Implementing Collaborative Skill-Based Interventions between State and Community Child-Welfare Services in Norway:Improving Child Well Being

The implementation of the Model of Change and development (OEM) is an international collaboration designed to improve long-term mental health, general well-being, and sustainable care of children in the protection of the Norwegian Child Welfare Services. The goal of OEM was to improve staff competence for clinical work with children and families with skills that support improved collaboration with mental health services and improved interaction between staff at Child Welfare institutions and municipalities. Youth in Child Welfare Services care often have a history of trauma, abuse, and neglect. They have significantly higher rates of mental problems, increased risk of suicidal behavior, drug use, and behavior problems. However, research shows that skill-focused and trauma-informed interventions for both the children and their families effectively reduce mental- and behavioral health problems and the risk of re-engaging with the Child Welfare System, which also proves to be highly cost-beneficial over time. OEM was originally developed for youth with mental health-related concerns at risk for substance use, suicide, or criminal behavior. The intervention is based on dialectic and cognitive behavior therapeutic principles. It has been adapted to the Norwegian Child Welfare system in collaboration between the University of Washington, Bufetat region north, and the Centre for Children and Adolescent Mental Health. OEM includes systematic assessments, emotion regulation, and skills training, with high user involvement. It provides preventive tools and transition support to families and foster homes in their home communities. This research project aimed to investigate the model's implementation in the Norwegian Child Welfare services and to examine the intervention's impact on children and their families. We found that the implementation of OEM 1) seemed to be successful for and accepted by children in the protection of the Norwegian Child Welfare Services, their caregivers, and institution staff, and 2) that OEM seemed to have positive effects on youth's mental health and behavioral outcomes. We, therefore, found that 3) it is possible to adapt an evidence-based approach developed in the United States to the Norwegian Child Welfare Services.

Oppnådde resultater: 1. OEM var gjennomførbart for norske barnevernsinstitusjoner. 2. OEM ble tatt godt imot av ungdom, foresatte og ansatte. 3. Tilpasning av modellen til norsk kontekst var nødvendig for å øke gjennomførbarhet og aksept i det norske barnevernet. Disse tilpasningene inkluderer blant annet oversettelse av materiale, begrepsendringer og større miljøfokus på institusjon. 4. En preliminær innsikt i utviklingen for ungdommer som mottar programmet, på områder som internaliserende og eksternaliserende atferd, evne til følelsesregulering og bruk av ferdigheter tillært i programmet. 5. Innsikt i implementeringsprosessen fra ansattes perspektiv. 6. Identifisering av styrker og forbedringsområder for implementering av modellen til kommunalt barnevern. 7. Konkrete forslag til hvordan modellens implementering kan styrkes, med bruk av implementeringsvitenskap og tjenestedesign. 8. Hvilke hjelpetiltak som eksisterer for ungdom i overgangsfasen fra institusjon, effekten av disse, samt evaluering av kvaliteten på evidensgrunnlaget. 9. Forskningskunnskap om hvilke elementer som brukes i tiltak for ungdom som oppholder seg på institusjon og som har eksternaliserende og/eller internaliserende vansker, og effekten av disse elementene. Resultatene har følgende betydning: 1. Våre resultater tilsier at det er mulig å tilpasse en evidensbasert tilnærming utviklet i USA til det norske barnevernet. 2. OEM, som er en DBT-tilpasning, ble godt mottatt av en hel organisasjon samt brukere. 3. OEMs fidelitet, adherence og aksept ble sikret gjennom jevnlig booster-trening og oppfølging. 4. Det ble utviklet flere nyttige verktøy for å evaluere implementering av OEM i barnevernet, inkludert en forenklet sjekkliste for individuelle sesjoner, miljøbehandlingstrekk og en fidelitetsskala for evalueringen av OEM. 5. OEM synes å være hensiktsmessig for, og akseptert av, barnevernsinstitusjonsbeboere, omsorgspersoner og institusjonsansatte. 6. OEM kan ha en positiv påvirkning på unges psykiske helse og atferdsmessige utfall. 7. Kjennetegn hos barn og unge som mottok hjelp fra kommunalt og statlig barnevern ble kartlagt. 8. Implementeringsprosessen ble ansett som positiv av de ansatte. 9. Styrker og forbedringsområder for implementering ble identifisert. 10. At hjelpetiltak for ungdom i overgangsfasen fra institusjon kan se ut til å ha en positiv effekt.

The implementation project is an international collaboration designed to improve long-term mental health, general well-being and sustainable care of children in protection of the Norwegian CWS through an unique implementation strategy that brings together the staff at the institutions and the municipalities in a collaborative project. Children in CWS often have a history of trauma such as neglect and abuse. They have significantly higher rates of mental problems than the general population and are at increased risk of suicidal behavior, drug use and behavior problems. Research shows that effective transition planning, coupled with skill-focused and trauma-informed interventions for both the children and their families effectively mitigates mental- and behavioral health problems and reduces the risk to re-engage with the CWS-system. Such efforts prove to be highly cost-beneficial over time. The proposed project aims to examine the feasibility and outcomes of a Norwegian adaptation(OEM)of a transition and prevention program (ITM-FIT) which targets skill-building at the institution, and provides preventive tools and transition support to families and foster homes in their home community. This trauma-informed program is designed for youth with mental health related concerns who are at risk for substance use, suicide, or criminal behavior. The therapeutic intervention combines components of family systems therapy, dialectical behavior therapy, motivational interviewing, behavioral parent management, and relapse prevention. The implementation targets the care and treatment CW institutions, foster homes and municipalities in region north. Program evaluation will examine 1)pre and post-treatment effects, 2)staff performance/competence, 3)level of adherence and fidelity. The project let us address critical implementation science questions; a)impact on staff b)mediating organizational and individual factors influence on treatment effect and c)impact of treatment adaptation.