Behavioral Program Research Articles

How Individuals with Mental Health Challenges Coped During the COVID-19 Pandemic.

There is growing awareness of the significant mental health impacts of the COVID-19 pandemic on many Americans. Less is known about the effects on individuals who were living with mental health conditions prior to the pandemic's onset. In addition, little research has explored how this group is coping positively with the challenges of COVID-19. Understanding the strengths these individuals bring to pandemic demands and disruptions can inform recovery for these individuals in the aftermath of this public health emergency. Using results from a cross-sectional, online survey administered during April and May 2020, we use qualitative methods to examine how individuals with symptoms of depression and anxiety were coping with COVID-19. Participants were recruited from two networks of statewide behavioral health community programs in New Jersey and New York. Data come from 48 participants who reported current symptoms of anxiety assessed by the Generalized Anxiety Disorder-2 Scale and/or depression assessed by the Patient Health Questionnaire-2. These respondents demonstrated resilience in navigating disruptions brought on by COVID-19 and reported a range of healthy coping strategies. We identified three themes characterizing successful coping strategies, including utilizing social support systems, practicing self-care, and adjusting one's mindset to deal with challenging experiences. When designing programs, policies, and clinical approaches to support people with mental health conditions, it is essential to focus on strengths. The coping strategies shared by the individuals in this study demonstrate and build on their resilience. More research is needed to discover the strengths people exhibit to deal with the challenges caused by the COVID-19 pandemic.

Examining the Law Guiding Prostitution in Uganda from the Lens of Kabalagala Parish-Makindye Division

This study examines the law guiding prostitution in Uganda. The study revealed that the increasing incidents of prostitution are clear evidence that the enforcement of laws against prostitution in Uganda is ineffective as it is like containing smoke while leaving the fire burning underneath. Based on these findings, the study calls for the authorities to engage social sciences experts to find out the real causes of prostitution and their probable solutions because ‘customers’ include married people. Without this, prostitution will be here to stay despite its being against the law and morals. More so, a combination of programmes that expand income-generating opportunities needs to be developed both in the short and long term. Furthermore, prostitutes should be called upon through their advocating organization placed in vocational training courses, and given parallel forms of support for involvement in entrepreneurial activities. Similarly, continuous training needs analysis should be undertaken for prostitutes to determine appropriate skills to be imparted for productive work. Finally, behavioral change programmes should be continued to discourage and eliminate risky behaviors in the communities, in the form of live drama performances, audio and visual materials, and recreation activities targeting both community members and prostitutes. Keywords: Anti-prostitution laws, Poverty, Prostitution, Sexual exploitation, Unemployment, Victimhood

Rehabilitation interventions for neuropathic pain: a systematic review and meta-analysis of randomized controlled trials.

Rehabilitation interventions for chronic pain typically include education, cognitive behavioural therapy, and exercise therapy, or a combination of these. A systematic review and meta-analysis of rehabilitation interventions for neuropathic pain was conducted. Randomized controlled trials were identified in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and PsycINFO databases from inception up to 3 March 2022. Adults with chronic (> 3 months) neuropathic pain. Primary outcomes were pain intensity, pain-related disability, and work participation. Secondary outcomes were quality of life, emotional strain, insomnia, and adverse outcomes, according to VAPAIN guidelines. Analyses were made post-intervention, which was defined as the assessment point immediately following the intervention or at the first-time measurement conducted after the intervention period. In total, 15 studies (total population, n = 764) were incorporated. Most common interventions were cognitive behavioural programmes including acceptance and commitment therapy (n = 4), mindfulness-based interventions (n = 5), and yoga (n = 2). Psychological interventions reduced both pain intensity (SMD -0.49, 95% CI -0.88 to -0.10) and pain-related disability (SMD -0.51, 95% CI -0.98 to -0.03), whereas other interventions had an effect on pain intensity but not on pain-related disability. Rehabilitation interventions, and psychological interventions in particular, seem to be of value for patients with chronic neuropathic pain.

Identifying Under- And Overutilization Patterns For Idaho Youth With Serious Emotional Disturbance.

