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Summary: Background: Although early childhood obesity prevention has become an important issue internationally, little evidence exists regarding longer term effects (i.e., sustainability) of early interventions. Objective: To determine whether intervention benefits at 2 years of age were sustained at 3.5 and 5 years. Methods: Follow‐up of the Early Prevention of Obesity in Children (EPOCH) individual participant data prospective meta‐analysis of four randomized controlled trials including 2196 mother–child dyads at baseline. Interventions were home‐ or community‐based, commenced within 6 months of birth, ended by 2 years of age, and comprised multiple sessions. Controls received standard care. BMI z‐score (primary outcome), other anthropometric measures and weight‐related behaviours were initially measured at 1.5–2 years and followed up at 3.5 and 5 years. Results: Positive intervention effects on BMI z‐scores at 1.5–2 years of age were not apparent by 3.5 years (−0.04 adjusted mean difference; 95% CI:−0.14, 0.06; p = 0.424), and 5 years (0.03; 95% CI: −0.08, 0.14; p = 0.60). While prolonged intervention benefits were detected for a few, but not the majority of, weight‐related behaviours at 3.5 years, these effects diminished over time. Conclusion: This meta‐analysis found that initial positive effects of childhood obesity interventions faded out after interventions ended, pointing toward the importance of a suite of interventions implemented at multiple stages across childhood. [ABSTRACT FROM AUTHOR]

Aim: To understand the earliest parent reported signs suggesting their child may have an eating disorder (ED), and to quantify time from symptom onset to specialist assessment. Methods: This is a secondary analysis of data derived from parents of 78 young people presenting to a British community ED service who completed a questionnaire asking when they first noticed their child displaying (a) a change in eating pattern, (b) weight concerns, (c) shape concerns. Parents were also asked to describe the first thing they noticed in terms of possible ED symptoms. Results: Mean age was 14.9 (SD: 1.58), 94% were female with diagnoses of anorexia nervosa (n = 50), bulimia nervosa (n = 10) and atypical anorexia nervosa (n = 18). Weight and shape concerns were most often noticed over a year prior to assessment (mean 12.7 months [SD: 12.8] and 13.3 months [SD: 13.2], respectively), with eating pattern change observed a mean of 9.7 months (SD: 7.6) before referral to specialist care. Seven main themes were developed from parents' descriptions of their child's symptoms: (1) eating pattern change, (2) shape concern, (3) weight concern, (4) observed weight loss, (5) binge eating/compensatory behaviours, (6) other mental health concerns and (7) physical symptoms. Conclusions: The most common parental concerns were eating pattern change, specifically their child becoming more rigid/rule‐bound with regard to eating and dietary restraint. Such external changes are likely observed before physical changes such as weight loss, offering potential for early identification by parents, primary care and other professionals, with implications for improved prognosis. [ABSTRACT FROM AUTHOR]

Objectives: Paranoia is most likely to emerge in adolescence. In adolescents with mental health disorders, the disruptive effect of paranoia on social relationships could worsen outcomes. However, little is known about clinical presentations of paranoia at this age. We therefore explored the development, experience, and impact of paranoia in adolescent patients. Design: A qualitative interview design with interpretative phenomenological analysis was used. Method: Twelve adolescents (11–17 years) with paranoia attending child and adolescent mental health services were interviewed. Results: Adolescents described a journey starting with their awareness of paranoia beginning to a paranoid experience of mistrust and fear of others, and, subsequently, their adjustment to paranoia in daily life. Paranoia onset was rooted in the discovery of interpersonal threat and personal vulnerability, shaped by challenging peer interactions, becoming aware of danger in the world, and personal adverse experiences. The paranoia experience included a struggle to trust friends, anticipating threat with intense fear, and using defensive strategies to keep safe. Adolescents described how the paranoia experience was confusing, negatively impacted self‐concept, held them back from teenage life, and caused disconnection from friends. Longer‐term responses to paranoia reflected a tension between reluctantly resigning to the experience and trying to resist the impact. Conclusions: The journey of paranoia in adolescence involves navigating multiple tensions, with young people balancing independence with vulnerability, trust with mistrust, and the desire to socialise with a fear of danger and deception. Decisions about how to respond to paranoia are likely to determine the next stage of their journey. [ABSTRACT FROM AUTHOR]

Aim: Increasing evidence points to the value of coordinated specialty care (CSC) for early intervention in psychotic disorders. This report characterizes clinical and socio‐demographic features of patients at CSC programs in Massachusetts (MA), assessed by a standardized battery incorporated into "real‐world" clinical care. Methods: The MA psychosis network for early treatment developed a pilot battery to coordinate assessments across six CSC clinics. Programs reported baseline, 6‐month, and 12‐month data from a sample of 287 patients with intake dates ranging from April 2015 to December 2020. Results: Patients showed improvements in functioning, emergency service use and several symptom domains at 6 and 12 months. Missing data proved to be a limitation. Conclusions: Patients improved on several meaningful domains within the first year of CSC treatment. Future implementation efforts in cross‐program data collection should consider strategies to circumvent limitations related to heterogeneity between clinics, patient discharge and clinics' capacity for data collection. [ABSTRACT FROM AUTHOR]

Objective: There is a lack of existing research regarding young people with bipolar I disorder (BD‐I) and psychotic features, who are not in education, employment, and training (NEET). Thus, the aims of the study were to: (a) establish rates of NEET at service entry to a specialist early intervention service; (b) delineate premorbid and current variables associated with NEET status at service entry and (c) examine correlates of NEET status at discharge. Method: Medical file audit methodology was utilized to collect information on 118 patients with first episode psychotic mania treated at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. NEET status was determined using the modified vocation status index (MVCI). Bivariate and multivariable logistic variables were used to examine relationships between premorbid, service entry and treatment variables, and NEET status at service entry and discharge. Results: The NEET rate was 33.9% at service entry, and 39.2% at discharge. Variables associated with NEET status at service entry were premorbid functioning and polysubstance use. NEET status at service entry was the only significant correlate of NEET status at discharge. When service entry NEET was taken out of the model, substance use during treatment was predictive of NEET status at discharge. Conclusions: NEET status at service entry was related to a history of premorbid decline, and risk factors such as substance use and forensic issues. NEET status can decline during treatment, and utility of vocational intervention programs specifically for BD, in addition to specialist early intervention, needs to be examined. [ABSTRACT FROM AUTHOR]

Background: Ultra‐high risk (UHR) people are a heterogeneous group with variable outcomes. This study aimed at (a) estimating trajectories of response to treatment to identify homogeneous subgroups; (b) establishing the impact on these trajectories of known predictors of outcome in UHR subjects. Methods: Mixed models of growth curves and latent class growth analysis (LCGA) were applied to the 24‐item brief psychiatric rating scale (BPRS) to measure the response to treatment over 2 years in 125 UHR participants. Group differences were tested on sociodemographic variables and clinical indicators that are known to affect the outcome in UHR people. Results: BPRS scores decreased across all tested models, with a greater decrease for affective and positive symptoms than for all other dimensions of BPRS. Past admissions to the hospital for psychiatric reasons other than psychosis and the presence of a decline in premorbid functioning before the episode were associated with a slower decrease of BPRS score. LCGA identified three classes, one (82% of participants) with a progressive decrease in the BPRS scores, a second class with a moderate improvement (10%), and a third with no improvement (8%). Those in the 'no improvement' class had a higher chance of receiving a diagnosis of psychosis within the spectrum of schizophrenia. Conclusion: Most UHR individuals that are treated within a specialized service undergo substantial improvement in their psychopathology, but some seem resistant to the protocol of treatment and need close reevaluation within the first 12 months of treatment. [ABSTRACT FROM AUTHOR]

