The movement towards the provision of evidence-based services has become increasingly important to psychological practice (CPA Task Force on Evidence-Based Practice of Psychological Treatments, 2012; Levant, 2005). One of the key components of this movement is the summarizing and dissemination of important findings to key stakeholders for interventions using techniques such as meta-analysis. Meta-analyses are typically based on reviews of the published literature on a particular topic, but increasingly researchers are acknowledging the importance of examining and including unpublished, grey literature in their reviews in presenting an accurate picture of a body of literature (Hopewell, McDonald, Clarke, & Egger, 2008; McAuley, Pham, Tugwell, & Moher, 2000). However, the inclusion of grey literature in meta-analyses and reviews remains controversial (Coad, Hardicre, & Devitt, 2006; Martin, Perez, Sacristan, & Alvarez, 2005; Seymour, 2010). A number of reviews of behavioural parenting interventions have been conducted. The body of literature in this area continues to grow quickly, and recent meta-analyses in this area have examined only subsets of the literature, thus necessitating an overall examination of all available literature in this area: published and unpublished. The present meta-analysis synthesized the results of 42 published and 6 unpublished behavioural parenting intervention studies conducted between 1966 and 2011. In the first manuscript, treatment efficacy was examined with respect to three different outcomes (parent behaviour, child behaviour, and parent adjustment). I also examined the differential effects of six moderator variables in two categories: child characteristics (child formal diagnostic status and child age) and methodological characteristics (overall quality, comparison group, experimenter allegiance, and publication status). In the second manuscript, I examined both the advantages and challenges of including grey literature in meta-analyses, and explored the use of an innovative search program. I also explored the influence of the inclusion of grey literature on outcomes, including whether effect sizes, sample homogeneity, and publication bias indices are affected by the inclusion of grey literature. Results of the present study confirm the efficacy of behavioural parenting interventions on parent behaviour, child behaviour, and parent adjustment outcomes. Further, I extend the knowledge base through the inclusion of recent reports, grey literature, searches of basic search engines such as Google and Yahoo, and the examination of previously unexplored moderator variables. My results underline the importance of consistent reporting practices in the field and their impact on the availability of evidence for policy-makers, administrators, researchers, clinicians and consumers. I also discuss the implications of these findings for the provision of evidence-based services for parents, knowledge translation, and grey literature.

This thesis analyzes impact of social trust on environmental regulations stringency. Negative effect is suggested. Thesis documents that, in a cross section of countries, there is no evidence of such an effect. On the other hand, there is evidence of positive impact of GDP per capita and level of education.

Bipolar disorder (BPD) is associated with negative health outcomes and high relapse rates and group psychoeducation (PE) is recognised as an effective intervention when used in conjunction with pharmacological treatment. Unhealthy beliefs and attitudes have not been measured or related to outcomes in group PE and the mechanism for how PE exerts its effect are unidentified. Aims: (a). An adapted group psychoeducation intervention will change (improve) unhealthy personal beliefs about illness and attitudes towards medication when compared to a treatment as usual group. (b). Changes in unhealthy personal beliefs and attitudes will be maintained overtime (a 12 month follow up period). (c). People who subsequently relapse compared to those who do not relapse, will have less improvement in their unhealthy personal beliefs about illness and attitudes towards medication from PE. (d). An evaluation of the efficacy of psychoeducation in a systematic review for bipolar disorder in preventing relapse and other outcomes will identify factors that relate to clinical outcomes. Methods: A 10 session PE intervention was adapted and 38 participants with bipolar disorder I or II (using DSM-IV criteria) were recruited from a Specialist Affective Disorders Service. A waiting list assessment time was used as a parallel group control and a longitudinal study took place over a 12 month follow up period in all participants once they had received the intervention. A mirror image study reviewed case notes to identify relapse 12 month pre versus post intervention. Assessments measuring, beliefs and attitudes, mood symptoms and satisfaction where carried out, 8 weeks prior to intervention (waiting list), pre intervention, and 6 and 12 months post intervention. Results Summary: The waiting list control comparison showed significant improvement in attitudes measured by the Personal Beliefs about Illness Questionnaire (PBIQ) and Drug attitude Inventory (DAI) and symptoms and functioning. Beliefs on all domains of the PBIQ improved significantly (p<0.001) as did attitudes toward medication (p<0.001) there were also small but significant improvements in mood symptoms. In all participants (n=38) improvements were maintained over the 12 month follow up period. Nine people relapsed in the 12 months after the intervention compared with 22 before (p<0.002) and relapsers improved significantly less than non-relapsers following PE on the PBIQ (p=0.012) and the DAI (p=0.046). Conclusions: A group PE intervention reduced unhealthy personal beliefs and attitudes, both manic and depressive relapse and improved functioning. Improvements are maintained over time except adherence which remained unchanged. The amount of improvement in the PBIQ and DAI is related to relapse with non relapsers improving more than relapsers. The systematic review provides reasonable evidence that psychoeducation is at least modestly effective in preventing relapse in bipolar disorder, with the strongest evidence for reducing overall and manic relapse.

