Publications by authors named "John Kjøbli"

14 Publications

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Evaluating Modular Approach to Therapy for Children with Anxiety, Depression, Trauma and Conduct Problems (MATCH-ADCT) in Norwegian child and adolescent outpatient clinics: Study protocol for a randomized controlled trial.

Trials 2019 Jan 7;20(1):16. Epub 2019 Jan 7.

Department of Psychology, Faculty of Arts and Sciences, Harvard University, 1030 William James Hall, 33 Kirkland Street, Cambridge, MA, 02138, USA.

Background: Norwegian health, care, and welfare services are experiencing increased demands to deliver services that are safe, effective, of high quality, and that ensure user involvement. Yet, evidence-based treatment for common disorders such as depression, anxiety, trauma, and behavioral problems in children are not regularly used in clinical practice in Norway. Possible explanations for this are that many standard, evidence-based treatments may have difficulty addressing the complexity and comorbidity of referred children and the fact that children's treatment needs often shift during treatment. The Modular Approach to Therapy for children with Anxiety, Depression, Trauma and Conduct problems (MATCH-ADTC) was designed to address these challenges and reduce some of the barriers to therapists' use of evidence-based treatment in their practice.

Methods/design: Participants will include 280 children (aged 6-14.5 years at intake) who receive treatment in child and adolescent mental health outpatient clinics in Norway, and their families. Families are randomly assigned to either the experimental group receiving treatment from therapists trained in MATCH, or to the comparison group receiving treatment from therapists delivering treatment as usual (TAU). Data on children's symptomology, child and family functioning, demographics, background information, and mental health outcomes are collected as well as frequent feedback on treatment response, plus video-recordings of treatment sessions and implementation quality scores from each participating clinic. Questionnaires are administered in six waves.

Discussion: MATCH has been tested in the US with promising results, but we do not know whether this treatment approach will produce similar results in Norway. The implications of this study are 1. Possibly better treatment outcomes and/or more efficient improvements for children and families treated in mental health outpatient clinics in Norway 2. Clinicians learning to use more evidence-based practices in their treatment 3. Implementation of standard procedures for obtaining feedback from children and families and sharing the feedback with clinicians 4. Increased understanding, at the end of the trial, of whether introducing MATCH improves outcomes for children and families treated in mental health outpatient clinics TRIAL REGISTRATION: ISRCTN, registration number: ISRCTN24029895 . Registered on 8 August 2016.
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http://dx.doi.org/10.1186/s13063-018-3074-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322284PMC
January 2019

Family Resources and Effects on Child Behavior Problem Interventions: A Cumulative Risk Approach.

J Child Fam Stud 2017 18;26(10):2936-2947. Epub 2017 May 18.

Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, P.O. Box 4623, Nydalen, 0405 Oslo Norway.

Family resources have been associated with health care inequality in general and with social gradients in treatment outcomes for children with behavior problems. However, there is limited evidence concerning cumulative risk-the accumulation of social and economic disadvantages in a family-and whether cumulative risk moderates the outcomes of evidence-based parent training interventions. We used data from two randomized controlled trials evaluating high-intensity ( = 137) and low-intensity ( = 216) versions of Parent Management Training-Oregon (PMTO) with a 50:50 allocation between participants receiving PMTO interventions or regular care. A nine-item family cumulative risk index tapping socioeconomic resources and parental health was constructed to assess the family's exposure to risk. Autoregressive structured equation models (SEM) were run to investigate whether cumulative risk moderated child behaviors at post-treatment and follow-up (6 months). Our results showed opposite social gradients for the treatment conditions: the children exposed to cumulative risk in a pooled sample of both PMTO groups displayed lower levels of behavior problems, whereas children with identical risk exposures who received regular care experienced more problems. Furthermore, our results indicated that the social gradients differed between PMTO interventions: children exposed to cumulative risk in the low-intensity (five sessions) Brief Parent Training fared equally well as their high-resource counterparts, whereas children exposed to cumulative risk in the high-intensity PMTO (12 sessions) experienced vastly better treatment effects. Providing evidence-based parent training seem to be an effective way to counteract health care inequality, and the more intensive PMTO treatment seemed to be a particularly effective way to help families with cumulative risk.
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http://dx.doi.org/10.1007/s10826-017-0777-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597683PMC
May 2017

Three Randomized Effectiveness Trials - One Question: Can Callous-Unemotional Traits in Children Be Altered?