Background: Emphasis on parental engagement strategies within occupational therapy and physiotherapy early intervention (EI) programmes for infants at high risk of cerebral palsy (CP) has increased. This reflects consensus that increasing parent participation enhances treatment efficacy, potentially improving infant and parent outcomes. However, evaluation of parental engagement in EI is complex. Despite the growing application of parental engagement strategies, aligned with family‐centred care practice, theoretical evaluation is currently lacking within the literature. This realist synthesis aimed to identify component theories underlying EI strategies to support parental engagement and to use empirical findings to evaluate how these work in practice. Methods: Realist synthesis: Databases Medline, Embase, Amed, CINAHL and PsychInfo were searched (from February 1985 ‐ February 2020); further articles were sourced from reference lists. A data extraction form was used, and a Critical Appraisal Skills Programme tool was used to assess study rigour. Results: Twenty‐six articles were included. Quality of relationships, parent education and intervention co‐design were the key themes related to parental engagement strategies. Findings indicate that constructive parent reasoning mechanisms of trust, belief, sense of control, perceived feasibility of home programme delivery and ultimately motivation are linked to the underlying intervention resources afforded by specific strategies (e.g., coaching pedagogy). These responses are precursors to engagement outcomes that include increased parental self‐efficacy and adherence. Importantly, parental self‐efficacy can initiate a process of change leading to improved parental confidence and anxiety. Conclusions: Sensitively designed programme strategies, centred on relational quality between parent, infant and therapist, are fundamental for effective parent connection, involvement and investment within EI for infants with CP. [ABSTRACT FROM AUTHOR]

Aims: A global movement, including in Asia, is seeking to establish integrated youth mental health services that provide early intervention in the continuum from mental health to mental illness. Clinical case management (CCM), in which a case manager becomes not only a coordinator of services but also a provider of psychosocial support, can establish a 'one‐stop network' that supports youth in densely populated areas with various social resources. In 2019, we opened a community‐based centre called 'SODA' in front of a metropolitan railway station, which was designed to be highly accessible, stigma‐free and youth‐friendly to provide CCM. We aimed to clarify its services and effectiveness of CCM. Methods: Data from 105 youths were investigated in a case‐controlled study, dividing them into two groups: those who had received CCM for 6 months, and those whose needs were met in fewer sessions. Results: Twenty‐one subjects who received CCM for 6 months had difficulties in more domains than the others. The mean of the total service minutes for the subjects who received CCM for 6 months was 491.3 min: psychological support (accounted for 24.8% of the time), support for community living (31.2%), work support (13.8%), family support (10.5%) and support for cooperation with other organizations (19.8%). Global Assessment of Functioning (GAF) score improved significantly, from 46.6 at baseline to 59.3 at 6 months. Conclusion: Even in metropolitan areas with numerous medical facilities, young people can face high barriers to access. CCM can be effective as an early intervention for subjects developing mental illness. [ABSTRACT FROM AUTHOR]

Using a multiple case study approach, this ethnography examined the experiences of parents of children deemed at risk for developmental delays or disabilities who had received early intervention ( EI) services (birth to age 3 years) in a large urban location in Western Canada. Participants (11 adult parents and 7 children) were drawn from six families. Methods of data collection included focus groups ( FG), face-to-face interviews and file reviews. Member check and expert reviews were conducted throughout data collection and data analyses as part of the validation process in this ethnography. Qualitative content analyses followed by thematic analyses highlighted the implementation of family-centred practices ( FCP) as a main theme. Parents identified how EI professionals using FCP embraced collaborative practices. FCP resulted in parents leading the EI process for their children. More specifically, EI professionals shared strategies and information to support parents in gaining a deeper understanding of their children's individual developmental characteristics. Parents expressed how empowering this level of understanding was for them as they learned to articulate what were their children's needs for developmental, health and educational services. Recommendations for future research include inquiring about parents' experiences for families of diverse constellations and/or residing in smaller urban or rural communities. [ABSTRACT FROM AUTHOR]

Objectives: There is no effective therapy to prevent the development of posttraumatic epilepsy (PTE). Recently, we reported that administration of the antiseizure medication (ASM) levetiracetam (LEV) shortly after trauma prevented the development of epileptiform activity in two experimental models of neurotrauma. However, the time window for effective intervention with LEV may be too narrow for most clinical settings. Using the controlled cortical impact (CCI) injury model, the current study tested whether early administration of brivaracetam (BRV), an ASM with 20 times the affinity of LEV for the SV2A synaptic vesicle protein, could improve upon the antiepileptogenic action observed with LEV. Methods: Rats (postnatal day [P] 24–32) subjected to CCI injury were given a single dose of BRV (21 or 100 mg/kg, i.p.) at one of three post‐injury time points: immediately (0–2 minutes), 30 minutes, or 60 minutes. Control animals received only vehicle (0.9% saline). Posttraumatic electrographic epileptiform activity was assayed ex vivo from coronal neocortical slices collected proximal to the injury (four per rat) 3–4 weeks after injury. In this model, ictal‐like burst discharges occur spontaneously or can be evoked in an "all or none" manner with applied electrical stimulation within the first 2 weeks after injury. Results: A single dose of BRV administered to rats up to 60 minutes after traumatic brain injury (TBI) significantly reduced the development of posttraumatic epileptiform activity by (1) inhibiting the development of both evoked and spontaneous epileptiform activity, (2) raising the threshold for stimulus‐evoked epileptiform discharges, and (3) reducing the intensity of epileptiform bursts that arise after cortical neurotrauma. Significance: Clinically there has been little success preventing the development of posttraumatic epilepsy. The results of this study support the hypothesis that early intervention with BRV has the potential to prevent or reduce posttraumatic epileptogenesis, and that there may be a limited time window for successful prophylactic intervention. [ABSTRACT FROM AUTHOR]

Aim: Cannabis use is common among individuals with first episode psychosis (FEP) and persistent use is associated with worse outcomes. The purpose of this qualitative study is to identify factors pertaining to onset of cannabis use and persistent use among young adults with early psychosis receiving coordinated specialty care (CSC) in the United States and begin to develop a theoretical framework to drive further study and hypothesis testing and inform the approach to treatment of cannabis use disorder in this setting. Methods: Participants were ages 16–30 years with early psychosis attending a CSC program in New York State. Interviews were conducted in December 2018. Coding and analysis was conducted in Atlas.ti and themes were identified via a thematic analysis approach. Results: Thirteen individuals completed the interview. The mean age in years was 20.7 and the majority were male (n = 10). Almost half (46%) were Black, non‐Hispanic and 39% were Hispanic. Seven participants indicated they were currently using cannabis and six participants indicated they had stopped for at least 6 months at the time of the interview. Several themes emerged including the influence of family and social norms, motivating factors for persistent use and for reduced use or abstinence, and ambivalence regarding the impact of cannabis use on mental health. Conclusion: A theoretical framework emerged which may help identify future research in this area and inform the approach to treatment of cannabis use disorder in this setting. [ABSTRACT FROM AUTHOR]

