias.

We can be confident about the results and quality of evidence from the included studies. When interpreting the results, it is important to take into consideration the 5 RCTs that supports this evidence. 

The studies were conducted internationally and do not include Aboriginal children and families.

Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.

Location

  • The studies were conducted in Norway and the Netherlands.

Sample

  • The studies’ samples ranged from 137 to 146 children.
  • The age of the children ranged from 3 to 12.
  • The largest study was conducted in the Netherlands. It investigated 146 families (96 intervention, 50 control) with children aged 4 to 11, referred to child services agencies with behavioural problems. Almost 90% of the parents were of Dutch nationality.
  • In the other papers, most parents had a Norwegian background, with a small percentage who reported other ethnicities.  

Implementation

Delivery model, mode and setting

  • PMTO® is delivered in-person and online, to the parent only, in a group setting with multiple parents, children and/or families, and to an organisation.
  • The program is typically conducted in adoptive homes, community settings, outpatient clinics, community-based agency or online.

Target cohort

  • Parents of children with disruptive behaviours, substance use and abuse, delinquency, police arrests, out-of-home placement and deviant peer association
  • Parents experiencing high stress and living in poverty
  • Birth parents whose children are in care because of abuse/neglect, and families with transitions such as divorce, single parenting and step-families
  • Children aged 2 to 18.

Program delivery

  • Parents are the focus of the intervention, however, children/youth and other family members can be part of the intervention in family sessions.
  • The core components of GenerationPMTO are:
    • Skill encouragement, teaching positive behaviour
    • Systematic, mild consequences for negative behaviour
    • Monitoring and supervision
    • Interpersonal problem solving
    • Positive involvement.
  • Interventions are tailored for specific problems, such as school problems, conduct problems, theft, antisocial behaviour, internalising and externalising problems and deviant per association.  
  • Fidelity of Implementation Rating System (FIMP) is used to direct observe segments of sessions and evaluate 5 theoretically relevant categories:
    1. Knowledge
    2. Structure
    3. Teaching
    4. Process Skills
    5. Overall Development.
  • The implementation approach involves training the adopting communities to conduct GenerationPMTO practice independently over time so that every implementation site achieves the capacity to train, coach, certify, recertify, and evaluate GenerationPMTO fidelity.
  • PMTO® can be provided in a group setting called Parenting Through Change (PTC).

Duration and intensity

  • A total 10 to 25 individual or family sessions over 3 to 6 months or longer, depending on circumstances. In some cases, 6 to 8 sessions may be used for mild problems or prevention.
  • The recommended intensity is 60 minute weekly individual or family sessions.

Guides and manuals

  • Pre-implementation guides are available to measure provider readiness through readiness checklists tailored for various types of implementation.
  • Implementation guides or manuals are provided at workshops to those who receive training in GenerationPMTO.

Additional information

Staffing

  • The team includes team members, PMTO® practitioners and coaches.
  • Staff require a master’s Degree in a relevant field or a bachelor’s Degree with 5 years appropriate clinical experience.
  • Staff must undergo an extensive training program to become a certified GenerationPMTO specialist.

Training 

  • A typical training program includes 18 workshop days across 3 to 5 workshops and coaching seminars. The coaching seminars include active teaching techniques, such as video demonstrations, modelling, role play, experimental exercises and video-recording of practice followed up with direct feedback. 
  • Certification takes an average of 22 months. Completing the process of certification involves candidates providing services to a minimum of 3 training families.
  • The cost of a year-long training program to become a certified GenerationPMTO Specialist in 2019 was USD$8,000. 

To our knowledge, PMTO® is not available and has not been implemented in Australia.

Cost

We were unable to locate any information on the cost of PMTO®.

References

Studies identified and included in the review

  • Hukkelberg S, Tømmerås T and Ogden T (2019). Parent training: Effects beyond conduct problems. Children and Youth Services Review 100: 405-414. 
  • Kjøbli J, Hukkelberg S and Ogden T (2013). A randomized trial of group parent training: reducing child conduct problems in real-world settings. Behaviour Research & Therapy 51(3): 113-121. 
  • Kjøbli J, Zachrisson HD and Bjornebekk G (2018). Three randomized effectiveness trials-One question: Can callous-unemotional traits in children be altered? Journal of Clinical Child and Adolescent Psychology 47(3): 436-443. 
  • Thijssen J, Vink G, Muris P and de Ruiter C (2017). The Effectiveness of Parent Management Training-Oregon Model in Clinically Referred Children with Externalizing Behavior Problems in The Netherlands. Child Psychiatry & Human Development 48(1): 136-150. 
  • Tommeras T and Kjøbli J (2017). Family resources and effects on child behavior problem interventions: A cumulative risk approach. Journal of Child and Family Studies 26(10): 2936-2947. 
  • Tommeras T, Kjøbli J and Forgatch M (2018). Benefits of Child Behavior Interventions for Parent Well-Being. Family Relations 67(5): 644-659. 

Studies identified but not counted towards the evidence rating due to study quality

  • Akin BA, Byers KD, Lloyd MH and McDonald TP (2015). Joining formative evaluation with translational science to assess an EBI in foster care: Examining social-emotional well-being and placement stability. Children and Youth Services Review 58: 253-264. 
  • Akin BA, Lang K, McDonald TP, Yan Y and Little T (2018a). Randomized Study of PMTO in Foster Care: Six-Month Parent Outcomes. Research on Social Work Practice 28(7): 810-826. 
  • Akin BA, Lang K, Yan Y and McDonald TP (2018b). Randomized trial of PMTO in foster care: 12-month child well-being, parenting, and caregiver functioning outcomes. Children and Youth Services Review 95: 49-63. 
  • Akin BA and McDonald TP (2018c). Parenting intervention effects on reunification: A randomized trial of PMTO in foster care. Child Abuse and Neglect 83: 94-105. 
  • Akin BA, Lang K, McDonald TP, Yan Y and Little T (2019). Randomized trial of PMTO in foster care: Six-month child well-being outcomes. Research on Social Work Practice 29(2): 206-222. 
  • Bjørknes R, Kjøbli J, Manger T and Jakobsen R (2012). Parent training among ethnic minorities: Parenting practices as mediators of change in child conduct problems. Family Relations 61(1): 101-114. 
  • Bjørknes R, Larsen M, Gwanzura-Ottemoller F and Kjøbli J (2015). Exploring mental distress among immigrant mothers participating in parent training. Children and Youth Services Review 51: 10-17. 
  • Bjørknes R and Manger T (2013). Can parent training alter parent practice and reduce conduct problems in ethnic minority children? A randomized controlled trial. Prevention Science 14(1): 52‐63. 
  • Ogden T and Hagen KA (2008). Treatment Effectiveness of Parent Management Training in Norway: A Randomized Controlled Trial of Children With Conduct Problems. Journal of Consulting and Clinical Psychology 76(4): 607-621. 
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