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Community-based HCV screening: knowledge and attitudes in a high risk urban population.

Fri, 12/19/2014 - 6:00am
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Community-based HCV screening: knowledge and attitudes in a high risk urban population.

BMC Infect Dis. 2014;14:74

Authors: Norton BL, Voils CI, Timberlake SH, Hecker EJ, Goswami ND, Huffman KM, Landgraf A, Naggie S, Stout JE

Abstract
BACKGROUND: In an attempt to curtail the rising morbidity and mortality from undiagnosed HCV (hepatitis C virus) in the United States, screening guidelines have been expanded to high-risk individuals and persons born 1945-1965. Community-based screening may be one strategy in which to reach such persons; however, the acceptance of HCV testing, when many high-risk individuals may not have access to HCV specific medications, remains unknown.
METHODS: We set out to assess attitudes about HCV screening and knowledge about HCV disease at several community-based testing sites that serve high-risk populations. This assessment was paired with a brief HCV educational intervention, followed by post-education evaluation.
RESULTS: Participants (n = 140) were surveyed at five sites; two homeless shelters, two drug rehabilitation centers, and a women's "drop-in" center. Personal acceptance of HCV testing was almost unanimous, and 90% of participants reported that they would still want to be tested even if they were unable to receive HCV treatment. Baseline hepatitis C knowledge was poor; however, the brief educational intervention significantly improved knowledge and increased acceptability of testing when medical access issues were explicitly stated.
CONCLUSIONS: Despite inconsistencies in access to care and treatment, high-risk communities want to know their HCV status. Though baseline HCV knowledge was poor in this population, a brief on-site educational intervention improved both knowledge and acceptability of HCV testing and care. These data support the establishment of programs that utilize community-based screening, and also provide initial evidence for acceptance of the implementation of the recently expanded screening guidelines among marginalized communities.

PMID: 24512462 [PubMed - indexed for MEDLINE]

Comparing the motivational interviewing integrity in two prevalent models of brief intervention service delivery for primary care settings.

Thu, 12/18/2014 - 6:00am

Comparing the motivational interviewing integrity in two prevalent models of brief intervention service delivery for primary care settings.

J Subst Abuse Treat. 2014 Nov 5;

Authors: Dunn C, Darnell D, Carmel A, Atkins DC, Bumgardner K, Roy-Byrne P

Abstract
This quasi experimental study compared the motivational interviewing (MI) integrity in two prevalent brief intervention (BI) service delivery models for drug abuse. Routine primary care providers (RCPs) and non-routine care providers (NRCPs) performed BIs using an MI style within the same medical setting, patient population, and Screening, Brief Intervention, and Referral for Treatment (SBIRT) protocol. Interventionists (9 RCPs and 6 NRCPs) underwent similar MI training and performed a total of 423 audiorecorded BIs. We compared the MI integrity scores for all audio recorded sessions from these two SBIRT models for up to 40months post MI training. Both groups met the lower standard (beginning proficiency in MI) on 4 of 5 MI integrity scores, but NRCPs met more of the higher standards (competency in MI) than RCPs. There may be limitations with regards to MI fidelity when using RCPs to conduct BIs in some primary care settings. Further experimental investigation is warranted to replicate this finding and identify casual factors of observed differences in MI fidelity.

PMID: 25515624 [PubMed - as supplied by publisher]

[The addiction patient in the family physicians' practice: tools and skills for a successful performance].

Wed, 12/17/2014 - 6:00am
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[The addiction patient in the family physicians' practice: tools and skills for a successful performance].

