Utilizing Ideas Impact Framework for Development and Testing of a Transdiagnostic Intervention Aimed at Preventing Child Maltreatment, Internalizing and Externalizing Problems

Introduction: Meta-analyses synthesizing several decades of child mental health prevention have shown that effect sizes have been attenuating, or at best, are at standstill in the magnitude of small to moderate. Despite a mounting focus on program fidelity to support evidence-based intervention (EBI) in the last two decades, the outcomes have generally not improved. One answer to this problem is to move beyond the one dimensional focus on evaluation of program “packages” towards empirically guided intervention development to optimize treatment content. Expanding the focus by accumulating evidence at the intervention component level, and attaining empirical evidence on what component works (or not) for whom in what context, the development of new intervention may increase the impact in EBI. Inspired by the Harvard Centre on the Developing child’s IDEAS Impact Framework, and grounded in two decades of evaluation and implementation of Parent Management Training – Oregon model (PMTO), the Norwegian Center for Child Behavioral Development have launched an innovation project to adapt and test new intervention components for a transdiagnostic intervention based on PMTO. In addition to child externalizing problems, the 4 – 12 sessions intervention targets internalizing problems and families at risk of maltreatment. Central aims are to promote implementability by developing a brief and transdiagnostic EBI that can be delivered in multiple frontline community services.

Methods: Core features in the IDEAS Impact Framework are to develop a conceptual model of intervention components, targets, and outcomes that is based on a theory of change derived from systematic literature searches. Other central features are the construction of an evaluation plan to describe optimization of treatment components in fast iterative cycles where we utilize single case experimental designs. We present results from the intervention development; the current pilot testing, the co-creation reference groups with intervention users, and the resulting conceptual and sequential models of the intervention.

Results: So far, we have developed a hybrid intervention with a theory of change combining (1) attachment-based intervention, and evidence from translational neurobiology, with evidence from (2) Social Interaction Learning model. Moreover, preliminary results from reference groups indicates that there is a need for an EBI that combines structured and adaptive sequences of delivery to promote both ease of use and tailoring according to individual needs. Thus, we currently pilot a (1) structured sequence of core components aimed improving parents’ and children’s self-regulatory capacities addressed in sensitive relationship building and emotion regulation components. The structured sequence is followed by (2) the adaptive sequence, where parents are trained in how to build specific competencies in their child according to child and family needs; including the components child skill building, rules and limits, and predictable routines.