Does an integrated outreach intervention targeting multiple stages of early psychosis improve the identification of individuals at clinical high risk?

AIMS: To explore the impact of a targeted case identification intervention, with training and education regarding first-episode psychosis and clinical high-risk syndromes, on the referral and identification of those at high risk. METHODS: Using a historical control design, referral information from pre-intervention and post-intervention periods was collected via administrative data and clinician notes from a catchment-based early psychosis service. RESULTS: A significant increase in the number of referrals sent to the service's clinical high-risk unit was observed following the intervention (P = 0.01). The proportion of referrals eligible was significantly higher post-intervention (P = 0.03), with the majority (26/44, 59.1%) referred via the first-episode psychosis service unit. CONCLUSIONS: An integrated outreach intervention for both first-episode psychosis and the clinical high-risk state was effective in increasing referrals of eligible cases to the service's at-risk unit. Rather than being stage-specific, targeted case identification strategies and service integration should span across the early stages of psychosis.

Intervenciones antibullying desarrolladas por enfermeros: revisión integradora de la literatura / Intervenções antibullying desenvolvidas por enfermeiros: revisão integrativa da literatura / Antibullying interventions developed by nurses: integrative review

Objetivos: Identificar y describir las intervenciones antibullying realizadas por enfermeros. Método: Revisión integradora de la literatura realizada en seis bases de datos (CINAHL, LILACS, PsycINFO, PUBMED, SciELO y Web of Science), utilizando en las buscas descriptores relacionados al fenómeno y a la enfermería. La pregunta que orientó la investigación fue: "¿Cuáles son las intervenciones antibullying desarrolladas en escuelas con la participación de enfermeros?". Resultados: Cinco artículos compusieron el corpus de análisis de la revisión. Los resultados indicaron una variedad de enfoques en las intervenciones realizadas (dramatización/teatro, grupo de apoyo, multidimensional y vídeos). Conclusión: La revisión presenta conocimientos que pueden orientar prácticas y programas de intervención antibullying a ser desarrollados por enfermeros o equipos de salud en Brasil (AU)

Objetivos: Identificar e descrever as intervenções antibullying realizadas por enfermeiros. Método: Revisão integrativa da literatura realizada em seis bases de dados (CINAHL, LILACS, PsycINFO, PUBMED, SciELO e Web of Science), utilizando nas buscas descritores relacionados ao fenômeno e à enfermagem. A questão norteadora da pesquisa foi: "Quais são as intervenções antibullying desenvolvidas em escolas com a participação de enfermeiros?". Resultados: Cinco artigos compuseram o corpus de análise da revisão. Os resultados indicaram uma variedade de enfoques nas intervenções realizadas (dramatização/teatro, grupo de apoio, multidimensional e vídeos). Conclusão: A revisão apresenta conhecimentos que podem orientar práticas e programas de intervenção antibullying a serem desenvolvidas por enfermeiros ou equipes de saúde no Brasil (AU)

Objective: To identify and describe anti bullying interventions developed by nurses. Method: Integrative review conducted in six databases using descriptors related to the phenomenon and nursing. The guiding question was: "What are the anti bullying interventions developed in schools by nurses?" Results: Five papers composed the corpus of analysis. The results indicate a variety of types of interventions (dramatization/role-playing, support group, multidimensional and videos). Conclusions: This review presents knowledge that can support anti bullying practices and intervention programs to be developed by nurses or health teams in Brazil (AU)

[Acute Care Rehabilitation is the First Link in a Chain of Rehabilitation Interventions]. / Frührehabilitation ist erstes Glied einer nahtlosen Rehabilitationskette.

