Mr Lindsey Coombes

Dyadic Developmental Psychotherapy (DDP) is a form of psychotherapy for families where children and young people have experienced early trauma or attachment disruption. This study used longitudinal survey data to understand the format of DDP as it is provided in England for children who are adopted or subject of a Special Guardianship Order (SGO), and to analyse the potential effects of DDP on standardised outcomes of child and caregiver wellbeing. Participants were 150 families who received DDP through funding from the Department for Education’s Adoption Support Fund in England between 2018 and 2021. Adoptive parents and special guardians (caregivers) answered surveys at three timepoints; before therapy was provided (baseline), when therapy had ended (wave 2), and 6 months later (wave 3). Linear mixed modelling demonstrated significant improvements in child/young person difficulties in multiple subscales of the SDQ, including emotional difficulties and conduct problems, between baseline and wave 2. In the same time frame, similar improvements in caregiver wellbeing were also observed, as measured by the SWEMBS. These findings suggest an association between the provision of DDP and an improvement in child/young person and caregiver wellbeing on standardised measures, with these improvements maintained 6 months later. Implications and recommendations for future research to substantiate the findings are discussed.

Identifying factors that affect adolescent lifestyle behaviors is essential in order to develop effective generic prevention approaches. This study aimed to investigate the association between parental monitoring, parental emotional support, parental-adolescent conflict and adolescent substance use, meal pattern and food choices. The study included data from 13,269 Norwegian adolescents aged 13–16 years collected in 2016. Multivariable logistic regression models adjusted for gender, age and parental education were applied. Results show that low parental monitoring was associated with increased substance use (Odds ratios (OR) ranging from 2.8; 95% Confidence intervals (CI) 2.1–3.6 to OR 3.8; 95% CI, 2.7–5.3) and irregular meal patterns (1.7; 1.3–2.1 to 2.6; 2.1–3.3), low fish intake (1.3;1.0–1.7), and high intake of sugar-sweetened beverages, diet beverages and energy drinks (1.4;1.1–1.7 to 2.1;1.6–2.8). Low parental emotional support was associated with increased substance use (1.8;1.5–2.1 to 2.5;1.9–3.2), irregular meal patterns (2.0; 1.8–2.3 to 2.1;1.9–2.3), low intake of vegetables, fruits and fish (1.3; 1.1–1.5 to 1.5; 1.3–1.7) and high intake of salty snacks, candy, cakes, sugar-sweetened beverages, diet beverages and energy drinks (1.4; 1.2–1.6 to 2.1;1.7–2.5). Finally, high parent-adolescent conflict was associated with increased substance use (2.3; 2.0–2.7 to 2.7; 2.3–3.1), irregular meal patterns (1.6 ;1.5–1.8 to 1.9;1.7–2.1), low intake of fruits and fish (1.3; 1.1–1.5 to 1.5; 1.3–1.7) and high intake of salty snacks, candy, cakes, sugar-sweetened beverages, diet beverages and energy drinks (1.5; 1.3–1.7 to 2.1; 1.8–2.5). Overall, parenting was associated with a range of lifestyle outcomes among adolescents. Family-strengthening interventions may have an impact on multiple public health domains.

This study sought to evaluate the cultural adequacy of materials and procedures of the Strengthening Families Program (SFP 10-14-UK) and to identify requirements for its cultural adaptation to Brazilian families. The descriptive study had 33 informants, including external observers, managers, multipliers, facilitators, adolescents, and parents. The data were collected at a pilot application in the Federal District. Direct observation was applied to four intervention groups, with seven meetings of 150 min for families, parents/guardians and adolescents, and mixed nominal groups at the end of the interventions. The results, analyzed through content analysis and descriptive statistics, provided evidence that SFP was perceived as sufficiently appealing, culturally relevant, and partially clear. Recommendations for cultural adaptation of linguistic aspects of the materials and procedures were made, considering the cultural and educational differences of the participant families. Focus on implementation quality, including infrastructure, families’ mobilization and continuous planning, was recommended. Replication studies in other Brazilian regions and analyses of contextual and political dimensions are suggested.

