Search

Aim Methods Results Discussion Conclusion The aim of this paper is to present 25 years of clinical experience with family psychoeducation (FPE) work at Stavanger University Hospital in Norway, highlighting the lessons learned in overcoming implementation barriers in publicly funded specialized mental health care.This retrospective analysis reviews the integration and sustainability of FPE work within the hospital's standard treatment protocols for psychosis, tracing its origins from the Early Treatment and Intervention in Psychosis (TIPS) study (1997–2000) to its current application. The paper examines key strategies for successful implementation, including staff training and resource allocation, as emphasized by international research.Stavanger University Hospital has successfully implemented and maintained both multi‐ and single‐family FPE approaches over the past 25 years. Initially part of the TIPS study, FPE has been integrated into routine clinical practice for treating psychosis and has recently been extended to families of patients with other severe mental disorders. The sustained success at Stavanger University Hospital is attributed to consistent staff training and the prioritization of sufficient resource allocation.The successful and sustainable integration of FPE at Stavanger University Hospital is relatively unique. International guidelines recommend FPE for psychosis, but its implementation remains inconsistent globally, despite over 50 years of supporting evidence. The hospital's experience underscores the critical role of continuous training and dedicated resources in embedding FPE into regular clinical practice. These findings suggest that addressing these areas can significantly enhance the uptake of FPE in other clinical settings.The 25‐year experience at Stavanger University Hospital demonstrates that with appropriate training and resources, FPE can be successfully integrated and sustained within standard mental health care practices. This case study provides valuable insights for other institutions aiming to implement FPE and improve treatment outcomes for patients with severe mental disorders. [ABSTRACT FROM AUTHOR]

The overarching goal of this paper is to examine the efficacy of early intervention when viewed through the lens of developmental neuroscience. We begin by briefly summarizing neural development from conception through the first few postnatal years. We emphasize the role of experience during the postnatal period, and consistent with decades of research on critical periods, we argue that experience can represent both a period of opportunity and a period of vulnerability. Because plasticity is at the heart of early intervention, we next turn our attention to the efficacy of early intervention drawing from two distinct literatures: early intervention services for children growing up in disadvantaged environments, and children at elevated likelihood of developing a neurodevelopmental delay or disorder. In the case of the former, we single out interventions that target caregiving and in the case of the latter, we highlight recent work on autism. A consistent theme throughout our review is a discussion of how early intervention is embedded in the developing brain. We conclude our article by discussing the implications our review has for policy, and we then offer recommendations for future research. [ABSTRACT FROM AUTHOR]

This two‐part paper examines a newly developed Multi‐Family Therapy (MFT) for clients and their families in the Early Psychosis Intervention Programme (EPIP) in Singapore. The first part of the paper describes the activities, its theoretical underpinnings and the therapist's observations of the families' responses. The second part of the paper evaluates the content, structure and effects of the MFT through feedback from the 17 families. Separate feedback was obtained from the EPIP team. The qualitative data was analysed using thematic analysis. The majority of the participants found 'Image of Psychosis' and 'Family Life River' activities most useful and reported that mutual learning and support were the key therapeutic factors. The EPIP professionals suggested ways to improve potential participants' understanding of MFT to help with recruitment. The preliminary results from the pilot programme support the use of MFT in the context of Singapore. Practitioner pointsAn activity‐based and experiential MFT programme engages families to work in a creative and playful way.Active involvement of the multidisciplinary team in the MFT programme helps to secure their engagement and support for interventions.Adopting an expert stance and focusing on practical concerns, rather than taking a reflective approach, is crucial in working with Singaporean families when adapting a Western‐based multi‐family psychoeducation group. [ABSTRACT FROM AUTHOR]

Background: There has been a significant uptake in the use of telepractice during the coronavirus SARS‐CoV‐2 (COVID‐19) pandemic. This study explored the experiences of speech and language therapists (SLTs), assistants (SLTAs) and parents with telepractice during the COVID‐19 pandemic. Aims: (1) To identify factors that influenced success of telepractice; and (2) to describe clinicians' and parents' preferences for the future mode of service delivery for preschoolers with communication disorders. Methods & Procedures: The study was conducted in partnership with one publicly funded programme in Ontario, Canada, that offered services to preschoolers with speech, language and communication needs at no cost. SLTs (N = 13), assistants (N = 3) and parents (N = 13) shared their experiences and perspectives during semi‐structured videoconference interviews. Outcomes & Results: Factors that influenced the success of telepractice were reported in three categories: the setting (i.e., where and how telepractice was being delivered); the nature of telepractice (i.e., the services that were provided via telepractice); and the individuals (i.e., who was involved in telepractice). These factors were reported to interact with each other. As the needs for each child and family are unique, parents and clinicians reported a preference for a hybrid and flexible service delivery model in the future. Conclusions & Implications: The themes identified in this study can be used by clinicians and managers to consider factors that influence the success of telepractice for children and families. WHAT THIS PAPER ADDS: What is already known on the subject?: Studies conducted before the COVID‐19 pandemic showed that telepractice was an effective and acceptable service approach. However, some clinicians and parents reported wanting to resume in‐person visits. The provision of telepractice services to families with children with communication disorders increased significantly during COVID‐19. What this paper adds to existing knowledge?: Parents and clinicians shared factors that influenced the success of telepractice during semi‐structured interviews. Factors were identified in three categories: the setting (i.e., where and how telepractice was being delivered); the nature of telepractice (i.e., the services that were provided via telepractice); and the individuals (i.e., who were involved in telepractice). As each child's and family's needs are unique, parents and clinicians reported a preference for a hybrid and flexible service delivery model in the future. What are the potential or actual clinical implications of this work?: SLTs and SLT managers can use the factors identified to discuss with parents and decide whether telepractice may be well suited to the needs of each child and family. [ABSTRACT FROM AUTHOR]

Background: Engagement of the child, parent and professional may facilitate positive outcomes for young children with communication disorders receiving early intervention (EI) via telepractice. Despite reported positive outcomes of engagement in a family‐centred model of EI, there is limited research exploring the nature engagement in the telepractice environment and guiding professionals on how to best interact with young children and their families. Aim: To identify a set of critical behaviours for building engagement in telepractice EI. Methods & Procedures: A two‐round modified e‐Delphi study was conducted. Participants were international experts in the field of paediatric communication disorders and telepractice EI from diverse allied health and education backgrounds. The experts used a nine‐point Likert scale to rate the importance of a predetermined set of critical behaviours for building engagement in telepractice EI across three different aspects of the telepractice interaction: (1) getting to know each other; (2) family‐centred telepractice; and (3) telepractice specific considerations. Outcomes & Results: A total of 30 experts completed round 1, with 21 participants from round 1 completing round 2 (70% response rate). Across the two rounds, a total of 64 of the 109 items presented (58.71%) achieved consensus as critical behaviours for building engagement in telepractice EI. Conclusions & Implications: The present study identified a set of individual aspects of the telepractice interaction that participants, particularly professionals, may need to intentionally address to engage with families of young children with communication disorders receiving EI via telepractice. The results from this study will contribute to the development of an observational tool to measure engagement in the telepractice EI environment. What this paper adds: What is already known on the subject: A growing body of research suggests telepractice is a feasible alternative for families of young children with communication disorders who lack access to high‐quality EI. The engagement of families through family‐centred care has long been recommended for children enrolled in EI. Although there is growing uptake of telepractice EI, limited research is available guiding professionals on how to engage with families of young children with communication disorders via telepractice. What this paper adds to existing knowledge: This study provides a set of 64 telepractice‐specific behaviours deemed critical to engagement for all participants of the telepractice interaction. The display of these behaviours could assist professionals to better engage with families of young children within the telepractice environment. What are the potential or actual clinical implications of this work?: The findings of this study provide a set of telepractice‐specific behaviours that professionals may need to deliberately display and encourage while interacting with young children with communication disorders and their families. Professionals displaying these behaviours could potentially enhance the engagement of families receiving EI services via telepractice. This set of critical behaviours will be refined with the aim of developing an evidence‐based observational tool to measure engagement in the context of telepractice EI. [ABSTRACT FROM AUTHOR]