Ther Umsch. 2014 Oct;71(10):585-91

Authors: Neuner-Jehle S

Abstract
Addiction patients are usually perceived as problematic patients in primary care practices: Encounters often are time-consuming and the approach to the patient is difficult. Moreover, patients sometimes are hiding their addictive behaviour and behave shameful. Other barriers are a lack of experience in communication skills among physicians or their own addictive behaviour. Nevertheless, to diagnose and treat addiction as early as possible is an important task for family doctors, as patients' confidence in them is an important factor to induce a behaviour change. We present four screening tests for the early diagnosis of addiction to alcohol (AUDIT, AUDIT-C, CAGE, SMAST-G) and discuss their strengths and shortcomings. The family doctor's practice is also a useful setting for brief interventions based on motivational interviewing (MI) techniques and the transtheoretical model of behaviour change (TTM). We shortly introduce to these techniques and attitudes using addiction to alcohol and nicotine as examples, and we present innovative methods as "defined drinking" and new quit smoking methods. A respectful attitude towards the patient and communication skills seem to be key factors for family physicians to successfully approach their addiction patients.

PMID: 25257112 [PubMed - indexed for MEDLINE]

SBIRT goes to college: interdisciplinary screening for alcohol use.

Mon, 12/15/2014 - 1:30pm
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SBIRT goes to college: interdisciplinary screening for alcohol use.

J Addict Nurs. 2013 Jan-Mar;24(1):45-50

Authors: Naegle M, Himmel J, Ellis P

Abstract
Although risky/harmful drinking, in the form of binge drinking, remains a national problem, only recently have health services in universities systematically screened for drinking, drug use, and smoking. This article recounts "lessons learned" in two nurse-directed, interdisciplinary health services, which adapted the National College Depression Partnership model to include screening and brief intervention (SBIRT) for risky/harmful alcohol use in the form of binge drinking. Using a planned change model, nurse leaders worked with university administrators, providers, and health service staff to screen all students seeking health services for risky drinking. The outcomes suggest that this process may increase staff and student awareness of the importance of alcohol consumption to health, show the ease of using SBIRT screening along with standard screening tools, and yield information on the normalization of high-risk drinking in collegiate settings. Project findings indicate that common perceptions in college students minimize negative outcomes and stress the importance of additional quality assurance initiatives that review the efficacy of combinations of standardized screening tools.

PMID: 24622529 [PubMed - indexed for MEDLINE]

Evaluation of a pilot training program in alcohol screening, brief intervention, and referral to treatment for nurses in inpatient settings.

Mon, 12/15/2014 - 1:30pm
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Evaluation of a pilot training program in alcohol screening, brief intervention, and referral to treatment for nurses in inpatient settings.

J Addict Nurs. 2013 Jan-Mar;24(1):8-19

Authors: Broyles LM, Gordon AJ, Rodriguez KL, Hanusa BH, Kengor C, Kraemer KL

Abstract
Alcohol screening, brief intervention, and referral to treatment (SBIRT) is a set of clinical strategies for reducing the burden of alcohol-related injury, disease, and disability. SBIRT is typically considered a physician responsibility but calls for interdisciplinary involvement requiring basic SBIRT knowledge and skills training for all healthcare disciplines. The purpose of this pilot study was to design, implement, and evaluate a theory-driven SBIRT training program for nurses in inpatient settings (RN-SBIRT) that was developed through an interdisciplinary collaboration of nursing, medical, and public health professionals and tailored for registered nurses in the inpatient setting. In this three-phase study, we evaluated (1) RN-SBIRT's effectiveness for changing nurses' alcohol-related knowledge, clinical practice, and attitudes and (2) the feasibility of implementing the inpatient curriculum. In a quasi-experimental design, two general medical units at our facility were randomized to receive RN-SBIRT or a self-directed Web site on alcohol-related care. We performed a formative evaluation of RN-SBIRT, guided by the RE-AIM implementation framework. After training, nurses in the experimental condition had significant increases in Role Adequacy for working with drinkers and reported increased performance and increased competence for a greater number of SBIRT care tasks. Despite some scheduling challenges for the nurses to attend RN-SBIRT, nurse stakeholders were highly satisfied with RN-SBIRT. Results suggest that with adequate training and ongoing role support, nurses in inpatient settings could play active roles in interdisciplinary initiatives to address unhealthy alcohol use among hospitalized patients.

PMID: 24622525 [PubMed - indexed for MEDLINE]

A Randomized Control Trial of a Chronic Care Intervention for Homeless Women With Alcohol Use Problems.

