Implementation Outcomes As a Function of Implementation Context and Culture: Parent Management Training–Oregon Model

Introduction: Parent Management Training–Oregon (PMTO) is a well-validated selective and targeted prevention program that has been implemented nationally and internationally in child welfare, juvenile justice, children’s mental health systems, and specialized contexts, such as with military and immigrant families. Effectiveness studies have established the short- and long-term effectiveness of PMTO in the USA and in Europe. Two implementation studies of the intervention have established the predictive validity of the PMTO fidelity of implementation system and have demonstrated that practitioner fidelity is associated over time with changes in parenting practices of mothers and of fathers. Studies also have examined the organizational context in which PMTO is implemented. For example, in a series of Norwegian studies, the number of therapists per agency trained in the PMTO intervention (three or more vs. two or less) was significantly associated with therapists’ positive workplace ratings (controlling for agency size, leadership quality, service population, and therapist education). Workplace ratings were significantly higher when at least three clinicians were trained in an agency.

Methods and Results: We examine variability in implementation outcomes such as certification of trainees and staff turnover in PMTO programs implemented across three U.S. children’s service systems (children’s mental health, child welfare, and juvenile justice). PMTO has been implemented statewide in Michigan and Kansas. Juvenile justice and child welfare system contexts were associated with less training completion, fewer interventionists certified, and higher turnover of interventionists during training, compared with children’s mental health system contexts. We describe each of the contexts, organizational cultures, and the modifications required for PMTO, and discuss system characteristics that may present challenges for the implementation of empirically supported prevention interventions.

Discussion: Findings suggest the relevance of assessing and addressing organization capacity, culture, and leadership when implementating selected interventions, such as PMTO, in real-world service settings.