Norway

Last updated : 08.07.2021
Country of origin
No country of origin defined
Last reviewed:
Age group
No defined Age group
Target group
The whole population in a delineated area
Programme setting(s)
Environmental setting
Community
Level(s) of intervention
Environmental prevention

Alcohol consumption can cause violent behaviour and related injuries. Subsequently, on premise alcohol sales (i.e. bars) may induce or reinforce such behaviour. This rationale suggests that regulating opening hours of pubs and bars could have an effect on violent behaviour. Restrictions in closing hours for on premise alcohol sales might reduce levels of violence in a delineated area.

Policies for regulating opening hours of on-premise alcohol sales are hypothesised to decrease levels of alcohol-related violence and injuries based on the availability theory. The core thesis of availability theory is that “the greater the availability of alcohol in a society, the greater the prevalence and severity of alcohol-related problems” (Single, 1988, p. 329 in Tesch & Hohendorf 2018). The basic mechanism is that higher alcohol availability leads to higher mean levels of consumption and thus to higher levels of moderate and heavy drinking which in turn produce more alcohol-related problems including violence and injury.

The prevalence of violence in or around on premise alcohol sales as well as alcohol-related injury is however influenced by a variety of individual and environmental factors that should be considered both in the implementation of regulations as well as in the evaluation of such strategies. The implementer should consider differential effects for varying subpopulations (e.g. men, individuals aged 25–34 years in the case of alcohol-related injuries, in De Goeij et al. see below) and match the regulations to local needs. Such regulations may additionally have harmful or iatrogenic effects such as displacement of assault and injury to other districts, to the private sphere, or peak prevalence caused by uniform closing hour regulations.

Subsequently, it is advisable to integrate such regulations in multicomponent environmental strategies that consider local environmental as well as individual risk variations and needs. Regulations can for instance be incorporated in broader environmental approaches that also include preventive activities such as training for staff of licensed premises, such as the ‘STAD’ project (Stockholm prevents alcohol and drug problems).

Links to this programme in other registries
No link
Contact details

Ingeborg Rossow,
Norwegian Institute for Alcohol and Drug Research,
Oslo, Norway
Email: ir[a]sirus.no

Moniek C.M. de Goeij,
Department of Public Health,
Academic Medical Center (AMC) - University of Amsterdam,
Amsterdam, The Netherlands,
Email: m.c.degoeij[a]amc.uva.nl

Evidence rating
Possibly harmful
Studies overview

The effect of changing bar closing hours have been studied in experimental evaluation designs in Norway (Rossow et al. 2012) and The Netherlands (De Goeij et al., 2012). Conducting an RCT is not possible because of the environmental nature of these measures.

Rossow and colleagues (2012) estimated the effect on violence of small changes in closing hours for on-premise alcohol sales and assessed whether a possible effect is symmetrical. The study demonstrated that each additional 1-hour extension to the opening times of premises selling alcohol was associated with a 16% increase in violent crime. The quasi-experimental evaluation study drew on data from 18 Norwegian cities that extended or restricted the closing hours for on-premise alcohol sales with a maximum of 2 hours. Closing hours were measured in terms of the latest permitted hour of on-premise trading, ranging from 1 a.m. to 3 a.m. The outcome measure comprised police-reported assaults that occurred in the city centre between 10 p.m. and 5 a.m. at weekends. Assaults outside the city centre during the same time window functioned both as a proxy for potential confounders and as a control variable. The data spanned a period of ten years (2000–2010) and included 774 observations. Outcomes from the main analyses suggested that each 1-hour extension of closing hours was associated with a statistically significant increase of 4.8 assaults (95% CI 2.60, 6.99) per 100 000 inhabitants per quarter (i.e. an increase of about 16%). Findings indicate that the effect is symmetrical (extending or restricting). These findings were consistent across three different modelling techniques.

De Goeij and colleagues (2015) studied the implementation of a new alcohol policy in Amsterdam allowing alcohol outlets in two of the five nightlife areas to extend their closing times from 1 April 2009 onwards. The study found that a 1-hour extension of alcohol outlet closing times in some of Amsterdam’s nightlife areas was associated with 34% more alcohol-related injuries. They investigated how levels and trends of hospital reported alcohol-related injuries changed after implementation of this alcohol policy by comparing areas with extended closing times to those without. A before-and-after evaluation compared changes in alcohol-related injuries between intervention and control areas. Participant alcohol-related ambulance attendances were compared between control and intervention areas between 1 April 2006 and 1 April 2009 (respectively n=544 and n=499) and between 1 April 2009 and 1 April 2011 (respectively, n=357 and n=480). The results demonstrate that after 1 April 2009, intervention areas showed a larger change in the level of alcohol-related injuries than control areas [incidence rate ratio 1.34, 95% confidence interval (CI) =1.12, 1.61], but trends remained stable in all areas. This increase was only statistically significant for the following subgroups: 2.00–5.59 a.m., weekend days, men, individuals aged 25–34 years, and people transported to a hospital. However, the increase did not differ between subgroups with statistical significance.

References of studies

Included:

de Goeij, M. C., Veldhuizen, E. M., Buster, M. C., & Kunst, A. E. (2015). The impact of extended closing times of alcohol outlets on alcohol-related injuries in the nightlife areas of Amsterdam: a controlled before-and-after evaluation. Addiction (Abingdon, England), 110(6), 955–964. https://doi.org/10.1111/add.12886

Rossow, I., & Norström, T. (2012). The impact of small changes in bar closing hours on violence. The Norwegian experience from 18 cities. Addiction (Abingdon, England), 107(3), 530–537. https://doi.org/10.1111/j.1360-0443.2011.03643.x

Not included:

Humprey, D. K. (2016), Liquor licensing or confounding events? Further questions about the interpretations of Menedez et al. (2015). Addiction, 111, 745-749

Parry, C., & Fitzgerald, N. (2020). Special Issue: Alcohol Policy and Public Health-Contributing to the Global Debate on Accelerating Action on Alcohol. International journal of environmental research and public health, 17(11), 3816. https://doi.org/10.3390/ijerph17113816

Sanchez-Ramirez, D. C., & Voaklander, D. (2018). The impact of policies regulating alcohol trading hours and days on specific alcohol-related harms: a systematic review. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention, 24(1), 94–100. https://doi.org/10.1136/injuryprev-2016-042285

Taylor, N., Miller P., Coomber, K., Mayshak, R., Zahnow, R., Patafio, B., Burn, M & Ferris, J. (2018). A mapping review of evaluations of alcohol policy restrictions targeting alcohol-related harm in night-time entertainment precincts. International Journal of Drug Policy. 62, 1-13, https://doi.org/10.1016/j.drugpo.2018.09.012.

Tesch, F., & Hohendorf, L. (2018). Do Changes in Bar Opening Hours Influence Violence in the Night? Evidence from 13 Bavarian Towns. Journal of Drug Issues. 48:2,295-306. doi:10.1177/0022042617753146

Wicki, M., Bertholet, N., & Gmel, G. (2020). Estimated changes in hospital admissions for alcohol intoxication after partial bans on off-premises sales of alcoholic beverages in the canton of Vaud, Switzerland: an interrupted time-series analysis. Addiction (Abingdon, England), 115(8), 1459–1469. https://doi.org/10.1111/add.14967

Countries where evaluated
Norway
Netherlands
Protective factor(s) addressed
Environmental physical: Bright lights in on-site alcohol-selling premise
Environmental physical: Music volume in on-site alcohol-selling premises
Environmental: Regular and obvious staff surveillance and reinforcement in on-site alcohol-selling premise
Environmental: Security plan in on-site alcohol-selling premise
Risk factor(s) addressed
Environmental: Extension of alcohol outlet opening hours
Outcomes targeted
No target outcomes defined
Description of programme

In Norway, trading hours (for both on-premise and off-premise alcohol sales) are decided at the municipality level, yet within national maximum trading hours. The national ‘normal closing hours’ for on-premise sales are 12 midnight for spirits and 1 a.m. for beer/wine, and the ‘maximum closing hours’ are 3 a.m. for all types of alcoholic beverages. Patrons are, by national law, allowed to consume alcohol 30 minutes after the closing hours for sales. The municipalities may decide to extend or restrict closing hours as long as they are within the national ‘maximum closing hours’. Over the past decade many Norwegian municipalities have changed—extended or restricted—the closing hours for on-premise sales, but the changes have been relatively minor, typically less than 2 hours. However, each additional 1-hour extension to the opening times of premises selling alcohol was associated with an increase in violent crime. (Rossow et al. 2012)

In the Netherlands, Amsterdam implemented a new alcohol policy allowing alcohol outlets in two of the five nightlife areas to extend their closing times from 1 April 2009 onwards. A 1-hour extension of alcohol outlet closing times in some of Amsterdam’s nightlife areas was associated with more alcohol-related injuries. (De Goeij et al. 2015)

Last updated : 09.01.2024
Country of origin
USA
Last reviewed:
Age group
0-5 years
6-10 years
Target group
Children aged 4-8 years who have oppositional defiant disorder and/or ADHD
Programme setting(s)
Community
School
Level(s) of intervention
Indicated prevention
Selective prevention

The child training component is comprised of weekly two-hour sessions for 18-19 weeks during which two therapists work with 6-7 children and focus on social skills, conflict resolution, empathy-building, problem solving and cooperation. Teachers and parents receive weekly letters explaining the concepts covered and strategies to reinforce skills taught. Children are assigned homework to complete with their parents and receive weekly good behaviour-charts that parents and teachers complete. The child training prevention programme is also described in a separate write-up.

