Identification of Multisystemic Therapy (MST) Subgroups with Distinct Trajectories on Ultimate Outcomes in Norway.

The effect of Multisystemic Therapy (MST) treatment for serious behavior problems among adolescents has been established through multiple studies. However, variations across individuals should also be examined to better understand how MST works or for whom. In this study, we explored and identified subgroups of youth with serious problems in Norway regarding their responses to MST in terms of ultimate MST outcomes (e.g., living at home, abstaining from violence) over time. We further explored whether immigrant background, in addition to gender and age of the youth at intake, predicted belonging to the subgroups. Data came from 1674 adolescents (MeanAge = 14.55, SDAge = 1.58; 60.7% boys) and their families referred to MST treatment by the municipal Child Welfare Services for serious and persistent antisocial behavior. The outcomes were assessed at five time-points from intake to 18-months after discharge for youth and families who completed the treatment. Latent class growth analyses revealed heterogeneous trajectories regarding youths' responses to MST. Results indicated a high and sustained degree of improvement across the ultimate outcomes for the vast majority of the youths. However, there was still variation in the groups, with improvement and deterioration trajectories for various outcomes. Most of these trajectories were predicted by gender and youth's age at intake, but not by immigrant status. Not every youth-at-risk responds similarly to MST, and more studies examining heterogeneity will help us to identify factors to be targeted to better tailor the MST interventions for youth with serious problems.

Evaluating Modular Approach to Therapy for Children with Anxiety, Depression, Trauma and Conduct Problems (MATCH-ADCT) in Norwegian child and adolescent outpatient clinics: Study protocol for a randomized controlled trial.

BACKGROUND: Norwegian health, care, and welfare services are experiencing increased demands to deliver services that are safe, effective, of high quality, and that ensure user involvement. Yet, evidence-based treatment for common disorders such as depression, anxiety, trauma, and behavioral problems in children are not regularly used in clinical practice in Norway. Possible explanations for this are that many standard, evidence-based treatments may have difficulty addressing the complexity and comorbidity of referred children and the fact that children's treatment needs often shift during treatment. The Modular Approach to Therapy for children with Anxiety, Depression, Trauma and Conduct problems (MATCH-ADTC) was designed to address these challenges and reduce some of the barriers to therapists' use of evidence-based treatment in their practice. METHODS/DESIGN: Participants will include 280 children (aged 6-14.5 years at intake) who receive treatment in child and adolescent mental health outpatient clinics in Norway, and their families. Families are randomly assigned to either the experimental group receiving treatment from therapists trained in MATCH, or to the comparison group receiving treatment from therapists delivering treatment as usual (TAU). Data on children's symptomology, child and family functioning, demographics, background information, and mental health outcomes are collected as well as frequent feedback on treatment response, plus video-recordings of treatment sessions and implementation quality scores from each participating clinic. Questionnaires are administered in six waves. DISCUSSION: MATCH has been tested in the US with promising results, but we do not know whether this treatment approach will produce similar results in Norway. The implications of this study are 1. Possibly better treatment outcomes and/or more efficient improvements for children and families treated in mental health outpatient clinics in Norway 2. Clinicians learning to use more evidence-based practices in their treatment 3. Implementation of standard procedures for obtaining feedback from children and families and sharing the feedback with clinicians 4. Increased understanding, at the end of the trial, of whether introducing MATCH improves outcomes for children and families treated in mental health outpatient clinics TRIAL REGISTRATION: ISRCTN, registration number: ISRCTN24029895 . Registered on 8 August 2016.

Measurement of implementation components ten years after a nationwide introduction of empirically supported programs--a pilot study.

BACKGROUND: Ten years after the nationwide dissemination of two evidence-based treatment programs, the status of the implementation components was evaluated in a cross-sectional study. The aim of the study was to pilot a standardized measure of implementation components by examining the factor structure, the reliabilities of the scores, and their association with implementation outcome variables. The aim was also to compare implementation profiles of the two evidence-based programs based on multi informant assessments. METHODS: The 218 participants in the study were therapists, supervisors, and agency leaders working with Parent Management Training, the Oregon model (PMTO), and Multisystemic Therapy (MST) in Norway. Interviewers filled in an electronic version of the Implementation Components Questionnaire during a telephone interview. RESULTS: The factor analysis of the eight one-dimensional subscales resulted in an individual clinical-level factor and an organizational system-level factor. Age, experience, and number of colleagues in the workplace were negatively correlated with positive ratings of the implementation process, but the number of colleagues working with the same program predicted positive ratings. MST and PMTO had different implementation profiles and therapists, supervisors, and managers evaluated some of the implementation drivers significantly differently. CONCLUSIONS: The psychometric quality of the questionnaire was supported by measures of internal consistency, factor analyses of the implementation components, and the comparisons of implementation profiles between programs and respondent groups. A moderate, but consistent association in the expected direction was found with the implementation outcome variables.