Publications by authors named "Terje Ogden"

33 Publications

Knowledge and Will: An Explorative Study on the Implementation of School-Wide Positive Behavior Support in Sweden.

Front Psychol 2021 16;12:618099. Epub 2021 Feb 16.

Norwegian Center for Child Behavioral Development, Oslo, Norway.

School-wide positive behavior support (SWPBIS) is a well-evaluated school approach to promoting a positive school climate and decreasing problem behaviors. Initial implementation is one of the most critical stages of program implementation. In this qualitative study, the initial implementation of SWPBIS in Swedish schools was studied using an implementation model of behavior change as guidance for interviews and analyses. The study makes significant contributions to previous research as little is known of the implementation of SWPBIS in Swedish context. Focus-group interviews were conducted with 59 professionals on implementation teams from nine schools. Themes were extracted according to implementation team members' perceptions and descriptions of how the initial implementation was carried out. The results of this study revealed relevant themes within the three domains of Capability, Opportunity, and Motivation. Core features were found under the themes of knowledge and experience of similar evidence-based programs, process or result orientation, time, manual content, organizational prerequisites, team functioning, implementation leadership, program as a unifying factor, program aligning with staff beliefs, plausible expectations, and emotional reinforcement. Results are discussed in terms of how they can be used in continuing to develop the Swedish model of SWPBIS. Implications regarding implementation in Swedish schools are discussed, as is the applicability of the model of behavior change for studying implementation in schools.
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http://dx.doi.org/10.3389/fpsyg.2021.618099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7951089PMC
February 2021

Bullying Victimization and Trauma.

Front Psychiatry 2020 14;11:480353. Epub 2021 Jan 14.

Norwegian Center for Child Behavioral Development, Oslo, Norway.

Bullying victimization and trauma research traditions operate quite separately. Hence, it is unclear from the literature whether bullying victimization should be considered as a form of interpersonal trauma. We review studies that connect bullying victimization with symptoms of PTSD, and in doing so, demonstrate that a conceptual understanding of the consequences of childhood bullying needs to be framed within a developmental perspective. We discuss two potential diagnoses that ought to be considered in the context of bullying victimization: (1) developmental trauma disorder, which was suggested but not accepted as a new diagnosis in the DSM-5 and (2) complex post-traumatic stress disorder, which has been included in the ICD-11. Our conclusion is that these frameworks capture the complexity of the symptoms associated with bullying victimization better than PTSD. We encourage practitioners to understand how exposure to bullying interacts with development at different ages when addressing the consequences for targets and when designing interventions that account for the duration, intensity, and sequelae of this type of interpersonal trauma.
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http://dx.doi.org/10.3389/fpsyt.2020.480353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841334PMC
January 2021

The relation between behavioral problems and social competence: A correlational Meta-analysis.

BMC Psychiatry 2019 11 9;19(1):354. Epub 2019 Nov 9.

Center for Child and Adolescent Mental Health, Oslo, Eastern and Southern, Norway.

Background: Previous studies have shown that children who display behavioral problems also tend to display low social competence. The relation does however vary according to type of behavior being measured, as well as demographic characteristics of the respondent. The present meta-analysis examined the correlation between different types of behavioral problems and social competence among children aged 3-13, and investigated possible moderators in this relation.

Methods: A systematic literature search was conducted for English language studies from January 2008 to January 2018 that reported correlations between three types of behavioral problems (i.e., externalizing behaviors, conduct problems, or aggression) and two types of social competence (i.e., social competence or social skills). The studies included reports from parents and teachers, or both as a dyad. The review included data from 54 independent studies and a total of 46,828 participants. Effect sizes were estimated using a random effects approach and moderator analyses between subsets of categorical variables were tested by the significant Q test.

Results: Results showed an overall correlation between behavioral problems and social competence of medium effect size (r = -.42, p < .01). Moderation analyses indicated no significant differences for different types of behavioral problems or social competence. However, a significant difference was found with regard to type of respondent; the correlation was significantly higher when both measures were reported by the same respondent (teacher or parent) compared to when measures were reported by parent-teacher as a dyad.

