Delivery Of Therapeutic Interventions Research Articles

Outcomes of Providing Children Aged 7-12 Years With Access to Evidence-Based Anxiety Treatment Via a Standalone Digital Intervention Using Immersive Gaming Technology: Real-World Evaluation.

Anxiety disorders are among the most common mental health conditions in childhood, but most children with anxiety disorders do not access evidence-based interventions. The delivery of therapeutic interventions via digital technologies has been proposed to significantly increase timely access to evidence-based treatment. Lumi Nova (BfB Labs Limited) is a digital therapeutic intervention designed to deliver evidence-based anxiety treatment for those aged 7-12 years through a mobile app incorporating immersive gaming technology. We aimed to evaluate the real-world impact of providing access to Lumi Nova through UK National Health Service-funded mental health services. We analyzed precollected anonymized data routinely captured through the implementation of Lumi Nova from children aged 7-12 years, who lived in the United Kingdom and had the opportunity to use the intervention for at least 1 week over an 18-month period. Engagement indices included whether the game key was activated, number of unique sessions, time spent engaging, and number of "challenges" completed. Clinical outcomes were assessed using the Goal-Based Outcomes measure and Child Outcome Rating Scale. Demographic data were analyzed to assess the health equality implications of Lumi Nova. Of 1029 eligible families invited to use Lumi Nova, 644 (62.5%) activated their game key, of whom 374 (58.1%) completed at least one in-game graded exposure challenge. The median number of unique sessions was 6 (IQR 3-12) and the median time spent engaging with the intervention was 42 (IQR 15-79) minutes. For the subset of young people with paired outcomes, there were statistically significant small to medium improvements in goal-based outcome scores (n=224; t223=5.78, P<.001; d=0.37, 95% CI 0.25-0.52) and Child Outcome Rating Scale scores (n=123; t122=5.10, P<.001; d=0.46, 95% CI 0.27-0.65) between the first and last data points. Two in 5 young people's scores reflected a change that would be considered reliable. Analysis of demographic characteristics tentatively suggested that children from ethnic minority backgrounds and those living in the most deprived neighbourhoods may be less likely to access Lumi Nova, but children from socioeconomically deprived areas were more likely to successfully complete a challenge once they accessed the intervention (P=.02). However, the level of missing data and small number of children in some demographic groups limited meaningful statistical comparisons. This study provides initial evidence that Lumi Nova may be associated with improved outcomes for those aged 7-12 years seeking anxiety treatment in real-world settings. However, the lack of a control comparator group and information about concurrent treatments accessed by the young people, in addition to substantial attrition, limited the analysis that could be conducted and confidence in the conclusions drawn.

Using a workbook to support cognitive behavioural therapy with young people: a survey of psychological practitioners

Abstract Practitioners have mixed views about the value of cognitive behavioural therapy (CBT) manuals, with some preferring to work based on professional judgement. The workbook represents a compromise, providing guidance and resources without prescribing standardised procedures. Workbooks have not previously been widely addressed in the CBT literature. This exploratory study analysed how practitioners use a CBT workbook (Think Good – Feel Good, TGFG) to support therapeutic work with young people (YP). Practitioners (n=238) completed an online survey about how TGFG is used and how it supports CBT. A convergent mixed-methods design was pursued. Qualitative and quantitative data were analysed using content analysis, descriptive statistics, and chi-squared tests before themes were defined to summarise the dataset. When deciding whether to use TGFG, practitioners consider a YP’s presenting difficulty, level of understanding, motivation, and availability of systemic support. Practitioners use TGFG inside and outside the therapeutic space to plan sessions, revise CBT concepts, and complete worksheets (particularly those with a cognitive focus). Practitioners use TGFG flexibly and pragmatically (combining it with other therapeutic approaches), and they adapt resources to suit a YP’s understanding and interests. TGFG appears to be a widely used resource for practitioners across the range of experience. Key learning aims (1) To expand upon the concept of the workbook as a therapeutic adjunct within the CBT literature. (2) To explore how a popular CBT workbook is useful to practitioners, how it is typically used, and the breadth of usage. (3) To consider whether and how workbooks are used flexibly by practitioners. (4) To encourage practitioners across the range of experience to reflect on how workbooks support planning and delivery of therapeutic interventions.

