Bettina Nielsen

• Nielsen, Bettina; Oddli, Hanne; Slinning, Kari & Drozd, Filip (2020). Implementation of attachment-based interventions in mental health and social welfare services: Therapist’s experiences from the Circle of Security-Virginia Family Intervention. Children and youth services review.  ISSN 0190-7409.  108 . doi: 10.1016/j.childyouth.2019.104550 Show summary

  Closing the gap between attachment theory and clinical practice can be challenging. However, the developers of the original Circle of Security intervention have tried to do this as they developed their intervention. The Circle of Security-Virginia Family model is one version of Circle of Security that has been implemented across Norway. The aim of this study was to investigate the implementation of the Circle of Security-Virginia Family model intervention in mental health- and social welfare services. A mixed method approach was used to gain an in-depth understanding of the specific implementation factors that facilitate and/or inhibit the use of the intervention from the therapist’s perspective. There were 25 participants (5 male and 20 female), 3 of whom were also supervisors. Participants answered an online Implementation Component Questionnaire and took part in a semi-structured interview. The results suggested an overall impression that the intervention is demanding, but effective. The factors that inhibit the implementation of the intervention appear to be mostly out of the therapist’s hands because of political, organizational and administrative issues. These include therapists not being allocated enough time to do the work as intended, not receiving supervision and evaluations after ending the Circle of Security training, pressures to meet the system’s demands and lack of decision support systems. Factors that facilitated the implementation were, for instance, more than one Circle of Security-Virginia Family model therapist within the organization, sufficient time with the families in and between sessions, and the presence of some form of supervision and/or professional networks.

• Nielsen, Bettina; Slinning, Kari; Oddli, Hanne & Drozd, Filip (2018). Identification of Implementation Strategies Used for the Circle of Security-Virginia Family Model Intervention: Concept Mapping Study. JMIR Research Protocols.  ISSN 1929-0748.  7(6), s 1- 13 . doi: 10.2196/10312 Full text in Research Archive. Show summary

  Background: A reoccurring finding from health and clinical services is the failure to implement theory and research into practice and policy in appropriate and efficient ways, which is why it is essential to develop and identify implementation strategies, as they constitute the how-to component of translating and changing health practices. Objective: The aim of this study was to provide a systematic and comprehensive review of the implementation strategies that have been applied for the Circle of Security-Virginia Family (COS-VF) model by developing an implementation protocol. Methods: First, informal interviews and documents were analyzed using concept mapping to identify implementation strategies. All documentation from the Network for Infant Mental Health’s work with COS-VF was made available and included for analysis, and the participants were interviewed to validate the findings and add information not present in the archives. To avoid lack of clarity, an existing taxonomy of implementation strategies, the Expert Recommendations for Implementing Change, was used to conceptualize (ie, name and define) strategies. Second, the identified strategies were specified according to Proctor and colleagues’ recommendations for reporting in terms of seven dimensions: actor, the action, action targets, temporality, dose, implementation outcomes, and theoretical justification. This ensures a full description of the implementation strategies and how these should be used in practice. Results: Ten implementation strategies were identified: (1) develop educational materials, (2) conduct ongoing training, (3) audit and feedback, (4) make training dynamic, (5) distribute educational materials, (6) mandate change, (7) obtain formal commitments, (8) centralize technical assistance, (9) create or change credentialing and licensure standards, and (10) organize clinician implementation team meetings. Conclusions: This protocol provides a systematic and comprehensive overview of the implementation of the COS-VF in health services. It constitutes a blueprint for the implementation of COS-VF that supports the interpretation of subsequent evaluation studies, facilitates knowledge transfer and reproducibility of research results in practice, and eases the replication and comparison of implementation strategies in COS-VF and other interventions.

• Drozd, Filip; Mork, Lia; Nielsen, Bettina; Raeder, Sabine & Bjørkli, Cato Alexander (2014). Better Days - A randomized controlled trial of an internet-based positive psychology intervention. Journal of Positive Psychology.  ISSN 1743-9760.  9(5), s 377- 388 . doi: 10.1080/17439760.2014.910822 Show summary

  The internet seems promising for delivering interventions to enhance well-being in a normal population. The aim of this study was to test the effects of an internet-based positive psychology intervention targeting gratitude, pleasant activities, strengths, mastery, acts of kindness, optimism, flow, attributions, and mindfulness. One-hundred and twelve participants were randomized to the intervention and 94 to the control group, and data were collected at baseline, one, two, and six months after intervention onset. The balance of positive to negative affect increased over time among participants in the intervention group (unstandardized beta coefficient [B] = 0.07, p < 0.01), as compared to the controls (B = 0.02, p = 010). The intervention worked equally well regardless of participants’ gender, age, or education. However, optimism did not mediate the effect of the intervention on affect balance. In conclusion, the intervention had a small, but significant effect on affect balance among healthy adults.

