A systemic approach to school-based consultation: Combining interventions that belong to different theoretical traditions. Chapter 9

This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.This chapter illustrates the idea that a systems perspective can encompass any idea that helps increase our understanding and effectiveness. An underlaying assumption is that the adoption of a systems perspective encourages—even requires—the possession of a plurality of theories and instruments because of the extremely complex nature of dynamic systems. The authors describe a real-life, school-based intervention that combines a normative approach (Marte Meo), with a non-normative perspective (Coordination Meetings), and how the interventions, derived from different philosophical and theoretical traditions, have been included within a single systems-oriented framework.publishedVersio

Systemic perspectives and psychiatric diagnosis: Mutually exclusive or mutually inclusive? Chapter 7

This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.In common with most others who work in the field of mental health, the authors have been obliged to develop a professional relationship with the two dominant diagnostic guides, The International Classification of Disease 10 (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). While they concur with the widely held view that there are many problematic issues connected to both diagnostic systems, many of the conflicts generated within the mental health field that we are aware of seem to emerge from the different meanings that are attributed to them and/or the ways in which they are applied. We argue for the position that a system of diagnostic categories is necessary for all psychotherapists, in a parallel but different manner to the way in which it is important for medical practitioners. We systemic therapists also have a fundamental need of organizing the domain of human suffering so that we can bring order to our clinical practice, our research and our professional communication. The most important question is “how?”.publishedVersio

Children subjected to family violence: A retrospective study of experiences of trauma-focused treatment

Exposure to adverse childhood experiences is a risk factor for the development of serious psy chiatric and somatic illness. Although trauma-focused therapy is effective in reducing symptoms, not all children benefit from it. To improve treatment efficacy, the children’s perspective on what they perceive as helpful versus hindering is necessary. This study aimed, retrospectively, to explore how children exposed to family violence experienced treatment at the Child and Adolescent Mental Health Service. Seventeen children and youths were interviewed 4–5 years after treatment. The thematic analysis resulted in five themes: confusion, the need to feel heard, fear of consequences, feelings of pain, and identifying oneself as an agent. The results emphasize the importance of the therapeutic relationship, and that trust, genuine interest, and reciprocity are necessary for the child to engage in treatment. However, neither the child’s own agency nor external obstacles such as continuous exposure to abuse should be underestimated in terms of the child’s engagement.publishedVersio

Bottom-up and top-down approaches to understanding oppositional defiant disorder symptoms during early childhood: a mixed method study

Background: Children with clinical levels of conduct problems are at high risk of developing mental health prob lems such as persistent antisocial behavior or emotional problems in adolescence. Serious conduct problems in child hood also predict poor functioning across other areas of life in early adulthood such as overweight, heavy drinking, social isolation and not in employment or education. It is important to capture those children who are most at risk, early in their development. The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) is commonly used in clinical settings, to identify children with conduct problems such as oppositional defant disorder (ODD).This paper presents a cross-sectional study in a clinical setting, and describes behaviors in 3- to 8-year-olds with ODD. Our aim was to investigate whether there were problematic behaviors that were not captured by the diagnosis of ODD, using two diferent methods: a clinical approach (bottom-up) and the nosology for the diagnosis of ODD (top-down). Method: Fifty-seven children with clinical levels of ODD participated in the study. The mothers were interviewed with both open questions and with a semi-structured diagnostic interview K-SADS. The data was analyzed using a mixed method, convergent, parallel qualitative/quantitative (QUAL+QUAN) design. For QUAL analysis qualitative content analysis was used, and for QUAN analysis associations between the two data sets, and ages-groups and gen der were compared using Chi-square test. Results: In the top-down approach, the ODD criteria helped to identify and separate commonly occurring opposi tional behavior from conduct problems, but in the bottom-up approach, the accepted diagnostic criteria did not cap ture the entire range of problematic behaviors-especially those behaviors that constitute a risk for antisocial behavior. Conclusions: The present study shows a gap between the diagnoses of ODD and conduct disorder (CD) in younger children. Antisocial behaviors manifest in preschool and early school years are not always sufciently alarming to meet the diagnosis of CD, nor are they caught in their entirety by the ODD diagnostic tool. One way to verify suspicion of early antisocial behavior in preschool children would be to specify in the ODD diagnosis if there also is subclinical CD.publishedVersio

