Early Intervention Model Research Articles

Об актуальности развития трансдисциплинарной модели организации работы специалистов службы ранней помощи

The team approach is one of the priorities in modern social practice and it is necessary for social practitioners to have professional and team-working competencies as well, and it is important for them to understanding the specifics of different approaches of team working organizing. For Russian social practitioners is important to know the essential specifics of different models of team work, their correct terminology definition and practical application. Based on the analysis of domestic and foreign sources, the article discusses the main models of multidisciplinary, interdisciplinary, trans-disciplinary team work of early intervention specialists; highlighted their essential characteristics, strengths and weaknesses. Interdisciplinary model of early intervention is the most common this time. The authors position is that the trans-disciplinary model of early intervention is the most promising and effective in family work. The needs, the barriers and the prospects of implementation of the trans-disciplinary model of early intervention family work in Perm region are analyses in this article.

School mental health program in India: Need to shift from a piecemeal approach to a long-term comprehensive approach with strong intersectoral coordination.

School mental health program (SMHP) has been recognized worldwide as key to improve the mental health and wellbeing of school going children. Unfortunately, in India, SMHP is badly neglected. There is no comprehensive SMHP that covers all school children (from rural and urban areas) across the country. A few sporadic activities that occur are praiseworthy; however, they lack a long-term approach. Major reasons for such neglect of SMHP in India could be lack of a steering body, poor intersectoral coordination, and minimal stakeholders' involvement. India, as any other country, needs to implement countrywide SMHP on the model of mental health promotion, prevention, and early intervention (PPEI). This paper outlines the deplorable state of SMHP in India and the needed steps to implement an effective countrywide SMHP on the PPEI model.

Early candidate urine biomarkers for detecting Alzheimer’s disease before amyloid‐plaque deposition in an APP (swe)/PSEN1dE9 transgenic mouse model for effective early intervention

AbstractBackgroundThe identification of candidate biomarkers before amyloid‐ plaque deposition occurs is therefore of great importance for the early intervention of AD. Urine, which is not regulated by homeostatic mechanisms, theoretically accumulates changes associated with AD earlier than cerebrospinal fluid and blood. In this study, an APP (swe)/PSEN1dE9 transgenic mouse model was used to identify candidate biomarkers for early AD.MethodUrine samples were collected from 4‐, 6‐, and 8‐month‐old transgenic mouse models, and the urinary proteomes were profiled using liquid chromatography coupled with tandem mass spectrometry (LC‐MS/MS). The pathways related to differential urinary proteins were analyzed. Early intervention was tested based on the pathway analysis.ResultThe levels of 29 proteins differed significantly between wild type and 4‐month‐old mice, which had not started to accumulate amyloid‐ plaques. Among these proteins, 13 have been associated with the mechanisms of AD, while 9 have been suggested as AD biomarkers. The result of intervention is promising. The details will be available before the meeting.ConclusionOur results indicated that urine proteins enable detection of AD before amyloid‐ plaque deposition, which may present an opportunity for effective intervention.

Early identification and intervention to prevent reading failure: A response to intervention (RTI) initiative

This article describes a Response to Intervention (RTI) model of early identification and intervention to prevent reading failure. A simple screening system to alert teachers to children who may not have some of the prerequisite skills necessary for reading and a whole class intervention system will be described. The success of these initiatives was measured systematically, and the incidence of reading difficulties was reduced to 1.5% in the children who had English as a first language and in children who had English as an additional language. The article also examines the relative influence of students’ first language on learning to read in English and the benefits of bilingualism.

Integrating the Early Start Denver Model into Israeli community autism spectrum disorder preschools: Effectiveness and treatment response predictors.

