Implementation of The Incredible years in Norway. Professor Willy-Tore Mørch Faculty of health sciences. University of Tromsø

Transkript

1 Implementation of The Incredible years in Norway Professor Willy-Tore Mørch Faculty of health sciences. University of Tromsø

2 Levels of services Treatment Diagnosed disorder, above clinical cut-off Indicated prevention Symptomes of disorders Targeted prevention Presence of risk factors Universal prevention No known risk factors or symptomes

3 Implementation strategy Dissemination The system model: Formal organizational structures in both the purveyor s and the receiving organization s are connected for safe anchoring of the intervention. Contact moves from a personel level to a system level in order to prepare for formal political and administrative decisions. The aim is to place the intervention as a part of the municipality s health policy

4 Implementation strategy Adaptation: Assessment of the characteristics of the municipality and the needs for the intervention Prevalence of individuals with the targeted problems, incidence rate of the problems, existing interventions etc

5 Implementation strategy Adaptation Agency readyness assessment Acceptability for the intervention in the agencies (agreement) Motivation for implementation, ideological compatibility between the agency and the intervention (e.g. theory, manual based intertvention) Identification of eary adopters, late adopters and refusers (Roberts, 1995) Identification of agency characteristics (number of employees) Allocation of resources for the intervention, both human, time and monetary

6 Implementation strategy Implementation: Selection of target population (e.g. adolescents with conduct disorder) Selection of service level (treatment, indicated/targeted and/or universal prevention) Training of personell by sertified mentors (program content, progression and methods, ethics, refinement/education, respect people s needs and problems, integrity) Supervision and coaching, longlasting supervision

7 Organizational detoriation Sustainability Prevention of organizational «amnesia» (shift of leadership, new ideas) Development of systems preventing close-down of the intervention due to resignments, pregnancies, illness etc Fidelity detoriation Drift in program content, dose, target population, implementation evaluatuion Competence detoriation Sertification, resertification, supervision, «super-days», annual conferences

8 The incredible years program components in Norway Classrooms Management program Small group Dinosaur school Dinoraur school In the classroom Baby and toddler Program 0-1 and 1-3 Pre-school age Program 3-5 Old Basic Closed down Fall 2012 School age Program 6-12 Universal prevention 3-6

9 Agencies with IY in Norway 110 agencies 80 municipalities, 30 specialist services Foreldreprogrammet Helse- Nord: Alta Kommune og BUP Alta (disse har ikke tilbudet p.t) BUP Tromsø, Berg, Lenvik og Tranøy kommuner (barneverntjenesten), BUP Midt-Troms (Finnsnes), BUP Nord-Troms (Storslett), Tromsø kommune, Kanutten Barnehage (Tromsø), Vågan kommune Helse- Midt: Inderøy kommune, Klæbu kommune, Levanger kommune, Midtre Gauldal kommune, Melhus kommune, Skaun kommune, Frol oppvekstsenter, Barnas stasjon (Lade behandlingssenter), Kristiansund BUP, KAF tiltaksteam (Kristiansund, Averøy og Frei kommune), Innherred kommune, Surnadal kommune, Trondheim kommune (alle fire bydeler), BUP Trondheim, Verdal kommune, Rauma kommune, Rennebu kommune, Røros kommune Helse-Vest: Austerheim kommune, Betanien BUP, Bufetat region vest, BUP Bryne, BUP Fjell, BUP Fana, BUP Haugesund, BUP Nordhordaland, BUP Sandnes, BUP Sogndal, BUP Sentrum (Bergen), BUP Stavanger, BUP Voss, Familievernkontoret i Stavanger (ikke tilbud p.t), Bømlo kommune, Fjell kommune, Fusa kommune, Klepp kommune, Lindås kommune, Modalen og Rauma kommune, Odda kommune, Randaberg kommune, Strand kommune, Stavanger kommune, Sandnes kommune, Solstrand barnevernssenter, Time kommune, Vaksdal kommune, Årstad familiesenter, Åsane bydel. Helse-Sør- Øst: Brusetkollen skole- og ressurssenter, BUP Bærum (ikke tilbud p.t), BUPA Vestfold, BUP enhet Nordstrand (ikke tilbud p.t), BUP enhet Nordre Aker/Sagene, BUP Elverum, BUP Hamar, BUP Kongsvinger, Fredrikstad kommune (Barnas stasjon), Gjerdrum kommune, Hamar kommune, Hole kommune, Holmestrand kommune, Lillehammer kommune, Nittedal kommune, Nøtterøy kommune, Oslo PPT skolegruppe D, Porsgrunn kommune, Porsgrunn BUP, Røyken kommune, Ringsaker kommune, Ringerike kommune, Sande kommune i Vestfold, Sarpsborg kommune, Ski kommune, Skien kommune, Skien BUP, Stenbråten skole, Hallagerbakken skole, Søndre Land kommune (ikke tilbud p.t), Sørum kommune, Tinn kommune

10 The clinical RCT study Larsson, B., Fossum, S., Clifford, G., Drugli, M. B., Handegård, B. H., & Mørch, W-T. (2008). Treatment of oppositional defiant and conduct problems in young Norwegian children: results of a randomized controlled replication trial. European Child and Adolescent Psychiatry, Vol 18. (1) s

11 Participants 127 children 4-8 år Screening with ECBI og Kiddie-sads 4 assigment waves One year follow-up ( ) 5-6 year follow-up (2009/10)

12 Resultater: foreldreferdigheter og stress

13 Changes in diagnosis Pre 1-årsFU ODD CD ADHD Angst/depr

14 Resultater: Behandlingsdose respons Høy deltakelses-prosent på foreldre-grupper og på Dinosaurusskolen Korrelasjon mellom deltakelsesprosent på foreldregrupper og endringsskår på ECBI: r = 0,18 (p > 0,05)

15 Diagnosis at the different assessment points Pre treatment N=127 % (n) 1 year FU n=88 % (n) 5-6 year FU n=54 % (n) ODD 100 (127) 34,0 (30) 31,5 (17) CD 18,9 (24) 3,4 (3) 9,3 (5) ADHD 35,4 (45) 25,0 (22) 50,0 (27) Angst/depresjon 10,2 (13) 5,7 (5) 7,4 (4)

16 Stability of ODD/CD diagnosis from 1 year FU to 5/6 year FU 38.9 (21) of the participants at 5/6 years FU had not ODD/CD at 1 year FU or 5/6 year FU The success children 9.3% (5) had ODD/CD at both assessment points The high risk children 28.8% (15) had ODD/CD at 1 year FU, but not at 5/6 year FU Delayed effect? 24.1% (13) had not ODD/CD at 1 year FU, but with 5/6 års FU The effect that disappeared?

17 The universal prevention program Reedtz, Mørch & Handegård, 2010 Reedtz, Martinussen, Jørgensen, Handegård & Mørch, 2011

18 An RCT from a normal population Total of families volunteered= children (22%) excluded due to ECBI intensity score > 90% (clinical cut-off) 22 families (10%) terminated their participation in the initial phase. Pre-post and 1 yr. Follow-up The relation building components of the IY parent program (Meeting 1-6)

19 RCT from a normal population parent and child characteristics Full time occupation: 61% Two-parent families: 80% Bacheor or higher education: 78% Children s age from 2-8, mean age <4 112 (59%) boys, 77 (41%) girls Mean ECBI score: 103,3 (SD=16,7) Mean Norwegian norms 93,0 (SD=23,6) Difference sign: <.001 No differences between the participants and non-participants (attrition analysis)

20 Effects on behavior problems, parenting skills and, parents sense of competence

21 Thank you for the attention