Journalstudie av ordinære akuttvedtak og akutt familieråd i barnevernet. En kartlegging av 329 akuttsaker i barnevernet. Delrapport III fra prosjektet ‘Familieråd når det haster med å finne en løsning’

In this report we present the main findings from a study comparing emergency cases in which ordinary emergency decision-making was used, with cases in which an emergency family group conferences (FGCE) were held. The empirical data is based on client records, altogether 329 records of emergency cases in child protection. 270 of these were ordinary emergency cases and 59 were FGCEs. The findings are to be viewed in the context of the summary of findings from the qualitative study presented at the beginning of this report. It must be stressed that this does not provide a basis for generalisation. Nevertheless, we believe that the survey identifies some important trends. The lack of studies on the use of FGCs makes it difficult to compare the findings with other research. Overall, findings from the study of client records support the findings from the qualitative interviews and demonstrate that the use of FGC in acute situations leads to greater mobilisation of relatives and networks, which better facilitates less-intrusive solutions for children in emergency situations. The findings from our study show that the use of FGC in acute situations creates impetus to find solutions among relatives and networks, leading to a decrease in the use of government measures in both the short and long term. The use of FGCE also appears to contribute to making the acute situation less dramatic and traumatic, and thereby reduces levels of insecurity in children and parents. This is related to the fact that children can be with someone they know, while providing them and their parents with more information and greater understanding of what is about to happen. This creates a greater sense of control and predictability for both children and parents, which reduces the levels of stress in the acute situation while preparing them for a possible relocation. Finally, we would like to mention that the qualitative study also identified challenges in the use of FGCEs, particularly when suspected violence and/or abuse is involved. In such cases, ordinary FGC should be considered, as well as 'shuttle councils' adapted to CWS cases involving violence and high levels of conflict. We are also critical of the use of FGC when children lack trust in the adults in the family and thus do not want to partake in a FGC.Prosjektet er finansiert av Barne- ungdoms- og familiedirektoratet (Bufdir).publishedVersio

Efficacy and moderators of efficacy of cognitive behavioural therapies with a trauma focus in children and adolescents: an individual participant data meta-analysis of randomised trials

Background: Existing clinical trials of cognitive behavioural therapies with a trauma focus (CBTs-TF) are underpowered to examine key variables that might moderate treatment effects. We aimed to determine the efficacy of CBTs-TF for young people, relative to passive and active control conditions, and elucidate putative individual-level and treatment-level moderators. Methods: This was an individual participant data meta-analysis of published and unpublished randomised studies in young people aged 6-18 years exposed to trauma. We included studies identified by the latest UK National Institute of Health and Care Excellence guidelines (completed on Jan 29, 2018) and updated their search. The search strategy included database searches restricted to publications between Jan 1, 2018, and Nov 12, 2019; grey literature search of trial registries ClinicalTrials.gov and ISRCTN; preprint archives PsyArXiv and bioRxiv; and use of social media and emails to key authors to identify any unpublished datasets. The primary outcome was post-traumatic stress symptoms after treatment (<1 month after the final session). Predominantly, one-stage random-effects models were fitted. This study is registered with PROSPERO, CRD42019151954. Findings: We identified 38 studies; 25 studies provided individual participant data, comprising 1686 young people (mean age 13·65 years [SD 3·01]), with 802 receiving CBTs-TF and 884 a control condition. The risk-of-bias assessment indicated five studies as low risk and 20 studies with some concerns. Participants who received CBTs-TF had lower mean post-traumatic stress symptoms after treatment than those who received the control conditions, after adjusting for post-traumatic stress symptoms before treatment (b=-13·17, 95% CI -17·84 to -8·50, p<0·001, τ2=103·72). Moderation analysis indicated that this effect of CBTs-TF on post-traumatic stress symptoms post-treatment increased by 0·15 units (b=-0·15, 95% CI -0·29 to -0·01, p=0·041, τ2=0·03) for each unit increase in pre-treatment post-traumatic stress symptoms. Interpretation: This is the first individual participant data meta-analysis of young people exposed to trauma. Our findings support CBTs-TF as the first-line treatment, irrespective of age, gender, trauma characteristics, or carer involvement in treatment, with particular benefits for those with higher initial distress

The 'essentially' feminine - a mapping through artistic practice of the feminine territory offered by Early Modern Music.

