| 1. |
- Billsten, Johan, 1971-, et al.
(författare)
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Organizational Readiness for Change (ORC) test used in the implementation of assessment instruments and treatment methods in a Swedish National study
- 2018
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Ingår i: Journal of Substance Abuse Treatment. - Amsterdam : Elsevier. - 0740-5472 .- 1873-6483. ; 84, s. 9-16
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Tidskriftsartikel (refereegranskat)abstract
- Organizational climate and related factors are associated with outcome and are as such of vital interest for healthcare organizations. Organizational Readiness for Change (ORC) is the questionnaire used in the present study to assess the influence of organizational factors on implementation success. The respondents were employed in one of 203 Swedish municipalities within social work and psychiatric substance/abuse treatment services. They took part in a nationwide implementation project organized by the Swedish Association of Local Authorities and Regions (SALAR), commissioned by the Swedish National Board of Health and Welfare. Aim The aims were: (a) to identify classes (clusters) of employees with different ORC profiles on the basis of data collected in 2011 and (b) to investigate ORC profiles which predicted the use of assessment instruments, therapy methods and collaborative activities in 2011 and 2013. Design and recruitment The evaluation study applied a naturalistic design with registration of outcome at consecutive assessments. The participants were contacted via official e-mail addresses in their respective healthcare units and were encouraged by their officials to participate on a voluntary basis. Statistics Descriptive statistics were obtained using SPSS version 23. A latent profile analysis (LPA) using Mplus 7.3 was performed with a robust maximum likelihood estimator (MLR) to identify subgroups (clusters) based on the 18 ORC indexes. Results A total of 2402 employees responded to the survey, of whom 1794 (74.7%) completed the ORC scores. Descriptive analysis indicated that the respondents were a homogenous group of employees, where women (72.0%) formed the majority. Cronbach's alpha for the 18 ORC indexes ranged from α = 0.67 to α = 0.78. A principal component analysis yielded a four-factor solution explaining 62% of the variance in total ORC scores. The factors were: motivational readiness (α = 0.64), institutional resources (α = 0.52), staff attributes (α = 0.76), and organizational climate (α = 0.74). An LPA analysis of the four factors with their three distinct profiles provided the best data fit: Profile 3 (n = 614), Profile 2 (n = 934), and Profile 1 (n = 246). Respondents with the most favorable ORC scores (Profile 3) used significantly more instruments and more treatment methods and had a better collaborating network in 2011 as well as in 2013 compared to members in Profile 1, the least successful profile. Conclusion In a large sample of social work and healthcare professionals, ORC scores reflecting higher institutional resources, staff attributes and organizational climate and lower motivational readiness for change were associated with a successful implementation of good practice guidelines for the care and treatment of substance users in Sweden. Low motivational readiness as a construct may indicate satisfaction with the present situation. As ORC proved to be an indicator of successful dissemination of evidence-based guidelines into routine and specialist healthcare, it can be used to tailor interventions to individual employees or services and to improve the dissemination of and compliance with guidelines for the treatment of substance users. © 2017
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| 2. |
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| 3. |
- Fridell, Mats, et al.
