1. The implementation of MultifunC within The National Board of Institutional Care

2. General phases in a implementation process (Implementation Research, Fixen et al., 2005)
Obtain knowledge from research
Develop best practice
Establish the program (starting up)
Implement
Full operation
Adjustment and innovation
Maintain and keep up

3. Program establishment in Sweden
Anchoring the project in SiS management (-00)
Research review published -03
Recruitment of project leader
Internal information campaign and interest notification (-04)
Practical preparations on site
Recruitment
Education and training
First juvenile in program autumn -05

4. Education
Education and training in procedures to employees, and in principles for effective institutional care
The model requires basic education in:
Cognitive-behavior theory
Motivational interviewing
ART
Token economy
No Power No Lose
MST analytic process
For the Family and aftercare team also MST and KOMET

5. All institutions in Sweden has gone trough the same phases
Education and planning
Enthusiasm
Juveniles challenging the system
Revealing weaknesses
Frustration and chaos
Amendments and adjustments
Gradually improved function according to the principles for MultifunC

6. Some challenges we have had
Handle externalizing behavior
Turnover
Culture within the institution –This is how we always done it
Challenging to establish good communication within the institution
Comprehension of assessment before placement
Comprehension of the concept that time in the institution is only part of the program
Comprehension for school in an external setting
Economic conditions

7. Challenging to go from theory to practice
To learn something is easy – to practice what you have learned is quite another thing
The analytic process before development of interventions
From long term targets to short term targets and evaluations
Balance between autonomy and control

8. Takes time to integrate new methods and thinking
Demanding and complex model – reflects the juveniles complex needs
Uncertainty -fear of doing the wrong thing
Relapse to traditional thinking
The need for punishment/ sanctions

9. Implementing a new program is a gradual process
Staff barriers:
Habits
Attitudes
Expectations
Turnover
Practical barriers:
Basis for care
Target group
Economic conditions
Learned skills
Fair performance
Achievement
Potential

10. What have we accomplished?
More than 100 juveniles have got the treatment and it seems they are benefitting from it
Maintaining good implementation status is a never ending story
An independent study of the effect is on its way
SiS has had a great deal of developmental help from this project, principles for effective institutional care, risk assesment, parental management programs…..