J Clin Child Adolesc Psychol 2018 May-Jun;47(3):436-443. Epub 2016 Jun 30.

a The Norwegian Center for Child Behavioral Development , University of Oslo.

Children with conduct problems and callous-unemotional (CU) traits are at risk for multiple problems. Outcome research and mediation analyses testing for mechanisms of change in CU traits have been limited. We examined whether parent training-in a short-term (Brief Parent Training; BPT) or a comprehensive format (Parent Management Training, Oregon Model; PMTO)-or child-directed social skills training (Individual Social Skills Training [ISST]) produced positive effects on CU traits. In mediation models we tested parenting practices as mechanisms of change for CU traits. We pooled data from three randomized effectiveness trials, and 551 families were included in this study. Families had children between 3 and 12 years of age and displayed emerging or present conduct problems at home, day care, or school (BPT M age = 7.28, 31.9% girls; PMTO M age = 8.56, 36.5% girls; ISST M age = 7.64, 19.7% girls). Assessments were completed preintervention, postintervention, and at follow-up (6 months following intervention). Both BPT (d = .32) and PMTO (d = .39) had positive effects on CU traits at posttest, whereas ISST did not (d = -.06). At follow-up, only PMTO produced a significant effect (d = .48) on CU traits. A significant indirect effect on CU traits emerged by positive parenting. Both parent training conditions outperformed ISST. Only PMTO maintained its effects at follow-up. The findings suggest that PMTO can reduce CU traits and that improved positive parenting is associated with positive outcomes for children's CU traits.
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http://dx.doi.org/10.1080/15374416.2016.1178123DOI Listing
May 2019

Parent Management Training-Oregon Model: Adapting Intervention with Rigorous Research.

Fam Process 2016 09 10;55(3):500-13. Epub 2016 Jun 10.

The Norwegian Center for Child Behavioral Development, Oslo, Norway.

Parent Management Training-Oregon Model (PMTO(®) ) is a set of theory-based parenting programs with status as evidence-based treatments. PMTO has been rigorously tested in efficacy and effectiveness trials in different contexts, cultures, and formats. Parents, the presumed agents of change, learn core parenting practices, specifically skill encouragement, limit setting, monitoring/supervision, interpersonal problem solving, and positive involvement. The intervention effectively prevents and ameliorates children's behavior problems by replacing coercive interactions with positive parenting practices. Delivery format includes sessions with individual families in agencies or families' homes, parent groups, and web-based and telehealth communication. Mediational models have tested parenting practices as mechanisms of change for children's behavior and found support for the theory underlying PMTO programs. Moderating effects include children's age, maternal depression, and social disadvantage. The Norwegian PMTO implementation is presented as an example of how PMTO has been tailored to reach diverse populations as delivered by multiple systems of care throughout the nation. An implementation and research center in Oslo provides infrastructure and promotes collaboration between practitioners and researchers to conduct rigorous intervention research. Although evidence-based and tested within a wide array of contexts and populations, PMTO must continue to adapt to an ever-changing world.
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http://dx.doi.org/10.1111/famp.12224DOI Listing
September 2016

Observed callousness as a predictor of treatment outcomes in parent management training.

Clin Child Psychol Psychiatry 2017 Jan 26;22(1):59-73. Epub 2016 Jul 26.

The Norwegian Center for Child Behavioral Development, University of Oslo, Norway.

Background: The goal of this study was to examine how observed Callous-Unemotional (CU) behavior influenced change in externalized and internalized problems, hyperactivity, social competence, and treatment satisfaction following parent management training.

