Denna arbetsrapport bygger på en förstudie av arbetsmodellen Trappan. Trappan är en samtalsmodell som riktar sig till barn som har bevittnat våld och som används inom främst socialtjänsten. Studien syftar till att lägga en grund för ett större forskningsprojekt och syftar till att undersöka hur trappan-modellen är konstruerad, hur den de facto används och i vilka typer av verksamheter. Vidare undersöks hur arbetet organiseras, om det faktiska arbetet överensstämmer med de grundantaganden som modellen vilar på samt de hinder och möjligheter metodanvändare upplever i arbetet.

Marie Cederschiöld högskola fick 2019 i uppdrag att utvärdera insatsen skolsociala team. Syftet blev att titta närmare på hur teamen arbetar med de elever som blir aktuella för stöd och vilken typ av stöd som kan vara verksamt. Resultaten bygger på intervjuer och enkätsvar. De visar att en relativt stor andel av eleverna som får stödet har en fastställd neuropsykiatrisk diagnos och att de olika stadsdelarna har organiserat arbetet med skolsociala team på en mängd olika sätt när det gäller rumslig placering, graden av individfokus och teamsammansättning. Att arbeta för att skapa en ökad trygghet och studiero, samt ett arbete med en rad olika typer av stödsamtal är de arbetssätt som används i högst utsträckning. I de fall samverkan beskrivs ha fungerat bra har eleverna också lyckats nå upp till insatsens uppsatta mål. Personkontinuitet, tillgänglighet, förmåga att skapa en förtroendefull relation till den enskilde eleven, samt uthållighet i arbetet är andra framgångsfaktorer som framkommer och stämmer överens med tidigare forskning kring hur elevers motståndskraft kan stärkas. Därför talar mycket för att relationsbyggande med enskilda elever bör utgöra en grundpelare i arbetet med skolsociala team. Den generella utmaningen med den här typen av verksamhetsöverskridande samverkan kring elever med frånvaro blir att kunna definiera teamens yttre gränser och målgrupp, samtidigt som flexibilitet och stabila relationer kan upprätthållas.

Barns fysiska och psykiska hälsa kan påverkas allvarligt både på kort och lång sikt av att uppleva våld. Att barn som upplever våld ges möjlighet till beprövade stöd och hjälpinsatser kan därför inte nog betonas. Trappanmodellen är en svensk stödmetod för krissamtal med barn som upplevt våld i sin familj som är brett använd främst inom socialtjänsten i Sverige. Att arbeta enligt Trappan modellen innebär att man erbjuder barn individuella krissamtal i tre steg, kontakt, rekonstruktion och kunskap. Genom Trappansamtalen får barn en möjlighet att berätta om sina upplevelser och tankar. Trappan modellen växte fram i ett projekt som Rädda Barnen drev 1996-1999. Målsättningen med projektet var att synliggöra barn som upplevt våld och att utveckla en modell för krissamtal för dessa barn. Boken ”och han sparkade mamma – Trappanmodellen i möte med barn som bevittnar våld ” skriven av Ami Arnell och Inger Ekbom, kom ut första gången på Rädda Barnens förlag 1999. Boken finns nu i en tredje omarbetad upplaga och idag arrangeras utbildning i Trappan modellen med högskolepoäng av Ersta Sköndal Bräcke högskola. Inger Ekbom, socionom och leg. Psykoterapeut kommer under dagen att berätta hur metoden är uppbyggd och hur den är tänkt att användas. Därefter kommer Susanne Björk studierektor för utbildningen och fil dr Maria Ingemarson beskriva en planerad förstudie som är tänkt att utgöra grunden för en tydlig definition av Trappans programteoretiska modell och ett genomförande av en större systematisk utvärdering av själva metoden och dess effekter. Förstudien har en kartläggande och en undersökande ansats och planeras innefatta litteraturstudier, frågeformulär till verksamheter i Sverige som har utbildats i Trappan samt semistrukturerade intervjuer med professionella metodutövare. 

