Early interventions for vulnerable children

Presentasjon om: "Early interventions for vulnerable children"— Utskrift av presentasjonen:

1 Early interventions for vulnerable children
Hilton Hotel, Reykjavik, Iceland May 8th 2018 Terje Ogden (PhD) Norwegian Center for Child Behavioral Development, University of Oslo

2 Common features of effective treatments
Comprehensive interventions that address an array of the known risk factors for the development of behavior problems, Providing services in community-based settings, The family and the social network, including schools as the primary vehicle for achieving favorable child and family outcomes (an ecological approach, family therapy, parenting, school-based interventions), Behavioral treatment principles applied within ecological and systemic conceptual frameworks, Relying on strong quality assurance procedures to support interventionist fidelity to the treatment models.

3 Family and community based program interventions
PMTO Parent Management Training MST Multisystemic Therapy PALS School-wide PBS model TIBIR Early intervention For Children at Risk Functional Family Therapy FFT MST & CM in drug abuse treatment PMTO for Minority Families and Children Treatment Foster Care Oregon (TFCO) “MATCH” Modularized treatment of children with anxiety, conduct problems and depression «KOBA» Homework intervention for child welfare children 11/16/2018 Side 3

4 The Norwegian version of the Schoolwide-Positive Behavior Support model (N-PALS)
To reduce problem behavior and to promote social competence and positive behavior support in the whole school, A school-wide, team-based approach with leadership commitment, Skills based research validated intervention components, Teaching rules and expectations to students and monitoring student behavior (e.g. SWIS) Monitoring implementation quality and intervention fidelity. Indicated level (1-5%) Selected level (5-10%) Universal level (80-90%) (Sprague & Walker, 2005; Sørlie & Ogden, 2015; Sørlie, Ogden & Olseth, 2015; 2016)

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6 N-PALS The Schoolwide positive behavior support and intervention model
Outcomes of the evaluation study: Reduced teacher rated problem behavior in school, Improved learning climate in the classrooms, Less exclusion of students, Improvements in the staffs' behavioral practice Increased individual and collective efficacy among staff. Moderating effect of: schools with high implementation quality (fidelity), small to moderately sized schools high-risk students. (Sørlie & Ogden, 2015; Sørlie, Ogden & Olseth, 2015 & 2016)

7 «Early interventions for children at risk»
Adapted from PMTO and implemented at the municipal level in child welfare, child health clinics, schools and child care. PMTO «Early interventions for children at risk» «TIBIR» Brief Parent Training Social skills training Parent groups School consul- tation Solholm, R., Kjøbli, J. & Christiansen, T. (2013). Early Initiatives for Children at Risk − Development of a program for the prevention and treatment of behavior problems in primary services. Prevention Science.

8 Ogden et al., 2017

9 «Early interventions for children at risk»
PMTO Individual & Group training Social Skills training Counceling Consultation Assessment Assessmentt Assessment Side 9 9 9

10 «Early Interventions for Children at Risk» (TIBIR)
Early Interventions for Children at Risk program was designed to help parents as early as possible, but who could manage with shorter interventions than full PMTO (Solholm, Kjøbli & Christiansen, 2013). Implemented in a variety of primary care settings with a low threshold for intake, and fewer sessions with lower intensity and shorter duration than full scale PMTO, By 2015, 1117 trained practitioners were active in 100 (out of 430) municipalities that have implemented one or more of the modules. Solholm, Kjøbli, & Christiansen (2013). Prevention Science, 14, 535–544 .

11 PMTO and adapted short term preventive interventions by local services
Intervention components Training of practitioners Target group Research PMTO (full scale) 20 days training over 18 months while receiving supervision on clinical work with five or more families Parents with children aged 4-12 RCT: Ogden & Hagen, 2008 Brief parent training 9 days training over 6 months followed by 6 months supervision of practitioners in local services Parents RCT: Kjøbli & Ogden, 2012 Social skills training 6 days training and supervision over 6 months Children RCT : Kjøbli & Ogden, 2013 PMTO group intervention for minority families PMTO therapists and 5 days training of bi-lingual link workers Ethnic Minority Mothers RCT: Bjørknes & Manger, 2013 PMTO group intervention 2 days training of certified PMTO therapists RCT: Kjøbli, Hukkelberg & Ogden, 2013 Consultation to practitioners in schools and child care 4 days consultation training for PMTO therapists and counselors in local services Staff in schools and child care In progress Solholm, R., Kjøbli, J. & Christiansen, T. (2013). Early Initiatives for Children at Risk − Development of a program for the prevention and treatment of behavior problems in primary services. Prevention Science.

