Archives: Intervention

Abstract

Delivery of the intervention

Group-based

Aim of the intervention

Incredible years teacher classroom management program increased social skills of 3-12 year-old children and prevents the development of behavioral problems in child groups. Incredible years teacher classroom management program strengthens the group management skills of education professional as well as reflexive and positive approach in education work in a child group.

Description of the intervention

The group-based method targeted at education professionals instructs child groups systematically, reduces behavioral problems among children in a group and enhances the self-regulation and emotional skills of individual children. Theoretically the intervention lies on the social learniing, attachment relationship, cognitive-behavioral and solution-focused therapies. Incredible years teacher classroom management program is used as a structured method in the early and primary education as well as in the child and family services. The group management skills of an education professional increases the academic success and emotional skills of the children (Korpershoek 2014) and reduces their aggression and mental health problems (Durlak et al. 2011; Greenberg et al. 2003; Zins et al. 2004). In the intervention the education professional is receives a training as a methodologist in group-based workshop trainings and uses the method when instructing a child group as a part of the training.

Availability of the intervention in Finland

An education professional can receive a training as an Incredible years teacher classroom management methodologist. After the method training it is possible to participate in a further training as a group instructor of the management program. In Finland the trainings are organized by the Research Center for Child Psychiatry at the University of Turku. The intervention is a part of the Incredible Years method family. The incredible Years was developed originally in the USA. There are approximately 700 methodologists in Finland, the availability of the method varies regionally.

Research- and evidence-based efficacy of the intervention

A meta-analysis including nine international, high level RCT-studies, an RCT-study (Seabra-Santos et al. 2018) and in the Nordic countries a Norwegian quasi-experimental study (Aasheim et al. 2018) have been conducted on the Incredible years teacher classroom management program (Nye 2018). The intervention has been found to effectively reduce children’s behavioral problems and increase social skills as compared to the control group (Nye 2018; Seabra-Santos et al. 2018). The ggroup management skills of the teachers using the intervention, increased as compared to the control group (Nye 2018). There is abundant research-based evidence for the effectiveness of the Incredible Years teacher classroom -management program.

Literature

Aasheim, M., Reedtz, C., Handegård, B.H., Martinussen, M. & Mørch, W-T. (2018). Change in teacher–student relationships and parent involvement after implementation of the Incredible years teacher classroom management programme in a regular Norwegian school setting. British Educational Research Journal.

Durlak, J.A., Weissberg, R.P., Dymnicki, A.B., Taylor, R.D. & Schellinger, K.B. (2011). The Impact of Enhancing Students’ Social and Emotional Learning: A Meta-Analysis of School-Based Universal Interventions. Child Develpoment, 82(1), 405–432.

Greenberg, M. T., Weissberg, R. P., O’Brien, M. U., Zins, J. E., Fredericks, L. & Resnik, H. (2003). Enhancing school-based prevention and youth development through coordinated social, emotional, and academic learning. American Psychologist, 58, 466–474.

Nye, E., Melendez-Torresb, G. J. and Gardner, F. (2018). Mixed methods systematic review on effectiveness and experiences of the Incredible years teacher classroom management programme. Review of Education.

Korpershoek, H., Harms, T., de Boer, H., van Kuijk, M. & Doolaard, S. (2014). Effective classroom management strategies and classroom management programs for educational practice: A meta-analysis of the effects of classroom management strategies and classroom management programs on students’ academic, behavioural, emotional, and motivational outcomes. Groningen: RUG/GION

Seabra-Santos, M. J., Gaspar, M. F., Major, S.O., Patras, J., Azevedo, A. F., Homem, T.C., Pimentel, M., Baptista, E., Klest, S. & Vale, V. (2018). Promoting mental health in disadvantaged preschoolers: A cluster randomized controlled trial of teacher training effects. Journal of Child and Family Studies.

Zins, J. E., Weissberg, R. P., Wang, M. C., & Walberg, H. J. (toim.). (2004). Building academic success on social and emotional learning: What does the research say? New York: Teachers College Press.

Abstract

Delivery of the intervention

Individual-/family-based

Aim of the intervention

The intervention aims to identify and prevent children’s behavioral problems at an early stage in the primary health care. The Voimaperheet-intervention supports and guides parents, who perceive challenges in bringing up a child with behavioral problems.

Description of the intervention

The Voimaperheet is a digital intervention for the families with a pre-school child demonstrating behavioral problems. The intervention is based on epidemiological research knowledge about childhood behavioral problems, which are associated with mental health problems in adulthood (Sourander et al. 2007) and the efficacy of parent training as a preventive intervention for childhood behavioral problems. The Voimaperheet also lies on research-based knowledge about formation of the therapeutic alliance through remote methods (Lingely-Pottie & McGrath 2006; 2008). The Voimaperheet model with population-based screening has been integrated as a part of the extended health check-up covering the age cohort. In the municipalities, which have implemented the intervention, the Voimaperheet–questionnaire is delivered to the families who attend the child health clinic checkup for children at the age 4. After screening the intervention is provided to those parents whose children display high levels of parent-reported behavioral problems. Family coach who has received a special Voimaperheet training guides the family through the program websites. In the beginning of the intervention, the coach and the parent(s) set contents and goals according to the specific needs of the child and family. Duration of the Voimaperheet-intervention is from three to four months, during which the family coach contacts the family via telephone on a weekly basis. After the intervention the family coaches conduct follow-up phone call.