Alcohol misuse in young people is cause of concern for health services, policy makers, prevention workers, criminal justice system, youth workers, teachers, parents. This is one of three reviews examining the effectiveness of (1) school-based, (2) family-based, and (3) multi-component prevention programs.

Objectives

To review evidence on the effectiveness of universal school-based prevention programs in preventing alcohol misuse in school-aged children up to 18 years of age.

Search methods

Background

Alcohol use and misuse in young people is a major risk behaviour for mortality and morbidity. Motivational interviewing (MI) is a popular technique for addressing excessive drinking in young adults.

Objectives

To assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol-related problems in young adults.

Search methods

We identified relevant evidence from the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 12), MEDLINE (January 1966 to July 2015), EMBASE (January 1988 to July 2015), and PsycINFO (1985 to July 2015). We also searched clinical trial registers and handsearched references of topic-related systematic reviews and the included studies.

Selection criteria

We included randomised controlled trials in young adults up to the age of 25 years comparing MIs for prevention of alcohol misuse and alcohol-related problems with no intervention, assessment only or alternative interventions for preventing alcohol misuse and alcohol-related problems.

Data collection and analysis

We used the standard methodological procedures expected by Cochrane.

Main results

We included a total of 84 trials (22,872 participants), with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow-up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short-term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.

At four or more months follow-up, we found effects in favour of MI for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95% confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95% CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95% CI −0.20 to 0.05, or a reduction from 0.144% to 0.131%; moderate quality evidence).

We found a marginal effect in favour of MI for alcohol problems (SMD −0.08, 95% CI −0.17 to 0.00 or a reduction in an alcohol problems scale score from 8.91 to 8.18; low quality evidence) and no effects for binge drinking (SMD −0.04, 95% CI −0.09 to 0.02, moderate quality evidence) or for average BAC (SMD −0.05, 95% CI −0.18 to 0.08; moderate quality evidence). We also considered other alcohol-related behavioural outcomes, and at four or more months follow-up, we found no effects on drink-driving (SMD −0.13, 95% CI −0.36 to 0.10; moderate quality of evidence) or other alcohol-related risky behaviour (SMD −0.15, 95% CI −0.31 to 0.01; moderate quality evidence).

Further analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer-term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.

None of the studies reported harms related to MI.

Authors' conclusions

The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol-related problems. Although we found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias.

Design/methods. The study comprised two parts: phase I was a web-based scoping and systematic analysis of UK National Health Service healthcare organisations' internal policies on missed appointments. Phase II involved a case study of how missed appointments were managed within one hospital trust, including interviews with hospital-based staff, review of organisational data and examination of policies and ‘systems’ in place.

Results Policies. accessed were of variable quality when benchmarked against a predetermined set of evidence-based standards. Additional material (eg, board minutes) gleaned through the searches found an apparent disconnect between nationally determined safeguarding requirements and strategies to reduce the cost pressures arising from missed appointments. Findings from the case study included the continuing use of the adult-centric term ‘did not attend’ (DNA), the challenges that may be inherent in attending appointments (with concomitant sympathy for parents) and a need to further explore general practitioner responses to DNA notifications, particularly given the acknowledged association between missed appointments and child maltreatment.

Conclusions. The web-based scoping exercise yielded a small number of organisational policies. These were of variable quality when rated against predetermined standards. Other material gathered through the search strategy found evidence that ‘missed appointment’ strategies aimed at reducing costs did not always acknowledge the discrete needs of children. The case study findings contribute to an understanding of the complexities and challenges of responding to a missed appointment and the importance of taking a child-centred approach.

The Strengthening Families (SF) child protection conference model attempts to address some of the weaknesses of traditional conferences by helping families participate more easily and by enhancing risk assessment. This study examined the impact and feasibility of implementing the SF model across one local authority. A mixed-methods design was adopted. Data collection included: semi-structured interviews with professionals and parents; non-participant observation of SF and traditional conferences; and anonymised child protection plans. Interviews and observation data were analysed thematically using NVivo8 software. Study findings indicated problems with the roll-out of training for the SF approach, yet model fidelity was largely adhered to during SF conferences. Most professionals reported initial child protection conferences (ICPCs) to be working well and they were perceived as constructive places for addressing child protection issues. While the majority of parents described their pre-conference preparation as good, many still felt disempowered by the child protection process. Thought is needed about how to tackle the perception amongst families that they are judged and that they are powerless during the ICPC process, particularly as our observations of SF conferences revealed that parents were active in their contributions to meetings.

