Content uploaded by Terje Ogden
Author content
All content in this area was uploaded by Terje Ogden on Dec 24, 2018
Content may be subject to copyright.
ISSN 2073-7629
111
© 2018 CRES Special Issue Volume 10, Number 2, November 2018 pp
Special Issue Volume 10, Number 2, November 2018 pp 111 - 117
www.um.edu.mt/ijee
Postscript
Ogden, T. & Sørlie, M.A. (2009) Implementing and Evaluating
Empirically Based Family and School Programmes for Children with
Conduct Problems in Norway. International Journal of Emotional
Education, 1(1), 96-107.
This paper discusses the implementation and evaluation of two family and community
based intervention programmes for children and young people implemented in Norway,
namely Parent Management Training (PMTO) (Ogden and Amlund Hagen in press) and
Multisystemic Therapy (Ogden and Halliday-Boykins 2004; Ogden and Amlund-Hagen
2006), and a school-wide intervention programme, PALS (Sørlie and Ogden 2007). In
PALS universal interventions are combined with treatment by offering PMTO to the
parents of the high risk children. The Norwegian experiences and results also illustrate
how evidence-based programs developed in the US have been transported across
geographical and language borders, implemented nationwide, evaluated for their
effectiveness in regular practice and examined for sustainability. This paper describes
this national strategy, and the main components and immediate outcomes of the PMTO-
and PALS-programmes in Norway.
Keywords: behaviour problems, intervention, PALS, PMTO, Norway
Access to paper: https://www.um.edu.mt/__data/assets/pdf_file/0015/183210/ENSECV1I1P5.pdf
POSTSCRIPT
Terje Ogden
1
and Mari-Anne Sørlie, Norwegian Center for Child Behavioral Development, Norway
This postscript presents the implementation and evaluation of family and community based
intervention programs for children and young people implemented in Norway. The Norwegian
experiences and results illustrate how evidence-based programs developed in the US have been
transported across geographical and language borders, implemented nationwide, evaluated for their
effectiveness in regular practice and examined for sustainability. This update describes this national
1
Corresponding author. Email address: ogden@online.no
ISSN 2073-7629
112
© 2018 CRES Special Issue Volume 10, Number 2, November 2018 pp
strategy, and the main components and immediate outcomes of the PMTO- and PALS-programs in
Norway.
Introduction
Since 1999, Norway has launched a national initiative to prevent and ameliorate conduct problems more
effectively and to promote social competence in children and young people. Several empirically based
programmes were implemented in the regular service systems, with the aim of building and maintaining
social and emotional competence. The Norwegian initiative is based on the collaborative efforts of a national
centre for programme training, implementation, dissemination and research, and the local child and
adolescent service systems. In order to increase capacity and meet the challenges of large scale
implementation, the Norwegian Center for Child Behavioral Development (NCCBD) was established at the
University of Oslo. It is organized as a three-tiered organization with development departments for children,
adolescents, and research. The national strategy further includes an extensive system of quality assurance,
including program-based training and supervision of professionals, and monitoring of program and
intervention adherence, and outcomes. An empirically and action-oriented approach focusing on risk
reduction and promotion of protective factors are at the heart of all programs implemented by the Centre.
Parent Management Training, the Oregon model (PMTO)
The Oregon model of Parent Management Training (PMTO) was developed by Gerald Patterson, Marion
Forgatch and their colleagues at the Oregon Social Learning Center (OSLC). A randomised controlled trial of
the Norwegian version of PMTO (Ogden, Forgatch, Askeland, Patterson, & Bullock, 2005) was conducted
with 112 children aged 12 or younger and their parents recruited through regular child welfare and child
mental health services in Norway (Ogden & Amlund-Hagen, 2008). The families were randomly assigned to
PMTO or regular services, and parents who received PMTO reported fewer externalizing behavior problems
in their children, whilst their teachers reported a higher level of social competence compared to the children
who had received regular services. Parents in the PMTO group were also more competent in limit setting or
disciplining their children. PMTO was particularly effective in problem behavior in children who were eight
years or younger at intake. The sustainability of outcomes was addressed in a 1-year follow-up of study
(Amlund-Hagen, Ogden, & Bjørnebekk, 2011). The study showed that even if the positive behavior changes
were sustained in the PMTO group, the comparison group caught up with the intervention group on several of
the outcome indicators. The scaling up of PMTO was examined in a study by comparing the child behavioral
outcomes in effectiveness and dissemination phases of implementation (Tømmerås & Ogden, 2015). Despite
the larger heterogeneity of the service providers and in the intake characteristics of the target group, no
attenuation of program effects was detected when PMTO was scaled up.
