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

1. The Incredible Years
Implementation, content and
research
Professor Willy-Tore Mørch
Faculty of health sciences. University of Tromsø

2. Levels of services
• Treatment
Diagnosed disorder, above clinical cut-off
• Indicated prevention
Symptomes of disorders
• Targeted prevention
Presence of risk factors
• Universal prevention
No known risk factors or symptomes
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3. Implementation strategy
Dissemination
• The system model:
Formal organizational structures in both the
purveyor’s and the receiving organization’s are
connected for safe anchoring of the intervention.
Contact moves from a personel level to a system
level in order to prepare for formal political and
administrative decisions.
The aim is to place the intervention as a part of the
municipality’s health policy
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4. Implementation strategy
Adaptation:
• Assessment of the characteristics of the
municipality and the needs for the intervention
Prevalence of individuals with the targeted
problems, incidence rate of the problems, existing
interventions etc.
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5. Implementation strategy
Adaptation
• Agency readyness assessment
Acceptability for the intervention in the agencies
(agreement) Motivation for implementation,
ideological compatibility between the agency and
the intervention (e.g. theory, manual based
intertvention)
Identification of eary adopters, late adopters and
refusers (Roberts, 1995)
Identification of agency characteristics (number of
employees)
Allocation of resources for the intervention, both
human, time and monetary
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6. Implementation strategy
Implementation:
Selection of target population (e.g. adolescents with
conduct disorder)
Selection of service level (treatment,
indicated/targeted and/or universal prevention)
Training of personell by sertified mentors (program
content, progression and methods, ethics,
refinement/education, respect people’s needs and
problems, integrity)
Supervision and coaching, longlasting supervision
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7. Sustainability
Organizational detoriation
Prevention of organizational «amnesia» (shift of
leadership, new ideas)
Development of systems preventing close-down of
the intervention due to resignments, pregnancies,
illness etc
Fidelity detoriation
Drift in program content, dose, target population,
implementation evaluatuion
Competence detoriation
Sertification, resertification, supervision,
«super-days», annual conferences
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8. The incredible years:
Parents, children, teachers
Treatment and prevention
Developed by
Carolyn Webster-Stratton, Ph.D.
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The Incredible Years Training

9. The incredible years program
components in Norway
Classrooms
Management
program
Small group Dinoraur school
Dinosaur In the
school classroom
School age
Old Basic Universal prevention
Pre-school age Program
Baby and toddler Closed down 3-6
Program 6-12
Program Fall 2012
3-5
0-1 and 1-3

10. The incredible years
(preschool and school age)
• How to play with your child
• Emotional, social, consitence,
academic coaching
• The art of praise
• Motivating children by reward
• Positive, effective limit setting
• Handling of behavior problems
• Problem solving for children
The Incredible Years Training Series

11. Parent Rare
Time
pyramide out
Ignore
Reduce nagging
Often
Positive limit setting
Enforce collaboration
Praise and reward
Building social competence
Play: positive parent-child relations
Emotional, social, consistence, academic
coaching
The Incredible Years Training Series

12. The incredible years
Strategies
• Focus on cognition, emotions and
behavior
• Developmentally based
• Empirically supported
• The collaborative process
• Promoting SELVSTENDIGHET
• Video clips
• Role play and rehersals
• Home assignments
• Parent support
The Incredible Years Training

13. Parent involvement
• In-depth interview
• 10-14 parents in the groups
• Partner support,
different parent backgrounds
• Day and evening groups
• Weekly 2 hour meetings
• Two group leaders
• Buddy calls
• Food
• Baby-sitters
• Transportation
The Incredible Years Training

14. The clinical RCT study
Larsson, B., Fossum, S., Clifford, G., Drugli, M.
B., Handegård, B. H., & Mørch, W-T. (2008).
Treatment of oppositional defiant and conduct
problems in young Norwegian children: results of a
randomized controlled replication trial. European
Child and Adolescent Psychiatry, Vol 18. (1) s. 42-
52.

15. Participants
• 127 children 4-8 år
• Screening with ECBI og
Kiddie-sads
• 4 assigment waves
2001-2003
• One year follow-up
(2002-2004)
• 5-6 year follow-up
(2009/10)

16. Results: behavior problems
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17. Resultater: foreldreferdigheter og
stress

18. Changes in diagnosis
120
100
80
Pre
60
1-årsFU
40
20
0
ODD CD ADHD Angst/depr

19. Resultater: Behandlingsdose
– respons
• Høy deltakelses-prosent på
foreldre-grupper og på
Dinosaurusskolen
• Korrelasjon mellom
deltakelsesprosent på
foreldregrupper og endringsskår
på ECBI:
 r = 0,18 (p > 0,05)

