Topic: Violence and abuse

Implementation of TF-CBT at Norwegian Child and Adolescents’ Mental Health Clinics and Child Advocacy Centers

Trauma Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based treatment method for trauma-exposed children with elaborated levels of Post-Traumatic Stress Symptoms. The Norwegian Knowledge Center on Violence and Traumatic Stress Studies (NKVTS) implement TF-CBT at Child and Adolescents' Mental Health Clinics (BUP) and Child Advocacy Centers as commissioned by the Ministry of Health.

2018 This project is ongoing 2023

Project Manager

  • Birkeland, Marianne Skogbrott

    Birkeland, Marianne Skogbrott

    Researcher Professor / Ph.D.

    View profile

Project Members

Main objective

The effect of TF-CBT has been investigated in a study conducted at eight Child and Adolescents’ Mental Health Clinics (BUP) in Norway. The results of the study showed that the method is more effective for severely traumatized children than therapy as usual. Please find information and results from this study here. The first project period lasted from 2012 to 2017. By the end of 2017, half of the BUP clinics in Norway had participated in the project. You can find additional information about this project here.

In Implementation of TF-CBT at Norwegian Child and Adolescents’ Mental Health Clinics 2018-2021, the aim is to maintain the treatment capacity of TF-CBT at these clinics, and to implement TF-CBT at the remaining clinics so that all children and adolescents who are struggling with posttraumatic stress can receive evidence-based treatment for their symptoms. From 2020, the Child Advocacy Centers will implement TF-CBT to make sure that we reach children in need for trauma focused treatment who do not receive services elsewhere. The implementation have a particular focus on ensuring sustainment of the method through thorough training, guidance and follow-up of TF-CBT therapists.

Subsidiary objectives

In line with the research literature, our experiences indicate that leadership support and organizational planning are important for sustained use of TF-CBT with fidelity. We implement and test an empirical and theoretical supported model for implementation leadership. The aim of the research is to investigate whether the inclusion of the Leadership and Organizational Change for Implementation (LOCI) will result in changes in implementation climate and the clinic’s ability to provide TF-CBT to children in need for trauma focused treatment.


The project will use a stepped wedge design to investigate the effectiveness of LOCI in supporting the implementation of TF-CBT. Questionnaires will be used to collect data from therapists and leaders at baseline and after 4, 8, 12, and 16 months. In addition, client data will be collected throughout the study period.

Further information

Questions about the project can be addressed to: 
Marianne Skogbrott Birkeland
Project leader 
Implementation of TF-CBT in Norwegian child and adolescent mental health services 


Peters, N., Borge, R. H., Skar, A. M. S., & Egeland, K. M. (2022). Measuring implementation climate: Psychometric properties of the Implementation Climate Scale (ICS) in Norwegian mental health care services. BMC Health Services Research. doi:10.1186/s12913-021-07441-w

Borge, R. H., Skar, A. M. S., Endsjø, M., & Egeland, K. M. (2021). Good soldiers in implementation: validation of the Implementation Citizenship Behavior Scale and its relation to implementation leadership and intentions to use evidence-based practices. Implementation Science Communications, 2. doi:10.1186/s43058-021-00240-8

Skar, A. M. S., Jensen, T. K., & Harpviken, A. N. (2021). Who Reports What? A Comparison of Child and Caregivers´ Reports of Child Trauma Exposure and Associations to Post-Traumatic Stress Symptoms and Functional Impairment in Child and Adolescent Mental Health Clinics. Research on Child and Adolescent Psychopathology. doi:10.1007/s10802-021-00788-y

Egeland, K. M., Skar, A. M. S., Endsjø, M., Laukvik, E. H., Bækkelund, H., Babaii, A., Granly, L. B., Granly, L., Husebø, G. K., Borge, R. H., Ehrhart, M. G., Sklar, M., Brown, C. H., & Aarons, G. A. (2019). Testing the leadership and organizational change for implementaion (LOCI) intervention in Norwegian mental health clinics: a stepped-wedge cluster randomized design study protocol. Implementation Science, 14(28). doi:10.1186/s13012-019-0873-7

Skar, A. M. S., Ormhaug, S. M., & Jensen, T. K. (2019). Reported Levels of Upset in Youth After Routine Trauma Screening at Mental Health Clinics. JAMA Network Open, 2(5), e194003. doi:10.1001/jamanetworkopen.2019.4003