What do we know about prevention of emotional disorders amongst adolescents Experiences from the FRI

1
What do we know about prevention of emotional
disorders amongst adolescents? Experiences from
the FRIENDS for life program in Norway.5th
SIHLWA MeetingADO SubgroupOslo

• S. P. Neumer
• E-mail simon-peter.neumer_at_r-bup.no

2
Topics

• Framework RBUP, Research in Norway
• Why anxiety disorders?
• The pilot study
• Discussion

3
Centre for Child and Adolescent Mental Health
(RBUP)

• RBUPs are new interdisciplinary institutions with
  a short history. Each centre has a own catchment
  area. The catchment area of the centre in Oslo
  encompasses roughly half of the total Norwegian
  population.

4
(No Transcript)
5
RBUPs Mandate

• R.BUPs mandate is to strengthen the quality of
  mental health services in their regions through
  research and education. This is a broader area of
  commitment than is usual for a research
  institution.
• A significant aim for R.BUPs is to develop
  programs, integrating research and education in
  collaboration with the university and other
  affiliated regional institutions.  
• Primary tasks are
• To conduct, coach and stimulate research and to
  develop projects through activities affiliated
  with clinical activity in their health regions.

6

• Centre for Child
• and Adolescent Mental Health
• Eastern and Southern Norway

7
(No Transcript)
8
The state of child and adolescent psychotherapy
research Kazdin A. E. (2002, p. 58)

• There has been considerable progress in child and
  adolescent psychotherapy research, as reflected
  in the quantity and quality of outcome studies
  and the identification of evidence based
  treatments for several problems.
• There is a great deal of concern in contemporary
  research to see the extent to which treatment
  effects obtained in research generalise to
  practice.

9
Treatment research and service evaluation in
Norway concerning children and adolescents

• a difficult area of research with many
  controversies
• Very few treatment studies have been undertaken.
• Studies are often difficult to perform in
  cooperation with clinical settings
• ? poor use of diagnostic instruments
• ? no tradition for RCT
• ? no history for CBT, few manualized treatments
  exist

10
Deployment-Focused Model (DFM)(Weisz, J., 2004,
p. 465)

• Protocol/Manual
• Efficacy test
• Field cases
• Effectiveness I
• Effectiveness II
• Staying Power

11
Funnel Model
Breadth of Reach

N 1.500-5.000 150 80
ES 0.0-0.2 (small) 0.4-0.6 (medium) 0.8-1.5 (lar
ge)
Universal Prevention
Increasing Intensity
Selective Prevention
Indicative Prevention
Treatment
Rehab.
12
Why anxiety disorders?

• Anxiety disorders among children and adolescents
• are frequent
• often have a lifelong course
• often comorbid, forerunner for depression and
  substance abuse
• run in families, important to conduct treatment
  trials including a family component
• So far there has been little focus on
  internalising disorders
• No treatment trial of a CBT-program aimed at
  children and adolescents with anxiety disorders
  has been previously conducted in Norway

13
The pilot study 2005-2006

• A treatment trial of manual driven CBT therapy
  the FRIENDS for life program (Barrett et al.)
  in local community clinics and one school.
• Target group clinics children and/or adolescents
  diagnosed with social anxiety, generalised
  anxiety or separation anxiety, age 7 12 years.
• Target group school N 103 children in grades 4
  through 6 were allocated class wise to either
  control (n61) or intervention (n42) condition

14
Aims

• The main goal of this pilot study was to ensure
  the feasibility of the Norwegian translation of
  FRIENDS for Life as well as the quality of the
  its translation of and adaptation to Norwegian
  language and culture.
• Test various instruments for assessment and
  diagnosing anxiety disorders in children.

15

• J. R. Weisz et al. 2005, s. 633.

16
The intervention FRIENDS for life

• Based on P. Kendalls Coping Cat
• Available in two versions 7 12 years, and 12
  16 years
• Consists of ten weekly meetings two booster
  sessions
• Group treatment
• Parents are offered parallel sessions (FAM), 6
  hrs
• Treatment manual is provided for the therapist
• Workbook is provided for children and parents
• The program is currently used in 12 different
  countries

17
What is the Friends program about?Is it strongly
culture (country) specific?

• The program is based on cognitive-behavioral
  skills. They are summarized in the acronym
  FRIENDS, helping the adolescents to remember the
  skills they learned
• Feelings
• Remember to relax
• I can do it
• Explore solution and Coping step plans
• Now reward yourself
• Dont forget to practice
• Smile! Stay calm for life

18
Coping Cat

• 12-session program
• A) The first six sessions are devoted to
  psychoeducation
• recognize different feelings,
• identify bodily symptoms of anxiety, relaxation
  skills,
• change anxious self-talk,
• how to evaluate their own performance,
• use coping skills in anxiety provoking situations
  (FEAR-PLAN)
• B) The last six sessions focus on exposure,
  beginning with situations causing little anxiety
  and steadily increasing the level
• of anxiety as the child makes progress.