20. Diagnosis at the different assessment points
Pre treatment 1 year FU 5-6 year FU
N=127 n=88 n=54
% (n) % (n) % (n)
ODD 100 (127) 34,0 (30) 31,5 (17)
CD 18,9 (24) 3,4 (3) 9,3 (5)
ADHD 35,4 (45) 25,0 (22) 50,0 (27)
Angst/depresjon 10,2 (13) 5,7 (5) 7,4 (4)

21. Stability of ODD/CD diagnosis from 1 year FU to
5/6 year FU
• 38.9 (21) of the participants at 5/6 years FU had not ODD/CD
at 1 year FU or 5/6 year FU
 The success children
• 9.3% (5) had ODD/CD at both assessment points
 The high risk children
• 28.8% (15) had ODD/CD at 1 year FU, but not at 5/6 year FU
 Delayed effect?
• 24.1% (13) had not ODD/CD at 1 year FU, but with 5/6 års FU
 The effect that disappeared?

22. The universal prevention program
 Reedtz, Mørch & Handegård, 2010
 Reedtz,Martinussen, Jørgensen,
Handegård & Mørch, 2011

23. An RCT from a normal
population
 Total of families volunteered=269
 58 children (22%) excluded due to ECBI
intensity score > 90% (clinical cut-off)
 22 families (10%) terminated their
participation in the initial phase.
 Pre-post and 1 yr. Follow-up
 The relation building components of the IY
parent program (Meeting 1-6)

24. RCT from a normal population
parent and child characteristics
 Full time occupation: 61%
 Two-parent families: 80%
 Bacheor or higher education: 78%
 Children’s age from 2-8, mean age <4
 112 (59%) boys, 77 (41%) girls
 Mean ECBI score: 103,3 (SD=16,7) Mean
Norwegian norms 93,0 (SD=23,6) Difference
sign: <.001
 No differences between the participants and
non-participants (attrition analysis)

25. Effects on behavior problems, parenting skills and,
parents sense of competence

26. Невероятные годы:
Родители, дети и учителя -
Программа тренировки
разработана
Каролин Вебстер-Страттон, доктор наук
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The Incredible Years Training

27. History and funding of IY in
Russia
 2004: Preparation for implementation of IY
 2005: First parent group in Sampo day-
care center in Petrozavodsk, Karelia.
 2008- today: Dissemination of IY to
Kostumuksha, Murmansk, Prjaza
(Republic of Karelia), Murmansk city,
Monteskorsk, Omba (Murmansk Oblast),
Arkhangelsk city (Arkhangelsk oblast),
Syktyvkar (Republic of Komi)
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28. History and funding of IY in
Russia
 2004-2008: IY funded by EU’s Northern
Dimension Partnership in Health and
Related Social Issues (NDPHS)
 2008: IY funded by «Children in Russia»
 2009-2012: IY funded by the Barents
Council’s program Children and Youth at
Risk (CYAR).
 2012-2015: Extended CYAR funding.
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30. ECBI Intensity score. Pre-post
ANCOVA
Significant effect
Eta square = 0.433 is a great effect.
Corresponds to Cohens d = 1,58
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31. ECBI Problem score. Pre-post
ANCOVA
Significant effect
Eta square = 0.359 is a great effect.
Corresponds to Cohens d = 1,41
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32. ECBI intensity pre-post-fu
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33. 1. Over protection
 Time by group effect: P = 0.007
 Scale: 0-10
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34. 3. Spoiling the child (Over
satisfaction)
 Time by group effect: P < 0.0005
 Scale: 0-10
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35. 4. Ignoring of child needs
 Time by group effect: P = 0.075
 Scale: 0-5
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36. 6. Low expectations to the
child
 Time by group effect: P < 0.0005
 Scale: 0-5
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37. 9. Negative parenting
 Time by group effect: P = 0.002
 Scale: 0-5
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38. 11. Inconsistent parenting
 Time by group effect: P = 0.02
 Scale: 0-5
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39. 14. Uncertainty in parent role
 Time by group effect: P < 0.0005
 Scale: 0-5
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40. The Status of IY in Russia and
future development
Ultimo 2011: 600 families has received the IY
2011-2015:
 Longlasting collaboration between Norway and Russia about
children and crime conviction.
 Coordinated by The Ministry of childtren, equation beween sexes
and inclusion of minorities and The ministry of justise and police
matters in Norway.
 The goals: Exchange of experience and knowledge of
prevention of crime and implementation of alternative types
penalty to prison for children.
 The IY is a integrated part of this work as a program documented
as effective prevention of juvenile crime (Blueprint).
 The CYAR project includes: IY, ART, Family group conference
(New Zealand), Mediation board and «What about us» (Families
with children with reduced level og functioning)
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41. Future developments
 2012. 4 new agencies in The Republic Karelia,
Murmansk Oblast, Arkhangelsk Oblast and The
Republic of Komi
 Implementing the peer coach system
 Recruitment of an additional mentor
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42. Thank you for your attention