Systematic review: emotion dysregulation and challenging behavior interventions for children and adolescents on the autism spectrum with graded key evidence-based strategy recommendations.

Challenging behavior, such as aggression, is highly prevalent in children and adolescents on the autism spectrum and can have a devastating impact. Previous reviews of challenging behavior interventions did not include interventions targeting emotion dysregulation, a common cause of challenging behavior. We reviewed emotion dysregulation and challenging behavior interventions for preschoolers to adolescents to determine which evidence-based strategies have the most empirical support for reducing/preventing emotion dysregulation/challenging behavior. We reviewed 95 studies, including 29 group and 66 single case designs. We excluded non-behavioral/psychosocial interventions and those targeting internalizing symptoms only. We applied a coding system to identify discrete strategies based on autism practice guidelines with the addition of strategies common in childhood mental health disorders, and an evidence grading system. Strategies with the highest quality evidence (multiple randomized controlled trials with low bias risk) were Parent-Implemented Intervention, Emotion Regulation Training, Reinforcement, Visual Supports, Cognitive Behavioral/Instructional Strategies and Antecedent-Based Interventions. Regarding outcomes, most studies included challenging behavior measures, while few included emotion dysregulation measures. This review highlights the importance of teaching emotion regulation skills explicitly, positively reinforcing replacement/alternative behaviors, using visuals and metacognition, addressing stressors proactively, and involving parents. It also calls for more rigorously designed studies and for including emotion dysregulation as an outcome/mediator in future trials.

Nurses' perceptions, experiences, and practices regarding human papillomavirus vaccination: results from a cross-sectional survey in Montana.

BACKGROUND: Nationally, much of the focus on improving human papillomavirus (HPV) vaccine uptake has been on effective strategies that physicians use to promote vaccination. However, in large, predominately rural states like Montana, nurses and medical assistants play critical roles in immunization services delivery, and their viewpoints are imperative in designing strategies to increase vaccination rates. We conducted a cross-sectional, descriptive study to determine nurses' perceptions, experiences, and practices regarding human papillomavirus vaccination in a rural and medically underserved region of the United States. METHODS: We designed, pilot-tested, and disseminated an online survey instrument to nurses and medical assistants working in clinics participating in the Vaccines for Children program in Montana. The online surveys were administered from November 2020 to March 2021. Survey questions focused on clinic vaccination practices, respondents' perceptions of the HPV vaccine, perceived barriers to vaccine uptake, and general opinions on potential strategies to improve HPV vaccination rates. RESULTS: We analyzed data from 227 respondents. Overall, 90% of nurses strongly agreed or agreed that the HPV vaccine is important and had confidence in the vaccine's safety. More nurses reported experiencing greater parental vaccine refusal or delay for male patients regardless of age. About 53.7% of nurses reported that their clinics had reminder/recall systems to encourage parents to bring their children for vaccination. Nurses identified misinformation from social media, infrequent wellness visits, and vaccine safety concerns as barriers to HPV vaccine uptake. CONCLUSIONS: Study findings identified several promising initiatives to accelerate vaccination in primarily rural states like Montana, including promoting widespread adoption of reminder/recall systems, training nurses in evidence-based techniques to provide strong vaccine recommendations, and leveraging social media to disseminate consistent messages about the HPV vaccine recommendations for both sexes and its role in cancer prevention.

Understanding Clinic and Community Member Experiences with Implementation of Evidence-Based Strategies for HPV Vaccination in Safety-Net Primary Care Settings.

