A new strategic plan for Green care (2012) Initiated by The Ministry - - PDF document

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Structure and research on Green care in Norway

• Dr. Bente Berget

Norwegian University of Life Sciences

NORWEGIAN UNIVERSITY OF LIFE SCIENCES www.umb.no

A new strategic plan for Green care (2012)

 Initiated by The Ministry of Agriculture and Food and the

Ministry of Local Government and Regional Development

 Goal:To develop quality-assured and socially beneficial welfare

services on farms

 The Ministries initiated the Green care promotion (2010-2012)

NOK 18 mill was allocated to projects organised by the county councils

 Totally 1100 Green care farms today (pedagogy, special needs

education, occupational training, health and care services)

 A quality assurance system is established from 2011  A approval system for Green care started in 2012

• Green care farms must gain approval based on the Green care quality

assurance system. The Norwegian Agricultural Quality System and Food Branding Foundation operates the system

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Therapeutic horticulture (TH) and clinical depression

• PhD project Marianne Thorsen Gonzalez (2010)
• Project owner: UMB
• Additional project group members:
• Prof. Terry Hartig, Uppsala University, Sweden
• Prof. Marit Kirkevold, Oslo University
• Prof. Egil Martinsen, Oslo University
• Assoc. Prof. Grete Patil, UMB

NORWEGIAN UNIVERSITY OF LIFE SCIENCES www.umb.no

The intervention

• Single group design with multiple measures
• 46 people with clinical depression
• Intervention: 12- weeks with outdoor garden activities, 3

hours 2 times a week. Four local farms in the Oslo area

• The farmer facilitated the activities
• The activities was adjusted to the groups and covered

sowing, planting

• and potting, weeding…
• … and the possibility to
• just be in the garden

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Key findings

• Score on depression (BDI) decreased from before (T1, T2) to

4 (T3), 8 (T4) and 12 (T5) weeks after start of the intervention

• Self reported effectiveness in daily activities requiring

cognitive recourses through directed attention (AFI) increased from before to after start of the intervention

• The participants who experienced the most fascination

with participating in the intervention also had the highest decrease in depression

Measurement point

T1 T2 T3 T4 T5

BDI

16 18 20 22 24 26 28 30 Study 1 Study 2

Measurement point

T1 T2 T3 T4 T5

AFI

62 64 66 68 70 72 74 76 78 80 82 Study 1 Study 2

Bente Berget (UMB), Øivind Ekeberg (UiO), Bjarne O. Braastad (UMB)

Animal-assisted therapy: effects on persons with psychiatric disorders working with farm animals

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Aim and method

 Aim: document effects of animal-assisted therapy (AAT) with farm

animals on humans with psychiatric disorders

 Method: RCT-design with 90 adult psychiatric patients with different

psychiatric diagnosis

 60 patients to treatment and 30 to control, with 41 completers (68 %)

in the treatment and 28 (93 %) in the control group

 12-week intervention with ordinary work with cattle (dairy cows and

beef cattle) or sheep three hours twice a week

 All participants continued their initial treatment  Self-reported questionnaires to assess depression (BDI), anxiety

(STAI), self-efficacy (GSE), coping ability (Coping Strategies Scale) and quality of life (QOLS-N) before, in the end, and at follow-up six months after the end of the intervention

 Video registrations (treatment group) in the beginning and at the end

• f the intervention

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Results

 No significant effects of treatment during the intervention

for any of the standardized instruments

 Significant effects of treatment at follow-up for STAI, BDI,

GSE and the Coping Strategies Scale

 No change in quality of life (QOLS-N) for any of the groups  Totally most time on physical contact with the animals  Moderate health effects, however none being negative

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Ingeborg Pedersen (UMB), Egil W. Martinsen (Oslo University Hospital), Bente Berget (UMB), Camilla Ihlebæk (UMB), Marit Kirkevold (UiO), Trine Nordaunet (UMB), Bjarne O. Braastad (UMB)