Children and adolescents with serious emotional disturbance represent 7-12percent of all youth in the United States. In 2017, the State of Idaho implemented the Youth Empowerment Service program, which allows youth with serious emotional disturbance who are younger than age eighteen living in households with income up to 300percent of the federal poverty level to qualify for Medicaid and receive intensive, community-based treatment. A uniquely detailed method was used to assess the need for services: the Child and Adolescent Needs and Strengths tool, a ninety-seven-indicator instrument administered by a clinician. We used these indicators and Idaho's 2018-22 administrative Medicaid claims data to study the association between children and adolescents' clinical needs complexity and their actual Medicaid behavioral and mental health service use. Our findings show that there was a substantial proportion of youth who were underusing Medicaid behavioral and mental health care services, and there were virtually no overusers. Our findings have implications for the appropriateness of Medicaid utilization management in behavioral health care and program efforts to maintain families with youth having serious emotional disturbance in the Youth Empowerment Service program.

A description of the development of an innovative multi-component long COVID treatment program based on central sensitization with preliminary patient satisfaction data

ObjectiveEstimates of the prevalence of Long COVID in the United States or worldwide are imprecise, but millions of people are thought to be affected. No effective treatment exists for the often devastating symptoms of Long COVID. Central Sensitization has been postulated as a causal/explanatory mechanism for developing Long COVID. No treatment to date has targeted Central Sensitization. The present cross-sectional study describes the first 140 patients treated in a multi-component treatment program that targets Central Sensitization to reduce symptom burden, improve functioning, and lower the psychological distress observed in these patients. Methods140 patients diagnosed with Long COVID after an extensive medical evaluation were assessed for function, depression, and pain catastrophizing using questionnaires and patient satisfaction measures after completion of a 16-h Cognitive Behavioral Therapy treatment program focused on Central Sensitization. ResultsUpon admission, patients diagnosed with Long COVID were significantly impaired in their ability to function due to their symptoms. Further, 70% of the patients were depressed. Pain catastrophizing was observed in up to 20% of patients. ConclusionPatient satisfaction measures were high for the sample at the end of the treatment program suggesting that a multicomponent treatment program targeting Central Sensitization is acceptable to patients. Further research is needed to explore the effectiveness and durability of this treatment approach.

Impact of a Brief Parenting Intervention on Parent and Infant Imitation

Research examining the effect of behavioral parenting interventions, such as parent–child interaction therapy (PCIT), on parent and child imitation is limited despite known benefits to early child development. We examined the effect of a brief, home-based adaptation of PCIT, the Infant Behavior Program (IBP), on changes in observed frequency of parent and infant imitation, moderating effects of parent language (English, Spanish), and mediational effects of parent and infant imitation on the effect of intervention on infant behavior problems. Participants were 60 12- to 15-month-olds with elevated behavior problems and their primary caregiver, all of which were mothers. Parent–infant dyads were randomly assigned to receive either the IBP or standard pediatric primary care. Parents receiving the IBP demonstrated significantly higher rates of observed imitation at postintervention and at the 3-month follow-up compared to those receiving standard care, and the effect at postintervention was stronger for English-speaking than for Spanish-speaking families. Although the IBP did not directly affect changes in infant imitation at postintervention or the 3-month follow-up, rates of infant imitation increased significantly for those who received the IBP at the 6-month follow-up. Additionally, moderation results suggested that the IBP led to improvements in infant imitation at post for Spanish-speaking families but not for English-speaking families. There were no significant mediational effects of parent or infant imitation. Future research is needed to examine the impact of increases in imitation on other aspects of child development, such as social–cognitive and language abilities, and to examine how cultural factors may play a role in individual differences in imitation.

