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Cheetham A, Arunogiri S, Lubman D. Integrated care – panacea or white elephant? A review of integrated care approaches in Australia over the past two decades. ADVANCES IN DUAL DIAGNOSIS 2023. [DOI: 10.1108/add-10-2022-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose
Integrated care is widely supported as a means of improving treatment outcomes for people with co-occurring mental health and substance use disorders. Over the past two decades, Australian state and federal governments have identified integrated care as a policy priority and invested in a number of research and capacity building initiatives. This study aims to examine Australian research evaluating the effectiveness of integrated treatment approaches to provide insight into implications for future research and practice in integrated treatment.
Design/methodology/approach
This narrative review examines Australian research evaluating empirical evidence of the effectiveness of integrated treatment approaches within specific populations and evidence from initiatives aimed at integrating care at the service or system level.
Findings
Research conducted within the Australian context provides considerable evidence to support the effectiveness of integrated approaches to treatment, particularly for people with high prevalence co-occurring disorders or symptoms of these (i.e. anxiety and depression). These have been delivered through various modalities (including online and telephone-based services) to improve health outcomes in a range of populations. However, there is less evidence regarding the effectiveness of specific models or systems of integrated care, including for more severe mental disorders. Despite ongoing efforts on behalf of the Australian government, attempts to sustain system-level initiatives have remained hampered by structural barriers.
Originality/value
Effective integrated interventions can be delivered by trained clinicians without requiring integration at an organisational or structural level. While there is still considerable work to be done in terms of building sustainable models at a system level, this evidence provides a potential foundation for the development of integrated care models that can be delivered as part of routine practice.
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Ledden S, Rains LS, Schlief M, Barnett P, Ching BCF, Hallam B, Günak MM, Steare T, Parker J, Labovitch S, Oram S, Pilling S, Johnson S. Current state of the evidence on community treatments for people with complex emotional needs: a scoping review. BMC Psychiatry 2022; 22:589. [PMID: 36064337 PMCID: PMC9442944 DOI: 10.1186/s12888-022-04171-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the quality of care in community settings for people with 'Complex Emotional Needs' (CEN-our preferred working term for services for people with a "personality disorder" diagnosis or comparable needs) is recognised internationally as a priority. Plans to improve care should be rooted as far as possible in evidence. We aimed to take stock of the current state of such evidence, and identify significant gaps through a scoping review of published investigations of outcomes of community-based psychosocial interventions designed for CEN. METHODS We conducted a scoping review with systematic searches. We searched six bibliographic databases, including forward and backward citation searching, and reference searching of relevant systematic reviews. We included studies using quantitative methods to test for effects on any clinical, social, and functioning outcomes from community-based interventions for people with CEN. The final search was conducted in November 2020. RESULTS We included 226 papers in all (210 studies). Little relevant literature was published before 2000. Since then, publications per year and sample sizes have gradually increased, but most studies are relatively small, including many pilot or uncontrolled studies. Most studies focus on symptom and self-harm outcomes of various forms of specialist psychotherapy: most result in outcomes better than from inactive controls and similar to other specialist psychotherapies. We found large evidence gaps. Adaptation and testing of therapies for significant groups (e.g. people with comorbid psychosis, bipolar disorder, post-traumatic stress disorder, or substance misuse; older and younger groups; parents) have for the most part only reached a feasibility testing stage. We found little evidence regarding interventions to improve social aspects of people's lives, peer support, or ways of designing effective services. CONCLUSIONS Compared with other longer term mental health problems that significantly impair functioning, the evidence base on how to provide high quality care for people with CEN is very limited. There is good evidence that people with CEN can be helped when specialist therapies are available and when they are able to engage with them. However, a much more methodologically robust and substantial literature addressing a much wider range of research questions is urgently needed to optimise treatment and support across this group.
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Affiliation(s)
- Sarah Ledden
- Division of Psychiatry, University College London, London, UK
| | - Luke Sheridan Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Merle Schlief
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK.