Methods: Three hundred twenty-three children and their families received Parent Management Training-the Oregon model (PMTO). They were compared at intake and after treatment in order to examine differences in 14 treatment outcomes using hierarchical regression analyses.

Results: Children with low levels of observed CU showed the greatest gains after PMTO treatment. This was evident in parent, therapist, self, and teacher reports.

Conclusions: The results indicate that it is possible to observe CU behavior among children with conduct problems, and that children with elevated levels of observed CU behavior may be in need of additional treatment or components of treatment or more intense versions of parent management treatment.
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http://dx.doi.org/10.1177/1359104515621961DOI Listing
January 2017

Children With Conduct Problems and Co-occurring ADHD: Behavioral Improvements Following Parent Management Training.

Child Fam Behav Ther 2015 Jan 9;37(1):1-19. Epub 2015 Mar 9.

Norwegian Center for Child Behavioral Development, University of Oslo , Oslo , Norway.

To scale up evidence-based treatment of conduct problems, parent management training, Oregon model (PMTO) has been disseminated throughout Norway. This study examined whether Attention Deficit Hyperactivity Disorder (ADHD) predicted the outcomes of PMTO. Of 253 children and families, 97 were reported to have an ADHD diagnosis. Although different at intake, the groups with and without ADHD had close to an equal change in behavioral status following treatment. Maternal depression and family income predicted the combined group's behavior following PMTO. The study indicates that reductions in conduct problems following PMTO are of the same magnitude in children with or without ADHD. However, some characteristics may differentially predict outcomes for children with combined problems.
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http://dx.doi.org/10.1080/07317107.2015.1000227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396403PMC
January 2015

A randomized effectiveness trial of individual child social skills training: six-month follow-up.

Child Adolesc Psychiatry Ment Health 2014 23;8(1):31. Epub 2014 Dec 23.

The Norwegian Center for Child Behavioral Development, University of Oslo, P.O. Box 7053, Majorstuen, 0306 Oslo Norway.

Background: Individual Social Skills Training (ISST) is a short term, individually delivered intervention (8-10 sessions) that promotes social skills in children with emerging or existing conduct problems. This study examined the effectiveness of ISST immediately and 6 months after the termination of the intervention.

Methods: The participants were 198 children (3-12 years) who were randomly assigned to ISST or practice as usual. The data were collected from parents, children and teachers.

Results: Findings showed positive change on most outcomes in both study conditions. However, examining the relative effectiveness of the intervention, only one positive effect of ISST emerged on parent-reported child conduct problems immediately after intervention.

Conclusions: These results suggest that compared to the control group, ISST had limited effects in ameliorating child problem behavior. These data suggest that it is not sufficient to provide ISST when aiming to reduce conduct problems in children.
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http://dx.doi.org/10.1186/s13034-014-0031-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4302715PMC
January 2015

Maternal mental distress influences child outcomes in brief parent training.

Child Adolesc Ment Health 2014 Sep 8;19(3):171-177. Epub 2013 Apr 8.

The Norwegian Center for Child Behavioral Development, Unirand, University of Oslo, Oslo, 0306, Norway.

Background: Brief Parent Training (BPT) promotes effective parenting in parents of children with conduct problems. As previous research has provided inconsistent results, this study explored the impact of maternal mental distress on outcomes of BPT.

Method: Participants included 216 families randomized to BPT or a comparison group.

Results: Maternal distress negatively predicted five of eight outcomes, regardless of intervention allocation. Low-maternal distress predicted lower conduct problems (parent- and teacher-reported), whereas high distress predicted higher teacher-reported conduct problems in BPT relative to comparisons.

Conclusions: Refinement of interventions to help children with conduct problems and distressed mothers should be prioritized.
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http://dx.doi.org/10.1111/camh.12028DOI Listing
September 2014

Early initiatives for children at risk--development of a program for the prevention and treatment of behavior problems in primary services.

