1. Implementing PMTO in The Nederlands Implementation study Nienke Bekkema Karin Wiefferink TNO Quality of Life

2. 2 Presentation today Rationales to implement PMTO in The Netherlands Why implementation research? Research method Preliminary results and learned lessons Future plans

3. 3 Participating agencies Dutch research institutes TNO Quality of Life University of Maastricht Dutch youth care agencies Bascule Amsterdam Cardea and Rivierduinen, Leiden Youthcare Drenthe Foreign partners OSLC (Oregon Social Learning Centre) ISII (Implementation Sciences International, Inc)

4. 4 Why implementing PMTO in The Netherlands? Increase in behavior problems & youngsters involved in criminality Lack of evidence based interventions  Journey to find high quality evidence based interventions abroad  PMTO has good potential to fit into the Dutch context

5. 5 PMTO: Parent Management Training Oregon Based on Social Interaction Learning Theory (SIL, Patterson, 2005) The effectiveness of PMTO has been extensively demonstrated Intensive system of quality control  Introduction in The Netherlands started in 2006  Other European countries that work with PMTO: Norway, Iceland and Denmark

6. 6 Why study the implementation of PMTO? Efficacy does not necessarily lead to effectiveness in “real world practice” Implementing innovations is no simple matter: several factors can help or hinder the process of implementation  Risk: intervention is not used as intended: Effectiveness of the intervention is endangered  However: empirically studying implementation processes is still very new in youth research

7. 7 Socio-political environment Organisation PMTO Therapist Implementation strategy Implementation Effectiveness Model: introducing innovations in organisations (Paulussen et al, 2007)

8. 8 Aim of implementation study: Collect knowledge on all success and failure factors that influence the implementation on PMTO to:  Construct a tailored implementation strategy  Enlarge treatment integrity and effectiveness

9. 9 Research questions 1)What are the expectations of therapists regarding PMTO? 2)Which success and failure factors affect the implementation of PMTO and to what extent do the success and failure factors change as a result of the implementation and working with PMTO?

10. 10 Research method Semi-structured interviews and questionnaires  Managers of youth care agencies (n=4)  PMTO-coordinators (n=4)  PMTO-therapists (n=30)  Non-PMTO-therapists (n=27) 4 assessment moments

11. 11 Preliminary results Questionnaires Table 1. Expectations concerning PMTO PMTO-therapistNon-PMTO-therapist Self-efficacy (1-5) Outcome beliefs parents (1-5) Outcome beliefs children (1-5) Clarity (1-6) Instrumentality (1-6) Expected benefits therapist (1-6) Importance benefits therapist (1-6) 4,3 4,2* 3,9 5,2* 4,6* 4,4* 4,2 3,9 3,7 4,8 4,1 3,5 3,7 * t-test, p<0.05.

12. 12 Preliminary results learned lessons during interviews Reasons to adopt PMTO: Managers: Evidence-based Match with mission and policy Therapists: Career perspective Education Coaching en supervision  Recruitment of agencies and therapists should be tailored to their expectations

13. 13 Screening and influx of families Insufficient influx of families can be caused by: Parental objections against video and amount of questionnaires Internal mismatch of family and intervention

14. 14 PMTO education and supervision Education and supervision are important factors in facilitating the use of PMTO as intended Group supervision by means of video fragments of family sessions: informative and objective

15. 15 Dutch PMTO treatment First experiences are very good: “PMTO is a treatment, no training. The manual should offer the reader a “PMTO-menu” with different ingredients to choose from” Role-play is valued by therapists and parents for practicing new techniques in an active manner Pay extra attention to: Objections of parents against video and questionnaires: clear face-to-face explanation. Motivating parents: e.g. by SMS en email

16. 16 Conclusion We identified success and failure factors influencing the implementation of PMTO  Input for constructing an (national) implementation strategy and implementation manual for introducing PMTO in new organizations

17. 17 Future research plans: Implementation study Analysis of therapist conceptions and attitudes (questionnaire data) Analysis of therapist fidelity related to family outcomes

18. 18 Other plans Effectiveness study 2008: Randomized Controlled Trial: PMTO compared to care as usual Expert centre Ensure quality control PMTO

19. Thank You! Information: Nienke.Bekkema@TNO.nl