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Brian Chi Fung Ching
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Brendan Hallam
- Division of Psychiatry, University College London, London, UK
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Mia Maria Günak
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Thomas Steare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Jennie Parker
- NIHR Mental Health Policy Research Unit Co-Production Group, University College London, London, UK
| | - Sarah Labovitch
- NIHR Mental Health Policy Research Unit Co-Production Group, University College London, London, UK
- West London NHS Trust, London, UK
| | - Sian Oram
- NIHR Mental Health Policy Research Unit, Department of Health Service and Population Research, King's College London, London, UK
| | - Steve Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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A Single-Case Series Trial of Emotion-Regulation and Relationship Safety Intervention for Youth Affected by Sexual Exploitation. PSYCH 2022. [DOI: 10.3390/psych4030037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Child sexual exploitation (CSE) is a significant global problem. Interventions implemented with youth affected by CSE frequently target singular adjacent issues (e.g., substance misuse or running away); however, research indicates these interventions are most efficacious when they simultaneously treat CSE sequelae (e.g., emotion dysregulation) paired with relationship skill-building; yet few such interventions exist. Furthermore, the evidence-based reports on CSE research currently lacks rigorous research methods, such as the use of validated measures and the provision of robust outcome data. The current study aimed to implement a combined emotion regulation and safe-relationships intervention (ERIC + YR: emotion regulation, impulse control and ‘your relationships’) in a community service providing outreach for young women affected by CSE. A randomised single-case series design was used to test the effects of ERIC + YR on emotion regulation strategies, psychological wellbeing, relationship safety knowledge and behaviours, across repeated measurements for young women affected by CSE (N = 2; Mage = 18.00). Phase A consisted of baseline measures for two to three weeks. Phase B consisted of 8-sessions of ERIC + YR delivered across three to six weeks by practitioners who had undertaken ERIC + YR training. Data collection included pre/post intervention measures as well as a daily questionnaire delivered via a smartphone application. While results showed clinically significant and reliable improvements in psychological wellbeing, no other outcome measures showed change between pre and post-intervention. The current study contributes to the evidence-base as an initial step in illuminating how an empirically driven intervention can be delivered as an adjunctive treatment for youth affected by CSE. Implications inform the current evidence-base, with future directions for intervention research discussed.
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Moore R, Gillanders D, Stuart S. The Impact of Group Emotion Regulation Interventions on Emotion Regulation Ability: A Systematic Review. J Clin Med 2022; 11:jcm11092519. [PMID: 35566645 PMCID: PMC9105582 DOI: 10.3390/jcm11092519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 02/04/2023] Open
Abstract
Emotional regulation (ER) as a concept is not clearly defined, and there is a lack of clarity about how individuals can improve their ability to regulate emotions. Nevertheless, there is increasing evidence of the importance of ER as a transdiagnostic treatment target across mental health problems. This review examines the impact of ER group interventions on ER ability compared with no intervention, other comparable group interventions, or control conditions. A systematic review was conducted, in which 15 studies were included. Although types of ER intervention were mixed, the interventions had a considerable overlap in skills taught and how ER was measured. In all but one study, the ER intervention improved ER ability. ER interventions were superior to waitlist or treatment as usual, but there was limited evidence to suggest they were superior to other active treatments. Data from some studies suggest that improved ER was sustained at follow-up. Across the studies, there was generally poor linking of theory to practice, which hampers understanding of how interventions were constructed and why different skills were included. Although the results need to be interpreted with caution due to issues with methodological quality with the included papers, there is promising evidence that ER group interventions significantly improve ER ability.
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Affiliation(s)
- Rebekah Moore
- NHS Greater Glasgow and Clyde, Glasgow Psychological Trauma Service, Festival Business Centre, 150 Brand Street, Glasgow G51 1DH, UK
- Correspondence:
| | - David Gillanders
- School of Health in Social Science, Elsie Inglis Quad, Teviot Place, University of Edinburgh, Edinburgh EH8 9AG, UK;
| | - Simon Stuart
- NHS Lanarkshire, Hunter Health Centre, Andrew Street, East Kilbride G74 1AD, UK;
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Mattingley S, Youssef GJ, Manning V, Graeme L, Hall K. Distress tolerance across substance use, eating, and borderline personality disorders: A meta-analysis. J Affect Disord 2022; 300:492-504. [PMID: 34986376 DOI: 10.1016/j.jad.2021.12.126] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/08/2021] [Accepted: 12/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Distress tolerance (DT) has received increased attention in recent years due to its purported role in dysregulated behaviours and their clinical manifestations, such as problematic substance use (PSU), disordered eating behaviours (e.g., binge-eating and purging; DEB), and borderline personality disorder (BPD) symptomatology. Despite the proposed transdiagnostic utility of DT across PSU, DEB, and BPD, there has yet to be a systematic and comprehensive examination characterising and comparing its association with this class of impulsive-type psychopathology. METHODS A systematic search was conducted across five electronic databases using search terms designed to capture extant literature on the association between DT and PSU, DEB, and BPD symptomatology. A series of meta-analyses were undertaken on correlation coefficients from 81 studies to examine the association between DT and each psychopathology domain, as well as impulsive-type psychopathology overall. Moderator analyses were conducted to examine whether these relationships were moderated by DT measurement type, sample type, age, and gender. RESULTS DT shared significant, negative, medium correlations with PSU (r = -.18,), DEB (r = -.20), and BPD symptomatology (r = -.27). The magnitude of these associations was not significantly different across the three psychopathology domains, supporting transdiagnostic conceptualisation. DT measurement type, age, and sample type moderated several of these indicated relationships. LIMITATIONS The majority of studies were conducted in adult samples from Western countries, limiting understanding of these relationships across development and different cultures. CONCLUSIONS The present findings support the putative transdiagnostic role of DT across PSU, DEB, and BPD, which may ultimately inform novel, cross-cutting interventions.
