Brief Behavioral Intervention Research Articles

Effectiveness of Clinic-Based Brief Behavioral Intervention (BBI) in Long-term Reduction of ADHD Symptoms Among Preschoolers.

Preschoolers commonly experience symptoms of ADHD and disruptive behavior problems. Behavioral parent management training (PMT) is an evidence-based intervention for addressing both ADHD and disruptive behaviors in this population; however, many PMT programs are burdensome in length and have limited data regarding long-term effectiveness for ADHD specific outcomes. This study examined outcomes up to 1year following completion of a brief behavioral intervention (M = 6.51 sessions) for preschoolers. Participants were children aged 2-6years with clinically significant disruptive behaviors and their parents. Results demonstrated significant improvements in parent-reported child hyperactivity and inattention from pre-to-post intervention, with sustained improvement at 6months and 1year post intervention. Teacher-reported hyperactivity and inattention also showed significant improvements from pre-to-post intervention, which were maintained across time points. These results were also found among a subset of participants with clinically significant ADHD symptoms at baseline. This study highlights the long-term effectiveness of a brief PMT program to address symptoms of ADHD and disruptive behaviors in preschoolers. Findings support the recommendation to offer PMT as a first-line intervention for preschoolers with ADHD symptoms to reduce the need for early intervention with stimulant medication and address comorbid disruptive behaviors.

Patient predictors of substance use disorder treatment initiation in primary care

IntroductionPrimary care clinics are opportune settings in which to deliver substance use disorder (SUD) treatment, but little is known about which patients initiate treatment in these settings. MethodsUsing secondary data from a RCT that aimed to integrate SUD treatment into a federally qualified health center (FQHC) using an organizational readiness and collaborative care (CC) intervention, we examined patient-level predictors of initiation of evidence-based practices for opioid and/or alcohol use disorders (OAUDs): a brief behavioral treatment (BT) based on motivational interviewing and cognitive behavioral therapy and medication-assisted treatment (MAT) (extended-release injectable naltrexone (XR-NTX) for patients with an alcohol use disorder or opioid use disorder and buprenorphine/naloxone (BUP/NX) for patients with an opioid use disorder). Using the Andersen model of health care access, we tested bivariate and multivariate logistic regression models to assess associations between patient factors and initiation of BT and MAT. ResultsTwenty-three percent of all participants (N = 392) received BT and 13% received MAT. In the multivariate model examining factors associated with initiation of BT, being of “other” or “multiple” races compared with being White (OR = 0.45, CI = 0.22, 0.92), being homeless (OR = 0.45, CI = 0.21, 0.97) and having been arrested within 90 days of baseline (OR = 0.21 CI = 0.63, 0.69) were associated with significantly lower odds of initiating BT. Greater self-stigma (OR = 1.60, CI = 1.06, 2.42), receiving MAT (OR = 5.52, CI = 2.34, 12.98), and having received the CC study intervention (OR = 12.95, CI = 5.91, 28.37) were associated with higher odds of initiating BT. In the multivariate model examining patient factors associated with initiating MAT, older age (OR = 1.07, CI = 1.03, 1.11), female gender (OR = 3.05, CI = 1.25, 7.46), having a diagnosis of heroin abuse or dependence (with or without alcohol abuse or dependence compared with have a diagnosis of alcohol dependence only (OR = 3.03, CI = 1.17, 7.86), and having received at least one session of BT (OR = 6.42, CI = 2.59, 15.94), were associated with higher odds of initiating MAT. ConclusionsIndividuals who initiate BT for OAUDs in a FQHC are less likely to be homeless and more likely to have greater self-stigma. Those who receive MAT are more likely to be of older age, female, and to have a diagnosis of heroin abuse or dependence, with or without concomitant alcohol abuse or dependence, rather than alcohol abuse or dependence alone. Receiving collaborative care (e.g., a warm handoff, and follow-up by a care coordinator) may be critical to initiating BT. Receiving at least one session of BT is associated with higher odds of receiving MAT, and receiving MAT is associated with higher odds of receiving BT. The Andersen model of health care access provides some insight into who initiates BT and MAT for OAUD treatment in FQHC-based primary care; further research is needed to explore system-level factors that may also influence treatment initiation.

