This case reports the implementation of post-care patient interviews to determine whether or not patients received screening and brief intervention (when needed) for alcohol problems.

yes / This systematic review of reviews aims to investigate how brief interventions (BIs) are defined, whether they increase physical activity, which factors influence their effectiveness, who they are effective for, and whether they are feasible and acceptable. We searched CINAHL, Cochrane database of systematic reviews, DARE, HTA database, EMBASE, MEDLINE, PsycINFO, Science Citation Index-Expanded and Social Sciences Citation Index, and Scottish Intercollegiate Guidelines Network from their inception until May 2015 to identify systematic reviews of the effectiveness of BIs aimed at promoting physical activity in adults, reporting a physical activity outcome and at least one BI that could be delivered in a primary care setting. A narrative synthesis was conducted. We identified three specific BI reviews and thirteen general reviews of physical activity interventions that met the inclusion criteria. The BI reviews reported varying definitions of BIs, only one of which specified a maximum duration of 30 min. BIs can increase self-reported physical activity in the short term, but there is insufficient evidence about their long-term impact, their impact on objectively measured physical activity, and about the factors that influence their effectiveness, feasibility and acceptability. Current definitions include BIs that are too long for primary care consultations. Practitioners, commissioners and policy makers should be aware of this when interpreting evidence about BIs, and future research should develop and evaluate very brief interventions (of 5 min or less) that could be delivered in a primary care consultation. / Citation sent on from Donna. Emailed Laura Lamming for final draft 16/03/2017 -sm

Context – The prevalence of problem substance use is a global concern, particularly for adolescents due to their ongoing developmental changes. Amongst other contributory factors, parenting styles adopted by parents and caregivers can either; increase the risks of their children developing substance misuse problems or prevent its onset. Knowledge about the needs and experiences of the caregivers of adolescents who misuse substances is limited and greatly under-researched. Brief interventions (BIs) have been identified as an effective means of tackling this problem-type behaviour among adolescents, including ‘Teen Intervene', which was developed in the US. This evidence-based intervention included a parent component which has been found to further enhance the interventions' positive outcomes. Rationale – In light of the unique caregiver structures in South Africa, the general neglect of their needs in the South African literature with regards to interventions and the high prevalence of adolescent substance misuse in the Western Cape, exploring these needs within the country's context is warranted and necessary. Design and data collection – This was a qualitative study and data for the study was collected in two main phases: through focus group discussions to identify caregivers needs and to explore perceptions of the intervention; and post-intervention interviews with caregivers and adolescents at a 1-month follow-up session. Findings – Template analysis revealed six main themes: 1) Access to knowledge about substance misuse; 2) Parenting skills; 3) Sources of emotional support; 4) Empowerment for female caregivers; 5) Financial concerns; and 6) Alternative solutions to adolescent's involvement in the justice system. Caregivers also reported various feelings that are a direct result of their experiences. Discussion – Caregivers have distinct needs that require designated responses, however, some of these needs can be addressed through their inclusion in treatment interventions for adolescents who misuse substances.

This study examined the utility of a pilot "call-in service" coordinated with two rural pediatric primary care clinics. This service provided practical, empirically supported recommendations to parents with concerns about their children's development, behavior, or emotional well-being. Over 70 weeks, 81 calls were received. Five specific concerns including daytime wetting, conduct problems, anxiety, sleep, and repetitive behavior comprised 75% of all calls. In addition to describing the service overall, the current article examined the top concerns in terms of their process and outcomes in this brief intervention format. Overall, calls averaged 21 min, and parents reported high satisfaction and positive outcomes at follow-up. This format appeared to be most useful for calls regarding daytime wetting and repetitive behaviors/habits. The utility of a call-in service has not been recently explored. Moreover, specific pediatric problems amenable to brief intervention in primary care have rarely been researched. This study provides direction for the future use of call-in services or brief interventions in primary care.