Wed, 12/10/2014 - 6:00am
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A Randomized Control Trial of a Chronic Care Intervention for Homeless Women With Alcohol Use Problems.

J Subst Abuse Treat. 2014 Nov 21;

Authors: Upshur C, Weinreb L, Bharel M, Reed G, Frisard C

Abstract
A clinician-randomized trial was conducted using the chronic care model for disease management for alcohol use problems among n=82 women served in a health care for the homeless clinic. Women with problem alcohol use received either usual care or an intervention consisting of a primary care provider (PCP) brief intervention, referral to addiction services, and on-going support from a care manager (CM) for 6months. Both groups significantly reduced their alcohol consumption, with a small effect size favoring intervention at 3months, but there were no significant differences between groups in reductions in drinking or in housing stability, or mental or physical health. However, intervention women had significantly more frequent participation in substance use treatment services. Baseline differences and small sample size limit generalizability, although substantial reductions in drinking for both groups suggest that screening and PCP brief treatment are promising interventions for homeless women with alcohol use problems.

PMID: 25488504 [PubMed - as supplied by publisher]

Effects of a Brief Intervention for Substance Use on Tobacco Smoking and Family Relationship Functioning in Schizophrenia and Related Psychoses: A Randomised Controlled Trial.

Thu, 12/04/2014 - 6:00am

Effects of a Brief Intervention for Substance Use on Tobacco Smoking and Family Relationship Functioning in Schizophrenia and Related Psychoses: A Randomised Controlled Trial.

J Subst Abuse Treat. 2014 Nov 5;

Authors: Tantirangsee N, Assanangkornchai S, Marsden J

Abstract
Surveys indicate that substance use is prevalent in populations with schizophrenia. Family members may be able to support brief interventions (BI). We conducted a randomised controlled trial with 6-month follow-up among adult patients with schizophrenia and related psychoses who were referred to two hospitals in southern Thailand. Patients with psychosis were screened using the Alcohol Smoking and Substance Involvement Screening Test (ASSIST). 169 participants (all at moderate substance risk on the ASSIST) were randomised to receive simple advice (the clinics' treatment-as-usual, TAU condition), or single-session brief intervention (BI), or a single-session BI with family support (BI-FS). Given observed substance use, the primary outcome was the ASSIST tobacco smoking involvement score (SIS). Secondary outcomes were cigarettes smoked per day, change motivation (Taking Steps from the Stages of Change and Treatment Eagerness Scale), and DSM-IV Axis V Global Assessment of Relational Functioning (GARF). At follow-up, BI-FS participants reported a lower SIS (mean difference, -2.82, 95% confidence interval [CI] -4.84 to -0.81; Glass' effect size [Δ]=0.57, 95% CI 0.19 to 0.95), smoked fewer cigarettes per day (mean difference -3.10, 95% CI -5.45 to -0.74; Δ=0.56, 95% CI 0.18 to 0.94), had greater change motivation (mean difference 3.05, 95% CI 0.54 to 5.57; Δ=0.41, 95% CI 0.03 to 0.79) and GARF (mean difference 6.75, 95% CI 1.57 to 11.93; Δ=0.54, 95% CI 0.16 to 0.92). The BI-FS group also had better relational functioning in comparison to those receiving BI only (mean difference 5.44, 95% CI 0.20 to 10.67; Δ=0.46, 95% CI 0.08 to 0.84). In schizophrenia and related psychoses, a brief intervention supported by a family member reduces smoking involvement, cigarette smoking intensity, and increases change motivation and relational functioning.

PMID: 25468004 [PubMed - as supplied by publisher]

Brief Interventions Implementation on Alcohol from the European Health Systems Perspective.

Thu, 11/27/2014 - 6:00am

Brief Interventions Implementation on Alcohol from the European Health Systems Perspective.