Early Imaging Associated With Improved Survival in Older Patients With Mild Traumatic Brain Injuries

BackgroundTraumatic brain injury (TBI) is a leading cause of trauma-related death and disability. Computed tomography (CT) imaging of the head is essential for diagnosis of intracranial hemorrhage. This study aimed to identify optimal time to imaging and its impact on mortality for older patients with mild TBIs. Materials and methodsState-wide quality collaborative data were used from level I-II trauma centers. Inclusion criteria were ICD-9/10 codes for head trauma, age ≥50, admission/emergency department Glasgow Coma Scale ≥14, injury severity score ≤20, nonfull trauma activation, and head CT imaging time between 5 and 90 min of arrival. Locally weighted scatterplot smoothing plot data were used to dichotomize patients into early and late head CT imaging cohorts. Multivariable logistic regression and negative binomial models were used to evaluate the effect of early verses late head CT on clinical outcomes. The primary outcome was in-hospital mortality. ResultsMortality nadired at 35 min. Each 1-min delay in CT imaging resulted in a 2% increase in mortality (P = 0.002). Early patients had significantly reduced in-hospital mortality (P = 0.03), shorter emergency department length of stay (P < 0.001), and were more likely to receive fresh frozen plasma within 4 h if anticoagulated (P = 0.03). Teaching, high-volume, and level 2 trauma centers were all less likely to provide early head CTs (all P < 0.05). ConclusionsDelay in head CT imaging in the setting of potential mild TBI was associated with an increase in mortality. A delay in diagnosis cascades into delays in delivery of therapeutic interventions. Head CT within 35 min should be evaluated as a quality metric for older patients with mild TBI.

A meta-analytic review of the emotional symptoms associated with mild traumatic brain injury

Given the prevalence of mild traumatic brain injury (mTBI) and enduring subjective complaints known as postconcussion symptoms (PCS), it is important to investigate the nature and extent of these difficulties. This study used meta-analytic techniques to integrate the available information on the emotional symptoms associated with mTBI. Small effect sizes were found across all domains (depression, anxiety, coping, and psychosocial disability); however, significance depended upon the weighting method employed. The results indicate that mTBI had a small to negligible effect on emotional symptom reporting. This has implications for the etiology of PCS, the delivery of therapeutic interventions, and medico-legal disputations.

Pediatric vitamin D and calcium nutrition in developing countries

Over one billion humans have insufficient circulating levels of vitamin D, and dietary insufficiency of calcium is common in developing countries. Worldwide, nutritional rickets is considered to be the most common non-communicable disease of children. Rickets can be due either to primary deficiencies of vitamin D or calcium or to combined deficiencies of both elements. Vitamin D deficiency is also increasingly linked to non-skeletal complications. Even without laboratory and radiologic resources, the diagnosis of rickets is considered clinically when a child presents with limb deformities and has beaded ribs and widened wrists and ankles. Prevention is possible through increased sun exposure and dietary enhancement. Treatment of nutritional rickets involves provision of adequate vitamin D and calcium. Further research is needed to elucidate the precise epidemiology of vitamin D and calcium deficiencies in developing countries, to determine the roles of additional pathologic factors contributing to the development and morbidity of rickets, to improve affordable and feasible means of diagnosing rickets in resource-limited areas, to better target at-risk populations for preventive interventions, to identify accurate dosing and delivery of therapeutic interventions, and to evaluate the long-term consequences of vitamin D and calcium deficiencies in childhood.

The construction and validation of a scale to assess psychological risk and well‐being in sex offender treatment providers

Purpose. Since 1991 over 1,400 Prison Service personnel have been trained in the delivery of therapeutic interventions with men convicted of sexual abuse. In that time anecdotal evidence of psychological difficulties experienced by treatment providers has emerged. However, empirical support for this evidence is sparse, and reflects a disproportionately low level of research into the impact on treatment providers of their work when compared with the efficacy of the treatment they deliver. One of the consistent shortcomings of the available research has been the lack of a valid and reliable psychometric assessment of the psychological well‐being of treatment providers, and this paper reports on the construction and validation of a scale designed to assess the personal and professional effects of working therapeutically with sex offenders.Method. A scenario technique was used to elicit items. Exploratory factor analysis of the responses of 182 active facilitators yielded a three‐factor scale comprising 61 items. The structure was replicated on an independent sample of 165 facilitators.Results. Negative reactivity to offenders (NRO) described generally adverse responses to offenders, ruminative vulnerability (RV) was characterized by emotional pre‐occupation with work and increasing sensitivity to emotional issues, and organizational dissatisfaction (OD) included items relating to lack of collegial and managerial support. Concurrent validation showed that the three factors were systematically related to a range of relevant variables.Conclusion. The new assessment of dynamic adaptation (ADA) scale should provide an invaluable tool for evaluating the effectiveness of SOTP training programmes.