Conclusions: Findings summarized and quantified a robust negative correlation between behavioral problems and social competence. The results indicate that intervention programs targeting problem behaviors in children would benefit from reducing behavioral problems and in concert, increase social competence to help children with emerging or present problem behaviors.
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http://dx.doi.org/10.1186/s12888-019-2343-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842530PMC
November 2019

Predictors of family focused practice: organisation, profession, or the role as child responsible personnel?

BMC Health Serv Res 2019 Nov 5;19(1):793. Epub 2019 Nov 5.

Monash University Department of Rural Health, Box 973, Moe, Victoria, 3825, Australia.

Background: Health professionals in Norway are required by law to help safeguard information and follow-up with children of parents with mental or physical illness, or who have substance abuse problems, to reduce their higher risk of psychosocial problems. Knowledge is lacking regarding whether organisation and/or worker-related factors can explain the differences in health professionals' ability to support the families when patients are parents.

Methods: Employing a translated, generic version of the Family Focused Mental Health Practice Questionnaire (FFPQ), this cross-sectional study examines family focused practice (FFP) differences in relation to health professionals' background and role (N = 280) along with exploring predictors of parent, child, and family support.

Results: While most health professions had begun to have conversations with parents on children's needs, under one-third have had conversations with children. There were significant differences between nurses, social workers, psychologists, physicians, and others on seven of the FFP subscales, with physicians scoring lowest on five subscales and psychologists providing the least family support. Controlling for confounders, there were significant differences between child responsible personnel (CRP) and other clinicians (C), with CRP scoring significantly higher on knowledge and skills, confidence, and referrals. Predictors of FFP varied between less complex practices (talking with parents) and more complex practices (family support and referrals).

Conclusion: The type of profession was a key predictor of delivering family support, suggesting that social workers have more undergraduate training to support families, followed by nurses; alternately, the results could suggest that that social workers and nurses have been more willing or able than physicians and psychologists to follow the new legal requirements. The findings highlight the importance of multidisciplinary teams and of tailoring training strategies to health professionals' needs in order to strengthen their ability to better support children and families when a parent is ill.
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http://dx.doi.org/10.1186/s12913-019-4553-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829823PMC
November 2019

Significance of Leaders for Sustained Use of Evidence-Based Practices: A Qualitative Focus-Group Study with Mental Health Practitioners.

Community Ment Health J 2019 11 12;55(8):1344-1353. Epub 2019 Jun 12.

Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, Lørenskog, 1478, Norway.

Evidence-based practices that are implemented in mental health services are often challenging to sustain. In this focus-group study, 26 mental health practitioners with high fidelity scores were interviewed regarding their experiences with implementing the illness management and recovery, an evidence-based practice for people with severe mental disorders, in their services and how this could influence further use. Findings indicate that high fidelity is not equivalent to successful implementation. Rather, to sustain the practice in services, the practitioners emphasized the importance of their leaders being positive and engaged in the intervention, and hold clear goals and visions for the intervention in the clinic. In addition, the practitioners' understanding of outcome monitoring as a resource for practice improvement must be improved to avoid random patient experiences becoming the decisive factor in determining further use.Trial registration: ClinicalTrials.gov NCT02077829. Registered 25 February 2014.
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http://dx.doi.org/10.1007/s10597-019-00430-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823318PMC
November 2019

Cognitive behavioral treatment for depressed adolescents: results from a cluster randomized controlled trial of a group course.

BMC Psychiatry 2019 05 22;19(1):155. Epub 2019 May 22.

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

Background: The group-based CBT intervention, the Adolescent Coping with Depression Course (ACDC), has previously been evaluated within a quasi-experimental design, showing reduction in depressive symptoms compared to a benchmark of similar studies. The aim of our study was to investigate the effectiveness of ACDC within a randomized controlled (RCT) design.

Method: Thirty-five course/control leaders randomly assigned to provide ACDC or usual care (UC) recruited 133 adolescents allocated to ACDC and 95 to UC. ACDC participants received eight weekly sessions and two follow-up sessions about 3 and 6 weeks after the last session. UC participants received usual care as implemented at the different sites. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale for adolescents (CES-D), perfectionism with the revised version of the Dysfunctional Attitude Scale (DAS), and rumination with the revised version of the Ruminative Responses Scale (RRS). Attrition was considered missing at random (MAR) and handled with a full information maximum likelihood (FIML) procedure.

