Is internet-based parent training for everyone? Predictors and moderators of outcomes in group vs. internet-based parent training for children with disruptive behavior problems.

Parent training is an effective treatment for disruptive behavior problems in children. However, as there is limited access to traditional face-to-face treatment, other delivery formats have been evaluated. This study aims to evaluate possible predictors and moderators of outcome, completion and engagement in parent training when delivered in group or through the internet. A recent randomized controlled non-inferiority trial (N = 161) demonstrated equal effectiveness of the parent training program Comet when delivered in group (gComet) and through the internet (iComet). Demographic, clinical and theory-driven variables were studied to find predictors and moderators of treatment effect, completion and engagement. Linear mixed effects models were used to determine predictors and moderators of change in disruptive behavior from baseline to the 3- and 12-month follow-up. Most variables did not have significant predictive or moderating effects. However, there were some variables that predicted or moderated outcomes that may have implications for practice (e.g., comorbid emotional problems, preferred treatment format, and ADHD). This trial can contribute to guiding clinical work with children with disruptive behavior and results indicate that parent training in both treatment formats can be offered regardless of a range of demographic and clinical factors. Taking patients' treatment preferences into account can increase treatment completion.

Parent Training via Internet or in Group for Disruptive Behaviors: A Randomized Clinical Noninferiority Trial.

OBJECTIVE: To evaluate if an internet-delivered parent training program is noninferior to its group-delivered counterpart in reducing child disruptive behavior problems (DBP). METHOD: This noninferiority randomized clinical trial enrolled families seeking treatment in primary care in Stockholm, Sweden, for DBP in a child 3-11 years of age. Participants were randomized to internet-delivered (iComet) or group-delivered (gComet) parent training. The primary outcome was parent-rated DBP. Assessments were made at baseline and 3, 6, and 12 months. Secondary outcomes included child and parent behaviors and well-being and treatment satisfaction. The noninferiority analysis was determined by a one-sided 95% CI of the mean difference between gComet and iComet using multilevel modeling. RESULTS: This trial included 161 children (mean age 8.0); 102 (63%) were boys. In both intention-to-treat and per-protocol analyses, iComet was noninferior to gComet. There were small differences in between-group effect sizes (d = -0.02 to 0.13) on the primary outcome with the upper limit of the one-sided 95% CI below the noninferiority margin at 3-, 6-, and 12-month follow-up. Parents were more satisfied with gComet (d = 0.49, 95% CI [0.26, 0.71]). At 3-month follow-up, there were also significant differences in treatment effect on attention-deficit/hyperactivity disorder symptoms (d = 0.34, 95% CI [0.07, 0.61]) and parenting behavior (d = 0.41, 95% CI [0.17, 0.65]) favoring gComet. At 12-month follow-up, there were no differences in any outcomes. CONCLUSION: Internet-delivered parent training was noninferior to group-delivered parent training in reducing child DBP. The results were maintained at 12-month follow-up. This study supports internet-delivered parent training being used as an alternative to group-delivered parent training in clinical settings. CLINICAL TRIAL REGISTRATION INFORMATION: Randomized Controlled Trial of Comet via the Internet or in Group Format; https://www. CLINICALTRIALS: gov/; NCT03465384.

Publication bias, time-lag bias, and place-of-publication bias in social intervention research: An exploratory study of 527 Swedish articles published between 1990-2019.

Publication and related biases constitute serious threats to the validity of research synthesis. If research syntheses are based on a biased selection of the available research, there is an increased risk of producing misleading results. The purpose fo this study is to explore the extent of positive outcome bias, time-lag bias, and place-of-publication bias in published research on the effects of psychological, social, and behavioral interventions. The results are based on 527 Swedish outcome trials published in peer-reviewed journals between 1990 and 2019. We found no difference in the number of studies reporting significant compared to non-significant findings or in the number of studies reporting strong effect sizes in the published literature. We found no evidence of time-lag bias or place-of-publication bias in our results. The average reported effect size remained constant over time as did the proportion of studies reporting significant effects.

The devil is in the details: Unpackaging the systematic in systematic reviews: Short reply to reconsidering the effectiveness of mentoring for prevention of juvenile criminal recidivism.

Replies to a comment made by DuBois (see record 2022-98051-005). The systematic review is an important tool for decision makers, intervention researchers, and practitioners to gain a clear and comprehensive overview of the available evidence on a given topic. We would, in this short reply, like to raise the two additional issues of critical appraisal and research synthesis. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Numbers of publications and citations for researchers in fields pertinent to the social services: a comparison of peer-reviewed journal publications across six disciplines.