Expanding the Behavioral Health Workforce: Pediatric Psychologists Training Master’s Level Students in Integrated Healthcare

ABSTRACT As mental and behavioral health needs continue to rise, additional providers are needed to expand the behavioral health workforce. Integrated behavioral health services result in increased access, reduced stigma, and improved quality of patient care. Psychologists are in a unique position to provide training to future mental health professionals in integrated settings, across multiple levels of training, and particularly to future master’s level providers, which make up the majority of the mental health workforce. The U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) Behavioral Health Workplace Education and Training (BHWET) Program aims to increase the behavioral health workforce in order to improve access to services. A priority is placed on care for children, adolescents, and transitional aged youth who are at risk for behavioral health disorders and highlights team-based approaches to care in integrated settings. An overview is provided of a HRSA BHWET funded training program implemented with master’s level students. Students completed clinical field placements in one of several integrated care settings and were provided specialized training in the areas of evidence-based treatments, integrated healthcare, and quality improvement. The overarching purpose of the Integrated Behavioral Services Training and Education Program (I-STEP) was to improve access to behavioral health services for underserved children and their families by expanding the behavioral health workforce. This was achieved through training master’s level counseling students to provide evidence-based services in integrated healthcare settings. I-STEP program goals, challenges, outcomes, and lessons learned are presented.

Treatment of chronic non-specific (musculoskeletal) back pain

Treatment of patients with chronic non-specific back pain (CNBP) is an important issue not only in medicine, but also in modern society as a whole, as it is associated with significant socio-economic burden.The lecture presents the most common anatomical sources of CNBP, the causes of CNBP and issues of differential diagnosis. Much attention is paid to the basic principles of therapy for CNBP: drug therapy, kinesiotherapy and psychological methods. Clinical observations are presented that demonstrate the effectiveness of a multimodal integrated approach to the treatment of CNBP based on the use of cognitive behavioral therapy, educational programs and kinesiotherapy and self-monitoring test tasks.

Understanding the selection of support partners in a behavioral weight loss program

Objective Engaging a support partner during behavioral weight loss (BWL) programs can improve outcomes. However, little information is available about those selected as support partners. The study aimed to (1) characterize support partners and qualities of the relationship, (2) assess differences in relationship dynamics across relationship types, and (3) assess differences in supportive relationships by participant gender. Methods and Measures Upon entering a 24-month BWL program, participants (N = 323) nominated a support person from their existing social networks. Participants completed self-report measures at baseline, including the Working Alliance Inventory and study-specific measures assessing characteristics of the support person and comfort in communicating with them. Results Spouse/partners were chosen by 43.3% of all participants. Among married participants, 80.9% of men and 53.8% of women chose their spouse/partner. Working alliance was lower when the support partner was a spouse/partner versus a friend (p < 0.05, r = −0.19). Comfort talking about exercise with a support partner was higher than talking about eating or weight (p < 0.001, η2 p = 0.05). Conclusion A variety of friends and family can be selected as support partners during BWL. Programs should attend to the unique needs of men versus women when identifying sources of support.

Predictors of parent self-monitoring patterns in a family-based behavioral weight loss treatment program.

Self-monitoring dietary intake is a critical component of family-based intensive health behavior and lifestyle treatment for pediatric obesity, but adherence rates are often low. This study identifies predictors of parent self-monitoring rates during treatment. A secondary analysis of parent self-monitoring data from a randomized controlled trial involving 150 parent-child dyads. Patterns of self-monitoring were identified using a latent class mixed model approach. Logistic regression analyses evaluated predictors of self-monitoring patterns. Latent class models identified two trajectory groups: a high consistent self-monitoring group and a low-decreasing self-monitoring group. When compared to parents in the low group, parents in the high group lost more weight throughout treatment. Children in the high group had a similar trajectory for weight loss; however, the groups were not statistically different. Higher levels of family chaos and poorer family problem-solving skills were associated with higher odds of being in the low group. This study identified two patterns of rates of parent self-monitoring, which were associated with parent weight loss and were differentiated by family chaos and poor problem-solving. These findings suggest that families with high levels of chaos and poor problem-solving could benefit from early intervention to improve outcomes in pediatric obesity treatment programs. Clinicaltrials.gov Identifier: NCT01197443.

