Riskilate konverents 2012: Willy Tore Morch: incredible years

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Willy Tore Morch ettekanne risiklaste konverentsil 3.-4.10.12, Tallinn

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Riskilate konverents 2012: Willy Tore Morch: incredible years

  1. 1. The Incredible Years Implementation, content and researchProfessor Willy-Tore MørchFaculty of health sciences. University of Tromsø
  2. 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 symptomes2 23.10.2012
  3. 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 policy3 23.10.2012
  4. 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.4 23.10.2012
  5. 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 monetary5 23.10.2012
  6. 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 supervision6 23.10.2012
  7. 7. Sustainability Organizational detoriation 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 conferences7 23.10.2012
  8. 8. The incredible years:Parents, children, teachers Treatment and prevention Developed byCarolyn Webster-Stratton, Ph.D.8 23.10.2012 The Incredible Years Training
  9. 9. The incredible years program components in Norway Classrooms Management program Small group Dinoraur school Dinosaur In the school classroom School age Old Basic Universal prevention Pre-school age Program Baby and toddler Closed down 3-6 Program 6-12 Program Fall 2012 3-5 0-1 and 1-3
  10. 10. The incredible years (preschool and school age)• How to play with your child• Emotional, social, consitence, academic coaching• The art of praise• Motivating children by reward• Positive, effective limit setting• Handling of behavior problems• Problem solving for children The Incredible Years Training Series
  11. 11. Parent Rare Timepyramide out Ignore Reduce nagging Often Positive limit setting Enforce collaboration Praise and reward Building social competence Play: positive parent-child relations Emotional, social, consistence, academic coaching The Incredible Years Training Series
  12. 12. The incredible years Strategies• Focus on cognition, emotions and behavior• Developmentally based• Empirically supported• The collaborative process• Promoting SELVSTENDIGHET• Video clips• Role play and rehersals• Home assignments• Parent support The Incredible Years Training
  13. 13. Parent involvement• In-depth interview• 10-14 parents in the groups• Partner support, different parent backgrounds• Day and evening groups• Weekly 2 hour meetings• Two group leaders• Buddy calls• Food• Baby-sitters• Transportation The Incredible Years Training
  14. 14. The clinical RCT studyLarsson, B., Fossum, S., Clifford, G., Drugli, M.B., Handegård, B. H., & Mørch, W-T. (2008).Treatment of oppositional defiant and conductproblems in young Norwegian children: results of arandomized controlled replication trial. EuropeanChild and Adolescent Psychiatry, Vol 18. (1) s. 42-52.
  15. 15. Participants • 127 children 4-8 år • Screening with ECBI og Kiddie-sads • 4 assigment waves 2001-2003 • One year follow-up (2002-2004) • 5-6 year follow-up (2009/10)
  16. 16. Results: behavior problems 16 23.10.2012
  17. 17. Resultater: foreldreferdigheter ogstress
  18. 18. Changes in diagnosis12010080 Pre60 1-årsFU4020 0 ODD CD ADHD Angst/depr
  19. 19. 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)
  20. 20. Diagnosis at the different assessment points Pre treatment 1 year FU 5-6 year FU N=127 n=88 n=54 % (n) % (n) % (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)
  21. 21. 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?
  22. 22. The universal prevention program Reedtz, Mørch & Handegård, 2010 Reedtz,Martinussen, Jørgensen, Handegård & Mørch, 2011
  23. 23. An RCT from a normal population  Total of families volunteered=269  58 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)
  24. 24. 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)
  25. 25. Effects on behavior problems, parenting skills and, parents sense of competence
  26. 26. Невероятные годы:Родители, дети и учителя - Программа тренировки разработанаКаролин Вебстер-Страттон, доктор наук 23.10.2012 26 The Incredible Years Training
  27. 27. History and funding of IY in Russia 2004: Preparation for implementation of IY 2005: First parent group in Sampo day- care center in Petrozavodsk, Karelia. 2008- today: Dissemination of IY to Kostumuksha, Murmansk, Prjaza (Republic of Karelia), Murmansk city, Monteskorsk, Omba (Murmansk Oblast), Arkhangelsk city (Arkhangelsk oblast), Syktyvkar (Republic of Komi)23.10.2012 27
  28. 28. History and funding of IY in Russia 2004-2008: IY funded by EU’s Northern Dimension Partnership in Health and Related Social Issues (NDPHS) 2008: IY funded by «Children in Russia» 2009-2012: IY funded by the Barents Council’s program Children and Youth at Risk (CYAR). 2012-2015: Extended CYAR funding.23.10.2012 28
  29. 29. 23.10.2012 29 The Incredible Years in Russia
  30. 30. ECBI Intensity score. Pre-post ANCOVA Significant effect Eta square = 0.433 is a great effect. Corresponds to Cohens d = 1,5823.10.2012 30
  31. 31. ECBI Problem score. Pre-post ANCOVA Significant effect Eta square = 0.359 is a great effect. Corresponds to Cohens d = 1,4123.10.2012 31
  32. 32. ECBI intensity pre-post-fu23.10.2012 32
  33. 33. 1. Over protection  Time by group effect: P = 0.007  Scale: 0-1023.10.2012 33
  34. 34. 3. Spoiling the child (Over satisfaction)  Time by group effect: P < 0.0005  Scale: 0-1023.10.2012 34
  35. 35. 4. Ignoring of child needs  Time by group effect: P = 0.075  Scale: 0-523.10.2012 35
  36. 36. 6. Low expectations to the child  Time by group effect: P < 0.0005  Scale: 0-523.10.2012 36
  37. 37. 9. Negative parenting  Time by group effect: P = 0.002  Scale: 0-523.10.2012 37
  38. 38. 11. Inconsistent parenting  Time by group effect: P = 0.02  Scale: 0-523.10.2012 38
  39. 39. 14. Uncertainty in parent role  Time by group effect: P < 0.0005  Scale: 0-523.10.2012 39
  40. 40. The Status of IY in Russia and future development Ultimo 2011: 600 families has received the IY 2011-2015:  Longlasting collaboration between Norway and Russia about children and crime conviction.  Coordinated by The Ministry of childtren, equation beween sexes and inclusion of minorities and The ministry of justise and police matters in Norway.  The goals: Exchange of experience and knowledge of prevention of crime and implementation of alternative types penalty to prison for children.  The IY is a integrated part of this work as a program documented as effective prevention of juvenile crime (Blueprint).  The CYAR project includes: IY, ART, Family group conference (New Zealand), Mediation board and «What about us» (Families with children with reduced level og functioning)23.10.2012 40
  41. 41. Future developments  2012. 4 new agencies in The Republic Karelia, Murmansk Oblast, Arkhangelsk Oblast and The Republic of Komi  Implementing the peer coach system  Recruitment of an additional mentor23.10.2012 41
  42. 42. Thank you for your attention

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