Farm animal-assisted interventions in clinical depression

9 NORWEGIAN UNIVERSITY OF LIFE SCIENCES www.umb.no 10

Main aim: Investigate changes in mental health of persons

with clinical depression participating in a farm animal-assisted intervention (work and contact with dairy cattle twice a week for 12 weeks)

 29 participants: 6 men and 23 women, mean age: 37.8

• Randomly assigned to intervention (n=16) or control (n=13)

 All participants continued their initial treatment  Assessments:

• Mental health (Beck Depression Inventory, Generalized Self-

Efficacy Scale, State-Trait Anxiety Inventory) at recruitment, start, 4 and 8 weeks, at the end of intervention, at follow-up three months after end of intervention

• Video recordings: twice (early and late, 1.5 – 3.0 hours)
• Qualitative interview of eight participants of their experience (work

tasks, animal interaction and contact with the farmer)

Aim and method

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Results

 The randomized controlled trial: – A statistical significant decline in depression and increase in self- efficacy in the intervention group at the farm, this was not seen in the control group. No significant differences between the intervention and control group  The video study: – Favorable correlations between work tasks that could be descried as complex and challenging like moving animals and milking procedures, and decline in depression and state-anxiety  The interview study: – A realistic working community is important and the farmer’s attitude and commitment is essential – Central elements: the interventions’ flexibility and experience of coping

Animal-assisted interventions and psychiatric disorders – knowledge and attitudes among practitioners

Bente Berget and Bjarne O. Braastad (UMB), Sverre Grepperud (UiO), Olaf Aasland, UiO and The Research Institute of the Norwegian Medical Association

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Aim, method and results

 Aim: Examine knowledge, attitudes and belief in treatment effects of AAI’s for psychiatric patients among GP’s, psychiatrists and psychologists in Norway  Method: A postal questionnaire made for the purpose sent to a representative sample of 400 GP’s, 400 psychiatrists and 300 psychologists  Results

 Response rate 42,9 %  2/3 had some or significant knowledge of AAI’s  2/3 was motivated to learn more about AAI and use it in own clinical

practice, psychiatrists and psychologists more motivated than GP’s, and young practitioners more motivated than the older practitioners

 Women more than men believed in treatment effects  Beliefs in treatment effects highest for improved physically capacity  9 out of 10 expressed that AAI’s should be used in psychiatric treatment

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The effect of the horse on adolescents’ self-efficacy, self-esteem and social skills

• a four-year project with a cross-over design

and control group

Hilde Hauge, PhD student Bjarne O. Braastad and Bente Berget (UMB), Ingela Lundin Kvalem, (UiO), Marie Jose Enders-Slegers, (Univ. of Utrecht)

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Aim and method

 Main aim: to examine what teenagers can learn

from being on a farm with horses, and how this can enhance their self-esteem and feeling of mastery

 Method:

• 80 adolescents aged 12-15 years are given an

intervention with horses on a small farm two hours a week for four months

• Registrations:
• inventories (self-efficacy, resilience, social competence,

relation to horses)

• video recording: “Adolescent’s mastery of tasks and

interaction with the horse through horse assisted activities” (study 1)

• 29 adolescents (13-15 years old),25 girls and 4 boys
• 7 participants had been riding before
• Registration of positive attitude towards the horses

15 NORWEGIAN UNIVERSITY OF LIFE SCIENCES www.umb.no

Results

 Adolescents given the opportunity to work with horses and

ride once a week for four months showed active behaviour and had positive contact with the horse both early and late in the intervention period. There were only positive or neutral responses from the horse

 The adolescents persisted in retrying tasks after failure

more frequently late in the intervention than in the

• beginning. The intervention might serve to enhance self-

efficacy among the adolescents in relation to tasks with the horses (Hauge, Braastad, Kvalem and Pedersen)

