Archives: Intervention

Abstract

Delivery of the intervention

Group-based

Aim of the intervention

The aim of the intervention is to teach children methods to reduce stress-reaction. The TRT-intervention is suitable for treating symptoms of post-traumatic stress disorder (PTSD), coping after a trauma and support the child’s recovery.

Description of the intervention

TRT is a group-based intervention for over 8 year-old children and their parents, who have been exposed to armed conflicts or natural catastrophes. The theoretical framework is provided by the trauma-focused cognitive-behavioural therapy. The intervention comprises five sessions in consecutive weeks for children and two consecutive weeks for the parents at the beginning of the children’ group. The parent groups focus on supporting and guiding methods, with which the parents can help their children in the traumatic situation. After the TRT-intervention a follow-up session can be organized to reinforce the learned contents and to share peer experiences. Intervention uses a guidebook developed for the intervention.

Availability of the intervention in Finland

Mental health, social and healthcare and education professionals can attain a TRT group leader training, organized by private mental health professionals. They must have been trained as a trainer by the Children and War Foundation (CWF). The trainings have been organized in Finland primarily based on bookings. The TRT has been originally developed for treating traumatic experiences caused by natural catastrophes and conflicts. The intervention has been used in Finland as a group-based method for immigrant children at school, in crisis work and for victims of sexual abuse.

Research- and evidence-based efficacy of the intervention

The effectiveness of the TRT-intervention has been tested in international RCT-studies, which have focused on the post-traumatic stress disorder (Barron et al. 2013; 2016; Pityaratstian et al. 2015; Qouta et al. 2012) in response to natural catastrophes (Pityaratstian et al. 2015) and conflicts (Barron et al. 2013; 2016; Diab et al. 2015; Qouta et al. 2012), depressive symptoms (Barron et al. 2013; 2016; Qouta et al. 2012), traumatic sadness and academic accomplishments (Barron et al. 2013), resilience (Diab et al. 2015) and dissociation (Barron  et al. 2016) in children. The studies have found strong evidence for the intervention in reducing depressive symptoms and traumatic sadness. Post-traumatic stress disorder symptoms were found to decrease in the intervention group compared to the control group, but the effect on the academic accomplishment, resilience and dissociation was small. There is neither peer reviewed research nor research-based evidence of effectiveness of the intervention in Finland.

Literature

Barron, I., Abdallah, G., & Heltne, U. (2016). Randomized control trial of Teaching Recovery Techniques in rural occupied Palestine: Effect on Adolescent Dissociation. Journal of Aggression, Maltreatment & Trauma, 25(9), 955–973.

Barron, I., Abdallah, G., & Smith, P. (2013). Randomized control trial of a CBT trauma recovery program in Palestinian school. Journal of Loss and Trauma: International Perspectives on Stress & Coping, 18(4), 306–321.

Diab, M., Peltonen, K., Qouta, S. R., Palosaari, E., Punamäki, R-L. (2015). Effectiveness of psychosocial intervention resilience among war-affected children and the moderating role of family factors. Child Abuse & Neglect, 40, 24–35.

Pityaratstian, N., Piyasil, V., Ketumarn, P., Sitdhiraksa, N., Ularntinon, S., & Pariwatcharakul, P. (2015). Randomized controlled trial of group cognitive behavioural therapy for post-traumatic stress disorder in children and adolescents exposed to tsunami in Thailand. Behavioural and Cognitive Psychotherapy, 43, 549–561.

Qouta, S. R., Palosaari, E., Diab, M., Punamäki, R-L. (2012). Intervention effectiveness among war-affected children: a cluster randomized controlled trial on improving mental health. Journal of Traumatic Stress, 25, 288–298.

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.

Summary 

Phenomena

Behavioural problems, emotions and emotional regulation, child-parent relationship and interaction, and parenting skills and knowledge

Introduction

Finnish Strongest Families (Voimaperheet in Finnish) is an evidence-based operating model that is based on parent training. It has been developed for the early identification of behavioural problems in children below school age and for digital, preventive care.  

Objective and research question

This systematic literature review assesses the effectiveness of the Voimaperheet operating model on the basis of research literature. The review answers the following question: Is the Finnish Strongest Families method, which is based on digital parent training, effective in reducing behavioural problems among children below school age and strengthening parenting skills in the Finnish context? 

Data and methods

This study used the Population, Concept and 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 done on the Finnish Strongest Families Parent Training Programme?  The following keywords were used: P = children under school age, C = Strongest families, Strongest families smart website, SFSW (Voimaperheet). Context was omitted to avoid an excessive restriction of the results of the search.  The primary area of interest in the search was effectiveness studies carried out on the method, although studies carried out by using 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. In addition, a search for publications in Finnish was performed on the Finna.fi service, and the search was supplemented by a manual search. 

Results

The Finnish Strongest Families Parent Training Programme has a sufficient description and theoretical basis. Based on the literature search, four studies carried out in Finland were selected for the review, three of which were effectiveness studies and one was an outcome study.  In the randomised effectiveness studies, the effectiveness of the method has not been compared to non-intervention. Instead, the Finnish Strongest Families intervention has been compared to the standard services available to families with children. In the three evaluated effectiveness studies (Appendix 2), the operating model’s effect on the externalising behavioural symptoms of the child was low for the primary outcome variables reported in one- and two-year follow-up measurements (d = 0.22–0.34; 95% confidence interval (CI) 0.02–0.53; NNT ( Number-Needed-To-Treat ) = 3.42–8.06). For the parenting skills of the parents, the effectiveness was moderate (d = 0.51–0.53, the confidence intervals could not be calculated based on the information provided in the article, NNT = 3.42–3.55). For all of the outcome variables, the effect ranged from very low to moderate (d = 0.09–0.53, NNT = 3.42–20.00). The studies evaluated in the review demonstrate that the Finnish Strongest Families Parent Training Programme is an effective intervention for reducing behavioural symptoms in children below school age and improving parents’ parenting skills. The effects persisted even in the two-year follow-up. The effectiveness was observable both in randomised controlled studies and in real-world practice as part of the universal service system for children and families. Implementation support for the Finnish Strongest Families intervention is diverse and sufficient, which maintains the implementation quality of the intervention.  

Methodology evaluation

The methodology evaluation score for the Finnish Strongest Families Parent Training Programme is 5/5, which means that there is strong evidence of the intervention’s effectiveness in the Finnish context. The evidence of the effectiveness of the Finnish Strongest Families Parent Training Programme has been observed with regard to behavioural problems in children under school age by comparing families who have participated in the programme with families that have not participated in it. Effectiveness was studied by examining outcome variables for both the child and the parent. 

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.

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.

1 2 3 4