Perfectionism is a transdiagnostic process implicated in several disorders, and is defined in the literature as having standards of performance that are excessively high and often unrealistic, rigidly pursuing these standards, and subsequently measuring one’s own self-worth on their ability to meet these self-set standards (Egan et al., 2011). Perfectionism is related to many negative outcomes for physical and mental health, warranting the need to identify effective treatments that are accessible to individuals experiencing clinical perfectionism. There is a growing need for discrete, single session therapeutic interventions, and research has found that patients who were provided with a brief intervention exhibited accelerated rates of change, compared to patients whose treatment was longer (Baldwin et al., 2009; Kroska, 2018). Therefore, the purpose of this study was to examine the effects of a 90-minute, single-session ACT intervention targeting psychological flexibility for perfectionistic beliefs and behaviors on perfectionism, psychological distress, and well-being utilizing a multiple baseline across participants experimental design. Four individuals completed the following self-report measures at each time point: the Personalized Psychological Flexibility Inventory (PPFI), the Multidimensional Psychological Flexibility Inventory (MPFI), the Frost Multi-Dimensional Perfectionism Scale (FMPS), the Self-Compassion Scale (SCS), the Depression, Anxiety, and Stress Scale-21 item (DASS-21), and the Flourishing Scale (FS). These measures were completed once per week for the five-week baseline period. After baseline, participant engaged in a 90-minute single-session ACT intervention targeting the development of psychological flexibility. For follow-up, participants completed the same measures twice a week for four weeks. Researchers hypothesized that the intervention would increase psychological flexibility, flourishing, self-compassion, and progress towards an idiographic goal, and decrease perfectionism, psychological inflexibility, and psychological distress post-intervention compared to the baseline assessment. A TAR trend analysis was conducted, and Bayes Factors were computed for each individual for each outcome variable to examine within-participant results. A between-case standardized mean difference effect size for SCED was calculated for each outcome variable to examine the results across participants, resulting in a d-statistic. Within participants, while two individuals completed the study with perfectionistic concerns scores below cut offs, this outcome did not change significantly from baseline, with greater evidence for a null effect on this outcome variable for most participants. However, there was evidence for treatment effects for decreasing perfectionistic strivings, psychological distress, and psychological inflexibility and increasing psychological flexibility and flourishing. Across participants, the intervention demonstrated small to large effect sizes. There were small effects on perfectionistic concerns, perfectionistic strivings, psychological distress, and psychological flexibility towards an individual goal. There were medium effects for psychological flexibility and flourishing. Large effects were demonstrated for psychological inflexibility and self-compassion. Overall, the results demonstrate promising evidence for increasing well-being within the context of clinical perfectionism using a single session intervention.

Yes / This systematic review of reviews aims to investigate how brief interventions (BIs) are defined, whether they increase physical activity, which factors influence their effectiveness, who they are effective for, and whether they are feasible and acceptable. We searched CINAHL, Cochrane database of systematic reviews, DARE, HTA database, EMBASE, MEDLINE, PsycINFO, Science Citation Index-Expanded and Social Sciences Citation Index, and Scottish Intercollegiate Guidelines Network from their inception until May 2015 to identify systematic reviews of the effectiveness of BIs aimed at promoting physical activity in adults, reporting a physical activity outcome and at least one BI that could be delivered in a primary care setting. A narrative synthesis was conducted. We identified three specific BI reviews and thirteen general reviews of physical activity interventions that met the inclusion criteria. The BI reviews reported varying definitions of BIs, only one of which specified a maximum duration of 30 min. BIs can increase self-reported physical activity in the short term, but there is insufficient evidence about their long-term impact, their impact on objectively measured physical activity, and about the factors that influence their effectiveness, feasibility and acceptability. Current definitions include BIs that are too long for primary care consultations. Practitioners, commissioners and policy makers should be aware of this when interpreting evidence about BIs, and future research should develop and evaluate very brief interventions (of 5 min or less) that could be delivered in a primary care consultation. / This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0608-10079). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The funder had no role in study design, data collection, data analysis, data interpretation, the writing of the manuscript, and decision to submit the manuscript for publication.

