The History of
ISII and PMTO™
Since the 1970s, colleagues at the Oregon Social Learning Center (OSLC) have developed and tested theory-based interventions to treat and prevent conduct and associated problems in children and youth. This research, which has been supported by the National Institutes of Health (NIH), has generated a set of intervention programs that are now recognized as empirically supported treatments (EST). The basic model underlying these methods is called Parent Management Training - the Oregon Model (PMTO). PMTO provides preventive and clinical interventions for families of youngsters with behavioral problems in the externalizing spectrum (e.g., aggression, antisocial behavior, conduct problems, conduct disorder, oppositional defiance, delinquency, and substance use). In order to extend these programs to the families who need help, a network of OSLC-affiliated organizations was established. Since 2001, ISII has become the driving force behind PMTO training for mental health professionals worldwide.
The first nationwide implementation of PMTO began in 1999 in Norway with a request from the Norwegian government to train a set of PMTO specialists. The goal was to establish a sustainable EST program to serve families in need in every municipality throughout the nation in two systems of care (child welfare and child mental health). This project led to the birth of ISII, a nonprofit corporation with the goal of providing professional training in PMTO and PMTO-associated methods to mental health and child welfare professionals both nationally and internationally.
Since 2001, leaders in Iceland, the Netherlands, Denmark, the State of Michigan, Wayne County Michigan, and Kansas have contracted with ISII for system-wide trainings of professionals in communities, states, and nations. Pilot programs have tested service provision for parents who have lost custody for maltreatment (Detroit), mothers in shelters because of domestic violence or homelessness (Minnesota), and Somalian immigrant parents (Minnesota). Three scientists have received NIH awards to adapt and test PMTO for Latina/o families in Utah, Minnesota, and Michigan. These studies have fostered implementation of a prevention program for parents in Mexico City.
ISII provides full program transfer from the purveyor to the community. This approach entails training a progenitor generation (Generation 1) and selecting leaders from this group to build an infrastructure to carry out training, fidelity checks, certification, coaching, and further tailoring. Data from the Norwegian project provides strong support that the full program transfer approach works with sustained fidelity over a period of 10 years (Forgatch & DeGarmo, 2011). For example, ISII trained and certified 29 G1 PMTO therapists. In the 10 years following their certification, 92% were still certified and practicing PMTO. In 2011, there are more than 400 certified PMTO therapists and a similar number trained in a PMTO-informed prevention model for parent counseling. This approach is now under way in Iceland, The Netherlands, Denmark, Michigan, and Kansas.
Understanding the processes that ensure sustainable PMTO implementation with fidelity is of great importance to ISII. We work with motivated partners who want to see the method sustained in their community with the highest level of fidelity for five years or more to ensure that PMTO effectively serves families in need. For these reasons, we always collect data on our implementation efforts from participating agencies, therapists, and families. Our goal is to understand which key factors predict sustained fidelity over time.
We have developed an observation-based measure to evaluate method fidelity - Fidelity of Implementation Rating System (FIMP: Knutson, Forgatch, Rains, & Sigmarsdóttir, 2009). The measure has been validated in two studies demonstrating that high FIMP scores observed during intervention predicts change in parenting practices observed between parents and their children before and after treatment (Forgatch & DeGarmo, 2011; Forgatch, Patterson, & DeGarmo, 2005). As part of the full transfer of PMTO, certified PMTO practitioners receive training to become part of our international FIMP network.
We are committed to ensuring success in the implementation process, which we define as sustained method fidelity that is measured during community practice. We are involved in selection of agencies, certification of PMTO specialists, facilitation of infrastructure development and maintenance through training of coaches, trainers, and fidelity raters. The overarching goal is to sustain fidelity in current and future generations.
As infrastructure is established and leadership is trained, we become less engaged and serve as consultants. What sets us apart from many programs is that we elicit local involvement, help their leaders select and train, and then we let go. To ensure sustained fidelity, we conduct periodic reliability checks between community and ISII FIMP rating teams.
We believe that cultural adaptations are best negotiated on-site and we work with our clients to best adapt our model to fit the needs of the targeted population.