Brief Report: A Brief Video Intervention for Increasing Autism Knowledge in a General Population Sample

Journal of Autism and Developmental Disorders - As many individuals in the general population will likely interact with autistic persons in various contexts, ensuring adequate autism knowledge and...     

Duration of Untreated Psychosis, Referral Route, and Age of Onset in an Early Intervention in Psychosis Service and a Local CAMHS

Background:  The aim of this study was to investigate associations between demographic and clinical variables and duration of untreated psychosis (DUP) in a sample of cases of psychosis across an adult early intervention in psychosis service and a child and adolescent community team.
Method:  Cross-sectional baseline data for cases of psychosis across the two teams on the caseload at a given time point were collected, including age of onset, gender, ethnicity, referral route, and DUP.
Results:  The median DUP across the entire sample was 91 days, while those patients with initial treatment for psychosis from the child and adolescent team had a median DUP of 69 days. Using multiple linear regression, there were two variables that showed a significant association with DUP: referral route ( p  < .001), and age of onset, with earlier age of onset associated with shorter DUP ( p  = .015).
Conclusion:  These findings are discussed in relation to possible explanatory factors, with particular focus on service-level variables and pathways to care. It is suggested that the involvement of child and adolescent teams is vital to the work of early intervention in psychosis services.     

Referral,Assessment and Use of Screening Measures Related to Autism Spectrum Disorder at a Tertiary Hospital Setting

Children with developmental concerns in Australia continue to experience inequitable healthcare and service-related delays, even when diagnostic risk is identified. This study sought to explore service and demographic pathway factors leading up to autism spectrum disorder (ASD) assessment, including value of screening measures applied at triage. Following a trial of centralised intake for referred young children with suspected ASD, observational, retrospective pathway data was explored using bivariate and regression analyses. The mean age of 159 children referred with autism symptoms was 3.6 years, and 64% were diagnosed with ASD. Service allocation was associated with diagnosis, whilst screening tool results were not. Improved pathways are needed to limit wasted waiting times and direct each child to needs-based services.

     

Effectiveness of Intensive Behavioral Intervention in a large, community-based program

Although the efficacy of Intensive Behavioral Intervention (IBI) for young children with Autism Spectrum Disorders (ASD) has been well documented in small model programs, IBI's effectiveness (i.e., does it work in the “real world”?) has been less studied and may not be as impressive, e.g. Bibby, Eikeseth, Martin, Mudford, and Reeves (2002). This study reports on the outcomes of 332 children, aged 2–7 years, enrolled in a large, community-based, publicly funded IBI Program in Ontario, Canada. File review data at intake and exit were compared on a group basis as well as on an individual basis. Results indicated statistically significant and clinically significant improvements: reduction in autism severity, gains in cognitive and adaptive levels, as well as a doubling of children's rate of development. There was a considerable heterogeneity in outcome, as expected, and children were classified into seven categories of progress/outcome. The majority of children (75%) showed some gains during IBI and 11% achieved average functioning. Although the study has clear methodological limitations (chiefly the lack of a comparison group), it suggests that IBI can be implemented effectively in a large, community-based program.     

Attitudes, Skills and Knowledge Change in Child and Adolescent Mental Health Workers Following AOD Screening and Brief Intervention Training

Adolescent mental health workers are generally poor at identifying and treating co-existing alcohol and other drug (AOD) disorder. This study aimed to evaluate the utility and acceptability of an AOD screening and brief intervention (BI) training package delivered to child and adolescent mental health workers and its impact on relevant attitudes, skills and knowledge. Quantitative data was collected before and after the BI training using a 55-item questionnaire. Focus groups explored issues around AOD screening and BI implementation in practice. The questionnaire and focus group were repeated 10 months later to ascertain change in behaviour. The BI training was well-received and led to improvements in attitudes, skills and knowledge around AOD screening and BI in youth mental health practitioners. Positive change in participants’ attitudes to performing screening and BI were demonstrated. Low response rates at follow-up limited analysis of behaviour change.     

Causes and Outcomes of Persistent Vegetative State in a Chinese Versus American Referral Hospital

Objective

To compare the etiologies and clinical outcomes of patients in a persistent vegetative state (PVS) between a Chinese and US referral hospital.

Methods

A retrospective, observational study at the Peking Union Medical College Hospital, Beijing, China and Johns Hopkins Hospital, Baltimore, USA (2001–2010) was performed.

Results

There were 36 cases of PVS diagnosed. In Beijing, there were 19 cases: mean age 57 years, range 3–86, (42 %) female, with 37 % of patients observed to survive more than 1 year (range >1 month to >28 years, median >6 months). Causes of PVS in Beijing were hemorrhagic stroke (n = 4, 21 %), ischemic stroke (n = 2, 11 %), cardiac arrest (n = 5, 26 %, including 4 with attempted cardiopulmonary resuscitation (CPR)), traumatic brain injury (n = 3, 16 %), and one each of mitochondrial encephalomyopathy, acute disseminated encephalomyelitis, Lennox Gastaut Syndrome, and epilepsy with craniopharyngioma (n = 4, 21 %). In Baltimore, there were 17 cases of PVS: mean age 43 years, range 15–83, 59 % female, with 41 % observed to survive more than 1 year (range >1 month to >10 years, median >3 years). Causes of PVS in Baltimore were ischemic stroke (n = 3, 18 %), cardiac arrest (n = 3, 18 %, including one with attempted CPR), traumatic brain injury (n = 3, 18 %), neurodegenerative conditions (n = 2, 12 %), and hypoxic ischemic encephalopathy due to respiratory arrest (n = 3, 18 %), metabolic derangements (n = 2, 12 %), and meningitis (n = 1, 6 %).