Randomised trials of complex interventions are typically designed, conducted, and analysed as if they are drug trials. Although there are many parallels there are also a number of important distinctions, which are seldom considered when designing individual trials. One of these concerns the involvement of therapists in delivering psychotherapy. Systematic reviews and meta-analyses provide an opportunity for exploring the full range and complexity of issues encountered in realistically complex situations. The first objective of the thesis was therefore to develop a conceptual framework for understanding the role of the therapist in trial designs. It was addressed by a review of the psychotherapy and statistical literatures structured according to the broad concepts of precision, internal and external validity and refined on the basis of a systematic methodological review of Cochrane reviews meta-analysing trials involving psychotherapy. The second objective was then to review, adapt, illustrate and compare methods for meta-analysing psychotherapy trials with nested designs. Methods for meta-analysing ICC estimates, absolute and standardised mean differences were adapted to allow for heteroscedasticity between treatments at the therapist- and patient- levels. These were illustrated using the example of counselling in primary care, with comparisons being made between aggregate and one-step approaches to the meta-analysis of individual-patient-data.It was argued that the therapist has two roles in randomised trials. Firstly, they are one component of a multi-component intervention, and are thus a potential treatment variable. Second, the nesting of patients within therapists creates an additional level in the design, so the therapist is also an experimental unit. The inability to conceal or randomise allocations leads to observational components within the trial design and to heteroscedasticity which deserves more attention. Characterising complex interventions, like psychotherapy, with more than one treatment variable could facilitate greater understanding of their components, how they interact, which are important, to what extent, and for whom. It also brings what is currently referred to as process research into the remit of trials, enabling a more complete evaluation of the causal effects. The broad concept of multiple experimental units makes cluster-randomised, longitudinal, multi-centre, crossover, therapist- and group-based intervention trials special cases of a more general class of multilevel trial. All involve clustering effects; their nature and the appropriate statistical model varying according to the design. Methods were proposed for the meta-analysis of continuous outcome data for two-level nested designs. A general approach was adopted, where possible, to incorporate methods covering cluster-randomised trials and the Behrens-Fisher problem. It was clear that this is a relatively untouched methodological area in need of further exploration. For the same reasons as it became necessary to summarise clinical research, it is recommended that systematic methodological reviews be carried out on a larger scale in future.

The Social and Emotional Aspects of Learning (SEAL) initiative for secondary schools was launched in England in 2007 as part of the Secondary National Strategy for School Improvement. Designed as a universal, whole-school approach for the development of key social and emotional skills, SEAL was expected to improve behaviour, attendance, attainment and the emotional health and well-being of all members of the school community (DfES, 2007a). Research studies examining the implementation of school-based interventions have revealed, however, that they are rarely implemented as intended by the programme developers (Berman and McLaughlin, 1976) and that this is likely to negatively impact upon the achievement of the expected outcomes (Durlak and DuPre, 2008). Implementation is typically variable between settings due to local adaptations or modifications (Blakely et al, 1987) and challenges to implementation at a range of levels, including programme, classroom and school (Greenberg et al, 2005).This longitudinal study examined the processes of implementation of SEAL in five case study schools in the north-west of England. The primary aims were to: (i) identify both positive and negative factors affecting implementation so that any necessary improvements to SEAL may be made prior to its broader dissemination; (ii) support future practitioners in the implementation of SEAL by highlighting effective strategies and potential challenges; (iii) expand understanding of the processes of implementation of school-based interventions in English educational contexts. Schools were visited five times during the first two years of the implementation of SEAL; lessons were observed, relevant documents reviewed and interviews conducted with a range of staff, pupils and Local Education Authority representatives. Data was analysed thematically using a combination of a priori and emergent themes. As anticipated, implementation was variable between schools; this was in the detail of implementation, however, and broader convergences were seen in the barriers presented and the non-implementation of key processes and elements. None of the schools were able to fully implement SEAL. Challenges to implementation were identified at all levels examined (programme, classroom and school) and included programme characteristics, staff resistance, insufficient training, lack of time and competing initiatives. The interaction of negative and positive factors both within and between levels suggested, however, that no one factor may be considered dominant. This study concluded that until programme level issues and shared contextual factors such as initiative overload are addressed, then the full implementation of SEAL in secondary schools is unlikely to be achieved.

