Building Infrastructure to Sustain Community-Based PMTO™
The goal of PMTO implementation is to develop a self-sustaining infrastructure for continued training and delivery of PMTO with fidelity within the target community. This process of full program transfer from purveyor to the community requires significant up-front resource investment to complete the multi-phase process. The four phases are as follows:
- Phase 1: Train the progenitor group of community-based clinicians to certification as PMTO specialists. Certified PMTO Specialists of Generation 1(G1) serve as the pool for future PMTO leadership in the community.
- Phase 2: Selecting and training G1 Certified Specialists to lead as trainers, coaches, and fidelity raters.
- Phase 3: Conducting the training, coaching and fidelity rating of the next generation(s) of community practitioners (G2 and beyond). ISII provides support and coaching to the G1 leaders during this process.
- Phase 4: Sustaining fidelity by maintaining a fidelity rating team that meets regularly for retraining and reliability checks.
To achieve certification as PMTO Specialists, candidates must complete an 18-month training process. G1 receives training by the purveyor. Subsequent generations are trained by selected G1 PMTO leaders from the community. ISII provides coaching and support to G1 leaders during the G2 training.
The PMTO Specialist certification training program requires the following:
- Reduction of existing caseload/workload during training
- 18 days of workshop training
- Supervised practice with a minimum of 3 ‘training’ cases (from agency caseload)
- All sessions video recorded
- All sessions uploaded to secure HIPAA compliant ISII portal/database
- Regular observation-based coaching
- Invitation to start 2 new ‘certification’ cases
- Submission of 4 sessions of best work from the certification cases
- Receipt of passing fidelity scores
A Full-Transfer Success Story
This full transfer process of implementation was evaluated in a nationwide PMTO program in Norway that provided services in community agencies in two systems of care: child welfare and child mental health (Forgatch & DeGarmo, 2011). The Norwegian team has sustained fidelity for five generations; 92% of the G1 clinicians who completed certification are still PMTO certified and practicing 10 years later. In a Norwegian conducted randomized controlled trial, PMTO yielded improved parenting, reduced child behavior problems, and increased child social competence (Amlund Hagen, Ogden, & Bjørnebekk, 2011; Ogden & Amlund Hagen, 2008).