An early, intensive rehabilitative therapy accelerates the recovery of the functions of patients. It contributes to a reduction in the complication rate as well as an improvement in physical and social functioning/participation in the long-term follow-up. Early rehabilitation must be strengthened on the basis of the existing structures: the creation and maintenance of adequately qualified early-stage rehabilitation facilities, at least in hospitals with priority and maximum supply contracts. Patients with long-term intensive care and polytrauma must be rehabilitated as soon as possible (intensive medical rehabilitation).Specialists in physical and rehabilitative medicine, rehabilitative geriatrists, neurologists, orthopaedists and accident surgeons and other regional physicians must cooperate in a targeted manner. Exclusion criteria using corresponding OPS codes must be canceled. Additional specialist physician groups (anesthetists and intensive care physicians, general practitioners, accident and thoracic surgeons, internists) must be sensitized to the importance of early rehabilitation.In the case of more than 500,000 hospital beds, 25,000 beds should be identified as age- and diagnosis-independent early-care beds in the country-specific bed-care plans. A cost-covering financing of the different, personal and cost-intensive early rehabilitation must be ensured. A phase model similar to the BAR guidelines for neurological-neurosurgical early rehabilitation is to be considered for other disease entities.In order to make the rehabilitation process as successful as possible, medical (acute) treatment, medical rehabilitation, occupational integration and social integration have to be understood as a holistic event and are effectively interrelated, as a continuous process which accompanies the entire disease phase-wise. For this purpose, a continuous case management or a rehabilitation guidance has to be established.

Health justice partnerships: initial insights into the delivery of an integrated health and legal service for youth in regional Victoria.

INTRODUCTION: This article presents interim findings from research examining the implementation of a health justice partnership (HJP) focusing on the legal and health needs of regional young people. HJPs provide an innovative service model offering an integrated health and legal service for the community. HJPs are a relatively new service model for Australia, yet the program is well suited to meet the needs of particular population cohorts, including young people and those in regional locations experiencing complex legal issues. METHODS: Funded by the Victorian Legal Services Board and Commissioner, an HJP in partnership with three organisations was established in a large regional area in Victoria, Australia. Research is being conducted alongside the program to examine its impact on young people, and the implications on practice for staff in the partner organisations. RESULTS: Findings provide preliminary support for the HJP model with a number of young people - from predominantly disadvantaged backgrounds and with varying legal issues - having been referred to the program in the first 6 months. Referrals were received from both partner agencies and external agencies. Initial client and staff survey responses indicate that the legal problem of the young people was affecting how they feel. CONCLUSIONS: While these findings provide preliminary support for the HJP further research will offer longer term insights about HJPs within the Australian context, particularly rural and regional settings.

Feasibility of a Team Approach to Complex Congenital Heart Defect Neurodevelopmental Follow-Up: Early Experience of a Combined Cardiology/Neonatal Intensive Care Unit Follow-Up Program.

Infants with complex congenital heart disease are at high risk for poor neurodevelopmental outcomes. However, implementation of dedicated congenital heart disease follow-up programs presents important infrastructure, personnel, and resource challenges. We present the development, implementation, and retrospective review of 1- and 2-year outcomes of a Complex Congenital Heart Defect Neurodevelopmental Follow-Up program. This program was a synergistic approach between the Pediatric Cardiology, Cardiothoracic Surgery, Pediatric Intensive Care, and Neonatal Intensive Care Unit Follow-Up teams to provide a feasible and responsible utilization of existing infrastructure and personnel, to develop and implement a program dedicated to children with congenital heart disease. Trained developmental testers administered the Ages and Stages Questionnaire-3 over the phone to the parents of all referred children at least once between 6 and 12 months' corrected age. At 18 months' corrected age, all children were scheduled in the Neonatal Intensive-Care Unit Follow-Up Clinic for a visit with standardized neurological exams, Bayley III, multidisciplinary therapy evaluations and continued follow-up. Of the 132 patients identified in the Cardiothoracic Surgery database and at discharge from the hospital, a total number of 106 infants were reviewed. A genetic syndrome was identified in 23.4% of the population. Neuroimaging abnormalities were identified in 21.7% of the cohort with 12.8% having visibly severe insults. As a result, 23 (26.7%) received first-time referrals for early intervention services, 16 (13.8%) received referrals for new services in addition to their existing ones. We concluded that utilization of existing resources in collaboration with established programs can ensure targeted neurodevelopmental follow-up for all children with complex congenital heart disease.