This paper introduces the Bodymind model of Art Therapy and delineates the processes through which it has salutary effects on individuals coping with a variety of health related challenges. The goal of this model is to articulate how activation, reorganization, growth and reintegration of the self can emerge from bodymind processes activated by art therapy. It provides a framework for the conduct of research that will test the key theoretical mechanisms through which art therapy benefits clients. We expect this model to be a spring board for discussion, debate and development of the profession of art therapy. Furthermore, we hope readers can use this model to conduct sound mechanistic studies. This paper can inform social scientists and medical professionals on the manner in which art making can contribute to health.

No

Syftet med denna systematiska litteraturöversikt är att undersöka vilka förebyggande metoder och/eller modeller som finns för att bemöta syskon till grovt kriminella ungdomar. Studien syftar dessutom på att jämföra metodernas olika för- och nackdelar. Resultaten i denna studie är framtagna genom att använda databaserna Libsearch och ProQuest. Vald litteratur har lästs och analyserats upprepade gånger, och två teman valdes för att beskriva artiklarnas fokus, och koppling till studiens syfte och frågeställningar. Valda teman är 1) intervention metoder, och 2) fördelar med MST. Trots en bristande mängd forskning på området så pekar resultatet på att familjeterapin Multisystemisk Terapi (MST) är den dominerande metoden. Förutom fokus på den kriminella individen i MST så involveras syskonet och påverkas direkt, eller indirekt i MST. Till skillnad från individuell terapi (IT) där endast den kriminella ungdomen involveras så sjunker risken att syskonet börjar begå brott markant med MST. Forskningen inom detta område behöver utökas och metoder och arbetssätt går att förbättra. / The aim with this systematic literature review is to investigate the intervention methods and/or models available to deal with siblings for serious criminal youths. The study also aims to compare the methods pros and cons. The results are produced by using the databases Libsearch and ProQuest. Chosen literature has been read and analysed several times, and two themes was selected to describe the articles focus and connection to the study’s aim and research questions. The chosen themes are 1) intervention methods, and 2) advantages with MST. Despite a small amount of research in the field, the result indicates that the family therapy method Multisystemic Therapy (MST) is a dominant method in the field. Except only focusing on the criminal individual in MST, the sibling is involved and directly or indirectly affected. Unlike individual therapy (IT) involving only the criminal juvenile, the risk of the sibling beginning to commit crimes significantly decreases with MST. Research in this area needs to be expanded and methods and ways of working can be improved.

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.