Early intensive intervention has been shown to significantly affect the development of children with autism spectrum disorder. However, the costly implementation of such interventions limits their wide dissemination in the community. This study examined an integration of the Early Start Denver Model into community preschool programs for children with autism spectrum disorder in Israel. Four community preschools implemented the preschool-based Early Start Denver Model and four implemented a multidisciplinary developmental intervention which is widely applied in Israeli community autism spectrum disorder preschools. Fifty-one children (aged 33–57 months) participated in the study. Twenty-six attended the preschool-based Early Start Denver Model preschools and twenty-five attended the multidisciplinary developmental intervention settings. Groups were comparable on age, developmental functioning, and socio-economic status. Compared to the multidisciplinary developmental intervention group, children in the preschool-based Early Start Denver Model treatment made greater gains on blinded measures of overall cognitive development, receptive and expressive language skills, as well as on parent- and teacher-reported adaptive communication and socialization abilities. In the preschool-based Early Start Denver Model group, children with lower symptom severity, higher adaptive functioning, and receptive language abilities at pre-treatment showed greater improvement. This study documents the successful integration of an Early Start Denver Model intervention into pre-existing community preschools, underlining the importance of disseminating evidence-based early intervention in community settings.Lay Early intensive intervention has been shown to significantly affect the development of children with Autism. However, the costly implementation of such interventions limits their wide dissemination in the community. This study examined an integration of a research-supported early intensive intervention model called the Early Start Denver Model into community preschool programs for children with Autism in Israel. Four community preschools implemented the preschool-based Early Start Denver Model and four implemented the existing multidisciplinary developmental intervention which is widely applied in Israeli community preschools for children with autism. Fifty-one children (aged 33–57 months) participated in the study. Twenty-six attended the preschool-based Early Start Denver Model preschools and twenty-five attended the multidisciplinary developmental intervention preschools. Before the intervention began, groups were comparable on children’s age and developmental functioning and on families’ socio-economic status. Results showed that, compared to the multidisciplinary developmental intervention group, children in the preschool-based Early Start Denver Model treatment group made greater gains on measures of overall cognitive development, language skills, as well as on parent- and teacher-reported adaptive communication and socialization abilities. Children who had lower autism symptom severity, higher adaptive functioning and better language understanding abilities before taking part in the preschool-based Early Start Denver Model program showed greater improvements following it. This study documents the successful implementation of an intensive early intervention program in pre-existing community preschools, underlining the importance of the integration of research-supported intervention programs into community settings.

فعالية برنامج قائم على استراتيجيات نموذج دينفر للتدخل المبکر في تنمية بعض المهارات الاستقلالية لدى الأطفال ذوي اضطراب التوحد

هدفت الدراسة الحالية تنمية بعض المهارات الاستقلالية للأطفال ذوي اضطراب التوحد من خلال استخدام برنامج قائم على استراتيجيات نموذج دينفر للتدخل المبکر، وتکونت عينة الدراسة من (6) أطفال ذوي اضطراب التوحد، تراوحت أعمارهم بين (30-56) شهرا، بمتوسط عمري قدره(43.8) وانحراف معياري قدره(8.9)، وهم (3) ذکور و(3) إناث، تراوحت نسبة ذکائهم (55-70) درجة، بمتوسط ذکاء قدره(63.8)، وانحراف معياري قدره(5.6)، وهم من فئة اضطراب التوحد المتوسطة، وتم الاعتماد على المنهج التجريبي باستخدام أسلوب دراسة الحالة الواحدة ذي الاختبار القبلي والبعدي، ولتحقيق أهداف الدراسة تم تصميم مقياس للمهارات الاستقلالية وبرنامج قائم على استراتيجيات نموذج دينفر للتدخل المبکر لذوي اضطراب التوحد، وهما من إعداد الباحث، وأظهرت نتائج الدراسة تحسنا ملحوظا لعينة الدراسة في المهارات الاستقلالية الأربعة (مهارات تناول الطعام والشراب، ومهارات النظافة والعناية الشخصية، ومهارات لبس الملابس وخلعها، ومهارات القيام ببعض الأعمال المنزلية) بعد تطبيق البرنامج التدريبي، کما أسفرت النتائج عن عدم وجود فروق بين متوسطي رتب درجات الأطفال ذوي اضطراب التوحد وفقا لمتغير الجنس (الإناث والذکور) في التطبيق البعدي على مقياس المهارات الاستقلالية؛ مما يؤکد فعالية البرنامج المستخدم. The Effectiveness of a Training Program Based on the Denver model for early intervention in improving some independence skills of children with autism disorder Abstract The current study aimed to develop some independence skills for children with autism by using a program based on Denver model early intervention strategies. The sample consisted of (6) children with autism disorder, ranging in age from (30 to 56) months, an average age of (43, 8) to an estimated standard deviation (8, 9), and a distribution of (3) males and (3) females, with an intelligence ratio of (55 to 70) degrees, with an average intelligence of (63, 8), and a standard deviation of (5, 6). They are in the intermediate autism disorder category, The experimental approach was used using the one-case study method with a pre and post test, and to achieve the objectives of the study, a scale of independence skills was designed and a training program based on the strategies of the Denver Model for Early Intervention for People with Autism Disorder, and the results of the study showed a significant improvement of the study sample in the four independence skills (Eating Skills Drinking, hygiene and personal care skills, dressing and undressing skills, and the skills to do some household work) after applying the training program based on the Denver model strategies for early intervention, and the results also resulted in no differences between the average ranks of the stairs. Children with autism disorder according to the gender variable (female and male) in the post-application of the scale of independence skills; Which confirms the effectiveness of the program used.

