No description available.

Background: Theory and research declares that family memberes engagement in adolescent treatment has positive impact on treatment outcomes. To get the famillies engaged is quite challenging for proffesionals in addiction treatment services. Motivation of individual members fluctuate a lot. The impact on treatment is due to the voluntarity of treatment or recomendation of a third side. Even dough engagement of legal representatives is declared condition of treatment in Regional Ambulance for Adddictions in Children and Youth, it is complicated to motivate them for cooperation. Aims: The aim of the thesis is to find out how the legal representatives percieve cooperation with outpatient services, if they percieve any obstacles in getting more involved and to find out, what is their view on adolescent's profit from treatment. Methods: For the research a qualitative approach was used in the form of semi- structured interview and interpretation of the data from client files and UniData program. Data collection took work during 05/18-11/18. For the data analysis the method of gestalts was used. Results: Thesis has shown that the main motivational element was some crisis of legal representatives, when they didn't know how to solve demanding situation. The main obstacles are the technical ones like...

Background: Difficulties with anxiety among children and young people are common and can impact upon their developmental trajectory leading to adverse outcomes in later life. There is, therefore, a need to increase access to early intervention services. Existing research has indicated that school-based cognitive behavioural interventions are effective for children and young people experiencing difficulties with anxiety, yet there remains a proportion of the population for whom they are not effective. In addition, there is a lack of research on how these may be implemented in real world settings as opposed to a research trial. The present research focuses on the provision of cognitive behavioural school-based interventions in two parts: a systematic review of psychological, interpersonal and social variables as predictors, mediators and moderators of mental health outcomes following a school-based intervention and an empirical mixed methods evaluation of the facilitators and barriers to the implementation of a school-based intervention. Method: A systematic search of electronic databases for studies examining interpersonal, psychological and social predictors, moderators and mediators of mental health outcome following school-based cognitive behavioural interventions was conducted. Effect sizes for these analyses were calculated and the quality of eligible studies was assessed using a standardised rating tool. Within the empirical project, the implementation of a school-based cognitive behavioural intervention was evaluated through a mixed methods approach. Semi-structured interviews with stakeholders in the intervention were analysed using grounded theory integrated with framework analysis. Quantitative data on the reach of the intervention, practitioner evaluation of training and coaching as well as routine outcome measures from children and young people receiving the intervention was collected. Results: Within the systematic review, twenty-two studies (N=22) met the predefined eligibility criteria. There was heterogeneity in the variables explored, effect size of these on treatment outcome and the quality of the literature within the included studies. Cognitive style was found to mediate treatment outcome, but there was limited evidence for other predictors, mediators and moderators of treatment outcome within the review. Quantitative results of the empirical project indicated that the model of the intervention was acceptable to both practitioners and children and young people, and preliminary data indicated a significant improvement in mental health outcomes. Facilitators that emerged from qualitative data included an enabling context, therapeutic engagement, motivation and congruence, self-efficacy and containment and encouragement. The exclusivity of the intervention, a lack of systemic understanding and transparency as well as demands and pressure on resources were barriers to implementation. Conclusions: Although preliminary evidence for potential predictors, mediators and moderators is presented, further research with improvements in the design and reporting of explanatory variables on treatment outcome is required prior to informing clinical decision-making. The successful implementation of school-based interventions requires multi-agency integration and collaboration as well as on-going support in managing systemic pressures and skill development.