Making in-roads across the youth mental health landscape in Singapore: the Community Health Assessment Team (CHAT).

AIM: Adolescence and early adulthood is marked by physical, emotional and psychological changes, and is the peak onset of mental disorders. Internationally, one-fifth of children and adolescents have serious mental health problems, yet services catering to them are scarce. Locally, traditional mental health services are associated with much stigma. In 2009, the Community Health Assessment Team (CHAT), a youth-focused outreach and assessment service, was set up to address service gaps and care barriers. METHODS: CHAT's key offering is a free and confidential mental health assessment service to facilitate help-seeking individuals between the ages of 16 and 30 gain access to early treatment. Young persons' profile and assessment outcomes were collected and entered into a database. RESULTS: Between May 2009 and March 2013, CHAT received 601 referrals: 40.1% (241/601) from young persons themselves and 40.9% (246/601) from school or community counsellors. 79.2% (313/395) of those assessed had mental health issues. 61.5% (243/395) were referred to specialist clinics and 28.6% (113/395) to school or community counsellors. CONCLUSION: There is a steady increase in our referrals; majority are self-referred or referred from school and community counsellors. This attests to the success of our general outreach and targeted capacity-building efforts. Cognizant of young persons' distress, CHAT continues to work with downstream services for continuity of care, which also presents opportunities to consolidate and expand our network of specialist and community partners. Future directions seek to address current challenges: having a mobile platform to complement our face-to-face assessments, and building collaborations to provide holistic services for young persons.

PORT (Programme of Recognition and Therapy): the first Polish recognition and treatment programme for patients with an at-risk mental state.

AIM: To present the activities of the first early intervention centre in Poland and the Programme of Recognition and Therapy (PORT) run by the centre. METHODS: An overview of the admission process, diagnostic procedures and therapeutic interventions offered to individuals with an at-risk mental state. RESULTS: The PORT programme, developed in 2010, included 81 individuals, aged 15-29 years so far. The diagnostic procedures consists of evaluation of symptoms with the use of the Comprehensive Assessment of At-Risk Mental State (CAARMS), assessment of premorbid and current personality traits and the evaluation of cognitive functions. Therapeutic interventions include cognitive behavioural therapy, diet supplementation with omega-3 fatty acids and pharmacological treatment. Overall rate of conversion into psychosis within the years 2010-2103 was 18.5%. The programme has also been a source of research in the field of early psychosis. CONCLUSIONS: The PORT programme enables young people with an ARMS an easy access to the specialized service offering treatment tailored to their specific needs.

Better Beginnings, Better Futures: Theory, research, and knowledge transfer of a community-based initiative for children and families / Better Beginnings, Better Futures [a mejor comienzo, mejor futuro]: teoría, investigación y transferencia de conocimientos de una iniciativa comunitaria con niños y familias

Better Beginnings, Better Futures is an early childhood initiative focused on promoting healthy development of children and families in economically disadvantaged communities. The Better Beginnings approach is ecological and holistic, community-driven, integrated with existing community services and supports, and universally available to children aged 4-8 within communities in which it is offered. The Better Beginnings initiative effectively illustrates the concept of wellness as fairness through its efforts to create more just social conditions and its connection to both procedural and distributive justice, the two principles of fairness outlined by Prilleltensky (2012). Through the development of programs that support children, parents, families, and the community as a whole, Better Beginnings initiatives are able to promote children’s development by building community capacity to create healthy and positive environments for children. This paper provides an overview of the Better Beginnings, Better Futures initiative from its outset in 1990 to the present, with a view towards examining the ways in which knowledge generated from such initiatives can be transferred to other communities