Effects of parental depression symptoms on parents and children with autism spectrum disorder in the play project home consultation program.

Solomon, et. al. (2014) reported a randomized controlled trial of the PLAY Project Home Consultation Intervention Program (PLAY) with 112 parents and preschool children with ASD. PLAY, a parent implemented model of early intervention for ASD, had significant intervention effects on parents’ interactive style, children's social engagement and ADOS social affect, as well as on parents’ depression symptoms. This secondary analysis investigated whether parents’ depression symptoms moderated PLAY intervention outcomes. Regression analyses indicated that parents’ depression symptoms did not moderate PLAY effects on parents’ interactive style, children's social engagement and ADOS social affect behaviors. Parents at high risk for depression were as successful implementing PLAY as parents at low risk for depression. However clinical levels of parent depression symptoms at Time 1 did moderate PLAY effects on parents’ depression symptoms. PLAY parents with high depression symptoms displayed greater reductions in their depression symptoms than PLAY parents with low depression symptoms. Findings from this study are clinically significant insofar as they suggest that high levels of depression symptoms do not impede parents’ participation in RBIs. Rather, results suggest that RBIs, such as PLAY, may be effective both at enhancing children's social functioning while having a secondary effect on reducing parents’ depression symptoms.

Intervención temprana tras los terremotos de Puerto Rico en enero de 2020: resiliencia, prevención y promoción de la salud mental infantojuvenil

Introducción: El artículo describe un modelo de intervención temprana para la prevención de patología, y promoción de la resiliencia, tras los terremotos de la isla de Puerto Rico en enero de 2020. El 7 de enero de 2020 un terremoto de magnitud 6,4 en la escala Richter, sacudió la isla de Puerto Rico. Como consecuencia, gran parte de la población sufrió desplazamientos de sus domicilios y cierres de muchas escuelas. Todo ello sobre lo ya anteriormente vivido, como el Huracán María en 2017, aumentando así su carga de estrés alostática. Tras la ayuda inicial de los cuerpos de rescate, se detecta la necesidad de apoyo psicológico a la población y a profesionales proveedores de dicho apoyo.
 Métodos: Contando con una precaria infraestructura, se decide realizar una intervención con el objetivo de proporcionar información del impacto del estrés traumático en el organismo, así como ejercicios prácticos de mindfulness dirigidos a dichos profesionales. El programa integra lecciones de la Terapia de Claves Traumáticas y ejercicios del currículo Pure Power.
 Resultados: Se confirma, a través de un cuestionario de satisfacción, la necesidad de este tipo de programas, y se valora extrapolar el modelo a otras poblaciones de riesgo similares, en términos de evitar las consecuencias del trauma, disminuir la carga alostática, y prevenir y promocionar la salud mental. Se sugiere realizar próximas formaciones de ampliación de este programa, para confirmar su efectividad y mantenimiento en el tiempo.