Early Interventions for Children at Risk
Many parents may manage with shorter or alternative interventions to the PMTO, and the Early Interventions
for Children at Risk program (TIBIR) was designed as modular structured version with lower threshold for
ISSN 2073-7629
113
© 2018 CRES Special Issue Volume 10, Number 2, November 2018 pp
intake to treatment in the municipal services, and with shorter or alternative intervention approaches
(Solholm, Kjøbli & Christiansen, 2013). This program can be considered an extended and adapted version of
PMTO based on the same principles. The intervention modules were tested in separate trials.
Brief Parent Training (BPT: Kjøbli & Ogden, 2012) promotes parenting skills in a short term
intervention (3-5 sessions) delivered by regular staff in municipal child and family services. In an RCT with
216 children (3-12 years) and their parents, the post intervention assessment documented beneficial outcomes
in parenting practices and child behavior (Kjøbli & Ogden, 2012). A follow-up study six months post
intervention found that the beneficial outcomes were sustained on most child and parent variables (Kjøbli &
Bjørnebekk, 2013), but generalization effects to the school and kindergarten were limited at both time points.
PMTO parent group training was delivered to groups of caregivers to 8 children who met weekly for
12 sessions. The intervention was evaluated both immediately following, and six months after termination of,
the intervention (Kjøbli, Hukkelberg, & Ogden, 2012). Short- and long-term beneficial effects were reported
from parents, although only short term effects and no follow-up effects were evident from teacher reports.
Individual Social Skills Training for children (ISST: Kjøbli & Ogden, 2014) did not achieve positive
outcomes as expected, and the program will be re-examined and refined in the next version. The evaluation of
the consultation model is completed, but is awaiting publication. Within this adapted program, the full-scale
PMTO intervention is still offered, but only as a backup for those families that need more extensive help.
Multisystemic Therapy
In the period from 1999 to 2003, 25 multisystemic therapy (MST)-teams were established in all regions of
Norway and 23 teams are still operating. Randomized controlled trials of MST in Norway have been
conducted at post-intervention (Ogden & Halliday-Boykins, 2004) and at a 2-year follow-up (Ogden &
Amlund-Hagen, 2006). As was the case with the RCT of PMTO, these studies tested the effectiveness of MST
as intervention was delivered via existing child and family services. Moreover, the sustainability of MST has
been investigated (Ogden, Amlund-Hagen & Andersen, 2007), as well as gender differences in treatment
response (Ogden & Amlund-Hagen, 2009). Finally, a study on the effect of MST on drug-abusing adolescents
has been published showing encouraging outcomes (Holth, Torsheim, Sheidow, Ogden & Henggeler, 2011).
All of the MST studies demonstrated positive outcomes for the MST groups compared to the groups receiving
regular practice.
The adapted Schoolwide Positive Behavior Support (SWPBS)
The SWPBS model, named N-PALS in Norway, is a structured yet flexible whole school approach with the
main goals to prevent and reduce school problem behavior and to promote an inclusive learning environment
that can facilitate safety and the psycho-social functioning and learning of all students (Arnesen, Meek-
Hansen, Ogden, & Sørlie, 2014; Sugai & Horner, 2006). The focus is on positive, systematic, data-driven,
educative and reinforcement-based practices conducted within a framework of research based, collective
(schoolwide), proactive, and predictable approaches. The schoolwide model involves all staff and students,
and takes approximately three to five years to fully implement. The model is an adapted and elaborated
ISSN 2073-7629
114
© 2018 CRES Special Issue Volume 10, Number 2, November 2018 pp
version of the School-wide Positive Behaviour Support model (Sprague & Walker 2005). It combines
modification of the social learning environment with direct teaching and behavioural interventions
implemented by the school staff.
PALS include components and strategies explicitly matched to the development of behaviour
problems, risk- and protective factors, and effective approaches to the prevention and management of
behaviour problems in school (Arnesen, Ogden & Sørlie 2006). The model is typically implemented over a
three year period. During this period training activities and supervision is offered on a school-wide basis and
adapted to each school‟s context and needs. Both staff and students are involved in training activities through
proactive actions and skills-oriented learning activities. In order to participate in PALS, a commitment to
participation is required from at least 80% of the staff at the school, as well as from the principal and the
school administration. A PALS-team with participants from staff, administration, parents and school
psychological services is organized at each school, and this team is responsible for the implementation
process. The implementation of the school-wide intervention model also makes provision for close
cooperation with the child welfare and child and youth mental health systems to provide additional support to
the parents of high-risk students when needed.