Eating disorders (ED) usually develop during adolescence, and intervention to stop further weight loss is believed to improve outcome and long-term prognosis. Adolescents with ED who do not receive effective treatment risk poor outcome and even untimely death as adults. The first aim of this thesis was to investigate long-term mortality and causes of death in a series of female adults with chronic ED. The second aim was to study the one-year outcome of an unselected series of adolescent girls with anorexia nervosa (AN) and “other restrictive eating disorders” who had been treated within a specialist ED out-patient service focused on nutritional rehabilitation based on family therapy and without planned hospitalization. The third aim was to investigate the possible metabolic and hormonal side effects of olanzapine when used as an adjunct to facilitate nutritional rehabilitation. The fourth aim was to investigate the relationship between polyunsaturated fatty acid (PUFA) status and depression. In adult women with chronic ED, a very low body mass index and psychiatric co-morbidity confer a substantially increased risk of premature death. A treatment programme for adolescent ED with rapid access to assessment and prompt start of treatment with initial emphasis on nutritional rehabilitation proved efficient. The outcome was encouraging, as 43% of all patients with ED and 19% of those with AN did not have an ED at one-year follow-up. Of the remaining patients the vast majority had gained weight and regained menstruation, and were back in school on a full-time basis. Olanzapine was used to reduce anxiety, excessive exercise and rumination over weight and shape. Side effects were similar to those observed in normal-weight individuals, and do not preclude its use in underweight adolescents with ED. Low ω3 PUFA were associated with depression. The ω3 PUFA status improved during nutritional rehabilitation with ordinary foods and without supplementation. The investigations indicate that adolescent ED can be successfully treated in an out-/day-patient setting. An essential feature of the service is rapid handling and weight gain. Further weight loss can be avoided, and chronic disease hopefully prevented.

For over 75 years the process of (un)forgiveness has been anecdotally understood to play an important role in the Twelve-Step Model of addiction and recovery. However, only very recently have scholars begun to examine the empirical evidence in support thereof. Multiple dimensions and aspects of forgivingness (trait), state forgiveness, and problematic substance use are relevant to one another in the context of addiction and recovery. Models of the association between forgiveness and problematic substance use have been developed, including the conceptual identification of the process of (un)forgiveness as inherent to and/or consistent with evidence-based treatment modalities. Relevant empirical evidence is reviewed and of the 21 empirical studies in the published scientific literature, 90 % show a salutary association. Indeed, forgivingness of self may be the most important dimension of forgiveness for recovery. A future research agenda is proposed and implications for individual, public, and societal health are discussed.

Physical activity is an important health-related behavior, and The Centers for Disease Control and Prevention (CDC) recommends that children engage in at least 60 minutes of moderate-to-vigorous-physical activity (MVPA) daily (CDC, 2015). However, worldwide, many children do not reach those requirements and health problems associated with physical inactivity are becoming more prevalent (CDC, 2015; World Health Organization [WHO], 2016). Recently, a few studies have conducted an intervention analysis to evaluate implications for function-based interventions to increase physical activity (Larson, Normand, Morley, & Miller, 2014; Zerger, Normand, Boga, & Patel, 2016). However, intervention analyses, indicate an overall decrease in levels of MVPA. This limitation could hinder further improvements of function-based interventions to increase physical activity, and is thus important to investigate. The current study partially replicated Zerger et al. (2016), and investigated the effects of alternating FA test conditions and repeated presentation of single condition exposure on maintenance of levels of MVPA in children. Additionally, the current study also evaluated the effectiveness of a more intermittent contingent schedules of reinforcement (i.e., fixed-interval limited-hold schedule) during intervention conditions. Results suggest it might be beneficial for caretakers and parents to deliver reinforcement in the form of social reinforcement to increase MVPA in preschool children. Additionally, the data suggest to promote MVPA, a more intermittent schedule of contingent social reinforcement does not reliably promote stable levels of MVPA.