HPV vaccination rates remain below target levels among adolescents in the United States, which is particularly concerning in safety-net populations with persistent disparities in HPV-associated cancer burden. Perspectives on evidence-based strategies (EBS) for HPV vaccination among key implementation participants, internal and external to clinics, can provide a better understanding of why these disparities persist. We conducted virtual interviews and focus groups, guided by the Practice Change Model, with clinic members (providers, clinic leaders, and clinic staff) and community members (advocates, parents, policy-level, and payers) in Los Angeles and New Jersey to understand common and divergent perspectives on and experiences with HPV vaccination in safety-net primary care settings. Fifty-eight interviews and seven focus groups were conducted (n = 65 total). Clinic members (clinic leaders n = 7, providers n = 12, and clinic staff n = 6) revealed conflicting HPV vaccine messaging, lack of shared motivation to reduce missed opportunities and improve workflows, and non-operability between clinic electronic health records and state immunization registries created barriers for implementing effective strategies. Community members (advocates n = 8, policy n = 11, payers n = 8, and parents n = 13) described lack of HPV vaccine prioritization among payers, a reliance on advocates to lead national agenda setting and facilitate local implementation, and opportunities to support and engage schools in HPV vaccine messaging and adolescents in HPV vaccine decision-making. Participants indicated the COVID-19 pandemic complicated prioritization of HPV vaccination but also created opportunities for change. These findings highlight design and selection criteria for identifying and implementing EBS (changing the intervention itself, or practice-level resources versus external motivators) that bring internal and external clinic partners together for targeted approaches that account for local needs in improving HPV vaccine uptake within safety-net settings.

A Digital Mental Health App Incorporating Wearable Biosensing for Teachers of Children on the Autism Spectrum to Support Emotion Regulation: Protocol for a Pilot Randomized Controlled Trial.

BACKGROUND: As much as 80% of children on the autism spectrum exhibit challenging behaviors (ie, behaviors dangerous to the self or others, behaviors that interfere with learning and development, and behaviors that interfere with socialization) that can have a devastating impact on personal and family well-being, contribute to teacher burnout, and even require hospitalization. Evidence-based practices to reduce these behaviors emphasize identifying triggers (events or antecedents that lead to challenging behaviors); however, parents and teachers often report that challenging behaviors surface with little warning. Exciting recent advances in biometric sensing and mobile computing technology allow the measurement of momentary emotion dysregulation using physiological indexes. OBJECTIVE: We present the framework and protocol for a pilot trial that will test a mobile digital mental health app, the KeepCalm app. School-based approaches to managing challenging behaviors in children on the autism spectrum are limited by 3 key factors: children on the autism spectrum often have difficulties in communicating their emotions; it is challenging to implement evidence-based, personalized strategies for individual children in group settings; and it is difficult for teachers to track which strategies are successful for each child. KeepCalm aims to address those barriers by communicating children's stress to their teachers using physiological signaling (emotion dysregulation detection), supporting the implementation of emotion regulation strategies via smartphone pop-up notifications of top strategies for each child according to their behavior (emotion regulation strategy implementation), and easing the task of tracking outcomes by providing the child's educational team with a tool to track the most effective emotion regulation strategies for that child based on physiological stress reduction data (emotion regulation strategy evaluation). METHODS: We will test KeepCalm with 20 educational teams of students on the autism spectrum with challenging behaviors (no exclusion based on IQ or speaking ability) in a pilot randomized waitlist-controlled field trial over a 3-month period. We will examine the usability, acceptability, feasibility, and appropriateness of KeepCalm as primary outcomes. Secondary preliminary efficacy outcomes include clinical decision support success, false positives or false negatives of stress alerts, and the reduction of challenging behaviors and emotion dysregulation. We will also examine technical outcomes, including the number of artifacts and the proportion of time children are engaged in high physical movement based on accelerometry data; test the feasibility of our recruitment strategies; and test the response rate and sensitivity to change of our measures, in preparation for a future fully powered large-scale randomized controlled trial. RESULTS: The pilot trial will begin by September 2023. CONCLUSIONS: Results will provide key data about important aspects of implementing KeepCalm in preschools and elementary schools and will provide preliminary data about its efficacy to reduce challenging behaviors and support emotion regulation in children on the autism spectrum. TRIAL REGISTRATION: ClinicalTrials.gov NCT05277194; https://www.clinicaltrials.gov/ct2/show/NCT05277194. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/45852.

Brief online behavioral cognitive intervention for anxiety symptoms: what was learned during and for after the pandemic period?

