The import of the IY to Norway, the clinical RCT and the Norwegian implementation policy

1
The import of the IY to Norway, the clinical RCT
and the Norwegian implementation policy

• Prof. Dr. Willy-Tore Mørch
• University of Tromsø
• Center for Child and Adolescent Mental Health
  North Norway (CCAMH-NN)
• The Conference of Evidence 2008
• Helsingør May 20th 2008

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The IY import and implemenation progression

• 1998 The Expert Commitee recommends IY,
  PMTO and MST
• 1988-1999 Translations and preparation for RCT
  in Trondheim and Tromsø
• 1999-2001 Training of group leaders for RTC
• 2001-2004 RTC
• 2002-2004 Governmental mandates
• 2005-2008 National Implementation
• 2009 Dissemination, ordinary service,
  maintenance of fidelity

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Ministry of HealthFinancial framework

• Covered by the Norwegian Government (1999-2008)
• Manuals, vignettes, puppets (for all agencies)
• Program Work-shops incl. registration fees
• Seven obligatory consultation days during the
  three first groups for all agencies
• Video-reviews
• Certification fee
• Books for parents and teachers
• Project leader posision
• Implementation secretary
• One posision for administrative support
• 40 posisions for all mentors
• All expences connected to mentoring (mentor
  meetings, conferences, consultations)
• One doctoral student posision (research fellow)
• All expences connected to the clinical and
  universal prevention RCT

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Ministry of HealthFinancial Framework

• Expenses covered by the agencies
• Group leader posisions
• Group equipment (toys, flip-over, name tags etc)
• Transportation for parents and children
• Food, drinks etc
• Room facilities
• Child care

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The Governments mandate for implementation of
the IY

• Report no.16 (2002-2003) to the Storting on
  peoples health. Chapter 10.3.3. Mental Health
• The Governments Strategic Plan for Child and
  Adolescent Mental Health (2004), Initiativ no 73
• Proposition no 1 (2003) on the National Budget.
  Chapter on education and research on conduct
  problems in children pp.173

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Governmental escalation plan for child and
adolescent mental health

• Period 2004-2008
• Investments 72 bill. NOK (7,2 bill)
• IY Appox 40 mill NOK ( 4 mill)

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IY secretariate
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IY management chart
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Service structure

• Community Services
• Universal service Parent program relation
  building elements, 6 weeks. RCT
• (all parents with children between 2 to 8 yrs.of
  age)
• Service to selective groups Parent groups, 12
  weeks
• (families in risk)
• Service to indicated groups Parent groups, 12
  weeks
• (children with CD/ODD symptoms)
• Specialist Services
• Clinical groups Parent program, Dinoschool and
  Teacher program/Dino in the classroom
• (Diagnosed children)
• Educational/Psychological Councelling Services
• School prevention Teacher program and Dina in
  classroom 6 work-shops/24 weeks

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Program delivery Pyramideof the IY

• Treatment
  Basic
• (Diagnosed
  Advanced
• Children)
  Dino School
• Indicated
  Basic
• and Targeted
• Prevention
  
• Teacher program
• Universal
  Relation
• Prevention
  building
• 
  programs
• in Basic
• 
  (Play,
  praise, Reward)
• Referrals
  

Clinic gt90 ECBI
Community Services lt90 of ECBI
Community health/social Services Paedagogical/psy
chological counselling services (Normal range of
ECBI)
Restricted to research only
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Implementation Strategy

• A combination of vouluntary application and
  strategic targeted implementation
• Criteria for strategic implementation
• Geographical dissemination
• Specialist service vs community services
• Treatemt vs prevention
• The implementation is coordinated with PMT-O

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Establishing IY in the agenciesProcedure

• First contact with the implemetation office
  (voulontary or active from IY staff
• Receive information brochure
• Informal contact with implementation staff
• Referral to Norwegian web-site
• Receiving a one day taster and/or formal
  meetings with a mentor or trainer
• Application procedure
• Agency readyness questionnaire (ARQ)
• Certification as IY agency
• Contract between IY and agency

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Quality assuranceand long term maintenance of
program fidelity

• Continous consultations with mentor
• Certification as group leader
• Re-certification (Catching up work-shop and video
  review)
• Annual IY delivery check (Quest back)
• Parent activity check list (for each group
  meeting)
• Regular pre-post data collection from all
  agencies
• Regional consultation days with mentor/trainer
• Weekly peer supervision meetings
• Mentors are responsible for the program fidelity
  in his/her district

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Dispersion in Norway
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The agenciesN 51

• North Norway Alta kommune, BUP Alta, Nordreisa
  kommune, BUP Tromsø, BUP Midt-Troms (Finnsnes),
  BUP Nord-Troms (Storslett), Tromsø kommune, Vågan
  kommune, BUP Gravdal
• Mid Norway Trondheim kommune (alle 4 bydeler),
  BUPTrondheim, Verdal kommune, Levanger kommune,
  Melhus kommune, BUP Kristiansund, Kristiansund
  kommune, Averøy kommune, Frei kommune , Inderøy
  kommune,
• Surnadal kommune, Innherred kommune, Verdal
  kommune
• West Norway Bergen kommune, BUP Fana, BUP
  Sentrum, BUP Nordhordland, Fjell kommune, Sogndal
  kommune, Odda kommune, Stavanger kommune, BUP
  Stavanger, Strand kommune, Randaberg kommune,
  Time kommune, Årstad familiesenter, Bufetat
  region vest, BUP Sogndal, Odda kommune, Klepp
  kommune, BUP haugesund, Sandnes kommune, BUP
  Sandnes
• South-East Norway Holmestrand kommune, BUP
  Bærum, BUP Søndre Nordstrand, BUP Nydalen/AMT,
  Forus/Kirkens bymisjon/Nanna Maries hjem, Arendal
  SSHF, Gjerdrum kommune, Nøtterøy kommune,
  Nittedal kommune, Ski kommune, Sørum kommune, BUP
  Elverum, BUP Kongsvinger, Hamar kommune,
  Lillehammer kommune, Sørum kommune, Ringsaker
  kommune, Hole kommune, Røyken kommune, Sarpsborg
  kommune, Skien kommune, Bleiker behandlingssenter

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2009 -

• From implementation to dissemination
• Negotiation with the Govenrment has started

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The end

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