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 (dusters) 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 73 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 alpha = 0.67 to alpha = 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 (alpha = 0.64), institutional resources (alpha = 0.52), staff attributes (alpha = 0.76), and organizational climate (alpha = 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. (C) 2017 Elsevier Inc. All rights reserved.

Introduction: Experience of violence towards a caregiver during childhood is associated with a risk of negative impact

on children’s health and development, and there is a need for effective interventions in clinical as well as in community

settings. Research has shown that existing interventions in Sweden for children with experience of violence towards a

caregiver are associated with positive but insufficient outcomes. In addition to implementation of new evidence based

interventions expanded knowledge is needed on outcomes of established interventions aiming at identifying possible

needs for improvement.

Method: The current study is an effectiveness study aiming at investigating the outcomes of two established group

interventions for children exposed to intimate partner violence and their non-offending parent, one community based

psychoeducative intervention and one psychotherapeutic treatment intervention. 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 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 still

reported child trauma symptoms at clinical levels post treatment. Preliminary results from the follow up assessments will

be presented, such as outcomes in symptoms reduction and possible associations with confounding variables.

Discussion: Theoretical, methodological and clinical implications will be discussed.

Young children’s experiences of participating in group treatment for children exposed

to intimate partner violence: A qualitative study

Karin Pernebo¹, Mats Fridell¹² and Kjerstin Almqvist³

¹Department of Psychology, Linnaeus University, Sweden

²Department of Psychology, Lund University, Sweden

³Department of Psychology, Karlstad University, Sweden

The risk of exposure to Intimate Partner Violence (IPV) between caregivers is increased

during early childhood. The adverse effects on the health and development of the youngest

children may be severe. Effective and promising interventions for children who have

experienced IPV have been developed and evaluated. However, there is a lack in knowledge

about how the children themselves experience the interventions.

The aim of this study was to elucidate young children’s own experiences of participating in

a group-treatment designed to improve their psychological health in the aftermath of family

violence. Nine children, ages four to six, were interviewed after participating in group-programs

specifically designed for children who have been exposed to intimate partner violence. A

semi-structured interviewguide with open-ended questions was used. The interviews were transcribed

and analyzed using interpretative phenomenological analysis toensure focus on the children’s

own views and experiences.

Five master themes embracing the children’s experiences were identified:

Joy - positive emotional experience of participation; Security - feeling safe; Relatedness -

relations within the group; To talk – externalized focus on the violence; and Competence –

new knowledge and skills. Theoretical and clinical implications and the benefit

Aim To investigate whether socio-economic status (SES) in childhood and school failure at 15 years of age predict illicit drug abuse in youth and young adulthood. Design setting and participantsRegister study in a Swedish national cohort born 1973-88 (n=1405763), followed from age 16 to 20-35 years. Cox regression analyses were used to calculate hazard ratios (HR) for any indication of drug abuse. Measurements Our outcomes were hospital admissions, death and criminality associated with illicit drug abuse. Data on socio-demographics, school grades and parental psychosocial problems were collected from censuses (1985 and 1990) and national registers. School failure was defined as having mean school grades from the final year in primary school lower than -1standard deviation and/or no grades in core subjects. Findings School failure was a strong predictor of illicit drug abuse with an HR of 5.87 (95% CI: 5.76-5.99) after adjustment for age and sex. Childhood SES was associated with illicit drug abuse later in life in a stepwise manner. The lowest stratum had a HR of 2.28 (95% CI: 2.20-2.37) compared with the highest stratum as the reference, when adjusted for other socio-demographic variables. In the fully adjusted model, the effect of SES was greatly attenuated to an HR of 1.23 (95% CI: 1.19-1.28) in the lowest SES category, while the effect of school failure remained high with an HR of 4.22 (95% CI: 4.13-4.31). Conclusions School failure and childhood socio-economic status predict illicit drug abuse independently in youth and young adults in Sweden.

This study aimed to estimate the cumulative direct criminal justice system costs incurred by age and offending year between 1975 and 2004 by a cohort of women with a co-occurring substance abuse and mental disorder (COD) placed in a compulsory treatment facility for substance abuse between 1997 and 2000. Official register data were obtained for the period 1975–2004 on criminal charges, prosecutions, judgments and sentences by a consecutive sample of 227 women. The 2010 unit price data were applied to resource use and total costs were calculated and reported by age and offending year. A total of 211 women (92.9%) were charged for at least one crime during the period under review. The mean length of criminal career was 8.58 years. Theft and narcotics offenses were the crime categories with the highest number of crimes committed and charges made. The total criminal justice system costs per person averaged 834,897 Swedish crowns (SEK, 2010) over the entire sample. This study provides cost data on the real criminal careers of women with COD which can be used to estimate the potential benefit of targeted interventions at various stages in an individual's criminal career. The results indicate that early, targeted, effective intervention can have substantial benefits.

Aims

To evaluate premature mortality and causes of death from young adulthood to middle age in a cohort of drug users followed during almost four decades

Design

Follow-up study of a consecutive cohort of patients with drug abuse/dependence.

Methods

A cohort of 561 drug abusers, admitted to a detoxification and short-term rehabilitation unit 1970–1978 was followed to December 31st, 2006. Standardized interviews and hospital records with toxicological analyses were used for demographic data, substance use and psychiatric diagnoses at admission. For Follow-up analyses, autopsy protocols including toxicology tests and death certificates were obtained for assessment of causes of death which were coded according to ICD-10. Age-group standardized mortality ratios were calculated independently for both sexes.

Results

204 persons (36.4%) were deceased by 2006. SMR was 5.94 for the cohort. Compared to an age- and gender-matched population, the risk of premature death was about eighteen times higher between the ages of 20–44 and about five times higher from 45 up to the age of 69. Of 120 (59%) drug-related deaths, 43 were opiate overdoses, and 3 were overdose from amphetamine. A total of 53 (26%) persons died violent deaths: 39 suicides, of which 25 were drug-related, 3 homicides and 12 accidents. The Swedish national causes of death register underestimated drug-related death by 37% and suicide by 85% compared to the results from this study.

Conclusions

The cohort of drug abusers had an increased risk of premature often drug-related and violent death well into middle age, and to a great extent the drug addicts died from the same drug they had abused when they were first admitted for treatment. The underestimation of drug-related death and suicide in some national death cause registers could be reduced if the doctor routinely records ICD codes when issuing death certificates and autopsy protocols.