JÁTÉKTERÁPIA SÉRÜLT CSECSEMŐKNEK ÉS KISGYERMEKEKNEK A KORAI FEJLESZTÉS ÉS GONDOZÁS TERÜLETÉN

The experts of early development working in the Hajdú-Bihar County Educational Service worked out new therapy for the damaged babies, young children, and their families while taking the local factors and resources into consideration. This therapy strongly fits the family-oriented approach and the coordinated, integrated provider model of early childhood intervention. The tool for this is play therapy, which is the most important element of the development of damaged children. The program is based on the healing play therapy designed by Tunyogi (2019). We added some elements of the Step By Step preschool program to the therapy, and for the design of the environment and conditions, we used the Work-Fun-Development concept of Schaffer (1988) Parts of the intensive, group play therapy: sensorimotor program, the differentiated stimulation therapy of the senses, the increase of learning abilities, a staged environment. This year, new elements and therapeutic tools have been added to the program, like the Points of YouTM phototherapy method for parents, as well as dog therapy and baby massage for the little ones.

Implementing a prospective surveillance and early intervention model of care for breast cancer-related lymphedema into clinical practice: application of the RE-AIM framework.

Chronic lymphedema following breast cancer (BC) affects individuals physically, functionally, psychologically, and financially. Despite national guidelines and evidence-based research supporting a prospective surveillance and early intervention model of care (PSM), bridging the gap between research and clinical practice has been difficult. As part of an international randomized controlled trial (RCT), Australian women with BC from four hospitals were recruited, monitored for lymphedema at regular intervals over a 3-year period, and were provided a compression garment if intervention was triggered. The reach, effectiveness, adoption, implementation and maintenance (RE-AIM) evaluation framework was used retrospectively to assess a PSM at the individual and organizational level for those who had completed at least 2-year follow-up (N = 219) in the RCT. The application of the RE-AIM framework retrospectively demonstrated an extensive reach to patients across public and private settings; the effectiveness of prospective surveillance and early intervention was achieved through low progression rates to clinical lymphedema (1.8%), and all hospital sites initially approached adopted the research study. Key implementation strategies necessary for effectiveness of this model of care included education to health professionals and patients, staff acceptability, and development of a referral and care pathway. Maintenance dimensions were evaluated both at the individual level with 92-100% adherence rates for all nonoptional study appointments over the 2-year period, and at the organizational-level, PSM was sustained after recruitment ceased for the research study. The PSM for lymphedema in BC can be successfully implemented using the RE-AIM framework applied retrospectively. The implementation of the PSM used in the RCT has assisted in changing clinical practices and improving the quality and effectiveness of the health care system.

Early Post-trauma Interventions in Organizations: A Scoping Review.

BackgroundIn some organizations, traumatic events via direct or indirect exposure are routine experiences. The National Institute for Health and Care Excellence reviews (2005; 2018) of post-traumatic stress disorder management in primary and secondary care did not address early interventions for trauma within emergency response organizations.AimsThis scoping review was designed to identify research which evaluates the use of early interventions in emergency and other high-risk organizations following exposure to primary or secondary trauma and to report on the effectiveness of the early intervention models in common use.MethodsA scoping review was conducted to examine early interventions for workers exposed to trauma, including emergency response, military, and humanitarian aid. Relevant data were extracted from the included studies and the outcomes were assessed using meta-ethnography.ResultsFifty studies of mixed quality met the inclusion criteria for this review. A synthesis of study outcomes found that early interventions help emergency responders to manage post-incident trauma when they are delivered in a manner that (a) respects distinct organizational culture, (b) is supported by organizations and senior management, and (c) harnesses existing social cohesion and peer support systems within teams.ConclusionThis review demonstrates that early interventions support emergency responders following exposure to trauma when these are tailored to the needs of the population, are supported by the host organization, and harness existing social cohesion and peer support processes within a team or unit. A number of recommendations for the delivery and evaluation of early interventions for psychological trauma in emergency response organizations were made.