Front Psychiatry. 2014;5:161

Authors: Colom J, Scafato E, Segura L, Gandin C, Struzzo P

Abstract
Alcohol-related health problems are important public health issues and alcohol remains one of the leading risk factors of chronic health conditions. In addition, only a small proportion of those who need treatment access it, with figures ranging from 1 in 25 to 1 in 7. In this context, screening and brief interventions (SBI) have proven to be effective in reducing alcohol consumption and alcohol-related problems in primary health care (PHC) and are very cost effective, or even cost-saving, in PHC. Even if the widespread implementation of SBI has been prioritized and encouraged by the World Health Organization, in the global alcohol strategy, the evidence on long term and population-level effects is still weak. This review study will summarize the SBI programs implemented by six European countries with different socio-economic contexts. Similar components at health professional level but differences at organizational level, especially on the measures to support clinical practice, incentives, and monitoring systems developed were adopted. In Italy, cost-effectiveness analyses and Internet trials shed new light on limits and facilitators of renewed, evidence-based approaches to better deal with brief intervention in PHC. The majority of the efforts were aimed at overcoming individual barriers and promoting health professionals' involvement. The population screened has been in general too low to be able to detect any population-level effect, with a negative impact on the acceptability of the program to all stakeholders. This paper will present a different point of view based on a strategic broadening of the implemented actions to real inter-sectoriality and a wider holistic approach. Effective alcohol policies should strive for quality provision of health services and the empowerment of the individuals in a health system approach.

PMID: 25426083 [PubMed - as supplied by publisher]

Brief overdose education can significantly increase accurate recognition of opioid overdose among heroin users.

Wed, 11/19/2014 - 6:00am
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Brief overdose education can significantly increase accurate recognition of opioid overdose among heroin users.

Int J Drug Policy. 2014 Jan;25(1):166-70

Authors: Jones JD, Roux P, Stancliff S, Matthews W, Comer SD

Abstract
BACKGROUND: In an effort to increase effective intervention following opioid overdose, the New York State Department of Health (NYSDOH) has implemented programs where bystanders are given brief education in recognizing the signs of opioid overdose and how to provide intervention, including the use of naloxone. The current study sought to assess the ability of NYSDOH training to increase accurate identification of opioid and non-opioid overdose, and naloxone use among heroin users.
METHODS: Eighty-four participants completed a test on overdose knowledge comprised of 16 putative overdose scenarios. Forty-four individuals completed the questionnaire immediately prior to and following standard overdose prevention training. A control group (n=40), who opted out of training, completed the questionnaire just once.
RESULTS: Overdose training significantly increased participants' ability to accurately identify opioid overdose (p<0.05), and scenarios where naloxone administration was indicated (p<0.05). Training did not alter recognition of non-opioid overdose or non-overdose situations where naloxone should not be administered.
CONCLUSIONS: The data indicate that overdose prevention training improves participants' knowledge of opioid overdose and naloxone use, but naloxone may be administered in some situations where it is not warranted. Training curriculum could be improved by teaching individuals to recognize symptoms of non-opioid drug over-intoxication.

PMID: 23773683 [PubMed - indexed for MEDLINE]

Evaluating Training of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Substance Use: Reliability of the MD3 SBIRT Coding Scale.

Tue, 11/18/2014 - 6:00am

Evaluating Training of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Substance Use: Reliability of the MD3 SBIRT Coding Scale.

Psychol Addict Behav. 2014 Nov 17;