Results: Intention to treat analysis (ITT), including baseline scores and predictors of missing data as control or auxiliary variables, showed a small to medium reduction in depressive symptoms for the ACDC group compared to UC (d = -.31). Changes in perfectionism and rumination in favor of the intervention were also significant. Sensitivity analyses confirmed the findings from the ITT analyses.

Conclusions: The current study supports the effectiveness of this group-based CBT intervention. The intervention can hopefully result in clinically significant reductions in symptoms associated with depression among adolescents.

Trial Registration: ISRCTN registry ISRCTN19700389 . Registered 6 October 2015.
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http://dx.doi.org/10.1186/s12888-019-2134-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532239PMC
May 2019

Impacts of school-wide positive behaviour support: Results from National Longitudinal Register Data.

Int J Psychol 2020 Jan 8;55 Suppl 1:4-15. Epub 2019 Apr 8.

Norwegian Center for Child Behavioral Development, Oslo, Norway.

Problem behaviour in schools may have detrimental effects both on students' well-being and academic achievement. A large literature has consistently found that school-wide positive behaviour support (SWPBS) successfully addresses social and behavioural problems. In this paper, we used population-wide longitudinal register data for all Norwegian primary schools and a difference-in-difference (DiD) design to evaluate effects of SWPBS on a number of primary and secondary outcomes, including indicators of externalising behaviour, school well-being, pull-out instruction, and academic achievement. Indications of reduced classroom noise were found. No other effects were detected. Analyses revealed important differences in outcomes between the intervention and control schools, independent of the implementation of SWPBS, and that a credible design like DiD is essential to handle such school differences.
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http://dx.doi.org/10.1002/ijop.12575DOI Listing
January 2020

Awareness and perceptions of clinical guidelines for the diagnostics and treatment of severe behavioural problems in children across Europe: A qualitative survey with academic experts.

Eur Psychiatry 2019 04 15;57:1-9. Epub 2019 Jan 15.

Curium-LUMC, Academic Centre of Child and Youth Psychiatry, Endegeesterstraatweg 27, 2342 AK Oegstgeest, the Netherlands; Lucertis - de Jutters, Child and Adolescent Psychiatry, Parnassia Group, the Netherlands.

Background: Severe behavioural problems (SBPs) in childhood are highly prevalent, impair functioning, and predict negative outcomes later in life. Over the last decade, clinical practice guidelines for SBPs have been developed across Europe to facilitate the translation of scientific evidence into clinical practice. This study outlines the results of an investigation into academic experts' perspectives on the current prevalence, implementation, and utility of clinical guidelines for SBPs in children aged 6-12 across Europe.

Methods: An online semi-structured questionnaire was completed by 28 psychiatry and psychology experts from 23 countries.

Results: Experts indicated that approximately two thirds of the included European countries use at least an unofficial clinical document such as textbooks, while nearly half possess official guidelines for SBPs. Experts believed that, although useful for practice, guidelines' benefits would be maximised if they included more specific recommendations and were implemented more conscientiously. Similarly, experts suggested that unofficial clinical documents offer a wide range of treatment options to individualise treatment from. However, they stressed the need for more consistent, evidence-based clinical practices, by means of developing national and European clinical guidelines for SBPs.

Conclusions: This study offers a preliminary insight into the current successes and challenges perceived by experts around Europe associated with guidelines and documents for SBPs, acting as a stepping stone for future systematic, in-depth investigations of guidelines. Additionally, it establishes experts' consensus for the need to develop official guidelines better tailored to clinical practice, creating a momentum for a transition towards European clinical guidelines for this population.
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http://dx.doi.org/10.1016/j.eurpsy.2018.12.009DOI Listing
April 2019

Differences in implementation of family focused practice in hospitals: a cross-sectional study.

Int J Ment Health Syst 2018 19;12:77. Epub 2018 Dec 19.

Norwegian Centre for Child Behavioural Development, Unirand, Majorstuen, Box 7053 0368 Oslo, Norway.

Background: Changes in Norwegian law and health policy require all health professionals to help safeguard the provision of information and follow-up for the children of parents with mental or physical illness, or substance abuse problems, to decrease their risk of psychosocial problems. There is a lack of knowledge on how the national changes have been received by hospital-based health professionals, and if they have led to an increase in family focused practice.

