Processes of Change in Early Childhood Interventions Mediation and Treatment Variability in the Incredible Years Teacher Classroom Management Programme
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- Institutt for psykisk helse 
Norsk Sammendrag Endringsprosesser i intervensjoner for barnehagen Det finnes et økende antall tidlig forebyggende intervensjoner rettet mot barns sosiale, emosjonelle, og atferdsmessige utvikling med dokumenterte behandlingseffekter. I hovedsak har evalueringer av slike intervensjoner fokusert på endringer i utfallsmålene, og i mindre grad undersøkt hvordan intervensjonene oppnår endringen. Samtidig vet man at en forståelse av endringsmekanismene er viktig for å optimalisere behandlingseffekter, gjenkjenne nødvendige betingelser for å oppnå effekt, samt identifisere årsaker til variasjon i behandlingseffekt blant deltagere. Avhandlingen baserte seg på data innhentet fra en velkjent forebyggende intervensjon, De Utrolig Årene - Barnehageprogrammet, hvor 1085 barn i alderen tre til seks år fra 90 barnehager deltok. Analysene viste at barna som deltok i intervensjonen opplevde en positiv endring i barn-voksen relasjonen, noe som videre styrket deres sosial kompetanse, samt minsket graden av emosjonelle og atferdsmessig vansker. I tillegg fant man at ulike grupper av barn opplevde ulik grad av endring, hvor barn med høy sosial kompetanse og mindre vansker hadde en begrenset behandlingseffekt, mens barn med moderate eller høye vansker opplevde størst grad av endring. Det kan argumenteres for at resultatene i avhandlingen gir støtte til både den underliggende teorien, samt de grunnleggende intervensjonsprinsippene, som De Utrolige Årene er bygget på. Videre kan det tenkes at økt fokus på endringsmekanismer vil kunne gi økte behandlingseffekter, og at en mer målrettet intervensjonspraksis vil bidra til å optimalisere behandlingen for de som trenger det mest.English Abstract Processes of Change in Early Childhood Interventions: Mediation and Treatment Variability in the Incredible Years Teacher Classroom Management Programme There is a growing number of early childhood interventions targeting children’s social, emotional, and behavioural development successful in achieving positive treatment effects. Understandably, initial evaluations mainly investigate changes in the target outcomes, more rarely delving into the respective processes of change – which mechanisms are responsible for change and under which conditions they apply. Yet, knowledge on these processes are essential towards improving efficacy, optimising treatment effects, identifying necessary conditions or causes of treatment variability, as well as informing the theories from which the interventions are conceived and designed. The objective of this thesis was to investigate the potential mediation of treatment effects through the child-teacher relationship, and if the children’s baseline characteristics constituted a probable cause of treatment variability, examining the Incredible Years Teacher Classroom Management (IY TCM) programme. More specifically, Paper I investigate the degree of change in the conflict and closeness dimensions of the child-teacher relationship following intervention, Paper II tested whether the expected changes in the child-teacher relationship mediated the treatment effects, and Paper III explored whether latent groups based on the children’s baseline scores showed sign of treatment variability. The thesis was based on data from a quasi-experimental pre-post trial of the IY TCM programme, with a matched control condition including 1085 children (50.3% boys, M age = 4.22 years; SD age = 0.88 years). In brief, the principles and content of the IY TCM is mainly based on social learning and attachment theory, proposing that children’s interactions and relationships with its primary caregivers has great influence on the children’s behaviour and mental health. The objective of the intervention is to support the teacher in developing positive interactional patterns and relationships with the children as a mechanism to promote socioemotional development, and prevent behaviour problems. The intervention lasted approximately nine months, implemented through workshops with two IY-qualified group leaders, and included role-play, discussions, one-on-on mentoring, and reading assignments. After each workshop, the participants received specific tasks to perform when back at their childcare unit, which were discussed during the following workshop. The analyses supported the theoretical assumptions: childcare teachers in the intervention reported more favourable changes in the child-teacher relationship than the teachers in the control condition (Paper I); changes in the child-teacher relationship were found to mediate the changes in the target outcomes (Paper II); and the latent groups, based on the baseline assessment, demonstrated signs of differential treatment effects following the intervention (Paper III). Evidence-based interventions are a continuous process, in which the design, implementation, and evaluation is understood as an iterative practice towards optimal treatment effect and intervention efficacy. The results provide integrity to the underlying principles of the IY TCM, indicating that the theory and actions performed are worth pursuing. More so, the thesis elucidates how distinct groups of children should be expected to experience differential treatment effects based on their functioning at the start of the intervention.