Authors: DiClemente CC, Crouch TB, Norwood AE, Delahanty J, Welsh C

Abstract
Screening, brief intervention, and referral to treatment (SBIRT) has become an empirically supported and widely implemented approach in primary and specialty care for addressing substance misuse. Accordingly, training of providers in SBIRT has increased exponentially in recent years. However, the quality and fidelity of training programs and subsequent interventions are largely unknown because of the lack of SBIRT-specific evaluation tools. The purpose of this study was to create a coding scale to assess quality and fidelity of SBIRT interactions addressing alcohol, tobacco, illicit drugs, and prescription medication misuse. The scale was developed to evaluate performance in an SBIRT residency training program. Scale development was based on training protocol and competencies with consultation from Motivational Interviewing coding experts. Trained medical residents practiced SBIRT with standardized patients during 10- to 15-min videotaped interactions. This study included 25 tapes from the Family Medicine program coded by 3 unique coder pairs with varying levels of coding experience. Interrater reliability was assessed for overall scale components and individual items via intraclass correlation coefficients. Coder pair-specific reliability was also assessed. Interrater reliability was excellent overall for the scale components (>.85) and nearly all items. Reliability was higher for more experienced coders, though still adequate for the trained coder pair. Descriptive data demonstrated a broad range of adherence and skills. Subscale correlations supported concurrent and discriminant validity. Data provide evidence that the MD3 SBIRT Coding Scale is a psychometrically reliable coding system for evaluating SBIRT interactions and can be used to evaluate implementation skills for fidelity, training, assessment, and research. Recommendations for refinement and further testing of the measure are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

PMID: 25402834 [PubMed - as supplied by publisher]

Predictors and Moderators of Aftercare Appointment-Keeping Following Brief Motivational Interviewing Among Patients With Psychiatric Disorders or Dual Diagnosis.

Fri, 11/14/2014 - 6:00am

Predictors and Moderators of Aftercare Appointment-Keeping Following Brief Motivational Interviewing Among Patients With Psychiatric Disorders or Dual Diagnosis.

J Dual Diagn. 2014 January-March;10(1):44-51

Authors: Pantalon MV, Murphy MK, Barry DT, Lavery M, Swanson AJ

Abstract
Objective: Non-adherence to psychiatric and substance abuse treatment recommendations, especially with regard to aftercare outpatient appointment-keeping following hospitalizations, exacts a high cost on mental health spending and prevents patients from receiving therapeutic doses of treatment. Our primary objective was to evaluate the relationship between potential predictors and moderators of aftercare appointment-keeping among a group of adult patients immediately following hospitalization for severe psychiatric disorders or dual diagnosis. Methods: Candidate predictors and moderator variables included demographics, psychiatric status, psychiatric symptom severity, and inpatient group adherence, while aftercare appointment-keeping was defined as attendance at the first aftercare appointment. Participants were 121 adult inpatients with a psychiatric disorder or dual diagnosis originally enrolled in an earlier randomized controlled trial comparing standard treatment with standard treatment plus brief motivational interviewing for increasing adherence. Results: Results indicated that, across treatment conditions, those who were female, did not have dual diagnosis, were older (older than 33 years), and were less educated (<high school) attended their first aftercare appointment at significantly higher rates than their counterparts. A treatment-by-gender interaction was noted, where only men were significantly more likely to keep their first aftercare appointment if they received standard treatment plus brief motivational interviewing, compared to standard treatment alone (OR = 9.58, p < .001). Conclusions: Findings suggest that gender, dual diagnosis status, age and education may be an important predictors of aftercare treatment adherence and that gender may be a moderator of motivational interviewing among individuals with psychiatric disorders or dual diagnosis.

PMID: 25392061 [PubMed - as supplied by publisher]

Screening, brief intervention, and referral to treatment: nurses do it best.

Thu, 11/06/2014 - 6:00am
Related Articles

Screening, brief intervention, and referral to treatment: nurses do it best.

J Addict Nurs. 2012 Dec;23(4):276-8

Authors:

PMID: 24622499 [PubMed - indexed for MEDLINE]

Unhealthy drug use-- How to screen, when to intervene.

Thu, 10/30/2014 - 10:30am
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Unhealthy drug use-- How to screen, when to intervene.

J Fam Pract. 2014 Sep;63(9):524-30

Authors: Zgierska A, Amaza IP, Brown RL, Mundt M, Fleming MF

Abstract
Recognizing and helping patients at risk for a substance use disorder doesn't have to be time-consuming. Here's how to make screening and implementing a brief intervention a routine part of care.

PMID: 25353031 [PubMed - in process]

Do risky friends change the efficacy of a primary care brief intervention for adolescent alcohol use?

Fri, 10/24/2014 - 6:00am
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Do risky friends change the efficacy of a primary care brief intervention for adolescent alcohol use?

