Euryph Line Solheim Kvamme
The project has been funded in its entirety by the Norwegian Research Concil project Implementing Collaborative Skill-Based Interventions between State and Community Child-Welfare Services in Norway:Improving Child Well Being (Project number 262789).
- Implementation science
- Evidence-based practice
- Quality of Life
- Child Welfare Services
- Public Health
About the project
Overview and background:
Familien i Fokus (FiF) is a therapeutic model designed to prevent institutionalization, and/or support the transition after leaving institutional settings for youth between the ages of 12-18. Target youth are characterized by pervasive conduct disorders, addiction problems and mental health needs,. The youth and their families enter a FiF intervention program with a duration of four to six months before Child Welfare Services staff reassess the need for institutionalization. FiF is a family-based intervention founded on Multisystemic Theory (MST) and Dialectic Behavioral Therapy (DBT). FiF was initially implemented as a pilot project in 8 Norwegian municipalities in 2015. FiF was listed as a recommended evidence-based intervention in the National Plan for Assistance Measures 2018-2024.
The current project aims to evaluate status of knowledge on aftercare for youth who have been institutionalized in general, as well as the specific efficacy and feasibility of FiF in the Norwegian context. The original model (Family Integrated Transitions – FIT) was developed in 2011, at the Center for Evidence-Based Practices at The University of Washington. Substantial adaptations have been made during the implementation process to accommodate the Norwegian delivery system and population. FiF families constitute a particularly vulnerable population, susceptible to long lasting detrimental life outcomes perhaps even after having received assistance from CWS. Therefore, outcome measures like recidivism or clinical symptoms may not be sensitive enough to capture significant changes in participants’ lives. Our aim is threefold: 1) To provide a foundation of evidence on transition services provided to youth who are leaving institutions, 2) To evaluate the FiF implementation by investigating feasibility and acceptability amongst therapists delivering the intervention, and 3) To evaluate the adherence and efficacy of FiF by measuring essential components and life outcomes of participants.
Study 1: A systematic review of reviews on transition programs for youth leaving institutions. Quality of evidence and risk of bias will be assessed, and results will be synthesized and subjected to meta-analysis. For further details, see the pre-registered research protocol.
Study 2: Thematic analysis based on semi-structured focus group interviews with all FiF therapists. Central themes from therapists’ experiences with the FiF framework, supervision and training will be discussed in light of future implementation efforts.
Study 3: Single Case Experimental Design (SCED) and multilevel analysis. This methodology enables high powered rigorous conclusions despite small sample sizes by using an elevated number of measurements across time points. Data will be collected from youth, caregivers and therapists actively participating in the FiF program. Data collection will be conducted throughout the duration of each intervention. Data from various sources will be merged to generate trajectories of change across time points per participant. The following forms of data collection will be used:
1. Ecological Momentary Assessment (EMA) mobile application. All participants (including FiF therapists) will access the tailored FiF EMA app. Data collection through EMA devices enhance ecological validity and response rates in self-report measures across time-points. EMA apps are designed to facilitate immediate responses in a non-invasive way. Youth and caregivers will report 5 times a week, yielding up to 120 time-points per participant across the span of the intervention. FiF therapists will give weekly reports on each participating client through the same app.
2. Observational data: FiF therapists will deliver audio recordings consultations. The recordings will be coded in accordance with essential elements of the FiF model to identify when and which components are being delivered at any given point in time. This data will be merged with self-reports from the EMA app to generate trajectories of change in behavior, affect, emotion regulation, parenting skills, family dynamics, negative life events, level of conflict and subjective wellbeing.
3. Weekly reports: Therapists will report on progression for each case. Reports will detail specific goals and tasks identified in collaboration between therapists and clients in each consultation. Reports will supplement our data on dosage and content of therapeutic contact.
4. Pre- and post-questionnaires: Standardized questionnaires on demographic characteristics, traumatic experiences, psychopathology, definitions of problem areas, motivation for change, therapeutic alliance and quality of life.
- Ragnhild Bang Nes (UiO, FHI),
- John Kjøbli (UiO, RBUP)
- Ottar Ness (NTNU)
Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP)
Gullhaugveien 1-3, 0484 Oslo
RBUP Øst og Sør, Pb. 4623 Nydalen, 0405 Oslo
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