(författare)
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Implementeringen av Socialstyrelsens riktlinjer för missbruks- och beroendevården: Utvärdering av det nationella utvecklingsarbetet Kunskap till Praktik
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- ABSTRACT Det nationella utvecklingsarbetet Kunskap till Praktik (KtP) inleddes under 2008. Rekryteringen av deltagande län gjordes i tre etapper: hösten 2008, våren 2009 och hösten 2009. Utvärderingen inleddes under 2009 och avslutades 2014. Urvalet var personal verksam inom landstings- och kommunal missbruks-/ beroendevård. Primärvårdspersonal deltog i ett fåtal län och inkludera-des därför inte. Urvalet i panelundersökningen omfattade personal i samtliga län. Det gjordes i två steg och bestod i den aktuella slut-rapporten av 3 063 respondenter i 203 kommuner i 20 av landets län. Stockholm inkluderades inte i panel-undersökningen men ingår i redovisningen av aktiviteter på länsnivå. Resultaten redovisas separat för respondenter, på kommunnivå samt länsnivå. Bortfallsanalyser visade små skillnader i bakgrundsvariabler mellan populationen och urval. Personalen var relativt homogen med ca 75% kvinnor, en medelålder av 46 år och 14 års yrkesverksamhet varav ca 7 år i missbruksarbete. Totalt fanns 8 yrkesgrupper representerade. Data för del-tagare från kriminalvård och privata behandlingsenheter samlades också in men redovisas inte. Bakgrundsdata i urvalet till panelen jämfördes med bakgrundsdata i det numerärt mycket större urvalet från baskurserna 2010-2011 och överensstämmer bra. Representativiteten och generaliserbarheten av resultaten bedöms god. Vid jämförelser mellan de fem mättillfällena: 2010-2014 hade respondenter som deltog i samtliga mätningar oftare funktioner inom KtP som nyckelperson, processledare, utbildare än de som ej ingick. Missing data fördelades jämnt över mättillfällena. På kommunnivå saknades uppgifter för 61 av de utvalda 264 kommunerna, mest de som inte gjort överenskommelser med KtP (jämförelsegruppen). Data analyserades för 154 kommuner och 74 landstingsenheter med 3 eller fler svarande. Inga kommuner föll bort p.g.a. missing data. Designen i den aktuella rapporten är en prospektiv uppföljning av en panel med deltagare med upprepade mätningar vid fem tillfällen. Samtliga bedömnings- och behandlingsmetoder har analyserats men i slutrapporten används sammanfattande mått för respektive typ av utfall. Variabler som kunde predicera högre användning analyserades på respektive nivå. Statistik: för analys av proportioner har χ2 använts. Principalkompo-nentanalyser användes för att gruppera variabler och variansanalys för att studera medelvärdesskillnader. Growth mixture modeling (GMM), en variant av SEM, användes som en grundmodell för att samtidigt urskilja kluster av respondenter eller kommuner som hade ett gemensamt beskriv-bart förlopp över de fem mätpunkterna. Modellen tar således hänsyn till vilka respondenter eller kommuner som ingår i ett visst kluster över tid. I beräkningarna väljs den modell som har bäst förklarings-nivå/effekt för respektive utfallsmått. Modellens styrka anges med sammanfattningsmåttet entropi. Därefter beräknades vilka variabler på respondent- respektive kommunnivå som ”predicerade” utfallet bäst. Path-analyser i Mplus användes för att beräkna prediktiviteten i ORC-indexvariablerna på utfallet i bedömnings- och behandlingsmetoder. Resultat: De första åren 2009-2011 kan betraktas som en dissemi-neringsfas, året 2012 som en stabiliseringsfas och åren 2013-2014 som en konsolideringsfas då det blev möjligt att studera vilka metoder och för vilka grupper som användningen av metoder fortsatte på en stabil nivå trots att finansieringen från KtP avbröts 2012. Analys av nivåer på genomförda utbildningsinsatser och ett kombinerat effektmått beräk-nades för fyra bedömningsmetoder och fyra behandlingsmetoder som ingick i KtPs utbildningssatsning. Den tidigare analysen av interventionsgrupp versus jämförelsegrupp (Rapport 2012) gav inga tydliga skillnader. Den aktuella analysen grupperade i stället nivåer av användning och förloppen i användning över fem år i olika ”kluster” och detta gav mer meningsfulla resultat. Det fanns således kluster som ökade användningen, de som planade ut liksom kluster som minskade användningen över tid. Hela 17% av socialtjänstförvaltningarna och 19% av landstingsenheterna använde inte några evidensbaserade metoder under hela studien. 1. Utbildningsinsatserna för både bedömnings- och behandlingsmetoder ökade flerfaldigt under de fem åren och en mycket stor del av urvalet i panelen (mellan 70% och 90%) uppgav att man utbildats inom ramen för KtP. Andelen utbildade i AUDIT och DUDIT och ASI ökade från 2010 till 2014 med respektive 63%, 54% och 58%. 