1. PMTO in The Netherlands Corine de Ruiter, Maastricht University Ferko Öry, TNO Quality of Life

2. Parent Management Training Oregon model PMTO A research-based effective intervention aimed at strenghtening the parenting skills of parents with children with externalizing behavior problems

3. PMTO Scientific foundation (Social Interaction Learning theory: Patterson, Reid, & Dishion) Certified as an effective program by SAMHSA in the US

4. Domains Family School Neighborhood Culture

5. PMTO For parents of children with serious externalizing behavior problems Outpatient treatment program of 20-25 sessions on average

6. Advantages PMTO Few parents dropout of the program Continuous monitoring of program integrity Program empowers parents and therapists Proven effectiveness in US International collaboration

7. The Netherlands- 2006: no effectiveness research on interventions for 4-12 yr old children with externalizing behavior problems Violent crime among adolescents show steady increase since the mid-90’s (Wittebrood, 2001). Systematic review by Trimbos-institute (2004): a lot of different interventions offered, but none are tested on effectiveness Interventions imported from abroad show program drift

8. Effects of PMTO Decrease of internalizing en externalizing problems in the children Less criminal offending, substance use at longer term follow up Decrease in depression in parents; increase in competence

9. Content of PMTO Parents are taught 5 key parenting skills: Thuis samen problemen oplossen (problem solving) Kinderen discipline bijbrengen (discipline) Thuis een warme & liefdevolle omgeving scheppen Kinderen volgen (monitoring) Kinderen sociale vaardigheden leren (skill training)

10. Organisation and design for PMTO in The Netherlands Partner institutions (1): ISII Oregon/Oslo and Oregon Social Learning Center: training of therapists, training in fidelity checks and assistance with implementation TNO Qaulity of Life (program management and implementation research) Maastricht University: fidelity checks; Randomized Controlled Trial (RCT), Cost-Utility Analysis (CUA) and Health Technology Assessment (HTA) study

11. Organisation and design for PMTO in The Netherlands Partner institutions (2): PI-Research (translation of PMTO material; implementation research) NIZW Youth: liaison with other “import” programs De Bascule, Cardea, Rivierduinen, Jeugdzorg Drenthe: training, intervision and use of PMTO program Trimbos-institute & Erasmus University: participation in RCT, KEA and HTA

12. Financing Now: 3,6 million euro via public–private partnership Government: Ministries of Health and Justice, Provincies and City regions Centraal Fonds RVVZ van de Zorgverzekeraars Private funds: (o.a. Kinderpostzegels Nederland, VSB- fonds, Rabobank Foundation en Fonds Psychische Gezondheid) In the future structural financing: via health insurance companies, (o.a. Diagnosis Behandel Combinaties DBC’s)

13. Research on effectiveness Treatment integrity: behandelintegriteit with fidelity checks Modification of PMTO training material for ethnic minorities Randomized Controlled Trial (RCT), Cost Utility Analysis (CUA of KEA) and Health Technology Assessment (HTA): vooraanmelding positief beoordeeld door Doelmatigheidsprogramma ZonMw Research on Implementation

14. Trainingplan for PMTO in The Netherlands PMTO conference 12 january 2006 Training 12 – 15 therapists March 2006 Training 12 – 15 therapists September 2006 Training fidelity coders during 2006 Research on implementation starts February 2006 RCT, CUA (KEA) and HTA start in 2007

15. Concept Organisational structure PMTO in The Netherlands

16. PMTO as a strategy Evidence-based and effective Preventing program drift by fidelity checks and intervision Parents as partners, own strength based Change in mentality of executing staff by using impact measures as guiding principle Increased professional identity of professionals and managers of participatring institutions New vision on implementation fed by research on implementation guided by impact & outcome data Maximal commitment of field staff by their possibility to feed in the program content

17. And now …..let’s hit the road!