Timely dissemination of knowledge is essential and fosters development of knowledge both within academe and the wider society, not least for knowledge that serves practises outside of academia. Here, we compare six disciplines which provide health-related knowledge that serve the health and social services. Most previous research compares the size and impact of the body of publications belonging to each discipline, which ignores the distribution of seniority, productivity, and impact amongst researchers. Instead, we consider the whole population of academics in Sweden employed or active within each discipline, including those who have nil publications. The disciplines form three clusters, where researchers in Public Health and Nursing and Caring science claim about 15 articles per author, Psychology about 10, and Education, Sociology and Social Work less than four. Their numbers of citations follow the same pattern, and are substantially correlated with the number of articles. Tenured or full professors had about 50% more publications and citations per publication than had associate professors. The distributions indicate clear modes at 0, 4, and 16 publications for each cluster, and provide the proportions of researchers within each discipline who have no such publications at all. We discuss the implications of these results for policy, practice, and knowledge quality in the social services and the welfare sector.

Systematic review and meta-analysis of noninstitutional psychosocial interventions to prevent juvenile criminal recidivism.

OBJECTIVE: To assess the effectiveness of noninstitutional psychosocial interventions in preventing recidivism among criminal adolescents. METHOD: We performed a systematic review and meta-analysis of randomized and nonrandomized controlled trials assessing the impact on recidivism among juveniles aged 12-17. The included studies had a low to medium risk of bias and were published between 2000 and 2019. Standardized mean differences or risk differences were calculated. RESULTS: We included 35 (20 randomized, 15 nonrandomized) studies evaluating 17 unique, noninstitutional psychosocial interventions. A meta-analysis found no significant reductions in recidivism for studied interventions compared to control conditions. Although single studies suggested some positive effects, the evidence provided by these studies was found to have very low certainty. Post hoc analyses indicated that studies including a low-intensity control condition might have stronger relative intervention effects compared to studies with medium or high-intensity control conditions. CONCLUSION: This systematic review did not find any one noninstitutional psychosocial intervention to be more effective than control treatments in reducing future criminality among juvenile offenders aged 12-17. We discuss the implications of the present findings for social work and child and adolescent psychiatry practices. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Stability and Change in Patterns of Adolescent Antisocial Behavior.

Research examining relations between various types of antisocial behavior (ASB) have generally been based on cross-sectional data. Although there is a strong correlation between types of ASB, it has been less common to examine how patterns of adolescents' problems vary over time. This study used a person-oriented approach to examine patterns of ASB in adolescents longitudinally and also investigated how these patterns were associated with three outcomes. The sample consisted of 778 Swedish adolescents in grade 7 (13 years old) followed over time to grade 9. Patterns of ASB were identified based on adolescent-reported tobacco and alcohol use, truancy, bullying in school, and delinquency. The outcomes were drug use, depressive symptoms, and missing grades in grade 9. Results revealed an escalation in the frequency and seriousness of ASB over time, although the largest single cluster over time evidenced no ASB. One cluster in particular increased the risk of drug use, depression, and missing grades at grade 9. Results are discussed in relation to school-based prevention efforts.

Colliding ideals - an interview study of how intervention researchers address adherence and adaptations in replication studies.

BACKGROUND: For an intervention to be considered evidence-based, findings need to be replicated. When this is done in new contexts (e.g., a new country), adaptations may be needed. Yet, we know little about how researchers approach this. This study aims to explore how researchers reason about adaptations and adherence when conducting replication studies, describe what adaptations they make and how these are reported in scientific journals. METHODS: This was an interview study conducted in 2014 with principal investigators of Swedish replication studies reporting adaptations to an intervention from another country. Studies (n = 36) were identified through a database of 139 Swedish psychosocial and psychological intervention studies. Twenty of the 21 principal investigators agreed to participate in semi-structured telephone interviews, covering 33 interventions. Manifest content analysis was used to identify types of adaptations, and qualitative content analysis was used to explore reasoning and reporting of adaptations and adherence. RESULTS: The most common adaptation was adding components and modifying the content to the target population and setting. When reasoning about adaptations and adherence, the researchers were influenced by four main factors: whether their implicit aim was to replicate or improve an intervention; the nature of evidence outlying the intervention such as manuals, theories and core components; the nature of the context, including approaches to cultural adaptations and constraints in delivering the intervention; and the needs of clients and professionals. Reporting of adaptations in scientific journals involved a conflict between transparency and practical concerns such as word count. CONCLUSIONS: Researchers responsible for replicating interventions in a new country face colliding ideals when trying to protect the internal validity of the study while considering adaptations to ensure that the intervention fits into the context. Implicit assumptions about the role of replication seemed to influence how this conflict was resolved. Some emphasised direct replications as central in the knowledge accumulation process (stressing adherence). Others assumed that interventions generally need to be improved, giving room for adaptations and reflecting an incremental approach to knowledge accumulation. This has implications for design and reporting of intervention studies as well as for how findings across studies are synthesised.