Cognitive therapies comprise a widely recognized group of psychological interventions with considerable empirical support for different mental health conditions. These interventions can be used both in a traditional clinical setting and in crisis situations, especially those involving self-perception of overestimated risk, high vulnerability, and low coping capacity. The world is currently under a crisis, specifically, the COVID-19 pandemic, which can bring substantial impact on people's routine and cause significant psychological distress. In this context, telehealth interventions are becoming a standard practice and, thus, cognitive therapists could also support patients and people in the general population using this tool for the emerging issues. This text provides a brief overview of the main issues that may arise in the current pandemic situation as possible targets for the practice of cognitive therapists and the main evidence-based strategies that could be used in this context.(AU)

As terapias cognitivas compreendem um grupo amplamente reconhecido de intervenções psicológicas, com considerável suporte empírico para diferentes condições de saúde mental. Essas intervenções podem ser utilizadas tanto em ambiente clínico tradicional quanto em situações de crise, principalmente aquelas envolvendo autopercepção de risco superestimado, alta vulnerabilidade e baixa capacidade de enfrentamento. O mundo vive atualmente uma situação de crise, especificamente, a pandemia de COVID-19, que pode trazer um impacto substancial na rotina das pessoas e causar sofrimento psicológico significativo. Nesse contexto, as intervenções de cuidado online estão se tornando uma prática padrão e, assim, os terapeutas cognitivos também poderiam apoiar seus pacientes e pessoas da população em geral usando esta ferramenta para as questões emergentes. Este texto fornece uma breve visão geral das principais questões que podem surgir na atual situação de pandemia como possíveis alvos para a prática de terapeutas cognitivos e as principais estratégias baseadas em evidências que podem ser utilizadas por eles neste contexto.(AU)

Las terapias cognitivas comprenden un grupo ampliamente reconocido de intervenciones psicológicas, con considerable apoyo empírico para diferentes condiciones de salud mental. Estas intervenciones pueden utilizarse tanto en un entorno clínico tradicional como en situaciones de crisis, especialmente aquellas que implican un riesgo auto percibido sobrestimado, alta vulnerabilidad y baja capacidad de afrontamiento. El mundo atraviesa actualmente una situación de crisis, específicamente la pandemia de COVID-19, que puede tener un impacto sustancial en la rutina de las personas y causar una angustia psicológica significativa. En este contexto, las intervenciones de atención en línea se están convirtiendo en una práctica estándar y, por lo tanto, los terapeutas cognitivos también podrían ayudar a sus pacientes y personas en la población general utilizando esta herramienta para problemas emergentes. Este texto ofrece una breve descripción de los principales problemas que pueden surgir en la situación pandémica actual como posibles objetivos para la práctica de los terapeutas cognitivos y las principales estrategias basadas en la evidencia que pueden ser utilizadas por ellos en este contexto.(AU)

Vaccine acceptance: How to build and maintain trust in immunization.

In Canada, over 80% of parents choose to vaccinate their children. Although this may appear positive, it is one of the lowest vaccination rates in the western world, and does not meet the 95% coverage rate needed to prevent outbreaks of vaccine-preventable diseases such as measles. A recent national immunization survey showed approximately 50% of parents are concerned about potential side-effects from vaccines, 25% believe that a vaccine can cause the disease it was meant to prevent, and 13% think alternative practices could eliminate the need for vaccines. In addition, vaccine hesitancy-defined by its determinants: confidence, complacency and convenience-is on rise. To address the complacency and trust (confidence) components of vaccine hesitancy, four best practices to optimize trust in vaccines and promote vaccine acceptance are presented. The first best practice is to understand the concerns; this is done at a population level via research and at individual level via motivational interviewing. The second best practice is to address these concerns by effectively presenting science-based information. This is done at a population level by communicating research and at an individual level by applying this research to the specific concerns, values and norms of the individual. Third, present immunization as a social norm, both in educational materials and in conversations. Finally, resilience is fostered by planning ahead (both at a population level and for individual practitioners) to manage events that can undermine trust and drive negative vaccine concerns, such as a new vaccine being added to the routine schedule or the emergence of an unexpected adverse event. Building and maintaining public trust in immunization takes time. Healthcare practitioners must keep in mind that while trust is a key element in vaccine acceptance, it is not the only element; convenience and access can also impact vaccine uptake. Nurturing trust is but one part of increasing vaccine acceptance and this brief will focus on strategies to build and nurture trust.

Impact of the ENSP eLearning platform on improving knowledge, attitudes and self-efficacy for treating tobacco dependence: An assessment across 15 European countries.