Conclusions

There may be a long survival period for patients with PVS, including in China where resource constraints exist for acute neurologic care. Stroke appears to be the most common underlying cause of PVS in Chinese patients, followed closely by cardiac arrest with attempted CPR. There appear to be more varied causes of PVS in the US referral hospital with a predominance of stroke, cardiac arrest, and traumatic brain injury.     

Brief Interventions for Patients Presenting to the Psychiatric Emergency Service (PES) with Major Mental Illnesses and At-risk Drinking

The presentation for care in psychiatric emergency setting provides an opportunity to assist individuals with mental health disorders and problems related to alcohol use. The purpose of this pilot study was to determine whether clinician-administered brief alcohol interventions are effective in reducing alcohol consumption in patients who screen positive for at-risk drinking in the psychiatric emergency setting. A total of 390 PES patients were screened; 87 (schizophrenia/bipolar disorder, n = 34; depression/anxiety, n = 53) met criteria for the study and received a brief alcohol intervention. Both groups dropped their drinking by ~7 drinks/week over the 6-months of the study (P < .05). The results of this study suggest that individuals with mental illnesses who drink at risk levels may benefit from a short, targeted brief alcohol intervention directed at changing their alcohol-related behavior and that, delivery of these interventions is feasible in a psychiatric emergency setting.     

Brief Report: Mediation of Treatment Effect in a Communication Intervention for Pre-School Children with Autism

Tests of mediation in treatment trials can illuminate processes of change and suggest causal influences in development. We conducted a mediation analysis of a previously published randomised controlled trial of parent-mediated communication-focused treatment for autism against ordinary care, with 28 children aged 2–5 years (Aldred et al. in J Child Psychol Psychiatr 45:1–11, 2004). The hypothesised mediating process, targeted by the intervention, was an increase in parental synchronous response within parent–child interaction. The results showed partial mediation, with change in synchrony accounting for 34% of the positive intervention effect on autism symptomatology (Autism Diagnostic Observation Schedule communication and social domain algorithm); the result was confirmed by bootstrap estimation. Improved parental synchronous response to child communication can alter short-term autism symptom outcome with targeted therapy.     

Comparison of 3 Depression Screening Methods and Provider Referral in a Veterans Affairs Primary Care Clinic

BACKGROUND: Concern about underdiagnosis and undertreatment of depression in primary care has led to support for routine screening. Although multiple screening instruments exist, we are not aware of studies to date that have compared different screening strategies, e.g., how the instrument is administered: by whom and in what setting. This study compared 3 separate screening strategies in terms of patient flow, coverage, patient characteristics, and other factors with the usual care system of provider referral. METHOD: We analyzed existing data from a completed randomized team trial of collaborative care depression treatment in which patients who met DSM-IV criteria for current major depressive disorder, dysthymic disorder, or both were recruited using the usual care system of provider referral (provider) and 3 separate screening strategies: (1) a 2-stage waiting room screening interview (waiting), (2) an in-clinic screen consisting of 2 self-report items embedded in a larger survey (in-clinic), and (3) a 2-stage self-report mail survey (mail). The team trial and analysis were conducted between January 1998 and July 2003. RESULTS: The usual care system of provider referral identified the most depressed patients and had relatively good coverage compared with the 3 screening strategies. Of the 3 screening strategies, the in-clinic strategy had the best coverage, while the mail strategy had the worst coverage. Provider referral patients were younger and had fewer chronic medical illnesses than did other patients. The waiting strategy identified more patients with bipolar affective disorder. CONCLUSION: While different strategies may be optimal for different resource levels and patient characteristics, this study suggests that an in-clinic self-report survey may be the best adjunct to provider referral for efficiently increasing coverage. This study also suggests that different screening strategies may capture different patient populations.     

Perception of Neighborhood Disorder and Health Service Usage in a Canadian Sample

Background  

Neighborhood environment, both actual and perceived, is associated with health outcomes; however, much of this research has relied on self-reports of these outcomes.     