Aim: Two integrated headspace Early Intervention Teams (hEITs) were established in 2017 to bridge gaps between headspace, the national primary care youth mental health programme in Australia, and the state funded secondary and tertiary mental health services. This study aims to describe functioning and outcomes of patients referred to hEIT over a 6‐month period. Methods: A retrospective file audit was conducted for all patients accepted into the service over a 6‐month period in 2018. Measures of distress, functioning and client satisfaction were collected and analysed. Exemplar vignettes were created to construct hypothetical examples and illustrate research findings. Results: At admission, the three most common presentations were depression/anxiety, trauma and stress related, and psychotic disorders. During their time in the service, young people displayed a statistically significant improvement in functioning, reduction in self‐harm in those 18 years and under, and a trend to reduction in distress scores. hEIT delivered a broad range of services covering social, occupational, educational, medical and mental health care, and the service was experienced positively by the patient cohort. Conclusions: hEIT appears to meet the needs of young people requiring greater care than primary care services can deliver. The integrated, wrap‐around care coordination facilitates treatments across social, educational and health domains. Further exploration of young people who disengage from care, improved outcome data reporting and economic evaluation are indicated. [ABSTRACT FROM AUTHOR]

This paper will describe the rationale for, and importance of, psychological interventions for young people early in the course of bipolar disorder. Emerging literature in this field will be discussed in addition to describing specific clinical challenges and opportunities with this population. In order to be more developmentally appropriate for young people with bipolar disorder, eight aspects of clinical work which may require modification were identified. The evidence base for the effectiveness of psychological interventions for people diagnosed with bipolar disorder is growing. However, some aspects relating to working with adults with bipolar disorder require modification to be effective in working with young people early in the course of the disorder. [ABSTRACT FROM AUTHOR]

If early intervention in dementia care is to be enhanced, it is important to have a critical debate over how this should be realized. In this paper, we offer a synthesis of two approaches to care: mental health recovery and person-centred care, and apply them to early-stage dementia care. 'Person-centred care' has become a catchphrase for good dementia care. However, many people have not experienced improvements in care, and other lynch pin concepts, such as 'mental health recovery', might have utility in driving reform. The similarities and differences between the two approaches are drawn out, and the difficulties of using the word 'recovery' when discussing a degenerative disease are highlighted. The implications of this discussion for early intervention are discussed. It could be seen that the two bodies of knowledge have much to offer each other, despite initial dissonance with the label of recovery in dementia care. [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]

Although the use of differential reinforcement has been recommended in previous investigations and in early intervention curriculum manuals, few studies have evaluated the best method for providing differential reinforcement to maximize independent responding. This paper reviews previous research on the effectiveness of differential reinforcement as treatment and describes important areas of future research. [ABSTRACT FROM AUTHOR]

Aim: The goal of this paper is to provide clarification with regard to the nature of mediator and moderator variables and the statistical methods used to test for the existence of these variables. Particular attention will be devoted to discussing the ways in which the identification of mediator and moderator variables may help to advance the field of early intervention in psychiatry. Methods: We completed a literature review of the methodological strategies used to test for mediator and moderator variables. Results: Although several tests for mediator variables are currently available, recent evaluations suggest that tests which directly evaluate the indirect effect are superior. With regard to moderator variables, two approaches (‘pick-a-point’ and regions of significance) are available, and we provide guidelines with regard to how researchers can determine which approach may be most appropriate to use for their specific study. Finally, we discuss how to evaluate the clinical importance of mediator and moderator relationships as well as the methodology to calculate statistical power for tests of mediation and moderation. Conclusion: Further exploration of mediator and moderator variables may provide valuable information with regard to interventions provided early in the course of a psychiatric illness. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to describe a service operating in Milan, Italy, that provides early intervention for young people aged 17–30 years at the onset and at high risk of psychosis. Method: Following 2 years of preliminary study and organization, Programma2000 was launched in Milan in 1999. This programme was targeted at early detection and intervention in subjects at the onset of, at risk of, or showing ‘prodromal’ signs of psychosis. This paper contains data on the organization and activities of Programma2000. Results: The service has been active since its launch and has received 378 referrals as of March 2009, 342 of which were thoroughly evaluated. At entry, patients undergo a detailed evaluation of their psychopathology, personal and social role functioning, and cognitive status, with repeated testing over time in order to multidimensionally assess outcome. Treatment involves cognitive–behavioural psychotherapy, structured and unstructured psychosocial interventions, and pharmacotherapy when deemed necessary. Treatment appears effective in reducing morbidity and improving social functioning. Conclusion: A team dedicated to the early identification and treatment of young people with early psychosis is a feasible and sustainable extension of the traditional methods of care for people with mental disorders in Italy. [ABSTRACT FROM AUTHOR]

Aims: This paper assesses the impact of different models of early intervention (EI) service provision on functional recovery and inpatient hospital admission. The study compares the outcome of a comprehensive EI team with a partial model (community mental health team (CMHT) plus specialist support) and traditional care (generic CMHT) over a 10-year period. Methods: The design is in comparison with historical control. The study compares the functional recovery outcomes of three cohorts from the same geographical area over the period 1998–2007. The primary outcomes were partial and full functional recovery defined with respect to readily identifiable UK benefit system thresholds and psychiatric inpatient admission days at 1 and 2 years post-referral. Results: Only 15% of individuals made a full or partial functional recovery at 2 years under the care of a traditional generic CMHT in 1998. In 2007, 52% of the cases were making a full or partial functional recovery under the care of the comprehensive EI team. A large reduction in inpatient admissions was associated with the EI strategy. Conclusions: The implementation of comprehensive EI teams can have a major impact in improving functional recovery outcomes in psychosis and reducing inpatient admissions. Partial implementation using limited funding of specialist workers in collaboration with traditional care appeared to have a more limited effect on these recovery dimensions. The implementation of targeted EI in psychosis strategies can result in substantive functional benefits. [ABSTRACT FROM AUTHOR]

Aim: To consider how early intervention in psychosis can support a recovery paradigm. Methods: Significant numbers of those developing a first episode of psychosis are on a path to a persisting and potentially life long condition. Constituting the schizophrenia spectrum disorders, such conditions demand the particular qualities and attitudes inherent within recovery-based practice. This paper explores some of these qualities and attitudes by examining the tension between a traditional ‘clinical’ narrative used by many health providers and a ‘human’ narrative of users of services and their families. Results: We draw out key features and constructs of recovery practice as they relate to the EI paradigm. These include: woodshedding, turning points, discontinuous improvement models, therapeutic optimism, gradualism and narratives of story telling. We also highlight the role of family members and other close supporters and believe their potential contribution requires greater consideration. Conclusions: The early intervention (EI) paradigm can resonate and indeed offer a stronghold for recovery-based practice where traditional mental health services have sometimes struggled. Conversely, failure of caregivers to provide such an approach in the early phase of illness can cause unnecessary and sometimes disastrous consequences. [ABSTRACT FROM AUTHOR]

