Effectiveness of School-Based Cognitive Behavioral Therapy in Alleviating Anxiety and Depression Among High-Risk Child and Young People: A Bayesian Meta-Analysis with Meta-Regression

BackgroundA range of interventions that aim to prevent domestic abuse has been developed for children and young people in the general population. While these have been widely implemented, few have been rigorously evaluated. This study aimed to discover what was known about these interventions for children and what worked for whom in which settings.Review methodsThis mixed knowledge review was informed by realist principles and comprised four overlapping phases: an online mapping survey to identify current provision; a systematic review of the existing literature; a review of the UK ‘grey’ literature; and consultation with young people and experts. Information from these four sources of evidence informed analysis of costs and benefits.ResultsThe evidence for interventions achieving changes in knowledge and attitudes was stronger than that for behavioural change. Shifting social norms in the peer group emerged as a key mechanism of change. Media campaigns act to influence the wider social climate within which more targeted interventions are received, and they are also a source for programme materials. While most interventions are delivered in secondary schools, they are increasingly targeted at younger children. The review emphasised the importance of a school’s ‘readiness’ to introduce preventative interventions which need to be supported across all aspects of school life. Involving young people in the design and delivery of programmes increases authenticity and this emerged as a key ingredient in achieving impact. Longer interventions delivered by appropriately trained staff appeared likely to be more effective. Teachers emerged as well placed to embed interventions in schools but they require training and support from those with specialist knowledge in domestic abuse. There was evidence that small groups of students who were at higher risk might have accounted for some results regarding effectiveness and that programme effectiveness may vary for certain subgroups. Increasingly, boys are being identified as a target for change. The study identified a need for interventions for disabled children and children and young people from black, Asian, minority ethnic and refugee groups and a particular lack of materials designed for lesbian, gay, bisexual and transgender young people.LimitationsVery little evidence was identified on costs and cost-effectiveness. Few studies showed an effect at the level of significance set for the review. Where it did exist, the effect size was small, except in respect of improved knowledge. The inability to calculate a response rate for the mapping survey, which used a snowballing approach, limits the ability to generalise from it.ConclusionsWhile it is appropriate to continue to deliver interventions to whole populations of children and young people, effectiveness appeared to be influenced by high-risk children and young people, who should be directed to additional support. Programmes also need to make provision to manage any resulting disclosures. Interventions appear to be context specific, and so those already being widely delivered in the UK and which are likely to be acceptable should be robustly tested.FundingThe National Institute for Health Research Public Health Research programme.

BackgroundMany young people at high risk for Chlamydia trachomatis (Ct) are not reached by current sexual health care systems, such as general practitioners and public sexual health care centres (sexually transmitted infection clinics).Ct is the most frequently diagnosed bacterial sexually transmitted infection (STI) among sexually active people and in particular young heterosexuals. Innovative screening strategies are needed to interrupt the transmission of Ct among young people and connect the hidden cases to care.MethodsIntervention Mapping (IM), a systematic approach to develop theory- and evidence-based interventions, was used to develop a strategy to target Ct testing towards young people who are currently hidden to care in The Netherlands. Both clinical users (i.e. sexual health care nurses) and public users (i.e., young people at risk for Ct) were closely involved in the IM process. A needs assessment study was carried out using semi-structured interviews among users (N = 21), a literature search and by taking lessons learned from existing screening programmes. Theoretical methods and practical applications to reach high risk young people and influence testing were selected and translated into specific programme components.ResultsThe IM approach resulted in the development of a secure and web-based outreach Ct screening strategy, named SafeFriend. It is developed to target groups of high-risk young people who are currently hidden to care. Key methods include web-based Respondent Driven Sampling, starting from young Ct positive sexual health care centre clients, to reach and motivate peers (i.e., sex partners and friends) to get tested for Ct. Testing and the motivation of peers were proposed as the desired behavioural outcomes and the Precaution Adoption Process Model was chosen as theoretical framework. End users, i.e., young people and sexual health care nurses were interviewed and included in the development process to increase the success of implementation.ConclusionsIM proved useful to develop an intervention for targeted Ct testing among young people. We believe this to be the first web-based outreach screening strategy which combines chain referral sampling with the delivery of targeted Ct testing to high risk young people within their sexual and social networks.

BackgroundSexually transmissible infections (STIs) continue to rise in people aged 15–29 in New South Wales (NSW), Australia (≥30,000 chlamydia (CT) notifications annually). However, STI testing rates are low and stigma...

International research on homeless adolescents has found that incidence and prevalence of sexually transmissible infections is relatively high. This study reports on a chlamydia prevalence survey conducted among high-risk young people (14-25 years) in New South Wales. The participants were recruited from youth health centres, which target homeless and high-risk youth. Of 333 clients (42.6% male), 84.1% were sexually active and mean number of sexual partners over the preceding 3 months was 1.4. Among sexually active participants, 24.6% claimed to use condoms always and 25% never. Sixteen of 274 available urine samples tested positive for Chlamydia trachomatis infection. Further research is warranted to better define high-risk groups and clarify the nature of associations between various factors impacting on sexual health. Most importantly, research is now called for into effective strategies for engaging and attracting young people to screening, treatment and contact tracing.