2. Användningen av bedömningsmetoder ökade för AUDIT och DUDIT med 40% respektive 36%. ASI ökade inte efter 2011 och ADAD ökade inte alls. Användningen ökade mer för metoder som KtP utbildat i jämfört med metoder som inte ingick i KtP:s utbildningsuppdrag. T ex ökade användningen av DOK med bara 1% även om andelen utbildade ökade med 24%. Sambanden mellan utbildning som givits av KtP och användning av motsvarande metoder var signifikanta. Från 2012 tillkom också en del nya bedömningsmetoder inom ramen för de tre nya utvärderingsmodellerna (särskilt LOKE och UIV). 3. Användning av de fyra behandlingsmetoder som ingick i KtP ökade, men det var främst två av metoderna som stod för ökningen från 2010 till 2014: MI med 28% och Återfallsprevention (ÅP) med 19%, medan haschavvänjningsprogrammet (HAP) och Community Reinforcement (CRA) ökade i liten omfattning med 10% respektive 4%. Även för några av de metoder som inte ingick i KtP:s metodutbildningar ökade andelen utbildade men på en låg nivå: 5% till som högst 12% för en av metoderna (KbT). 4. Prediktionsanalyser på respondentnivå visade att högst effekter fanns i program med respondenter som var mer involverade i arbetet med KtP i olika funktioner. 5. På kommun/landstingsnivå fanns de mest framgångsrika organisatio-nerna i regioner med högre befolkningstäthet, större städer, och i betingelsen ”interventionskommuner” än i jämförelsekommuner och i lägst grad i den sist inkluderade ”omgången” i KtP. 6. För behandlingsmetoder fanns ett samband med 10 av 18 index i ORC medan för bedömningsmetoder bara ett av 18 index predicerade en hög användning år 2014. Organisationsfaktorer som ledarskap, förmåga att motivera medarbetarna, medinflytande, låg stress, tydliga mål och uppdragsformulering predicerade ökad användning. 7. Respondenternas uppfattning om betydelsen av samverkan mellan huvudmän var hela tiden positiv och som mest (2014) svarade 71% att samverkan fanns etablerad. Bedömningen fick stöd i en separat enkät-undersökning där 17 av 20 län upprättat integrerade mottagningar mellan socialtjänst och sjukvård/psykiatri år 2014 och samverkansavtal hade ingåtts i 14 län. Respondenter inom sjukvården uttryckte en måttlig men signifikant mer positiv syn på samverkan än respondenter inom socialtjänsten. 8. Brukarmedverkan bedömdes som en angelägen uppgift för socialtjänst och sjukvård under hela studien, men viktigare inom sjukvård än inom socialtjänst. Ökningen i brukarmedverkan validerades i två separata undersökningar till landets brukarråd och beroendemottagningarna i samtliga län. 9. Synen på Socialstyrelsen riktlinjer var positiv från 2010 och genom hela studien. Personal från sjukvård var mer positiv till riktlinjerna än personal inom socialtjänsten. 10. Kunskapsutvecklingen och behovet av ökade kunskaper betonades av samtliga respondenter under hela undersökningsperioden men personal inom socialtjänsten bedömde kunskapsökningen som större än sjukvården under hela undersökningsperioden. Ökningen av utbildningsnivån i respondentenkäterna validerades mot de årliga rapporterna från KtP. 11. Implementeringen av tre uppföljningsmetoder genomfördes mellan 2011 och 2014 och följdes kontinuerligt i 13 av initialt 15 län. Det var tre inbördes mycket olika metoder som användes och som fick ekonomiskt stöd från KtP under tre år. UIV var den mest traditionella uppföljningsmetodiken och implementerades i tre nya län förutom Göteborg där den användes reguljärt. Mångbesökarmodellen avsåg att kartlägga sökandeströmmen för brukare med multipla vårdbehov och stora insatser. (5 län). LOKE syftade till att skapa kontinuerlig och systematisk dokumentation av målgrupper, insatser och resultat och att generera kunskap om de egna arbetsmetoderna. Initiala intervjuer gjordes med ansvariga, enkäter till deltagarna och avslutande intervju till både brukare och personal. Resultat: Samtliga tre metoder disseminerades planenligt. UIV nådde 385 personalmedlemmar och 848 brukare/klienter. Mångbesökarmodellen prövades och genomfördes i 5 län med 110 personalmedlemmar och 57 brukare. Metoden bedömdes som ”ej fullt utvecklad” av dem som använde den och var komplicerad att implementera. LOKE användes i 5 län och hade nått 1700 personalmedlemmar och en population klienter inom socialtjänsten med 5.700 brukare från olika typer av socialtjänstverk-samheter. 12. Arbetet med brukarmedverkan och brukarinflytande markerade en uttalad ambition att stärka brukarnas inflytande inom missbruks- och beroendevården. KtP vände sig till brukarföreningarna i landet. Metodik i uppföljningen var observationer vid möten, enkäter till de ansvariga för brukarorganisationerna och en avslutande enkät som riktade sig såväl till brukarråd som till verksamhetsansvariga inom samtliga beroendecentra i landet. Resultat: Antalet brukarråd ökade från ett till två år 2009 till minst ett i vardera 20 län år 2014. Utbildningar i brukarrevisionsmetodik ökade så att vid årsskiftet 2013/2014 totalt 15 län utbildat brukar-revisorer och 10 län hade genomfört brukarstyrda brukarrevisioner fram till 2013/2014. Det fanns ett klart samband mellan de insatser som gjordes av KtP och
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| 4. |
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| 5. |
- Fridell, Mats, et al.