Background This paper analyses the costs and benefits of commissioning memory services for early diagnosis and intervention for dementia. Method A model was developed to examine potential public and private savings associated with delayed admissions to care homes in England as a result of the commissioning of memory services. Findings The new services would cost around £220 million extra per year nationally in England. The estimated savings if 10% of care home admissions were prevented would by year 10 be around £120 million in public expenditure (social care) and £125 million in private expenditure (service users and their families), a total of £245 million. Under a 20% reduction, the annual cost would within around 6 years be offset by the savings to public funds alone. In 10 years all people with dementia will have had the chance to be seen by the new services. A gain of between 0.01 and 0.02 QALYs per person year would be sufficient to render the service cost-effective (in terms of positive net present value). These relatively small improvements seem very likely to be achievable. Interpretation These analyses suggest that the service need only achieve a modest increase in average quality of life of people with dementia, plus a 10% diversion of people with dementia from residential care, to be cost-effective. The net increase in public expenditure would then, on the assumptions discussed and from a societal perspective, be justified by the expected benefits. This modelling presents for debate support for the development of nationwide services for the early identification and treatment of dementia in terms of quality of life and overall cost-effectiveness. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim: Early medical or behavioural intervention to slow cognitive decline might be a viable strategy for reducing disability and rates of institutional care in older persons. This paper details the published work supporting cross-sectional and longitudinal associations between vascular risk factors, depressive symptoms and progressive cognitive decline. Evidence for the beneficial effects of providing relevant interventions is assessed. Methods: Relevant published work from the areas of dementia research, ‘vascular depression’ and the cognitive benefits that might result from treating vascular risk factors, managing depression or promoting nutrition, cognitive or physical exercise was ascertained from electronic database searches and recent reviews of key areas. Results: The existing published work does not provide many examples of early intervention strategies that target vascular strategies or active treatment of depression to reduce the rate of cognitive decline. Most studies have major limitations including the evaluation of only single-risk-factor interventions, the observational designs and the inadequate measurement of cognition. An optimal early intervention strategy might be to target multiple risk factors within relevant experimental or health service frameworks. Conclusions: Early identification and multifaceted reduction of vascular risk factors, active management of depression, engagement in cognitive activity and physical exercise and promotion of better nutrition might together help to slow some forms of cognitive decline or progression to dementia. This health services approach now requires systematic evaluation. [ABSTRACT FROM AUTHOR]

Behaviour problems make up approximately 30–50% of all referrals to child and adolescent mental health services. Behavioural parent training is one of the most effective interventions for young children. However, those families most at risk of difficulties fail to access services. This paper outlines the Children And Parents Service (CAPS), a citywide multi-agency, early intervention service to young children and their families. The intervention includes parent training groups, multi-agency training and liaison in community settings. The model of service delivery is outlined and the obstacles to service implementation and the strategies used to overcome them are discussed. The service has adopted a well validated evidence-based model of parent training, monitoring of outcomes and user involvement, and is delivered in the wider context of multi-agency systems. A thorough evaluation of service delivery models, including CAPS, would be beneficial. Whilst research trials examine the efficacy of treatments, the effective delivery of treatments within clinical services requires clarity about the place of the intervention within wider systems. The CAPS model proposes a framework for delivering interventions within these systems. [ABSTRACT FROM AUTHOR]

Objective: To determine whether an early intervention using a psychological debriefing format is effective in preventing psychological distress in child road traffic accident survivors. Design: Randomised controlled trial. Setting: Accident and Emergency Department, Royal United Hospital, Bath. Subjects: 158 children aged 7–18. Follow-up assessment completed eight months post accident with 132 (70/82 of the experimental group and 62/76 in the control group). Main outcome measures: Self-completed measures of psychological distress; fulfilment of diagnostic criteria for post-traumatic stress disorder. Results: Children in both groups demonstrated considerable improvements at follow-up. The early intervention did not result in any additional significant gains. Conclusions: Although children in this study made significant improvements it is unclear whether these are better or worse than natural recovery rates. The specific intervention did not result in additional gains although the structured assessment provided for both groups may have been helpful in reducing subsequent pathology. [ABSTRACT FROM AUTHOR]

This article summarizes a symposium held at the 2004 Annual Meeting of the Research Society on Alcoholism in Vancouver, British Columbia, Canada. It was prepared by the conference co-organizers/co-chairs with substantial input from each of the symposium participants. Increasingly, alcohol abuse interventions focus on preventing alcohol problems or intervening early before risky drinking behavior becomes ingrained. Universal prevention programs have produced no or only modest effects on the drinking behavior of youths. Although some existing targeted prevention programs have proved effective, they have not tapped the full range of potential intervention targets, such as the underlying motivations for alcohol misuse in youths who are at greatest risk. The set of papers presented in this symposium outline exciting new developments in the field of targeted prevention and early intervention programs for adolescent drinking problems, presented by an international panel of researchers. These developments include attention to making interventions relevant to adolescents' lives, focus on personality and motivational factors underlying alcohol misuse, and combining existing cognitive behavioral programs with expectancy challenge and motivational interviewing techniques. [ABSTRACT FROM AUTHOR]

Gender differences in adolescents' depressive symptoms associated with interpersonal stress and competence were examined in a sample of 2157 high school students in the southeastern United States. How interpersonal competencies directly influenced depressive symptoms, and moderated associations among interpersonal stress and depressive symptoms were tested. Key findings showed that stress across different contexts positively predicted depressive symptoms. Initiating new relationships was shown to be a protective factor while providing emotional support and negative assertion were associated with greater depressive vulnerability for girls. Moderation results showed that girls have stronger associations between parent and peer stress and depressive symptoms. Recommendations are made for the assessment of interpersonal stress and competence, as well as prevention and early intervention for depressive symptoms. Assessing diverse interpersonal competencies and contexts of stress may be useful for enhancing adolescents' capacity to address interpersonal stress and help diminish associations between stress and depressive symptoms. [ABSTRACT FROM AUTHOR]

Aim: Premorbid history may have a major influence on the way patients cope with the onset of psychosis. This issue has been widely studied in the context of early intervention in schizophrenia but considerably less is known regarding affective psychosis. Our first goal was to investigate if subgroups could be identified among affective psychosis patients based on premorbid factors. Our second goal was to compare these subtypes according to the evolution of mood symptoms and outcomes at the end of the program. Methods: We conducted a 3‐year prospective study on a sample of 74 adults aged 18–35 with a first episode of affective psychosis. Latent class analysis (LCA) was used to reveal distinct exploratory subgroups within affective psychosis patients. Results: Three distinct subgroups could be distinguished. One with later onset of psychosis mainly including women with more severe depressive symptoms in the first 6 months contrasting with two other subgroups with more severe manic symptoms all along the follow‐up and earlier onset of psychosis, with or without many serious antecedents. The subgroup with many serious antecedents was more likely to require several hospitalizations, less likely to achieve recovery, especially regarding professional integration and return to premorbid general functioning. Conclusions: This study provides further evidence of poor functional recovery in the early phase of affective psychosis and shows that premorbid characteristics allow the identification of subgroups with distinct outcome which may require specification of treatment. [ABSTRACT FROM AUTHOR]