19
Training schedule for 2006

• May 2006
• Main Training (Level 2)
• Two-days training in use of manual
• (Jon Oslo team/page by page)
• One- day supervision (Jon Oslo team)
• October 2006
• 11.-13.10. Fourth World Conference in Oslo
• 12.10. (day two) Plenary session 4
• Effective dissemination and implementation
• 300-320 Keynote Overview current
  prevention research (P. Barrett)
• 415-545 Workshop Friends for preschoolers
  (P. Barrett)
• 12.10.-13.10. Main Traning (Level 2)
• Two-days training in use of manual
• (Jon Oslo team/page by page)
• One- day supervision (Barrett Oslo team)

20
Research group pilot 2006

• Team-members
• - senior researcher (Simon)
• - two doctoral fellows (Kicki Marianne)
• - special advisor and researcher (Jon)
• - 10 clinicians/educators (already trained)
• - secretarial resources (Lil, Malin, Margrethe)
  
• - network of international contacts
• Close cooperation with Pathways
• - promotion of Friends to other research
• groups (Bergen, Tromsø and Scandinavia)
• - organizing two stays in Norway and keynote
• - plans for extended cooperation/training at
  Pathways

21
Paula Barret (Pathways)
FRIENDS-Prosjekt
Stephen May (Australian Academic Press)

• - kontrakt med Paula Barret
• koordinering
• økonomi, strategi,
• presentasjon, publisering
• spesialist-veiledning

FORSKNING
IMPLEMENTERING
Simon Prosjektleder
internasjonal Australia nasjonal Bergen
internasjonal Australia regional
Klinikkene
Marianne Stipendiat
Kicki Klinisk prosj.koordinator

• forskning i klinikk
• kontakt forskningsmiljøer
• - Friendsmanual ungdom
• - Pilot skole

• undervisning/ opplæring
• kontakt klinikk
• nettverk forskningsbaserte tiltak
• - Friendsmanual barn
• - Pilot klinikk

Martina Forskningsassist.

• data innhenting, kontroll,
• arkivering analyse
• medarbeid presentasjoner
• prosjektorganisasjon
• og støttespiller

Friends-Team Bergen
22
Norwegian Study of FRIENDS

• Effectiveness and Multi-Centre Study encompassing
  two stages
• 1. Pilot Stage 01.01.06 31.12.06
• Pilot Study Trial of the Friends Program under
  realistic conditions
• Objective establish collaborative efforts with
  clinics, assess feasibility, test instruments
• Cooperation Partners 3 (10) clinics and 1 school
  in the Eastern and Southern region
• 2. Key Project To commence in 2007
• Duration approx. 4 years, two doctorate projects
• Objective evaluate programs effectiveness and
  further develop anxiety specific measurement
  instruments (see below).

23
SOUTH EAST
Screening 10 10
10
Ringeriket Clinic
Jessheim Clinic
Follo Clinic
Inclusion SA, GAD Exclusion OCD, PTSD, PA, IQlt70
n 8
n 4
n 8

• Sample I

Nordby School
n 42 EG n 61 CG
Sample II
Participants N 121 Therapists n 13
24
Measurement Instruments
25
Does it work?

• Previous treatment trials show positive effects
  of the program (seewww.friendsinfo.net Friends
  for life. Evidence based abstracts)
• Treatment / children (7 12 years) comparably
  comprehensive body of evidence
• Prevention / children (7 12 years) limited
  body of evidence
• Treatment and prevention / adolescents (12-16
  years) fairly limited body of evidence

26
Pilot Study Results

• Examining the effects of the program was not the
  main purpose of the pilot study. Data must be
  interpreted with caution.
• The program can be conducted in schools and
  community clinics in Norway.
• The teachers, therapists and families evaluated
  the intervention favorably.
• Cooperative relations between clinics and schools
  have been established. This provides a solid
  foundation for a larger treatment study from 2008.

27
Pilot Study Results cont.

• Clinic
• Results based on the ADIS and self-report
  measures indicate that 39 of the children have
  improved significantly on both outcomes.
• School
• No significant results, but positive trends for
  symptoms of depression (ES0.2) and resilience
  (ES0.34)

28
Resultats school
F F-score p signifikanse (p 0.05 p
0.01) MASC Multidimensional Anxiety Scale
for Children SCARED Screen for Child Anxiety
Related Disorders MFQ Recent Mood and
Feelings Questionaire.
29
Is it expensive?
30
(No Transcript)
31
Summary

• Emotional disorders are serious, and are the most
  common problems in youth, mainly girls.
• Working with emotional problems in youth can be
  challenging as the body of evidence is fairly
  limited.
• A successful pilot must incorporate plans for the
  main study. It is dependent on the availability
  of economic resources, having a solid project
  structure, adequate knowledge within the extended
  team, the degree of intervention and timing.
• FRIENDS for life is, in many ways, an attractive
  program and can probably be adapted and licensed
  by P. Barrett and Pathways.

32
Carr, A. (2002), s. 12