Links to this programme in other registries
USA - Blueprints Programs
The Netherlands - Databank Effectieve Jeugdinterventies
UK - CYAT - mentor-adepis
UK - Early Intervention Foundation Guidebook
Contact details

Dr. Carolyn Webster-Stratton, Ph.D
Incredible Years, University of Washington
1411 8th Avenue West
Seattle, WA 98119
USA
Phone: 1 (206) 285-7565 / 1(888) 506-3562
Email: cwebsterstratton[a]comcast.net
Website: www.incredibleyears.com

Evidence rating
Additional studies recommended
Studies overview

The programme has been evaluated in two small studies, one each in Wales, UK and Turkey, and two randomised controlled trials, one each in Ireland in Norway.

The Welsh study was a small pilot with 24 children aged 5 to 9 years. It is unclear how groups were allocated but the implementation was alongside the Incredible Years Teacher Classroom Management programme. There were no significant differences between groups on any of the measures (assessing behaviour).

Another small study was conducted in Turkey with 32 children aged 4 to 6 years. The study found effects on social problem-solving, but not on child behaviour and social competence.

The Irish study was conducted with 45 children aged 3-7 years with symptoms of ADHD. There were two intervention groups and one control group. Both intervention groups received the Incredible Years Parent Programme; one also received the child training. The difference between the combined group and control group were largely insignificant, with the exception of SDQ impact scale. Compared to the parent-only intervention group, there was a significant difference only on one outcome – hyperactivity – in favour of the parent-only group, suggesting no added benefit of the child training.

The Norwegian study used a similar design with 136 children aged 4-8 years displaying oppositional or conduct problems randomly allocated to three groups: parent-only, parent and child training combined and control group. At posttest, children in the combined parent and child training had significantly lower aggression scores (as reported by mothers, but not fathers) compared to the control. In terms of parent measures, there were significant intervention effects on all 4 mother reports (harsh discipline, inconsistent parenting, positive parentings and stress), and 2/4 father reports. There were no effects on attention problems, internalising problems or intensity. Compared to the parent-only group, the only significant difference (father reported problems) favoured the parent-only group.

References of studies

Bayrak, H. U., & Akman, B. (2018). Adaptation of the" Incredible Years Child Training Program" and Investigation of the Effectiveness of the Program. Educational Sciences: Theory & Practice, 18(2).

Beauchaine, T. P., Webster-Stratton, C., & Reid, M. J. (2005). Mediators, moderators, and predictors of one-year outcomes among children treated for early-onset conduct problems: A latent growth curve analysis. Journal of Consulting and Clinical Psychology, 73(3), 371-388.


*Drugli, M. B., & Larsson, B. (2006). Children aged 4-8 years treated with parent training and child therapy because of conduct problems: Generalizing effects to day-care and school settings. European Child and Adolescent Psychiatry, 15(7), 392-399.


*Drugli, M. B., Larsson, B., Fossum, S., & Morch, W. T. (2010). Five- to six-year outcome and its prediction for children with ODD/CD treated with parent training. The Journal of Child Psychology and Psychiatry, 51(5), 559-566.


*Hutchings, J., Bywater, T., Gridley, N., Whitaker, C., Martin-Forbes, P., & Gruffydd, S. (2012). The incredible years therapeutic social and emotional skills programme: A pilot study. School Psychology International, 33, 285-293.

*McGilloway, S., Ni Mhaille, G., Leckey, Y., Kelly, P., & Bracken, M. (n.d.)

*Larsson, B., Fossum, S., Clifford, G., Drugli, M., Handegard, B., & Morch, W. (2009). Treatment of oppositional defiant and conduct problems in young Norwegian children. European Child Adolescent Psychiatry, 18, 42-52.


Reid, M. J., Webster-Stratton, C., & Hammond, M. (2003). Follow-up of children who received the Incredible Years intervention for oppositional defiant disorder: Maintenance and prediction of 2-year outcome. Behavior Therapy, 34, 471-491.


Webster-Stratton, C., & Hammond, M. (1997). Treating children with early-onset conduct problems: A comparison of child and parent training interventions. Journal of Consulting and Clinical Psychology, 65, 93-109.


Webster-Stratton, C. H., Reid, M. J., & Beauchaine, T. (2011). Combining parent and child training for young children with ADHD. Journal of Clinical Child and Adolescent Psychology, 40(2), 191-203.


Webster-Stratton, C., Reid, M. J., & Hammond, M. (2004). Treating children with early-onset conduct problems: intervention outcomes for parent, child, and teacher training. Journal of Clinical Child and Adolescent Psychology, 33(1), 105-124.


Webster-Stratton, C., Reid, M.J., & Stoolmiller, M. (2008). Preventing conduct problems and improving school readiness: An evaluation of the Incredible Years Teacher and Child Training Programme in high risk schools. Journal of Child Psychology and Psychiatry, 49(5), 471-488.

Countries where evaluated
Ireland
Norway
United Kingdom
Protective factor(s) addressed
Family: attachment to and support from parents
Family: parent involvement in learning/education
Family: parent social support
Individual and peers: Problem solving skills
Individual and peers: skills for social interaction
School and work: opportunities for prosocial involvement in education
Risk factor(s) addressed
Family: aggressive or violent parenting
Family: family management problems
Family: neglectful parenting
Individual and peers: anti-social behaviour
Individual and peers: hyperactivity
Individual and peers: other
School and work: low commitment/attachment to school/workplace
Outcomes targeted
Positive relationships
Relations with peers
Other behaviour outcomes
Description of programme

The Incredible Years Series is a comprehensive programme for parents, teachers, and children with the goal of preventing, reducing, and treating behavioural and emotional problems in children aged two to eight. There are versions for parents, teachers and children.

The last addition was the training series for children (Dina Dinosaur Curriculum), a "pull out" treatment programme for small groups of children exhibiting conduct problems. This curriculum emphasizes emotional literacy, empathy and perspective taking, friendship development, anger management, interpersonal problem-solving, following school rules, and school success.

Last updated : 09.01.2024
Country of origin
USA
Last reviewed:
Age group
11-14 years
15-18/19 years
Target group
Male young offenders aged 12-18 years
Programme setting(s)
Community
Juvenile justice setting
Mental health/treatment centre
School
Level(s) of intervention
Indicated prevention
Selective prevention

Aggression Replacement Training consists of three major components: Skillstreaming, to teach prosocial behaviours; Anger Control Training, to reduce and control aggression; and Moral Education, to promote higher levels of moral reasoning. Together, these three components allow youth to not only develop prosocial values, but also learn concrete techniques promoting overt prosocial behaviour and inhibiting antisocial behaviour. The training curriculum is somewhat flexible in length, but the core components require at least 10 weeks of multiple sessions in each of the three areas.

Links to this programme in other registries
Norway - Ungsinn a.
Norway - Ungsinn b.
The Netherlands - Databank Effectieve Jeugdinterventies
Finland - Kasvun Tuki
Contact details

Barry Glick
New York State Division for Youth
Phone: +1 (718) 665-5500

Evidence rating
Additional studies recommended
Studies overview

The programme has been evaluated in one randomised controlled trial in Norway, and four quasi-experimental studies, one each in Norway, Sweden, the UK and Turkey.

In the RCT, 14 adolescents aged 14 to 20 years, and 25 children aged 7 to 12 years who displayed behaviour problems participated. Adolescents in the intervention group had a non-significant increase in social skills and decrease in problem behaviours, while those in the control group showed a non-significant decrease in both, social skills and problem behaviour. There was a significant improvement on social skills and problems among children in the intervention group from pre to post intervention, but a non-significant change among children in the control group. Significance of difference between groups is not reported.

The Norwegian QED included 47 youth aged 12-14 years receiving ART and 18 youths as controls. Participants in the ART group indicated significant improvement, but participants in the comparison group did not, in general, indicate improvement - the ART group demonstrated significant improvement on 9 out of 10 tests; the comparison group demonstrated improvement on 2 out of 10 tests. However, (due to a relatively small sample and ‘heterogeneous’ groups), the intervention effect (group x time interaction) was not statistically significant.

The Swedish study included 64 adolescents, with a mean age of 17 years, placed at the institutions for compulsory treatment. Two institutions administered the intervention and two served as controls. It is not mentioned how the groups were allocated. There were no significant effects, but it should be noted that all four institutions were compared rather than intervention and control groups.

The UK study was conducted with 41 adolescents aged 11 to 17 years. Non-parametric statistical tests demonstrated no significant improvements in the intervention participant’s social skills or problem behaviours.

The Turkey study was conducted with 65 adolescents, with a mean age of 16 years, from juvenile and youth prisons. The study found significant intervention effects only on 1/10 measures of anger and aggression, and on the secondary outcome of problem-solving skills.

An additional Swedish study by Larden et al. examined the effects of ART on adult offenders' criminal recidivism and found no effects of reoffending (Larden et a. 2017). The ART program is originally designed for adolescents, and it might be that the program should be adjusted for adults.