12 Kommuner som har implementert én eller flere moduler,
Bodø Alta Saltdal Nesseby Vardø Steigen Harstad Rana Karasjok Tana Namsos Stjørdal Volda Sande Trondheim Steinkjer Levanger Hareid Sunndal Molde Ulstein Ålesund Nærøy Vikna Verdal Malvik Herøy Meråker Selbu Tydal Haram Orkdal Fjaler Førde Klepp Gulen Fyllingsdalen Haugesund Kvinnherad Ytre-Bygda Voss Hyllestad Sola Balestrand Solund Masfjorden Høyanger Askvoll Larvik Sandefjord Porsgrunn Tønsberg Grimstad Evje Kristiansand Øvre Eiker Nedre Eiker LørenskogNesodden Grorud Østensjø Søndre Nordstrand Alna Oppegård Moss Ski Sel Lillehammer Dovre Lom Kongsvinger Skjåk Vågå Ringsaker Lesja

13 MST-CAN Piloting MST-child abuse and neglect in Bærum and Asker municipalities, A team-based treatment of children and adolescents between 6 and 18 years of age who have experienced physical violence or neglect in their home; *6-9 months of treatment, *3-4 meetings per week, *3-4 families per therapist.

14 Common elements in treatment interventions
Chorpita og Daleiden examined 322 randomised studies in order to identify the most commom elements across studies

15 Depression Anxiety Traumatic stress Conduct problems
MATCH: Modular Approach to Therapy for CHildren with anxiety, depression and conduct problems Anxiety Depression Traumatic stress Conduct problems

16 The Modular Approach to Therapy for CHildren with anxiety, depression, trauma and conduct problems (MATCH) Well-known practice elements from cognitive behavioral therapy for anxiety, depression, traumatic stress and parenting for families with children and adolescents with behavioral problems. The content is the same as in other evidence-based intervention models, but the treatment design is different The MATCH model is tested in a multi-site randomized trial in 6 Norwegian Child and Adolescent Psychiatric Policies from 2016, [A collaborative project between clinicians and researchers at the NCCBD (K.A.Hagen as PI) and The Harvard Lab for Youth Mental Health (John Weisz)]

17 Learning about depression:
Booster Closure Closure Closure Look ahead Sustainability Coping plans Sustainability School-home report Trauma-narrative Cognitive coping Exposure Planning Relaxation Positiv presentation Timeout Fear ladder Security plan Reward Calming exercises Fear ladder Good directions Psycho- education about anxiety: Teaching parents & child about traumatic stress Relaxation Ignoring Problem-solving Praise Child & Parent Engaging parents Alliance Learning about depression: Alliance Alliance Parent & child Bli kjent - angst For å begynne å etablere en relasjon med barnet og lage en plan Fryktstige  For å lage en liste over angstfremmende situasjoner å øve på Lære om angst – barn Psykoedukasjon om angst til barnet. Alarmbegrepet. Tanker, følelser og atferd. Lære om angst – foreldre Psykoedukasjon om angst til foreldre Øve Eksponering for situasjoner/stimuli som utløser angst Vedlikehold Oppsummering og planlegging av avslutning av behandling for angstproblemer Kognitiv-STANS For å korrigere uhensiktsmessige kognisjoner relatert til angst Avslutning Avslutning med barnet Bli kjent - depresjon Lære om depresjon – barn Psykoedukasjon om depresjon til barnet. Tenke – føle – gjøre. Øve. Verktøy. Lære om depresjon - foreldre Psykoedukasjon om depresjon til foreldre Problemløsning For å lære barnet trinn for å løse problemer mer effektivt. Aktivitetsvalg For å lære barnet å identifisere og velge hyggelige aktiviteter for å bedre humøret Lære å slappe av Progressiv muskelavslapning, visualisering og sakte pust Roe seg ned raskt Stressmestring til bruk i det offentlige rom og når tiden er knapp (muskelavslapning, dyp pust og å forestille seg et avslappende sted). Presentere seg selv positivt Trening i å presentere seg på en måte som kan ha positiv innvirkning på både eget humør og sosiale relasjoner Kognitiv mestring – VOND For å korrigere uhensiktsmessige kognisjoner relatert til depresjon. Vente det verste. Overdrive, Negative briller og Det er min skyld. Kognitiv mestring - SSS Kognitive strategier for depresjon. Snakk med en venn, Se etter lys i tunnelen, skift kanal. Mestringsplaner Oppsummering og planlegging av avslutning av behandling for depresjon Sikkerhetsplanlegging Sikkerhetsplan Trening i å ivareta personlig sikkerhet Traumenarrativ Gjennomgang av skriftlig narrativ om traumatiske hendelser Å engasjere foreldrene Engasjere foreldrene For å øke foreldrenes motivasjon for behandlingen Å lære om atferd Lære om atferd Psykoedukasjon til foreldre om atferdsproblemer En-til-en-tid For å øke positiv samhandling mellom foreldre og barn Ros Foreldre får trening i oppmuntre barnet gjennom å rose umiddelbart og konkret Aktiv ignorering Foreldrene lærer å ignorere uønsket atferd og rettet oppmerksomheten mot ønsket atferd Om å gi effektive instruksjoner Effektive beskjeder Foreldrene får trening i å gi gode beskjeder for å øke barnets samarbeid Belønning Belønninger Foreldrene får trening i å ta i bruk et belønningssystem - Pausetid Foreldrene får trening i bruk av pausetid for å forhindre konflikteskalering og lære barnet å ta valg Å lage en plan Lage en plan Foreldrene lærer å håndtere forutgående hendelser eller triggere for å redusere atferdsproblemer Daglig rapport kort Skole-hjem-kort Foreldrene får verktøy til å følge med på atferd som finner sted på skolen. Se fremover For å oppsummere og avslutte et terapiforløp for atferdsproblemer Booster-time Alliance