Better Beginnings, Better Futures [a mejor comienzo, mejor futuro] es una iniciativa dirigida a la primera infancia para fomentar el desarrollo de la salud de niños y familias en comunidades económicamente des favorecidas. El enfoque Better Beginnings es ecológico, holístico, impulsado por la comunidad, integrado en los servicios y el apoyo existentes en la comunidad y de acceso universal para niños de entre 4 y 8 años en aquellas comunidades a las que se ofrece. Esta iniciativa ilustra meridianamente el concepto de bienestar como justicia a través de su esfuerzo por crear unas condiciones sociales más justas y su relación tanto con la justicia procedimental como con la distributiva, los dos principios descritos por Prilleltensky (2012). Mediante la puesta en marcha de programas de apoyo a niños, padres, familias y comunidad como un todo, estas iniciativas pueden impulsar el desarrollo de los niños al crear la capacidad comunitaria para potenciar entornos saludables y positivos para los niños. Este trabajo presenta una descripción de la iniciativa Better Beginnings, Better Futures desde su arranque en 1990 hasta la actualidad, con la vista puesta en el análisis de las distintas maneras de traspasar los conocimientos surgidos de estas iniciativas a otras comunidades

How successful are first episode programs? A review of the evidence for specialized assertive early intervention.

PURPOSE OF REVIEW: It has been hypothesized that the first 5 years after first episode of psychosis are a critical period with opportunities for ameliorating the course of illness. On the basis of this rationale, specialized assertive early intervention services were developed. We wanted to investigate the evidence basis for such interventions. RECENT FINDINGS: The evidence for the effectiveness of specialized assertive early intervention services is mainly based on one large randomized clinical trial, the OPUS trial, but it is supported by the findings in smaller trials, such as the Lambeth Early Onset trial, the Croydon Outreach and Assertive Support Team trial and the Norwegian site of Optimal Treatment trial. There are positive effects on psychotic and negative symptoms, on substance abuse and user satisfaction, but the clinical effects are not sustainable when patients are transferred to standard treatment. However, the positive effects on service use and ability to live independently seem to be durable. SUMMARY: Implementation of specialized assertive early intervention services is recommended, but the evidence basis needs to be strengthened through replication in large high-quality trials. Recommendation regarding the duration of treatment must await results of ongoing trials comparing 2 years of intervention with extended treatment periods.

A job analysis of community health workers in the context of integrated nutrition and early child development.

Stunting and poor child development are major public health concerns in Malawi. Integrated nutrition and early child development (ECD) interventions have shown potential to reduce stunting, but it is not known how these integrated approaches can be implemented in Malawi. In this paper, we aimed to evaluate the current jobs status of community health workers and their potential to implement integrated approaches. This was accomplished by a desk review of nutrition and ECD policy documents, as well as interviews with key informants, community health workers, and community members. We found that Malawi has comprehensive policies and well-outlined coordination structures for nutrition and ECD that advocate for integrated approaches. Strong multidisciplinary interaction exists at central levels but not at the community level. Integration of community health workers from different sectors is limited by workload, logistics, and a lack of synchronized work schedules. Favorable, sound policies and well-outlined coordination structures alone are not enough for the establishment of integrated nutrition and ECD activities. Balanced bureaucratic structures, improved task allocation, and synchronization of work schedules across all relevant sectors are needed for integrated intervention in Malawi.

Strengthening systems for integrated early childhood development services: a cross-national analysis of governance.

While there has been substantial growth in early childhood development (ECD) services in low- and middle-income countries (LMICs), there is considerable inequity in their distribution and quality. Evidence-based governance strategies are necessary, but currently they are insufficient for widespread, quality implementation. In particular, there is a limited understanding of the use of systems approaches for the analysis of ECD services as they go to scale. The aim of this paper is to present findings from four countries, using a cross-national case study approach to explore governance mechanisms required to strengthen national systems of ECD services. While different sets of governance strategies and challenges were identified in each country, overarching themes also emerged with implications for systems strengthening. Study results focus on local, mid-level and central governance, with recommendations for effective coordination and the integration of ECD services in LMICs.

Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: a brief review.