Availability of the intervention in Finland

Voimaperheet coach -training is provided for the healthcare professionals. The training is based on a structured curriculum and ongoing work supervision is provided for the coaches to ensure fidelity and method skills. The participating municipalities provide training for the implementation of the Voimaperheet-intervention. The Research Center for Child Psychiatry at the University of Turku, in co-operation with the Canadian Strongest Families research group, has developed the intervention, and is responsible for the training. Research on the development and follow-up of the Strongest Families has been conducted for over a decade. The implementation of the intervention extends currently across one third of the child health clinics in Finland. The Voimaperheet is a digital intervention and is thus suitable also in regions where conventional face-to-face services are not available.

Research- and evidence-based efficacy of the intervention

Voimaperheet is based on the Canadian Strongest Families programme. The Strongest Families has been tested in a Canadian study, which comprised three separate RCT- studies (McGrath et al. 2011) as well as in a Finnish RCT (Sourander et al. 2016). In the Canadian study, a psychiatric diagnosis was set for less children in the intervention group than in the control group who received treatment as usual (McGrath et al. 2011). In turn, the Finnish study found that the children in the intervention group (n=232) had significantly less behavioural problems compared to the control group (n=232) (McGrath et al. 2013; Sourander et al. 2016). A two-year follow-up study indicated that, in the intervention group, parenting skills improved, behavioural problems were significantly reduced, and sought help in the mental health services significantly less than in the control group (Sourander et al. 2018). There is strong research-based evidence for effectiveness of the Stongest Families in reducing behavioural problems in preschool children, and it is classified as a strong intervention. The Voimaperheet is successfully implemented widely in primary health care covering one third of Finnish child health clinics. The implementation resulted in good feasibility, fidelity, accessibility when compared with intervention in RCT study setting. The discontinuation of treatment in the implementation group was exceptionally low (12,4%). (Ristkari et al. 2019.)

Literature

Lingely-Pottie P. & McGrath, P. J. (2006). A therapeutic alliance can exist without face-to-face contact. Journal of Telemedicine and Telecare 1, 396–399.

Lingley-Pottie P & McGrath P.J. (2008). A pediatric therapeutic alliance occurs with distance intervention. Journal of Telemedicine and Telecare 14, 236–240.

McGrath P., Lingley-Pottie P., Thurston C., MacLean, C., Cunningham, C., Waschbusch, DA., Watters, C. Stewart, S., Bagnell, A., Santor, D. & Chaplin, W. (2011). Telephone-based mental health interventions for child disruptive behavior or anxiety disorders: Randomized trials and overall analysis. Journal of the American Academy of Child Adolescent Psychiatry, 50, 1162–1172.

McGrath P.J., Sourander A., Lingley-Pottie P., Ristkari T., Cunningham C., Huttunen J., Filbert K., Aromaa M., Corkum P., Hinkka-Yli-Salomäki S., Kinnunen M., Lampi K., Penttinen A., Sinokki A., Unruh A., Vuorio J. & Watters C. (2013). Remote population-based intervention for disruptive behavior at age four: study protocol for a randomized trial of Internet-assisted parent training (Strongest Families Finland-Canada). BMC Public Health 13, 985.

Ristkari, T., Kurki, M., Suominen, A., Gilbert, S., Sinokki, A., Kinnunen, M., Huttunen, J., McGrath, P., Sourander, A. (2019). Web-Based Parent Training Intervention With Telephone Coaching for Disruptive Behavior in 4-Year-Old Children in Real-World Practice: Implementation Study. Journal of Medical Internet Research, 11, 21(4):e11446.

Sourander A., Jensen P., Davies M., Niemelä, S., Elonheimo, H., Ristkari, T., Helenius, H., Sillanmäki, L., Piha, J., Kumpulainen, K., Tamminen, T., Moilanen, I. & Almqvist, F. (2007). Who is at greatest risk of adverse long-term out-comes? The Finnish from a boy to a man study. Journal of American Academy of Child and Adolescent Psychiatry, 46, 1148–1161.

Sourander, A., McGrath, P.J., Ristkari, T., Cunningham, C., Huttunen, J., Lingley-Pottie, P., Hinkka-Yli-Salomäki, S., Kinnunen, M., Vuorio, J., Sinokki, A., Fossum, S. & Unruh, A. (2016). Internet-assisted parent training intervention for disruptive behavior in 4-year old children. A randomized clinical trial. JAMA Psychiatry 73, 378–87.