This paper uses novel experimental data from a prototypical early childhood home visiting program in China with high‐frequency measurements to investigate the growth of multiple skills. After identifying the presence of child skill development on multiple skills during the intervention, we further study the features of child learning patterns. We find that individual heterogeneity and previous task performance (state dependence) are key properties of the child's task performance during the intervention, consistent with models of reinforcement learning. [ABSTRACT FROM AUTHOR]

Objective: This paper outlines the evidence base for early intervention for eating disorders; provides a global overview of how early intervention for eating disorders is provided in different regions and settings; and proposes policy, service, clinician and research recommendations to progress early intervention for eating disorders. Method and Results: Currently, access to eating disorder treatment often takes many years or does not occur at all. This is despite neurobiological, clinical and socioeconomic evidence showing that early intervention may improve outcomes and facilitate full sustained recovery from an eating disorder. There is also considerable variation worldwide in how eating disorder care is provided, with marked inequalities in treatment provision. Despite these barriers, there are existing evidence‐based approaches to early intervention for eating disorders and progress is being made in scaling these. Conclusions: We propose action steps for the field that will transform eating disorder service provision and facilitate early detection, treatment and recovery for everyone affected by eating disorders, regardless of age, socioeconomic status and personal characteristics. Highlights: Early intervention for eating disorders is in its infancy.We summarise existing early intervention approaches for eating disorders from around the globe.We propose key policy, service, clinician, and research recommendations to progress early intervention for eating disorders. [ABSTRACT FROM AUTHOR]

Background: Children with cleft palate with or without cleft lip (CP±L) are at high risk of problems with early speech sound production, and these difficulties can persist into later childhood. Early intervention could help to reduce the number of children whose problems become persistent. However, much research in the field to date has focused on older children. There is a need to determine if providing intervention during the phase of early typical speech development leads to better outcomes. Aims: To review the evidence for the effectiveness of interventions targeting speech, delivered in the first 3 years of life for children with CP±L, and discuss factors such as intervention type, facilitator, dosage, outcome measures and the age of the child. Methods & Procedures: The systematic review was registered with PROSPERO (CRD42019121964). Eight bibliographic databases including CINAHL and MEDLINE were searched in August 2018. Studies were included if participants received speech and language interventions before 37 months and if they reported outcomes for speech. Two reviewers independently completed inclusion reviews, quality analysis and data extraction. Outcome & Results: The review included seven papers: one pilot randomized controlled trial, one controlled trial, four cohort studies and one case series report. Interventions largely took a naturalistic approach, namely focused stimulation and milieu teaching. The findings provide preliminary support for naturalistic interventions and suggest that these interventions can be delivered by parents with suitable training. Studies included in the review provided low‐strength evidence with variation in both the type of intervention, the manner of delivery and in the risk of bias in the designs used. Conclusions & Implications: The papers included in this review suggest that early naturalistic interventions can have positive impacts on the speech development of children with CP±L. However, the reported methodological quality of the publications overall was weak, and the current evidence lacks clarity and specificity in terms of therapy technique, delivery and optimum age of delivery. Future research should use more robust methodological designs to determine whether early speech interventions are beneficial for children born with CP±L. What this paper adds: What is already known on the subject: Children with CP±L show difficulties with early speech development and often have restricted speech sound inventories. They may reach the canonical babbling stage later than children without CP±L and studies have shown that 20% of children with CP±L have speech which is considered unintelligible or barely intelligible at age 5. It has been proposed that early intervention can lessen the impact of CP±L on speech development. However, currently, the evidence for early interventions for children with CP±L is limited, with the majority of studies focusing on children aged 3 years and older. What this paper adds to existing knowledge: This paper reviews the evidence for different types of early interventions for speech provided to children born with CP±L and whether these interventions are effective in supporting speech sound development. In this review, early intervention is defined as intervention provided to children in the first 3 years of life. This review describes intervention approaches and how they are delivered for this population. What are the potential or actual clinical implications of this work?: In the UK, children born with CP±L and their families are supported by National Health Service (NHS) services over a 20‐year period and speech and language therapy sessions may take place over many weeks and months. If providing early intervention in the first 3 years of life is effective, there is the potential for improved speech outcomes in early childhood and a reduced burden of care on children, families and services. This review considers the evidence for early speech intervention for children with CP±L in the first 3 years of life and identifies areas for future research. [ABSTRACT FROM AUTHOR]

Accessible summary: This paper is about how parents adjust to parenting their child who has a developmental disability.We spoke to parents about their experiences and developed a theory to help explain how parents adjust when their child has a developmental challenge.As well as describing the stress, that parents experience, this theory also captures the fulfilment and sense of purpose that parents experience as they parent their child.This research is important because it helps explain what happens for parents after their child's diagnosis and provides suggestions on how services can improve to help families. This paper describes a study exploring the parental response to the diagnosis of their child's developmental disability. A classic grounded theory methodology was used to analyse data comprising 19 interviews and 11 memoirs written by parents. The theory explains how parents adjust to champion their child, who has been identified as having a developmental challenge. At the heart of becoming a champion is a psychological process in which parents refine their perspectives on disability awareness, their aspirations and parenting capacity as they develop their championing skills. Refining perspectives and championing are influenced by two factors: the nature of the child's challenges and service factors. The theory of Confident Championing offers a multivariant model that explains the dynamic nature of the adjustment process, capturing both the stress and the fulfilment and sense of purpose that parents experience. [ABSTRACT FROM AUTHOR]

Schleider and colleagues' paper on the application of single‐session interventions (SSIs) to eating disorders is timely given the broader focus in mental health on flexible approaches to delivering support at the time the person needs it most. The eating disorder field needs to embrace these innovations including developing a "single‐session mindset" with greater attention paid to testing the relevance of SSI for eating disorders. The use of well‐powered trials of brief, focused and rapidly scalable interventions is an ideal vehicle for generation and evaluation of new and longer interventions. Our future research agenda needs to carefully consider our target audience, the primary outcome variable of most relevance, and the SSI topic that would be most likely to effect change. Research in prevention might focus on weight concern and evaluation of SSIs that focus on self‐compassion or cognitive dissonance related to appearance ideals in the media. Work in early intervention could target denial and disordered eating using SSIs on growth mindset, behavioral activation, and imagery rescripting. Treatment waitlists provide another suitable opportunity, evaluating SSIs that aim to increase hope for change, treatment retention, and kick start early change in therapy, a robust predictor of better treatment outcome. [ABSTRACT FROM AUTHOR]

The Routine‐Based Interview is a promising method to collect information in Early Intervention, since it focuses on all members of the family and their routines, while seeking to highlight what parents consider a priority in the intervention. For that reason, in this paper, we aim to analyse the kind of benefits and difficulties that may be found in the Routine‐Based Interview's implementation process. The present research comprises the qualitative interview method, according to which semi‐structured interviews were carried out by eight Portuguese professionals enrolled in the Portuguese System for Early Intervention. The professionals highlight the benefits of the Routine‐Based Interview as a way to clearly and objectively evaluate and identify the concerns and priorities of the family, as well as the child's competencies and the functional goals that will be included in the intervention plan. All participants stress the need for more training in the Routine‐Based Interview process. [ABSTRACT FROM AUTHOR]