Screening, brief intervention, and referral to treatment (SBIRT) is a public health approach to the delivery of early intervention and treatment services for individuals at risk of developing substance use disorders (SUDs) and those who have already developed these disorders. SBIRT can be flexibly applied; therefore, it can be delivered in many clinical care settings. SBIRT has been adapted for use in hospital emergency settings, primary care centers, office- and clinic-based practices, and other community settings, providing opportunities for early intervention with at-risk substance users before more severe consequences occur. In addition, SBIRT interventions can include the provision of brief treatment for those with less severe SUDs and referrals to specialized substance abuse treatment programs for those with more severe SUDs. Screening large numbers of individuals presents an opportunity to engage those who are in need of treatment. However, additional research is needed to determine how best to implement SBIRT.

Effectiveness of brief interventions as part of the screening, brief intervention and referral to treatment (SBIRT) model for reducing the non-medical use of psychoactive substances: a systematic review protocol.

BACKGROUND: There is a significant public health burden associated with substance use in Canada. The early detection and/or treatment of risky substance use has the potential to dramatically improve outcomes for those who experience harms from the non-medical use of psychoactive substances, particularly adolescents whose brains are still undergoing development. The Screening, Brief Intervention, and Referral to Treatment model is a comprehensive, integrated approach for the delivery of early intervention and treatment services for individuals experiencing substance use-related harms, as well as those who are at risk of experiencing such harm. METHODS: This article describes the protocol for a systematic review of the effectiveness of brief interventions as part of the Screening, Brief Intervention, and Referral to Treatment model for reducing the non-medical use of psychoactive substances. Studies will be selected in which brief interventions target non-medical psychoactive substance use (excluding alcohol, nicotine, or caffeine) among those 12 years and older who are opportunistically screened and deemed at risk of harms related to psychoactive substance use. We will include one-on-one verbal interventions and exclude non-verbal brief interventions (for example, the provision of information such as a pamphlet or online interventions) and group interventions. Primary, secondary and adverse outcomes of interest are prespecified. Randomized controlled trials will be included; non-randomized controlled trials, controlled before-after studies and interrupted time series designs will be considered in the absence of randomized controlled trials. We will search several bibliographic databases (for example, MEDLINE, EMBASE, CINAHL, PsycINFO, CORK) and search sources for grey literature. We will meta-analyze studies where possible. We will conduct subgroup analyses, if possible, according to drug class and intervention setting. DISCUSSION: This review will provide evidence on the effectiveness of brief interventions as part of the Screening, Brief Intervention, and Referral to Treatment protocol aimed at the non-medical use of psychoactive substances and may provide guidance as to where future research might be most beneficial.

Evaluation of family-centred practices in the early intervention programmes for infants and young children in Singapore with Measure of Processes of Care for Service Providers and Measure of Beliefs about Participation in Family-Centred Service.

BACKGROUND: The primary purpose of this study was to report on an evaluation of the perceptions and beliefs of service providers towards family-centred practices in 11 early intervention programmes for infants and young children in Singapore. METHODS: The Measure of Processes of Care for Service Providers (MPOC-SP) and Measure of Beliefs about Participation in Family-Centred Service (MBP-FCS) were administered to 213 service providers made up of teachers, therapists, psychologists and social workers providing centre-based therapy to children with special needs who were below the age of 6 years. RESULTS: Exploratory factor analyses were performed with both scales. Nineteen of the 27 MPOC-SP items were retained and supported the original four-factor structure model. The exploratory factor analyses on MBP-FCS provided a less satisfactory outcome. Fourteen of the 28 items were retained and these loaded onto four factors. The two factors relating to Beliefs about benefits of FCS and Beliefs about the absence of negative outcomes from FCS failed to emerge as separate factors. Further multiple regressions indicated that more direct work with families and positive self-efficacy in implementing FCS contributed significantly to explaining service providers' positive perception towards family-centred practice in service delivery. CONCLUSIONS: This is the first time MPOC-SP and MBP-FCS were administered to a population in an Asian context. While MBP-FCS would benefit from further development work on its construct, MPOC-SP offered important insights into service providers' perspectives about family-centred practices that would have useful implications for professional and service development.