Implementation and experiences with The Incredible years in Norway

1. Implementation and experiences with The Incredible years in Norway Professor Dr. Willy-Tore Mørch Faculty of health sciences. University of Tromsø Tallinn June 5th 2013

2. Levels of services • Treatment Diagnoseddisorder, aboveclinicalcut-off • Indicatedprevention Symptomesofdisorders • Targetedprevention Presenceof risk factors • Universal prevention No known risk factors or symptomes

3. Change in focusIncrease in program fidelity2008-2011

4. Change of fucusIncrease in implementation2011 – 2016

5. Agencies • Approx: 100 municipalities (Communityhealthcenters, social services, childprotection services • 25 outpatienceclinics (regional hospital specialistcervice) Parent program: 100 municipalities, 31 outpatientclinics Child program: 31 outpatientclinics, 10-15 municipalities School/kindergarten: Approx. 50 municipalities, 80 kindergartens, 40 schools (research)

6. Funding • 100% Ministryofhealth. • 1,5 mill Euro pr year. • 500.000 Euro pr year (reserach) 2012-2015: Increase in funding to 1,7 mill Euro Maintenanceofresearchfunding Increase in implementation in collaborationwith PMTO Increase in thenumber om mentors and peer coaches.

7. The incredible years: Parents, children, teachers Treatment and preventionDeveloped by Carolyn Webster-Stratton, Ph.D. The Incredible Years Training Series 10/00

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

9. 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 3/00

10. Parent pyramide Rare Time 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 3/00

11. The incredible yearsStrategies • Focus on cognition, emotions and behavior • Developmentally based • Empirically supported • The collaborative process • Promoting independence • Video clips • Role play and rehersals • Home assignments • Parent support The Incredible Years Training Series 3/00

12. 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 Series 3/00

13. 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.

14. 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)

15. Results: behavior problems

16. Results: parenting skills and stress

17. Changes in diagnosis

18. Results – Treatment dosage • Correlationbetweenpercentageofparticipation and change score on ECBI r = 0,18 (p > 0,05)

19. 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?

20. The universal prevention program • Reedtz, Mørch & Handegård, 2010 • Reedtz, Martinussen, Jørgensen, Handegård & Mørch, 2011

21. 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)

22. RCT from a normal populationparent 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)

23. Effectsonbehavior problems, parenting skills and, parentssenseofcompetence

24. Cost-effects IY in Norway • Starting point: 20-50% of xchildren with early debut develop problems in school, low education, low income, criminality and substance abuse. 10% are in prison. • Michael Parsonage (senior advisor for the departement of education in UK): Totale cost savings for children with early CD/ODD debut in a life perspective: £150.000. • Fra Knapp, McDaid & Parsonage. (2011). Mental health promotion and mental illness prevention: The economic case. Report. Department of Health, London • IY in Norway: Approx. 5000 children treated in the last 12 years. 60% sustainable successfull treatment (3000 children). DekningsgradContribution rate 0,083-0,092% of the children population • Make for basis: 10% successfull sustainable treatment (low estimate): £ 45 mill. savings for the society

25. Cost-benefit analysis (march 2012) 15 %

26. Cost-benefit – Let’s save some money! Save approx. 211 mio. euro per year with IY

27. Thankyou for yourattention