Adolescent girls in context: Not all patterns may be created equal.

Much research exists on the importance of risk factors within individual contexts of parenting, neighborhood, school, and peers for adolescent development. However little exists on whether risks in certain contexts may be more or less likely for risk accumulation across contexts - referred to as the Weighted Risk Phenomenon (WRP). One way to study WRP is to study adolescent patterns of co-existing risk characteristics across domains and over time. The present study focuses on studying information about parenting, neighborhood, school, and peers in order to understand how risk can have different patterns over time. Participants were all girls recruited from junior high schools in rural and metropolitan areas of Sweden. The results illustrate that there are stable structural and individual pathways across four contexts of adolescent girls which may represent risk over time. Structurally, patterns which emerged at grade 7 reappeared again a year later and again a year after that in grade 9. In general, the same individuals seem to re-emerge in the same or similar patterns over time. Those who showed risk accumulation patterns tended to report prior risk factors in the parenting context. Such trends are supported in the literature and give support to the postulation that parenting is one of the strongest risk factors for adolescents. The findings indicate possible underpinnings of WRP.

School environment and mental health in early adolescence - a longitudinal study in Sweden (KUPOL).

BACKGROUND: Longitudinal studies indicate strong associations between school proficiency and indicators of mental health throughout adulthood, but the mechanisms of such associations are not fully elucidated. The Kupol study is a prospective cohort study in Sweden set up in order to: (i) describe the association of school pedagogic and social environment and its specific dimensions with the risk of mental ill-health and psychiatric disorders in adolescence; (ii) evaluate the direct effects of school pedagogic and social environment on mental health and the effects mediated by the individual's academic achievements; and (iii) assess if school pedagogic and social environment are associated with mental ill-health through epigenetic mechanisms, in particular those involving genes regulating the response to stress. METHODS: The Kupol cohort at baseline consists of 3959 children attending the 7th grade of compulsory school (13-14 years old) in 8 regions of central Sweden in the school years 2013-2014 or 2014-2015. Three follow-up surveys in subsequent years are planned. Teachers' and students' perceptions of the culture, climate and ethos of their schools, and students' mental ill-health are assessed at the whole school level by annual questionnaire surveys. In order to conduct epigenetic analyses saliva specimens are collected from a nested sample of students at inception and two years later. Further, class-, family- and child-level information is collected at baseline and during each year of follow-up. Self-reported information is being complemented with register data via record-linkages to national and regional health and administrative registers. DISCUSSION: The topic being investigated is new, and the sample constitutes the largest adolescent cohort in Sweden involved in an ad hoc study. Epigenetic analyses centered on environmental cues to stress response are a thoroughly new approach. Finally a notable feature is the multi-informant and multi-method data collection, with surveys at the school, class, family, and student level. Collaboration and data access: interested investigators should contact the coordinating centre. Additional information is available on the study's website, http://kupolstudien.se/ .

Research that Guides Practice: Outcome Research in Swedish PhD Theses Across Seven Disciplines 1997-2012.

The core of evidence-based practice (EBP) as advocated for within the practice arms of the health and social sciences is to promote the routine incorporation of the best available research evidence into practice efforts. This requires discipline-specific education that is not only grounded in professional practice but also prepares would-be scientists in the application of the sophisticated techniques that characterize today's high research standards. Doctoral-level education is an important primer for future scientific endeavors across disciplines. This study examined 2334 theses published across Sweden in public health, criminology, nursing, psychiatry, psychology, social work, and sociology during the period 1997-2012. Of the theses reviewed, 13% aimed to investigate the effects of interventions. The highest percentage of effectiveness studies was found in nursing, public health, and psychology. The percentage of outcome research increased during the period. Controlled studies (with comparison group and pre- and post-test) occurred primarily within public health, nursing, psychiatry, and psychology. Of the 296 theses that included an intervention effectiveness study, 131 (44%), or 5.6% of all theses reviewed, met all four assessment criteria for quality. PhD education across seven disciplines in Sweden may be producing a professional core of scientists that is ill prepared to produce the type of research that is necessary to inform practice of the effects of its interventions as exposure to the rigors of quality effectiveness research is all but non-existent. This has implications for the advancement of an evidence-based practice and intervention science more broadly.