Clarity of school rules and teachers’ use of praise are strategies suggested to facilitate a positive classroom climate. Studies indicate difficulties for teachers to use such approaches in classrooms with higher levels of disruption. To study (1) if student-rated clarity of school rules, use of praise, and classroom climate differ between students in classes with lower numbers of disruptive students versus classes with higher numbers, (2) if clarity of school rules and teacher’s use of praise are longitudinally associated with classroom climate, (3) if the possible longitudinal association differs between groups, classes (n = 109) in school grades 5–7 were divided into two groups, based on head teacher ratings of disruptive students in class. Baseline and 12-month follow-up responses collected within a Swedish trial were used to perform multiple regression analysis, to compare groups and to investigate possible longitudinal associations. Students in classes with less disruption rated all variables more positively. Classroom climate deteriorated over time in both groups, even if the low disruption group perceived their climate as more positive at follow up. Clarity of school rules did not substantially contribute to classroom climate longitudinally, whereas teacher’s use of praise to some extent did. The difference in longitudinal associations between groups was marginal, hence our hypothesis on weaker associations in the high disruption group could not be confirmed. Clarity of school rules is not longitudinally associated with classroom climate, but teachers may positively influence the learning environment by giving praise, regardless of level of disruption.

PS is multi-component intervention at the primary prevention level and aims at creating a positive learning environment and decreasing problem behaviours among students in the school years 4-9. During 2009-2012 the programme was both implemented and studied for the first time in a Swedish context. The present thesis comprises four studies of PS and applies a mixed methods approach. The thesis aims to study: 1) If the programme is effective in enhancing the classroom climate, and decreasing problem behaviours among students (Study I), 2) teachers and school staff’s perceptions of programme and implementation (study II and III) and 3) if teacher’s use of praise and clarity of school rules, regardless of programme use, are useful as classroom management techniques, and if there are any differences between classes in terms of disruption (study IV). A quasi-randomized trial was conducted in study I, comprising 3207 students in school grades 5-7 and 188 teachers in 23 schools in the wider area of Stockholm. The participating children and their head teachers answered self-report questionnaires on three occasions: At baseline and one and two years after programme initiation. Degree of implementation in the schools was also measured. Further, a qualitative design with semi-structured interviews and thematic content analysis was used in study II and III. The interviews were conducted in seven PS schools with seven school leaders and 13 school teachers during 2010 and 2011. In study IV, students (n=2266) and classes were divided into two groups, based on teacher ratings of disruptive students in class. Baseline and 12-month follow-up responses were used to perform multiple regression analysis, to compare groups and to investigate possible longitudinal associations. Study I showed no significant effects on students’ problem behaviours and classroom climate at last follow-up. The findings from study II indicated barriers to programme commitment in terms of lack of consensus, collaboration barriers and insufficient process management. It was concluded that leadership, coaching and staff selection need particular attention when implementing a programme like PS, since those factors have been defined as important implementation drivers, both in this study and previously. Study III showed that teachers’ professional identity, programme understanding and experience of change were factors affecting implementation. Ambiguities regarding the boundaries of the social assignment, opposition against the theoretical underpinnings and an unclear core component were identified as implementation barriers. In study IV it was shown that clarity of school rules did not substantially contribute to classroom climate, whereas teacher’s use of praise to some extent did. The hypothesis on weaker associations in the low disruption group could not be confirmed. This thesis cannot provide an answer to the question whether PS is effective or not, since findings indicate that the implementation did not succeed. However, findings in the last study indicate that teacher’s use of praise may contribute to improve the classroom climate. If the PS programme is to be used again there is a need for revisions, and sufficient time for schools to consider programme adoption will be crucial. Aspects of programme implementation are further discussed.

Prevention in School (PS) is a comprehensive program which aims to improve the learning climate and reduce problem behavior in elementary schools. Core components are teaching of school rules, praise and rewards to support prosocial behavior, and a forum involving parents. This trial investigated the effects of PS on its intended outcomes, and includes 23 schools, 3,207 students, and 188 teachers. Multilevel regression analyses indicated no program effects two years after the start of the program. Problems with program components, implementation and study limitations may have contributed to the null findings. The lessons learned may be used to guide program revisions, and are important to consider in future attempts to implement and evaluate similar school interventions in a Swedish context.