ESTABLISHING EARLY INTERVENTION AND INTEGRATED EDUCATION MODEL FOR CHILDREN WITH DISABILITIES IN PRESCHOOLS - SITUATION AND SOLUTIONS

Early intervention and inclusive education for children with disabilities in preschools is a model being implemented in Vietnam to implement the policy of inclusive education. However, this model is mainly implemented in big cities, so there are still many limitations and shortcomings. The paper addresses the current situation and solutions to develop early intervention and inclusive education models in preschools in Vietnam in order to solve existing problems and meet social needs to create opportunities for children with disabilities to learn and integrate in the community.

Exploring the Role of Practitioner Confidence in Prevention and Early Intervention in Child Welfare: A Case Study of Irish Youth Workers in Meitheal

ABSTRACT This study analyses the role of youth workers’ confidence in Meitheal: an Irish model of prevention and early intervention in child welfare. This study had an exploratory mixed methods design. Semi-structured interviews were carried out with youth workers to analyse their knowledge of prevention, early intervention, Meitheal and partnerships in child welfare. These were analysed using inductive thematic analysis. Additionally, youth workers completed a questionnaire to explore the levels of confidence in their role. Due to the small sample only descriptive and non-parametric statistics were used to analyse the data obtained. Youth workers see support and advocacy of young people as their primary role in Meitheal, despite this, participants described explaining what they do with other child welfare agencies as a challenge which was understood as a possible insecurity on the part of youth workers, alongside a presumption that their role and profession is not understood. Overall, this study found the need for youth workers to be more confident when engaging in Meitheal to facilitate their role and ensure that young people and their families are appropriately supported by the discipline of Youth Work specifically but also as part of the overall Meitheal model.

22-OR: Increased Adverse Glycemia and Hospital-Acquired Infection following Withdrawal of the RAPIDS Early Intervention Model for Diabetes Care in Medical and Surgical Inpatients

Background: We previously reported an early intervention model of diabetes care, whereby an inpatient diabetes team performed glycemic surveillance and provided proactive management within 24 hours of admission. In the RAPIDS cluster randomized study, early intervention decreased hyperglycemia and hospital-acquired infection (HAI) compared to usual care [Diabetes Care. 2019;42(5):832-40]. We investigated if improvements in ward glucose control and patient outcomes were sustained following the completion of proactive care intervention. Methods: We performed a 3-month extension observational study on eight medical and surgical wards immediately following the completion of the RAPIDS study, recruiting consecutive inpatients with pre-existing diabetes or new hyperglycemia. Glycemic and clinical outcomes during the three time periods: baseline (usual care), active (proactive care), and extension (usual care) were compared. Results: We analyzed 1518 inpatients (mean age 71y, 87% type 2 diabetes, 25% insulin-treated) and observed 8610 patient-days. In the intervention wards, during baseline, active and extension periods, patient-day mean glucose were: mean 9.4 (SD 3.3), 9.0 (2.7), and 9.4 (3.1) mmol/L (p<0.001); and proportion of patient-days with mean glucose >15 mmol/L were 7.3%, 3.3%, and 5.7% (p<0.001). HAI rates paralleled hyperglycemia: 6.4% during baseline period, 2.4% active period (p=0.022 vs. baseline), and 5.4% extension period (p=0.056 vs. active). In the control wards there was no change in hyperglycemia or HAI rates. Conclusion: Following withdrawal of proactive care with early intervention, hyperglycemia and HAI rates increased to baseline levels. Ongoing intervention with specialist diabetes care teams may be required to achieve sustained glycemic and clinical improvements in hospital. Disclosure M. Kyi: None. J. Wang: None. P.R. Wraight: None. P.G. Colman: None. S. Fourlanos: Advisory Panel; Self; Medtronic, Mylan, Sanofi. Speaker’s Bureau; Self; AstraZeneca, Novo Nordisk Inc. Funding Australian Diabetes Society; Sanofi; National Health and Medical Research Council of Australia (APP1093152); Royal Melbourne Hospital (GIA-030-2019, GIA-027-2016)