The Brief Behavioral Intervention for Preschoolers With Disruptive Behaviors: A Clinical Program Guide for Clinicians

Abstract Introduction Disruptive behavior problems are the most common referral reason to behavioral health professionals among preschool-age children. Parent management training (PMT) is the prima...

Tobacco Cessation Training for Complementary and Alternative Medicine Practitioners: Results of a Practice-Based Trial.

Brief behavioral intervention (BI) is a tobacco-cessation best practice well established among conventional healthcare practitioners. Complementary and alternative medicine (CAM) practitioners treat significant numbers of tobacco users, but do not systematically receive BI training. The CAM Reach study developed and evaluated a tobacco cessation BI training program/practice system intervention adapted specifically for CAM practitioners, and evaluated in real-world CAM practices. Single-arm intervention. Data were collected in 2010-2014 and analyzed in 2015. Private practices of 30 chiropractors, 27 acupuncturists, 42 massage therapists (N=99), in metropolitan Tucson, Arizona. Eight-hour tobacco cessation BI continuing education workshop, in-office BI skills practice/assessment, and system intervention. Training tailored to the CAM practice setting addressed tobacco cessation best practices from the U.S. Public Health Service Guidelines. Seventeen items (assessing practitioner behavior, motivation, and self-efficacy with tobacco cessation) comprising three factors, Tobacco Cessation Activity, Tobacco Cessation Motivation, and Non-CAM Tobacco Cessation Comfort, were assessed at baseline and 3, 6, 9, and 12 months post-training by practitioner self-report. Research staff visited practices at approximately the same intervals to directly observe changes in clinical practice systems. At 3 months, there were significant increases in practitioners' tobacco cessation activities, motivation and confidence in helping patients quit tobacco, and comfort with providing information and referrals for guideline-based tobacco cessation aids (p<0.0001). Practitioners significantly increased rates of discussing cessation medications with patients (AOR=3.76, 95% CI=1.84, 7.68), and routinely asking about tobacco use in clinical practice (AOR=2.62, 95% CI=1.11, 6.20). Increases occurred across all three practitioner types and were sustained at 12 months-despite heterogeneity in professional training, practice patterns/organization, and practice business models. Results suggest CAM practitioners are willing and able to offer BIs, and are an important, yet overlooked channel for promoting tobacco cessation and use of evidence-based cessation aids.

Brief behavioral intervention for disruptive behavior in a child following frontal and temporal resection for medically intractable epilepsy: A case report.

Children with epilepsy are at an increased risk for psychopathology, especially disruptive behavior disorders (DBD). Rates of DBD are especially high in children with frontal seizure foci who undergo frontal lobe surgery. Despite evidence that family and parenting factors have been shown to predict psychopathology in childhood epilepsy, there have been no studies of parenting interventions targeting disruptive behavior in these children. In the present case report, we adapted a validated parent management training intervention, the Brief Behavioral Intervention (BBI), to treat DBD in a 7-year-old boy who had undergone frontotemporal resection for medically intractable epilepsy. The family participated in 12 BBI sessions over a period of 19 weeks. Both parent and teacher report indicated reduction of significant disruptive behaviors to the normal range, with treatment gains generally maintained 2 months following treatment. The present case report demonstrates that parent management training in general, and BBI specifically, can be effective for treating problem behaviors in children with severe neurologically based behavioral presentations.

Long-Term Relief of Poststroke Depression

Poststroke depression (PSD) is common, affects recovery, and increases mortality. Antidepressants are effective, but only in some patients. An effective nonpharmacological treatment for PSD would be useful. Researchers randomized 101 patients with depression within 4 months of an ischemic stroke (mean age, 57; 60% men) to receive a brief psychosocial–behavioral intervention (9 sessions for 8 weeks) or usual care. Primary care providers could prescribe antidepressants, which was …

Topiramate or Quetiapine for Alcohol Dependence

Alcohol dependence remains difficult to treat pharmacologically. Disulfiram requires regular compliance, and acamprosate and naltrexone have only small-to-medium effect sizes. Two research groups examined other pharmacologic agents added to brief behavioral interventions. In 2003, researchers conducting a randomized controlled trial established the efficacy of topiramate for alcohol dependence. Now, the same group has conducted a longer and larger (14 vs. 8 weeks; n=371 vs. 150), multisite, randomized, placebo-controlled, manufacturer-funded trial of topiramate. Topiramate (dose, ≤300 mg/day, titrated over 6 weeks [titration …