Background: Prenatal alcohol consumption is one of the leading preventable causes of birth defects, including fetal alcohol syndrome and learning disabilities. Although there is strong evidence of the benefits of screening and alcohol brief interventions (ABIs) in reducing hazardous and harmful drinking among the primary care population, evidence of its effectiveness with the antenatal care population is limited. Nevertheless, the Scottish Government is incorporating an alcohol screening and ABI programme as part of the routine antenatal care provided to women in a bid to protect the health and safety of the unborn child and improve subsequent health and developmental outcomes. This research therefore seeks to increase understanding of the factors that are likely to influence the effectiveness of this recently implemented programme. It also aims to explore the extent to which contemporary issues such as change in guidelines regarding alcohol consumption during pregnancy influences perceptions and attitudes, and the possible implications of these on the screening and ABI delivery. Methods: The study described in this thesis employed a realistic evaluation methodology. Realistic evaluation is a theory-driven approach to investigating social programmes. It is concerned with hypothesising, testing and refining programme theories by exploring the interaction of contexts, mechanisms and outcomes. To identify the relevant screening and ABI programme theories, two separate systematic reviews, a critical review and four face-to-face interviews were undertaken with health policy implementers. The findings were used to construct context, mechanism and outcomes propositions. The propositions were then tested by conducting individual interviews with seventeen pregnant women and fifteen midwives, a further six midwifery team leaders were involved in a focus group discussion. A thematic approach using a hybrid of inductive and deductive coding and theme development informed the qualitative analysis. Results: In the context of uncertainties regarding the threshold of drinking that causes fetal harm, pregnant women reported that screening assessment helped them to reflect on their drinking behaviour and facilitate behaviour change. For women who drank at hazardous and harmful levels before attending the booking appointment, screening and ABI may be helpful in terms of eliciting behaviour change. However, they may not be very beneficial in terms of reducing harm to the fetus as it has been found that drinking during the first trimester poses the most risk to the fetus. Training and resources provided to midwives as part of the screening and ABI programme were found to be facilitating mechanisms that midwives indicated improved their skills and confidence. However, most of the midwives had not subsequently employed the motivational interviewing skills required for the ABI delivery, as many of the pregnant women reported that they reduced or abstained from alcohol consumption once pregnancy was confirmed. The outcome noted was that midwives confidence decreased leading to missed opportunities to appropriately deliver the ABI to eligible women. The small numbers of women being identified for ABI meant midwives rarely delivered the ABI. This negatively influenced midwives attitudes as they then accorded ABI low priority in their workload. Other disenabling mechanisms noted to be hampering the implementation of the screening and ABI initiative included midwives contending with competing priorities at the booking appointments, and the lack of adequate rapport between midwives and pregnant women at the booking appointment to discuss alcohol issues appropriately, leading to women providing socially desirable responses to screening questions. Conclusions: The findings of this study has generated greater explanations of the working of the screening and ABI programme in antenatal care setting and has provided transferable lessons that can be used by others intending to implement similar programmes in other settings.