The theory of change underlying the PALS model claims that schools, as a major context of
childrenʼs social development, may influence the studentsʼ behavior in positive or negative ways. A key
element of the change theory is that the students‟ behavior is “directly influenced by how teachers and other
members of the staff collectively model behavior, how they express positive expectations, how they teach and
enforce discipline, and how they support social skills” (Sørlie & Ogden, 2015, p. 203). The behavior is the
outcome of mutual positive relations and interactions among students and staff. The schoolwide
implementation of rules and positive expectations are accompanied by systematic positive behavior support,
but also moderate corrections from staff. Through clearly formulated and communicated rules and
expectations, the students are expected to demonstrate socially competent and prosocial behavior as well as
complying with school rules.
The school program is organized according to the principle of „matching interventions to students‟
risk level‟. More specifically, the intervention model relies on a three-tiered system of prevention and
supports. Tier I interventions (universal, primary prevention) apply to everyone and all settings in the school
with the goal to prevent problems by defining and teaching consistent behavioral expectations across the
school setting and recognizing students for expected and appropriate behaviors. Tier II interventions
(selected, secondary prevention) are designed for students at moderate risk for severe behavior problems and
who might not respond sufficiently to the universal interventions. The interventions are standardized and
mostly delivered in short term organized small-groups. Tier III (indicated, tertiary prevention) targets the few
students with or at high risk of conductive disorders. The interventions at this level are intensive, highly
individualized and multi-modal.
N-PALS has still been systematically implemented in more than 200 primary schools across the
country. The adapted Norwegian model has been evaluated and reported in several publications (Sørlie &
Ogden, 2007; 2014; 2015; Sørlie, Ogden & Olseth, 2015; 2016). Results from the longitudinal effectiveness
ISSN 2073-7629
115
© 2018 CRES Special Issue Volume 10, Number 2, November 2018 pp
study indicate several positive and practically significant intervention effects after three and four years of
implementation. These include a) lower level of more and less severe problem behavior occurring within and
outside the classroom context, b) better psycho-social classroom climate (measured as students‟ relations and
student-teacher relations), c) reduced number of students segregated from class due to challenging behavior,
d) increased teacher collective efficacy and self-efficacy, e) increased use of effective discipline practices
(e.g., positive and proactive behavior support strategies, mild and predictable sanctioning of problem
behaviors), f) more positive behavioral development among high-risk students over time, and g) in general,
greater benefits were achieved for schools implementing N-PALS with high fidelity. Several user surveys,
including one among all principals in schools with 1-10 year experience with the N-PALS model, support the
positive evaluation results. Nine out of 10 principals reported positive benefits from N-PALS and expressed
great satisfaction with this preventive system approach (Sørlie, Ogden, Arnesen, Olseth, & Meek-Hansen,
2014).
Conclusion
Hopefully, the experiences from Norway may inspire large scale implementation of evidence-based practice
combining „top-down‟ and „bottom-up‟ initiatives in the child and adolescent services. The message from our
research is that effective interventions should be based on sound theory and extensive research and
simultaneously target multiple social systems including family, peers, school and child care. Moreover,
interventions should motivate, engage and support children and adolescents in the change process.
Implementing evidence-based programs and practices with high fidelity, assessing them in field trials and
monitoring and evaluating them as they are implemented in regular practice on a large scale, constitute the
challenges of today.
References
Amlund-Hagen, K., Ogden, T., & Bjørnebekk, G. (2011). Treatment outcomes and mediators of Parent
Management Training: A one-year follow-up of children with conduct problems. Journal of Clinical
Child and Adolescent Psychology, 40(2), 1-14.
Arnesen, A., Meek-Hansen, W., Ogden, T., & Sørlie, M-A. (2014). Positiv læringsstøtte i skolen. Hele skolen
med. Oslo: Universitetsforlaget.
Arnesen, A., Ogden, T., & Sørlie, M. A. (2006). Positiv atferd og støttende læringsmiljø i skolen. Oslo:
Universitetsforlaget
Holth, P., Torsheim, T., Sheidow, A. J., Ogden, T., & Henggeler, S. (2011). Intensive quality assurance of
therapist adherence to behavioral interventions for adolescent substance use problems. The Journal of
Child and Adolescent Substance Abuse, 20(4), 289-313.