Background: Despite being an important aspect of effective early intervention service delivery, 'engagement' has been inconsistently defined in paediatric healthcare. Previous research has identified that engagement in early speech–language pathology intervention is complex and multifaceted. However, more research is needed to understand the ways that different families may engage with intervention in different settings. Aims: To explore the complexity of engagement in early speech–language pathology intervention from the perspectives of both families and their speech–language pathologists (SLPs). Method & Procedures: Video‐reflexive ethnography was used to explore engagement with 21 matched SLP–family dyads in early intervention services. Up to three intervention appointments for each participating family were video recorded. Short video segments were selected and played to participants during individual semi‐structured interviews where participants were invited to reflect on the interactions captured (i.e., 'video‐reflexive sessions'). Interview data were analysed using thematic analysis. Outcomes & Results: Results from the interview data were organized into one overarching theme 'Families may have "different levels of engagement"', and four individual themes that reflected how families engage differently in various aspects of intervention, including (1) attending sessions and coming into the room; (2) actively participating in sessions; (3) continuing to actively participate outside sessions; and (4) having open and honest communication with their SLPs. Conclusions & Implications: Families may have different levels of engagement in various aspects of intervention, which contribute to their unique profile of engagement. Findings of this study prompt SLPs to move beyond using blanket statements about whether or not families are engaged, to instead describing in detail how families are uniquely engaged. What this paper addsWhat is already known on the subjectIn early speech–language pathology intervention, the term 'engagement' refers to (1) a complex, multifaceted state of families 'being engaged' in intervention both inside and outside sessions; and (2) a relational, co‐constructed process where many families 'become engaged' in intervention as they work together with SLPs. Although research has acknowledged engagement may look different for each parent and family, little is known about how families are uniquely engaged in early speech pathology intervention in different settings.What this paper adds to existing knowledgeThis study is the first to explore engagement from the perspectives of both families and SLPs working together in intervention. Both groups of participants described the complexity of engagement in this setting and acknowledged that families engage differently in different aspects of intervention, which contribute to their unique profile of engagement.What are the potential or actual clinical implications of this work?Being able to identify potential indicators of engagement, such as the ones described in this study, provide opportunities for SLPs to take a reflexive approach to engaging with individual families, in line with principles of family‐centred care. Findings of this study therefore prompt SLPs to reflect on how the families they work with are engaged in intervention, and to consider their own role in facilitating engagement. In addition, results highlight the importance of SLPs initiating open conversations with families themselves about how they would like to be engaged in intervention, and what support would be most beneficial to them. [ABSTRACT FROM AUTHOR]

Background: Information is available about what predicts Lidcombe Program treatment time, but nothing is known about what predicts treatment prognosis. Aims: To investigate the predictors of treatment dropout and treatment outcome for children who were treated for early stuttering with the Lidcombe Program (N = 277). Methods & Procedures: A total of 32 variables were used as predictors in regression analyses of short‐ and medium‐term Lidcombe Program outcome, and of treatment dropout. Outcomes & Results: Regression analyses associated children who have better language skills and easy temperament with better treatment outcome, although only a small portion of the variance of treatment outcome was accounted for by these variables. There was an association between treatment dropout and parental scores on a personality screening tool relating to their impulsivity. Conclusions & Implications: Variables identified as predictors of Lidcombe Program treatment outcome were statistically significant, but not clinically significant. They did not account for a clinically substantive portion of treatment outcomes. Findings about parental impulsivity and their relationship with intervention drop‐out require replication with prospective methods and comprehensive assessment of parent psychological status. This is particularly important because parents are involved in conducting all early interventions. What this paper addsWhat is already known on the subjectInformation is available about what predicts Lidcombe Program treatment time, but nothing is known about what predicts Lidcombe Program treatment outcome.What this paper adds to existing knowledgeThere are predictors of Lidcombe Program treatment outcome that are statistically significant, but none are clinically significant.What are the potential or actual clinical implications of this work?Clinicians can tell parents that nothing has been found that can assist with making prognostic indications about treatment outcome for their children. [ABSTRACT FROM AUTHOR]

Background: Specialist early intervention (SEI) service models are designed to treat symptoms, promote social and vocational recovery, prevent relapse, and resource and up‐skill patients and their families. The benefits of SEI over the first few years have been demonstrated. While early recovery can be expected to translate to better long‐term outcomes by analogy with other illnesses, there is limited evidence to support this from follow‐up studies. The current study involves the long‐term follow‐up of a sub‐set of first episode psychosis (FEP) patients, with a range of diagnoses, who were first treated at Orygen's Early Psychosis Prevention and Intervention Centre (EPPIC) between 1998 and 2000. The aim of this paper is to present the methodology for this follow‐up study. Methods: Between January 1998 and December 2000, 786 patients between the ages of 15–29 years were treated at EPPIC, located in Melbourne, Australia. Our cohort consists of 661 people (82 were transferred/discharged and 43 were not diagnosed with a psychotic disorder at time of discharge). The 18‐month treatment characteristics of this cohort have been extensively examined in the First Episode Psychosis Outcome Study (FEPOS). The ≥15 year outcomes of this cohort are being examined in this study, known as FEPOS15. Results: Participant follow‐up is ongoing. In order to extend and assess broader outcomes of the cohort, data linkage with health‐related databases will be conducted. Conclusion: This study will provide a comprehensive evaluation of the long‐term trajectory of psychotic disorders after treatment for FEP in a SEI service. [ABSTRACT FROM AUTHOR]

Aim: The provision and implementation of early intervention for psychosis services (early intervention services [EIS]) has received increasing attention over recent years. Maximizing engagement with EIS is of clinical and economic importance, and exploring the experiences of those who access EIS is vital. Although research has been conducted exploring the experiences of engaging with EIS from both a service user and carer/family member point of view, these data have not been systematically collated to generate new understanding. The primary aim of this study is to review, critically appraise and synthesize qualitative findings relating to the experiences of service users and/or carers and family members engaging with EIS. Methods: Four databases were systematically searched. Studies were analysed using an inductive thematic analysis approach, within a critical realist epistemological framework. Studies were critically appraised using the critical appraisal skills programme tool. Results: Fourteen papers were identified for inclusion. Three main themes were identified: the importance of a personal relationship with an EIS staff member, the impact of this relationship and consideration of life after EIS. The importance of a strong relationship with EIS staff was the most prominent theme throughout the papers reviewed. Conclusions: The quality of the therapeutic relationship with at least one EIS staff member was the single most important factor in determining whether the experience of accessing EIS was a positive or negative one. The majority of the studies reviewed were conducted in the United Kingdom or Australia. Therefore, more research across countries is needed to understand transferability of findings. [ABSTRACT FROM AUTHOR]

Autism symptoms vary from child to child, but the overall severity can be lessened through early intervention—often specifically early intensive behavioral intervention—when administered at a young enough age. The high costs and heavy time commitment of this intervention, however, tend to discourage public school districts from spending on these programs. In this paper, the cost of early intervention and its impact on the subsequent costs of special education, is compared to the costs of public school special education for autistic children who do not receive intervention. The analysis suggests that North Carolina potentially saves an estimate of over $250,000 per child in reduced annual special education costs by implementing early intervention for their autistic population. [ABSTRACT FROM AUTHOR]