Primärvårdens uppdrag innefattar behandling av psykisk ohälsa och för närvarande överstiger behandlingsbehovet vårdnivåns resurser. Integrerad beteendehälsa (IBH) är en organisationsmodell för primärvård som tidseffektivt tillgängliggör psykologisk behandling. Föreliggande pilotstudie ägde rum under perioden januari till april 2019 på vårdcentralen Centrum, som arbetade enligt modellen för IBH. Syftet för studien var att utvärdera effekterna av behandling med Brief Interventions (BI) respektive vägledd självhjälp avseende patienternas vardagliga funktionsnivå, livskvalitet och symtom. Mätningar genomfördes innan behandling påbörjades, efter fyra veckor samt efter åtta veckor. Vidare undersöktes processfaktorer, så som hur stor andel av patienterna som skulle kunna tillgodogöra sig behandling med självhjälp, samt huruvida införande av en sådan behandling skulle kunna vara motiverad i primärvårdsmiljö utifrån tidseffektivitetsperspektiv. Totalt randomiserades 41 patienter mellan behandling med BI respektive en utökad bedömning följt av behandling med vägledd självhjälp. De patienter som vid den utökade bedömningen inte befanns lämpliga för vägledd självhjälp fick behandling med BI. Sammantaget fullföljde 29 patienter behandling inom ramen för studien. Resultaten visade att både BI och självhjälp förbättrade patienternas vardagliga funktionsnivå, livskvalitet och symtomnivå, samt att det fanns få skillnader i behandlingsutfall mellan grupperna. Tidsåtgången för personalen var större för behandling med självhjälp jämfört med BI. Vidare forskning behövs för att utvärdera psykologisk behandling anpassad till primärvården. / A commitment of primary care is mental health treatment. At present the need for treatment exceeds accessible resources. Primary Care Behavioral Health (PCBH) is a model of organization of primary care with the aim to make access to mental treatment from a time-efficiency perspective. The present study was conducted between January and April 2019 at Vårdcentralen Centrum, a primary care unit organized in accordance with PCBH. The aim of the present study was to evaluate the effects of treatment with Brief Interventions (BI) and guided self-help regarding daily functioning, quality of life and aggregate level of symptoms. Self-assessments were filled out by the patients before treatment, at FU4 and at FU8. Furthermore, proportion of patients suitable for self-help treatment was examined, and whether introduction of such a treatment might be justified in the context of primary care on basis of time effectiveness approach. In overall, 41 patients were randomized to two conditions: BI treatment and, respectively, extended assessment with subsequent self-help treatment. Participants, not found suitable for self-help at the extended assessment, got treatment with BI. Within the study, 29 patients went through treatment. The results showed that groups treated with BI and self-help had improved significantly between before treatment and FU8 regarding daily functioning, quality of life and level of symptoms. There were in general little differences in improvement between the two groups. Furthermore, timescale for the group that got extended assessment and subsequent self-help treatment, was significantly larger than timescale for the group that got BI treatment. For future research, evaluation of short-term forms of mental treatment in primary care ought to be relevant.

Considering serious health, social and subsequently economic impacts which are rising due to the heavy alcohol consumption in the Czech Republic and the whole of Europe, the WHO proposed scientifically based tools, the aim of which is to minimize damage caused by alcohol. Health service is, therefore, highly recommended to establish Screening and brief interventions (SBI). The SBI method belongs to behavioural and cognitive-behavioural therapies. The goal is to identify people with risk or harmful alcohol consumption, to stop its usage, to diminish risks and get a motivation to seek specialized assistance. The majority of recommendations to establish SBI for risk and harmful drinking are especially aimed at primary care, mostly at doctors. Nurses with their broad competence in a lot of medical fields are left behind even though their activity including direct contact with patients involves analysing the levels of risk factors which alcohol is a part of. The purpose of the study is to clarify under which circumstances it is possible to effectively apply the SBI methodology into nursing practice in a selected Czech district, to describe the current engagement and extent of nurses' motivation to deal with alcohol prevention, to look for possibilities of SBI integration into real nursing practice and...