Aim: Late teens and early adulthood is the peak age of onset for mental disorders. Currently, there is a gap between primary mental health care and more intensive mental health services for young people in New South Wales (NSW), Australia. Two headspace Early Intervention Teams (hEITs) were developed to bridge this gap in Sydney Local Health District (SLHD), in Sydney, Australia. This study aims to explore clinician experiences of hEIT after the first 2 years of implementation. Methods: Semistructured interviews were conducted with key clinicians working within hEIT or closely associated with hEIT. Nine interviews were conducted, transcribed and analysed using qualitative thematic analysis. Results: Four themes were identified: (1) building a bridge between services, (2) filling a clinical gap, (3) service collaborations and their challenges and (4) difficulties of small team size. Conclusions: There is evidence that clinicians value the service provided by hEIT. There are difficulties such as referral confusion, staff turnover and suggestions to increase staffing to improve the stability, skill diversity and viability of the service. Findings have implications for other collaborative youth mental health models. [ABSTRACT FROM AUTHOR]

Aim: To determine whether a multi-domain school readiness screening, the Before School Check (B4SC), identifies children at risk of low educational achievement and to compare the educational outcomes between those referred for intervention and those with B4SC concerns who were not referred.Methods: In this longitudinal cohort study of children born at risk of neonatal hypoglycaemia (N 331), the B4SC was performed at 4.5 years of age and a standardised curriculum-based measure of educational achievement was completed at 9-10 years of age. Outcomes of school readiness screening were categorised into 'school readiness concern' or 'no school readiness concern' while 'below standard' and 'well below standard' ratings of educational achievement were combined into a single category of 'low educational achievement'.Results: Overall, 52% of children had ≥1 school readiness concerns at the B4SC, predominantly about behaviour (46%). Having ≥1 school readiness concern was associated with a nearly twofold increase in the likelihood of low academic achievement (OR 1.85, 95% CI 1.14, 3.02), which was apparent only for behaviour concerns. Of the 128 children with behaviour concerns, only 10 (8%) were referred for further interventions. There was a statistically non-significant increase in the rates of low academic achievement among those referred than those non-referred (60% vs. 47%).Conclusion: Identification of behaviour concerns during B4SC is associated with a moderate increase in the likelihood of low academic achievement at 9-10 years. Further, research is needed to determine how academic achievement can be improved in children with behaviour concerns at school entry. [ABSTRACT FROM AUTHOR]

Background: Family‐centred practice (FCP) has become a recommended practice for early intervention services for children with disabilities in many countries. However, its feasibility in Chinese context has been unclear. This study is the first to explore the perceptions of early intervention service practitioners about the implementation of FCP in mainland China. Methods: Focus groups were employed to collect data from 37 early intervention practitioners who attended a workshop about FCP in Wuhan, China and two officers from the provincial disabled persons' federation. The data were analysed thematically. Results: Four themes were identified: (a) family‐centred early intervention is possible, (b) traditional concepts are not friendly towards FCP, (c) parents do not collaborate and (d) financing and personal resources are not sufficient to implement FCP. Chinese practitioners agreed with the philosophies of FCP; however, there was concern that widespread implementation may meet conceptual and practical challenges. Conclusions: The results highlighted practitioners were optimistic and keen for FCP implementation in the Chinese context, but to do so across China may still be some way in the future. [ABSTRACT FROM AUTHOR]

Aim Mental health is a major concern among adolescents. Most mental illnesses have their onset during this period, and around 14% of all young people aged 12 to 17 years experience a mental illness in a 12-month period. However, only 65% of these adolescents access health services to address their mental health problems. Approximately 70% of all Australian adolescents participate in sport, and this presents an opportunity for mental health promotion. Methods This paper reviewed current approaches by sporting organizations to mental health promotion, prevention and early intervention by searching peak body websites, as well as the wider Internet. Results Findings revealed many of the sport organizations reviewed acknowledged the importance of mental components of their sport to increase competitiveness, but few explicitly noted mental health problems or the potential of their sport to promote good mental health. Although some had participated in mental health promotion campaigns, there was no evaluation or reference to the evidence base for these campaigns. Conclusions We describe a framework for integrating mental health promotion into sports organizations based on the MindMatters programme for schools. [ABSTRACT FROM AUTHOR]

Objective: Socio‐economic‐status (SES) has rarely been reported or investigated in eating disorders (EDs) research. This Research Forum considers, from various perspectives, how SES may impact on evaluating evidence‐based treatments for EDs. Method: We first reviewed previous literature that informs how SES impacts prevalence of EDs, help‐seeking, and treatment outcome. We then present findings from a case series effectiveness study of an early intervention program in low SES areas for EDs and discuss implications about the impact of SES on the effectiveness of evidence‐based interventions. Finally, we examine barriers to conducting rigorous evaluations in this population and discuss directions for future treatment outcome research. Results: Evidence suggests a higher level of disordered eating but less help seeking in lower SES groups. In our case series, 96 participants started treatment and completed a mean of 13.85 sessions, 84 (87.5%) completed a mean of 6.40 sessional measures on ED cognitions and behaviors, but only 31% completed more extensive pre‐treatment and post‐treatment measures. The completer effect size decrease for the global Eating Disorder Examination‐Questionnaire score was 2.05 (95% CI: 1.43, 2.68) commensurate with other effectiveness studies in mixed SES groups. The high rates of missing data related to more extensive assessment present a barrier to evaluating evidence‐based treatments in this population. Discussion: Evidence from the present study revealed individuals from low SES can achieve similar treatment outcomes to other populations when receiving evidence‐based ED treatment. Future studies should investigate a range of approaches to maximizing data collection, including use of shorter sessional measures. [ABSTRACT FROM AUTHOR]

Aim: Pennsylvania (PA) first‐episode psychosis (FEP) program evaluation is a statewide initiative, supported by the PA Office of Mental Health and Substance Abuse Services (PA‐OMHSAS) and administered by PA Early Intervention Center/Heads Up, which evaluates fidelity and outcomes of PA Coordinated Specialty Care (CSC) programs. Programs participate in standard computerized measures of CSC outcomes using centralized informatics. The aims of the current report are to describe implementation of this core battery for program evaluation in PA and to present 6‐ and 12‐month outcomes. Methods: Participants (n = 697) from nine PA CSC programs completed the core battery at admission. The battery was re‐administered at 6‐ and 12‐month follow‐up, and data were analysed for individuals (n = 230) who had completed 12‐months of treatment. Domains assessed via clinician report and/or self‐report included symptoms, role and social functioning, self‐perceived recovery and service utilization. Results: PA FEP CSC participants showed improvement over time in several domains, including decreased symptoms, higher role and social functioning, decreased hospitalizations, and improved self‐perception of recovery, quality of life, and services satisfaction. Trends towards improvements were observed for participant happiness, hopelessness, and school‐enrolment. Nearly all improvements were observed at 6‐month follow‐up, with earlier gains maintained at 12‐months. Conclusions: PA FEP CSC programs demonstrate the ability to assess and improve critical outcomes of coordinated specialty care in PA. Improved outcomes by 12 months in treatment provides evidence of an effective treatment model and supports the continuation of these programs in pursuit of our goal of reducing schizophrenia disease burden on individuals and society. [ABSTRACT FROM AUTHOR]