Optimising a digitally delivered behavioural weight loss programme: study protocol for a factorial cluster randomised controlled trial

BackgroundDigitally delivered weight loss programmes can provide a convenient, potentially cheaper, and scalable treatment option for people who may need to lose weight. However, outcomes are often inferior to in-person interventions in the long-term. This trial will use principles from the Multiphase Optimisation Strategy (MOST) framework to test whether it can enhance the effectiveness of a commercial digital behavioural weight loss programme. This trial aims to identify an optimised combination of four intervention components to enhance weight loss over a 24-week period. We will also explore which components contribute to improvements in participant retention and engagement with the programme.MethodsApproximately 1400 adults with a BMI > 21 kg/m2 will be enrolled and randomised to one of 16 experimental conditions in a 24 factorial cluster design. The trial will test four intervention components: an introductory video call with the health coach, drop-in webchat sessions with the health coach, goal setting statements, and food diary review and feedback. All participants will receive the core digital behavioural weight loss programme and up to four new intervention components. Participation in the trial will last for 24 weeks. The primary outcome will be weight change at 16 weeks. Other outcomes, measured at 4, 16, and 24 weeks, include programme drop-out and engagement (number of interactions with the three main app functions). Fidelity and acceptability will be assessed using data on component adherence and self-report questionnaires. Decision-making for the enhanced programme will be based on components that contribute to at least a minimal improvement in weight loss, defined as ≥ 0.75kg, alone or in combination with other components.DiscussionThe factorial design is an efficient way to test the efficacy of behavioural components alone, or in combination, to improve the effectiveness of digital weight loss programmes. This trial will test the implementation of the MOST framework in an industry setting, using routinely collected data, which may provide a better way to refine and evaluate these types of interventions in a model of continuous service improvement.Trial registrationTrial registration: ISRCTN, ISRCTN14407868. Registered 5 January 2024, 10.1186/ISRCTN14407868.

An Observational Study of a Digital Substance Use and Recovery Program.

Digital substance use treatment programs present an opportunity to provide nonresidential care for people with problematic substance use. In June 2021, the provincial government in Ontario provided free access to Breaking Free Online (BFO), a digital behavioral change program for people with substance use disorders. An observational study was conducted with retrospective data to characterize clients' use and engagement patterns in BFO and examine changes in self-reported outcomes. In total, 6,370 individuals registered for BFO between June 2021 and October 2022, of whom 3,650 completed the intake assessment. Most of these clients were self-referred (64%), with 37% having been referred by health service providers. More than one-half of the clients (52%) resided in Ontario West or East regions. Support for addressing problematic alcohol use was the most requested program (40%). By October 2022, about 44% of the clients had completed between one and four of 12 program strategies. Analysis revealed significant changes in pre-post scores across four validated scales (p<0.001), indicating a decrease in anxiety and depression, an increase in quality of life, an improvement in recovery progression, and a decrease in severity of symptoms associated with substance use disorders. BFO clients with higher completion rates had the most improvement across the scales used; however, clients with lower and medium completion rates also had improvements. Because of the shame and stigma associated with substance use, digital supports with low barriers to entry can help support the autonomy, privacy, and preferences of individuals seeking help for problematic substance use.

Integrating the Sufficiency Economy Royal Philosophy and Participatory Action Research Approach to Promote Self-Care for Stroke Prevention in Selected Communities of Southern Thailand.

(1) Introduction: Effective control of stroke risk factors can reduce stroke incidence. Motivation for participatory action of community dwellers to practice self-care to modify stroke risk after providing them with knowledge of stroke risk factors is considered useful under a situation of limited healthcare resources. This study aimed to evaluate the outcomes of integrating the sufficiency economy philosophy (SEP), a royal economic philosophy in Thailand, and the participatory action research (PAR) approach on stroke risk factors control among selected communities. (2) Methods: Villagers who had medium to high stroke risk from two provinces with leading stroke incidences in southern Thailand were invited to participate in an eight-month SEP-PAR program conducted in 2019. Group meetings among the study participants, local healthcare providers, the researchers, and relevant stakeholders in the communities were held to co-design a health behaviors program targeting lower waist circumference (WC), body weight (BW), blood pressure (BP), fasting blood sugar, blood lipids, and smoking and alcohol consumption rates. Follow-up physical measurements and blood tests were compared with the baseline results for significant differences by descriptive statistics (p < 0.05) using the R program. (3) Results: Of 126 participants, 75.4% were female. Moderate and high stroke risk levels were found in 58.2% and 19.8%, respectively. Elevated baseline WC, BW, BP, and blood test results were found in 50-80% of the participants. The co-designed health behaviors in this study were dietary control, regular exercise, relieving psychological stress, and stopping smoking and alcohol consumption. Overall, the participants had significant adherence to the co-designed health behaviors. At the end of the program, the follow-up tests showed significant reductions in BW, BP, fasting blood sugar, and lipids, but not in WC. (4) Conclusions: A combined SEP and PAR approach was effective for stroke risk factors control among the community dwellers. Motivation for self-care is a significant strategic outcome expected of this approach. Longer follow-up studies in larger populations are needed.