Background: There is a clear predominance of programmes aimed at improving aspects related to language production in pupils with developmental language disorder (DLD). However, programmes aimed at improving their receptive skills are limited. Aims: The main aim was to assess the effectiveness of an intervention programme for oral language comprehension skills in preschoolers with typical development (TD) and pupils with DLD. Methods & Procedures: Participants were 99 five‐year‐old pupils, with and without DLD, divided into four groups: two control groups (TD‐C = 25; DLD‐C = 25) and two experimental groups (TD‐T = 24; DLD‐T = 25), from schools on the Spanish island of Tenerife. The study used, as pre‐ and post‐measures, the receptive language subtests of the CELF‐4‐Spanish: Concepts and Following Directions, Word Classes—Receptive and Sentence Structure, as well as two tasks assessing comprehension of paragraphs and narratives. Due to the strong link between oral comprehension skills and executive functions, working memory and semantic fluency are included in this research. The Backward Digit Span subtest of the Wechsler Intelligence Scale for Children (WISC‐IV) and Semantic Fluency subtest of the Controlled Oral Word Association Test (COWAT) were used to assess working memory and semantic fluency, respectively. The intervention programme followed a multitiered system of support (MTSS) model, with 95 sessions lasting 60 min each delivered jointly by teachers and speech and language therapists, and focused on lexical–semantic, morphological, syntactic and narrative skills; inferences; verbal working memory; and semantic fluency. Outcomes & Results: The results showed, as expected, that pupils diagnosed with DLD initially performed worse on oral language comprehension and executive functions than pupils with TD. Further, the DLD‐T and TD‐T groups showed greater gains following the programme, especially in word classes—receptive, sentence structure, verbal working memory and semantic fluency. Finally, a significant positive correlation was found between the gains obtained by the participants in verbal working memory and semantic fluency, with the gains obtained in the three CELF‐4‐Spanish subtests. Conclusions & Implications: An intervention programme applied at an early age fosters oral language comprehension skills and executive functions in pupils with DLD and TD. The intervention organized at different levels of support, following an MTSS model, showed clear progress of the DLD and TD groups in oral language comprehension and executive functions. What this paper adds: Pupils with DLD present deficits in linguistic comprehension and executive functions. There are many intervention programs focused on improving language production skills. It is also necessary to consider the skills underlying language problems in pupils with DLD. Oral language, inference, working memory and semantic fluency activities improve comprehension. A collaborative and inclusive intervention of teachers and speech language therapists. Psycholinguistic and neuropsychological skills training should become part of the academic curriculum as early as preschool age. What is already known on the subject: Pupils with DLD show problems related to both comprehension and production language. However, there is a clear predominance of programs just aimed at improving aspects related to language production. Clinical implications of this study: An intervention program applied at an early age fosters oral language comprehension skills and executive function in pupils with DLD. The intervention organized at different levels of support, following an adaptation of the Response Tier Intervention models, showed clear progress of the DLD in comprehension oral language and executive functions. [ABSTRACT FROM AUTHOR]

Aims: Developing early intervention services (EIS) in healthcare organizations (HCOs) is difficult because it is necessary to integrate service approaches across units. To accommodate the needs of patients and relatives, Oslo University Hospital (OUH) chose to use service design (SD) to redesign their first‐episode services with an emphasis on easy access to care. This paper discusses the results and how SD can help to overcome known barriers to change in complex organizations. Method: SD is a method that relies on principles of participation, innovation and visualization to develop coherent services. The method emphasizes the exploration of a problem area from the perspective of multiple stakeholders to create a shared understanding of the complexity. Idea generation, visualization and early modelling of possible solutions are employed to test alternatives involving stakeholders. Results: A low threshold EIS was developed. A helpline with a specialist managing the phone was established. High‐quality assessment regarding possible psychosis development was thus made available to patients, relatives and professionals, eliminating the need for paper referral. This approach was supported by a communication strategy that includes web‐based information. A dedicated cross‐specialist team was established to increase collaboration in complex cases. Finally, outreach services were improved. Conclusion: SD is a suitable method to incorporate the views of different stakeholders (patients, relatives and professionals) to develop EIS services in complex organizations and can help overcome known barriers to change in HCOs. [ABSTRACT FROM AUTHOR]

Aim: This paper aims to describe the entry protocol of the Prevention and Early Intervention for Psychosis Program (PEPP)‐Montreal, an early intervention program for psychosis. The protocol is designed to fulfil a key objective of the early intervention movement—reducing delays to accessing high‐quality care. The paper also aims to describe how this rapid entry protocol can be deployed in other services interested in reducing delays in initiating treatment. Methods: PEPP provides rapid, easy access to quality care by placing a single, well‐trained professional, the intake clinician, at the point of entry. Anyone can refer a youth directly and without formalities to the intake clinician who responds promptly and sensitively to all help‐seeking, whether by a youth, a family member, a school counsellor or anyone acting on behalf of a youth in need. To promote accessibility, PEPP guarantees an initial assessment within 72 hours; maintains relationships with referral sources; and conducts awareness‐enhancing outreach activities. Results: Since 2003, PEPP has received 1750 referrals, which have all been responded to within 72 hours. Families have been involved in the intake process in 60% of the cases and hospitalization may have been averted in over half of the referrals originating from emergency‐room services. Another indicator of success is the very low turnover in the intake clinician's position. Overall, the PEPP model has succeeded in providing rapid, engaging, easy and youth‐friendly access to high‐quality care. Conclusion: The success of this protocol at PEPP has inspired the entry protocols at other first‐episode psychosis services. Its ability to provide rapid, engaging access to high‐quality services may allow this protocol to become a model for other early intervention services for psychosis and other mental illnesses. [ABSTRACT FROM AUTHOR]

The Early Psychosis Prevention and Intervention Centre Statewide Services (ESW) team provides training for multidisciplinary clinicians that specialise in early psychosis across the State of Victoria, Australia. The aim of this paper is to describe the 4‐phase approach utilised by ESW to prepare for and deliver workshops, to report on participants’ ratings of the ESW workshops, and to make recommendations for other trainers of early psychosis clinicians. Between March 2009 and September 2014, ESW provided 85 training workshops that had a strong focus on evidence‐based approaches and international guidelines, and utilized clinical examples of early psychosis interventions. At the conclusion of each workshop, participants were asked to complete a questionnaire that comprised qualitative and quantitative elements. These assessed perceived trainer knowledge, learning, interactivity and specific topic feedback. The focus of this paper will be on describing the quantitative data resulting from these questionnaires. A total of 1708 clinicians provided feedback on the 85 workshops. There was a high level of compliance, with 83.0% of workshop participants completing the questionnaires. Feedback was positive across all areas, with the 2 areas that were most highly endorsed being that presenters “appeared to know their subject matter well” (endorsed by 98.4% of participants) and that “topics were explained well” (endorsed by 96.8% of participants). Training for early psychosis clinicians that focusses on core clinical topics, is well planned, incorporates feedback from previous training, and is based on adult learning principles, is likely to be effective and well received by early psychosis clinicians. [ABSTRACT FROM AUTHOR]

Unaccompanied asylum‐seeking children (UASC) are a vulnerable group who are exposed to multiple traumatic events such as persecution, sexual maltreatment, imprisonment, torture, and losses in their home country (Bean, Derluyn, Eurelings‐Bontekoe, Broekaert, & Spinhoven, 2007; Wiese and Burhorst, 2007). They are also subjected to continuous transitions throughout their migration trajectory (Bhugra, 2004). Although many studies have investigated the efficacy of bilateral movement in treatment of one single traumatic event (e.g. Fernandez, 2007), there is limited literature around bilateral movements interventions being used with perpetuated and multiple traumas within this cohort. This paper looks at the evidence for early intervention trauma work based on EMDR principles, the benefits of using running as a form of bilateral movement and the findings of a UASC sport trauma group with children in Kent, UK. It also gives recommendations for future research into early intervention trauma work with unaccompanied asylum‐seeking children. The data showed a significant rise in the Validity of Cognition scores with a reduction in Subjective Units of Disturbance scores of those participating in the programme. This highlights the validity of this protocol and shows promising results for future enquiry. [ABSTRACT FROM AUTHOR]

Aims: Eating disorders are serious psychiatric disorders with high rates of morbidity and mortality. Early intervention can improve treatment outcomes and reduce disruption to psychosocial development. However, early intervention is not well established in the eating disorder field. First episode rapid early intervention for eating disorders (FREED) was developed to address barriers to early, effective eating disorder treatment in emerging adults aged 16 to 25 years. Since 2014, FREED has progressed from a single‐site research project to an evidence‐based care approach in nine eating disorder services. This paper aims to summarize key learning from the scaling of FREED to date, with attention to how this learning may generalizes to other models of care. Methods: We describe the development, scaling and implementation of FREED with reference to the RE‐AIM (reach; effectiveness/efficacy; adoption; implementation; maintenance) framework. We also summarize challenges and learning in each of the RE‐AIM domains. Results: FREED has demonstrated real‐world validity across diverse clinical contexts, geographical regions and populations. Key outcomes are seen for each of the RE‐AIM domains. Conclusions: FREED provides an example of effective, non‐commercial scaling of an early intervention eating disorder care pathway. This work is likely to be particularly relevant to others looking to scale‐up early intervention models and for those working in secondary and tertiary mental health settings. [ABSTRACT FROM AUTHOR]