Integrating Hospital and Community Care for Homeless People with Unmet Mental Health Needs: Program Rationale,Study Protocol and Sample Description of a Brief Multidisciplinary Case Management Intervention

The Coordinated Access to Care for Homeless People (CATCH) program is a brief multidisciplinary case management intervention for homeless adults discharged from hospital in Toronto, Canada. Here we describe the rationale for CATCH program development, details of the mixed methods evaluation underway, and the characteristics of 225 CATCH service users. Funded in 2010 by the local health authority, CATCH aimed to improve access, continuity of care, health and service use outcomes for homeless adults discharged from hospital. To assess the feasibility, acceptability and impact of the program, a mixed methods case study was undertaken in 2013. In total, 225 CATCH program users were enrolled in the study and completed quantitative survey measures at program entry to assess key health and social outcomes using a pre-post cohort study design. Follow-up assessments took place at 3- and 6-months. At study entry, most participants were male (79%), white (65%), Canadian-born (74%), single or never married (60%), and their average age was 39.9?±?12.0 years. Nearly all participants (88%) had at least one emergency department visit in the past 6 months, more than half (53%) indicated at least three chronic health conditions, and 44% indicated at least three mental health diagnoses. In addition, qualitative data was collected to evaluate the experiences of continuity of care and challenges during care transitions for this population using in-depth interviews with a sample of CATCH service users (n?=?22) and managers of partnered organizations (n?=?7), as well as focus groups with CATCH staff (n?=?8), other service providers (n?=?7) and people with lived experience of homelessness (n?=?8). Improving health and health service use outcomes among homeless adults with chronic health conditions are key priorities in many jurisdictions. Future findings can inform service delivery to homeless adults discharged from hospital, by exposing factors associated with positive program outcomes, as well as barriers and facilitators to continuity of care for this disadvantaged population.     

The Verbal Clock Test: Preliminary Validation of a Brief,Vision- and Motor-Free Measure of Executive Function in a Clinical Sample

Assessment of executive functions is frequently time-consuming, and although some brief measures exist they are subject to problems associated with limited education, culture of origin, impairments of motor or visual systems, and tolerability. Preliminary validation of a newly developed measure, the Verbal Clock Test (VCT), was conducted in a clinical sample of 294 patients who underwent neuropsychological evaluation. The evidence supports the interpretation of VCT scores as demonstrating construct validity, criterion-related validity, and sound internal consistency. Performance does not vary substantially with gender or mood, and variability associated with age, education, and ethnicity is modest. Confounding effects of motor and visual impairments are eliminated. Initial data suggest the VCT represents a reasonable method of assessing abstract reasoning and concept formation when clinical circumstances limit the use of currently available measures.     

Ethnic Variations in Mental Health Attitudes and Service Use Among Low-Income African American, Latina, and European American Young Women

This study examines the predictors of mentalhealth service use among patients in an ethnicallydiverse public-care women's clinic. While waiting fortheir clinic appointments, 187 Latina, African American, and White women were interviewed about theirattitudes towards mental illness and mental healthservices. White women were much more likely to have madea mental health visit in the past than the ethnic minority women. Having a substance use problem,use of mental health services by family or friends, andbeliefs about causes of mental illness were allpredictors of making a mental health visit.     

A Brief Treatment Engagement Intervention for Individuals with Co-occurring Mental Illness and Substance Use Disorders: Results of a Randomized Clinical Trial

Study objectives were to evaluate a brief intervention designed to facilitate outpatient engagement following an inpatient psychiatric stay for individuals with mental illness and substance use. A total of 102 veterans were randomly assigned to one of two conditions: (1) Time Limited Care-Coordination (TLC), an eight-week co-occurring disorders intervention or (2) a matched attention (MA) control condition in the form of health education sessions. Both groups also received treatment as usual in inpatient and outpatient settings. Sixty-nine percent of TLC participants attended an outpatient appointment within 14 days of discharge, compared to only 33% of MA participants (P < 0.01). TLC participants were also more likely to be engaged in outpatient services at the end of the intervention period (44 vs. 22%, P < 0.01). This study provided evidence that an eight-week intervention could improve treatment engagement. Research is currently underway to examine impact of TLC intervention beyond the 8 week study period.     

Age Variability in the Association Between Heavy Episodic Drinking and Adolescent Suicide Attempts: Findings From a Large-Scale,School-Based Screening Program

ObjectiveAlcohol use is a risk factor for suicidal behavior among adolescents, but it is not clear whether this association is consistent during the adolescent period. This study examined the age-specific associations between heavy episodic drinking (HED) and self-reported suicide attempts in a large and diverse sample of adolescents.MethodScreening data from 32,217 students, between the ages of 11 and 19 years, in 225 schools were analyzed. Logistic regression analyses estimating the impact of HED on self-reported suicide attempts in the past year were performed.ResultsHeavy episodic drinking was significantly associated with self-reported suicide attempts (odds ratio 1.78, p < .05) controlling for depressive symptoms. However, there was substantial age variability in this association, with the association between HED and self-reported attempts stronger among younger adolescents. Among youths aged 13 years and younger, those who reported an episode of HED during the past year were roughly 2.6 times more likely to report an attempt than those who did not report HED in the past year, in contrast to 1.2 times among youths aged 18 years and older.ConclusionsHeavy episodic drinking is a clear risk factor for suicidal behavior among younger adolescents, beyond the risk conveyed by depressive symptoms. Further research investigating the bases for increased suicide risk among younger adolescents engaging in HED is warranted. Results provide support to AACAP's practice parameters calling for attention to substance abuse in the assessment of suicide risk and suggest that routine screening for HED by physicians may improve the detection of adolescent suicide risk, particularly among younger adolescents.