Aim: Mental health problems are a growing challenge in tertiary institutions warranting psycho‐educational intervention programmes such as mental health first aid (MHFA) that provide training to identify and support affected individuals. The present study assesses the impact of MHFA interventions on tertiary students and staff. Specifically, we examine (1) MHFA application rates and the types of mental health issues encountered, (2) how MHFA was provided, (3) application of the MHFA action plan, and (4) perceived outcomes of MHFA. Methods: MHFA‐trained staff within a tertiary institution were electronically surveyed. Quantitative data were analysed using descriptive statistics, whereas abductive coding yielded qualitative themes. Results: Ninety participants completed the questionnaire (26%). Fifty‐seven percentage of respondents had applied MHFA within the tertiary context. All participants reported applying MHFA in response to anxiety or depression at least once. Anxiety (37%) and depression (27%) were the most frequently encountered mental health issues. All participants had administered MHFA face‐to‐face, with telephone calls (35%) and text messaging (33%) also frequently employed. On average, participants reported completing 4.2 (out of 5) MHFA action plan actions, with 47% completing all actions. Most participants believed that their intervention was helpful (88%) with 65% of recipients seeking professional assistance. Recipients experienced perceived positive affective responses, which were also associated with approach strategies. Conclusions: MHFA is widely applied in the tertiary context through a variety of modes. Most interventions featured at least four of the recommended MHFA action plan actions. The outcomes of MHFA were largely positive, suggesting that MHFA is an effective early intervention in the tertiary context. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to examine the psychometric performance of the Recovering Quality of Life scale 10‐item version (ReQoL‐10) using a sample from a Singapore first‐episode psychosis intervention program, to explore its clinical and sociodemographic correlates, and to discuss its utility as a patient‐reported outcome measure (PROM). Methods: Sociodemographic data, duration of untreated psychosis (DUP), and diagnosis were collected from 300 participants. Clinical data, which included baseline and current scores on the Patient Health Questionnaire 9‐item version, EuroQoL‐5 Dimension 3‐level version, Positive and Negative Syndrome Scale, and Global Assessment of Functioning scale, were extracted. The ReQoL‐10 was tested for structural validity, internal consistency, and construct validity, and a multiple linear regression determined if any of the baseline factors were statistically significant predictors of the total ReQoL‐10 scores. Results: The mean (SD) total ReQoL‐10 score of the sample was 27.8 (7.8). Confirmatory factor analysis confirmed the bifactor model structure of the ReQoL‐10. The instrument demonstrated good internal consistency and adequate construct validity. Being older was associated with higher total ReQoL‐10 scores, while being married, having a highest educational level of vocational/diploma, longer DUP, and a diagnosis of affective psychosis were associated with lower total ReQoL‐10 scores. Conclusions: This study has validated the ReQoL‐10 as suitable for routine use to measure recovery‐specific quality of life in a psychiatric setting among patients with first‐episode psychosis, and is a potential tool to initiate recovery conversations. As a PROM, it can facilitate shared decision making, in line with efforts to evaluate and improve quality of care. [ABSTRACT FROM AUTHOR]

Aim: This review identifies interventions involving the fathers of preterm infants that have been tested in neonatal intensive care units (NICU). It examines their effects on the fathers and infants and highlights any differences between fathers and mothers who took part in the same interventions.Methods: A systematic search was performed in English from 1995 to 1 September 2020, using the CINAHL, Cochrane Central Register of Controlled Trials, Embase, PubMed and PsycINFO databases. We examined 14 peer-reviewed studies that investigated NICU interventions involving 478 fathers, whose 511 infants were born before 37 weeks of gestation. These included empirical studies with clinical outcomes.Results: Studies on fathers' interventions in NICUs were limited and mainly restricted to basic skin-to-skin contact or tactile interventions. The interventions had similar general positive effects on mothers and fathers when it came to infant physiological and behavioural reactions. There was also evidence of a positive effect on the fathers, including their mental health.Conclusion: Including fathers as active partners in the care of their preterm newborn infants produced good outcomes for both of them. Further research is needed to develop new, multimodal and interactive interventions that provide fathers with positive contact with their preterm infants. [ABSTRACT FROM AUTHOR]

Aim: The involvement of young people in the development, implementation and evaluation of youth mental health services, policy and research programs is essential to ensure they are appropriate and responsive to the needs of young people. Despite the increasingly central role that youth engagement and participation plays internationally, such activities are rarely described in detail. This article aims to provide a thorough description of the development and implementation of an organization‐wide, 3‐year Youth Engagement and Participation Strategy for Orygen, a national youth mental health organization in Australia. Methods: A descriptive account of the development and implementation of the Strategy, with detailed examples of programs and initiatives. Results: The Strategy was developed based on available evidence, focus groups with key stakeholders and best practice principles. The implementation of the Strategy resulted in a number of programs being delivered that involved a range of young people from across Australia. Despite being successful overall, a number of challenges were experienced. Ongoing considerations include ensuring diversity of partnerships, 'raising the bar' of youth participation and creating meaningful pathways. Conclusions: Youth participation and engagement within a youth mental health context is best seen as an evolving ambition that must remain flexible to the needs of all stakeholders. Despite some challenges and ongoing fine‐tuning, it is possible to successfully implement youth participation and engagement across all areas of youth mental health, including service design and delivery, research and translation, and policy. [ABSTRACT FROM AUTHOR]

A study of programme quality of early intervention in a large governmental early special education service in Queensland, Australia employed a collaborative methodology of participatory action research. This approach has been encouraged strongly for disability-focused research, but the approach is demanding and few examples have been reported. In this multistage 4-year project, indicators of programme quality were generated from staff and parents in the service, validated throughout the service, and generalized across the nation. Examples of the implementation of this methodology across these stages are reported, and benefits and compromises are examined. [ABSTRACT FROM AUTHOR]