Novel Programs, International Adoptions, or Contextual Adaptations? Meta-Analytical Results From German and Swedish Intervention Research.

One of the major dilemmas in intervention and implementation research is adaptation versus adherence. High fidelity to an intervention protocol is essential for internal validity. At the same time, it has been argued that adaptation is necessary for improving the adoption and use of interventions by, for example, improving the match between an intervention and its cultural context, thus improving external validity. This study explores the origins of intervention programs (i.e., novel programs, programs adopted from other contexts with or without adaptation) in two meta-analytic intervention data sets from two European countries and compares the effect sizes of the outcomes of the interventions evaluated. Results are based on two samples of studies evaluating German child and youth preventative interventions (k = 158), and Swedish evaluations of a variety of psychological and social interventions (k = 139). The studies were categorized as novel programs, international adoption and contextual adaptation, with a total of six subcategories. In the German sample, after statistically controlling for some crucial methodological aspects, novel programs were significantly more effective than adopted programs. In the Swedish sample, a trend was found suggesting that adopted programs were less effective than adapted and novel programs. If these results are generalizable and unbiased, they favor novel and adapted programs over adopted programs with no adaptation and indicate that adoption of transported programs should not be done without considering adaptation.

The Swedish implementation of multisystemic therapy for adolescents: does treatment experience predict treatment adherence?

Treatment effects may not be observed if an empirically supported intervention is not administered with treatment adherence. This retrospective study investigated how therapists' adherence to Multisystemic therapy (MST) varied during a 6-year period in Sweden. Adherence was measured using the Therapist Adherence Measure, which was provided by caregivers. The associations between treatment adherence and therapist-reported posttreatment youth outcomes were also assessed. Retrospective adherence data were obtained for 973 families with youths between 12 and 17 years old who received MST from 68 therapists divided into 10 teams. Implementation of MST occurred in 2 waves between March 2003 and August 2009. Multilevel structural equation modelling was used to evaluate family- and cohort-level predictors and outcomes of treatment adherence. The results confirm previous research: Treatment adherence predicts MST treatment outcomes. With respect to the relationship between MST treatment experience and MST treatment adherence, the analysis showed mixed results. An increase in years that a team had been active predicted an increase in therapist adherence to MST. Therapists from the 2nd implementation wave had higher therapist adherence rates than therapists from the 1st implementation wave. Nevertheless, a therapists' experience with MST did not predict MST treatment adherence. The results suggest that the found links among treatment experience, treatment adherence, and treatment outcomes provide support for the hypothesis that the collective experience of the team members promotes treatment adherence. However, results are mixed and further research is needed.

Evaluation of a Swedish version of the Strengthening Families Programme.

BACKGROUND: Adolescents' alcohol consumption is a public health concern in Sweden as well as in many other countries. Underage drinking is associated with increased risks of alcohol-related injuries, risky sexual behaviours and dependence later in life. Different strategies have been used in the effort to prevent this behaviour, and to postpone the onset of alcohol. The Strengthening Families Programme 10-14 (SFP 10-14) from the USA has been highlighted as one of the more effective prevention programmes. The aim of the present article was to evaluate the effectiveness of a culturally adapted Swedish version of the SFP 10-14. METHODS: This was a cluster randomized controlled trial including 587 sixth-grade students (age 12) and their parents in 19 elementary schools in Stockholm. Schools were randomly assigned to either control (9 schools, 216 students) or to the family skills training intervention (10 schools, 371 students). The SFP Swedish version consisted of two parts with seven and five sessions, respectively, held separately for youths and parents except two joint family sessions. Measures of students' self-reported episodes of drunkenness, smoking, illicit drug use and other norm-breaking behaviours were collected at baseline (March 2003) and at three subsequent yearly surveys. Data were analysed using multilevel models with an intention-to-treat approach. RESULTS: No preventive effects were found for smoking, alcohol and illicit drug use and other norm-breaking behaviours, nor did moderators affect the outcome. CONCLUSION: The Swedish version of the SFP 10-14 was not effective in preventing youths' substance use in a Swedish context.

Going Global: A Model for Evaluating Empirically Supported Family-Based Interventions in New Contexts.

The spread of evidence-based practice throughout the world has resulted in the wide adoption of empirically supported interventions (ESIs) and a growing number of controlled trials of imported and culturally adapted ESIs. This article is informed by outcome research on family-based interventions including programs listed in the American Blueprints Model and Promising Programs. Evidence from these controlled trials is mixed and, because it is comprised of both successful and unsuccessful replications of ESIs, it provides clues for the translation of promising programs in the future. At least four explanations appear plausible for the mixed results in replication trials. One has to do with methodological differences across trials. A second deals with ambiguities in the cultural adaptation process. A third explanation is that ESIs in failed replications have not been adequately implemented. A fourth source of variation derives from unanticipated contextual influences that might affect the effects of ESIs when transported to other cultures and countries. This article describes a model that allows for the differential examination of adaptations of interventions in new cultural contexts.

