Adolescent Gender and Age Differences in Responsiveness to Functional Family Therapy.

The current study contributes to a sparse literature on moderators of Functional Family Therapy (FFT) by examining whether responsiveness to FFT, measured by a broad range of outcomes, varies by adolescent gender, age, and their interaction. This study was informed by 687 families (n, adolescents = 581; n, caregivers = 933) and utilized a pre-post comparison design. Fixed-effects regressions with gender, age, and their interaction included as explanatory variables were conducted to calculate the average change in youth mental health, callous-unemotional traits, academic outcomes, substance use, and family functioning. Moderation analyses revealed that according to parent report, girls had significantly greater improvements in peer problems and family functioning, and boys benefited more in increased liking of school. There were differential effects by age, such that older youth had less beneficial mental health outcomes and a smaller decrease in frequency of hash use. The gender by age interaction was significant for adolescents' report of mental health and family functioning outcomes, which suggests that girls benefit from FFT less than boys during early adolescence, but benefit more than boys in late adolescence. This finding adds to literature which has evidenced that family functioning is particularly important for girls by suggesting that FFT is important for improving older girls' mental health and family functioning in particular. The study's results expand the examination of outcomes of FFT to include academic outcomes, and provide insight into key factors that should be considered in addressing adolescent behavioral problems and family functioning.

El presente estudio contribuye a una bibliografía escasa sobre los moderadores de la terapia familiar funcional (TFF) analizando si la capacidad de respuesta a la TFF, medida por una amplia gama de parámetros, varía según el género, la edad y la interacción de los adolescentes. Este estudio se valió de 687 familias (n, adolescentes=581; n, cuidadores= 933) y utilizó un diseño de comparación previa y posterior. Se llevaron a cabo regresiones de efecto fijo con el género, la edad y su interacción incluidos como variables explicativas a fin de calcular el cambio promedio en la salud mental, los rasgos de insensibilidad emocional, los resultados académicos, el consumo de sustancias y el funcionamiento familiar de los jóvenes. Los análisis de moderación revelaron que de acuerdo con el informe de los padres, las niñas tuvieron mejoras considerablemente mayores en los problemas con los pares y el funcionamiento familiar, y los niños se beneficiaron más en el mayor agrado de la escuela. Hubo efectos diferenciales según la edad, de modo que los jóvenes de más edad tuvieron menos resultados beneficiosos en la salud mental y una disminución más pequeña en la frecuencia del consumo de hachís. La interacción del género según la edad fue significativa para los resultados del informe de salud mental y funcionamiento familiar de los adolescentes, que sugiere que las niñas se benefician de la TFF menos que los niños durante la adolescencia temprana, pero se benefician más que los niños en la adolescencia tardía. Este hallazgo aporta a la bibliografía que indica que el funcionamiento familiar es particularmente importante para las niñas, sugiriendo que la TFF es importante para mejorar la salud mental y el funcionamiento familiar de las niñas de más edad en particular. Los resultados del estudio amplían el análisis de los resultados de la TFF para incluir los resultados académicos, y permiten conocer mejor los factores clave que deben tenerse en cuenta a la hora de abordar los problemas conductuales y el funcionamiento familiar de los adolescentes.

Community-Based Caregiver and Family Interventions to Support the Mental Health of Orphans and Vulnerable Children: Review and Future Directions.

The goal of this paper was to conduct a review of studies from 2008 to 2019 that evaluated community-based caregiver or family interventions to support the mental health of orphans and vulnerable children (OVC) in sub-Saharan Africa, across four domains: (a) study methodology, (b) cultural adaptation and community participation, (c) intervention strategies, and (d) effects on child mental health. Ten interventions were identified. Findings revealed that the majority of studies used a randomized controlled trial or quasi-experimental design, but few conducted long-term follow-up; that all programs undertook cultural adaptation of the intervention using community participatory methods, or were locally developed; that the majority of interventions targeted caregiving behavior and/or caregiver-child relationships using behavioral and cognitive-behavioral strategies, or were home visiting interventions; and that interventions had mixed effects on OVC mental health. Progress and gaps revealed by these findings are discussed, as are suggestions for possible new directions in this area of intervention science.

The mediating role of the therapeutic alliance in understanding early discontinuance.