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Effects of activities and work on a farm and its nature surroundings on health, social well-being and working ability for people out of work

Lina H. Dalskau, PhD student (UMB), Camilla Ihlebæk (UMB) Bente Berget, (UMB), Gunnar Tellnes (UiO)

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Main objective of the project

 A nationwide survey – Reveal perceived success criteria among participants and farmers that are important to stimulate activity and working capacity – Assess coping, self-esteem, psychological distress, subjective health complaints, social support, function in daily life and working ability for participants (adults with addiction, psychiatry and vocational training)  A longitudinal register data study – To which extent Green care programs may enhance the process

• f returning to ordinary work (RTW) using register data on RTW

status in a follow-up study – Use matched control group to investigate possible effects of Green care programs on RTW  A qualitative study of 10 participants experiences (activities, social aspects, health, beliefs in RTW and future education)

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Progress so far in the project

 Mapping Green care providers in Norway (adults with addiction,

psychiatry and vocational training)

 Almost finished the participant and provider survey  Finished the qualitative study  Some preliminary results from the participant survey:

19 ROGCS

Mental health promotion by Recovery-oriented Green Care services at the University College of Hedmark

• The aim is to contribute to the documentation of the

possible health effects of various Green care services

The project group consists of:

• Project leader: Associate professor Ragnfrid Kogstad
• Researchers: Professor Bengt G. Eriksson, Associate professor

Arild Granerud, Assistant professor Mark Steven Hopfenbeck, Assistant professor Rita Agdal, PhD student Anne Mari Steigen

• Research supervisor: Professor Jan Kåre Hummelvoll

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The project consists of 4 sub-studies:

• I: A quantitative study of people between 16-30 years old who is
• ut of work or school because of mental and/or

drug related problems, and who are going through a Green care program

• II: A qualitative study: Users experiences with Green care –

participants from 18-64 years

• III: A qualitative process study: Young peoples` (16-24 years old)

experiences with Green care

• IV: Discourse analytic approach: Different languages and discourses

among participants in the field such as farmers, activity leaders, participants, work and welfare officers, and health and agricultural professionals

ROGCS

Preliminary results

The findings in the different sub-studies all point to some core factors:

• The importance of safe personal relationships
• Environments that promote mastering abilities
• Holistic approach to the person in the recovery process
• Emphasis on respect and equality in the relationship between

the farmer and the participants

• Meaningful work tasks
• Experiences dignity
• Continuity between different parts of the help service systems
• The positive interaction between human and animals
• Kogstad, R., Hopfenbeck, M.S., Hummelvoll, J.K. (2012). Political intentions behind the Green Care development initative.

(In norwegian) Elverum: Hedmark University College, Working paper nr. 3

• Eriksson, B.G., Granerud, A. (2012). Users’ experiences with Green Care Services. Paper presented at Refocus on Recovery

2012 Conference, London 5th-7th of March. ROGCS5th-7th

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“Inn på tunet” (IPT) in the municipal service

From project to operation

Finn Ove Båtevik (project leader) Møreforsking Geirmund Dvergsdal, Møreforsking Randi Bergem, Møreforsking Else Jørgensen, Univ. College of Molde Gerd Grimsæter, Univ. College of Bergen

Aims, method and results

• Project goals
• Examine the knowledge of IPT in three counties in Western Norway

(Hordaland, Sogn and Fjordane, and Møre and Romsdal)

• Identify the factors (both positive and negative) that influence the use
• f IPT in the municipal services
• Identify cases (municipals) with success criteria and critical variables,

and use this knowledge to suggest processes and implementation of IPT in the municipal services in Norway

• Method
• Surveys (political, administrative and academic leaders)
• Qualitative interviews in selected municipalities that use IPT now, who

used IPT earlier and perhaps those who have not used IPT

• Preliminary results
• Responses from 88% of the municipalities
• IPT is known by most municipalities, 61% have used IPT-services,

44% use it today