Resilience Program Research Poul Lundgaard Bak MD The

Resilience Program Research Poul Lundgaard Bak, MD The Comittee for Health Education Copenhagen, Denmark Professor Antonella Marchetti Department of Psychology The Catholic University Milan, Italy Minimal Intervention Trials Theory of Mind Trial

First of all: THANK YOY !!! For making this project possible For wonderful cooperation and inspiration Aarhus Municipality Tryg Foundation Socialstyrelsen Commitee for Health Education Aarhus University Copenhagen University Greenland University College London Anna Freud Centre, London Tavistock Centre, London Catholic University Milan Co-authors in articles and books And many other professionals, children, young people and parents

Minimal Intervention Trials Major Results • All slides will be available – and contact information – sign up to the Newsletter on www. robusthed. dk • All details are described in the research articles • References on the last slide.

The Resilience Program www. robusthed. dk http: //myresilience. org A simple mental health education program with established knowledge about Mentalizing: How to think about your own thoughts - and the thoughts of others

Theory of change Assumptions • Mentalizing is helpful in complex situations • Mentalizing is a skill which you can practise Give people knowledge in simple terms about how to mentalize Improved conditions for mentalizing – individually and in groups Coping with challenges become easier Improved wellbeing, learning & social function

Research aim • We are looking at the delivery model of the program - the impact of minimal intervention • We are not looking at the content of the program – because the content is already established knowledge.

Intervention intensity Classic intervention – training and supervision Minimal intervention – short info • Skilled users • Useful for people for whom training is not possible? • Useful for busy people • Useful in the internet-age • Low cost - large scale

Minimal Intervention Trials A A letter with • short info • link to the program • invitation to local intro-lecture Send to 1. Foster carerers and residential institutions 2. Young adults with ADHD B Short introduction lecture 1. Public schools 2. Educational institutions (SOSU)

The Letter trials – population and method The Care Trial The ADHD Trial • 9114 children and young people in care • Randomized by care place into control and trial group • Letter send to trial group care places in august 2014 • Outcome measure: National test in danish reading spring 2016 • Intention to treat analysis • 7297 young people (18 -27 year) with ADHD diagnosis • Randomized into control and trial group • Letter send to trial group individuals in august 2014 • Outcome measure: Social security benefit frequency 2016 • Intention to treat analysis

The Letter trials – Results The Care Trial Significant higher danish reading results in the trial group compared to the control group The ADHD Trial No significant difference between trial and control group in terms of social security benefit frequency

The School & Education trials – population and method The Public School Trial • 24 trial schools (4253 students) 28 control schools (4669 students) • 1½-2 hour intro-lectures in trial schools in last semester 2014 • Outcome measure: National test in danish reading spring 2016 • Intention to treat analysis The Education Trial • Social and Health Education (SOSU) • 2 Trial Institutions 12 Control Institutions • Intro-lectures in trial institutions in last semester 2014 • Outcome measure: Social security benefit frequency 2016 • Intention to treat analysis

The School & Education trials – Results The Public School Trial The Education Trial No significant difference in danish reading results between trial group and control group No significant difference between trial and control group in terms of social security benefit frequency

Why these results? • Children in care: Improved reading • ADHD, Public Schools, SOSU: No significant results

Why these results? – WE DONT KNOW • Children in care: Improved reading • ADHD, Public Schools, SOSU: No significant results GUESSES: • Good and bad timing • Intervention dose • Outcome measures • xxx

Arguments for continued research and implementation studies. Implementation - Professional users Effect studies • DK Social club study: 90% users after 3 years • UK School Study Implementation rank: 4 on a 1 -6 scale • DK Prison Study: 79 % users after ½ year • DK Social club study: Major impact on high risk conflicts • Italy: Theory of Mind development

Arguments for continued research and implementation studies. Case studies Experienced users say: You need training and supervision International edition is published by Routledge early 2018.

Near future Research recommendations • Effect studies in specific (vulnerable) target groups - with regular training of staff and target group individuals. • No further research into minimal delivery models Current research and implementation Research projects • GP early intervention • Early prevention of child obesity • Policy analysis Greenland Implementation • Foster care – the Danish Parliament • Prevention of suicide in Greenland • Increasing interest and demand

The Committee for Health Education - Probably the best place to be for a program CHE has decades of experience: • High quality sustainable implementation in Health Education and Patient Empowerment • Collaboration with national and international research institutions in building up the evidence base for Health Programs • A comprehensive municipality and national authority network • The Committee is partner in actual and future Resilience Program research projects. • The Committee offer manualized Resilience Program training and supervision to organisations who want to implement the Program systematically.

Beyond research… The Resilience Program is simply a platform with established and common sense knowledge about careful thinking in daily language and metaphors People seems interested: The number of page visits this year on the program website is 481. 152

References • Fogtmann C: Forståelsens Psykologi • Lundgaard Bak, P. (2012). “Mentalizing communities for children, ” in: Mentalization Based Interventions with Children and Families, eds N. Midgley and I. Vrouva (London: Routledge). • Lundgaard Bak, P. (2016). Evaluation of the implementation of the Resilience Program in a Danish prison. State Prison Mid-Jutland Internal Report (in Danish). • Lundgaard Bak P. , Svendsen K. K. , Obel C. (2017). Randomized controlled evaluation of a minimal intervention delivery model for The Resilience Program - a mentalization-based health education program. Frontiers – in publication… • Lundgaard Bak P. , Svendsen K. K. , Obel C. (2017). Evaluation of a minimal school intervention for The Resilience Program - a mentalization-based health education program. Frontiers… • Lundgaard Bak, P. (2018). Resilience; A practical guide to teamwork with children and adolescents. Routledge – in press. • Lundgaard Bak (ed): Robusthed i børn og unges liv. Klim 2017. • Midgley N, Vrouva I (eds): Minding the child, Routledge 2012. • Valle A, Massaro D, Castelli I, Sangiuliano Intra F, Lombardi E, Bracaglia E and Marchetti A (2016) Promoting Mentalizing in Pupils by Acting on Teachers: Preliminary Italian Evidence of the “Thought in Mind” Project. Front. Psychol. 7: 1213. doi: 10. 3389/fpsyg. 2016. 01213.