J Adolesc Health. 2014 Apr;54(4):449-53

Authors: Louis-Jacques J, Knight JR, Sherritt L, Van Hook S, Harris SK

Abstract
PURPOSE: To determine if peer risk (having friends who drink or approve of drinking) modifies the effects of a computer-facilitated screening and provider brief advice (cSBA) intervention on adolescent alcohol use.
METHODS: We assessed the intervention effect using logistic regression modeling with generalized estimating equations on a sample of 2,092 adolescents. Effect modification by peer risk was analyzed separately for alcohol initiation (drinking at follow-up in baseline nondrinkers) and cessation (no drinking at follow-up in baseline drinkers) by testing an interaction term (treatment condition by peer risk). Interpretation of the interaction effect was further clarified by subsequent stratification by peer risk.
RESULTS: The intervention effect on alcohol cessation was significantly greater among those with peer risk (adjusted relative risk ratios; risk 1.44, 1.18-1.76 vs. no risk .98, .41-2.36) at 3 months' follow-up. There was no such finding for alcohol initiation.
CONCLUSIONS: Alcohol screening and brief provider counseling may differentially benefit adolescent drinkers with drinking friends.

PMID: 24216313 [PubMed - indexed for MEDLINE]

Teen Options for Change: An Intervention for Young Emergency Patients Who Screen Positive for Suicide Risk.

Fri, 10/17/2014 - 2:30pm
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Teen Options for Change: An Intervention for Young Emergency Patients Who Screen Positive for Suicide Risk.

Psychiatr Serv. 2014 Oct 15;

Authors: King CA, Gipson PY, Horwitz AG, Opperman KJ

Abstract
Objective: Previous research has documented the feasibility of screening in emergency departments for adolescent suicide risk. This randomized trial examined the effectiveness of Teen Options for Change (TOC), an intervention for adolescents seeking general medical emergency services who screen positive for suicide risk.
Methods: Participants were 49 youths, ages 14 to 19, seeking services for nonpsychiatric emergencies. They screened positive for suicide risk because of recent suicidal ideation, suicide attempt, or depression plus substance abuse. Youths were randomly assigned to the TOC intervention or to enhanced treatment as usual. Depression, hopelessness, and suicidal ideation were assessed at baseline and two months later.
Results: Adolescents assigned to TOC showed greater reductions in depression than adolescents assigned to the comparison group (Cohen's d=1.07, a large effect size). Hopelessness, suicidal ideation, and substance abuse outcomes trended positively (nonsignificantly), with small to moderate effect sizes.
Conclusions: TOC may be a promising, brief intervention for adolescents seeking emergency services and at risk of suicide.

PMID: 25321886 [PubMed - as supplied by publisher]

Substance Abuse Screening and Brief Intervention for Adolescents in Primary Care.

Wed, 10/08/2014 - 6:00am

Substance Abuse Screening and Brief Intervention for Adolescents in Primary Care.

Pediatr Ann. 2014 Oct 1;43(10):412

Authors: Pitts S, Shrier LA

Abstract
Adolescent substance use is common and is associated with serious mental, physical, and social risks, warranting systematic screening in the primary care setting. It is important for clinicians to become familiar with Screening, Brief Intervention, and Referral to Treatment (SBIRT), including administration of validated screening tools to identify level of risk associated with substance use and application of appropriate brief interventions. Positive reinforcement and brief advice is indicated for those adolescents with no or minimal risk for a substance use disorder. Providing a brief intervention using motivational interviewing strategies with subsequent close clinical follow-up is warranted when an adolescent meets criteria for a mild to moderate substance use disorder. Referral to treatment is recommended in cases of severe substance use. Immediate action, including breaking confidentiality, may be necessary when an adolescent's behavior raises acute safety concerns. Making time to interview adolescents alone is essential. It is also important to review the limitations of confidentiality with patients and parents/guardians and offer them strategies to discuss sensitive issues with their adolescents. Available resources for adolescents, parents/guardians, and clinicians regarding the risks of adolescent substance use and evidence-based treatment options can be used to support implementation of SBIRT in adolescent primary care. [Pediatr Ann. 2014;43(10):e248-e252.] To read more and to earn CME credit for reading this article, access the full text by going to Healio.com/pedann.