(författare)
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Prediction of psychiatric comorbidity on premature death in a cohort of patients with substance use disorders : A 42-year follow-up
- 2019
-
Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 19:1, s. 150-150
-
Tidskriftsartikel (refereegranskat)abstract
- Background: We need to better understand how the use of different substances and psychiatric comorbidity influence premature death generally and cause-specific death by overdose, intoxication and somatic disorders in people with substance use disorders. Method: A cohort of 1405 patients consecutively admitted to a Swedish detoxification unit for substance use disorders in 1970-1995 was followed-up for 42 years. Substances were identified by toxicological analyses. Mortality figures were obtained from a national registry. Causes of death were diagnosed by forensic autopsy in 594 patients deceased by 2012. Predictions were calculated by competing risks analysis. Results: Forty-two per cent of the cohort died during follow-up; more men than women (46.3% vs 30.4%). The standardised mortality ratio (SMR) was calculated as the ratio of observed deaths in males and females in specific age groups in the cohort versus expected deaths in corresponding groups in the general population. SMR was 5.68 for men (CI 95%; 5.04-6.11) and 4.98 (CI 95%; 4.08-5.88) for women. The crude mortality rate (number of deaths divided by number of person observation years) was 2.28% for men and 1.87% for women. Opiates predicted increased risk of premature death while amphetamine and cannabis predicted lower risk. Comorbid psychiatric disorders were identified in 378 cases and personality disorders in 763 cases. Primary psychoses or mood/depression and anxiety disorders predicted a higher risk of premature mortality. Death by overdose was predicted by male gender, younger age at admission to substance treatment, opiate use, and comorbid depression and anxiety syndromes. Cannabis and amphetamine use predicted a lower risk of overdose. Death by intoxication was predicted by male gender, use of sedatives/hypnotics or alcohol/mixed substances, primary psychoses and depression/anxiety syndromes. Premature death by somatic disorder was predicted by male gender and alcohol/mixed abuse. Conclusion: Psychiatric comorbid disorders were important risk factors for premature drug-related death. Early identification of these factors may be life-saving in the treatment of patients with substance use disorders.
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| 6. |
- Fridell, Staffan, 1952-, et al.
(författare)
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Märkligt märke
- 2015
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Ingår i: Saga och sed. - 0586-5360. ; , s. 87-89
-
Tidskriftsartikel (refereegranskat)
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| 7. |
- Fridell, Staffan, 1952-, et al.
(författare)
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Om det förhistoriska Roden
- 2018
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Ingår i: Namn och bygd. - 0077-2704. ; 106, s. 159-160
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Tidskriftsartikel (refereegranskat)
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| 8. |
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| 9. |
- Fridell, Staffan, 1952-, et al.
(författare)
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The Dialect of the Kensington Stone
- 2019
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Ingår i: Futhark. - : Uppsala University. - 1892-0950 .- 2003-296X. ; 8, s. 163-166
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 10. |
- Fridell, Staffan, 1952-, et al.
(författare)
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Var låg noret i Norunda härd?
- 2019
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Ingår i: Namn och bygd. - 0077-2704. ; 107, s. 31-37
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Tidskriftsartikel (refereegranskat)
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| 11. |
- Olsson, Tina M., et al.
