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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]

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]

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]

This paper discusses aspects of the implementation of the Common Assessment Framework (CAF) in the UK, introduced under the Change for Children Programme and designed to facilitate early intervention and improve multi-agency working. The study area was rural in character and findings are compared with evaluation of early CAF implementation which focused primarily on urban areas. The study provided lessons for practice, many of which resonate particularly with rural problems identified in the international literature. There may be advantages in rural areas in ease of involvement of families in processes, in early awareness of practitioners of difficulties in families and in depth of relationships with families. These in turn may support early intervention. Disadvantages centre around resource issues, those of skills and confidence and lack of contact with and therefore distrust of other agencies. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this review is to report on existing literature regarding children and adolescents younger than 16 years of age experiencing a first-episode psychiatric disturbance. Rather than providing a comprehensive list of service implications, this paper identifies some of the gaps in knowledge and practice to encourage ongoing analysis regarding better practices for early intervention for children and adolescents experiencing a first-episode psychiatric disturbance. Methods: A search was conducted to identify key evidence-based literature published from 1985 to 2007 discussing various aspects of child and youth mental health in Canada, the USA, the UK, Australia and New Zealand. The review also included ‘grey’ literature. Categories of information include diagnoses, pharmacological and non-pharmacological treatment, prevalence, environmental and other risk factors, and demographic variables. Results: Understanding first-episode psychiatric disturbance for patients under the age of 16 years is limited because of a scarcity of controlled studies focusing on this population. Programme evaluations are sparse, perhaps because of the small number of specialized units servicing this population. It may be helpful to enlist early intervention psychosis programmes that have been successful in assisting young people aged 16–24 in the development of better practices and care outcomes for younger age groups. Conclusions: The authors highlight information that has the potential to assist in optimizing care for those youth younger than 16 years experiencing or exhibiting signs of a first-episode psychiatric disturbance. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a survey, which examined how people with psychosis and their carers had experienced local mental health services. The research was conducted prior to the establishment of an early intervention service and other service improvements in the region. The results suggest that the mental health service is improving overall for individuals with psychosis and their carers. The experiences of recent service users and carers seem more positive than those whose first contact with the services occurred during the 1970s and 1980s. Both service users and their carers report feeling largely supported by mental health professionals and voluntary support agencies, and feel included in the treatment approach. However, a number of important issues were highlighted. These include (i) the need for public education (which may help to reduce the delay which currently occurs between people seeking support and receiving treatment); (ii) improved access to alternative treatments, such as psychosocial therapies (in conjunction with pharmacological treatment); the provision of appropriate psychiatric facilities; and (iii) the inclusion of an early intervention treatment approach. The survey provides descriptive information from one NHS trust, which shows support for larger scale research findings and government recommendations. [ABSTRACT FROM AUTHOR]

A number of studies have demonstrated that Early Intervention in Psychosis (EIP) services can produce improved outcomes for service users. However, the essential elements that produce these results remain elusive. This paper considers a number of hypotheses, with a particular focus on one service in the UK, which was designed according to policy guidance. It concludes that the structure of EIP services allows for the effective implementation of evidence based psychosocial interventions, which often fail to be implemented successfully within standard mental health services. [ABSTRACT FROM AUTHOR]

Aim: Early intervention for psychosis services (EIS) has been established worldwide and is offered to individuals experiencing a first episode of psychosis. Engagement with EIS typically lasts for 3 years, after which point, service users are either transferred to primary care or community mental health teams, according to perceived needs. Although UK National Institute for Clinical Excellence (NICE) guidelines recommend transfer of care should be arranged in conjunction with the receiving service, there exists little, if any, practical guidance as to how this should actually be managed. This study aims to investigate the barriers and facilitators of transition from EIS to both primary and secondary care services in the United Kingdom from the perspectives of service users. Methods: Fifteen EIS service users who had either been discharged to primary or secondary services were interviewed about their experience of discharge. Data were analysed using interpretive thematic analysis, adopting a critical realist stance. Results: Four themes were identified: feeling ready for discharge; relationships and trust; planning for discharge; life after EIS. Conclusions: This is the first in‐depth exploration of a sample of largely male service users' views on transition from EIS to primary and/or secondary care services. We highlight several practical steps that EIS and receiving services can take to facilitate a more optimal discharge and transition experience for EIS service users. Taking into account service pressures, the discharge process should be one that is gradual, allowing time for the service user to both process the news and gradually sever ties with keyworkers. [ABSTRACT FROM AUTHOR]