Background Depending on the definitions used, between 5 and 20 % of all Swedish children grow up with at least one parent suffering from alcohol problems, while 6 % have at least one parent who has received inpatient psychiatric care, conditions that may affect the children negatively. Nine out of ten Swedish municipalities therefore provide support resources, but less than 2 % of these children are reached by such support. Delivering intervention programs via the Internet is a promising strategy. However, web-based programs targeting this at-risk group of children are scarce. We have previously developed a 1.5-h-long web-based self-help program, Alcohol & Coping, which appears to be effective with regards to adolescents’ own alcohol consumption. However, there is a need for a more intense program, and therefore we adapted Kopstoring, a comprehensive Dutch web-based psycho-educative prevention program, to fit the Swedish context. The purpose of the program, which in Swedish has been called Grubbel, is to strengthen protective factors, such as coping skills and psychological well-being, prevent the development of psychological disorders, and reduce alcohol consumption.

Methods/design The aim of the current study is to evaluate the effectiveness of Grubbel, which targets 15–25-year-olds whose parents have substance use problems and/or mental illness. Specific research questions relate to the participants’ own coping strategies, mental health status and substance use. The study was initiated in the spring of 2016 and uses a two-armed RCT design. Participants will be recruited via social media and also through existing agencies that provide support to this target group. The assessment will consist of a baseline measurement (t0) and three follow-ups after six (t1), 12 (t2), and 24 months (t3). Measures include YSR, CES-DC, Ladder of Life, Brief COPE, AUDIT-C, and WHOQOL-BREF.

Discussion Studies have revealed that the majority of children whose parents have substance use or mental health problems are not reached by the existing support. Thus, there is an urgent need to develop, implement, and evaluate novel intervention programs and disseminate successful programs to a broader audience. This study, investigating the effects of a web-based intervention, therefore makes an important contribution to this field of research.

Trial registration ISRCTN10099247. Retrospectively registered on August 31, 2016.

Purpose - The purpose of this paper is to investigate how teachers received and perceived the school programme Prevention in School (PS), a positive behavioural support programme; how did the teachers perceive the programme characteristics and themselves as providers; and how did this affect programme implementation? Design/methodology/approach - Qualitative methods with semi-structured interviews with 13 teachers and thematic content analysis were used. Findings - The teachers were heterogeneous in their views, with professional identity, programme understanding and experiencing change being important factors for the implementation. Ambiguities regarding the boundaries of the social assignment, opposition against the theoretical underpinnings and an unclear nomenclature in a core component affected the implementation negatively. Among the perceived benefits were instant rewards in the form of aha moments and increased self-awareness. The nature of the implementation barriers indicates that PS is in need of further development. Practical implications - Compatibility with teachers' ideologies, clarification of the social assignment and enough time to consider programme adoption are vital when implementing a programme like PS. Originality/value - The study provides context-specific understanding of teachers' perceptions of a behavioural support programme and of their role when trying to implement it. It is known that providers' perceptions affect the implementation and this study contributes to the field of implementation research, with particular respect to the school setting and comprehensive programmes like PS.

This study focuses on schools' organizational capacity to implement a Swedish school-wide programme, Prevention in School (PS). It is based on semi-structured interviews with seven headmasters and 13 teachers from seven Swedish schools. The interviews were analyzed by the use of qualitative content analysis. The findings show that the adoption of a comprehensive intervention like PS challenges the school organization as the staff encountered a variety of organizational barriers when implementing the programme. Factors connected to lack of consensus, collaboration and insufficient programme management were the main barriers that were identified. Teachers wanted a more extensive support from their headmasters in terms of participation in different programme activities. It was emphasized that peer coaches need to be prepared for their task, although the headmasters found it difficult to be able to choose those teachers who they perceived as the most suitable. It is concluded that leadership, coaching and staff selection need particular attention when implementing a programme like PS, since those factors have been defined as important implementation drivers, both in this study and previously.