The ‘essentially’ feminine — a mapping through artistic practice of the feminine territory offered by Early Modern Music, is the somewhat complicated title of this book. But the content is not hard to understand a year into the #metoo-movement. It turns out that 400-year-old songs use the same rules as abusive men still do. Songs of love from a man to a woman in seventeenth-century England often contain patterns that today’s survivors of domestic violence recognise: to reject a ‘no,' accuse, threaten and question the loved one’s character. The researcher Katarina A Karlsson has read 755 songs from the time. Among the love songs from a man to a woman, more than half use these rules to varying degrees. Is it possible to perform the songs at all? Katarina A Karlsson, who is also a singer and a writer, has worked with the songs together with musicians, singers, directors, costume designers and lighting designers. Photos document some of this scenic work. Other authors include a psychologist, associate professor Ulf Axberg, a director, professor emerita Gunilla Gårdfeldt-Carlsson and the renowned expert in Early Modern English Music, professor Christopher R. Wilson from the University of Hull. The unique collaboration frames the English Lute Song through artistic research, psychology, musicology, and gender theory. So what kind of territory was the Early Modern woman offered through the music of the time? - A place where she risked losing everything.Images by Harald Nilsson, costumes by Nonno NordqvistVetenskapsråde

No child is an island – The life situation before and during treatment for children exposed to family violence

Compelling evidence indicates that child maltreatment is a risk factor for developing serious psychopathology. Trauma-focused treatment has been found to be effective, but not all children benefit from it. Interventions that consider multiple aspects of treatment that could improve the efficacy need to be developed. The present study explored how children exposed to family violence described their life situation before and during their contact with the child and adolescent mental health service. Thirteen children and adolescents were interviewed and we analysed the material using thematic analysis. Several of the participants reported continued violence, conflict and insecurity at home, in school and in other contexts. These results indicate how important it is never to assume that because children exposed to family violence are in treatment, they are safe in their homes. Interventions should therefore include continuous assessment of ongoing victimization and safety planning, considering children, not as isolated units, but in the context of complex life situations in which their well-being is affected by their parents, siblings and friends

Journalstudie av ordinære akuttvedtak og akutt familieråd i barnevernet. En kartlegging av 329 akuttsaker i barnevernet. Delrapport III fra prosjektet ‘Familieråd når det haster med å finne en løsning’

In this report we present the main findings from a study comparing emergency cases in which ordinary emergency decision-making was used, with cases in which an emergency family group conferences (FGCE) were held. The empirical data is based on client records, altogether 329 records of emergency cases in child protection. 270 of these were ordinary emergency cases and 59 were FGCEs. The findings are to be viewed in the context of the summary of findings from the qualitative study presented at the beginning of this report. It must be stressed that this does not provide a basis for generalisation. Nevertheless, we believe that the survey identifies some important trends. The lack of studies on the use of FGCs makes it difficult to compare the findings with other research. Overall, findings from the study of client records support the findings from the qualitative interviews and demonstrate that the use of FGC in acute situations leads to greater mobilisation of relatives and networks, which better facilitates less-intrusive solutions for children in emergency situations. The findings from our study show that the use of FGC in acute situations creates impetus to find solutions among relatives and networks, leading to a decrease in the use of government measures in both the short and long term. The use of FGCE also appears to contribute to making the acute situation less dramatic and traumatic, and thereby reduces levels of insecurity in children and parents. This is related to the fact that children can be with someone they know, while providing them and their parents with more information and greater understanding of what is about to happen. This creates a greater sense of control and predictability for both children and parents, which reduces the levels of stress in the acute situation while preparing them for a possible relocation. Finally, we would like to mention that the qualitative study also identified challenges in the use of FGCEs, particularly when suspected violence and/or abuse is involved. In such cases, ordinary FGC should be considered, as well as 'shuttle councils' adapted to CWS cases involving violence and high levels of conflict. We are also critical of the use of FGC when children lack trust in the adults in the family and thus do not want to partake in a FGC