Recent work suggests that differences in functional brain development are already identifiable in 6- to 9-month-old infants from low socio-economic status (SES) backgrounds. Investigation of early SES-related differences in neuro-cognitive functioning requires the recruitment of large and diverse samples of infants, yet it is often difficult to persuade low-SES parents to come to a university setting. One solution is to recruit infants through early intervention children's centres (CCs). These are often located in areas of high relative deprivation to support young children. Given the increasing portability of eye-tracking equipment, assessment of large clusters of infants could be undertaken in centres by suitably trained early intervention staff. Here, we report on a study involving 174 infants and their parents, carried out in partnership with CCs, exploring the feasibility of this approach. We report the processes of setting up the project and participant recruitment. We report the diversity of sample obtained on the engagement of CC staff in training and the process of assessment itself. We report the quality of the data obtained, and the levels of engagement of parents and infants. We conclude that this approach has great potential for recruiting large and diverse samples worldwide, provides sufficiently reliable data and is engaging to staff, parents and infants. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Accessible Summary An advocate helps you know your rights and what is expected of you., An advocate helps you speak up for yourself., Parents with learning disabilities need advocates when professionals are worried about their children., There is not much money for advocacy at the moment. Not all parents with learning disabilities can get advocacy., This is why we tried to find out if it makes sense for the government to spend more money on advocacy., We found out that advocacy can be good value for money. It can help parents and children. It can mean that social services have to pay less to help parents and their children., Summary Advocacy can help service users both to understand their rights and choices and also to support them in resolving issues of great significance to their lives. We investigated some of the costs and outcomes of advocacy provided to parents with learning disabilities at risk of having their children taken into care. Through two workshops and a survey, we gathered information about service use and outcomes at case- and project-levels. We used evidence from previous studies to assign unit costs to service use and to value the economic consequences of outcomes. We combined data with simple decision-modelling techniques. The mean cost of the advocacy intervention was £3040; potential cost savings per case ranged from £720 if we only considered the impact on children's social services, to over £3130 if savings to other public services were considered. Estimated improvements in quality of life and earnings were worth an additional £550. The limitations of our study mean those findings should be interpreted cautiously. Nonetheless, they suggest there is scope for securing better value for money through introducing advocacy for parents with learning disabilities. [ABSTRACT FROM AUTHOR]

Early intervention is key for children with special educational needs or disabilities ( SEND), and therefore early assessment is crucial. Information from parents about children's current ability and their developmental history can make valid and useful contributions to developmental assessments. Parental input is also important in early education for children with and without SEND. In England, recent changes to statutory guidance for early education highlight partnership working with parents, progress checks and continuous observation. The Early Years Developmental Journal ( EYDJ), an Early Support tool primarily aimed at families, aims to support early identification and assessment for children with SEND and early education for all children. The article describes Early Support to provide a backdrop and then outlines the purpose, structure and rigorous development process of the EYDJ. Use of the EYDJ to support parents, early years education practitioners, health visitors, developmental assessments and the forthcoming English special educational needs ( SEN) reforms is also described. [ABSTRACT FROM AUTHOR]

Aims National EDEN aims to evaluate the implementation and impact on key outcomes of somewhat differently configured Early Intervention Services ( EIS) across sites in England and to develop a model of variance in patient outcomes that includes key variables of duration of untreated psychosis ( DUP), fidelity to the EIS model and service engagement. The cohort is being followed up for two further years as patients are discharged, to observe the stability of change and the impact of the discharge settings. Methods A longitudinal cohort study of patients with a first episode of a psychosis, managed by EIS in six services across England. Patients are followed up 12 months after inception, then up to 2 years following discharge. Measures of DUP, psychosis, social functioning and relapse were taken. User and carer experience of EIS were monitored over time; as was the fidelity of each EIS to national guidelines. Service use is costed for a health economic evaluation. Results 1027 people consented to the study of which 75% were successfully followed up at 12 months, with almost 100% data on treatment, relapse and recovery and service use. Conclusions National EDEN is the largest cohort study of young people with psychosis receiving care under EIS. It will be able definitively to indicate whether this major investment in the United Kingdom in EI is achieving meaningful change for its users in practice and provide indications concerning who does well under this approach and who does not, and the long-term stability of any improvements. [ABSTRACT FROM AUTHOR]