Les procédures impliquant des aiguilles sont la plus importante source de douleur chez les enfants. Considérant qu’il est impossible d’éliminer complètement la douleur ressentie lors de procédures douloureuses, il est de la responsabilité professionnelle de l’infirmière d’assurer sa gestion à l’aide d’interventions non-pharmacologiques et/ou pharmacologiques. Les interventions actuellement disponibles pour le soulagement de la douleur procédurale des enfants nécessitent beaucoup de temps ou de personnel, ce qui représente des barrières à leur implantation dans les services d’urgence. Par conséquent, l’utilisation d’une intervention non-pharmacologique rapide et facile d’utilisation pourrait permettre de pallier ces contraintes. À cet effet, un dispositif combinant le froid et la vibration (Buzzy) a été développé dans l’objectif d’optimiser le soulagement de la douleur procédurale pédiatrique. Ce dernier repose sur deux mécanismes permettant la modulation du message douloureux, soit la théorie du portillon et les contrôles inhibiteurs nociceptif diffus. Le dispositif Buzzy semble donc être une avenue prometteuse pour surmonter les obstacles reliés à la gestion de la douleur lors de procédures impliquant des aiguilles dans les services d’urgence. Le but principal de cette étude était de déterminer si un dispositif combinant le froid et la vibration (dispositif Buzzy) était considéré comme étant non-inférieur à un anesthésique topique (lidocaïne liposomale 4%) pour la gestion de la douleur d’enfants lors de procédures impliquant des aiguilles dans les services d’urgence. Cet essai clinique randomisé de non-infériorité parallèle à deux groupes a été mené dans le service d’urgence d’un centre hospitalier universitaire pédiatrique (CHU Sainte-Justine, Montréal, Canada). Un total de 352 enfants âgés entre 4 et 17 ans a été recruté et 346 ont été randomisés, soit au groupe expérimental (dispositif Buzzy=172) ou au groupe contrôle (anesthésique topique=174). Pour les participants ayant été assignés au groupe expérimental, le dispositif Buzzy a été appliqué à environ 5 cm au-dessus du site d’insertion et a été maintenu en place tout au long de la procédure. Pour les participants ayant été assignés au groupe contrôle, un anesthésique topique (lidocaïne liposomale 4%) a été appliqué au niveau du site d’insertion 30 minutes avant la procédure. Selon l’analyse en intention de traiter, la différence moyenne de douleur procédurale entre les deux groupes à l’étude (dispositif Buzzy : 3,92  3,13; anesthésique topique : 3,27  3,02) était de 0,64 (95%IC -0,10 à 1,26) sur l’échelle de mesure Color Analogue Scale (0-10). Ceci démontre donc que le dispositif Buzzy n’est pas considéré comme étant non-inférieur à l’anesthésique topique. En ce qui concerne la détresse procédurale, aucune différence statistiquement significative n’a été décelée avec les deux échelles de mesures utilisées (Procedure Behavior Check List : p=0,104 ; Children’s Fear Scale : p=0,421). Il n’y avait également aucune différence statistiquement significative en ce qui concerne le succès de la procédure au premier essai (p=0,489) ainsi que la mémoire de la douleur 24 heures après la procédure (p=0,346). De plus, aucun effet secondaire n’a été enregistré pour les participants ayant utilisé le dispositif Buzzy et seulement un évènement est survenu chez un participant ayant reçu l’anesthésique topique. Enfin, les parents des deux groupes ont rapporté être satisfaits avec l’intervention reçu par leur enfant (p=0,257) et la majorité des infirmières (65,0%) ont manifesté une préférence pour le dispositif Buzzy. Le dispositif Buzzy n’est pas considéré comme étant non-inférieur à un anesthésique topique pour la gestion de la douleur d’enfants lors de procédures impliquant des aiguilles. Toutefois, considérant que les anesthésiques topiques sont sous-utilisés dans les services d’urgence, le dispositif Buzzy représente une alternative intéressante à cette méthode pharmacologique nécessitant un temps d’application. Par conséquent, le dispositif Buzzy pourrait être davantage transférable à la pratique et les cliniciens pourraient possiblement l’intégrer plus facilement dans leur routine quotidienne. / Needle-related procedures are considered as the most important source of pain in children in hospital settings. It is now recognized that even minor procedures can result in physiological, psychological and emotional consequences. For these reasons, management of children’s pain and distress through pharmacological and/or non-pharmacological intervention is essential. Healthcare professionals working in the Emergency Department (ED) setting face particular challenges regarding procedural pain management related to their work environment. Time constraints, heavy workload, and busy environment represent barriers to the use of available interventions for pain management during needle-related procedures. Therefore, the use of a rapid, easy-to-use intervention could improve procedural pain management practices in the context of the ED. As such, the Buzzy device, which is a bee-shaped device combining vibration and cold, seems to be a promising alternative. The theoretical bases of this device are the Gate Control Theory and the diffuse noxious inhibitory controls, both generating the modulation of pain. The primary objective of this study was to determine if a device combining cold and vibration (Buzzy device) was considered as non-inferior (no worse) to a topical anesthetic (liposomal lidocaine 4% cream) for pain management in children undergoing needle-related procedures in the ED. This randomized, controlled, non-inferiority trial with two parallel groups was conducted in the ED of a university pediatric tertiary hospital center (CHU Sainte-Justine, Montreal, Canada). A total of 352 participants were enrolled and 346 were randomized to either experimental (Buzzy device=172) or control (topical anesthetic=174) groups. For the participants allocated to the experimental, the Buzzy device was applied 5 cm above the insertion site group just before the needle-related procedure and was maintained in place throughout the procedure. For the participants allocated to the control group, a topical anesthetic cream (liposomal lidocaine 4%) was applied at the insertion site 30 minute before the needle-related procedure. Using an intention-to-treat analysis, the mean difference in procedural pain scores between the experimental group (3,92  3,13) and the control group (3,27  3,02) was 0.64 (95%CI -0,10 to 1,26) using the Color Analogue Scale, showing that the Buzzy device was not non-inferior to the topical anesthetic. Regarding the procedural distress, no significant difference was found between groups using the both measuring scales (Procedure Behavior Check List: p=0,104; Children’s Fear Scale: p=0,421). In addition, no significant difference was also found between groups regarding the success of the procedure at first attempt (p=0,489) and the memory for pain 24 hours after the procedure (p=0,346). Parents of both groups were satisfied with the received interventions (p=0,257) and the majority of nurses (65,0%) preferred the Buzzy device over the topical anesthetic. No adverse events occurred in the cold and vibrating group and one adverse event was reported in the topical anesthetic cream group. The non-inferiority of the cold and vibrating device over a topical anesthetic was not demonstrated for pain management of children during needle-related procedure in the ED. However, considering that topical anesthetics are underused in the ED setting, the Buzzy device seems to be a promising alternative as it is a rapid, low-cost, easy-to-use and reusable intervention. Consequently, it could be more likely to be translated into clinical practice and adopted by clinicians for routine use.