An Enhancement of Career Adaptability Through Positive Cognitive Behavioral Training Program

An Enhancement of Career Adaptability Through Positive Cognitive Behavioral Training Program

Correction: Wiriyasirikul et al. The Effectiveness of Promoting a Vegetable and Fruit Consumption Behavior Program among Preschool Children in Nakhon Si Thammarat Province, Thailand. Sustainability 2023, 15, 14350

The authors would like to make the following corrections about the published paper [...]

Pepea Pamoja:† Applying the Ecological Validity Framework to co-develop a wellbeing and behavioural training program for caregivers of young children with autism in low-resource settings of Kenya and the United States.

Autism is a complex neurodevelopmental disability with global prevalence of one in 100 individuals. Poor access to interventions in both under-resourced regions of high-income countries and low- and middle-income countries has deleterious effects on the health and wellbeing of individuals with autism and their families. Our objective was to utilize a reciprocal innovation framework and participatory methods to adapt and co-develop a culturally grounded group-based wellbeing and naturalistic developmental behavioural intervention (NDBI) training program for caregivers of young children with autism to be implemented in Kenya and rural Indiana. This study was conducted within the Academic Model Providing Access to Healthcare (AMPATH) program. An evidence-informed Naturalistic Developmental Behavioral Intervention (NDBI) previously utilized in Indiana was adapted and iteratively refined using the Ecological Validity Framework (EVF) by a team of US and Kenyan disability experts. Key adaptations to the program were made across the EVF domains of language, persons, metaphors/content, concepts, goals, methods, and context. Substantial cultural adaptations were made to the NDBI following the EVF model, including the addition of traditional Kenyan cultural practices, use of narrative principles, and focus on daily routines over play. Pepea, the adapted program, involves 10 group sessions covering content in basic education on autism, positive caregiver coping strategies, and behavioural skills training to promote child communication and reduce challenging behaviour. Key adaptations for Pepea were integrated back into a US NDBI caregiver training program. This study fills a critical gap by detailing the adaptation process of a caregiver wellbeing and naturalistic developmental behavioural training program for caregivers of children with autism in low-resource settings. Our next steps are to report on mixed-methods outcomes from pilot implementation. Our long-term goal is to apply these insights to advance sustainable and scalable autism intervention services across the globe.

The effectiveness and efficacy of driving interventions with ADHD: a Dutch perspective

The diagnosis of attention deficit hyperactivity disorder (ADHD) has been identified as a factor associated with an increased risk of involvement in car crashes. As a result, individuals in the Netherlands who are diagnosed with ADHD are mandated to undergo a psychiatric evaluation before obtaining their driving licence, optionally complemented with a driving test. Recent research has, however, demonstrated that 96% of individuals pass this procedure and can drive unrestrictedly, suggesting that current regulations have a limited impact and that a different regulatory approach may be warranted. This paper addresses three such potential interventions, exploring the scientific basis of implementing mandatory behavioural training programmes, the mandatory installation of driver monitoring systems, and temporary driving restrictions. To initiate this exploration, an analysis is made of the body of literature pointing towards a subpar driving performance in those with ADHD, accompanied by a discussion of the underlying symptoms and behaviours contributing to these findings. Furthermore, between- and within-individual factors affecting ADHD driving performance are reviewed. This examination illuminates a consistent pattern of substandard driving performances among those with ADHD, whereby the period shortly post-licensure stands out as a focal point for regulatory approaches. Following these results, the three potential driving interventions are reviewed to discern their impact on road safety when implemented specifically for drivers with ADHD. Corresponding studies suggest that all these interventions hold promise in improving driving performances, but the analysis is limited by the scarcity of long-term, ADHD-specific research. The paper concludes by discussing the feasibility of these ADHD-specific driving interventions, weighing their potential benefits, e.g., reduced crash rates, along with their associated costs, such as potential stigma and hindrance in societal integration and participation. Additionally, avenues for future research in these domains are outlined.