Background Neuromuscular electrical stimulation (NMES) has shown to improve skeletal muscle strength and exercise capacity in stable patients with chronic obstructive pulmonary disease (COPD). Variations in NMES protocols are considerable. We aimed to compare changes in muscle strength after high-frequency and low-frequency NMES in patients admitted to hospital with an acute exacerbation of COPD. Methods Patients were referred for inpatient (IP) rehabilitation during hospitalisation for an acute worsening of their COPD. They received 30-minute daily NMES to both quadriceps at a frequency of 35 or 50 Hz. NMES intensity was titrated to patients' tolerance. Isometric quadriceps muscle strength and endurance walking (ESWT) time were measured at baseline and on hospital discharge. Results A total of 10 patients in each treatment group underwent NMES during hospitalisation (mean [SD] age 68.0 [±7.4] years, FEV1 0.99 L [±0.58], FEV1/FVC 47% [± 27%], MRC 5 [IQR ±1]). There were no significant differences in baseline characteristics between groups. Muscle strength (legs combined) increased in both groups regardless of the NMES frequency used (35 Hz - 3.8 ± 4.9; 50 Hz - 3.4 ± 5.5 kg). This was only significant within the 35 Hz group. The change in ESWT also showed a trend to increase in both groups (35 Hz - 109 ± 92.7; 50 Hz - 145.6 ± 94.7). There was no significant difference between groups for either outcome. Conclusion NMES is a feasible intervention to improve muscle strength in a cohort of patients admitted with an exacerbation of COPD. The response appears to be independent of the frequency used and both were well-tolerated. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background The UK Government introduced a large-scale early childhood intervention programme, Sure Start, in 1999. Sure Start is to be further expanded, to achieve national coverage. US experience is highly relevant for anticipating challenges that this expansion will raise. Methods This is a focused, narrative review. We examine the impact, funding, quality-improvement and programme objectives of Head Start and Early Head Start programmes. Results (1) Early childhood interventions can make a significant difference to children’s life chances; (2) expansion without adequate funding threatens quality; (3) narrower objectives, which are easier to measure, can crowd out broader objectives, which are difficult to measure; (4) programmes must balance fidelity to the model and flexibility to local conditions; (5) multiple objectives may conflict; and (6) programmes may have differential impacts. We consider the implications of these findings for Sure Start, focusing on funding, quality control and parental involvement. We also consider that the potential Sure Start should offer for tackling health inequalities in early childhood and suggest ways in which this aspect of the Programme could be enhanced. Conclusion Head Start has been dogged by concerns about quality and effectiveness. Many of these problems stemmed from an over-hasty expansion, which locked the Programme into inadequate funding and uneven project- and staff-quality. These issues have been addressed through large funding increases and more rigorous performance measures. Nevertheless, concerns about the aims of the Programme and the extent of parental involvement in management remain. Current funding for Sure Start appears to be adequate, while systematic evaluation procedures have been built in from its inception. Concerns have been raised about the implications of expansion for funding, quality and for parental involvement in management of local programmes. US experience shows that these are centrally important issues and that, if they are not addressed early on, they can take many years to rectify. [ABSTRACT FROM AUTHOR]

In this article, the current climate of early intervention is considered, advocating the necessity for it to remain a cutting-edge service that attends to the changing needs profiles of children and their families. The article reviews the difficulties experienced by families in the UK, where, as the government acknowledges, life chances are still unequal. It emphasises that early interventions can increase the likelihood of the family being able to engage or re-engage with mainstream societal services, thus reducing the long-term costs to society. It discusses the past and present UK policy context from 2004, when Sohns reported that the UK was the only country without a national policy of infrastructure in relation to early childhood intervention, until the present when, a raft of legislation is in place acknowledging its importance and the need for priority. Central to many effective early intervention programmes is the goal of establishing shared communication in the infant–key carer dyad, using alternative communication and therapy-based interventions. The article discusses parent-inclusive programmes which meet the needs of both parents and children, and receive endorsement from parents. Finally, the article considers evaluation of early childhood services, and the necessity of increasing the centrality of the family in service delivery in order to provide services which are integrated, relevant and efficacious. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the extent to which Government plans for early intervention in psychosis services have been realized in England, the UK. Methods: Data from the Mental Health Mapping Exercise and Department of Health quarterly performance monitoring were used. Semi-structured interviews were also conducted with the nine regional early intervention in psychosis Leads from the National Institute for Mental Health in England in order to ascertain their views and experiences regarding early intervention in psychosis service development. Results: By 2006 118 teams were operating. However, the staffing and skill mix of each varied considerably with only half reporting that they met all the criteria set out in the original policy guidance. Conclusion: Although an impressive number of services have been developed, concerns remain regarding their size, configuration and functional capacity. [ABSTRACT FROM AUTHOR]

Abstract Background Although international interest in intensive home-based early behavioural intervention for children with autism is increasing, there is little or no published research on the experiences of families conducting these programmes. Methods One hundred and forty-one UK parents conducting Lovaas-style interventions with their young child with autism were asked to identify factors that acted as facilitative factors and barriers to the implementation of these programmes. Parents responded to written questions contained within a questionnaire survey, and their responses were subjected to a content analysis procedure. Results Several of the facilitative factors and barriers were found to be similar. For example, a supportive therapy team was the most frequently cited facilitative factor, and problems recruiting and maintaining a suitable team was the most frequently reported barrier. Other factors seemed to be more independent constructs. For example, an important barrier was the lack of time and personal energy, but plenty of time and energy was not cited as a facilitative factor. Conclusions The practical implications of these results for families and for services supporting families engaged in intensive early behavioural intervention are discussed. In addition, more general implications for the designers of behavioural intervention programmes are identified. [ABSTRACT FROM AUTHOR]