Randomized Controlled Trial (RCT) of Parent Management Training Oregon model (PMTO) for children with externalizing behaviour problems in The Netherlands

As longitudinal research has demonstrated a high degree of stability and
aggravation of conduct problems in childhood into criminal and violent behavior
in adulthood, early interventions can result in great benefit. There is
currently a high need for (cost)effective treatment programs for children 4-10
years with antisocial conduct problems in The Netherlands. The Ministry of
Health decided in 2005 to fund the implementation of Parent Management Training
Oregon model (PMTO), a theory-driven, evidence-based intervention for parents
of children with externalizing behavior problems.
The following specific hypotheses will be tested in the current research
project:

(1) PMTO, compared to CAU, will result in statistically significant benefits in
terms of:
(a) parenting skills
(b) parenting stress
(c) child behavior problems (externalizing and internalizing)
(d) child prosocial behavior
(e) costs related to the intervention

(2) Benefits of PMTO will be observed at 6 months post baseline, and maintained
in the ensuing follow-ups at 12 and 18 months.

(3) PMTO program integrity, as measured by means of the FIMP rating system,
will have a significant positive correlation with PMTO effectiveness.

(4) PMTO, compared to CAU, will have higher treatment compliance and fewer
dropouts.

The proposed RCT has as its goal to test the effectiveness of PMTO against Care
As Usual (CAU).

The study will be conducted as Randomized Controlled Trial (RCT) with
assessments at regular intervals, i.e. baseline (pretreatment), 6, 12 and 18
months. Four youth (mental health) care institutions in The Netherlands are
committed to participate in the current project, and have guaranteed sufficient
patient supply.

The theoretical model underpinning PMTO is Social Interaction Learning (SIL;
Patterson, 2005), a model that specifies that parents mediate the effect of
harsh family contextual factors, such as stress, poverty, parental
psychopathology, on child adjustment. Because the SIL model emphasizes the
importance of parental influence on child development, parents are the primary
recipients of the intervention.
PMTO is built around 5 theoretically based effective parenting practices: skill
encouragement, setting limits, monitoring, problem solving, and positive
involvement. Essentially, a central role of the PMTO therapist is to coach
parents in applying effective parenting strategies to diminish coercive tactics
through these core practices. *Skill encouragement* incorporates ways in which
adults promote competencies using contingent positive reinforcement (e.g.,
establishing reasonable goals, breaking goals into achievable steps, promoting
behavior, rewarding progress, use of praise, incentive charts). *Setting limits
or discipline* involves the establishment of appropriate rules with the
application of mild contingent sanctions for rule violations. Parents are
taught to be consistent in their use of short, relatively immediate negative
consequences (e.g., time out, work chores, privilege removal) contingent upon
the child*s problematic behavior. *Monitoring* (supervision) becomes especially
critical as children spend more time away from home. This skill requires
keeping track of children*s activities, associates, whereabouts, and arranging
for appropriate supervision. *Problem solving* involves skills that help family
members negotiate disagreements, establish rules, and specify consequences for
following or violating rules. *Positive involvement* reflects the many ways
parents invest time and plan activities with their children (Forgatch and
Knutson, 2002; Martinez and Forgatch, 2001). Other topics that are relevant to
families with behaviorally disordered children are also part of the
intervention, such as regulating emotion, communication skills, and promoting
school success. Components may be added to enhance the program*s effectiveness,
depending on the family setting and context (e.g., issues specific to single
mothers, stepfamilies; sibling conflict).

Parents and children will participate in assessments at fixed time intervals.
This will require some time and effort on their part. There are no risks
involved. Possible benefits to parents and children are: increased parenting
competence, decrease in child behaviour problems, overall stress reduction
within the family, prevention of future antisocial development.