Prev Sci 2013 Dec;14(6):535-44

Department of Clinical Psychology, University of Bergen, Bergen, Norway,

During the past decade, Norwegian authorities have initiated and funded a project to scale up the use of evidence-based programs for the prevention and treatment of conduct problems in children. The first step in this process was to increase treatment competence by implementing the Parent Management Training-Oregon Model (PMTO) in specialist services for children. The second step was to develop the program Early Initiatives for Children at Risk (Norwegian acronym, TIBIR), designed to identify children with possible conduct problems as early as possible and to offer tailored interventions as part of the ordinary primary services for children in individual municipalities. The theoretical rationale and practical considerations leading to the design of TIBIR are presented, together with the program modules and current research activities. Some of the challenges concerning the program's ability to reach various risk groups are discussed, as are the challenges encountered regarding quality assurance and fidelity maintenance. Finally, some future research questions are presented and discussed.
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http://dx.doi.org/10.1007/s11121-012-0334-xDOI Listing
December 2013

A randomized trial of group parent training: reducing child conduct problems in real-world settings.

Behav Res Ther 2013 Mar 7;51(3):113-21. Epub 2012 Dec 7.

The Norwegian Center for Child Behavioral Development, University of Oslo, P.O. Box 7053, Majorstuen, 0306 Oslo, Norway.

Objective: Group-based Parent Management Training, the Oregon model (PMTO, 12 sessions) was delivered by the regular staff of municipal child and family services. PMTO is based on social interaction learning theory and promotes positive parenting skills in parents of children with conduct problems. This study examined the effectiveness of the group-based training intervention in real world settings both immediately following and six months after termination of the intervention.

Methods: One hundred thirty-seven children (3-12 years) and their parents participated in this study. The families were randomly assigned to group-based training or a comparison group. Data were collected from parents and teachers.

Results: The caregiver assessments of parenting practices and child conduct problems and caregiver and teacher reported social competence revealed immediate and significant intervention effects. Short- and long-term beneficial effects were reported from parents, although no follow-up effects were evident on teacher reports.

Conclusions: These effectiveness findings and the potential for increasing the number of families served to support the further dissemination and implementation of group-based parent training.
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http://dx.doi.org/10.1016/j.brat.2012.11.006DOI Listing
March 2013

A randomized effectiveness trial of brief parent training in primary care settings.

Prev Sci 2012 Dec;13(6):616-26

The Norwegian Center for Child Behavioral Development, Unirand, University of Oslo, P.O. Box 7053, Majorstuen, 0306 Oslo, Norway.

Brief Parent Training (BPT) is a short-term intervention (3-5 sessions) delivered by regular staff in municipal child and family services. BPT is based on social interaction learning theory and Parent Management Training, the Oregon model (PMTO) and promotes parenting skills in families with children who either are at an early stage of problem behavior development or have developed conduct problems. This study examined the effectiveness of BPT compared to regular services in primary care settings at post assessment. Participants were 216 children (3-12 years) and their parents who were randomly assigned to BPT or the comparison group. Data were collected from parents and teachers. Significant intervention effects emerged for caregiver assessments of parenting practices, child conduct problems, and social competence. The results suggested that BPT had beneficial effects for families, although the generalization of the effects to school was limited.
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http://dx.doi.org/10.1007/s11121-012-0289-yDOI Listing
December 2012

Measurement of implementation components ten years after a nationwide introduction of empirically supported programs--a pilot study.

Implement Sci 2012 May 31;7:49. Epub 2012 May 31.

Norwegian Center for Child Behavioral Development, University of Oslo, P.O. Box 7053, Majorstuen, 0306 Oslo, Norway.

Background: Ten years after the nationwide dissemination of two evidence-based treatment programs, the status of the implementation components was evaluated in a cross-sectional study. The aim of the study was to pilot a standardized measure of implementation components by examining the factor structure, the reliabilities of the scores, and their association with implementation outcome variables. The aim was also to compare implementation profiles of the two evidence-based programs based on multi informant assessments.