Kjøbli, J., & Bjørnebekk, G. (2013). A randomized effectiveness trial of Brief Parent Training: Six-month
follow-up. Research on Social Work Practice, 23(6), 603−612.
Kjøbli, J., & Ogden, T. (2012). A Randomized Effectiveness Trial of Brief Parent Training in Primary Care
Settings. Prevention Science, 13(6), 616-626.
ISSN 2073-7629
116
© 2018 CRES Special Issue Volume 10, Number 2, November 2018 pp
Kjøbli, J., Hukkelberg, S., & Ogden, T. (2012). A randomized trial of Group Parent Training: Reducing child
conduct problems in real-world settings. Behaviour Research and Therapy, 51, 113−121.
Ogden, T., & Amlund-Hagen, K. (2006). Multisystemic Treatment of Serious behaviour Problems in Youth:
Sustainability of Effectiveness two years after intake. Child and Adolescent Mental Health, 11, 142–
149.
Ogden, T., & Amlund-Hagen, K. (2009). What works for whom? Gender differences in intake characteristics
and treatment benefit of Multisystemic Therapy. Journal of Adolescence, 32, 1425-1435.
Ogden, T., & K. Amlund-Hagen. (2008). Treatment effectiveness of Parent Management Training in Norway:
A randomized controlled trial of children with conduct problems. Journal of Consulting and Clinical
Psychology, 76(4), 607-621.
Ogden, T., Amlund-Hagen, K., & Andersen, O. (2007). Sustainability of the effectiveness of a programme of
multisystemic treatment (MST) across participant groups in the second year of operation. Journal of
Children’s Services, 2, 4-14.
Ogden, T., Forgatch, M., Askeland, E., Patterson, G. R., & Bullock, B. (2005). Implementation of Parent
Management Training at the national level: The case of Norway. Journal of Social Work Practice, 19,
317-329.
Ogden,T., & Halliday-Boykins,C.A. (2004). Multisystemic treatment of antisocial adolescents in Norway:
Replication of clinical outcomes outside of the US. Child and adolescent mental health, 9, 76-82.
Solholm, R., Kjøbli, J. & Christiansen, T. (2013). Early Initiatives for Children at Risk − Development of a
program for the prevention and treatment of behavior problems in primary services. Prevention
Science, 14(6), 535−544.
Sørlie, M. A., & Ogden, T. (2007). Immediate impacts of PALS: A school-wide multilevel programme
targeting behaviour problems in elementary school. Scandinavian Journal of Educational Research,
51, 471–492.
Sørlie, M. A., & Ogden, T. (2014). Reducing threats to validity by design in a nonrandomized experiment of a
school-wide prevention model. International Journal of School & Educational Psychology, 4, 235-
246.
Sørlie, M. A., & Ogden, T. (2015). School-Wide Positive Behaviour Support - Norway: Impacts on problem
behaviour and classroom climate. International Journal of School & Educational Psychology, 00, 1–
16. doi: 10.1080/21683603.2015.1060912
Sørlie, M. A., Ogden, T., & Olseth, A. R. (2015). Preventing problem behavior in school through school-wide
staff empowerment: Intervention outcomes. World Journal of Educational Research, 2(2), 117.
Sørlie, M. A., Ogden, T., & Olseth, A. R. (2016). Examining teacher outcomes of the school-wide positive
behavior support model in Norway: Perceived efficacy and behavior management. SAGE Open, 6(2).
doi: 10.1177/2158244016651914
Sørlie, M. A., Ogden, T., Arnesen, A., Olseth, A. R., & Meek-Hansen, W. (2012). Skoleledere om PALS
[School leaders comments on PALS]. Spesialpedagogikk, 1, 17-29.
ISSN 2073-7629
117
© 2018 CRES Special Issue Volume 10, Number 2, November 2018 pp
Sugai, G., & Horner, R. H. (2006). A promising approach for expanding and sustaining school-wide positive
behavior support. School Psychology Review, 35, 245–259
Tømmerås, T., & Ogden, T. (2015). Is there a scale up penalty? Testing attenuation effects in the scaling up
of Parent Management Training in Norway. Administration and Policy in Mental Health and Mental
Health Services, 44(2), 203-216. doi:10.1007/s10488-015-0712-3.