References of studies

Currie, M. Wood, C., Williams, B. & Bates, G. (2012). Aggression Replacement Training (ART) in Australia: A longitudinal youth justice evaluation. Psychiatry, Psychology and Law, 19(4), 577-604.

*Gundersen, K., & Svartdal, F. (2006). Aggression replacement training in Norway: Outcome evaluation of 11 Norwegian student projects. Scandinavian journal of educational research, 50(1), 63-81.

Grimes, S. (2015). An evaluation of Aggression Replacement Training: the impact of a multi-component, CBT-based intervention on the problem behaviours, pro-social skills and moral development of pupils in English secondary schools(Doctoral dissertation, University of Nottingham).

Kaya, F., & Buzlu, S. (2016). Effects of aggression replacement training on problem solving, anger and aggressive behaviour among adolescents with criminal attempts in Turkey: A quasi-experimental study. Archives of psychiatric nursing, 30(6), 729-735.

Lardén, M., Nordén, E., Forsman, M., & Långström, N. (2018).Effectiveness of aggression replacement training inreducing criminal recidivism among convicted adult offenders. Criminal behaviour and mental health, 28(6), 476-491

*Luke Moynahan & Børge Strømgren (2005) Preliminary results of Aggression Replacement Training for Norwegian youth with aggressive behaviour and with a different diagnosis, Psychology, Crime & Law, 11:4, 411-419, DOI: 10.1080/10683160500256784

*Holmqvist, R., Hill, T., & Lang, A. (2007). Effects of aggression replacement training in young offender institutions. International journal of offender therapy and comparative criminology.

Glick, B., & Goldstein, A. (1987). Aggression Replacement Training. Journal of Counseling and Development, 65, 356-362.

Goldstein, A., & Glick, B. (1994). Aggression Replacement Training: Curriculum and Evaluation. Simulation and Gaming, 25, 9-25.

Nugent, W.R., Bruley, C., & Allen, P. (1998). The effects of Aggression Replacement Training on antisocial behavior in a runaway shelter. Research on Social Work Practice, 8, 637-656.

Washington State Institute for Public Policy. (2004). Outcome evaluation of Washington State's research-based programmes for juvenile offenders. Olympia, WA: WSIPP.

Countries where evaluated
Norway
Sweden
Protective factor(s) addressed
Individual and peers: clear morals and standards of behaviour
Individual and peers: individual/peers other
Risk factor(s) addressed
Individual and peers: other
Outcomes targeted
Emotional well-being
Emotion regulation, coping, resilience
Other behaviour outcomes
Violence
Description of programme

Aggression Replacement Training consists of three major components: Skillstreaming, to teach prosocial behaviours; Anger Control Training, to reduce and control aggression; and Moral Education, to promote higher levels of moral reasoning. Together, these three components allow youth to not only develop prosocial values, but also learn concrete techniques promoting overt prosocial behaviour and inhibiting antisocial behaviour. The training curriculum is somewhat flexible in length, but the core components require at least 10 weeks of multiple sessions in each of the three areas.

(1) Structured Learning Training, or Skillstreaming, consists of a curriculum of skillstreaming skills (a broad array of interpersonal and daily living skills) taught through modelling, role-playing, and performance feedback; moral reasoning dilemmas; and anger control training steps. Skillstreaming facilitates prosocial behaviour. The skills fall into one of six families: beginning social skills, advanced social skills, skills for dealing with feelings, alternatives to aggression, skills dealing with stress, and planning skills.

(2) Anger Control Training enables youth to control their level of anger arousal. Youth are trained to respond to their hassles with a chain of behaviours that include identifying triggers, identifying cues, using reminders to stay calm, using reducers such as deep breathing to lower the level of anger, and using self-evaluation.

(3) Moral Education increases youths' sense of fairness, justice, and concern for the right of others. Participants meet in small groups in which individuals are functioning at different levels of moral reasoning. A group leader then describes scenarios and real life situations posing moral dilemmas, and participants fully examine and discuss these scenarios and possible solutions to it.

Implementation Experiences
Feedback date
Contact details

Peter Bleumer
pbleumer[a]iae.nl

Tim Tiemissen
timtiemissen[a]gmail.com

Main obstacles

With respect to individual professionals

The client group is complex to work with, and this requires experience and training. New trainers, having completed a five-day course on how to deliver the intervention, have different struggles with their first aggression replacement training groups (6-10 people). The struggles new trainers often face are how to deliver the programme sensitively in the setting where they work without sacrificing too much of the programme’s integrity (i.e. following the treatment manuals), group management and trainee resistance and delivering training procedures in a methodical, correct way (usually moral reasoning training is found to be quite difficult at first, as is making effective use of cognitive-behavioural therapy techniques and effectively conducting role play).

With respect to social context

Every social structure has delimiting systemic elements that impact on how a programme can be delivered. In an enclosed forensic psychiatric setting, a floor effect (aggression is already at a high level in prison) can have an impact on how clients can benefit from the training. In schools, there is a curriculum and the programme must be made to fit that curriculum, and in outpatient clinics clients might not show up. Patients might not be intrinsically motivated to take part in the aggression replacement training. In addition, people and practitioners can be stubborn and decide to leave certain things out of the protocol that have an impact on the quality of the intervention.

With respect to organisational and economic context

Aggression replacement training remains under-researched. Conducting randomised controlled trials costs a lot of time and money and conducting research with this client group is difficult because of high dropout rates. Motivating organisations to monitor programme effects remains a challenge.

How they overcame the obstacles

With respect to individual professionals

There are programme integrity checklists, and new trainers can receive coaching on the job. Twice a year, aggression replacement trainers come to a supervision day during which their aggression replacement training skills are fine-tuned and kept ‘on model’.

With respect to social context

When a new organisation starts aggression replacement training, we take extra care to develop a package that fits not only the context but also the specific client group to which it is delivered. As a result, we spend time with programme mangers helping them plan ART sessions, helping with pre- and post- measurements and setting up a supervision structure within the organisation to take care of trainers (because it’s quite complex working with people with aggression problems).

With respect to organisational and economic context

Try to keep an open mind and encourage people to work together instead of seeing one another as competitors.

Lessons learnt

With respect to individual professionals

Giving new trainers the support that they need and modelling and practising with effective training/treatment procedures helps new ART practitioners gain confidence and experience success in delivering the treatment.

With respect to social context

So many people have been trained in various settings. Keeping in contact with these people is a challenge but is important to maintain or attain a level of congruence in the way aggression replacement training is delivered. In addition, there needs to be a balance between wanting to share our material and giving people the freedom to add to it, making it fit in their organisational context and maintaining programme integrity.

With respect to organisational and economic context

Try to emphasise the value of treating aggressive behaviour over competing in a healthcare market (the term says enough).

Strengths
  •  Paying attention to participants motivation and their social support to take part in aggression replacement training reduces drop out.
  • Modelling training procedures and practising them makes new aggression replacement trainers more competent than when they just talk about doing it.
  • Working together with different service providers helps set the stage for intervention success.
  • Making use of the programme integrity checks keeps you on model as a trainer.
  • Evaluating intervention participants and scoring and discussing changes in aggressive behaviour halfway through the intervention helps participants finish the full programme.
  • Practising difficult client encounters through role play helps you deal with them in the real word.
Weaknesses
  • It is difficult to stay in contact with everyone we have trained.
  • It is difficult to maintain programme integrity when so many different institutions are delivering ART.
  • It is hard to motivate institutions to evaluate programmes.
Opportunities

Aggression replacement training is delivered all over the world. However, it remains understudied (in the sense of methodological quality), and this is an opportunity. It would be great if the presupposed working principles would be systematically tested using experimental or quasi-experimental designs.

Threats

People tend to favour developing something new over first researching whether that something works in the first place. Methodologically sound research on ART is needed before we start to change the intervention.

Recommendations

With respect to individual professionals

Always work in couples; make sure the organisations provide a room to deliver the training and the necessary materials and also time, etc.

With respect to social context

Really try to engage the client group and pay attention to motivational problems prior to delivering the intervention. Try to get people around the client involved in the treatment, i.e. a partner or parent who can give a client positive feedback when they succesfully employ what they have learnt in aggression replacement training.

With respect to organisational and economic context

Try to get people around the client involved in the treatment, i.e. a partner or parent who can give a client positive feedback when they succesfully employ what they have learnt in aggression replacement training.

Note from the authors

See website (in Dutch): http://www.goldstein.nl/

https://www.nji.nl/nl/Databank/Databank-Effectieve-Jeugdinterventies/ART-Aggression-Replacement-Training

Number of implementations
1
Country
Netherlands
Last updated : 09.01.2024
Country of origin
USA
Last reviewed:
Age group
0-5 years
6-10 years
11-14 years
Target group
Preschool children aged 3-4 and school aged children aged 5-14
Programme setting(s)
School
Level(s) of intervention
Universal prevention

Second Step is a violence prevention programme with developmentally appropriate curriculum for children Pre-K (4 years of age) through 9th grade (14 years of age). The programme addresses attitudes and behaviours that contribute to violence by teaching children impulse control and anger management. Aggressive attitudes and behaviour are replaced with increased empathy, self-awareness, social competence and pro-social responses to conflict.