(författare)
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The five-year costs and benefits of extended psychological and psychiatric assessment versus standard intake interview for women with comorbid substance use disorders treated in compulsory care in Sweden
- 2018
-
Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Women with comorbid substance use disorders are an extremely vulnerable group having an increased relative risk of negative outcomes such as incarceration, morbidity and mortality. In Sweden, women with comorbid substance use disorders may be placed in compulsory care for substance abuse treatment. Clinical intake assessment procedures are a distinct aspect of clinical practice and are a foundation upon which client motivation and continued treatment occurs.Method: The current study is a naturalistic quasi-experiment and aims to assess the five-year costs and benefits of a standard intake interview versus an extended psychological and psychiatric assessment for a group of chronic substance abusing women placed in compulsory care in Sweden between 1997 and 2000. Official register data on criminal activity, healthcare use, compulsory care stays and other services was retrieved and all resources used by study participants from date of index care episode was valued. In addition, the cost of providing the intake assessment was estimated.Results: Results show that the extended assessment resulted in higher net costs over five years of between 256,000 and 557,000 SEK per person for women placed in care via the Law on Compulsory Care for Substance Abusers (LVM). Higher assessment costs made up a portion of this cost. The majority of this cost (47-57%) falls on the local municipality (social welfare) and 11.6-13.7% falls on the individual patient.Conclusions: Solid evidence supporting the clinical utility or incremental validity of assessment for improving treatment outcomes in this setting was not confirmed.
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| 12. |
- Olsson, Tina, et al.
(författare)
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Women with comorbid substance dependence and psychiatric disorders in Sweden: a longitudinal study of hospital care utilization and costs.
- 2015
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Substance use disorders are regarded as one of the most prevalent, deadly and costly of health problems. Research has consistently found that the prevalence of other psychiatric disorders among those with substance related disorders is substantial. Combined, these disorders lead to considerable disability and health years lost worldwide as well as extraordinary societal costs. Relatively little of the literature on substance dependence and its impact on healthcare utilization and associated costs has focused specifically on chronic drug users, adolescents or women. In addition, the research that has been conducted relies largely on self-reported data and does not provide long-term estimates of hospital care utilization. The purpose of this study is to describe the long-term (24-32 year) healthcare utilization and it's associated costs for a nationally representative cohort of chronic substance abusing women (adults and adolescents) remanded to compulsory care between 1997-2000 (index episode). As such, this is the first study investigating healthcare costs for women in compulsory treatment in Sweden.
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| 13. |
- Pernebo, Karin
(författare)
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Children in group interventions after exposure to violence toward a caregiver : Experiences, needs, and outcomes
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis consists of three empirical studies, all part of the same research project, with a general aim to explore interventions for children exposed to intimate partner violence (IPV). Because witnessing violence toward a caregiver is associated with negative impact on children’s health and development, effective interventions for children exposed to IPV are necessary.The aim of Study I was to elucidate young children’s experiences of participating in group interventions for children exposed to IPV. Nine children, aged 4 to 6 years, were interviewed after participating in group programs designed for children exposed to IPV. The interviews were analyzed using interpretative phenomenological analysis. Five master themes embracing the children’s experiences were identified: joy; security; relatedness; talking; and competence.The aim of Study II was to investigate young children’s accounts of their abused parent. Interviews were conducted with 17 children between 4 and 13 years old who had witnessed IPV. Thematic analysis identified three main themes: coherent accounts of the parent; deficient accounts of the parent; and parent as a trauma trigger.Study III was an effectiveness study investigating the outcomes of two group interventions for children exposed to IPV and their non-offending parent: one psycho-educative community-based intervention (CBI) and one psychotherapeutic treatment intervention. The study included 50 children between 4 and 13 years old and their mothers. Child and maternal mental health problems and trauma symptoms were assessed before and after treatment. The results indicate that although children benefited from both interventions, symptom reduction was larger in the psychotherapeutic intervention. Despite these improvements, most of the children’s mothers still reported child trauma symptoms at clinical levels post treatment. Both interventions, however, significantly reduced maternal post-traumatic stress.The results showed that children generally appreciated and benefited from both interventions studied, but most still showed symptoms at clinical levels post treatment and a possible need for additional and/or different support and interventions. These results indicate not only the need for continuous and post-treatment assessment of children’s symptoms in routine clinical practice, but also the value of including children as informants in research.
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| 14. |
- Pernebo, Karin, et al.