PMID: 25290131 [PubMed - as supplied by publisher]

A randomized trial of computerized vs. in-person brief intervention for illicit drug use in primary care: Outcomes through 12months.

Mon, 10/06/2014 - 6:00am

A randomized trial of computerized vs. in-person brief intervention for illicit drug use in primary care: Outcomes through 12months.

J Subst Abuse Treat. 2014 Sep 16;

Authors: Gryczynski J, Mitchell SG, Gonzales A, Moseley A, Peterson TR, Ondersma SJ, O'Grady KE, Schwartz RP

Abstract
This study examined outcomes through 12months from a randomized trial comparing computerized brief intervention (CBI) vs. in-person brief intervention (IBI) delivered by behavioral health counselors for adult community health center patients with moderate-level drug misuse (N=360). Data were collected at baseline, 3-, 6-, and 12-month follow-up, and included the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and laboratory analysis of hair samples. Repeated measures analyses examined differential change over time. There were no significant differences in drug-positive hair tests over time or by condition. Global ASSIST scores decreased in both conditions (p<.001), but there were no significant differences between conditions in overall change across 12months of follow-up (p=.13). CBI produced greater overall reductions in alcohol (p=.04) and cocaine (p=.02) ASSIST scores than IBI, with initial differences dissipating over time. Computerized brief interventions present a viable alternative to traditional in-person brief interventions.

PMID: 25282578 [PubMed - as supplied by publisher]

Early intervention to protect the mother-infant relationship following postnatal depression: study protocol for a randomised controlled trial.

Sat, 10/04/2014 - 6:00am

Early intervention to protect the mother-infant relationship following postnatal depression: study protocol for a randomised controlled trial.

Trials. 2014 Oct 3;15(1):385

Authors: Milgrom J, Holt C

Abstract
BACKGROUND: At least 13% of mothers experience depression in the first postnatal year, with accompanying feelings of despair and a range of debilitating symptoms. Serious sequelae include disturbances in the mother-infant relationship and poor long-term cognitive and behavioural outcomes for the child. Surprisingly, treatment of maternal symptoms of postnatal depression does not improve the mother-infant relationship for a majority of women. Targeted interventions to improve the mother-infant relationship following postnatal depression are scarce and, of those that exist, the majority are not evaluated in randomised controlled trials. This study aims to evaluate a brief targeted mother-infant intervention, to follow cognitive behavioural therapy treatment of postnatal depression, which has the potential to improve developmental outcomes of children of depressed mothers.Methods/design: The proposed study is a two-arm randomised controlled trial with follow-up to 6 months. One hundred participants will be recruited via referrals from health professionals including maternal and child health nurses and general practitioners, as well as self-referrals from women who have seen promotional materials for the study. Women who meet inclusion criteria (infant aged <12 months, women 18+ years of age) will complete the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-IV-TR Axis I Disorders. Those with a clinical diagnosis of current major or minor depressive disorder and who do not meet exclusion criteria (that is, currently receiving treatment for depression, significant difficulty with English, medium to high suicide risk, current self-harm, current substance abuse, current post-traumatic stress disorder, current manic/hypomanic episode or psychotic symptoms) will be randomised to receive either a 4-session mother-infant intervention (HUGS: Happiness Understanding Giving and Sharing) or a 4-session attention placebo playgroup (Playtime) following a 12-session postnatal depression group treatment programme. Primary outcome measures are the Parenting Stress Index (self-report measure) and the Parent-child Early Relational Assessment (observational measure coded by a blinded observer). Measurements are taken at baseline, after the postnatal depression programme, post-HUGS/Playtime, and at 6 months post-HUGS/Playtime.
DISCUSSION: This research addresses the need for specific treatment for mother-infant interactional difficulties following postnatal depression. There is a need to investigate interventions in randomised trials to prevent detrimental effects on child development and make available evidence-based treatments.Trial registration: Australia and New Zealand Clinical Trials Register: ACTRN12612001110875. Date Registered: 17 October 2012.