• Research shows that neglect in early life can affect biobehavioral development. • Children who have experienced neglect show distinct cortisol production patterns. • Early interventions have been shown to produce more typical cortisol patterns. • Future research should consider additional biomarkers and policy implications. Research on the effects of early life adversity, and in particular on the absence of responsive caregiving, has shown long-term impacts on well-being and development. These investigations have been conducted both in human populations and in animal models. The work has demonstrated that neglect experienced in the early years can affect not only behavior but also neurobiological functioning. In particular, studies of children in the foster care system show convergence with research on children adopted following institutional rearing in terms of dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which produces the neuroendocrine hormone cortisol. The characteristic pattern that has been most commonly observed involves diminished diurnal cortisol production, particularly in terms of low levels of cortisol upon awakening. Notably, however, a number of evidence-based interventions for infant, toddler, and preschool-aged foster children have been shown to produce more typical patterns of cortisol production, in combination with improved behavioral, socioemotional, and foster care placement outcomes. In this paper, we review the literature on the effects of early disruptions in care on biobehavioral development, and summarize the results of the interventions for young foster children. [ABSTRACT FROM AUTHOR]

The Common Assessment Framework provides a model of early intervention, which is familiar in local authorities throughout England, and asserts a participatory framework of child and family engagement. This paper is based on a qualitative study of parents and children who were subject to a multi‐agency process of early intervention in children's social care in a local authority in the Midlands of England. I advance the concept of assemblage to consider the basis of an active service user participation as rather more a struggle to achieve than something that has been granted by practitioner agencies. Interview extracts are used to show the enrolment and assembly of participation as a process of service users developing their active human agency in a multi‐agency setting. The article explores the assembling of skills in administration and management of meetings and plans, accessing knowledge and expertise through service user networks, and challenging professional expertise and institutional space while developing personal qualities of confidence and voice as a means of marshalling an effective participation in a multi‐agency setting. [ABSTRACT FROM AUTHOR]

Public policies encourage the service system to work in new ways to promote health and increase social equality. This paper presents four categories that show the character of the low-threshold services in Norwegian family centres from the professionals' and parents' perspectives, focusing on accessibility and participation: easy access, low level of bureaucracy, collaborative competences and inclusive arena. This paper is based on an inductive study in three municipalities that have chosen to establish family centres as interdisciplinary co-located services that aim to offer low-threshold services for children and their families. Data were generated through a fieldwork, and participatory observation and interviews were the main source of data. The methodological framework for the analysis was grounded theory, in which the data generation and analysis interchanged throughout the study, and theoretical sampling set the focus for the fieldwork. Exploring the actor's perspective highlighted both strengths and challenges with the low-threshold services in the family centres. The four elements presented emphasize that the value of these low-threshold services are not found in one single hallmark; rather, the value depends on an interaction between different elements that must be addressed when establishing, evaluating and developing low-threshold services in family centres. [ABSTRACT FROM AUTHOR]

Aim: Early intervention programmes for first episode psychosis (FEP) aim to reduce the duration of untreated psychosis (DUP) and improve functional outcomes. The sustained maintenance of improved outcomes depends largely on patients' adherence to prescribed treatment. This paper examines the prevalence of non‐adherence in a cohort of patients with FEP and the sociodemographic and clinical factors associated with non‐adherent behaviour. Methods: The sample included consecutive patients accepted from 2007 to 2012 into the Early Psychosis Intervention Programme (EPIP) in Singapore. Sociodemographic variables as well as DUP, insight, severity of psychopathology and clinical diagnoses were collected. Patients were assessed at baseline and 1 year with the PANSS and Global Assessment of Functioning Scale (GAF). Medication adherence was grouped into 3 categories: no‐adherence, partial adherence and regular adherence. Results: Of the 445 patients included, 51% were male with a mean age of 26.3 years, 74.6% had schizophrenia spectrum and delusional disorders, 14% had affective psychosis and 11.3% had brief psychotic disorder or psychotic disorder not otherwise specified. At 1 year follow up, 65.5% reported regular adherence, 18.7% were partially adherent and 15.8% were non‐adherent. Non‐adherence was correlated with male gender, living alone and having poorer judgement and insight. Partial adherence was associated with Malay ethnicity and having undergone national service. Conclusion: Medication adherence is prevalent in FEP and associated with a variety of factors. This study supports the use of culturally appropriate interventions in addressing barriers to adherence. Further studies would need to be done to address specific factors affecting adherence outcomes. [ABSTRACT FROM AUTHOR]

Aim: Youth mental health is of paramount significance to society globally. Given early onset of mental disorders and the inadequate access to appropriate services, a meaningful service transformation, based on globally recognized principles, is necessary. The aim of this paper is to describe a national Canadian project designed to achieve transformation of mental health services and to evaluate the impact of such transformation on individual and system related outcomes. Method: We describe a model for transformation of services for youth with mental health and substance abuse problems across 14 geographically, linguistically and culturally diverse sites, including large and small urban, rural, First Nations and Inuit communities as well as homeless youth and a post‐secondary educational setting. The principles guiding service transformation and objectives are identical across all sites but the method to achieve them varies depending on prevailing resources, culture, geography and the population to be served and how each community can best utilize the extra resources for transformation. Results: Each site is engaged in community mapping of services followed by training, active stakeholder engagement with youth and families, early case identification initiatives, providing rapid access (within 72 hours) to an assessment of the presenting problems, facilitating connection to an appropriate service within 30 days (if required) with no transition based on age within the 11 to 25 age group and a structured evaluation to track outcomes over the period of the study. Conclusions: Service transformation that is likely to achieve substantial change involves very detailed and carefully orchestrated processes guided by a set of values, principles, clear objectives, training and evaluation. The evidence gathered from this project can form the basis for scaling up youth mental health services in Canada across a variety of environments. [ABSTRACT FROM AUTHOR]

Aim: This paper aims to advance our understanding of the experience of participating in peer support groups for family members of persons with psychosis and to expand the scant body of literature on peer support in the context of early intervention services for psychosis. Such an examination is relevant because the implementation and uptake of family‐focused interventions remain inconsistent in early intervention services, despite their proven benefits. Methods: To enable family caregivers to support one another, a family peer support project was initiated at an early intervention service for psychosis in Montreal, Canada. A family peer support provider and researchers collaboratively designed and conducted this study to examine the experience of those who participated in family peer support groups. Forty‐four family members completed an English or French online questionnaire. Thematic analysis was used to code responses to open‐ended questions to unpack crucial elements of this peer support intervention. Results: Three key themes were identified—the impact of psychosis on families; understanding and coping with psychosis through family peer support; and improving family peer support services. Mutual support through sharing experiences; gains in knowledge of the illness and its treatment; emotional support; and increased caregiving and self‐care capacities and skills were identified as critical benefits of family peer support. Conclusion: Family peer support can be an acceptable and cherished means of engaging and sustaining families and enhancing their caregiving skills. Its integration into early intervention services holds the promise of helping promote recovery and reducing caregiver burden. [ABSTRACT FROM AUTHOR]