Methods: This cross-sectional study examined the adherence of health professionals' ( = 280) in five hospitals to new guidelines for family focused practice, using a translated and generic version of Family Focused Mental Health Practice Questionnaire.

Results: Overall, health professionals scored high on knowledge and skills, and were confident in working with families and children, but reported moderate levels of family support and referrals. Comparison of the five hospitals showed significant differences in terms of workplace support, knowledge and skills and family support. The smallest hospital had less workplace support and less knowledge and skills but scored medium on family support. The two largest hospitals scored highest on family support, but with significant differences on parents refusing to have conversations with children.

Conclusions: Differences in implementation of family focused practice highlight the need to tailor improvement strategies to specific barriers at the different hospitals. The use of implementation theories and improvement strategies could promote full implementation, where all families and children in need were identified and had access to family support. The study is approved by the Regional Committee on Medical and Health Research Ethics South-East Q5 37 (reg. no. 2012/1176) and by the Privacy Ombudsman.
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http://dx.doi.org/10.1186/s13033-018-0256-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6299542PMC
December 2018

Behavioral Trajectories During Middle Childhood: Differential Effects of the School-Wide Positive Behavior Support Model.

Prev Sci 2018 11;19(8):1055-1065

University of Bergen, Bergen, Norway.

The aims of this study were to assess the longitudinal trajectories of externalizing problem behavior during middle childhood among typically developing children and to examine subgroup differences in the effectiveness of the School-Wide Positive Behavior Support (SWPBS) model, called N-PALS in Norway. Participants were approximately 3000 students, and behavioral assessments were performed by class head teachers at four time points from the 4th or 5th grade through the 7th grade. Using a combination of latent class growth analyses (LCGA) and growth mixture modeling (GMM), four distinct trajectory classes were identified, i.e., persistent low (84.4%), persistent high (2.5%), decreasing (7.9%), and increasing (5.3%). An indication of a significant positive effect of the N-PALS model was found for students with a persistently high-risk trajectory. The current study adds to the evidence that this school-wide prevention model can moderate the development of externalizing behavior problems among children and youth.
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http://dx.doi.org/10.1007/s11121-018-0938-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208577PMC
November 2018

Hospitals implementing changes in law to protect children of ill parents: a cross-sectional study.

BMC Health Serv Res 2018 08 6;18(1):609. Epub 2018 Aug 6.

Norwegian Center for Child Behavioral Development, Unirand, Box 7053, Majorstuen, 0368, Oslo, Norway.

Background: Norway is one of the first countries to require all health professionals to play a part in prevention for children of parents with all kinds of illnesses (mental illness, drug addiction, or severe physical illness or injury) in order to mitigate their increased risk of psychosocial problems. Hospitals are required to have child responsible personnel (CRP) to promote and coordinate support given by health professionals to patients who are parents and to their children.

Methods: This study examined the extent to which the new law had been implemented as intended in Norwegian hospitals, using Fixsen's Active Implementation Framework. A stratified random sample of managers and child responsible personnel (n = 167) from five Hospitals filled in an adapted version of the Implementation Components Questionnaire (ICQ) about the implementation of policy changes. Additional information was collected from 21 hospital coordinators (H-CRP) from 16 other hospitals.

Results: Significant differences were found between the five hospitals, with lowest score from the smallest hopitals. Additional analysis, comparing the 21 hospitals, as reported by the H-CRP, suggests a clear pattern of smaller hospitals having less innovative resources to implement the policy changes. Leadership, resources and system intervention (strategies to work with other systems) were key predictors of a more successful implementation process.

Conclusions: Legal changes are helpful, but quality improvements are needed to secure equal chances of protection and support for children of ill parents.

Trial Registration: The study is approved by the Regional Committee on Medical and Health Research Etics South-East (reg.no. 2012/1176 ) and by the Privacy Ombudsmann.
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http://dx.doi.org/10.1186/s12913-018-3393-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6080385PMC
August 2018

Dimensionality of oppositional defiant disorder.

Child Adolesc Ment Health 2018 May 11;23(2):121-129. Epub 2017 Nov 11.

The Norwegian Center for Child Behavioral Development (NUBU) , Oslo, Norway.

Background: The present study examined dimensionality of oppositional defiant disorder (ODD) using 10 alternative items using network analysis and confirmatory factor analysis.