Objective: The objective of this study was to test whether the therapeutic alliance mediated the relationship between previously identified predictors of premature termination and dropout during the first three sessions of treatment. Method: In this naturalistic study, 994 cases receiving individual, couple and family, or high-conflict coparenting therapy provided demographic information and completed assessments prior to treatment. Following the first session, clients completed a measure of the therapeutic alliance. Two hundred and five (20.6%) discontinued therapy prior to the fourth session. Logistic and ordinary least squares regression was used across m = 20 imputed datasets to examine the effect of pressure to attend therapy, age, gender, education, distress, therapy format, and therapist experience on whether clients continued in therapy and whether the alliance mediated this relationship. Results: After controlling for age, therapist experience, education, and pressure to attend therapy; general distress and participating in high-conflict coparenting were associated with higher rates of early termination. The effect of both distress and therapy format on dropout, however, was mediated by the therapeutic alliance. Conclusions: By focusing on improving the therapeutic alliance with high-conflict coparenting cases as well as clients with higher levels of distress, therapists may be able to increase client retention.

Routine hospital data - is it good enough for trials? An example using England's Hospital Episode Statistics in the SHIFT trial of Family Therapy vs. Treatment as Usual in adolescents following self-harm.

BACKGROUND: Use of routine data sources within clinical research is increasing and is endorsed by the National Institute for Health Research to increase trial efficiencies; however there is limited evidence for its use in clinical trials, especially in relation to self-harm. One source of routine data, Hospital Episode Statistics, is collated and distributed by NHS Digital and contains details of admissions, outpatient, and Accident and Emergency attendances provided periodically by English National Health Service hospitals. We explored the reliability and accuracy of Hospital Episode Statistics, compared to data collected directly from hospital records, to assess whether it would provide complete, accurate, and reliable means of acquiring hospital attendances for self-harm - the primary outcome for the SHIFT (Self-Harm Intervention: Family Therapy) trial evaluating Family Therapy for adolescents following self-harm. METHODS: Participant identifiers were linked to Hospital Episode Statistics Accident and Emergency, and Admissions data, and episodes combined to describe participants' complete hospital attendance. Attendance data were initially compared to data previously gathered by trial researchers from pre-identified hospitals. Final comparison was conducted of subsequent attendances collected through Hospital Episode Statistics and researcher follow-up. Consideration was given to linkage rates; number and proportion of attendances retrieved; reliability of Accident and Emergency, and Admissions data; percentage of self-harm episodes recorded and coded appropriately; and percentage of required data items retrieved. RESULTS: Participants were first linked to Hospital Episode Statistics with an acceptable match rate of 95%, identifying a total of 341 complete hospital attendances, compared to 139 reported by the researchers at the time. More than double the proportion of Hospital Episode Statistics Accident and Emergency episodes could not be classified in relation to self-harm (75%) compared to 34.9% of admitted episodes, and of overall attendances, 18% were classified as self-harm related and 20% not related, while ambiguity or insufficient information meant 62% were unclassified. Of 39 self-harm-related attendances reported by the researchers, Hospital Episode Statistics identified 24 (62%) as self-harm related while 15 (38%) were unclassified. Based on final data received, 1490 complete hospital attendances were identified and comparison to researcher follow-up found Hospital Episode Statistics underestimated the number of self-harm attendances by 37.2% (95% confidence interval 32.6%-41.9%). CONCLUSION: Advantages of routine data collection via NHS Digital included the acquisition of more comprehensive and timely trial outcome data, identifying more than double the number of hospital attendances than researchers. Disadvantages included ambiguity in the classification of self-harm relatedness. Our resulting primary outcome data collection strategy used routine data to identify hospital attendances supplemented by targeted researcher data collection for attendances requiring further self-harm classification.

Measuring Use of Evidence Based Psychotherapy for Posttraumatic Stress Disorder in a Large National Healthcare System.

To derive a method of identifying use of evidence-based psychotherapy (EBP) for post-traumatic stress disorder (PTSD), we used clinical note text from national Veterans Health Administration (VHA) medical records. Using natural language processing, we developed machine-learning algorithms to classify note text on a large scale in an observational study of Iraq and Afghanistan veterans with PTSD and one post-deployment psychotherapy visit by 8/5/15 (N = 255,968). PTSD visits were linked to 8.1 million psychotherapy notes. Annotators labeled 3467 randomly-selected psychotherapy notes (kappa = 0.88) to indicate receipt of EBP. We met our performance targets of overall classification accuracy (0.92); 20.2% of veterans received ≥ one session of EBP over the study period. Our method can assist with identifying EBP use and studying EBP-associated outcomes in routine clinical practice.