INTRODUCTION: In 2018, the European Network for Smoking Cessation and Prevention (ENSP) released an update to its Tobacco Treatment Guidelines for healthcare professionals, which was the scientific base for the development of an accredited eLearning curriculum to train healthcare professionals, available in 14 languages. The aim of this study was to evaluate the effectiveness of ENSP eLearning curriculum in increasing healthcare professionals' knowledge, attitudes, self-efficacy (perceived behavioral control) and intentions in delivering tobacco treatment interventions in their daily clinical routines. METHODS: We conducted a quasi-experimental pre-post design study with 444 healthcare professionals, invited by 20 collaborating institutions from 15 countries (Albania, Armenia, Belgium, Italy, France, Georgia, Greece, Kosovo, Romania, North Macedonia, Russia, Serbia, Slovenia, Spain, Ukraine), which completed the eLearning course between December 2018 and July 2019. RESULTS: Healthcare professionals' self-reported knowledge improved after the completion of each module of the eLearning program. Increases in healthcare professionals' self-efficacy in delivering tobacco treatment interventions (p<0.001) were also documented. Significant improvements were documented in intentions to address tobacco use as a priority, document tobacco use, offer support, provide brief counselling, give written material, discuss available medication, prescribe medication, schedule dedicated appointment to develop a quit plan, and be persistent in addressing tobacco use with the patients (all p<0.001). CONCLUSIONS: An evidence-based digital intervention can be effective in improving knowledge, attitudes, self-efficacy and intentions on future delivery of tobacco-treatment interventions.

Promoting immunization resiliency in the digital information age.

The avalanche of online information on immunization is having a major impact on the percentage of the population who choose to get vaccinated. Vaccine misinformation spreads widely with the interactive Web 2.0 and social media; this can bury science-based information. A plethora of immunization misinformation online is affecting trust in health care professionals and in public immunization programs. There are no simple solutions to this, but seven evidence-based strategies can help. First, listen to patients' and parents' concerns, and demonstrate responsiveness by adopting best immunization practices, such as pain mitigation. Second, recognize and alert others to anti-immunization tactics, namely, conspiracy theories, fake experts, selectivity, demands that vaccines be 100% safe and effective, misrepresentation and false logic. Third, avoid unproductive debates with those who have strongly held views, both in person and when using social media. Be respectful, stick to your key message, identify where to find useful information and exit. Fourth, consider establishing an attractive, easily searchable online presence that reflects the complex art of persuasion. Emphasize the benefits of vaccine, use reader-friendly graphics and highlight facts with stories to strengthen your case. Fifth, work with social media platform providers, not to stifle freedom of expression, but to help ensure that misinformation is not favoured in searches. Sixth, promote curriculum development in the schools to improve students' understanding of the benefits and safety of immunization and to foster critical thinking skills. To do this, optimize the use of age-appropriate comics and interactive learning tools such as electronic games. Seventh, to shift the narrative in specific communities with low vaccination rates, work with community leaders to build tailored programs that foster trust and reflect local values.

Motor vehicle injury prevention in eight American Indian/Alaska Native communities: results from the 2010-2014 Centers for Disease Control and Prevention Tribal Motor Vehicle Injury Prevention Program.

OBJECTIVES: The aim of the study is to increase seat belt (SB) use and reduce motor vehicle (MV) injuries and death; eight tribal communities implemented evidence-based strategies from the Guide to Community Preventive Services during 2010-2014. STUDY DESIGN: SB use was measured through direct observational surveys and traffic safety activity data. Traffic safety activities included enhanced enforcement campaign events, ongoing enforcement of SB laws, and media. The number of MV injuries (including fatal and non-fatal) was measured through MV crash data collected by police. RESULTS: Percentage change increases in SB use were observed in all eight projects; average annual increases of three projects were statistically significant (ranging from 10% to 43%). Four of the eight projects exceeded their goals for percentage change increases in SB use. Approximately 200 media events and 100 enforcement events focused on SB use were conducted across the eight projects. Five projects had an annual average of ≥100 SB use citations during the project period. MV injuries (fatal and non-fatal combined) significantly decreased in three projects (ranging from a 10% to 21% average annual decrease). CONCLUSIONS: Increases in SB use and decreases in the number of MV injuries can be achieved by tailoring evidence-based strategies to tribal communities.