Objective: Cognitive behavioural therapy (CBT) has demonstrated efficacy for treating of psychotic symptoms and is recommended as an evidence‐based practice (EBP) in early psychosis services. Despite this recommendation, there is limited information about the feasibility of training community clinicians, working in an early psychosis service, to competence in the delivery of this intervention. Method: Fifty clinicians working in an early psychosis service across five programs in Northern California were trained in CBT for psychosis (CBTp) between 2010 and 2014. Following the training, clinicians attended weekly group consultation and submitted taped sessions for review. Tapes were rated for competency using the Cognitive Therapy Scale‐Revised (CTS‐R). Clinicians who achieved competence were engaged in a train‐the‐trainer model to support ongoing sustainability of the training program. Results: Data from 40 clinicians were reviewed for achievement of competence. Over the training period 18 clinicians achieved competence while 20 clinicians left the service before achieving competence and 12 were still in the process of achieving competence at the point of data analysis. It took on average 54 weeks (range 17‐130 weeks) and an average of six tape reviews (range 3‐18) to train clinicians to competency. Conclusions: Community clinicians working in an early psychosis program can be trained to competence in CBTp following an initial didactic period and ongoing weekly group consultation, although staff turnover hindered implementation. Challenges and opportunities for future implementation in community sites are presented in the context of further expansion of early psychosis services in the United States. [ABSTRACT FROM AUTHOR]

Aim: Many adolescents who meet diagnostic criteria for an eating disorder do not self‐identify as having a problem and may consequently be less likely to seek help. Extant research investigating self‐identification has been limited to specific populations (ie, girls meeting criteria for bulimic‐type eating disorders). This study investigated how self‐identification varied across sex, eating disorder diagnoses, and the presence of extreme eating behaviours, and how self‐identification was related to help‐seeking in adolescents. Methods: Participants included 1002 Australian school students (75.5% female, Mage = 15.14 years, SD = 1.40) who met DSM‐5 diagnostic criteria for an eating disorder. An online survey assessed self‐identification of having a body image problem, as well as sex, eating disorder diagnosis, extreme eating behaviours, help‐seeking for a body image problem, and other potential correlates of self‐identification (demographics, psychological distress, social function, weight and shape concerns). Results: Approximately, 2 in 3 adolescents with an eating disorder self‐identified as having a body image problem. Girls who met criteria for a major eating disorder diagnosis, and those engaging in extreme eating behaviours, were more likely to self‐identify. When adjusting for covariates, only sex remained significantly associated with self‐identification. Adolescents who self‐identified were 2.71 times more likely to seek help for a body image problem, adjusting for covariates. Conclusions: Public health strategies ought to promote awareness regarding the different ways that body image problems might manifest among both girls and boys, as well as the potential gravity of such problems. Awareness among parents, teachers and primary care providers should also be considered. [ABSTRACT FROM AUTHOR]

Background: Despite the prevalence of depression among women in the justice system, and its potentially significant consequences, there is a dearth of studies investigating psychological treatments for depression in this context, especially outside prison.Aims: Our aim was to gather preliminary data on whether individual interpersonal psychotherapy (IPT) is an acceptable and effective treatment for depression in women at an early stage in the justice system.Method: In this pilot study, IPT was offered to 24 depressed women following their first or second contact with the justice system. The women were assessed using a range of scales to quantify depression, anxiety, post-traumatic stress disorder (PTSD) and social support. Multilevel models were used to explore interactions between change in depression and other features given the multiplicity and complexity of problems. Details on engagement and attrition were also collected.Results: Therapy attrition was low, despite challenging life-circumstances and depression scores followed a linear trajectory with scores significantly decreasing over the time (β = -0.59, SE = 0.07, p < 0.001). Participants with more adverse life events, attachment related anxiety and lower social support had poorer outcomes.Conclusions and Implications: Results are encouraging. More than half of the hard-to-reach women who were eligible did engage, and retention rates suggest the therapy was acceptable to them. Depression scores improved, and potential factors affecting treatment outcome were identified. A randomised controlled trial is now warranted, ensuring adequate supplementary support for women with dependants living on their own and without employment. [ABSTRACT FROM AUTHOR]

Background: Preterm infants have a higher risk of development disorders. Prematurity can be considered a source of stress, in both children and their parents, due to the high number of interventions that they require. Early intervention (EI) programmes have shown to have a positive influence on the neurodevelopment of children with neurological risk. On the other hand, parenting stress has a negative influence on the development of any child. This systematic review aimed to identify the effect of EI programmes on decreasing parenting stress suffered by parents of preterm babies. Methods: Systematic review and meta‐analysis of experimental studies in accordance with the PRISMA declaration guidelines were applied in this work. Results: Fifteen randomized clinical trials were included whose methodological quality was assessed using the PEDro scale. Stress data extraction was meta‐analysed using the inverse variance method in a random effects model. Statistical heterogeneity was assessed with the I2 heterogeneity statistic. The domains most commonly reported in the trials were the childcare‐related stress (Child Domain), personal discomfort (Parent Domain) and computation of both (Total Stress). The results showed significant (P < 0,05) and clinically relevant differences in favour of the EI programme group at 18 months and 5 years. Conclusions: This review found moderate to strong evidence of the impact of EI programmes on the reduction of parenting stress in parents of preterm babies. These findings offer useful insights regarding the delivery of current support and the development of future family interventions. Finally, recommendations are provided for future intervention evaluation studies in this area. [ABSTRACT FROM AUTHOR]

Background: Early intervention (EI) can improve a range of outcomes for families of children with developmental disabilities. However, research indicates the level of access does not always match the level of need. To address disparities, it is essential to identify factors influencing access. Method: We propose a framework where access to EI is conceptualised as a process that includes three main phases. A narrative review examined potential barriers, facilitators and modifiers of access for each phase. Results: The process of access to EI includes the following: 1) recognition of need, 2) identification or diagnosis and 3) EI provision or receipt. Several factors affecting access to EI for each phase were identified, related to the family, services, the intersection between family and services, and the context. Conclusion: A broad range of factors appear to influence the process of access to EI for this population. Our framework can be used in future research investigating access. Broad implications for policy, practice and future research to improve access to EI are discussed. [ABSTRACT FROM AUTHOR]

Objective: Brief self‐guided activities designed for focused and immediate benefits, termed microinterventions, have the potential to aid reach and engagement in mental health interventions; however further validation is needed. This study evaluated effects of two microinterventions for responding to appearance‐ideal media on risk and protective factors for disordered eating. Method: Undergraduate women (N = 202, Mage = 19.90, SD = 2.75) were allocated quasi‐randomly to one of three 15‐min video‐based microinterventions (mindfulness, cognitive dissonance, educational control) in the lab and assessed on state outcomes at baseline and immediate posttest. One week later, trait factors were assessed and participants underwent an appearance‐ideal media exposure task. Results: Both mindfulness and dissonance groups reported significant immediate benefits to state appearance‐ideal internalization, perceived sociocultural pressures and related distress, and mood, compared to educational control (Glass's Δ effect sizes =.40–.94), but not state weight or appearance satisfaction. At 1‐week follow‐up, mindfulness and dissonance groups demonstrated improved trait appearance‐ideal internalization (Δ =.40 and.42), weight and shape concerns (Δ =.27 [ns] and.44), and body appreciation (Δ =.39 and.46) compared to the educational control. There were no effects on trait perceived pressures, negative affect, or body image psychological flexibility, and no differential changes in state outcomes from premedia to postmedia exposure. Discussion: Microinterventions using mindfulness and dissonance techniques show promise for improving some risk and potential protective factors for disordered eating in the immediate and short‐term. Further research is required to substantiate their place within the spectrum of eating disorder prevention, early intervention and treatment techniques. [ABSTRACT FROM AUTHOR]