[Evaluation of the Family-based Familien stärken-Program for Preventing Substance Abuse and Behavior Problems in Youth]. / Evaluation des familienbasierten Programms Familien stärken zur Prävention von Sucht- und Verhaltensproblemen bei Jugendlichen.

The Strengthening Families Program was developed in the USA and is regarded as an effective family-based prevention programme for youth. The evaluation of an adapted German version was carried out as a randomised-controlled multicentre trial. 292 families were recruited, 150 followed the intervention, and 142 received a minimal intervention. Acceptance from families and programme facilitators was high. Results about the effectiveness will be reported as soon as follow-up assessments are completed.

Demographics and treatment of the American family.

There have been numerous changes to the US family over the past several decades. Traditional family roles have changed, and the conception of what Americans consider a 'family' has likewise shifted with differing societal views regarding gender, gender roles, race, and ethnicity. This review examines demographics of the American family as well as a number of family therapies that have been historically and are presently used to treat family problems. We expect that with the changes present in US society, family therapies will need to continue to be sensitive and adaptive to these shifts in order to be effective.

Framework for modelling the cost-effectiveness of systemic interventions aimed to reduce youth delinquency.

BACKGROUND: Many interventions initiated within and financed from the health care sector are not necessarily primarily aimed at improving health. This poses important questions regarding the operationalisation of economic evaluations in such contexts. AIMS OF THE STUDY: We investigated whether assessing cost-effectiveness using state-of-the-art methods commonly applied in health care evaluations is feasible and meaningful when evaluating interventions aimed at reducing youth delinquency. METHODS: A probabilistic Markov model was constructed to create a framework for the assessment of the cost-effectiveness of systemic interventions in delinquent youth. For illustrative purposes, Functional Family Therapy (FFT), a systemic intervention aimed at improving family functioning and, primarily, reducing delinquent activity in youths, was compared to Treatment as Usual (TAU). "Criminal activity free years" (CAFYs) were introduced as central outcome measure. Criminal activity may e.g. be based on police contacts or committed crimes. In absence of extensive data and for illustrative purposes the current study based criminal activity on available literature on recidivism. Furthermore, a literature search was performed to deduce the model's structure and parameters. RESULTS: Common cost-effectiveness methodology could be applied to interventions for youth delinquency. Model characteristics and parameters were derived from literature and ongoing trial data. The model resulted in an estimate of incremental costs/CAFY and included long-term effects. Illustrative model results point towards dominance of FFT compared to TAU. DISCUSSION: Using a probabilistic model and the CAFY outcome measure to assess cost-effectiveness of systemic interventions aimed to reduce delinquency is feasible. However, the model structure is limited to three states and the CAFY measure was defined rather crude. Moreover, as the model parameters are retrieved from literature the model results are illustrative in the absence of empirical data. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The current model provides a framework to assess the cost-effectiveness of systemic interventions, while taking into account parameter uncertainty and long-term effectiveness. IMPLICATIONS FOR HEALTH POLICIES: The framework of the model could be used to assess the cost-effectiveness of systemic interventions alongside (clinical) trial data. Consequently, it is suitable to inform reimbursement decisions, since the value for money of systemic interventions can be demonstrated using a decision analytic model. IMPLICATIONS FOR FURTHER RESEARCH: Future research could be focussed on testing the current model based on extensive empirical data, improving the outcome measure and finding appropriate values for that outcome.

European youth care sites serve different populations of adolescents with cannabis use disorder. Baseline and referral data from the INCANT trial.