PMID: 25277158 [PubMed - as supplied by publisher]

Intimate Partner Violence During Pregnancy: Maternal and Neonatal Outcomes.

Tue, 09/30/2014 - 6:00am

Intimate Partner Violence During Pregnancy: Maternal and Neonatal Outcomes.

J Womens Health (Larchmt). 2014 Sep 29;

Authors: Alhusen JL, Ray E, Sharps P, Bullock L

Abstract
Abstract The effects of intimate partner violence (IPV) on maternal and neonatal outcomes are multifaceted and largely preventable. During pregnancy, there are many opportunities within the current health care system for screening and early intervention during routine prenatal care or during episodic care in a hospital setting. This article describes the effects of IPV on maternal health (e.g., insufficient or inconsistent prenatal care, poor nutrition, inadequate weight gain, substance use, increased prevalence of depression), as well as adverse neonatal outcomes (e.g., low birth weight [LBW]), preterm birth [PTB], and small for gestational age [SGA]) and maternal and neonatal death. Discussion of the mechanisms of action are explored and include: maternal engagement in health behaviors that are considered "risky," including smoking and alcohol and substance use, and new evidence regarding the alteration of the hypothalamic-pituitary-adrenal axis and resulting changes in hormones that may affect LBW and SGA infants and PTB. Clinical recommendations include a commitment for routine screening of IPV in all pregnant women who present for care using validated screening instruments. In addition, the provision of readily accessible prenatal care and the development of a trusting patient-provider relationship are first steps in addressing the problem of IPV in pregnancy. Early trials of targeted interventions such as a nurse-led home visitation program and the Domestic Violence Enhanced Home Visitation Program show promising results. Brief psychobehavioral interventions are also being explored. The approach of universal screening, patient engagement in prenatal care, and targeted individualized interventions has the ability to reduce the adverse effects of IPV and highlight the importance of this complex social disorder as a top priority in maternal and neonatal health.

PMID: 25265285 [PubMed - as supplied by publisher]

Addressing Adolescent Substance Use: Teaching SBIRT and MI to Residents.

Sat, 09/27/2014 - 6:00am

Addressing Adolescent Substance Use: Teaching SBIRT and MI to Residents.

Subst Abus. 2014 Sep 26;:0

Authors: Whittle AE, Buckelew SM, Satterfield JM, Lum PJ, O'Sullivan P

Abstract
ABSTRACT. Background: The American Academy of Pediatrics Committee on Substance Use recommends screening, brief intervention, and referral to treatment (SBIRT) at every adolescent preventive and all appropriate urgent visits. We designed an SBIRT curriculum as part of the adolescent block of a pediatric residency that combined online modules with an in-person workshop, faculty feedback on resident interactions with patients, and resident self-reflection on their motivational interviewing (MI) skills. Methods: To evaluate the curriculum, we measured resident satisfaction and self-reported confidence in using SBIRT and MI with teens using a retrospective pre/post questionnaire. We used qualitative analysis to evaluate the written comments from faculty observations of patient-trainee interactions and comments from residents' self-reflections on patient interactions. Results: Thirty-two residents completed the curriculum. Residents reported high satisfaction with the training. Comparing retrospective pre/post scores on the survey of resident self-reported confidence, measures increased significantly in all domains, including for both alcohol and other drug use. Regarding self-reported MI skillfulness also increased significantly. Analysis of specific faculty feedback to residents revealed subthemes such as normalizing confidentiality and focusing more on the patient's perspectives on substance use. Resident reflections on their own abilities with SBIRT/MI focused on using the ruler tool and on adapting the MI style of shared decision-making. Conclusions: A curriculum that combines online training, small group practice, clinical observations and self-reflection is valued by residents and can increase resident self-reported confidence in using SBIRT and MI in adolescent encounters. Future studies should examine to what extent confidence predicts performance using standardized measures of MI skillfulness in patient encounters.

PMID: 25260121 [PubMed - as supplied by publisher]

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