1. IMPLEMENTATION OF PMTO IN ICELAND EVIDENSEKONFERENCE – DENMARK 2012 Margrét Sigmarsdóttir

2. AGENDA Introduction to the Implementation Results from the implementation study Method of the implementation study Discussions and experiences

3. INTRODUCTION

5. PMTO was developed by Gerald Patterson, Marion Forgatch and colleagues at the Oregon Social Learning Center Builds on Gerald Patterson´s theory about the development of antisocial behavior

6. REACHING MORE THAN HALF OF THE POPULATION 2012

8. SUCCESSFUL IMPLEMENTATION Building base Recruiting professionals Ongoing training/coaching Infrastructure Many critical steps Fidelity *

9. INFRASTRUCTURE A small department in the community of Hafnarfjördur Serves as the central department for the PMTO nationwide implementation infrastructure PMT-FORELDRAFÆRNI

10. FIDELITY Fidelity measures provide information about the manner in which practitioners adhere to content and practices of a given method The Fidelity of Implementation Rating System (FIMP) is an observation-based measure assessing therapist’s competence and adherence to PMTO (Knutson, Forgatch, Rains & Sigmarsdóttir 2009)

11. FIDELITY Earlier findings have shown that high FIMP scores predict greater improvement in outcomes (Forgatch & DeGarmo, 2011; Forgatch, Patterson & DeGarmo, 2005; Ogden & Amlund Hagen, 2008)

12. Child adjustment Parenting practices Therapist behavior FIMP ( Fidelity of Implementation Rating System) Adapted in Iceland from Marion Forgatch by Margrét Sigmarsdóttir 2011

13. GOAL WITH THE STUDY To explore if fidelity will sustain by comparing and assessing therapists´ competence and adherence to PMTO between the first three groups of therapists trained in the country

14. METHOOD

15. Competent Adherence to the PMTO Method FIMP FIVE DIMENSIONS Rated on a 9-Point Liker Scale (Knutson et al.,2009) Knowledge Structure Teaching Process skills Overall development 1-3 needs work 4-6 acceptable work 7-9 good work

16. KNOWLEDGE Evaluates therapists’ understanding of the PMTO model and principles, taking into account accuracy of technical details, integration of core and supportive components and application of the model (Knutson et al.,2009)

17. STRUCTURE Measures use of a PMTO agenda followed with relevant phasing and timing while, at the same time, being responsive to families’ needs (Knutson et al.,2009)

18. TEACH Therapists’ ways of balancing instructional strategies to focus on active rather than didactic approaches (Knutson et al.,2009)

19. Examples include use of short, specific raps (verbal summaries that give key information) balanced with role play and other exercises to practice procedures as well as problem solving strategies that engage participants in the learning process (Knutson et al.,2009) TEACH

20. PROCESS SKILLS Therapists´ skills to create a safe and balanced environment for learning to take place. Therapists’ support, effective use of the questioning process, and sophisticated clinical tools are factors measured on this dimension (Knutson et al.,2009)

21. OVERALL DEVELOPMENT A dimension that measures how therapists manage to engage families, create growth in their PMTO skills, motivate them to use the principles and come back to next session (Knutson et al.,2009)

22. EXAMPLES

24. PARTICIPANTS There were 3.9 therapists in Norway per 100.000 from the first three groups 16 therapists from the first three groups of PMTO therapists trained to certification in IS All candidates held graduate degrees from different academic disciplines From the first three groups there were 3.8 therapists in Iceland per 100.000

25. PROCEDURE Reliable FIMP coders rated certification sessions, which consisted of four video- recorded sessions of therapist and parents in PMTO individual therapy

26. PROCEDURE These sessions addressed the following required content: introducing encouragement, troubleshooting encouragement, introducing discipline and troubleshooting discipline

27. RESULTS

28. Sigmarsdóttir & Guðmundsdóttir, 2012

29. CHILD OUTCOME; SEM structural equation model (Sigmarsdóttir, Thorlacius, Guðmundsdóttir, DeGarmo & Forgatch, 2012)

30. DISCUSSION

31. The PMTO implementation in Iceland was a success in terms of demonstrating that the method could be transferred fully from the purveyor to the community without loss of fidelity to the method

32. FIMP score patterns were similar to data from the Norwegian implementation

33. A drop in fidelity for G2 is likely due to an adapting period where material needed translation and coaching and training methods needed to be transferred to the adopting nation

34. In our study we assessed fidelity at certification only Assessing maintenance over time is equally important for future studies FUTURE

35. It is necessary to have a sophisticated assessment tool to measure therapists’ competence and adherence to the method when implementing an EST in the real world

36. Margrét Sigmarsdóttir margret@hafnarfjordur.is