BACKGROUND: MDFT (Multidimensional Family Therapy) is a family based outpatient treatment programme for adolescent problem behaviour. MDFT has been found effective in the USA in adolescent samples differing in severity and treatment delivery settings. On request of five governments (Belgium, France, Germany, the Netherlands, and Switzerland), MDFT has now been tested in the joint INCANT trial (International Cannabis Need of Treatment) for applicability in Western Europe. In each of the five countries, study participants were recruited from the local population of youth seeking or guided to treatment for, among other things, cannabis use disorder. There is little information in the literature if these populations are comparable between sites/countries or not. Therefore, we examined if the study samples enrolled in the five countries differed in baseline characteristics regarding demographics, clinical profile, and treatment delivery setting. METHODS: INCANT was a multicentre phase III(b) randomized controlled trial with an open-label, parallel group design. It compared MDFT with treatment as usual (TAU) at and across sites in Berlin, Brussels, Geneva, The Hague and Paris.Participants of INCANT were adolescents of either sex, from 13 through 18 years of age, with a cannabis use disorder (dependence or abuse), and at least one parent willing to take part in the treatment. In total, 450 cases/families were randomized (concealed) into INCANT. RESULTS: We collected data about adolescent and family demographics (age, gender, family composition, school, work, friends, and leisure time). In addition, we gathered data about problem behaviour (substance use, alcohol and cannabis use disorders, delinquency, psychiatric co-morbidity).There were no major differences on any of these measures between the treatment conditions (MDFT and TAU) for any of the sites. However, there were cross-site differences on many variables. Most of these could be explained by variations in treatment culture, as reflected by referral policy, i.e., participants' referral source. We distinguished 'self-determined' referral (common in Brussels and Paris) and referral with some authority-related 'external' coercion (common in Geneva and The Hague). The two referral types were more equally divided in Berlin. Many cross-site baseline differences disappeared when we took referral source into account, but not all. CONCLUSIONS: A multisite trial has the advantage of being efficient, but it also carries risks, the most important one being lack of equivalence between local study populations. Our site populations differed in many respects. This is not a problem for analyses and interpretations if the differences somehow can be accounted for. To a major extent, this appeared possible in INCANT. The most important factor underlying the cross-site variations in baseline characteristics was referral source. Correcting for referral source made most differences disappear. Therefore, we will use referral source as a covariate accounting for site differences in future INCANT outcome analyses. TRIAL REGISTRATION NUMBER: ISRCTN: ISRCTN51014277.

[Psychological treatment of physical maltreatment and negligence in children and adolescents: a meta-analysis]. / Tratamiento psicológico del maltrato físico y la negligencia en niños y adolescentes: un meta-análisis.

The results of a meta-analysis about the efficacy of psychological treatment for children who have suffered physical maltreatment and neglect by their parents or tutors are presented. Sixteen studies that met our selection criteria were included, providing 22 treated groups and 8 control groups. The results showed an absence of clear differences among the diverse treatments, although all of them exhibited a low-to-medium practical significance. The longer they are, the more effective are the treatments and also when neglect was the type of maltreatment suffered by the children. The effect estimates do not seem to be affected by biases. Finally, the clinical implications of the results, as well as those for future research, are discussed.

Effectiveness of Family Intervention for Preventing Relapse in First-Episode Psychosis Until 24 Months of Follow-up: A Systematic Review With Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Relapse risk during the early years of first-episode psychosis (FEP) considerably increases the risk of chronicity. The effectiveness of family intervention for psychosis (FIp) for preventing relapse after FEP remains unknown. We assessed the effectiveness of FIp until 24 months of follow-up for preventing relapse and other relapse-related outcomes in patients following FEP. METHODS: We searched the Cochrane, PubMed, PsycINFO, and ProQuest databases in June 2018. A systematic review with meta-analysis of randomized controlled trials (RCTs), sensitivity analyses, and publication bias were performed, comparing to treatment as usual (TAU) or TAU plus other psychosocial interventions. Outcomes assessed were relapse rates, duration of hospitalization, psychotic symptoms, and functionality. Risk ratios (RRs) and (standardized) mean differences (SMD; MD) were calculated. RESULTS: Of the 2109 records retrieved, 14 (11 RCTs) were included. Pooled results showed that FIp was effective for preventing relapse (RR = 0.42; 95% CI = 0.29 to 0.61) compared to TAU and/or other psychosocial interventions. It also proved effective when compared to TAU alone (RR = 0.36) and TAU plus other psychosocial interventions (RR = 0.48). FIp showed benefits in reducing duration of hospitalization (TAU, MD = -3.31; other interventions, MD = -4.57) and psychotic symptoms (TAU, SMD = -0.68), and increased functionality (TAU, SMD = 1.36; other interventions, SMD = 1.41). CONCLUSIONS: These findings suggest that FIp is effective for reducing relapse rates, duration of hospitalization, and psychotic symptoms, and for increasing functionality in FEP patients up to 24 months. The study's main limitations were the inclusion of published research only; authors were not contacted for missing/additional data; and high heterogeneity regarding relapse definition was observed.