BACKGROUND:

Globally, harmful use of alcohol results in approximately 2.5 million deaths each year. About 9% of these deaths are young people between the ages of 15 and 29 years (WHO 2011), mainly resulting from motor vehicle accidents, homicides, suicides and drownings. Hazardous drinking levels for men (consuming over 40 g/day alcohol on average, that is 5 units) double the risk of liver disease, raised blood pressure, some cancers and violent death (because some people who have this average alcohol consumption drink heavily on some days). For women, over 24 g/day average alcohol consumption (3 units) increases the risk for developing liver disease and breast cancer. Motivational interviewing (MI) is a popular technique for addressing excessive drinking in young adults but its effectiveness has not previously been examined in a Cochrane review.

OBJECTIVES:

The specific objectives were:(1) to summarise current evidence about the effects of MI intended to address alcohol and alcohol-related problems in young adults, compared with no intervention or a different intervention, on alcohol consumption and other substantive outcome measures;(2) to investigate whether the effects of MI are modified by the length of the intervention.

SEARCH METHODS:

Relevant evidence was identified from (1) Cochrane Central Register of Controlled Trials (CENTRAL) (October 2013), (2) MEDLINE (January 1966 to October 2013), (3) EMBASE (January 1988 to October 2013), and (4) PsycINFO (1985 to October 2013). References of topic-related systematic reviews and the included studies were handsearched.

SELECTION CRITERIA:

Randomised controlled trials and cluster randomised controlled trials of young people up to the age of 25 years in college and non-college settings comparing MIs with no intervention or a different intervention for prevention of alcohol misuse and alcohol-related problems were included.

DATA COLLECTION AND ANALYSIS:

We used the standard methodological procedures expected by The Cochrane Collaboration.

MAIN RESULTS:

A total of 66 randomised trials (17,901 participants) were included four of which were cluster randomised. Studies with longer-term follow-up (four plus months) were of more interest when considering the sustainability of intervention effects.At four or more months follow-up, effects were found for the quantity of alcohol consumed (standardised mean difference (SMD) -0.14; 95% confidence interval (CI) -0.20 to -0.08 or a reduction from 13.7 drinks/week to 12.2 drinks/week), moderate quality of evidence; frequency of alcohol consumption (SMD -0.11; 95% CI -0.19 to -0.03 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.57 days), moderate quality of evidence; and peak blood alcohol concentration (BAC) (SMD -0.14; 95% CI -0.23 to -0.05 or a decrease in peak BAC from 0.144% to 0.129%), moderate quality of evidence. A marginal effect was found for alcohol problems (SMD -0.08; 95% CI -0.15 to 0.00 or a reduction in an alcohol problems scale score from 8.91 to 8.18), low quality of evidence. No effects were found for binge drinking (SMD -0.05; 95% CI -0.12 to 0.01), moderate quality of evidence; or average BAC (SMD -0.08; 95% CI -0.22 to 0.06), moderate quality of evidence. We also considered other outcomes and at four or more months follow-up we found no effects on drink-driving (SMD -0.11; 95% CI -0.31 to 0.09), moderate quality of evidence; or other alcohol-related risky behaviour (SMD -0.14; 95% CI -0.30 to 0.02), moderate quality of evidence.Further analyses showed that the type of control comparison (assessment only versus alternative intervention) did not predict the outcome in a clear or straightforward way; and there was no consistent relationship between the duration of the MI intervention (in minutes) and effect size.

AUTHORS' CONCLUSIONS:

The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for the prevention of alcohol misuse. Although some significant effects were found, we interpret the effect sizes as being too small, given the measurement scales used in the studies included in the review, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings.