Aim: headspace is Australia's innovation in youth mental healthcare and comprises the largest national network of enhanced primary care, youth mental health centres world‐wide. headspace centres aim to intervene early in the development of mental ill‐health for young people aged 12 to 25 years by breaking down the barriers to service access experienced by adolescents and emerging adults and providing holistic healthcare. Centres have been progressively implemented over the past 12 years and are expected to apply a consistent model of integrated youth healthcare. Internationally, several countries are implementing related approaches, but the specific elements of such models have not been well described in the literature. Method: This paper addresses this gap by providing a detailed overview of the 16 core components of the headspace centre model. Results: The needs of young people and their families are the main drivers of the headspace model, which has 10 service components (youth participation, family and friends participation, community awareness, enhanced access, early intervention, appropriate care, evidence‐informed practice, four core streams, service integration, supported transitions) and six enabling components (national network, Lead Agency governance, Consortia, multidisciplinary workforce, blended funding, monitoring and evaluation). Conclusion: Through implementation of these core components headspace aims to provide easy access to one‐stop, youth‐friendly mental health, physical and sexual health, alcohol and other drug, and vocational services for young people across Australia. [ABSTRACT FROM AUTHOR]

Intervening early during childhood and adolescence to prevent mental health problems from becoming chronic, or even to prevent them occurring at all, has become an increasingly popular approach within the field of mental health over the past three decades. The importance of, and potential for, early preventive interventions in infancy, the pre‐natal period and even pre‐conception is highlighted by several of the papers featured in the current issue of the Journal, which are summarised in this editorial. Identifying children most at risk of mental illness in order to selectively target preventive efforts and carefully testing the effectiveness of these interventions, particularly in low‐and middle‐income country contexts, are crucial next steps as we move towards an era of more personalised and earlier prevention and intervention in mental health. [ABSTRACT FROM AUTHOR]

Criminologists and other developmental researchers have long acknowledged the importance of both continuity and change in antisocial and criminal behaviour over the life-course. To the extent that young offenders having contact with the police will persist with offending into adulthood is an important social issue with significant implications for the ongoing development and implementation of early intervention and prevention programs. Using data from New South Wales, this paper tracks a cohort of 8,797 juvenile offenders over ten years and is among the first of its kind to use multivariate techniques to examine the long-term outcomes of those who were cautioned, conferenced or convicted in that state. The study finds that just over half of all juvenile offenders were reconvicted in court of a further offence and that reconviction rates were higher for young males and Indigenous offenders than for females or non-Indigneous offenders. In concluding, this paper draws attention to the need for improved assessment and early intervention efforts that more accurately target those young people most at risk of persisting with offending into adulthood. [ABSTRACT FROM AUTHOR]

Research groups across Europe have been networking to share information and ideas about research on preschool children with autism. The paper describes preliminary work to develop capacity for future multi-site randomized controlled trials of early intervention, with a specific focus on the need to measure treatment adherence where parents deliver therapy. The paper includes a review of randomized and controlled studies of parent-mediated early intervention from two sources, a recent Cochrane Collaboration review and a mapping of European early intervention studies in autism published since 2002. The data extracted focused on methods for describing parent adherence, that is, how and to what extent parents carry out the strategies taught them by therapists. Less than half of the 32 studies reviewed included any measure of parent adherence. Only seven included a direct assessment method. The challenges of developing pan- European early intervention evaluation studies are discussed, including choice of intervention model and of important outcomes, the need for translation of measurement tools and achievement of joint training to reliability of assessors. Measurement of parent-child interaction style and of adherence to strategies taught need further study. [ABSTRACT FROM AUTHOR]

Aim: One of the basic challenges of Early Psychosis Intervention (EPI) programs for rural populations is translating best practice which developed for urban high-population density areas to rural and remote settings. This paper presents data from two different models (hub and spoke and specialist outreach) of rural EPI practice in Ontario, Canada. Methods: This cross-sectional study used a convenience sample of clients from two rural EPI programs between 2005 and 2007. Data about client outcomes specific to general functioning, admissions to hospital and emergency room (ER) visits were collected. For all dichotomous variables, chisquare tests were used to test differences between two groups. Results: The total clients served in hub and spoke were 457 compared to 91 in specialist outreach. Although not statistically significant, the hub and spoke group showed better functioning in the community. There was a significant difference between the two groups with regard to hospital admissions. Although not significant, there was a greater percentage (58.3%) of specialist outreach clients who visited the ER in the previous 12 months as compared to clients serviced by the hub and spoke model (34.9%). Conclusions: The observed data from these two rural models suggest that there may be differing outcomes. There are limitations to this study, and this paper does not address why there are differences. Future work needs to continue to further explore why differences exist and whether they persist so we can provide equity and quality care for rural and remote populations. [ABSTRACT FROM AUTHOR]

Aim One of the basic challenges of Early Psychosis Intervention ( EPI) programs for rural populations is translating best practice which developed for urban high-population density areas to rural and remote settings. This paper presents data from two different models ( hub and spoke and specialist outreach) of rural EPI practice in Ontario, Canada. Methods This cross-sectional study used a convenience sample of clients from two rural EPI programs between 2005 and 2007. Data about client outcomes specific to general functioning, admissions to hospital and emergency room (ER) visits were collected. For all dichotomous variables, chi-square tests were used to test differences between two groups. Results The total clients served in hub and spoke were 457 compared to 91 in specialist outreach. Although not statistically significant, the hub and spoke group showed better functioning in the community. There was a significant difference between the two groups with regard to hospital admissions. Although not significant, there was a greater percentage (58.3%) of specialist outreach clients who visited the ER in the previous 12 months as compared to clients serviced by the hub and spoke model (34.9%). Conclusions The observed data from these two rural models suggest that there may be differing outcomes. There are limitations to this study, and this paper does not address why there are differences. Future work needs to continue to further explore why differences exist and whether they persist so we can provide equity and quality care for rural and remote populations. [ABSTRACT FROM AUTHOR]

Aim: Youth participation is central to early intervention policy and quality frameworks. There is good evidence for peer support (individuals with lived experience helping other consumers) and shared decision making (involving consumers in making decisions about their own care) in adult settings. However, youth programs are rarely tested or described in detail. This report aims to fill this gap by describing a consumer focused intervention in an early intervention service. Methods: This paper describes the development process, intervention content and implementation challenges of the Choices about Healthcare Options Informed by Client Experiences and Expectations (CHOICE) Pilot Project. This highly novel and innovative project combined both youth peer work and youth shared decision making. Results: Eight peer workers were employed to deliver an online shared decision‐making tool at a youth mental health service in New South Wales, Australia. The intervention development involved best practice principles, including international standards and elements of co‐design. The implementation of the peer workforce in the service involved a number of targeted strategies designed to support this new service model. However, several implementation challenges were experienced which resulted in critical learning about how best to deliver these types of interventions. Conclusions: Delivering peer work and shared decision making within an early intervention service is feasible, but not without challenges. Providing adequate detail about interventions and implementation strategies fills a critical gap in the literature. Understanding optimal youth involvement strategies assists others to deliver acceptable and effective services to young people who experience mental ill health. [ABSTRACT FROM AUTHOR]

Background: Early Intervention in Psychosis (EIP) services have been implemented with the dual aims of preventing harmful outcomes associated with early‐onset psychosis and improving prognosis. However, concerns have been raised regarding the ethical implications of involving young people in EIP services. One way to ensure high ethical standards and promote good practice in EIP delivery is through governance of clinical practice. This study aimed to investigate the normative dimensions of good practice in EIP through examination of clinical guideline documents published in England over the past 15 years. Methods: A total of 14 clinical guidelines and relevant policy documents for EIP were retrieved and analysed using a mixed inductive and deductive thematic approach. Themes were derived from the data itself, whereas the development of broader categories was performed through a constant comparison with the scientific literature describing ethical issues in EIP. Results: Ethical touchpoints of good practice in EIP included both procedural and substantive factors, which were seen to be interdependent and mutually constitutive. These ethical touchpoints were largely implicit in the documents analysed. Procedural requirements of EIP service delivery consisted of norms and rules pertaining to EIP service structure, adherence to codes of ethics, inclusivity, patient and family centredness and appropriate treatment provision. Substantive factors consisted of moral attributes that should be cultivated by healthcare professionals working in EIP: competency, empathy, sensitivity and trustworthiness. Conclusions: We argue that, to ensure good practice in EIP, procedural and substantive ethical expectations embedded in EIP guideline documents should be made explicit in EIP service and care delivery. We suggest that the procedural and substantive factors highlighted in this paper contribute useful dimensions for the eventual evaluation of good practice in EIP services across England. [ABSTRACT FROM AUTHOR]

