Identification of Multisystemic Therapy (MST) Subgroups with Distinct Trajectories on Ultimate Outcomes in Norway

The effect of Multisystemic Therapy (MST) treatment for serious behavior problems among adolescents has been established through multiple studies. However, variations across individuals should also be examined to better understand how MST works or for whom. In this study, we explored and identified subgroups of youth with serious problems in Norway regarding their responses to MST in terms of ultimate MST outcomes (e.g., living at home, abstaining from violence) over time. We further explored whether immigrant background, in addition to gender and age of the youth at intake, predicted belonging to the subgroups. Data came from 1674 adolescents (MeanAge = 14.55, SDAge = 1.58; 60.7% boys) and their families referred to MST treatment by the municipal Child Welfare Services for serious and persistent antisocial behavior. The outcomes were assessed at five time-points from intake to 18-months after discharge for youth and families who completed the treatment. Latent class growth analyses revealed heterogeneous trajectories regarding youths’ responses to MST. Results indicated a high and sustained degree of improvement across the ultimate outcomes for the vast majority of the youths. However, there was still variation in the groups, with improvement and deterioration trajectories for various outcomes. Most of these trajectories were predicted by gender and youth’s age at intake, but not by immigrant status. Not every youth-at-risk responds similarly to MST, and more studies examining heterogeneity will help us to identify factors to be targeted to better tailor the MST interventions for youth with serious problems.publishedVersio

Preventing Problem Behavior in School through School-Wide Staff Empowerment: Intervention Outcomes

The aim of this study was to examine the effects of the universal “Preventing Problem Behavior in School” (PPBS) intervention on both establishing high-quality learning environments and increasing the use of positive teaching strategies to prevent student problem behavior. PPBS was developed and piloted in Norway as an abbreviated version of the School-Wide Positive Behavior Support Model (SWPBS) and includes a four-day in-service training program for a school’s entire staff. Seventeen primary schools (Grades 1-7) implementing PPBS and 20 control schools engaging in “practice as usual” were compared using a three-wave measurement design. Multilevel analyses based on staff ratings indicated significant positive main effects of PPBS in the moderate range on the level of school behavior problems, positive behavior management, and perceived staff efficacy. Moreover, school size, implementation quality, proportion of unqualified staff members, and program training dosage moderated the intervention outcomes. Student ratings did not, however, support the staff ratings. The results are discussed in relation to the outcomes of the full-scale SWPBS model, meta-analyses of school-wide interventions, and measurement issues. Study limitations, strengths, practical implications, and future directions are highlighted

Teacher Rated Social Skills. An empirical evaluation of factor structure and measurement invariance of the Norwegian version of the Social Skills Rating System

Social Skills Rating System (Gresham & Elliott, 1990) is one of the most widely used instruments for assessment and measurement of children’s and youth’s social skills both within research and clinical work. The validity and reliability of the English original of the Social Skills Rating System has been assessed in several different studies. The Norwegian language version is, however, less studied, and to my knowledge there has not been conducted any confirmatory factor analysis or examinations of measurement invariance of this version of the rating scales. The present study investigates factor structure and measurement invariance of teacher ratings using the Social Skills Rating System (SSRS-T) in a sample of Norwegian 4th through 7th graders. The sample used consists of 8016 students from 64 primary schools that participated in an effectiveness trial of the Norwegian School-Wide Positive Behavior Support model. Four specific questions regarding the SSRS-T were addressed in separate analyses. First, the original three-factor structure proposed by Gresham and Elliot was examined in a confirmatory factor analysis for categorical indicators (CCFA). This factor structure was not replicated in the current sample. Second, a hypothesis about method effects caused by the different indicators’ assessing social skills either in situations involving peers or involving adults was tested in a CCFA. This hypothesis was also rejected. As neither of these models was found to acceptably fit the data, a model re-specification based on the original factor structure was conducted within the CCFA framework. An alternative factor structure that acceptably fit the sample data was found, and the results were replicated in a second sample. Third, measurement invariance of the alternative factor structure between boys and girls was investigated in multiple-groups CCFA. The results indicate that the measurement was invariant across child gender. Finally, the viability of using the re-specified factor structure in combination with the isolated uniqueness approach for parceling indicators was assessed in a confirmatory factor analysis for continuous variables using ML estimation. The results indicated tentative support for this approach. The findings in this study indicate that there may be problems associated with the use of Gresham and Elliot’s original factor structure in the Norwegian version of the SSRS-T for primary school level. Future studies should closely examine the indicators used in the Norwegian SSRS-T for primary school level and further assess the original factor structure. The alternative factor structure proposed in this thesis shows promising psychometric qualities, including indices of convergent and discriminant validity and measurement invariance across child gender. However, the alternative factor structure should be replicated in other samples and also studied in relation to other operationalizations of social skills and related constructs, before more firm conclusions should be drawn