Findings indicated a difference between the use of power in traditional and Strengthening Families conferences. In traditional conferences the power was mostly static (held by the chair), and in the Strengthening Families conferences power was shifted from the leader of the collaboration (chair) to the people who administer the collaboration (conference participants). Also, in the Strengthening Families model more interaction between conference participants and better group coherence were evident; however, in both types of conference communication was limited between the professionals. Sociograms proved a useful method for exploring group dynamics in the context of child protection conferences. It is suggested that a broader understanding of the underpinning principles of the Strengthening Families model is needed to successfully empower parents' participation in conferences and to enhance collaboration between conference participants.

The Strengthening Families Programme 10–14 (SFP10–14; UK) is a seven-session DVD-based family skills training programme. While the programme has been extensively evaluated in the United States, no randomized controlled trial (RCT) of the SFP10–14 has been conducted in the United Kingdom. This exploratory Phase II study was an evaluation of a universally delivered prevention programme using a mixed-methods design study blending both quantitative and qualitative data. It aimed to examine intervention versus control differences in young person's substance use, aggressive behaviours and school absence, parenting behaviour and measures of family life. All parents/carers (n = 53) with a young person aged 10–14 years (n = 69) attending three schools in different locations in England were invited to complete self-report questionnaires pre- and post-intervention, and at 3 months after completion of the SFP10–14 (UK). A purposive sample of parents/caregivers (n = 16) and young people (n = 14) provided qualitative feedback from participating families. Participant recruitment to the study was slow and many families were reluctant to be randomly allocated, instead indicating a preference for the SFP10–14 (UK) group. Rather than abandoning the trial, a decision was made to proceed as a quasi-experimental study, that is, without randomization.


Read More: https://informahealthcare.com/doi/abs/10.3109/09687637.2012.658889

The changes that young people experience during early adolescence increase the risk that they may not reach their full potential. Poor parenting skills and an adverse family environment exacerbate existing behavioural problems and often result in academic failure. There is an expanding body of research supporting the important role of parents, family and community in determining young people's academic success in school. Parent and family-mediated interventions that target parenting skills have been shown across multiple intervention studies to be the most effective for reducing risk behaviour and preventing the development of later problem behaviour in adolescence. This article reports on the implementation of one such family intervention -the SFP10-14 (UK)- in a school in the north of England. It suggests a number of ways that practitioners working in the community can engage with families through family-mediated interventions to promote academic success in early adolescence.

Prevalence studies of emotional health and well-being (EHWB) of young people indicate that that there is cause for concern. Very few studies have examined EHWB from the perspective of young people. This study examined the views of young people about their EHWB in the context of secondary education in the UK. Eight focus groups were conducted in five secondary schools with pupils in year 10 (aged 13-14). The findings suggested that whilst pupils thought some aspects of EHWB are well provided for in the school curriculum, there were problems with coherence of EHWB policy. Mental health topics were thought to be neglected in the EHWB curriculum especially in relation to self-harm. Three problems regarding talking about EHWB were identified. Firstly, the quality of EHWB lessons depended on the enthusiasm and creativity of the teacher taking the lesson. Secondly, pupils were concerned about confidentiality. Thirdly, many pupils preferred to talk to friends about EHWB issues. The findings of the study suggest a need for greater involvement of young people in the planning, implementation and evaluation of the EHWB curriculum.