Methods: The sample constituted 551 Norwegian children aged 2-12 and their parents. We used network analysis to investigate the connections between different symptoms. Next, we analysed data using traditional confirmatory factor methods, including the more recently proposed bifactor approach.

Results: The bifactor model, with a strong general factor and three specific factors, provided the best model fit. Omega values did, however, reveal that only the general and the specific hurtful factor had satisfactory reliability. Network analysis showed that symptoms in general were positively connected within the ODD network. Strong connections between several symptoms within the irritable and hurtful cluster emerged, whereas some symptoms of the headstrong cluster seem to function as bridge nodes between the irritable and hurtful symptom clusters.

Conclusions: The findings support a bifactor model of ODD indicators, but omegas only gave support to the use of a general latent factor, and one specific factor. Network analysis did, however, provide some additional and interesting findings, revealing clusters of strongly connected symptoms and central bridge node symptoms. Implications of the results are discussed.
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http://dx.doi.org/10.1111/camh.12248DOI Listing
May 2018

General and specific factors of working alliance in parent training: A bifactor exploratory structural equation modelling approach.

Psychother Res 2019 02 13;29(2):267-276. Epub 2017 Jun 13.

a The Norwegian Center for Child Behavioral Development (NUBU) , UNIRAND, University of Oslo , Oslo , Norway.

The Working Alliance Inventory Short form (WAI-S) comprises 12 items that measure 3 subdomains (goal, task, and bond). In the present study, we evaluated the factor structure of WAI-S in a parent management training (PMT) context, by investigating a series of different factor models, including standard confirmatory factor analyses (CFA) models and more recent alternatives, like the exploratory structural equation model (ESEM), the bifactor-CFA, and the bifactor exploratory structural equation model (B-ESEM). The study sample consisted of 259 Norwegian parents receiving PMT - the Oregon model (PMTO). Alliance was rated by parents of children with emerging or present conduct problems after the first therapy session. Results showed that the B-ESEM model provided best model fit to the data. Estimated sources of variance and omega reliabilities supported a strong general alliance factor, but revealed poor quality of the specific factors. Overall, the present study implies that specific factors of working alliance should be interpreted with caution; rather one should rely on a general working alliance construct. Clinical or methodological significance of this article: Findings suggest that working alliance, as measured by WAI-S in a PMT context, is best reflected by a general construct that also take into account multidimensionality. However, only the general factors provide acceptable reliability. Consequently, practitioners should use the specific factors with caution. The indicators of the specific factors should be improved.
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http://dx.doi.org/10.1080/10503307.2017.1330574DOI Listing
February 2019

How to implement Illness Management and Recovery (IMR) in mental health service settings: evaluation of the implementation strategy.

Int J Ment Health Syst 2017 23;11:13. Epub 2017 Jan 23.

Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway.

Background: The purpose of this study was to evaluate the implementation strategy used in the first-phase of implementation of the Illness Management and Recovery (IMR) programme, an intervention for adults with severe mental illnesses, in nine mental health service settings in Norway.

Methods: A total of 9 clinical leaders, 31 clinicians, and 44 consumers at 9 service settings participated in the implementation of IMR. Implementation was conducted by an external team of researchers and an experienced trainer. Data were gathered on fidelity to the intervention and implementation strategy, feasibility, and consumer outcomes.

Results: Although the majority of clinicians scored within the acceptable range of high intervention fidelity, their participation in the implementation strategy appeared to moderate anticipated future use of IMR. No service settings reached high intervention fidelity scores for organizational quality improvement after 12 months of implementation. IMR implementation seemed feasible, albeit with some challenges. Consumer outcomes indicated significant improvements in illness self-management, severity of problems, functioning, and hope. There were nonsignificant positive changes in symptoms and quality of life.

Conclusions: The implementation strategy appeared adequate to build clinician competence over time, enabling clinicians to provide treatment that increased functioning and hope for consumers. Additional efficient strategies should be incorporated to facilitate organizational change and thus secure the sustainability of the implemented practice. ClinicalTrials.gov NCT02077829. Registered 25 February 2014.
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http://dx.doi.org/10.1186/s13033-017-0120-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5259843PMC
January 2017

Predictors of changes in child behaviour following parent management training: Child, context, and therapy factors.