Examining Teacher Outcomes of the School-Wide Positive Behavior Support Model in Norway

Research on teacher outcomes of the School-Wide Positive Behavior Support (SWPBS) model has been scarce. The present study adds to the knowledge base by examining the effects of the Norwegian version of SWPBS (N-PALS) on school staffs’ behavior management practices and on their individual and collective efficacy. Questionnaire data were collected from staff and students (Grades 4-7) at four measurement points across four successive school years in 28 intervention schools and 20 comparison schools. Using longitudinal multilevel analyses, indications of positive 3-year main effects of the N-PALS model were observed for staff-reported collective efficacy, self-efficacy, and positive behavior support practices. The intervention effects as measured by Cohen’s d ranged from .14 to .91. The effects on student perceptions of teachers’ behavior management strategies were, however, not consistent with the positive staff ratings. Results are discussed in relation to prior research, future research, and study limitations

Environmental and temperamental correlates of alcohol user patterns in grade 7 students

AIMS – We examined the effects of temperamental dispositions, friends using alcohol and parental monitoring on grade 7 students’ alcohol use patterns

Evaluating Modular Approach to Therapy for Children with Anxiety, Depression, Trauma and Conduct Problems (MATCH-ADCT) in Norwegian child and adolescent outpatient clinics: Study protocol for a randomized controlled trial

Abstract Background Norwegian health, care, and welfare services are experiencing increased demands to deliver services that are safe, effective, of high quality, and that ensure user involvement. Yet, evidence-based treatment for common disorders such as depression, anxiety, trauma, and behavioral problems in children are not regularly used in clinical practice in Norway. Possible explanations for this are that many standard, evidence-based treatments may have difficulty addressing the complexity and comorbidity of referred children and the fact that children’s treatment needs often shift during treatment. The Modular Approach to Therapy for children with Anxiety, Depression, Trauma and Conduct problems (MATCH-ADTC) was designed to address these challenges and reduce some of the barriers to therapists’ use of evidence-based treatment in their practice. Methods/design Participants will include 280 children (aged 6–14.5 years at intake) who receive treatment in child and adolescent mental health outpatient clinics in Norway, and their families. Families are randomly assigned to either the experimental group receiving treatment from therapists trained in MATCH, or to the comparison group receiving treatment from therapists delivering treatment as usual (TAU). Data on children’s symptomology, child and family functioning, demographics, background information, and mental health outcomes are collected as well as frequent feedback on treatment response, plus video-recordings of treatment sessions and implementation quality scores from each participating clinic. Questionnaires are administered in six waves. Discussion MATCH has been tested in the US with promising results, but we do not know whether this treatment approach will produce similar results in Norway. The implications of this study are1.Possibly better treatment outcomes and/or more efficient improvements for children and families treated in mental health outpatient clinics in Norway2.Clinicians learning to use more evidence-based practices in their treatment3.Implementation of standard procedures for obtaining feedback from children and families and sharing the feedback with clinicians4.Increased understanding, at the end of the trial, of whether introducing MATCH improves outcomes for children and families treated in mental health outpatient clinics Trial registration ISRCTN, registration number: ISRCTN24029895. Registered on 8 August 2016