Aim Significant overlap and comorbidity has been demonstrated among young people with mental health problems. This paper examined demographic characteristics, heterogeneity of need descriptors and services provided among young people (12-25 years) engaging in brief interventions at J igsaw in the Republic of Ireland. Method Between 1 January 2013 and 31 December 2013, a total of 2571 young people sought help from 1 of 10 J igsaw sites. Of these, 1247 engaged in goal-focused brief interventions, typically consisting of one to six face-to-face sessions. Descriptive statistics were used to summarize social and demographic factors. Latent class analysis was used to cluster young people into relevant typologies of presenting issues. Multinomial logistic regression was then performed to determine significant predictors of class membership. Results The most common age of young people was 16. More women (59.6%) than men engaged in brief interventions, 56% attended school, 74% lived with their family of origin or with one parent, and 54.2% came from families where parents were married. Using established fit criteria, four relevant typologies emerged: Developmental (26.8%), Comorbid (15.8%), Anxious (42.7%) and Externalising (14.6%). Predictors varied by class membership, but general family problems and lack of adult support emerged as the strongest predictors for all classes. Conclusion This study demonstrated that the mental health needs of young people in Ireland are significant and diverse. Because J igsaw favours a more descriptive approach to problem identification, the four typologies suggest a need to determine program capacity in engaging youth with heterogeneous presenting issues and to tailor brief interventions to each group's clinical profiles. [ABSTRACT FROM AUTHOR]

Background Recent government initiatives in the UK encourage collaborative working among professionals and highlight the importance of a co-ordinated and collaborative approach in early years for families and children. There are many models of collaborative working but the evidence base for its effectiveness in early years (0-2.5 years) in a community setting in the UK is patchy. The aim of this study is to objectively evaluate the transdisciplinary model of collaborative working in this setting. Methods This paper describes the development of a transdisciplinary early intervention team providing services to a 0- to 2.5-year-old age group in a community setting in the UK, between 2004 and 2007. The effects on waiting times, therapy session attendance and caseload were evaluated. Results Statistically significant reduction in waiting times from an average 114-35.6 days for the highest priority children was demonstrated. Attendance at therapy sessions increased significantly from 49% in 2005 to 56% in 2006 and 75% 2007, despite an increasing case load from 29 in 2004 to 64 in 2008 through more efficient utilization of time and resources. Conclusion It is felt that this paper demonstrates, for the first time, the objective benefits to clients and fundholders/Primary Care Trust (PCT) of practical application of the theory of transdisciplinary working in a community paediatric service setting in the UK. [ABSTRACT FROM AUTHOR]

Aim: Although the different approaches to psychosis research have made significant advances in their own fields, integration between the approaches is often lacking. This paper attempts to integrate a strand of cognitive research in psychotic disorders (specifically, social cognition research) with phenomenological accounts of schizophrenia and other psychotic disorders. Method: The paper is a critical investigation of phenomenological models of disturbed selfhood in schizophrenia in relation to cognitive theories of social cognition in psychotic disorders. Results: We argue that disturbance of the basic sense of self, as articulated in the phenomenological literature, may underlie the social cognition difficulties present in psychotic disorders. This argument is based on phenomenological thinking about self-presence (‘ipseity’) being the primary or most basic ground for the intentionality of consciousness – that is, the directedness of consciousness towards others and the world. A disruption in this basic ground of conscious life has a reverberating effect through other areas of cognitive and social functioning. We propose three routes whereby self-disturbance may compromise social cognition, including dissimilarity, disruption of lived body and disturbed mental coherence. Conclusions: If this model is supported, then social cognition difficulties may be thought of as a secondary index or marker of the more primary disturbance of self in psychotic disorders. Further empirical work examining the relationship between cognitive and phenomenological variables may be of value in identifying risk markers for psychosis onset, thus contributing to early intervention efforts, as well as in clarifying the essential psychopathological features of schizophrenia and other psychotic disorders. [ABSTRACT FROM AUTHOR]

Recent evidence has shown that early pharmacological and psychosocial treatment dramatically ameliorates poor prognosis and outcome for individuals with psychotic disorders, reducing conversion rates to full-blown illness and decreasing symptom severity. In a companion paper, we discussed methodological issues pertaining to early intervention in bipolar disorder (BPD), reviewed clinical studies that focus on high-risk subjects as well as first-episode patients, and reviewed findings from brain imaging studies in the offspring of individuals with BPD as well as in first-episode patients. In this paper, we discuss how drugs that modulate cellular and neural plasticity cascades are likely to benefit patients in the very early stages of BPD, because they target some of the core pathophysiological mechanisms of this devastating illness. Cellular and molecular mechanisms of action of agents with neurotrophic and neuroplastic properties are discussed, with a particular emphasis on lithium and valproate. We also discuss their potential use as early intervention strategies for improving symptoms and functioning in patients in the earliest stages of BPD, as well as high-risk individuals. [ABSTRACT FROM AUTHOR]

Background Early intervention services adopting a family-centred approach are considered important for ensuring parent satisfaction. This study investigated the satisfaction of two mothers with an early intervention programme for young children with autistic spectrum disorder. Materials and Methods While 16 mother–child dyads participated in a larger study, two mothers who reported considerably lower satisfaction with the programme than the rest of the mothers were the focus of this paper. Using descriptive case studies, various child, parent and service delivery factors that may have influenced satisfaction are described. Results Child and parent factors that may have lessened satisfaction for these two mothers included the child’s lack of improvement, child’s goal performance post-intervention, parenting stress and decreased parenting competence. Both mothers also had decreased perceptions of the family-centredness of the service and expressed difficulties with establishing collaborative partnerships. Conclusion This paper proposes that parental satisfaction may be influenced by numerous factors relating to the child, parent and service. Relationships with service providers appear to be particularly important. [ABSTRACT FROM AUTHOR]

This paper reports on a single case history taken from the `Dementia Action Research and Education' project, a 15-month primary care intervention study that was undertaken in North Wales in the early part of 2000. The study sought to address the meaning, context and diversity of early intervention in dementia care and employed a community mental health nurse and a psychiatric social worker to undertake early and psychosocial interventions with older people with dementia (aged 75 years and over) and their families. The workers tape-recorded, documented and analysed their interventions with 27 older people with dementia and their families over the 15-month duration of the study. Clinical supervision was also undertaken during the intervention phase. One case history is presented in this paper to illustrate the work of the community mental health nurse and to identify areas of practice development. Greater role transparency, collaborative working and improvement in educational preparation for practice are called for. [ABSTRACT FROM AUTHOR]

Aim Individuals with at-risk mental state ( ARMS) experience subtle changes in thinking, behaviour and emotion before their first psychotic episode. Research has shown intervention provided during this period could delay, reduce, or even prevent the conversion to psychosis. In March 2008, the Support for Wellness Achievement Programme ( SWAP) was launched for the assessment and treatment of patients with ARMS in Singapore. This paper examines the sociodemographic and clinical characteristics of patients at baseline. Methods In total, 384 patients were screened and 155 were accepted into the service. All patients were evaluated using the Comprehensive Assessment of At- Risk Mental State ( CAARMS). Severity of psychopathology was assessed by Positive and Negative Syndrome Scale for Schizophrenia ( PANSS) and levels of functioning were assessed using the Social and Occupational Functioning Assessment Scale ( SOFAS). Results The mean age of the patients was 21.0 years (standard deviation ( SD) = 3.5) and 69.7% were men, 42.6% had a relative with a mental health problem and 69.8% met the criterion solely for the attenuated symptoms group. The mean PANSS total score was 48.9 ( SD = 10.8). There was also a high rate of comorbidity with 34.8% having depression and 20.0% had anxiety disorders. The mean baseline SOFAS score was 51.5 ( SD = 9.8), indicating moderate impairment in their functioning. Conclusion These preliminary findings have highlighted that our data are similar to other ARMS programmes, and in addition to the management of ARMS, there is a need to treat both the comorbidities and impairment in social occupational functioning. [ABSTRACT FROM AUTHOR]