Int J Psychol 2017 Apr 18;52(2):106-115. Epub 2016 Jul 18.

Norwegian Center for Child Behavioral Development, Oslo, Norway.

This non-randomised study examined a set of predictive factors of changes in child behaviour following parent management training (PMTO). Families of 331 Norwegian girls (26%) and boys with clinic-level conduct problems participated. The children ranged in age from 3 to 12 years (M = 8.69). Retention rate was 72.2% at post-assessment. Child-, parent- and therapy-level variables were entered as predictors of multi-informant reported change in externalising behaviour and social skills. Behavioural improvements following PMTO amounted to 1 standard deviation on parent rated and ½ standard deviation on teacher rated externalising behaviour, while social skills improvements were more modest. Results suggested that children with higher symptom scores and lower social skills score at pre-treatment were more likely to show improvements in these areas. According to both parent- and teacher-ratings, girls tended to show greater improvements in externalising behaviour and social skills following treatment and, according to parents, ADHD symptomology appeared to inhibit improvements in social skills. Finally, observed increases in parental skill encouragement, therapists' satisfaction with treatment and the number of hours spent in therapy by children were also positive and significant predictors of child outcomes.
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http://dx.doi.org/10.1002/ijop.12365DOI Listing
April 2017

Psychometric properties of the Norwegian version of the Evidence-Based Practice Attitude Scale (EBPAS): to measure implementation readiness.

Health Res Policy Syst 2016 Jun 17;14(1):47. Epub 2016 Jun 17.

Akershus University Hospital, Division of Mental Health Services, Sykehusveien 25, 1478, Lørenskog, Norway.

Background: Attitudes can be a precursor to the decision of whether or not to try a new practice. In order to tailor the implementation of evidence-based practices (EBPs) in mental health settings, we must first consider practitioner attitudes towards EBP adoption. To assess these attitudes, the Evidence-Based Practice Attitude Scale (EBPAS) was developed. The purpose of this study was to investigate the psychometric properties of the Norwegian version of the EBPAS, and to examine differences in attitudes towards implementing EBPs among mental health practitioners.

Methods: The EBPAS was translated into Norwegian and administered to 294 practitioners from seven primary and 22 specialized mental care units within a defined geographical area of Norway.

Results: The EBPAS showed good psychometric properties. The less clinical experience the practitioner had, the more positive their attitude toward EBPs. Primary care practitioners reported more positive attitudes towards implementing EBPs that were required of them than specialized care practitioners.

Conclusions: The Norwegian version of the EBPAS is a promising tool for measuring implementation readiness in mental health services, and can be used in clinical practice to tailor implementation efforts.

Trial Registration: The study was approved by the regional committees for medical and health research ethics [ REK 2013/2035 ] on 25(th) of May, 2014.
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http://dx.doi.org/10.1186/s12961-016-0114-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912744PMC
June 2016

The short Working Alliance Inventory in parent training: Factor structure and longitudinal invariance.

Psychother Res 2016 11 1;26(6):719-26. Epub 2016 Feb 1.

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

Objective: The purposes of the present study were twofold: (a) to examine the factor structure of the Working Alliance Inventory, Short (WAI-S) and (b) to investigate if factor loadings and thresholds fulfilled properties of longitudinal measurement invariance across two waves of data.

Method: The study sample consisted of 259 Norwegian parents receiving Parent Management Training, the Oregon model. Parents rated alliance at sessions 3 and 12 during the therapy. Confirmatory factor analyses to assess the fit of a one-, two-, and three-factor model were performed using robust weighted least squares estimation for categorical indicators.

Results: The results showed that data provided best fit for the three-factor solution with goal, task, and bond. Furthermore, results demonstrated satisfactory invariance for factor loadings and thresholds across time.

Conclusions: Overall, the results indicate that the WAI-S three-factor solution has acceptable psychometric properties for longitudinal measurement comparisons.
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http://dx.doi.org/10.1080/10503307.2015.1119328DOI Listing
November 2016

Is There a Scale-up Penalty? Testing Behavioral Change in the Scaling up of Parent Management Training in Norway.

Adm Policy Ment Health 2017 Mar;44(2):203-216

Norwegian Center for Child Behavior Development, P.O. Box 7053, Majorstuen, 0306, Oslo, Norway.