Methods: The 218 participants in the study were therapists, supervisors, and agency leaders working with Parent Management Training, the Oregon model (PMTO), and Multisystemic Therapy (MST) in Norway. Interviewers filled in an electronic version of the Implementation Components Questionnaire during a telephone interview.

Results: The factor analysis of the eight one-dimensional subscales resulted in an individual clinical-level factor and an organizational system-level factor. Age, experience, and number of colleagues in the workplace were negatively correlated with positive ratings of the implementation process, but the number of colleagues working with the same program predicted positive ratings. MST and PMTO had different implementation profiles and therapists, supervisors, and managers evaluated some of the implementation drivers significantly differently.

Conclusions: The psychometric quality of the questionnaire was supported by measures of internal consistency, factor analyses of the implementation components, and the comparisons of implementation profiles between programs and respondent groups. A moderate, but consistent association in the expected direction was found with the implementation outcome variables.
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http://dx.doi.org/10.1186/1748-5908-7-49DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405482PMC
May 2012

School outcomes of a community-wide intervention model aimed at preventing problem behavior.

Scand J Psychol 2008 Aug 6;49(4):365-75. Epub 2008 May 6.

The Norwegian Center for Child Behavioral Development, Oslo, Norway.

The Early Intervention for Children at Risk for Developing Behavioral Problems (EICR) is a community-wide intervention model preventing and treating problem behavior and promoting social competence in children. The aim of the study was to test whether EICR would result in fewer incidences of problem behavior and improved learning climate in elementary schools in a Norwegian municipality. The municipality was divided in two, each section having equal chance of being assigned to the intervention condition. Participants were principals and school staff. One year after the initiation of EICR, the prevalence of student problem behavior was significantly lower, and student relations were significantly better for schools located in the intervention area than for schools located in the comparison area. The findings support further development, implementation and research on the EICR model.
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http://dx.doi.org/10.1111/j.1467-9450.2008.00648.xDOI Listing
August 2008

Personality traits and drinking to cope as predictors of hazardous drinking among medical students.

J Stud Alcohol 2004 Sep;65(5):582-5

Atferdssenteret, Unirand AS, P.O. Box 1565 Vika, 0118 Oslo, Norway.

Objective: The purpose of this study was to describe the prevalence and development of drinking to cope and hazardous drinking among medical students and to examine whether various personality traits and drinking to cope predict hazardous drinking.

Method: In a 6-year prospective study of a nationwide sample of medical students (N = 421) assessments were made by questionnaire at the beginning (T1) and at the end (T2) of each participant's tenure at medical school. A cohort of 272 medical students (56% women) from all medical schools in Norway participated at both T1 and T2. The questionnaires encompassed measures of personality characteristics (Basic Characteristic Inventory) and alcohol-use (hazardous drinking and drinking to cope).

Results: The levels of drinking to cope and hazardous drinking were not significantly different between T1 and T2, rising from 9.2% to 11.8% and from 17.7% to 19.2%, respectively. Hazardous drinking at T1 (odds ratio [OR] = 7.0; 95% confidence interval [CI]: 3.2-15.4) and level of control (personality trait) at T1 (OR = 0.7; 95% CI: 0.6-0.9) predicted hazardous drinking at T2 among all the students. Hazardous drinking (OR = 3.5; 95% CI: 1.4-9.0), control (OR = 0.7; 95% CI: 0.6-0.9) and drinking to cope at T1 (OR = 5.0; 95% CI: 1.0-24.1) independently predicted hazardous drinking at T2 among the men, whereas the only predictor among the women was hazardous drinking at T1 (OR = 42.1; 95% CI: 8.1-218.2).

Conclusions: Drinking to cope should be targeted for preventive measures against hazardous drinking, particularly among men. The effects of personality and drinking to cope differ by gender and should be studied further.
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http://dx.doi.org/10.15288/jsa.2004.65.582DOI Listing
September 2004