Evidence Register Green List Prevention: Analysis of the listed effectiveness-tested programmes

In the areas of prevention and health promotion, there is a large number of measures for children and adolescents. One way of facilitating evidence-based action for those involved in these taks is by making available online evidence registers with customised, effectiveness-tested measures. The Green List Prevention is such a register and offers an overview of evidence-based programmes in Germany, currently with a focus on psychosocial health. The aims of this study were (a) to analyse the characteristics of the available and evaluated programmes on the psychosocial health of children and adolescents, (b) to identify priorities and underrepresented areas of the Green List Prevention and (c) to optimise the search functions of the register. The characteristic features were recorded on the basis of the existing upper categories of the register entries which were differentiated into subcategories in an inductive procedure by at least two persons. In addition, deductive categories were added for relevant aspects concerning content and implementation. The upper and lower categories formed were operationalized with characteristic values. All entries were analyzed by using a data sheet and were descriptively evaluated. The 102 programmes listed (as of 2/2024) addressed not only the primary target group of children and youth, but also secondary target groups (mainly teachers and guardians). Social and life skills programmes as well as trainings for guardians represented a focus. Behavioral prevention programmes on the topics of violence (including bullying) (63.7%), addiction (46.1%) and/or mental health (35.3%) were frequently represented, whereas nutrition and/or physical activity (4.9%) were hardly represented. Most of the programmes (88.2%) could be assigned to the eligibility criteria of the statutory health insurers (§20a SGB V). Potentials digital implementation forms and further implementation aspects were identified. The Green List Prevention bundles a large number of different measures and that there is potential for expansion. Processing knowledge about effective measures in a user-friendly manner can be optimised through expanded search functions, so that resource-conserving, evidence-based action can be facilitated.

A Menu of Integrated Behavioral Health Options

Integrated behavioral health programs require a different approach to healthcare delivery. This includes changes in coding and billing, clinical skill sets, medical record documentation, and team-based approaches to patient healthcare. There is a gap in mental health training in the philosophy of integrated care, population health concepts, medical home model, and the Triple Aim. Explicit respecialization training is required for most mental healthcare professionals. Choosing a model of integrated mental health is essential, with five formal models to consider. These models have clear, uniform training standards and increased likelihood of finding the right behavioral health providers for the program. All models can use clinical outcome instruments to gauge patient progress.

Which components of behavioral weight management programs are essential for weight loss in people living with obesity? A rapid review of systematic reviews.

The optimal treatment and organization of care for people with obesity is one of the greatest challenges facing today's health services. While surgery and pharmacotherapy offer effective treatment options for some people with obesity, behavioral interventions are important to support long-term behavioral change. However, little is known about the most effective components of behavioral interventions, and this is especially the case for people with complex or severe obesity (i.e. body mass index [BMI] > 35 kg/m2). Accordingly, the current rapid review aimed to identify which behavior change techniques (BCTs) are effective for weight loss in adults with (severe) obesity. A secondary aim was to review the effects of BCTs on dietary behaviors and physical activity, and psychological outcomes, recognizing that behavioral interventions commonly target these. A search of Scopus, Ovid Medline, and Web of Science resulted in 1227 results, with 22 reviews eligible for inclusion. The most commonly reported BCTs were self-monitoring and goal setting, but these had variable effects on weight in adults with obesity. Combining these BCTs with other self-regulatory techniques led to increased weight loss. Further, for adults with severe obesity, so-called 'nudge' techniques and self-regulatory techniques were associated with greater weight loss. Three reviews also found that while self-monitoring increased physical activity, behavioral commitments increased changes to dietary behaviors. BCTs were not associated with psychological well-being. The review confirms that behavioral interventions have an impact in weight management, including for individuals with more complex or severe obesity, but highlights the need for further investigation of their use within clinical settings.