(författare)
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Outcomes of a psychotherapeutic and a psychoeducative group intervention for children exposed to intimate partner violence
- 2017
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Konferensbidrag (refereegranskat)abstract
- Introduction: Experience of violence towards a caregiver during childhood is associated with a risk of negative impacton children’s health and development, and there is a need for effective interventions in clinical as well as in communitysettings. Research has shown that existing interventions in Sweden for children with experience of violence towards acaregiver are associated with positive but insufficient outcomes. In addition to implementation of new evidence basedinterventions expanded knowledge is needed on outcomes of established interventions aiming at identifying possibleneeds for improvement.Method: The current study is an effectiveness study aiming at investigating the outcomes of two established groupinterventions for children exposed to intimate partner violence and their non-offending parent, one community basedpsychoeducative intervention and one psychotherapeutic treatment intervention. The study included 50 children, 24girls and 26 boys, aged 4-13 years. Background information, child and parental mental health problems and traumasymptoms was assessed pre- and post-treatment as well as 6 and 12 months post treatment.Results: The results indicate that children benefit from both interventions, yet mothers of a majority of the children stillreported child trauma symptoms at clinical levels post treatment. Preliminary results from the follow up assessments willbe presented, such as outcomes in symptoms reduction and possible associations with confounding variables.Discussion: Theoretical, methodological and clinical implications will be discussed.
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| 15. |
- Pernebo, Karin, et al.
(författare)
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Outcomes of group interventions for children exposed to intimate partner violence, 6- and 12-months follow-up of an effectiveness study
- 2018
-
Konferensbidrag (refereegranskat)abstract
- AbstractIntroduction: Intimate partner violence is a global public health problem. Many children worldwide are living with a mother who is a victim of intimate partner violence, a situation associated with a serious risk of short- as well as long-term consequences to children’s health and development.There is a need for effective interventions for children exposed to intimate partner violence. Existing interventions in Sweden have shown positive but insufficient outcomes. Extended knowledge on lasting outcomes, aiming at improving established interventions is needed.Method: The current study is an effectiveness study investigating the outcomes of two established group interventions for children exposed to intimate partner violence and their non-offending parent. The study included 50 children, 24 girls and 26 boys, aged 4-13 years. Background information, child and parental mental health problems and trauma symptoms were assessed pre- and post-treatment, as well as 6 and 12 months post treatment.Results: The results indicate that children benefit from the group interventions, although post intervention a majority of mothers still reported symptoms in their children at clinical levels. Late improvements were registered at the follow-up assessments. The findings indicate that mothers benefit from these primarily child-oriented interventions, showing considerable and lasting reduction of symptoms.Discussion: Currently data from the 6- and 12-months follow-up assessments are being analyzed. Preliminary results include paths of continuous symptoms reduction for children and mothers. Possible associations between child and maternal levels of symptoms, as well as methodological and clinical implications will be discussed.
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| 16. |
- Pernebo, Karin, et al.
(författare)
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Outcomes of psychotherapeutic and psychoeducative group interventions for children exposed to intimate partner violence
- 2018
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Ingår i: International Journal of Child Abuse & Neglect. - : Elsevier Ltd. - 0145-2134 .- 1873-7757. ; 79, s. 213-223
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Tidskriftsartikel (refereegranskat)abstract
- Witnessing violence toward a caregiver during childhood is associated with negative impact on children's health and development, and there is a need for effective interventions for children exposed to intimate partner violence in clinical as well as in community settings. The current effectiveness study investigated symptom reduction after participation in two established group interventions (one community-based psychoeducative intervention; one psychotherapeutic treatment intervention) for children exposed to intimate partner violence and for their non-offending parent. The study included 50 children—24 girls and 26 boys—aged 4–13 years and their mothers. Child and maternal mental health problems and trauma symptoms were assessed pre- and post-treatment. The results indicate that although children showed benefits from both interventions, symptom reduction was larger in the psychotherapeutic intervention, and children with initially high levels of trauma symptoms benefited the most. Despite these improvements, a majority of the children's mothers still reported child trauma symptoms at clinical levels post-treatment. Both interventions substantially reduced maternal post-traumatic stress. The results indicate a need for routine follow-up of children's symptoms after interventions.
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| 17. |
- Pernebo, Karin, et al.