Links to this programme in other registries
Germany - Green List Prevention
Contact details

Ms. Joan Duffell
2203 Airport Way South, Suite 500
Seattle, WA 98134-2027
USA
Phone: 1 (206) 343-1220

Evidence rating
Possibly beneficial
Studies overview

The programme has been evaluated in one quasi-experimental in Norway and one randomised controlled trial in Germany. The Norwegian study, testing the adaption called ‘Steg for Steg’, used an age-cohort design and 1153 students from Grade 5 to 7 (10-12 years) from 11 schools participated. The German study, testing the adaption called ‘Faustlos’, randomised 44 classes with 718 children aged 5-6 years.

There were significant effects in the Norwegian study but few in the German evaluation. The programme increased social competence and reduced externalising problems. In the Norwegian study. there was a significant positive effect on social competence among grade 5 students (ES: 0.18) and girls in grade 6 (ES: 0.32). For externalising behaviour, only boys in grade 5 showed a significant improvement (ES: 0.27). There was no effect on internalising behaviour.

In the German study, only 3 of 30 outcome measures had a significant intervention effect. There was a reduction in self-reported fear of loss of control, parent reported anxiety and depression and internalising behaviour. No significant impact was found on any teacher-reported outcome.

References of studies

Beland, K., & Sylvester, L. (1997). Teacher and Student Evaluation of Second step, Middle School/Junior High 1995-1996 Pilot Project Seattle: Committee for Children.

Frey, K. S, Nolen, S. B., Edstrom, L. V., & Hirschstein, M. K. (2005). Effects of a school-based social-emotional competence programme: linking goals, attributions, and behavior. Accepted for publication in the Journal of Applied Developmental Psychology.

Frey, K. S., Nolen, S. B., Edstrom, L. V., and Hirschstein, M. K. (2005). Effects of a school-based social-emotional competence programme: Linking children's goals, attributions, and behavior. Applied Developmental Psychology, 26, 171-200.

Grossman, D. C., Neckerman, H. J., Koepsell, T. D., Liu, P., Asher, K. N., Beland, K., Frey, K, & Rivara, F. P. (1997). Effectiveness of a violence prevention curriculum among children in elementary school: A randomized controlled trial. JAMA, 277, 1605-1611.

*Holsen, I., Smith, B. H., & Frey, K. S. (2008). Outcomes of the social competence programme Second Step in Norwegian elementary schools. School Psychology International, 29(1), 71-88.

McMahon, S. D., Washburn, J., Felix, E., Yakin, J., and Childrey, G. (2000). Violence prevention: Programme effects on urban preschool and kindergarten children. Applied and Preventive Psychology, 9, 271-281.

Moore, B., & Beland, K. (1992). Evaluation of Second Step, Preschool-Kindergarten: A Violence-Prevention Curriculum Kit, Summary Report. Seattle, Washington: Committee for Children.

Orpinas, P., Parcel, G.S., McAlister, A., and Frankowski, R. (1995). Violence prevention in middle schools: A pilot evaluation. Journal of Adolescent Health, 17, 360-371.

*Schick, A., & Cierpka, M. (2005). Faustlos: Evaluation of a curriculum to prevent violence in elementary schools. Applied and Preventive Psychology, 11(3), 157-16.

Social and Character Development Research Consortium (2010). Efficacy of Schoolwide Programmes to Promote Social and Character Development and Reduce Problem Behavior in Elementary School Children (NCER 2011-2001). Washington, DC: National Centre for Education Research, Institute of Education Sciences, U.S. Department of Education.

Sylvester, L., Beland, K., & Frey, K. S. (1997). A preliminary evaluation of Second Step, Middle School/Junior High: Changes in social attitudes and knowledge. Seattle, Washington: Committee for Children.

Sylvester, L., & Frey, K. (1997). Summary of Second Step Programme Evaluations. Seattle, WA: Committee for Children.

Taub, J. (2001). Evaluation of the Second Step violence prevention programme at a rural elementary school. School Psychology Review, 31(2), 186-200.

Van Schoiack-Edstrom, L., Frey, K., and Beland, K. (2002). Changing adolescent’s attitudes about relational and physical aggression: An early evaluation of a school-based intervention. School Psychology Review, 31(2), 210-216.

Countries where evaluated
Germany
Norway
Protective factor(s) addressed
Individual and peers: clear morals and standards of behaviour
Individual and peers: individual/peers other
Individual and peers: Problem solving skills
Individual and peers: refusal skills and decision making
Individual and peers: skills for social interaction
Risk factor(s) addressed
Individual and peers: anti-social behaviour
Individual and peers: favourable attitudes towards anti-social behaviour
Individual and peers: other
Outcomes targeted
Emotional well-being
Emotion regulation, coping, resilience
Other behaviour outcomes
Description of programme

The Second Step curriculum teaches skills to reduce impulsive and aggressive behaviour in children and increase their level of social competence. It uses developmentally appropriate lessons at each grade level Preschool/Kindergarten (4-5 years of age), Grades 1-3 (6 – 8 years of age), Grades 4-5 (9 – 10 years of age) and Middle School/Junior High (11 – 14 years of age), to cover the same three skill units, Empathy, Impulse Control, and Anger Management. Lessons for Pre-K (4 years of age) through fifth grade (10 years of age) consist of assessment of scripted social situations using stories and pictures, discussion of appropriate responses and role-playing. The Middle School/Junior High curriculum uses the same teaching mediums but deals with more difficult issues faced by older children, i.e. gangs, gossip and peer pressure. The more advanced curriculum also introduces the concept of goal setting.

Second Step also offers families a video-based parent programme called A Family Guide to Second Step: Parenting Strategies for a Safer Tomorrow. It is designed to help parents and caregivers of Second Step students apply prosocial skills to parenting situations. The family component familiarizes parents with the Second Step curriculum, assists them with reinforcing the skills at home, and gives families the skills to communicate feelings, solve problems, control anger, and deal with conflict.

Intervention Variation

Steg for Steg is a version of the programme that is translated and adapted for the Norwegian setting. Lessons are taught once a week or every second week.

Faustlos is a German adaptation and uses developmental-psychological theories on the deficits of aggressive children. The units of empathy, impulse control and anger management are taught in 51 lessons. It is taught by trained teachers from Grade 1 (6 years of age) to 3 (8 years of age).

Last updated : 18.06.2024
Country of origin
Norway
Last reviewed:
Age group
6-10 years
11-14 years
Target group
Children aged 10-14
Programme setting(s)
School
Level(s) of intervention
Selective prevention

The Olweus Bullying Prevention programme is a school-wide programme designed to prevent bullying amongst children aged 10-14. It includes administering a bullying survey, establishing a Bullying Prevention Coordinating Committee and addressing bullying incidents through separate follow-up meetings for bullies and victims. The classroom level component involves establishing clear and consistently enforced rules against bullying, along with regular class discussions and activities designed to reinforce rules and anti-bullying values and norms. Discussions and activities also present the harm caused by bullying and strategies for preventing it. The programme encourages parental involvement through meetings and discussion of the problem and efforts to address it.

Links to this programme in other registries
USA - Blueprints Programs
Germany - Grüne Liste Prävention
Norway - Ungsinn
Contact details

Ms. Lydia Arneson
OBP Programme Coordinator
Clemson University
2038 Barre Hall
Clemson, SC 29634
USA
Phone: 1 (864) 656-6712
Email: lydia[a]clemson.edu / nobully[a]clemson.edu
Website: www.clemson.edu/olweus

Evidence rating
Likely to be beneficial
Studies overview

The programme has been evaluated in two quasi-experimental studies in Norway and one quasi-experimental study in England, UK.

The original Norwegian study used comparisons of adjacent age-cohorts, with 2500 students in Grades 4 to 7 from 42 schools. There were reductions in self-reported bullying, antisocial behaviours (theft, vandalism and truancy) and self-reported victimisation, improved school climate, as well as teacher and peer reports of bully-victim problems. The outcomes were found in the first follow-up (8 months after baseline) as well as the second follow-up (20 months after baseline).

The second Norwegian study was conducted in grades 7 to 9 in 6 schools. The study evaluated the effects on substance use behaviours and did not include bullying measures. There were significant effects on 3 of 9 measures. There were significant differences between groups in levels of cannabis use, smoking, and drunkenness between groups, with levels much higher among control group.

The English study was also conducted with adjacent age-cohorts. of 6,758 students, aged 8 to 16 years, from 24 schools participated. Although for most measures, changes were better in treatment schools than in comparison schools, the study only showed a significant intervention effect on frequency of bullying.

References of studies

*Amundsen, E. J., & Ravndal, E. (2010). Does successful school-based prevention of bullying influence substance use among 13- to 16-year-olds? Drugs: education, prevention and policy, 17(1), 42-54.

Bauer, N.S., Lozano, P., & Rivara, F.P. (2007). The effectiveness of the Olweus Bullying Prevention Programme in public middle schools: A controlled trial. Journal of Adolescent Health, 40, 266-274.

Bowllan, N. M. (2011). Implementation and evaluation of a comprehensive, school-wide bullying prevention programme in an urban/suburban middle school. Journal of School Health, 81(4), 167-173.

*Eslea, M. (1998). The long-term effectiveness of anti-bullying work in primary schools. Educational Research, 40, 203-218.