INTRODUÇÃO: As Estratégias de Diagnóstico e Intervenções Breves (EDIB) propostas pela Organização Mundial de Saúde são consideradas efetivas para o diagnóstico e prevenção dos agravos decorrentes do uso do álcool. Atitudes, crenças e expectativas dos profissionais de saúde em relação ao uso de álcool influenciam o efeito destas novas propostas. OBJETIVO: Este trabalho propõe a avaliação do efeito do treinamento em EDIB sobre as crenças e expectativas a respeito do uso de álcool. MÉTODOS: O estudo é do tipo observacional, transversal, comparativo, sobre uma amostra de 88 profissionais da atenção primária à saúde, provenientes de Ribeirão Preto e região, que concordaram em participar da pesquisa conforme os procedimentos éticos recomendados, treinados pelo Programa de Ações Integradas para Prevenção e Atenção ao Uso de Álcool e Drogas na Comunidade (PAIPAD) no período de 2003 a 2006. Os dados foram coletados através de questionários individuais aplicados antes do treinamento e no período de 4 a 6 meses depois. Os questionários incluíram um formulário sócio-demográfico, o Teste de Conhecimento sobre álcool e Intervenções Breves (IB), o Inventário de Expectativas e Crenças Pessoais acerca do Álcool (IECPA) e um formulário de estimativas sobre o uso do AUDIT (Alcohol Use Disorder Identification Test) e das IB. A amostra foi caracterizada quanto à prática e preparação profissional na atenção primária, papel, atitudes e crenças dos profissionais em relação aos problemas relacionados ao uso de álcool ou outras drogas pelos seus pacientes. RESULTADOS: No Teste de Conhecimento sobre álcool e Intervenções Breves, a pontuação média foi maior após o treinamento, passando de 4,1 para 5,57(Wilcoxon Test: z= -4,936; p 0,001). Os resultados médios do IECPA passaram de 93,45 pontos na fase pré para 78,74 pontos na fase pós-treinamento (Wilcoxon, z=-4,138; p 0,001). Através do teste de Spearman observou-se tendência à correlação positiva entre a aquisição de conhecimento e as variações no IECPA (p=0,095); o nível de conhecimento pré-treinamento e as estimativas de realização de EDIB(p=0,082); as estimativas de aplicação de AUDITS e o intervalo de tempo(p=0,009). As variações do IECPA se correlacionaram positivamente com as expectativas de aplicação de EDIB (Nonparametric Chi-Square: p=0,053). No Teste de Conhecimento, o nível médio (incompleto e completo) apresentou menor nível de aproveitamento que os outros níveis de escolaridade. As maiores variações no IECPA foram observadas entre os profissionais de nível de escolaridade superior (incompleto e completo). Os profissionais com ocupações de nível superior apresentaram maiores variações positivas quanto ao conhecimento que os de nível técnico, e maior redução na pontuação do IECPA. CONCLUSÕES: A estratégia de formação oferecida pelo PAIPAD foi efetiva, promovendo mudanças nas crenças e expectativas da equipe sobre uso de álcool, interferindo positivamente na conduta preventiva dos profissionais treinados junto aos pacientes. / BACKGROUND: The Strategies of Screening, Brief Intervention and Referral to Treatment (SBIRT) proposed by World Health Organization (WHO) are considered effective to perform the diagnosis and the prevention of damage caused by alcohol. Attitudes, beliefs and expectations of health professionals in relation to alcohol use have influence over the effect of these new proposals. OBJECTIVE: This study aimed at evaluating the effect of training in SBIRTs on the beliefs and expectations of professionals about the alcohol use. METHODS: The study is observational, cross-sectional and comparative, with a sample of 88 professionals of primary care, from Ribeirão Preto and region, who agreed to participate following ethical procedures, trained by Program of Integrated Action for Prevention and Attention to Alcohol and Drug Use in the Community (PAIPAD), in period from 2003 to 2006. Data were collected through individual questionnaires applied before the training and in the period from 4 to 6 months later. The questionnaires included a socio-demographic inventory, the Test of Knowledge about alcohol and brief interventions (IB), the Inventory of Positive Expectations and Beliefs about Alcohol (IECPA) and an inventory of estimates on the use of the AUDIT (Alcohol Use Disorder Identification Test) and brief interventions. The sample was characterized in relation to the practice and professional preparation in primary care, the professional role in primary care and attitudes and beliefs of professionals about problems related to alcohol or other drugs for their patients. RESULTS: In the Test of Knowledge about alcohol and brief interventions, the average score was higher after the training, increasing from 4.1 to 5.57 (Wilcoxon test: z =- 4.936, p0001). The IECPA average changed from 93.45 points to 78.74 points after intervention, in the post-training (Wilcoxon, z =- 4.138, p0001). A trend toward positive correlation between the acquisition of knowledge and changes in IECPA (p = 0,095) was found (Spearman test), as well the level of pre-training knowledge and estimates of conducting SBIRTs (p = 0,082), estimates of implementing AUDIT and the time (p = 0,009). In the Test of Knowledge, the intermediate level of schooling (complete and incomplete) showed lower score than the others. Variations of IECPA correlated positively with the expectations of applying SBIRTs (Nonparametric Chi-Square: p = 0,053). The highest changes in IECPA were seen among higher level professionals (complete and incomplete). The professionals of higher-level occupations showed bigger positive changes in knowledge than workers of technical level and higher reduction in scores of IECPA. CONCLUSIONS: The strategy of training offered by PAIPAD was effective, promoting changes in beliefs and expectations of the team about alcohol use, interfering positively in the preventive attitudes of trained professionals with the patients.