Aim: This paper describes the Toddlers at Risk of Autism Clinic (TRAC), which utilises the Social Attention and Communication Study (SACS) and/or Autism Detection in Early Childhood (ADEC) play-based assessments to facilitate the early diagnosis of autism. Methods: A retrospective audit was conducted of all 42 children assessed over a 3-year period in the TRAC. A semi-structured interview and play-based assessment (SACS and ADEC) were used to aid experienced clinicians in diagnosing autism. Intervention was recommended, and families were routinely followed up. Analysis was conducted on the tools used, the outcomes of assessment, diagnosis and stability of diagnosis on follow-up. Results: During this period, 35 boys and 7 girls were assessed, with a mean age of 25 months. The average waiting time for clinic was 11.6 weeks. Twenty-five patients were diagnosed with autism; 90.5% of toddlers given an initial diagnosis retained that diagnosis at follow-up. Out of the 17 children who were not diagnosed with autism in the TRAC, one child was later diagnosed with autism. Conclusion: Experienced clinicians can use the SACS and/or ADEC to assist with a Diagnostic and Statistical Manual diagnosis of autism in toddlers. [ABSTRACT FROM AUTHOR]

Aim On the basis of applying 'ultra-high-risk' ( UHR) criteria, initially high rates of transition to psychosis were reported. However, a decline in transition to psychosis has been observed in recent years. The current descriptive paper aims to investigate if this drop in transition rate may be due to potential changes in patterns of referral to a large UHR clinic. Methods One hundred fifty young people who were referred to the Personal Assessment and Crisis Evaluation ( PACE) Clinic in Melbourne, Australia, between August 2000 and July 2004 were included. Their referral pathways were assessed using a semistructured interview. Results were compared with a similar study of a cohort referred to the same clinic between 1995 and 1996. Results The mean number of contacts prior to referral to the PACE Clinic was 1.93 (standard deviation ( SD) = 1.15), and the average time between symptom onset and referral to PACE was 46.5 weeks ( SD = 57.4). In comparison with the earlier cohort (mean = 2.36; SD = 1.32), our results indicate a lower number of contacts ( Cohen's d = 0.35, r = 0.17). Furthermore, participants in the current study were referred twice as fast to the PACE Clinic. Conclusions Increasing awareness of UHR symptoms among professionals and in the general population seems to have resulted in faster referral of young people to specialized mental health services. The global drop in transition rate might be due to a change in referral pathways to UHR services. [ABSTRACT FROM AUTHOR]

This paper seeks to add to the literature on working with fathers by focusing on early intervention. It draws on research into fathers involved in a home visitation service delivered by the Family Nurse Partnership in England and evaluates the men's experiences of the intervention. The vulnerability of fathers was striking and many were helped to develop their practical skills and confidence in caring for their babies. The intervention was effective because of the quality time that was invested in developing relationships with fathers (as well as mothers), the focus on their strengths as well as areas for improvement and the skilled, therapeutically oriented, holistic approach through which the service was delivered. The 'early' nature of the help was crucial to its success because of how it so effectively tapped into the men's redefinition of themselves as caring fathers during pregnancy and following the birth. We argue that there is important learning here for social care and health services in general about how to engage men and promote fathers' capacities to care for their children. [ABSTRACT FROM AUTHOR]

Objectives Clinical staging is widespread in medicine - it informs prognosis, clinical course, and treatment, and assists individualized care. Staging places an individual on a probabilistic continuum of increasing potential disease severity, ranging from clinically at-risk or latency stage through first threshold episode of illness or recurrence, and, finally, to late or end-stage disease. The aim of the present paper was to examine and update the evidence regarding staging in bipolar disorder, and how this might inform targeted and individualized intervention approaches. Methods We provide a narrative review of the relevant information. Results In bipolar disorder, the validity of staging is informed by a range of findings that accompany illness progression, including neuroimaging data suggesting incremental volume loss, cognitive changes, and a declining likelihood of response to pharmacological and psychosocial treatments. Staging informs the adoption of a number of approaches, including the active promotion of both indicated prevention for at-risk individuals and early intervention strategies for newly diagnosed individuals, and the tailored implementation of treatments according to the stage of illness. Conclusions The nature of bipolar disorder implies the presence of an active process of neuroprogression that is considered to be at least partly mediated by inflammation, oxidative stress, apoptosis, and changes in neurogenesis. It further supports the concept of neuroprotection, in that a diversity of agents have putative effects against these molecular targets. Clinically, staging suggests that the at-risk state or first episode is a period that requires particularly active and broad-based treatment, consistent with the hope that the temporal trajectory of the illness can be altered. Prompt treatment may be potentially neuroprotective and attenuate the neurostructural and neurocognitive changes that emerge with chronicity. Staging highlights the need for interventions at a service delivery level and implementing treatments at the earliest stage of illness possible. [ABSTRACT FROM AUTHOR]

Objectives Early intervention and preventive strategies have become major targets of research and service development in psychiatry over the last few years. Compared to schizophrenia, bipolar disorder ( BD) has received limited attention in this regard. In this paper, we review the available literature in order to explore the public health significance of BD and the extent to which this may justify the development of early intervention strategies for this disorder. Methods The main computerized psychiatric literature databases were accessed. This included Medline and PsychInfo, using the following keywords: bipolar, early intervention, staging model, burden, caregiver, public health, and manic depression. Results BD is often recurrent and has an impact that goes well beyond symptomatic pathology. The burden it incurs is linked not only to its cardinal clinical features, but also to cognitive dysfunction, poor functional outcome, poor physical health, high rate of comorbidities, and suicide. At a societal level, BD induces enormous direct and indirect costs and has a major impact on caregivers. The available literature reveals a usually long delay between illness onset and the start of treatment, and the absence of specific guidelines for the treatment of the early phase of BD. Conclusions Considering the major impact of BD on patients and society, there is an urgent need for the development of early intervention strategies aimed at earlier detection and more specific treatment of the early phase of the disorder. [ABSTRACT FROM AUTHOR]

Oppositional defiant disorder ( ODD) or conduct disorder ( CD) occurs when children's disruptive and antisocial behaviours start to interfere with their academic, emotional and/or social development. Recently, there has been a considerable investment to implement national school-based early intervention programs to help prevent the onset of ODD/ CD. Aim: This paper describes the delivery of the Royal Children's Hospital, Child and Adolescent Mental Health Service and Schools Early Action Program: a whole school, multi-level, multidisciplinary approach to address emerging ODD/ CD and pre- versus post-delivery assessment in 40 schools over a 4-year period (2007-2010). Methods: All children from preparatory to grade 3 (ages 4-10 years) were screened for conduct problems ( n = 8546) using the Strengths and Difficulties Questionnaire. Universal, targeted and indicated interventions were delivered in school settings. In total, 304 children participated in the targeted group program where the Child Behaviour Checklist was used as a pre- and post-intervention measure. Cohen's d effect sizes and a reliability change index were calculated to determine clinical significance. Results: Significant reductions in both parent- and teacher-reported internalizing and externalizing symptoms were noted. Parent, teacher and child feedback were very positive. Conclusions: A future randomized controlled trial of the program would address potential placebo and selection bias effects. [ABSTRACT FROM AUTHOR]

This paper briefly describes narrative and open dialogue approaches before exploring their shared values, ways of working, their differences and the possibilities for integration. Both authors have extensive experience in using a narrative therapy approach, while Val Jackson, a family and systemic psychotherapist, also uses an open dialogue approach in her work in an early intervention in psychosis service in Yorkshire, UK. [ABSTRACT FROM AUTHOR]