Research and practice for ultra-high risk for psychosis : a national survey of early intervention in psychosis services in England

Background: Evidence from meta-analyses of randomized clinical trials show interventions for young people at ultra-high risk (UHR) of developing psychosis are effective both clinically and economically. While research evidence has begun to be integrated into clinical guidelines, there is a lack of research on the implementation of these guidelines. This paper examines service provision for UHR individuals in accordance with current clinical guidelines within the National Health Service (NHS) in England. Method: A self-report online survey was completed by clinical leaders of early intervention in psychosis (EIP) teams (N = 50) within the NHS across England. Results: Of the 50 EIP teams responding (from 30 NHS trusts), 53% reported inclusion of the UHR group in their service mandate, with age range predominantly 14 to 35 years (81%) and service provided for at least 12 months (53%). Provision of services according to NICE clinical guidelines showed 50% of services offered cognitive behavioural therapy (CBT) for psychosis, and 42% offered family intervention. Contrary to guidelines, 50% of services offered antipsychotic medication. Around half of services provided training in assessment by Comprehensive Assessment of At Risk Mental States, psycho-education, CBT for psychosis, family work and treatment for anxiety and depression. Conclusions: Despite clear evidence for the benefit of early intervention in this population, current provision for UHR within EIP services in England does not match clinical guidelines. While some argue this is due to a lack of allocated funding, it is important to note the similar variable adherence to clinical guidelines in the treatment of people with established schizophrenia

Towards a model of uncertainty distress in the context of Coronavirus (Covid-19)

The paper forms part of a series of papers outlining the theoretical framework for a new model of uncertainty distress (this paper), treatment implications arising from the model, and empirical tests of the model. We define uncertainty distress as the subjective negative emotions experienced in response to the as yet unknown aspects of a given situation. In the first paper we drawn on a robust body of research on distinct areas including: threat models of anxiety, perceived illness uncertainty and intolerance of uncertainty. We explore how threat and uncertainty are separable in anxiety and how we can understand behaviours in response to uncertainty. Finally, we propose a clinically, theoretically, and empirically informed model for uncertainty distress and outline how this model can be tested. Caveats, clinical applications and practitioner key points are briefly included, although these are more fully outlined in the treatment implications article. While we outline this model in the context of novel coronavirus (Covid-19), the model has broader applications to both mental and physical health care settings

Should we 'hug a hoodie'? Protocol for a systematic review and meta-analysis of interventions with young people not in employment, education or training (so-called NEETs)

Background: Whilst the majority of young people succeed in education and make a positive transition to the world of work and adult life, recent statistics identify that youth comprise 40 of the world's unemployed, equating to nearly 75 million individuals. These numbers are associated with both decreased economic activity and adverse well-being, with accompanying social, health and financial costs. As a result, a wide range of providers have implemented interventions targeting this population; however, their relative effectiveness is unknown. This is exacerbated by a diverse literature base, the delivery of provision and policy across multiple sectors and disparate approaches to programme evaluation. Methods and design: We will undertake a systematic review of interventions targeting youth not in employment, education or training (NEET) populations. Only randomised and non-randomised controlled trials will be included. The objectives of the review will be to: (i) systematically review, synthesise and quality appraise experimental evidence on the effects of interventions with NEET young people, (ii) estimate effects on current NEET status, well-being and other relevant psychological and behavioural outcomes, (iii) investigate potential variation in intervention effects among sub-groups stratified by pre-trial duration of current status, socioeconomic status, gender, sub-classifications of NEET individuals and intervention components (e.g. type, frequency, duration, provider and setting) and (iv) assess the robustness of results in separate sensitivity analyses that exclude studies with higher risk of bias (e.g. in terms of study quality) or follow-up length. A rigorous literature search of English language publications post-1990 will be conducted using the following electronic databases: Medline, Embase, PsycINFO, ERIC, EPPI-Centre (Bibliomap), Social Science Citation Index, British Education Index, Conference Proceedings Index, Dissertation Abstracts, Popline and grey literature collections (e.g. GLADNET). These database searches will be supplemented with hand searching, requests for unpublished literature and website searches. Discussion: A report and executive summary will be developed by the research team with input from consultant stakeholders to aid translation of the findings into practice. The research will be disseminated at national and international conferences and submitted for peer-reviewed publication. © 2014 Oliver et al

Are we failing young people not in employment, education or training (NEETs)? A systematic review and meta-analysis of re-engagement interventions

Background Youth comprise 40% of the world?s unemployed, a status associated with adverse wellbeing and social, health, and economic costs. This systematic review and meta-analysis review synthesises the literature on the effectiveness of interventions targeting young people not in employment, education, or training (NEET). Methods Randomised and quasi-randomised trials with a concurrent or counterfactual control group and baseline equivalence are included. Cochrane collaboration tools are used to assess quality, and a narrative synthesis was undertaken. The primary outcome is employment; secondary outcomes were health, earnings, welfare receipt, and education. Results Eighteen trials are included (9 experimental and 9 quasi-experimental), sample sizes range from 32 to 54,923. Interventions include social skills, vocational, or educational classroom-based training, counselling or one-to-one support, internships, placements, on-the-job or occupational training, financial incentives, case management, and individual support. Meta-analysis of three high-quality trials demonstrates a 4% (CI 0.0?0.7) difference between intervention and control groups on employment. Evidence for other outcomes lacks consistency; however, more intensive programmes increase employment and wages over the longer term. Conclusions There is some evidence that intensive multi-component interventions effectively decrease unemployment amongst NEETs. The quality of current evidence is limited, leaving policy makers under-served when designing and implementing new programmes, and a vulnerable population neglected

A short-form version of the Intolerance of Uncertainty Scale: Initial development of the IUS-5

Intolerance of Uncertainty (IU) is an individual´s "tendency to be bothered or upset by the (as yet) unknown elements of a situation, whether the possible outcome is negative or not." This construct, originally proposed in the context of Generalised Anxiety Disorder (GAD), is now considered a transdiagnostic construct. The Intolerance of Uncertainty Scale (IUS; Freeston, Rhéaume, Letarte, Dugas, & Ladouceur, 1994) has been the gold standard measure for IU, both the original 27-item and the 12-item (IUS-12; Carleton, Norton, & Asmundson, 2007) versions. The present study, conducted in the context of a broader research project about IU and the COVID-pandemic by the UNiCORN team, aims to develop an even shorter version of the IUS, both psychometrically sound and quicker to administer, which would increase its utility in research studies with an elevated number of measures. Initial analyses conducted in currently available data from four countries (UK, Italy, Spain and Greece) suggest that it is possible to reduce the IUS-12 to 5 items, including two items measuring desire for predictability, one item assessing uncertainty paralysis, and two items describing aversiveness of uncertainty. The five-item version of the questionnaire (IUS-5) showed adequate internal consistency across languages (English, Italian, Spanish, Greek) and across situations (e.g., before and during COVID-19), and its total score is highly correlated with the total score of the IUS-12. Overall, preliminary results suggest that the IUS-5 may represent a valid and reliable measure of IU to be used across samples, languages, and countries