Psychosocial working conditions, school sense of coherence and subjective health complaints. A multilevel analysis of ninth grade pupils in the Stockholm area.

This study explores the psychosocial working conditions of 7930 Swedish 9th grade students, distributed over 475 classes and 130 schools, in relation to their subjective health using multilevel modeling. At the individual level, students with "strained" working conditions in school (i.e. those experiencing a high level of demands in combination with a low level of control) demonstrated significantly worse health compared to students in "low-strain" situations. "Strained" conditions in combination with a weak school-related sense of coherence were especially unfavourable for health. These findings remained significant when support from teachers, school marks, norm-breaking behaviours, family-relations and certain class- and school-contextual conditions were adjusted for. Thus, while demands are an essential part of school work, this study suggests that high levels of control and a strong school-related sense of coherence can protect against the more detrimental effects on health that high demands at school may cause.

A randomized controlled effectiveness trial of parent management training with varying degrees of therapist support.

This study examined the effectiveness of a Swedish parent management training (PMT) intervention for parents of children aged 3 to 10 within the context of regular social service. Self-referred parents of 159 children (aged 3 to 10) with conduct problems were randomly assigned to either 11 practitioner-assisted group sessions (PMT-P), or a single instructional workshop followed by self-administration of the training material (PMT-S), or a waitlist control group. Intent-to-treat analyses showed that both PMT-P and PMT-S improved parent competence and reduced child conduct problems compared to the waitlist at posttest. Both training conditions showed further significant improvements at the 6-month follow-up. In direct comparison, PMT-P was superior to PMT-S on measures of child conduct problems at both posttest and follow-up. Improvement in child conduct was mediated by improvement in parent competencies and homework fidelity. The findings in this study have implications for large-scale dissemination of parent management training through different means of delivery.

The transportability of multisystemic therapy to Sweden: short-term results from a randomized trial of conduct-disordered youths.

This randomized clinical trial assessed the effectiveness of multisystemic therapy (MST) for 156 youths who met the diagnostic criteria for conduct disorder. Sweden's 3 largest cities and 1 small town served as the recruiting area for the study. A mixed factorial design was used, with random allocation between MST and treatment as usual groups. Assessments were conducted at intake and 7 months after referral. With an intention-to-treat approach, results from multiagent and multimethod assessment batteries showed a general decrease in psychiatric problems and antisocial behaviors among participants across treatments. There were no significant differences in treatment effects between the 2 groups. The lack of treatment effect did not appear to be caused by site differences or variations in program maturity. MST treatment fidelity was lower than that of other studies, although not clearly related to treatment outcomes in this study. The results are discussed in terms of differences between Sweden and the United States. One difference is the way in which young offenders are processed (a child welfare approach vs. a juvenile justice system approach). Sociodemographic differences (e.g., rates of poverty, crime, and substance abuse) between the 2 countries may also have moderating effects on the rates of rehabilitation among young offenders. (PsycINFO Database Record (c) 2008 APA, all rights reserved).

Blueprints in Sweden. Symptom load in Swedish adolescents in studies of Functional Family Therapy (FFT), Multisystemic Therapy (MST) and Multidimensional Treatment Foster Care (MTFC).

The purpose of the present study was to compare symptom load in youth groups treated with three Swedish Blueprint programmes - Functional Family Therapy (FFT), Multisystemic Therapy (MST) and Multidimensional Treatment Foster Care (MTFC) - to see if symptom load matches the intensity of the treatment model as expected. These youth groups were also compared with in- and outpatients from child and adolescent psychiatry, and a normal comparison group. In addition, we compared the symptom load of their mothers. Symptom load was measured by the Achenbach System of Empirically Based Assessment (ASEBA) in the adolescents, and by the Symptom Checklist 90 in their mothers. The results showed that youth in the MST and MTFC studies had a higher symptom load than in the FFT study, and the same pattern of results was found in their mothers. It is concluded that there seems to be a reasonable correspondence between the offered resources and the symptom load among youth and parents; treatment methods with higher intensity have been offered to youth with higher symptom load. The correlation between internalized and externalized symptoms was high in all study groups. The MST and MTFC groups had an equally high total symptom load as the psychiatric inpatient sample.