Background: Both early alcohol debut, behavioural and health problems are reported to enhance adolescence substance use. This prospective study investigate the influence of behavioural and health problems on adolescents" alcohol and drug use. Method: Prospective population based cohort study of 2 399 adolescents attending the Young-HUNT study, aged 13-15 at baseline in 1995/97, and 17-19 at follow-up 4 years later. Exposure variables were self reported conduct problems, attention problems, anxiety and depressive symptoms, and muscular pain and tension. Outcome variables at follow-up were frequent alcohol use and initiation of drug use. Associations were estimated by logistic regression models, influence of gender and drinking status at baseline were controlled for by stratification. Results: At follow-up 19% of the students drank alcohol once a week or more frequently. Baseline conduct problems (OR 2.2, CI 1.7-3.0) and attention problems (OR 1.5, CI 1.2-2.0) increased the risk for frequent alcohol use at follow-up in the total population. Girls who had experienced alcohol-intoxications at baseline showed strong association between baseline problems and frequent alcohol use at follow-up. Conduct problems (OR 2.5, CI 1.3- 4.8), attention problems (OR 2.1, CI 1.2-3.4), anxiety/depressive symptoms (OR 1.9, CI 1.1-3.1) and muscular pain and tension (OR 1.7, CI 1.0-2.9) all were associated with frequent alcohol use among early intoxicated girls. 14% of the students had tried cannabis or other drugs at follow-up. Conduct problems atbaseline increased the odds for drug use (OR 2.6, CI 1.9-3.6). Any alcohol intoxications at baseline, predicted both frequent alcohol use (boys OR 3.6, CI 2.4-5.2; girls OR 2.8, CI 1.9-4.1), and illegal drug use (boys OR 4.7; CI 3.2-7.0, girls OR 7.7, CI 5.2-11.5) within follow-up. Conclusions: Conduct problems in high-school more than doubles the risk for both frequent alcohol use and initiation of drug use later in adolescence. The combination of health problems and alcohol intoxication in early adolescence was closely associated with more frequent drinking later in adolescence among girls. Overall, early alcohol intoxication was closely associated with both frequent alcohol use and drug use at follow up in both genders

BACKGROUND: The aims of this study were to describe alcohol use among Norwegian teenagers and investigate the associations between mental health problems and alcohol intoxications with focus on age and gender. METHODS: Population based, cross-sectional survey addressing all adolescents aged 13-19 years, attending secondary or high school in North - Trondelag County, Norway. 8983 youths (91%) answered the Young-HUNT questionnaire in the 1995-1997 survey. Logistic regression models were used to study associations.RESULTS: 80% of the respondents reported that they had tried drinking alcohol, and 57% had been intoxicated at least once. The proportion of the students, which had tried alcohol, was equal in both genders and increased with age. Attention problems and conduct problems were strongly associated with frequent alcohol intoxications in both genders. Anxiety and depressive symptoms among girls were also related to high numbers of intoxications CONCLUSION: Gender differences in number of alcohol intoxications were small. There was a close association between both conduct and attention problems and high alcohol consumption in both genders. Girls with symptoms of anxiety and depression reported more frequent alcohol intoxications.

The aim of this study was to evaluate the Strengthening Families Programme for young people aged ten to 14 and their parents (SFP 10-14) in Barnsley, a northern English city, based on the experience of facilitators and families who had participated in the programme. A mixed methods design blending both quantitative and qualitative data was used in the study carried out in two phases over a nine-month period in 2005. Quantitative data were collected through: the SFP 10-14 Parent/Caregiver Survey Questionnaire, the SFP 10 -14 Young Persons' Survey Questionnaire and the Strengths and Difficulties Questionnaire. Questionnaire data were compared at the beginning of the SFP 10-14 programmes (weeks 1-2) and at the end of the programmes (week 7). In addition, two focus group meetings were held with families who had undertaken the SFP 10-14 programme; and three focus group meetings were conducted with facilitators of SFP 10-14 programmes. Once quantitative and qualitative data had been analysed separately, a synthesis of the main findings from both approaches was then completed. Following the programmes, parents reported significant changes in communication limit setting, emotional management, prosocial behaviour and drugs/alcohol use. Total difficulties scores were also significantly different pre- and post SFP 10-14 programmes. For the young people, communication, and emotional management were improved and their drugs/alcohol use was less. Their total difficulties scores were also significantly different. Qualitative evidence indicated that families who participated in the study found the SFP 10-14 useful in preventing young people's alcohol and drug use in terms of: learning more about alcohol and drugs, using knowledge and skills to reduce behaviours that might lead to alcohol and drug use and, for young people, dealing with peer pressure that might lead to drug and alcohol use. Parents/caregivers and young people reported that the SFP 10-14 had played a part in improving family functioning through strengthening the family unit. The findings from this exploratory study suggest that the SFP 10-14 may be a useful primary prevention intervention in helping to prevent drug and alcohol misuse in young people.