Purpose: To examine the effect of an additional 2‐week health professional‐led functional exercise programme compared to usual care for patients after hip fracture during a short‐term nursing home stay directly after hospital discharge. Method: One hundred and forty participants, 65 years or older with hip fracture, admitted to a short‐term nursing home stay were randomised to an intervention group or control group. Participants in the intervention group (n = 78) received the experimental programme consisted of functional exercises, performed by health care professionals up to four times a day, 7 days a week, in addition to usual care during a 2‐week short‐term nursing home stay. Participants in the control group (n = 62) received usual care alone. Primary outcome was Short Physical Performance Battery (SPPB). Secondary outcomes were Timed Up & Go, New Mobility Score, The University of California, Los Angeles Activity Scale, Fall Efficacy Scale International, The EuroQol five dimension five‐level questionnaire, and Numeric Rating Scale for pain. Outcome measures were assessed after 2 weeks in a short‐term nursing home stay and 3 months after hip fracture surgery. The activity monitor ActivPal registered activity during the 2‐week short‐term nursing home stay. Results: No statistically significant differences between groups was found in any outcomes after 2 weeks or 3 months (p > 0.05). There were statistically significant within‐group improvements in primary outcome SPPB and in most secondary outcomes at all time points in both groups (p > 0.05). Conclusions: A 2‐week health professional‐led functional exercise programme in addition to usual care demonstrated no difference in clinical outcomes compared to usual care alone up to 3 months after hip fracture. The patients with hip fracture are fragile and vulnerable in this early phase, and usual physiotherapy may be sufficient to improve their physical function. Trial registration: ClinicalTrials.gov NCT02780076. [ABSTRACT FROM AUTHOR]

Introduction: Playgroups are community‐based programs for children and families aiming to improve child outcomes, enhance family and community networks and increase parenting capacity. Despite the prevalence of playgroups in Australian communities there is a lack of research clearly articulating the key components of playgroups, specifically from the perspective of parents attending these groups. This study aimed to identify the key components of supported and therapeutic playgroups impacting on perceived effectiveness from the perspective of parents with a child with a developmental delay and/or disability. Methods: This study explored the experiences of 23 parents attending supported or therapeutic playgroups using a qualitative interpretive phenomenological approach. Data were collected through three focus groups and seven individual interviews and analysed using Colaizzi's (1978) qualitative method of data analysis. Results: Findings indicated playgroup components that most strongly impacted on perceived effectiveness were feeling accepted; providing opportunities for child development, socialisation and enjoyment; and enhancing parental knowledge and skills. Findings reinforced the importance of family centred practice and facilitating peer support for families of children with developmental delay and/or disability. Conclusion: Supported and therapeutic playgroups emerged as a valuable model for parents of children with developmental delays and/or disabilities but require an interplay of specific facilitator, parent and child characteristics to be effective. This study contributes to the understanding of key components of successful supported and therapeutic playgroup models, highlighting the importance of engaging consumers in developing evidence‐based meaningful interventions for children with developmental delay and/or disabilities and their families. [ABSTRACT FROM AUTHOR]

People with a psychotic disorder suffer from major cognitive impairments which prevent their functional recovery. Source memory impairments have been shown to be associated with psychotic symptoms and even to precede their onset. Source memory has thus been hypothesized as a cognitive precursor of psychosis. However, few interventions targeting source memory are included in current therapeutic approaches for early psychosis. Aim: This systematic review aimed to identify non‐pharmacological interventions for early psychosis which have impacted source memory processes. Methods: Studies were selected from nine databases when they included: (a) a non‐pharmacological intervention involving a sample of patients with early‐onset psychotic disorder or subclinical psychotic symptoms; and (b) effects on source memory processes, measured directly or inferred through an episodic memory task. Results: Thirteen studies were identified, including two cognitive remediation programs and one repetitive transcranial magnetic stimulation treatment that reported beneficial effects on source memory. Conclusions: Relevant intervention strategies for source memory impairments were identified. This review points up a need to further develop interventions targeting theoretically defined source memory concepts and assess their effects with specific and valid tasks. Recommendations regarding underlying mechanisms which could have a beneficial impact on source memory may provide guidance for the future development of early psychosis interventions. [ABSTRACT FROM AUTHOR]

Aim: Transition to university is associated with unique stressors and coincides with the peak period of risk for onset of mental illness. Our objective in this analysis was to estimate the mental health need of students at entry to a major Canadian university. Methods: After a student‐led engagement campaign, all first year students were sent a mental health survey, which included validated symptom rating scales for common mental disorders. Rates of self‐reported lifetime mental illness, current clinically significant symptoms and treatment stratified by gender are reported. The likelihood of not receiving treatment among those symptomatic and/or with lifetime disorders was estimated. Results: Fifty‐eight per cent of all first‐year students (n = 3029) completed the baseline survey, of which 28% reported a lifetime mental disorder. Moreover, 30% of students screened positive for anxiety symptoms, 28% for depressive symptoms, and 18% for sleep problems with high rates (≅45%) of associated impairment. Only 8.5% of students indicated currently receiving any form of treatment. Females were more likely to report a lifetime diagnosis, anxiety and depressive symptoms, as well as current treatment. Over 25% of students reported lifetime suicidal thoughts and 6% suicide attempt(s). Current weekly binge drinking (25%) and cannabis use (11%) were common, especially in males. Conclusions: There is limited systematically collected data describing the mental health needs of young people at entry to university. Findings of this study underscore the importance of timely identification of significant mental health problems as part of a proactive system of effective student mental health care. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to analyse community management of patients during the symptomatic period prior to admission with acute decompensated heart failure (ADHF). Methods and results: We conducted a prospective, two‐centre, two‐country observational study evaluating care pathways and patient experience in patients admitted to hospital with ADHF. Quantitative and qualitative data were gathered from patients, carers, and general practitioners (GPs). From the Irish centre, 114 patients enrolled, and from the English centre, 50 patients. Symptom duration longer than 72 h prior to hospitalization was noted among 70.4% (76) Irish and 80% (40) English patients, with no significant difference between those with a new diagnosis of HF [de novo HF (dnHF)] and those with known HF [established HF (eHF)] in either cohort. For the majority, dyspnoea was the dominant symptom; however, 63.3% (31) of these Irish patients and 47.2% (17) of these English patients did not recognize this as an HF symptom, with no significant difference between dnHF and eHF patients. Of the 46.5% (53) of Irish and 38% (19) of English patients reviewed exclusively by GPs before hospitalization, numbers prescribed diuretics were low (11.3%, six; and 15.8%, three, respectively); eHF patients were no more likely to receive diuretics than dnHF patients. Barriers to care highlighted by GPs included inadequate access to basic diagnostics, specialist support and up‐to‐date patient information, and lack of GP comfort in managing HF. Conclusion: The aforementioned findings, consistent across both health care jurisdictions, show a clear potential to intervene earlier and more effectively in ADHF or to prevent the need for hospitalization. [ABSTRACT FROM AUTHOR]