Limber, S. P., Olweus, D., Massiello, M., Molnar-Main, S., & Moore, D. (2012). Evaluation of the Olweus Bullying Prevention Programme in a large scale study in Pennsylvania. Unpublished.

Melton, G.B., Limber, S.P., Cunningham, P., Osgood, D.W., Chambers, J., Flerx, V., Henggeler, S., & Nation, M. (1998). Violence among rural youth. Final report to the Office of Juvenile Justice and Delinquency Prevention. Washington, DC: Office of Juvenile Justice and Delinquency Prevention.


*O'Moore, A.M., & Minton, S.J. (2005). Evaluation of the effectiveness of an anti-bullying programme in primary schools. Aggressive Behavior, 31, 609-622.

* Olweus, D. (2005). New positive results with the Olweus Bullying Prevention Programme in 37 Oslo schools. Report. Bergen, Norway: Research Centre for Health Promotion, University of Bergen.

*Olweus, D. (1993). Bullying at school: What we know and what we can do. Oxford, England: Blackwell.

*Olweus, D. (1992). Bullying among school children: Intervention and prevention. In R.D. Peters, R.J. McMahon, & V.L. Quinsey (eds.), Aggression and violence throughout the life span (pp.100-125). Newbury Park, CA: Sage Publications.

*Olweus, D., & Alsaker, F.D. (1991). Assessing change in a cohort-longitudinal study with hierarchical data. In D. Magnusson, L.R. Bergman, G. Rudinger, & B. Torestad (Eds.), Problems and methods in longitudinal research: Stability and change (pp. 107-132). New York, NY: Cambridge University Press.

*Olweus, D. (1987). Schoolyard bullying-grounds for intervention. School Safety, 4, 4-14.

Pepler, D.J., Craig, W.M., Ziegler, S., & Charach, A. (1994). An evaluation of an anti-bullying intervention in Toronto schools. Canadian Journal of Community, 13, 95-110.


Schroeder, B. A., Messina, A., Schroeder, D., Good, K., Barto, S., Saylor, J., Masiello, M. (2011). The implementation of a statewide bullying prevention programme: Preliminary findings from the field and the importance of coalitions. Health Promotion Practice, 13(4), 489-495.

*Smith, P.K. (1997). Bullying in schools: The UK experience and the Sheffield anti-bullying project. The Irish Journal of Psychology, 18, 191-201.

*Whitney, I., & Smith, P.K. (1993). A survey of the nature and extent of bullying in junior/middle and secondary schools. Education Research, 35, 3-25.


*Whitney, I., Rivers, I., Smith, P.K., & Sharp, S. (1994). The Sheffield Project: Methodology and findings. In P.K. Smith and S. Sharp (eds.), School bullying: Insights and perspectives (pp. 20-56). London, England: Routledge.


Countries where evaluated
Ireland
Norway
United Kingdom
Protective factor(s) addressed
Community: opportunities and rewards for prosocial involvement in the community (including religiosity)
Family: parent involvement in learning/education
Individual and peers: clear morals and standards of behaviour
Individual and peers: individual/peers other
Individual and peers: interaction with prosocial peers
Individual and peers: opportunities and rewards for prosocial peers involvement
Individual and peers: Problem solving skills
Individual and peers: refusal skills and decision making
Individual and peers: skills for social interaction
School and work: opportunities for prosocial involvement in education
Risk factor(s) addressed
No defined risk factors
Outcomes targeted
Education
Academic performance
Positive relationships
Relations with peers
Substance-related behaviours
Bullying
Crime
Other behaviour outcomes
Description of programme

The Olweus Bullying Prevention Programme targets the problem of bullying at three levels: the school, the classroom and the individual. Designed for elementary and middle schools, the programme addresses the problem of bullying with multiple strategies at each level. At the school level, students are given an anonymous questionnaire (25-45 minutes long) to assess the nature and prevalence of bullying at the school. The survey is administered in spring of the school year prior to programme implementation. Secondly, the school administration convenes a conference day, during which programme consultants and school staff discuss findings from the student questionnaire, familiarize themselves with the programme and its effects (through discussions with programme consultants, handbooks and videos), form a Bullying Prevention Coordinating Committee, and plan for programme implementation. The coordinating committee includes representatives from all constituencies involved with the school, i.e. administration, teachers, counsellors, health professionals, parents and students. The school level component also involves increased adult supervision of school areas that are frequently the setting for bullying, i.e., the playground, cafeteria and restrooms.

The classroom level component involves establishing clear and consistently enforced rules against bullying, along with regular class discussions and activities designed to reinforce rules and anti-bullying values and norms. Discussions and activities also present the harm caused by bullying and strategies for preventing it. The programme encourages parental involvement through meetings and discussion of the problem and efforts to address it.

Individual level components include interventions with bullies, victims and their parents. Interventions are designed to ensure the cessation of the bullying behaviour and to provide support to victims.

Last updated : 16.12.2019
Country of origin
Norway
Last reviewed:
Age group
11-14 years
15-18/19 years
Target group
Pupils between grades 7 and 9 (12-15 years), as well as teachers and parents
Programme setting(s)
School

The BE smokeFREE intervention is a classroom-based intervention that aims to enhance students’ self-efficacy to help them cope with pressure. The intervention also aims to increase positive expectancies of a smoke-free lifestyle. The intervention is delivered by teachers and other school staff over three academic years from grade 7 to 9 (12-15 years of age). There are eight hours’ of content in the first year, five in the second and six in the third.

Keywords
No data
Links to this programme in other registries
No link
Contact details

Dr Ola Josendal, PhD
Research Centre for Health Promotion, Norway
Email: Ola.josendal[a]psych.uib.no

Evidence rating
Beneficial
Studies overview

The programme has been evaluated in a cluster randomised controlled trial (RCT) in Norway involving children aged approximately 13 years. At post-test, there was a statistically significant positive effect on self-reported smoking, with the intervention participants having a lower probability of becoming a smoker, smoking daily or smoking weekly. Programme participants also had a significantly lower probability of using cannabis compared to the control condition.

References of studies

*Jøsendal, O., Aarø, L. E., Torsheim, T. and Rasbah, J. (2005), ‘Evaluation of the school-based smoking prevention programme “BE smokeFREE”’, Scandinavian Journal of Psychology 46, pp. 189-199.

Countries where evaluated
Norway
Protective factor(s) addressed
Family: parent involvement in learning/education
Individual and peers: refusal skills and decision making
Risk factor(s) addressed
Individual and peers: early initiation of drug/alcohol use
Outcomes targeted
Other health outcomes
Smoking (tobacco)
Description of programme

The BE smokeFREE intervention was developed by the Norwegian Cancer Society and was designed as a smoking prevention programme for students in grades 7-9 (12-15 years of age). The BE smokeFREE intervention is a classroom-based, teacher-delivered intervention based on the social influence model and focused on opportunities for individuals to choose. In line with Bandura’s social cognitive theory, the intervention aims to enhance students’ self-efficacy to help them cope with pressure. The intervention also aims to increase positive expectancies of a smoke-free lifestyle. This is achieved by providing details on the smoking and the positive short- and long-term effects of not smoking on health.

The intervention is delivered by teachers in a classroom setting; it consists of eight hours in the first year, five in the second and six in the third. Each school hour allocated to the programme involves elements of non-traditional classroom activities using videos, games and group work. There is no information about what the content of the intervention actually entails, but some of the features that had been used in previous successful anti-smoking programmes are incorporated.

Implementation Experiences
Feedback date
Contact details

Ola Jøsendal
ola.josendal[a]helse-vest.no

Main obstacles

With respect to individual professionals

The critical point of entrance was the school principal/top administration. Two thirds of all Norwegian secondary schools implemented the programme. A third did not implement it, because of the above mentioned.

Once the schools decided to join the programme, we encountered very few obstacles; it was implemented by highly motivated teachers.

With respect to social context

At the beginning of the implementation, one could observe anti-programme subcultures among the smokers. However, as the years went by, the number of smokers decreased, and, in parallel to this, there was a reduction in the anti-programme obstacles.

With respect to organisational and economic context

The main obstacle was, as mentioned before, the key to the implementation: the principal/top administration at the schools. In as many as one third of the schools, the programme was not implemented.

How they overcame the obstacles

With respect to individual professionals

The programme was heavily supported by governmental institutions as well as physicians and other well-qualified personnel.

With respect to social context

The issue was mainly not paying much attention to such obstacles. A well-planned programme with a recognised and well-documented effect should be performed without wasting energy on resistance based on a lack of knowledge.

With respect to organisational and economic context

Endure the obstacles and perform at the schools that are involved in the programme.

Lessons learnt

With respect to individual professionals

Ensure support from governmental institutions as well as academic and professional societies.

With respect to social context

It was a major success, based on the will and skill to endure obstacles that arose.

With respect to organisational and economic context

Endure and perform. The results were very encouraging.

Strengths

Well-planned; well-documented results; support from governmental institutions as well as professional and academic institutions

Weaknesses

Maybe it should have been mandatory for all secondary schools to join the programme.

Opportunities

NA

Threats

NA

Recommendations

With respect to individual professionals

Provide well-prepared documentation of all aspects of the programme. Point out the excellent results.

With respect to social context

Ensure support from both health and educational governmental institutions.