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• Nielsen, Bettina; Oddli, Hanne; Slinning, Kari & Drozd, Filip (2017). The Use and Implementation of the Circle of Security-Virginia Family Model in Health and Social Services. Show summary

  Along with the growing body of evidence that demonstrates the negative consequences attachment problems can have on a child’s psychological development, there has been an increased focus on effective preventive measures such as improving parenting skills to reduce future psychological problems for at-risk children. Accordingly, there has been a shift toward more attachment-based methods in health and social services. Due to a great demand, attachment-based interventions such as Circle of Security (COS) have been implemented in various health and social services. The implementation of interventions has proved to be challenging due to a variety of factors such as individual and organizational values, cultures, and other characteristics that shape practice. The aim of this study was to identify any strengths, weaknesses, opportunities, and threats (SWOTs) to the individual, therapeutic Circle of Security–Virginia family model, in order to adapt and facilitate COS for continued and future use in the health and social services. Results from both quantitative and qualitative methods will be discussed in the symposium.

• Nielsen, Bettina & Drozd, Filip (2016). Circle of Security-Familiemodellen.
• Nielsen, Bettina; Sandnes, Kjersti; Lindberg, Astri; Drozd, Filip & Slinning, Kari (2016). Implementering av Trygghetssirkelen i norske helse- og sosiale tjenester: En studie ved bruk av ulike forskningsperspektiver. Show summary

  Tilknytningsvansker kan ha mange negative konsekvenser for barns psykologiske utvikling, og av den grunn har det blitt et økt fokus på hvordan det å forbedre omsorgsgiveres foreldreferdigheter kan være et viktig forebyggende tiltak mot barns senere psykologiske problemer. Som et resultat har det skjedd et skifte mot mer tilknytningsbaserte metoder i helse- og sosiale tjenestene. På grunn av stor etterspørsel, har tilknytningsbaserte tiltak slik som Trygghetssirkelen, blitt importert fra andre land og implementert i Norge. Implementeringen av tiltak innebærer en praksisendring som ofte viser seg å være utfordrende, fordi det krever en sterk og aktiv strategi for å iverksette og innføre et tiltak. Målet med studien er å kvalitetssikre at Trygghetssirkelen blir levert med høy metode- og program integritet i helse- og sosiale tjenestene, som spesifisert av programleverandørene, slik at tjenestene oppnår ønskede resultater for målgruppen (dvs. barn og deres omsorgsgivere) gjennom Trygghetssirkelen. Studien har som hensikt å identifisere styrker, svakheter, utfordringer og muligheter ved Trygghetssirkelen, for å kunne tilpasse og tilrettelegge for bruk av Trygghetssirkelen i norske helse- og sosiale tjenester. Resultater fra kvalitative tilnærminger vil bli presentert og diskutert gjennom tre ulike perspektiver; (1) terapeutenes og (2) veilederes opplevelse og erfaringer med Trygghetssirkelen, samt (3) deres erfaringer fra et implementeringsperspektiv.

• Nielsen, Bettina; Mork, Lia; Kraft, Pål & Drozd, Filip (2012). Evaluation of an internet-based intervention for mild-to-moderate depression and promotion of psychological well-being: A randomized controlled trial. Show summary

  Background: High prevalence of minor depression and low well-being constitutes both individual and societal burden. The Internet provides a promising platform for treatment delivery. Objective and Method: A randomized controlled trial was conducted to determine the efficacy of an internet-based self-help intervention Bedre Hverdag (BH) for mild-to-moderate depression and promotion of well-being. Long-term effects (i.e.6 months) of BH were assessed in comparison to a waiting-list control group. Results: Of the 206 eligible participants, 112 were randomized to the experimental group and 94 to the waiting-list control group. Data from 34 participants in the experimental group and 47 from the control group were subjected to statistical analyses. Individuals assigned to BH reported significant increases in positive affect (PA) at 1 month follow-up, as measured by Positive Affect Schedual (PANAS); z = - 2.49, p = .011, r = .42 , which were significantly different from levels of PA at the same time period in the control group, U = 589, z = -2.01 , p = .044 , r = .2. Increases in PA were no longer significant at 2 and 6 month follow-ups. No statistically significant reductions in negative affect (NA) as measured by the Negative Affect Schedual (PANAS) and depressive symptoms as measured by the Center for Epidemiologic Studies Depression scale (CES-D) were observed in the experimental group as compared to the control group. Treatment x Educational attainment interaction explained 5.3% of variance in depressive symptoms, and 10.7% of variance in NA at 1 month follow-up, above and beyond the main effects. Individuals with lowest level of educational attainment reported largest reductions in both CES-D scores and NA. Conclusion: BH produced significant increases in PA at 1 month post-treatment. No significant reductions were observed in either depressive symptoms or NA. Educational attainment moderated the intervention's effects on depressive symptoms and NA.

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