(författare)
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Reduced psychiatric symptoms at 6 and 12 months’ follow-up of psychotherapeutic and psychoeducative group interventions for children exposed to intimate partner violence
- 2019
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Ingår i: International Journal of Child Abuse & Neglect. - : Elsevier. - 0145-2134 .- 1873-7757. ; 93, s. 228-238
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Tidskriftsartikel (refereegranskat)abstract
- Background: Long-term follow-up studies of interventions for children exposed to intimate partner violence are few, and the sustainability of their outcomes often remains unexplored and uncertain. Current research including follow-up assessment suggests that treatment gains may be maintained or continue post termination. In addition some children may show increased levels of symptoms. Objective: The present effectiveness study investigated the long-term outcomes of two established group interventions for children exposed to intimate partner violence and their non-offending parent. Participants and Setting: The study included 50 children, 24 girls and 26 boys, aged 4 to 13 years attending a psychotherapeutic child and adolescent mental health service intervention and a psychoeducative community-based intervention. Methods: Background information, child and parental mental health problems, trauma symptoms, and exposure to violence were assessed pre- and post treatment and at 6 and 12 months’ follow-up. Results: Sustained treatment gains and late improvements in children's internalizing and externalizing symptoms and in symptoms of traumatic stress were recorded from post treatment to the follow-up assessments (p =.004–.044; d = 0.29–0.67). No significant increase in symptoms was reported. Additionally, very little continued or renewed child exposure to violence was reported. Conclusions: The results of the study indicate that the children did benefit from the two interventions studied and that the outcomes of reduced child symptoms and protection from exposure to violence were sustainable. Children with severe trauma symptoms benefited the most, though maternal psychological problems may for some have hindered recovery. Clinical implications are discussed.
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| 18. |
- Pernebo, Karin, et al.
(författare)
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Six and 12-month follow-up of group interventions for children exposed to intimate partner violence
- 2019
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Konferensbidrag (refereegranskat)abstract
- Introduction: Children exposed to intimate partner violence are at risk of long-term consequences on their health and development as well as of continued or renewed exposure to witnessing violence and of being subjected to physical child abuse.There is a need for effective interventions for children exposed to intimate partner violence. Existing interventions in Sweden have shown positive but insufficient outcomes. Long term health effects and children’s protection from violence are often not investigated. Extended knowledge on lasting outcomes, aiming at improving established interventions is needed.Method: The current study is an effectiveness study investigating the outcomes of two established group interventions for children exposed to intimate partner violence and their non-offending parent. The study included 50 children, 24 girls and 26 boys, aged 4-13 years. Background information, child and parental mental health problems and trauma symptoms were assessed pre- and post-treatment, as well as 6 and 12 months post treatment. Additionally children’s exposure to physical and psychological child maltreatment and to intimate partner violence was tracked.Results: The results indicate that children benefit from the group interventions. Late improvements were registered at the follow-up assessments. The findings indicate that children’s exposure to violence decreased, with physical maltreatment decreasing prior to exposure to psychological maltreatment.Discussion: Currently data from the 6- and 12-months follow-up assessments are being analyzed. Preliminary results include paths of continuous symptoms reduction for children and children’s long-term exposure to violence. Possible associations between child and maternal levels of symptoms, as well as methodological and clinical implications will be discussed.
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| 19. |
- Pernebo, Karin, et al.
(författare)
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Utvärdering av två svenska gruppinterventioner för barn med erfarenhet av våld i föräldrarnas nära relation.
- 2016
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Konferensbidrag (refereegranskat)abstract
- Utvärdering av två svenska gruppinterventioner för barn med erfarenhet av våld i föräldrarnas nära relation.Karin Pernebo¹², Mats Fridell 3, Idor Svensson1 and Kjerstin Almqvist4¹ Department of Psychology, Linnaeus University, Sweden² Department of Research and Development, Region Kronoberg3 Department of Psychology, Lund University, Sweden4 Department of Psychology, Karlstad University, Sweden AbstractErfarenhet av våld mot primär omsorgsgivare medför risk för negativ påverkan på barns hälsa och utveckling och det finns ett behov av genomförbara och verksamma interventioner för dessa barn. Tidigare studier visar att befintliga insatser i Sverige till barn med erfarenhet av våld i föräldrarnas nära relation är uppskattade av barn och föräldrar samt är förknippade med positivt men otillräckligt utfall. Ökad kunskap behövs för att bättre förstå vad som är verksamt och hur insatser kan förbättras. I en pågående studie granskas två väletablerade och manualiserade gruppinterventioner som erbjuds inom ramen för ordinarie etablerad klinisk verksamhet för barn med erfarenhet av våld mot primär omsorgsgivare. Den ena interventionen är tydligt psykoedukativ och den andra har sin grund i utvecklingspsykologi, traumateori och psykodynamisk teori. Interventionerna innehåller parallella grupper för barn och för den våldsutsatta föräldern med ett besök per vecka, vid 12-15 tillfällen. 50 barn i åldern 4-13 år ingår i studien. Barn och föräldrar har inkluderats kontinuerligt under en tvåårsperiod. Kontextuella faktorer, förekomst av våld (dvs. förälderns utsatthet, barnets exponering för våld mot föräldern och barnets egen våldsutsatthet), generell symtombelastning samt symtom på posttraumatisk stress hos barnen och generell symtombelastning samt symtom på posttraumatisk stress hos den våldsutsatta föräldern mäts före och efter intervention, samt efter 6 månader och efter 1 år. Preliminära resultat från före och eftermätning presenteras vad gäller traumasymtom och generella symtom på psykisk ohälsa hos barnen. Eventuella samband med exempelvis typ av gruppintervention, barnets egen våldsutsatthet, förälders psykiska ohälsa, pågående rättsliga tvister och umgänge diskuteras.