With respect to organisational and economic context

Ensure that the programme supports schools with free materials and so forth.

Note from the authors

Implemented nationwide in 2001.

Number of implementations
1
Country
Norway
Last updated : 09.01.2024
Country of origin
USA
Last reviewed:
Age group
11-14 years
15-18/19 years
Target group
Young offenders aged 12-17 years
Programme setting(s)
Community
Family
Juvenile justice setting
Level(s) of intervention
Targeted intervention

Multisystemic Therapy® (MST®) is an intensive family- and community-based treatment that addresses the multiple causes of serious antisocial behaviour in juvenile offenders. The MST programme seeks to improve the real-world functioning of young people by changing their natural settings — home, school and neighbourhood — in ways that promote prosocial behaviour while decreasing antisocial behaviour. Therapists work with young people and their families to address the known causes of delinquency on an individualised yet comprehensive basis. By using the strengths in each system (family, peers, school and neighbourhood) to facilitate change, MST addresses the multiple factors known to be related to delinquency across the key systems within which young people are embedded. The extent of treatment varies by family according to clinical need. Therapists generally spend more time with families in the initial weeks (meeting daily if necessary) and gradually reduce the frequency of their meetings (to as infrequently as once a week) over the three- to five-month course of treatment.

Keywords
No data
Links to this programme in other registries
USA - Blueprints Programs
Norway - NUBU
Norway - Ungsinn
The Netherlands - Databank Effectieve Jeugdinterventies
UK - Early Intervention Foundation Guidebook
Contact details

Mr Marshall Swenson
MST Services
Email: marshall.swenson[a]mstservices.com
Website: www.mstservices.com or www.mstinstitute.org

Evidence rating
Possibly beneficial
Studies overview

The programme has been evaluated in four randomised controlled trials, one each in Norway, Sweden, the UK and the Netherlands.

In Sweden, 156 young people aged 12-17 with a clinical diagnosis of conduct disorder using the DSM-IV-TR were randomly allocated to either receive MST or to continue with treatment as usual. No significant differences between groups was found at post-test or month follow-up  – indicating no effects on child behaviour, social skills, delinquency, alcohol or drug use.

In Norway, 105 young people aged 12-17 years referred for problem behaviour such as law-breaking or other anti-social acts, serious academic difficulties, dysfunctional interpersonal relationships, verbal aggression and threats of hurting others were randomly allocated to MST or regular services. At posttest, there a marginally significant positive intervention effect on internalising and externalisaling behaviour, social competence and family cohesion, but not of family functioning.

In the Netherlands, 256 young people aged 12-18 years displaying severe and violent antisocial behaviour were randomly allocated to MST or usual service. At post-test and six-month post intervention, intervention group adolescents improved significantly more compared to the control group on parent and self-reported externalizing, parent-reported oppositional defiant and conduct disorder, and self-reported property offences. The There were no significant differences in groups in frequency or number of arrests two years after the program ended.   effect on self-reported violence was not significant.

In the UK, 108 young people aged 13-17 years on a court referral order for treatment, supervision, or following imprisonment were randomized into MST or Youth Offending Teams control group. The number of offenses between the two study groups did not differ at post-test, and 6-month follow-up but became significant (p<.001) at the 12-month follow-up assessment. There was a significant difference between groups, favouring MST, on the measure of six-month period of no offences, although the effects at different assessments points is not disentangled. Sub-group analyses showed this was significant for non-violent offences, and not for violent offences. Out of 21 tests for secondary outcome measures, 5 (24%) were significant, including aggression and delinquency.

I a quasi-experimental study in the Netherlands (Eeren et al., 2018), 697 adolescents with an average age of 15 years, were allocated to either the FFT intervention or the MST intervention according to the Risk-Need-Responsivity model. The FFT intervention is thereby seen as the control group. In this aspect, results of the comparison showed no significant differences between outcomes. Only the engagement in school or work after the treatment was higher in the group who completed MST.

References of studies

Outcome evaluations/results:

Asscher, J. J., Deković, M., Manders, W. A., van der Laan, P. H., Prins, P. J.M., van Arum, S., & Dutch MST Cost-Effectiveness Study Group. (2014). Sustainability of the effects of multisystemic therapy for juvenile delinquents in The Netherlands: effects on delinquency and recidivism. Journal of Experimental Criminology, 10(2), 227-243.

Asscher, J. J., Deković, M., Manders, W. A., Van der Laan, P. H., Prins, P. J. M., & Dutch MST Cost- Effectiveness Research Group (2012). A randomized clinical trial of Multisystemic Therapy in The Netherlands. Journal of Experimental Criminology. doi: 10.1007/s11292-012-9165-9.

Butler, S., Baruch, G., Hickey, N., & Fonagy, P. (2011). A randomized controlled trial of Multisystemic Therapy and a statutory therapeutic intervention for young offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 50(12), 1220-1235.

Löfholm, C., Olsson, T., Sundell, K., & Hansson, K. (2009). Multisystemic therapy with conduct-disordered young people: stability of treatment outcomes two years after treatment. Evidence & Policy, 4, 373-397.

Ogden, T., Hagen, K. A., & 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.

Sundell, K., Hansson, K., Löfholm, C., Olsson, T., Gustle, L-H., & Kadesjö, C. (2008). The transportability of Multisystemic Therapy to Sweden: Short-Term Results From a Randomized Trial of Conduct-Disordered Youths. Journal of Family Psychology, 22, 550-560.

 

Concept papers/other:

*Asscher, J. J., Deković, M., Van der Laan, P. H., Prins, P. J. M. and van Arum, S. (2007), ‘Implementing randomized experiments in criminal justice settings: an evaluation of multi-systemic therapy in the Netherlands’, Journal of Experimental Criminology 3, pp. 113–129.

* Asscher, J. J., Dekovic, M., Manders, W. A., van der Laan, P. H. and Prins, P. J. M. (2013), ‘A randomized controlled trial of the effectiveness of multisystemic therapy in the Netherlands: post-treatment changes and moderator effects’, Journal of Experimental Criminology 9, pp. 169 187.

Borduin, C. M., Henggeler, S. W., Blaske, D. M. and Stain, R. J. (1990), ‘Multisystemic treatment of adolescent sexual offenders’, International Journal of Offender Therapy and Comparative Criminology 35, pp. 105-114.

Borduin, C. M., Mann, B. J., Cone, L. T., Henggeler, S. W., Fucci, B. R., Blaske, D. M. and Williams, R. A. (1995), ‘Multisystemic treatment of serious juvenile offenders: long-term prevention of criminality and violence’, Journal of Consulting and Clinical Psychology 63, pp. 569-578.


Borduin, C. M., Schaeffer, C. M. and Heiblum, N. (2009), ‘A randomized clinical trial of Multisystemic Therapy with juvenile sexual offenders: effects on youth social ecology and criminal activity’, Journal of Consulting and Clinical Psychology 77, pp. 26-37.


Brown, T. L., Henggeler, S. W., Schoenwald, S. K., Brondino, M. J. and Pickrel, S. G. (1999), ‘Multisystemic treatment of substance abusing and dependent juvenile delinquents: effects on school attendance at posttreatment and 6-month follow-up’, Children’s Services: Social Policy, Research, and Practice 2, pp. 81-93.


Camp, G. M. and Camp, C. G. (1993), The Corrections Yearbook, Criminal Justice Institute, South Salem, NY.


Dekovic, M., Asscher, J. J., Manders, W. A., Prins, P. J. M. and van der Laan, P. (2012), ‘Within-intervention change: mediators of intervention effects during Multisystemic Therapy’, Journal of Consulting and Clinical Psychology 80, pp. 574-587.

Eeren, H. V., Goossens, L., Scholte, R. H., Busschbach, J. J., & Van der Rijken, R. E. (2018). Multisystemic therapy and functional family therapy compared on their effectiveness using the propensity score method. Journal of Abnormal Child Psychology, 46(5), 1037-1050.

Fain, T., Greathouse, S. M., Turner, S. F. and Weinberg, H. D. (2014), ‘Effectiveness of Multisystemic Therapy for minority youth: outcomes over 8 years in Los Angeles County’, Journal of Juvenile Justice 3, pp. 24-37. 


Henggeler, S. W., Rodick, J. D., Borduin, C. M., Hanson, C. L., Watson, S. M. and Urey, J. R. (1986), ‘Multisystemic treatment of juvenile offenders: effects on adolescent behavior and family interaction’, Developmental Psychology 22, pp. 132-141.


Henggeler, S. W., Borduin, C. M., Melton, G. B., Mann, B. J., Smith, L. A., Hall, J. A., Cone, L., et al. (1991), ‘Effects of multisystemic therapy on drug use and abuse in serious juvenile offenders: a progress report from two outcome studies’, Family Dynamics of Addiction Quarterly 1, pp. 40-51. 


Henggeler, S. W., Melton, G. B. and Smith, L. A. (1992), ‘Family preservation using multisystemic therapy: an effective alternative to incarcerating serious juvenile offenders’, Journal of Consulting and Clinical Psychology 6, pp. 953-961.


Henggeler, S. W., Melton, G. B., Smith, L. A., Schoenwald, S. K. and Hanley, J. H. (1993), ‘Family preservation using multisystemic treatment: long-term followup to a clinical trial with serious juvenile offenders’, Journal of Child and Family Studies 2, pp. 283-293.

