Future of PMTO: A Cultural Adaptation

Research finds that antisocial and disruptive behavior in children and adolescents is costly to society as they account for a larger percentage of health care costs than children with chronic health conditions (Zisser & Eyberg, 2010). Continuation of overt behavior may also lead to truancy, delinquency, and criminal behavior if not addressed properly during the youth’s development. Ethnic minority youths, such as the Hispanic population, in the United States are found to be a large percentage in utilizing mental health services and more at risk (Huey & Polo, 2010). Parent Management Training – Oregon Model (PMTO) is a theory-driven intervention practice proven to treat and prevent antisocial behavior in adolescents (Forgatch & Patterson, 2010). By incorporating culturally sensitive elements toward intervention models, one such as the PMTO, it is believed that the United States’ diverse youth populations can enjoy healthier environments of growth and development.

The emphasis of PMTO is based on social interaction and learning, with a focal point in positive parenting practices that empower parents in the use of positive communication and encouragement than the use of more coercive approaches (Forgatch & Patterson, 2010). Forgatch and Patterson (2010) find that social environment with adverse contexts can indirectly disrupt the social influence with the youth’s growth. Adverse contexts such as poverty, environmental conditions of high-crime and discrimination backgrounds can deviate youth adjustment trajectories into delinquency should families fail to structure positive coaching steps for the child (Forgatch & Patterson, 2010). As such, the program incorporates highly structured, yet malleable, sessions for families to discuss and develop ideas to better respond to the needs of the youth. The treatment for the youth is heavily emphasized on the five dimensions of positive parenting practices: breaking complex behaviors through skill encouragement scaffolding, limit setting as a teaching tool, monitoring youth activities, problem-solving through goal setting and finally more love and attention to the development of the child (Forgatch & Patterson, 2010).

The family sessions are extensively focused on three phases, the introduction of change with a focus on strengths, providing effective directions, and teaching through encouragement. Parents are often encouraged to track and record strengths that make up the fiber of the family, and the strengths will be the foundation toward which change will be built upon (Forgatch & Patterson 2010). Hereafter, Forgatch and Patterson (2010) introduce the element of support through effective direction through role-playing with therapists to enhance cooperation. Afterward, the teaching of new behavior through encouragement is implemented. In all these treatment steps, skill encouragement through positive reinforcement is utilized before limit-setting and reproachful criticism. With four decades of practice behind the development and practice of PMTO, it has shown to reduce depression, delinquency, antisocial behavior, suicidal youth, and a multitude of other problematic behaviors (Forgatch & Patterson, 2010). In most research studies, it was found that an increase in positive parent practice leads to a decrease in child problem behavior. In return, the parent has also shown to benefit from such treatment programs, with a reduction in stress and police arrests, thereby creating more wealth and income for the family.

While the PMTO may be efficient and effective in the past, the future calls for a more interdisciplinary approach in cultural fluency with different minority youth groups. The PMTO originated in the early 1960s and has evolved to incorporate new dimensions in its development. Throughout the decades, PMTO has grown from research in addressing clinical problems to developing a focus on therapy-based treatment and prevention. However, it also needs to address a growing population of minority-based youths that grow in a myriad of social circumstances. In particular, the PMTO should address concerns related to minority group youths that are more steeped in socially disadvantaged circumstances. As Robbins, Szapocznik and Ucha (2010) found, Hispanic youths have the highest reported rates of illicit drug use, with 17%, 27% and 32% in grades 8, 10 and 12 respectively by 2007. Such trends, along with the growing presence of other minority growth, calls for attention on better developing effective treatment practices for minority-based youth groups.

As Huey and Polo (2010) pointed out, while efforts abound to generate cultural competency guidelines, there is no uniform consensus on what is considered culturally competent. Some contend that using therapists of the same race and ethnicity as the family has correlational positive effects (Huey & Polo, 2010). Meanwhile, others contend that cultural enhancement to the treatments provide no additional benefits. Yet, in order to understand the effectiveness of culturally adapted treatment programs, it is wise to consult on one that has been successful prior. One of the programs that showed significant promise is the BSFT. The Brief Strategic Family Therapy (BSFT) program was developed in the 1970’s in Miami, by the Spanish Family Guidance Center, as an intervention program to respond to increasing Hispanic youth drug use, delinquency, and other problematic behavioral problems. Much like PMTO, the BSFT focuses on three central phases: system, structure/patterns of interaction, and strategy (Robbins, Szapocznik & Ucha, 2010). However, unlike PMTO, the emphasis on the BSFT is on actual therapies and observation of how the family interacts, considering the cultural differences and individual needs. In the BSFT, a therapist will observe and try to instigate change through matching the tempo, mood, and style of the family’s interaction instead of prescribing a generic sequence of treatment (Robbins, Szapocznik & Ucha, 2010). Such a program has shown to produce effective results, decreasing antisocial and delinquent behavior in children and instigating change in positive family dynamics. 

References

Forgatch, M. S. & Patterson, G. R. (2010). Parent management training- Oregon Model, An intervention for antisocial behavior in children and adolescents. Weisz, J. and Kazdin, A. E. (2nd Edition). Evidence Based Psychotherapies for Children and Adolescents (159-178). New York: Oxford University Press.

Huey Jr., S. & Polo, A. J. (2010). Assessing the effects of evidence-based psychotherapies with ethnic minority youths. Weisz, J. and Kazdin, A. E. (2nd Edition). Evidence Based Psychotherapies for Children and Adolescents (451-465). New York: Oxford University Press.

Robbin, M. S., Horigian, V., Szapocznik, J., & Ucha, J. (2010). Treating Hispanic youths using brief strategic family therapy. Weisz, J. and Kazdin, A. E. (2nd Edition). Evidence Based Psychotherapies for Children and Adolescents (375-390). New York: Oxford University Press.

Zisser, A. & Eyberg, S. M. (2010). Parent-child interaction therapy and the treatment of disruptive behavior disorder. Weisz, J. and Kazdin, A. E. (2nd Edition). Evidence Based Psychotherapies for Children and Adolescents (179-193). New York: Oxford University Press.