Sourander, A., McGrath, P., Ristkari, T., Cunningham, C., Huttunen, J., Hinkka-Yli-Salomäki, S., Kurki, M. & Lingley-Pottie, P. (2018). Two-year follow-up of internet and telephone assisted parent training for disruptive behavior at age 4. J Am Acad Child Adolesc Psychiatry, 57, 658–668.

Abstract

Introduction

The parent’s mental health problems affect the whole family. A child has double the risk of developing a mental health problem if their parent has a serious mental health disorder. However, the intergenerational transmission of mental health problems can be prevented.

The Family Talk Intervention, which is one of the Effective Child & Family methods, aims to strengthen the resilience of children and families and to prevent the intergenerational transmission of mental health problems by addressing the problem that affects the whole family in a joint discussion. The method was originally developed for families with a parent with a mood disorder and children aged 8 to 15, but it has also been used in families where parents have other mental health problems.

Data and Methods

The literature search was carried out using the Population, Concept, Context (PCC) search strategy typical for literature reviews with the question: What research has been conducted on the Family Talk Intervention? (P = pre-school-aged children, primary-school-aged children, young people, families, parents, C = Family Talk, C = healthcare, social welfare, home, school, day-care, third sector). The primary focus of the literature search was on impact studies. A systematic literature search was carried out in the following databases: PubMed/MEDLINE, CINAHL, ERIC, APA PsycInfo, Web of Science and Scopus.

Results

The literature search found 11 studies selected for a systematic review, four of which were selected for assessment (3 Nordic impact studies, 1 Finnish implementation study). Of the seven qualitative studies selected for review, five were non-Nordic impact studies, one was a Nordic implementation study, and one was a Finnish non-impact or non-implementation study. According to the assessment, the Family Talk Intervention model has a sufficient description and theoretical background.

The method has positive impacts on factors related to children’s resilience, and the observed effects remained 10, 12 and 18 months after the intervention. The extent of the impacts was large (d = -0.74, 95% confidence interval (LV) = (-1.52-0.00); NNT (Number-Needed-to-Treat) = 2.50 and d = 0.92, 95% LV = (0.68-1.16); NNT 2.07). According to the results, when three families receive the intervention, one family benefits from it. The quality of impact studies ranged from poor to good. As the readiness to implement the Family Talk Intervention is achieved in less than half of the required areas, there is still room for improvement in its implementation in the Finnish context.

Overall assessment

The method receives an overall score of 4(/5) i.e. there is moderate documented evidence of the method in the Finnish context.

Summary

Phenomena

Behavioural and substance abuse problems

Introduction

Behavioural and substance abuse problems during adolescence are a significant burden on the young person, their loved ones and society at large. Multidimensional family therapy (MDFT) is a family- and system-oriented working method for social and healthcare workers who support young people experiencing wide-ranging and diverse challenges. The goal of MDFT is to reduce the adolescent’s behavioural and substance abuse problems and to support interaction between the adolescent and their parents.

Research question

Is the MDFT method effective on the wide-ranging and diverse behavioural and substance abuse problems of young people aged 12–18in a Finnish context?

Data and methods

This study used the Population, Concept, Context (PCC) strategy to search for literature, which is a typical strategy in exploratory literature reviews. The search targeted the following question: What research has been carried out on the multidimensional family therapy method? The keywords used were: P = children and adolescents aged 12–18, C = Multidimensional Family Therapy (MDFT), C = Child welfare, outpatient care in specialised health care, other. The primary areas of interest in the search were the effectiveness studies carried out on the method, although studies with different frameworks were also included. A systematic search was carried out for the following six databases: MEDLINE, APA PsycInfo, CINAHL, ERIC, Web of Science and Scopus.

Results

Based on themethod guide, the MDFT method has a sufficient description and theoretical basis. Based on the literature search, one systematic review, three meta-analyses and nine original studies were selected. The studies were conducted in the United States and Central Europe. No Finnish or Nordic implementation studies were found. The effectiveness of the method has not been compared to non-treatment (people in queue), but in randomised effectiveness studies, MDFT has been compared to active interventions, such as enhanced standard services, cognitive behavioural therapy, individual and group therapy, long-term institutional care and motivational enhancement therapy. In these comparisons, the effects on 12–18-year-old adolescents ranged from small to large in response variables (d = 0.24–1.23, NNT [Number-Needed-to-Treat ] = 1.62–7.46 ). Regarding response variables related to substance abuse and behavioural disorders, MDFT is equal to other comparative methods, or in some respects, more effective. The quality of the studies included in the meta-analyses was moderate at most, and the quality of the studies evaluated for the review ranged from poor to good. There is sufficient support for implementing the MDFT method.

Method assessment

MDFT’s method assessment is 5/5, which means that there is strong effectiveness research on the method in a US and European context, but no data is available for the Nordic countries and Finland. There is evidence to support that MDFT is effective compared to active methods when treating adolescents aged 12–18 who have substance abuse or behavioural problems. The method assessment is based on the criteria of the Kasvun tuki (Early Interventions) assessment system.

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