Henggeler, S. W., Melton, G. B., Brondino, M. J., Scherer, D. G. and Hanley, J. H. (1997), ‘Multisystemic Therapy with violent and chronic juvenile offenders and their families: the role of treatment fidelity in successful dissemination’, Journal of Consulting and Clinical Psychology 65, pp. 821-833.


Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D. and Cunningham, P. B. (1998), Multisystemic treatment of antisocial behavior in children and adolescents, The Guilford Press, New York.


Henggeler, S. W., Pickrel, S. G. and Brondino, M. J. (1999), ‘Multisystemic treatment of substance-abusing and dependent delinquents: outcomes, treatment fidelity, and transportability’, Mental Health Services Research 1, pp. 171-184.


Henggeler, S. W., Clingempeel, W. G., Brondino, M. J. and Pickrel, S. G. (2002), ‘Four-year follow-up of Multisystemic Therapy with substance-abusing and substance-dependent juvenile offenders’, Journal of the American Academy of Child and Adolescent Psychiatry 41, pp. 868-874.


Henggeler, S. W., Letourneau, E. J., Chapman, J. E., Borduin, C. M., Schewe, P. A. and McCart, M. R. (2009), ‘Mediators of change for multisystemic therapy with juvenile sexual offenders’, Journal of Consulting and Clinical Psychology 77, pp. 451-462.


Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D. and Cunningham, P. B. (2009), Multisystemic therapy for antisocial behavior in children and adolescents (2nd edn), The Guilford Press, New York.


Huey, S. J., Henggeler, S. W., Brondino, M. J. and Pickrel, S. G. (2000), ‘Mechanisms of change in multisystemic therapy: reducing delinquent behavior through therapist adherence and improved family and peer functioning’, Journal of Consulting and Clinical Psychology 68, pp. 451 467.

Leschied, A. and Cunningham, A. (2002), Seeking effective interventions for serious young offenders: interim results of a four-year randomized study of multisystemic therapy in Ontario, Canada, Centre for Children and Families in the Justice System, Canada.


Letourneau, E. J., Henggeler, S. W., Borduin, C. M., Schewe, P. A., McCart, M. R., Chapman, J. E. and Saldana, L. (2009), ‘Multisystemic Therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial’, Journal of Family Psychology 23, pp. 89-102.


Ogden, T. and Halliday-Boykins, C. A. (2004), ‘Multisystemic treatment of antisocial adolescents in Norway: replication of clinical outcomes outside of the US’, Child and Adolelscent Mental Health 9, pp. 77-83.


Ogden, T. and Hagen, K. A. (2006), ‘Multisystemic Therapy of serious behaviour problems in youth: sustainability of therapy effectiveness two years after intake’, Journal of Child and Adolescent Mental Health 11, pp. 142-149.


Ogden, T. and Hagen, K. A. (2009), ‘What works for whom? Gender differences in intake characteristics and treatment outcomes following Multisystemic Therapy’, Journal of Adolescence 32, pp. 1425-1435.


Sawyer, A. M and Borduin, C. M. (2011), ‘Effects of Multisystemic Therapy through midlife: a 21.9-year follow-up to a randomized clinical trial with serious and violent juvenile offenders’, Journal of Consulting and Clinical Psychology 79, pp. 643–652.


Schaeffer, C. M. and Borduin, C. M. (2005), ‘Long-term follow-up to a randomized clinical trial of Multisystemic Therapy with serious and violent juvenile offenders’, Journal of Consulting and Clinical Psychology 73, pp. 445-453.


Schoenwald, S. K., Ward, D. M., Henggeler, S. W., Pickrel, S. G. and Patel, H. (1996), ‘Multisystemic Therapy treatment of substance abusing or dependent adolescent offenders: costs of reducing incarceration, inpatient, and residential placement’, Journal of Child and Family Studies 5, pp. 431-444.


Timmons-Mitchell, J., Bender, M., Kishna, M. A. and Mitchell, C. (2006), ‘An independent effectiveness trial of Multisystemic Therapy with juvenile justice youth’, Journal of Clinical Child and Adolescent Psychology 35, pp. 227-236.


Wagner, D. V., Borduin, C. M., Sawyer, A. M. and Dopp, A R. (2014), ‘Long-term prevention of criminality in siblings of serious and violent juvenile offenders: a 25-year follow-up to a randomized clinical trial of multisystemic therapy’, Journal of Consulting and Clinical Psychology 82, pp. 492-499.


Weiss, B., Han, S., Harris, V., Catron, T., Ngo, V. K., Caron, A., Gallop, R. et al. (2013), ‘An independent randomized clinical trial of Multisystemic Therapy with non-court-referred adolescents with serious conduct problems’, Journal of Consulting and Clinical Psychology 81, pp. 1027-1039.

Countries where evaluated
Netherlands
Norway
Sweden
United Kingdom
Protective factor(s) addressed
Community: opportunities and rewards for prosocial involvement in the community (including religiosity)
Family: attachment to and support from parents
Family: opportunities/rewards for prosocial involvement with parents
Family: parent involvement in learning/education
Family: parent social support
Individual and peers: clear morals and standards of behaviour
Individual and peers: interaction with prosocial peers
Individual and peers: opportunities and rewards for prosocial peers involvement
Individual and peers: Problem solving skills
Individual and peers: skills for social interaction
School and work: commitment and attachment to school
School and work: opportunities for prosocial involvement in education
School and work: rewards and disincentives in school
Risk factor(s) addressed
Community: community disorganisation (crime, drugs, graffiti, abandoned buildings etc)
Community: laws and norms favourable to substance use and antisocial behaviour
Community: low neighbourhood attachment
Family: aggressive or violent parenting
Family: family conflict
Family: family management problems
Family: neglectful parenting
Family: parental attitudes favourable to alcohol/drug use
Family: parental attitudes favourable to anti-social behaviour
Family: parental depression or mental health difficulties
Individual and peers: anti-social behaviour
Individual and peers: early initiation of drug/alcohol use
Individual and peers: interaction with antisocial peers
Individual and peers: peers alcohol/drug use
Individual and peers: rebelliousness and alienation
School and work: low commitment/attachment to school/workplace
Outcomes targeted
Depression or anxiety
Other mental health outcomes
Relations with parents
Relations with peers
Alcohol use
Use of illicit drugs
Crime
Other behaviour outcomes
Violence
Description of programme

Multisystemic Therapy® (MST®) is an intensive family- and community-based treatment that addresses the multiple causes of serious antisocial behaviour across key settings, or systems, within which young people are embedded (family, peers, school and neighbourhood). Because MST emphasises promoting behavioural change in the young person’s natural environment, the programme aims to empower parents with the skills and resources needed to independently address the inevitable difficulties that arise in raising teenagers, and to empower young people to cope with the problems they encounter in the family, peer, school, and neighbourhood domains.

In the context of support and skill building, the therapist places developmentally appropriate demands on adolescents and their families to reduce problem behaviour. Initial therapy sessions identify the strengths and weaknesses of the adolescent, the family and their transactions with extrafamilial systems (e.g. peers, friends, school, parental workplace). Problems identified both by family members and by the therapist are explicitly targeted for change by using the strengths in each system to facilitate such change. Treatment approaches are derived from well-validated strategies such as strategic family therapy, structural family therapy, behavioural parental training and cognitive behavioural therapy.

While MST focuses on addressing the known causes of delinquency on an individualised yet comprehensive basis, several types of interventions are typically identified for serious juvenile offenders and their families. At the family level, MST interventions aim to remove barriers to effective parenting (e.g. parental substance abuse, parental psychopathology, low social support, high stress and marital conflict), to enhance parenting competencies, and to promote affection and communication among family members. Interventions might include introducing systematic monitoring, reward and discipline systems; prompting parents to communicate effectively with each other about adolescent problems; problem solving for day-to-day conflicts; and developing social support networks. At the peer level, interventions are frequently designed to decrease affiliation with delinquent and drug-using peers and to increase affiliation with prosocial peers. Interventions in the school domain may focus on establishing positive lines of communication between parents and teachers, ensuring parental monitoring of the adolescent’s school performance and restructuring after-school hours to support academic efforts. Individual-level interventions generally involve using cognitive behavioural therapy to modify the individual’s social perspective-taking skills, belief system or motivational system, and encouraging the adolescent to deal assertively with negative peer pressure.

A master’s level therapist, with a caseload of four to six families, provides most mental health services and coordinates access to other important services (e.g. medical, educational and recreational). While the therapist is available to the family 24 hours a day, 7 days a week, the direct contact hours per family vary according to clinical need. Generally, the therapist spends more time with the family in the initial weeks of the programme (meeting daily if necessary) and gradually reduces the frequency of their meetings (to as infrequently as once a week) during a three- to five-month course of treatment.

Treatment fidelity is maintained by weekly group supervision meetings involving three to four therapists and a doctoral level or advanced master’s level clinical supervisor. The group reviews the goals of and progress in each case to ensure the multisystemic focus of the therapists’ intervention strategies, identify barriers to success and facilitate the attainment of treatment goals. In addition, an MST expert consultant reviews each case with the team weekly to promote treatment fidelity and favourable clinical outcomes.