The early identification of non-responding psychotherapy clients and reducing their treatment failure rates are the principal functions of Clinical Support Tools (CST). Nearly two decades of patient-focused research have produced several "evidence-based treatment monitoring" (EBTM) practices, that measure individual patients' responses to theory-guided treatments and alert therapists of clients who are at risk of eventual treatment failure. Clinical Support Tools are a quality management program that bundle several EBTM practices, and have been shown to improve outcomes in failing clients (Shimokawa, Lambert & Smart, 2010). Appropriately, EBTM has generated significant interest as it expands notions of what constitutes evidence-based practice with non-responding patients (APA, 2006). There is a practical need to disseminate Clinical Support Tools to a wider audience of clinicians and practice environments. The current study was designed to advance understanding of CST mechanisms by providing detailed, qualitative data that demonstrate how CST procedures are utilized in routine practice. Eleven doctoral-level psychologists experienced in using Clinical Support Tools at a university counseling center were interviewed about their use of Clinical Support Tools with a recent non-responding client and about their general experiences with past non-responding clients. Clinicians' responses were categorized as Actions, Decisions, or Attitudes, and were subjected to inductive, thematic content analysis. Results were interpreted to indicate which CST functions were active or inactive in the therapists' routine care. Findings indicated that therapists utilized CST resources to monitor patient status, to identify problems that may have explained therapy non-response, and to initiate corrective interventions. Although it was clear that therapists used the CST signal-alarm system to initiate a problem assessment and corrective intervention, it was less clear whether therapists used CST's to determine significance of client change or to determine the client's prognosis. This observation needs to be confirmed through further investigation. Future research that quantifies CST utilization and investigates implementation-outcome relationships is recommended. Finally, practical avenues for increasing the influence and prevalence of EBTM practices in behavioral healthcare are discussed.

PURPOSE: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has not yet been systematically evaluated in the Caribbean context, particularly with Hispanic youth exposed to multiple disasters. The objective of this project was twofold: 1) to train mental health providers in Puerto Rico in TF-CBT as part of a clinical implementation project within the largest managed behavioral health organization (MBHO) on the island, and 2) to conduct a program evaluation to determine the feasibility of implementation and the effectiveness of the treatment. METHOD: Fifteen psychologists were trained in TF-CBT. These psychologists then provided TF-CBT to 56 children and adolescents, ages 5-18, in community-based mental health clinics and one primary care clinic with a co-located psychologist in Puerto Rico. The mean number of traumatic events reported by youth referred for TF-CBT was 4.11. RESULTS: Thirty-six out of 56 children enrolled in the project (64.3%) successfully completed all components of TF-CBT. Results demonstrated large effect sizes for reduction in youth-reported posttraumatic stress symptoms (PTSS) (Cohen's d = 1.32), depressive symptoms (Cohen's d = 1.32), and anxiety symptoms (Cohen's d = 1.18). CONCLUSIONS: These results suggest that it was feasible to train providers in TF-CBT, that providers were able to deliver TF-CBT in community-based settings both in person and via telehealth (due to the COVID-19 pandemic), and that TF-CBT was an effective treatment option to address trauma-related concerns for youth in Puerto Rico in a post-disaster context. This project is an important first step in the dissemination and implementation of evidence-based trauma-focused treatment for Hispanic youth and disaster-affected youth in the Caribbean.

Introduction. Anorexia nervosa (AN) is an eating disorder with one of the highest mortalityrates of all psychiatric illnesses. One county hospital in Sweden has seen an increase in theprevalence of adolescent AN over the last year. To meet these heightened demands, thecounty’s child and adolescent psychiatric (CAP) clinic established a new level of care for thesepatients. The main component of the intervention was mealtime support. Aim. The aim of the study was to evaluate the experiences of adolescent patients and theirparents regarding a day-patient treatment for AN in a county hospital in Sweden. Methods. Patients and their legal guardians were interviewed separately or in dyads, accordingto their wishes. An interview guide with open-ended questions was used. The audio files weretranscribed verbatim, and the texts were then studied with inductive content analysis. Fivepatients and nine parents from seven different families participated in the study. Results. The participants painted a nuanced picture of the intervention. The four overarchingthemes that emerged were ambivalence, distinguishing the person from the disease, parentalstruggling and perceptions of the treatment and the staff. Strict rules around food combinedwith an empathetic and flexible attitude towards the child were described as successful carestrategies. The treatment was depicted as time-consuming and strenuous, but parents alsoexperienced the intervention as relieving. Conclusions. The intervention was for the most part experienced as well-functioning, and theintensive nature of the treatment was described as a key factor.

No description available.