In the present study, the scaling up of Parent Management Training, Oregon Model (PMTO) in Norway was examined by investigating how large-scale dissemination affected the composition of the target group and the service providers by comparing child behavioral outcomes in the effectiveness and dissemination phases of implementation. Despite the larger heterogeneity of the service providers and the intake characteristics of the target group, which are contrary to the expectations that were derived from the literature, no attenuation of program effects was detected when scaling up PMTO. In Norway, a long-term-funded centralized center, combined with an active implementation strategy, seems to have affected the quality of PMTO delivered system-wide in services for children with behavior problems.
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http://dx.doi.org/10.1007/s10488-015-0712-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5306432PMC
March 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

Normative development of physical aggression from 8 to 26 months.

Dev Psychol 2014 Jun 7;50(6):1710-20. Epub 2014 Apr 7.

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

This study investigated the normative use and developmental course of physical aggression (PA), defined as use of physical force such as hitting, biting, and kicking, from 8 to 26 months and predictors thereof. We used data from the Behavior Outlook Norwegian Developmental Study, comprising 1,159 children (559 girls and 600 boys). Both mothers and fathers reported frequently about their child's use of PA in personal and telephone interviews. Mean number of reports per child was 7.16 (SD 1.70), with 90% having at least 6 reports. We employed Rasch scaling to construct a single linear PA measure and multilevel growth curve modeling to address the research questions. The results confirm that the development of PA is nonlinear, with a peak in frequency at about 20-22 months, which is followed by a decline toward 26 months. There is both within- and between-child variance in the development of PA. Higher levels of PA were predicted by the presence of a same-age sibling, maternal and paternal mental distress, and difficult child temperament (high activity level and distress due to limitations), whereas the main effect of gender was only trend-significant. Growth of PA across this developmental period was predicted by the presence of a same-age sibling and high activity level. The results both support and transcend previous research within this field.
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http://dx.doi.org/10.1037/a0036324DOI Listing
June 2014

Working alliance and treatment fidelity as predictors of externalizing problem behaviors in parent management training.

J Consult Clin Psychol 2013 Dec 29;81(6):1010-20. Epub 2013 Jul 29.

Norwegian Center for Child Behavioral Development.

Objective: The study investigated treatment fidelity and working alliance in the Parent Management Training-Oregon model (PMTO) and investigated how these relate to children's externalizing problem behaviors, as reported by parents and teachers.

Method: Participants were 331 Norwegian parents who rated the client-therapist working alliance at 3 time points (Sessions 3, 12, and 20). Competent adherence to the PMTO treatment protocol was assessed by PMTO specialists from evaluations of videotaped therapy sessions using the Fidelity of Implementation (FIMP) system (Knutson, Forgatch, & Rains, 2003). Parents and teachers reported children's problem behaviors at baseline and at the end of therapy. Structural equation modeling was used to analyze the repeated measures data.

Results: Parents reported high and stable levels of alliance and fidelity from Time 1 to Time 3, with no correlational or direct relations between the 2. Treatment fidelity predicted reductions in parent-reported externalizing behavior, whereas working alliance was related to less change in problem behavior. Alliance and fidelity were unrelated to teacher-reported behavior problems.

Conclusions: The findings point to treatment fidelity as an active ingredient in PMTO and working alliance as a negative predictor of postassessment parent-reported externalizing behavior. More research is needed to investigate whether these findings can be replicated and extended beyond PMTO.
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http://dx.doi.org/10.1037/a0033825DOI 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

Intensive Quality Assurance of Therapist Adherence to Behavioral Interventions for Adolescent Substance Use Problems.

J Child Adolesc Subst Abuse 2011 Jan;20(4):289-313

Norwegian Center of Child Behavioral Development and Akershus University College.