Dissemination and effectiveness of multisystemic treatment in New Zealand: a benchmarking study.

The transportability of Multisystemic Therapy (MST) for the treatment of juvenile offenders in a community-based context was examined in the current study. Results of this New Zealand study showed that significant pre- to posttreatment improvements occurred on most indicators of ultimate (i.e., offending behavior) and instrumental (i.e., youth compliance, family relations) treatment outcomes. Reductions in offending frequency and severity continued to improve across the 6- and 12-month follow-up intervals. In comparison to benchmarked studies, the current study demonstrated a more successful treatment completion rate. Additionally, overall treatment effect sizes were found to be clinically equivalent with the results of previous MST outcome studies with juvenile offenders and significantly greater than the effect sizes found in the control conditions. The findings of this evaluation add to the growing body of evidence that supports MST as an effective treatment for antisocial youth.

The metric-frequency measure of similarity for ill-structured data sets, with an application to family therapy.

Similarity measures have been studied extensively in many domains, but usually with well-structured data sets. In many psychological applications, however, such data sets are not available. It often cannot even be predicted how many items will be observed, or what exactly they will entail. This paper introduces a similarity measure, called the metric-frequency (MF) measure, that can be applied to such data sets. If it is not known beforehand how many items will be observed, then the number of items actually observed in itself carries information. A typical feature of the MF is that it incorporates such information. The primary purpose of our measure is that it should be pragmatic, widely applicable, and tractable, even if data are complex. The MF generalizes Tversky's set-theoretic measure of similarity to cases where items may be present or absent and at the same time can be numerical as with Shepard's metric measure, but need not be so. As an illustration, we apply the MF to family therapy where it cannot be predicted what issues the clients will raise in therapy sessions. The MF is flexible enough to be applicable to idiographic data.

Creative consensus on interpretations of qualitative data: the Ward method.

The Ward method (1987) offers an iterative approach to consensus building that encourages the development and consideration of each contributor's unique perspectives. Collaborators begin by orienting to the method and project-specific goals and then engage in an iterative process, cycling between individual creative work and group meetings. Meetings serve as opportunities to share ideas within a noncritical atmosphere. Paradoxically, much of the work of reaching consensus occurs while collaborators are working independently; across iterations, versions tend to converge as collaborators adapt and adopt what they like of one another's ideas. This article, which was itself written using the Ward method, describes the method, its strengths, and challenges associated with its use.

Reflecting on the Past: A Content Analysis of Family Therapy Research from 2000-2015.

In this content analysis, researchers examine articles published from 2000 to 2015 in three family therapy journals, yielding a total of 948 empirical articles. The purpose is to provide an overview of the research being published, assess who is publishing, and investigate the current state of clinical effectiveness research in marriage and family therapy (MFT). Most first authors were affiliated with MFT programs and primarily included diversity and couples in their research. There was a significant increase of research on clinical process-though the number of clinical outcome studies held steady. There were no significant changes with regard to research funding. Implications support the use of innovative research methods to provide evidence of clinical effectiveness.

Evaluating Scholarship Productivity in COAMFTE-Accredited Doctoral Programs: An Update.

Scholarly productivity continues to be used as a significant factor when universities make decisions about granting tenure to faculty, allocating resources, and supporting program goals. In 2009, DuPree, White, Meredith, Ruddick, and Anderson reviewed research productivity in faculty from COAMFTE-accredited PhD programs. As an update, the purpose of this article is to re-examine scholarly productivity trends among COAMFTE-accredited doctoral programs through the use of several evaluation methods. Specifically, productivity was examined in the following areas: (a) family therapy journal publications; (b) publications in any type of peer-reviewed journal; (c) h-factor index scores; and (d) historic and recent journal publication trends.

Pre-treatment patient characteristics as predictors of drop-out and treatment outcome in individual and family therapy for adolescents and adults with anorexia nervosa: A systematic review and meta-analysis.

