Project SMART: an interdisciplinary collaboration to design and test a mentored health promotion program for school children.

Interdisciplinary collaborations and effective community partnerships can be important in advancing public health initiatives in economically disadvantaged communities. This community-based participatory research pilot study determined the feasibility of designing and implementing Project SMART, a mentored after-school health promotion program for school children in an underserved neighborhood. Interdisciplinary faculty and their students collaborated with community stakeholders to provide a program tailored to address community identified health risks. Preassessment and postassessment of study participants revealed a significant increase in nutrition knowledge among the children and a significant increase in the general health subscale of Short-Form Health Survey for the mentors. Content analysis of interviews conducted with the mentors revealed four themes on the meaning of the experience for them: being present; having purpose; raising personal health consciousness; and transferring life experiences. University faculty and students strengthened their relationships in the community and their ability to conduct community-based participatory research. The program was a catalyst for other important ongoing changes in the community. The Project SMART program is an initiative that may be applied successfully in other communities where it is important to address environmental health disparities and promote health.

Substance abuser impulsivity decreases with a nine-month stay in a therapeutic community.

BACKGROUND: Substance abuse continues to be a major public health problem. Keeping substance abusers in treatment is a challenge, and researchers continue to investigate ways to increase retention. OBJECTIVE: The aim of this study was to investigate the relationship between impulsivity in substance abusers and length of stay in the context of therapeutic community. METHODS: The Barratt Impulsiveness Scale- 11 (BIS-11) was used to assess impulsivity in 138 substance abusers at admission and at nine months in a therapeutic community. RESULTS: Impulsivity significantly decreased in subjects who completed nine months in the therapeutic community. Legal stipulation increased length of stay, on average, by three months. On admission, female participants were on average more impulsive than their male counterparts. CONCLUSION: Impulsivity decreased in subjects who remained in therapeutic community for nine months although self-reported impulsivity at baseline did not seem to be associated with retention. SCIENTIFIC SIGNIFICANCE: Therapeutic community factors contribute to a decrease in self-reported impulsivity and these factors might be enhanced to increase retention in therapeutic community.

Mindfulness-based stress reduction in therapeutic community treatment: a stage 1 trial.

OBJECTIVE: This trial compared Mindfulness-Based Stress Reduction, adapted for therapeutic community treatment (MBTC), with treatment as usual (TAU) for reducing stress and increasing retention in a residential facility for substance use disorders. METHOD: Four-hundred and fifty-nine participants, who met DSM-IV criteria for substance dependence were recruited (TAU = 164, MBTC = 295). RESULTS: A survival analysis of time to dropout did not show a significant difference between groups, however level of participation in MBTC was associated with decreased likelihood of dropout (p = < .01), and higher Symptoms of Stress Inventory (SOSI) scores at baseline were associated with increased likelihood of dropout (p = .03). CONCLUSION: The association between retention and level of stress on intake as well as level of participation in MBTC provides support for further research on integrating MBTC into therapeutic community treatment.

Behavioral therapies trials: a case example.

BACKGROUND: Behavior change is integral to the prevention and treatment of many disorders associated with deleterious lifestyles. Rigorous scientific testing of behavior change interventions is an important goal for nursing research. APPROACH: The stage model for behavioral therapy development is recommended as a useful framework for evaluating behavior change strategies. The NIH model specifies three stages from initial testing of novel behavioral therapies to their dissemination in community settings. Definitions of each step in a Stage I trial and a case example of Mindfulness-Based Stress Reduction (MBSR) in therapeutic community treatment are provided. RESULTS: It is feasible to adapt a behavioral therapy such as MBSR using the stage model framework. Steps in the process include: (a) determining pilot study design and describing the population; (b) modifying the intervention and developing the manual; (c) training the teachers; (d) implementing a pilot study; and (e) monitoring treatment integrity. DISCUSSION: The development of behavior therapies requires the same scientific rigor used in pharmacotherapy research. Stage I of the model enables consideration of the "dose" of a behavioral intervention necessary to achieve behavior change in a defined population. The stage model offers an excellent approach to achieving rigor in a variety of potentially useful therapies of interest to nurse researchers.