18 Measurement Feedback systems (MFS)
Weekly feedback is obtained from the family in order to find out if the treatment actually helps them to experience recovery, The feedback guides the treatment and is presented visually so it may be applied in a meaningful way in a busy clinical day.   Et nettbasert hjelpemiddel for å innhente informasjon fra klienten og følge med på progresjonen i terapien PATH innebærer strukturert bruk av kliniske instrumenter for å måle endring. Systemet innhenter barnets/ungdommens og foreldrenes vurdering av egendefinerte problemer og symptomskårer samler informasjon om hva som skjer i terapitimene Systematiserer denne informasjonen som skal være til støtte når beslutninger skal tas i behandlingsplanleggingen PATH gir en visuell presentasjon av barnets/ungdommens behandlingsprogresjon gjennom … Barnets/ungdommens rapportering av egendefinerte problemer og subjektive opplevelser av endring i tilstand (symptomskårer) Foreldrenes rapportering av barnets/ungdommens problemer og symptomskårer Terapeutens beskrivelse av aktivitetene i terapitimen

19 The KOBA project Improving educational outcomes for children at risk
A common elements-methodology to identify research based core components with a significant positive effect on academic attainment, Integrated Knowledge Translation (IKT) is an approach that engages researchers and practitioners in collaborative partnerships to improve educational outcomes for children at risk, Inclusion criteria: Children (1st to 7th grade) and caregivers receive support from the municipal Child Welfare Services, Intervention: The components are delivered by child welfare workers to families in six sessions over a period of six months; delivered at home-visits, or in other settings at the family’s preference. Kristine Amlund Hagen (Principal investigator) Thomas Engell; Ingvild Barbara Follestad; Anne Andersen

20 “Enhanced Academic Support” (EAS)
A co-creation phase were researchers and practitioners developed an Enhanced Academic Support, based on the core components profiles, The core components of EAS: Guidance in positive parental involvement in school, Structured tutoring in reading and math, Guidance in homework structure and routines, and Guidance in positive reinforcement, praise and feedback. An implementation phase, in which the training program is developed, recruiters and assessors are trained, The evaluation phase; in which the EAS interventions are evaluated along with the implementation strategies,

21 The take-home message The successful transport of EBPs across borders has demonstrated that Evidence-Based Programs and Practices can be implemented with standards for training and evaluation of competence which ensures implementation fidelity, An important component is a national center for implementation and research which continuously support the development of knowledge based practices, including training, supervision, implementation and quality assurance, Research should be an integrated part of the implementation of resarch-based practices, preferrably multi-allegiance research which ranges across different programs and interventions.

22 © The Norwegian Center for Child Behavioral Development
Thank you – that was all! 11/16/2018 © The Norwegian Center for Child Behavioral Development