Understanding variables predicting drop-out or unfavourable outcome following treatment for anorexia nervosa (AN) may help to improve upon intervention efforts. However, the current literature has demonstrated sparse and inconsistent significant findings. The current systematic review and meta-analysis summarised the evidence base examining baseline predictors of drop-out and outcome in AN treatment. A literature search was conducted to identify research investigating predictors of drop-out and outcome in individuals treated for AN. Four online databases were searched, and predictors were organised by category and dependent variable (outcome versus drop-out). 27 studies were included. Lower motivation, lower BMI, and having the binge-purge subtype of AN predicted drop-out. Greater ED pathology and poorer motivation predicted poorer outcome. Clinical recommendations include taking particular care during assessment stages to identify patients at risk of drop-out and/or poor outcome based on their clinical profile and level of motivation for recovery. At-risk patients should be receiving tailored treatment to enhance engagement and reduce risk of drop-out. In conclusion, there's some evidence that motivation, BMI, subtype, and ED pathology predicts drop-out and/or outcome in individual and family-based therapy for AN amongst adolescents and adults; however, research incorporating carefully designed multi-site studies is required to further examine these findings.

The State of Sex Research in MFT and Family Studies Literature: A Seventeen-Year Content Analysis.

The ability to conceptualize and treat sexual problems has been widely accepted as a crucial skill to master the MFT training. However, clients' sexual relationships are often ignored by clinicians because of a lack of experience or training, or personal discomfort. In this content analysis, we review sex and sex therapy research within MFT and family studies journals since the turn of the century. Of the 13,919 articles published within the 15 journals, 137 focused on sexuality or sex therapy. The articles were divided into five themes: sexual and relational health, sexual diversity, treatment and contributors of sexual dysfunction, sex therapy practices, and sexual education and development. Implications for clinical practices, sex therapy integration, and future research are discussed.

Mandatory reporting of child maltreatment when delivering family-based treatment for eating disorders: A framework analysis of practitioner experiences.

BACKGROUND: Increasingly, evidence-based treatment guidelines emphasize the role of parents in first-line treatment approaches for child and adolescent psychiatric disorders. Yet there are no best practice guidelines for practitioners on the identification and reporting of suspicions and disclosures of child maltreatment to child protection services (CPS) in these circumstances. This is particularly concerning given that undetected and unreported child maltreatment may exacerbate the vulnerabilities of youth with mental illness. OBJECTIVE: The objective of this study is to describe family-based practitioners' experiences of reporting child emotional abuse (CEA) and child exposure to intimate partner violence (CEIPV) to CPS. PARTICIPANTS AND SETTING: Data from 30 practitioners based in five countries were included in this study. METHODS: We use deductive framework analysis of qualitative interviews with practitioners providing family-based treatment to youth diagnosed with eating disorders. Interviews for the primary study elicited participants' perceptions and experiences of identifying and responding to CEA and CEIPV in practice. All transcripts were analysed by two authors using constructs identified by a qualitative meta-synthesis of mandatory reporting experiences among service providers. RESULTS: Three participants identified as male, 27 as female. Practitioners described negative experiences when reporting CEA and CEIPV to CPS, as well as variable CPS responses to their reports. Findings confirm the need for additional training for mental health practitioners to recognize and report CEA and CEIPV. CONCLUSIONS: Management of CEA and CEIPV while delivering family-based treatment remains an important area of practice that requires further inquiry.

Research and practice for ultra-high risk for psychosis: A national survey of early intervention in psychosis services in England.

BACKGROUND: Evidence from meta-analyses of randomized clinical trials show interventions for young people at ultra-high risk (UHR) of developing psychosis are effective both clinically and economically. While research evidence has begun to be integrated into clinical guidelines, there is a lack of research on the implementation of these guidelines. This paper examines service provision for UHR individuals in accordance with current clinical guidelines within the National Health Service (NHS) in England. METHOD: A self-report online survey was completed by clinical leaders of early intervention in psychosis (EIP) teams (N = 50) within the NHS across England. RESULTS: Of the 50 EIP teams responding (from 30 NHS trusts), 53% reported inclusion of the UHR group in their service mandate, with age range predominantly 14 to 35 years (81%) and service provided for at least 12 months (53%). Provision of services according to NICE clinical guidelines showed 50% of services offered cognitive behavioural therapy (CBT) for psychosis, and 42% offered family intervention. Contrary to guidelines, 50% of services offered antipsychotic medication. Around half of services provided training in assessment by Comprehensive Assessment of At Risk Mental States, psycho-education, CBT for psychosis, family work and treatment for anxiety and depression. CONCLUSIONS: Despite clear evidence for the benefit of early intervention in this population, current provision for UHR within EIP services in England does not match clinical guidelines. While some argue this is due to a lack of allocated funding, it is important to note the similar variable adherence to clinical guidelines in the treatment of people with established schizophrenia.