BackgroundMonitoring of inhaler use in high-risk children has the potential to reduce asthma attacks and asthma-related deaths. We, therefore, undertook the first UK primary care study to identify high-risk children and young people by searching primary care health records and provided the Hailie® smart inhaler to monitor their asthma medication usage. In this article, we present data from the nested qualitative study, conducted with key stakeholders.MethodsThis qualitative interview-based study explored a range of topics relating to the experiences of paediatric asthma care and management, including the use of the Hailie® smart inhaler, from the perspectives of the children, their parents/carers and healthcare professionals. Interview transcripts were generated and thematically analysed.ResultsSix parent–child dyads and one parent were interviewed, either online or face-to-face. Additionally, three healthcare professionals (1 Nurse, 1 Pharmacist and 1 Practice Manager) involved in paediatric asthma care and/or management were also interviewed. Two specific themes were identified: Firstly, app-based monitoring was generally viewed positively and was reassuring to parents. Children also appreciated learning about using their inhalers. Secondly, challenges with synching were identified and users had some practical suggestions for improvement. Healthcare professionals also observed that monitoring should not replace clinical support for self-management.ConclusionOur findings support the acceptability and usefulness of the Hailie® smart inhaler amongst children with high-risk asthma, although some technical difficulties need to be addressed. Further research is needed to assess effectiveness in clinical care management.

PROTOCOL: Cognitive‐Behavioural Therapies for Young People in Outpatient Treatment for Non‐Opioid Drug Use

BackgroundDespite the availability of regular STI care by STI clinics and general practitioners many young people at high risk for Chlamydia trachomatis are hidden to care. Members of the social...

To describe the prevalence of nicotine dependence and acceptance of nicotine replacement therapy (NRT) in young people entering custody, where smoking is not allowed. Cross-sectional study in 2013. All New South Wales Juvenile Justice Centres. Incarcerated youth, aged 12-21 years. gender, age, ethnicity, cannabis use. rates of smoking, cannabis use, nicotine dependence, NRT acceptance. Data were collected from 252 Initial Reception Assessments (90.1% male, 56.3% Aboriginal, mean age 16.6 years ± 1.2 standard deviation). According to Fagerstrom screening, 207 (82.1%) young people smoked cigarettes immediately prior to their current incarceration, and of the smokers, 78 (38.4%) were nicotine dependent. Most young people (76.4%) were also daily cannabis users, with 85.6% of cigarette smokers also using cannabis daily. NRT (as 24-h nicotine patches prescribed for 2 weeks) was offered to 54 nicotine dependent and 7 non-dependent young people. Only 13 (21.3%) young people accepted NRT (all daily cannabis-using males), and only 2 young people completed the full prescription. Reasons for refusing or not completing NRT were a fear of 'weird dreams', sleeping issues or that it was no longer needed. Many young people entering custody are nicotine-dependent cigarette smokers and daily cannabis users, and are at high risk of nicotine withdrawal on abstinence. NRT as patch therapy has poor acceptance in this group, except in young men who are daily cannabis users. Screening for nicotine dependence in high-risk young people should include questions about cannabis use, and alternatives to patch therapy deserve further research.

The impossible dream: can psychiatry prevent psychosis?

Forensic child and adolescent mental health services (FCAMHS) became a service within the Tavistock and Portman NHS Foundation Trust in 2018, and since then has become a multidisciplinary expansion of the Portman Clinic’s consultation and assessment work. FCAMHS provides specialised consultation, assessment and brief interventions to professionals, families, and young people across 13 boroughs in Central, North, and East London. As a service provider we aim to support third sector service users who are working directly with some of the most vulnerable, at risk, and risky young people in our area. Through an existing contact in a local youth organisation we began to discuss the idea of creating a space where professionals could come together as a group to reflect on experiences and identify areas of difficulty in their work. Reflective practice groups offered by the Portman Clinic are often psychoanalytically-informed consultation groups which offer a way of working with professionals and young people by reflecting on the meaning, communication and experience of the young person’s behaviour, and our own responses to this. Therefore, we decided to offer a reflective practice group to third sector professionals known to FCAMHS from local youth services and other local agencies, who work with some of the most vulnerable, challenging and high risk young people in this location of London. This reflective practice group has now been running for almost two years and provides a valuable space for youth workers to process and make sense of their work with this challenging forensic population.

Age-related differences in glycaemic control in diabetes

PROTOCOL: Multidimensional Family Therapy (MDFT) for young people in treatment for non‐opioid drug use

The Resilience Complex

The mental health of adolescents and young adults is an issue of concern worldwide due to the increase in violent incidents that have been perpetrated by members of this age group. Young people at high-risk of mental disability are easily ignored. Therefore, social tensions in society have increased due to safety issues arising from the problems that are associated with mental disabilities in this population. This paper discusses the importance of early identification and early prevention of mental disabilities in high-risk young people, defines high-risk mental illness, and identifies the various subcategories of mental diseases. Based on our review of the literature, the present paper suggests targeting young people in high-risk categories with health promotion that addresses the following six health-promotion lifestyle habits: engaging in regular exercise, eating a balanced diet, managing stress, engaging in social relationships, taking responsibility for personal health, and fulfilling self-actualization. This discursive analysis discusses these strategies as safe and sustained interventions for adolescents and young adults that may improve self-awareness and thus maintain health and enhance opportunities to promote an ideal health status.

The High-Risk Young People's Program: A summing up