Towards Implementation of an Early Intervention Model by a Paraguayan Organization

Implementation science has been developed to help understand why evidence-based practices are not adopted as rapidly as they might. We describe here the process a rehabilitation center in Paraguay is undergoing to transform itself into a state-of-the-art early intervention program. We describe the organization and its contextual strengths and barriers, the model it chose to implement, and the implementation procedures it has attempted. The implications for model fidelity are highlighted, as this organization needed to make adaptations to the model as designed, to fit the particular context of its mission and the Paraguayan culture. Features of the Routines-Based Model are described.***Rumo à implementação de um modelo de intervenção precoce por uma Organização Paraguaia***A ciência da implementação foi desenvolvida para ajudar a entender as razões que levam a que as práticas baseadas na evidência não sejam adotadas pelos profissionais tão rapidamente quanto deveriam ser. Descrevemos aqui o processo de transformação que um centro de reabilitação no Paraguai está a passar se tornar num programa de intervenção precoce de última geração. Descrevemos a sua organização, os seus pontos fortes e as barreiras contextuais, o modelo que escolheu implementar e os procedimentos de implementação que utilizou. As implicações para a fidelidade do modelo são destacadas, pois a organização necessitava fazer adaptações ao modelo conforme previsto, para se ajustar ao contexto específico da sua missão e da cultura paraguaia. São descritas as características do modelo baseado nas rotinas.Palavras-chave: Ciência da implementação, centrado na família, baseada nasrotinas, funcional.

Positional plagiocephaly from structure to function: Clinical experience of the service of pediatric osteopathy in Italy

ObjectiveAim of the study is to evaluate disorders related to positional plagiocephaly and introduce a new model of early intervention based on the osteopathic integrated approach. MethodsWe review clinical experience of the “Program for Neurodevelopmental Follow-up and Pediatric Osteopathy”, a service dedicated to newborns at risk for developmental disorders. ResultsWe present clinical data of 310 newborns followed during first years of life. Data analysis examines perinatal history, general features and disorders that could be related to plagiocephaly. ConclusionsThe experience confirms that plagiocephaly is not only a problem regarding the shape of the head, it involves the functions. In our Service most babies (81%) with positional plagiocephaly showed isolated or associated disorders that had an impact on growth, behavior and development. The early intervention based on the osteopathic integrated approach is addressed not only to the cranial shape but consider the baby as a whole, and the environment where he lives.

Role of technology in a prospective surveillance and early intervention model for preventing lymphedema: The RE-AIM framework.

e14005 Background: Translation of research derived technology into busy clinical practice can be difficult. The effectiveness of technology translation can be assessed by applying the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) evaluation framework. Methods: The RE-AIM evaluation framework was applied to the use of bioimpedance spectroscopy (BIS) in the prospective surveillance and early intervention model of care for breast cancer survivors at risk of arm lymphedema. Data was obtained during an interim analysis from four hospital sites (public and private settings) in Australia who were participating in the PREVENT international study. Women with breast cancer were monitored for lymphedema from a pre-treatment baseline and at regular intervals for a minimum of 12-months. Results: Each of the RE-AIM framework components were evaluated at patient, practitioner and institutional levels. Patients in both public (n = 50) and private settings (n = 61) were Reached with BIS technology which demonstrated Effectiveness of early surveillance with 16 participants being identified for an early prevention intervention. Each of the four sites Adopted the use of BIS technology using various Implemented strategies like education of all stakeholders and development of referral and care pathways. Adherence rates for mandatory study visits was 88. 48% for the prospective surveillance and the early intervention model of care group and were Maintained for a minimum 12 months following completion of the recruitment phase of the study. Conclusions: The effectiveness of using a technology such as BIS in a prospective surveillance and early intervention model of care in breast cancer in both public and private settings has been demonstrated using the RE-AIM framework. The translation of research into clinical practice has been successfully achieved with the PREVENT study. Clinical trial information: NCT02167659.