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| 20. |
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| 21. |
- Strandberg, Svante, 1942-, et al.
(författare)
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Thorsten Andersson
- 2018
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Annan publikation (populärvet., debatt m.m.)
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| 22. |
- Thylstrup, Birgitte, et al.
(författare)
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Did you get any help? A post-hoc secondary analysis of a randomized controlled trial of psychoeducation for patients with antisocial personality disorder in outpatient substance abuse treatment programs
- 2017
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: People in treatment for substance use disorder commonly have comorbid personality disorders, including antisocial personality disorder. Little is known about treatments that specifically address comorbid antisocial personality disorder. Methods: Self-rated help received for antisocial personality disorder was assessed during follow-ups at 3, 9 and 15 months post-randomization of a randomized trial of psychoeducation for people with comorbid substance use and antisocial personality disorder (n = 175). Results: Randomization to psychoeducation was associated with increased perceived help for antisocial personality disorder. Perceived help for antisocial personality disorder was in turn associated with more days abstinent and higher treatment satisfaction at the 3-month follow-up, and reduced risk of dropping out of treatment after the 3-month follow-up, and perceived help mediated the effects of random assignment on days abstinent at 3-month.follow-up. Conclusions: Brief psychoeducation for antisocial personality disorder increased patients' self-rated help for antisocial personality disorder in substance abuse treatment, and reporting having received help for antisocial personality disorder was in turn associated with better short-term outcomes, e.g., days abstinent, dropout from treatment and treatment satisfaction. Trial registration: ISRCTN registry, ISRCTN67266318 , retrospectively registered 17/7/2012.
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| 23. |
- Öhlin, Leif, et al.
(författare)
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Buprenorphine maintenance program with contracted work/education and low tolerance for non-prescribed drug use: a cohort study of outcome for women and men after seven years.
- 2015
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 15:1, s. 56-68
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundA seven-year follow-up of heroin dependent patients treated in a buprenorphine-maintenance program combining contracted work/education and low tolerance for non-prescribed drug use. Gender-specific differences in outcome were analysed. MethodsA consecutively admitted cohort of 135 men and 35 women, with eight years of heroin abuse/dependence on average was admitted to enhanced buprenorphine maintenance treatment. Standardized interviews, diagnostic assessments of psychiatric disorders and psychosocial conditions were conducted at admission and at follow-ups. Outcome associated with gender was reported for abstinence, retention, psychiatric symptoms, employment and criminal convictions. Results148 patients started treatment. After seven years, 94/148 patients (64%) were retained in the program, employed and abstinent from drugs and alcohol. Women had more continuous abstinence, retention and employment than men (76% versus 60%). After one year patients with a high-risk consumption of alcohol were no longer heavy consumers of alcohol and remained so throughout the study (p < .001). All women regained custody of their children. At admission, more women than men had been admitted for psychiatric disorders (70%/44%) and to compulsory care for substance abuse (30%/18%). Initial gender differences of psychiatric co-morbidity decreased and were no longer significant after one year. More men than women had been imprisoned (62% versus 27%) or in non-institutional care (80% versus 49%). Criminal convictions were reduced from 1751 convictions at admission to 742 (58%) after seven years. Eight patients in the entire cohort died over the 7 years (0.7% per year). One patient died in the completers group while still in the program (0.1% per year). ConclusionsAfter seven years, two thirds of the patients in the program were abstinent and employed. Convictions ceased in the completers group. One patient died in the completers group. Women had superior long-term outcome compared to men: more continuous abstinence, employment and fewer convictions. Women also lived with their children to a higher extent than men. The positive outcome highlights the importance of maintaining high structure in combining pharmacological treatment with a focus on employment and psychological treatment and low tolerance for non-prescribed drug use.
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