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

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.

Method

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

 m.s.birkeland@nkvts.no 

Publications

Aminihajibashi, S., Skar, A. M. S., & Jensen, T. (2022). Professional wellbeing and turnover intention among child therapists: a comparison between therapists trained and untrained in Trauma-Focused Cognitive Behavioral Therapy. BMC Health Services Research, 22(1). doi:10.1186/s12913-022-08670-3

Birkeland, M. S., Skar, A. M. S., & Jensen, T. (2022). Understanding the relationships between trauma type and individual posttraumatic stress symptoms: A cross-sectional study of a clinical sample of children and adolescents. Journal of Child Psychology and Psychiatry. doi:10.1111/jcpp.13602

Borge, R. H., Egeland, K. M., Aarons, G. A., Ehrhart, M. G., Sklar, M., & Skar, A. M. S. (2022). “Change Doesn’t Happen by Itself”: A Thematic Analysis of First-Level Leaders’ Experiences Participating in the Leadership and Organizational Change for Implementation (LOCI) Strategy. Administration and Policy in Mental Health and Mental Health Services Research. doi:10.1007/s10488-022-01199-x

Braathu, N., Laukvik, E. H., Egeland, K. M., & Skar, A. M. S. (2022). Validation of the Norwegian versions of the Implementation Leadership Scale (ILS) and Multifactor Leadership Questionnaire (MLQ) in a mental health care setting. BMC Psychology. doi:10.1186/s40359-022-00725-8

Egeland, K. M., Skar, A. M. S., Babaii, A., Borge, R. H., Braathu, N., Bækkelund, H., Endsjø, M., Granly, L., Hansen, K. S., Husebø, G. K., & Peters, N. (2022). Implementering av traumebehandling i spesialisthelsetjenesten: En nasjonal implementering av behandling av posttraumatisk stresslidelse (PTSD) for barn og voksne. Oslo: Nasjonalt kunnskapssenter om vold og traumatisk stress. (Rapport 1/2022).

Jensen, T., Braathu, N., Birkeland, M. S., Ormhaug, S. M., & Skar, A. M. S. (2022). Complex PTSD and treatment outcomes in TF-CBT for youth: A naturalistic study. European Journal of Psychotraumatology, 13(2), 1-11. doi:10.1080/20008066.2022.2114630

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

Skar, A. M. S., Braathu, N., Jensen, T., & Ormhaug, S. M. (2022). Predictors of nonresponse and drop-out among children and adolescents receiving TF-CBT: investigation of client-, therapist-, and implementation factors. BMC Health Services Research, 22(1), 1-13. doi:10.1186/s12913-022-08497-y

Skar, A. M. S., Braathu, N., Peters, N., Bækkelund, H., Endsjø, M., Babaii, A., Borge, R. H., Wentzel-Larsen, T., Ehrhart, M. G., Sklar, M., Brown, C. H., Aarons, G. A., & Egeland, K. M. (2022). A stepped-wedge randomized trial investigating the effect of the Leadership and Organizational Change for Implementation (LOCI) intervention on implementation and transformational leadership, and implementation climate. BMC Health Services Research, 22(1). doi:10.1186/s12913-022-07539-9

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