Avoiding the Swell: Advances in Lymphedema Prevention, Detection, and Management.

Lymphedema is a feared complication of cancer treatments that negatively affects survivors' quality of life. The true incidence of lymphedema is difficult to determine given its long latency period. As the number of survivors of cancer is increasing in the United States, lymphedema is poised to be a major health concern. The most noteworthy risk factor for lymphedema is comprehensive lymph node dissection. The last 2 decades have witnessed a dramatic shift in cancer treatment in an attempt to systematically de-escalate therapeutic interventions, specifically seeking to shift treatment away from routine lymph node dissection in favor of sentinel node biopsy or radiation strategies, thereby reducing the risk for lymphedema while maintaining survival outcomes. A growing body of robust evidence supports prospective screening and thereby a prospective surveillance model (PSM) for early diagnosis and intervention for the prevention and treatment of lymphedema. Finally, investigators are actively evaluating the effectiveness of contemporary surgical procedures in ameliorating the symptoms and disability of patients with lymphedema and reducing the risk of future episodes of cellulitis, with outcomes of surgery significantly better than with conservative therapy alone. In this article, we review the current data surrounding these initiatives.

Statin adherence and LDL-C reduction in a pediatric population

Statins have demonstrated efficacy and safety in children with primary dyslipidemias such as familial hypercholesterolemia; however, adherence plays a key role in the ability of a statin to lower low-density lipoprotein cholesterol (LDL-C) levels. The objective of this study was to examine the role medication adherence plays in statin efficacy for the treatment of primary and secondary pediatric dyslipidemias. Retrospective review of a pediatric preventive cardiology database identified all subjects <22 years old who were prescribed a statin. Dosing, adverse effects, pre- and on-treatment LDL-C levels, medication adherence, and family history of atherosclerotic cardiovascular disease (ASCVD) were recorded. Adherence to medication was considered adequate if subject self-reported taking ≥80% of prescribed doses in the 14 days prior to lowest treatment LDL-C value. Chart review identified 131 subjects aged 6–21 years prescribed a statin with pre- and on-treatment data available. Of these 131 subjects, 123 (94%) had LDL-C > 130 mg/dL before beginning a statin. On treatment, 100/131 subjects (76%) met the LDL-C target of ≤130 mg/dL. Of 83 subjects with adherence data available, 61 (73%) met the adherence threshold and the adherent group had significantly greater mean reduction in LDL-C compared to the non-adherent group (−91 mg/dL versus −20 mg/dL, p = .0001). There were no reported adverse effects. These findings indicate that reductions in LDL-C were dependent on medication adherence. Utilizing a model of early intervention, family education, and intensive follow-up to improve adherence may improve clinical outcomes and reduce future ASCVD events in children with primary and secondary dyslipidemias that require lipid-lowering therapy.

First episode rapid early intervention for eating disorders (FREED): From research to routine clinical practice.

Eating disorders are serious psychiatric disorders with high rates of morbidity and mortality. Early intervention can improve treatment outcomes and reduce disruption to psychosocial development. However, early intervention is not well established in the eating disorder field. First episode rapid early intervention for eating disorders (FREED) was developed to address barriers to early, effective eating disorder treatment in emerging adults aged 16 to 25 years. Since 2014, FREED has progressed from a single-site research project to an evidence-based care approach in nine eating disorder services. This paper aims to summarize key learning from the scaling of FREED to date, with attention to how this learning may generalizes to other models of care. We describe the development, scaling and implementation of FREED with reference to the RE-AIM (reach; effectiveness/efficacy; adoption; implementation; maintenance) framework. We also summarize challenges and learning in each of the RE-AIM domains. FREED has demonstrated real-world validity across diverse clinical contexts, geographical regions and populations. Key outcomes are seen for each of the RE-AIM domains. FREED provides an example of effective, non-commercial scaling of an early intervention eating disorder care pathway. This work is likely to be particularly relevant to others looking to scale-up early intervention models and for those working in secondary and tertiary mental health settings.