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Affiliation(s)
| | - George J Youssef
- Deakin University, Geelong, Australia, School of Psychology; Centre for Drug Use, Addictive, and Anti-social Behaviour Research (CEDAAR), Deakin University, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Victoria Manning
- Monash Addiction Research Centre (MARC), Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia
| | - Liam Graeme
- Deakin University, Geelong, Australia, School of Psychology
| | - Kate Hall
- Deakin University, Geelong, Australia, School of Psychology; Centre for Drug Use, Addictive, and Anti-social Behaviour Research (CEDAAR), Deakin University, Australia.
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Hall K, Youssef G, Simpson A, Sloan E, Graeme L, Perry N, Moulding R, Baker AL, Beck AK, Staiger PK. An Emotion Regulation and Impulse Control (ERIC) Intervention for Vulnerable Young People: A Multi-Sectoral Pilot Study. Front Psychol 2021; 12:554100. [PMID: 33868064 PMCID: PMC8047628 DOI: 10.3389/fpsyg.2021.554100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 03/08/2021] [Indexed: 01/01/2023] Open
Abstract
Objective: There is a demonstrated link between the mental health and substance use comorbidities experienced by young adults, however the vast majority of psychological interventions are disorder specific. Novel psychological approaches that adequately acknowledge the psychosocial complexity and transdiagnostic needs of vulnerable young people are urgently needed. A modular skills-based program for emotion regulation and impulse control (ERIC) addresses this gap. The current one armed open trial was designed to evaluate the impact that 12 weeks exposure to ERIC alongside usual care had on young people's ability to regulate emotions, as well as examine potential moderating mechanisms. Methods: Seventy nine young people (50.6% male; M = 19.30; SD = 2.94) were enrolled to the 12 week intervention period. Twenty one practitioners from youth and community health services delivered relevant ERIC modules adjunct to usual care. Linear mixed effects regression (with random intercept) was used to examine change over time across the primary outcome of emotion dysregulation and secondary outcomes of depression, anxiety, stress, experiential avoidance and mindfulness. Moderation analyses were conducted to test whether the magnitude of change in emotion dysregulation moderated change over time in secondary outcomes. Results: Analyses revealed significant improvement in the primary outcome of emotion dysregulation with a moderate effect size (Mean Change = -10.24, 95% CI (-14.41, -6.06; Cohen's dav = -0.53), in addition to decreases in the secondary outcomes of depression, anxiety, stress and experiential avoidance. No improvements in mindfulness were reported. Moderation analyses revealed that the residualised change over time in emotion dysregulation moderated the change over time in symptoms of distress, depression, anxiety, stress, experiential avoidance, and mindfulness. Conclusion: Reductions in the severity of emotion dysregulation, depression, anxiety, stress and experiential avoidance are promising, and were evident despite the complexity of the participants and the diversity of the service setting. The improvements found in each outcome were only observed for those young people whose emotion regulation also improved, providing preliminary evidence for the role of emotion regulation as a key treatment target in this population.
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Affiliation(s)
- Kate Hall
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
| | - George Youssef
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Angela Simpson
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
| | - Elise Sloan
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
| | - Liam Graeme
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Natasha Perry
- School of Medicine and Public Health (Psychiatry), University of Newcastle, Newcastle, NSW, Australia
| | - Richard Moulding
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health (Psychiatry), University of Newcastle, Newcastle, NSW, Australia
| | - Alison K. Beck
- School of Medicine and Public Health (Psychiatry), University of Newcastle, Newcastle, NSW, Australia
| | - Petra K. Staiger
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
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Rehm IC, Staiger PK. Emotion regulation and psychopathology: Current understanding and new directions. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Imogen C. Rehm
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia,
| | - Petra K. Staiger
- School of Psychology, Deakin University, Geelong, Australia,
- Deakin Centre for Drug Use, Addictive and Anti‐Social Behaviour Research (CEDAAR), Deakin University, Geelong, Australia,
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