This study was a crosscultural replication of a study that investigated therapist adherence to behavioral interventions as a result of an intensive quality assurance system which was integrated into Multisystemic Therapy. Thirty-three therapists and eight supervisors participated in the study and were block randomized to either an Intensive Quality Assurance or a Workshop Only condition. Twenty-one of these therapists treated 41 cannabis-abusing adolescents and their families. Therapist adherence and youth drug screens were collected during a five-month baseline period prior to the workshop on contingency management and during 12 months post workshop. The results replicated the previous finding that therapist adherence to the cognitive-behavioral interventions, but not to contingency management, showed a strong positive difference in trend in favor of the intensive quality assurance condition. While the clinical impact of such quality assurance may be delayed and remains to be demonstrated, cannabis abstinence increased as a function of time in therapy, and was more likely with stronger therapy adherence to contingency management, but did not differ across quality assurance interventions.
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http://dx.doi.org/10.1080/1067828X.2011.581974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185378PMC
January 2011

Treatment outcomes and mediators of parent management training: a one-year follow-up of children with conduct problems.

J Clin Child Adolesc Psychol 2011 ;40(2):165-78

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

This effectiveness study presents the results of a 1-year follow-up of a randomized controlled trial of Parent Management Training. Families of 112 Norwegian girls and boys with clinic-level conduct problems participated, and 75 (67%) families were retained at follow-up. Children ranged in age from 4 to 12 at intake (M = 8.44). Families randomized to the control group received an active treatment alternative as would be normally offered by participating agencies. Multi-informant, multisetting outcome measures were collected and results from both intention-to-treat and treatment-on-the-treated analyses are presented. In two separate indirect effects models, assignment to Parent Management Training-the Oregon model predicted greater effective discipline and family cohesion at postassessment, which in turn predicted improvements in several child domains at follow-up.
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http://dx.doi.org/10.1080/15374416.2011.546050DOI Listing
July 2011

Intervention and prevention with adolescents.

J Adolesc 2009 Dec 7;32(6):1343-5. Epub 2009 Nov 7.

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http://dx.doi.org/10.1016/j.adolescence.2009.10.004DOI Listing
December 2009

What works for whom? Gender differences in intake characteristics and treatment outcomes following Multisystemic Therapy.

J Adolesc 2009 Dec 19;32(6):1425-35. Epub 2009 Jul 19.

Norwegian Center for Child Behavioral Development, Unirand, University of Oslo, Majorstuen, 0368 Oslo, Norway.

Aims Of The Study: We investigated whether girls and boys had similar referral symptoms and background characteristics at intake to Multisystemic Therapy (MST) and whether adolescent girls with serious behavior problems benefited as much from MST treatment as did boys. We also examined gender differences in rate of co-morbidity at intake and whether the families of boys and girls referred to MST differed in their evaluation of the treatment received.

Method: Participants were 117 Norwegian adolescent girls (35%) and boys (65%), ranging in age from 12 to 17 (M=14.58), referred to MST treatment in the first and second year of the program operation.

Results: Gender differences appeared for some referral reasons, intake characteristics and treatment changes, but the similarities between girls and boys far outnumbered their differences.

Conclusions: Although girls may present a somewhat different problem profile than do boys and their risk factors for developing conduct problems may be somewhat different, MST seemed flexible and robust enough to be effective for most adolescents in the present sample, regardless of gender.
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http://dx.doi.org/10.1016/j.adolescence.2009.06.006DOI Listing
December 2009

Treatment effectiveness of Parent Management Training in Norway: a randomized controlled trial of children with conduct problems.

J Consult Clin Psychol 2008 Aug;76(4):607-621

Norwegian Center for Child Behavioral Development.

This study was a randomized control trial (RCT) of Parent Management Training--The Oregon Model (PMTO) in Norway. A sample representing all health regions of Norway and consisting of 112 children with conduct problems and their families participated in the study. Families were randomly assigned to either PMTO or a regular services comparison group. PMTO was delivered via existing children's services, and families were recruited using the agencies' regular referral procedures, making this the first effectiveness study of PMTO and the first RCT of PMTO conducted outside of the United States. Using a multiagent-multimethod approach, results showed that PMTO was effective in reducing parent-reported child externalizing problems, improving teacher-reported social competence, and enhancing parental discipline. Age level and gender modified the effects of PMTO treatment on other outcomes. In a path model, participation in PMTO was associated with improved parental discipline, and effective discipline predicted greater child compliance, fewer child-initiated negative chains, and lower levels of child externalizing problems. Findings are presented along with a discussion of the implications for practice and research and the challenges accompanying effectiveness trials.
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http://dx.doi.org/10.1037/0022-006X.76.4.607DOI Listing
August 2008