The design and implementation of MST interventions are based on the following nine core principles of MST. An extensive description of these principles, with examples that illustrate the translation of these principles into specific intervention strategies, is provided in comprehensive clinical volumes (Henggeler et al., 1998; 2009).

  • The primary purpose of assessment is to understand the ‘fit’ between the identified problems and their broader systemic context.
  • Therapeutic contacts emphasise the positive and use systemic strengths as levers for change.
  • Interventions are designed to promote responsible behaviour and decrease irresponsible behaviour among family members.
  • Interventions are present-focused and action-oriented, targeting specific and well-defined problems.
  • Interventions target sequences of behaviour within and between multiple systems that maintain the identified problems.
  • Interventions are developmentally appropriate and fit the developmental needs of the young person.
  • Interventions are designed to require daily or weekly effort by family members.
  • Intervention effectiveness is evaluated continuously from multiple perspectives, with providers assuming accountability for overcoming barriers to successful outcomes.
  • Interventions are designed to promote treatment generalisation and long-term maintenance of therapeutic change by empowering caregivers to address family members’ needs across multiple systemic contexts.

Intervention variation

The study was a randomised controlled trial with participants randomly allocated either to receive multisystemic therapy (MST) or to continue with treatment as usual. Randomisation was computer-generated at a ratio of 50:50 and with sites used as a blocking variable. Over 12 months, from March 2004, young people aged 12-17 were referred to the study and screened for a clinical diagnosis of conduct disorder using the DSM-IV-TR.

A total of 256 juveniles who were referred for MST between 2006 and 2010 participated in the study. The study took place in three MST institutions in the Netherlands. Adolescents were referred by primary healthcare workers (GPs) or child social workers in 39 % of cases. Of the adolescents, 51 % were referred for treatment as a result of a court order and 11 % were self-referred. Immediately after referral, participants were randomised using a computerised randomisation programme. This programme was executed separately for each site. The randomisation ratio was adjusted in a 1:2 ratio in favour of MST for a 6-month period, due to a low number of referrals.

The programme allocated 147 young people to the intervention group and 109 to the control group. Participants in the control group received an alternative treatment that would have been offered had MST not been available. Mostly, these services included individual treatment (individual counselling or supervision by a probation officer or case manager, 21 %) and family-based interventions (family therapy, parent counselling, parent groups or home-based social services, 53 %). Of this group 7 % received a combination of care (e.g. individual treatment and family counselling) and 4 % were placed in a juvenile detention facility. For various reasons such as moving house or repeated failure to attend treatment sessions, 14 % received no treatment in the end.

Implementation Experiences
Feedback date
Contact details

Terje Ogden
terje.ogden[a]nubu.no
 

Main obstacles

With respect to individual professionals

Some practitioners opposed the manual-driven approach, stating that it was a threat to professional autonomy and to the principle of freedom of method choice. At the clinical level, the lack of specific, explicit therapeutic skills also turned out to be a challenge. Weekly group supervision and consultation in MST, and feedback from families on the therapists’ treatment adherence were collected on a regular basis. But, to our knowledge, no trainees dropped out of training because of these requirements, and the therapists gradually adapted to the skills-oriented approach and the increased transparency of the therapy process.

With respect to social context

The MST and MST/CM programmes were not immediately accepted by the Norwegian public and practitioners. Adolescents with behavioural and substance abuse problems were placed out of home on a regular basis. Moreover, a common objection was that ‘MST may have worked in the United States, but it won’t work here.’ No matter how many studies proved that evidence-based programmes worked in the United States, it was not assumed that the same results would be achieved in Norway. Norway previously had a strong tradition of incarcerating drug-abusing and criminal youth or transferring them to treatment institutions or homes. Home-based treatment of this target group was quite difficult to grasp for the public, politicians and professionals.

In RCTs, treatment-as-usual (TAU) groups in the United States are often exposed to risk factors that are both more severe and more numerous than those in Norway. The prevalence of stressors such as neighbourhoods with high rates of crime and substance abuse is more common in the United States. Moreover, the regular services to which MST was compared in Norway were likely to be more comprehensive and to have more elements of treatment than the regular services offered to comparison groups in previous MST trials in North America. In the United States, ‘regular services’ often consist of probation office visits and referral to social services when deemed necessary. In Norway, they involve a wide array of social services and mental health treatment, including placement in institutions and in-home services.

With respect to organisational and economic context

The new programme challenged the traditional strategy of placing children and youth out of home in institutions or foster homes for longer periods of time. When children and, to a greater extent, youth are treated within their family and local environment, the result can be increased pressure on their social networks, including families, schools and neighbourhoods.

Some local agency leaders were not prepared for the new demands that were put on them and their agencies to establish practical routines for recruiting and training, as well as to support the evidence-based practices of MST. There are still great variations in how much leaders of local agencies and regional services have adapted their leadership style to the needs and demands of MST. Some still claim that it would be better to incarcerate the young offenders. This is as much a policy discussion as a discussion about ‘what works’ for children who act out, and we expect this to be a part of the continuing discussion about ‘punishment or treatment’ in Norwegian society. Efforts to treat drug abuse in family-based treatment programmes such as MST and MST/CM were particularly challenging. There were several challenges and controversies in the process of implementing the evidence-based programmes, particularly in the initial phases. Critics claimed that the ‘relation’ was more important than the ‘evidence’ and that the practitioners had to be more important than the programmes.

How they overcame the obstacles

With respect to individual professionals

In addition, to ensure that they had pragmatic appeal, the interventions were robust enough to adapt to contextual and cultural variations. Norwegian MST therapists and supervisors reported few problems in engaging ethnic minorities in treatment, stating that the highly contextual nature of the model helped to make it possible to adapt the treatment to each family’s cultural needs.

The introduction of the new programme was considered by some to be an implicit critique of regular practice, and the implementation team had to engage in several information and negotiation activities. No systematic strategy was applied in this process, and several ad hoc countermeasures were used, such as information meetings, emails, phone calls and distribution of written information such as journal articles, newspaper articles, etc.

With respect to social context

The power of the RCT replication studies nonetheless influenced attitudes towards MST and MST/CM in Norway, and both are now part of regular practice in Norway.

With respect to organisational and economic context

The RCT replication studies made an important contribution to establishing the credibility of the programmes. MST and MST/CM developed in North America seemed to work equally well in Norway. The programmes were initially implemented with no major modification of the original model. Few adaptations were called for in order to make the programmes work in the Norwegian context, and the programmes’ ability to match the individual families’ needs and situations were indicated by the low number of dropouts from treatment, encouraging youth outcomes and positive user evaluations. ‘Core components’ were defined by both the developers and the Norwegian change agents as those with the strongest empirical underpinnings in controlled trials. They appeared to work equally well in Norway and the United States.

An large amount of MST training material has been translated, but it could not be translated back and forth in a rigorous way without totally altering the clinical meaning of the texts. Therefore, English sentences had to be rewritten to make sense in Norwegian. It was considered clinically important that the translation be done by the staff members at the Department for Adolescents, who were all bilingual and specialists in clinical psychology.

To a very small extent, the local services had to transfer funding from existing resources. Long-term financial support from the ministries through the Norwegian Centre for Child Behavioural Development (NCCBD) has been crucial for the sustainability of the fidelity of the programmes and to handle turnover of therapists.

Lessons learnt

With respect to individual professionals

The turning point for many of the therapists happened when the parents receiving PMTO (Parent Management Training — Oregon mode) and MST expressed their satisfaction with the positive changes in their families and in their children’s behaviour. Moreover, the objections and resistance did not reduce the number of practitioners volunteering to learn and practise the programmes.

With respect to social context

The experiences from Norway could serve as a model and inspiration for large-scale implementation of MST in other nations. It is possible to have clear standards for training and evaluation of competence that ensure implementation fidelity and support local efforts.

With respect to organisational and economic context

Federal funding of training and technical support, combined with allowing agency employees to volunteer to participate, is a promising strategy. Moreover, research should be an integrated part of the implementation of MST.

Among the factors that may have contributed to the long-term sustainability and effectiveness of MST in Norway, the following seem to be most important: (1) a genuine interest in and commitment to the national implementation of evidence-based practices at the political and administrative levels, (2) increased interest in evidence-based practices among practitioners, (3) establishing a self-sustaining national centre for implementation and research, (4) the ability of the programme developers to support the implementation and research efforts, and (5) positive evaluations from families and positive media feedback.

Strengths

Home-based treatment, a national centre for training, quality assurance and research, long-term funding, support at the policy level and from the public.

Weaknesses

Expensive, not in accordance with the theoretical orientation of most practitioners in the field (who are eclectic or psychodynamically oriented), competition from non-evidence-based interventions, including treatment institutions and group homes.

Opportunities

Increased capacity and competence in the treatment of serious behavioural problems, including crime and drug abuse; early interventions for adolescents at risk of entering a drug abuse trajectory; and empowering parents, families and networks.

Recommendations

With respect to organisational and economic context

Implement several evidence-based programmes, for instance MST, functional family therapy and Treatment Foster Care Oregon, so that there are opportunities to choose from among them.

Note from the authors

Multisystemic Therapy (MST) & MST/ Contingency Management (CM)   

Number of implementations
1
Country
Norway
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