Behavioral Intervention

A BOUT 8 MILLION INDIVIDUALS IN the United States currently meet diagnostic criteria for alcohol dependence, a leading preventable cause of morbidity and mortality and a major contributor to health care costs. In primary care settings, the prevalence of alcohol use disorders ranges from 20% to 36% 5 ; most of those patients are never treated and, if they are ).

Observational studies indicate that psychologic factors strongly influence the course of coronary artery disease (CAD). In this review, we examine new epidemiologic evidence for the association between psychosocial risk factors and CAD, identify pathologic mechanisms that may be responsible for this association, and describe a paradigm for studying positive psychologic factors that may act as a buffer. Because psychosocial risk factors are highly prevalent and are associated with unhealthy lifestyles, we describe the potential role of cardiologists in managing such factors. Management approaches include routinely screening for psychosocial risk factors, referring patients with severe psychologic distress to behavioral specialists, and directly treating patients with milder forms of psychologic distress with brief targeted interventions. A number of behavioral interventions have been evaluated for their ability to reduce adverse cardiac events among patients presenting with psychosocial risk factors. Although the efficacy of stand-alone psychosocial interventions remains unclear, both exercise and multifactorial cardiac rehabilitation with psychosocial interventions have demonstrated a reduction in cardiac events. Furthermore, recent data suggest that psychopharmacologic interventions may also be effective. Despite these promising findings, clinical practice guidelines for managing psychosocial risk factors in cardiac practice are lacking. Thus, we review new approaches to improve the delivery of behavioral services and patient adherence to behavioral recommendations. These efforts are part of an emerging field of behavioral cardiology, which is based on the understanding that psychosocial and behavioral risk factors for CAD are not only highly interrelated, but also require a sophisticated health care delivery system to optimize their effectiveness. (J Am Coll Cardiol 2005;45:637-51)

The purpose of this research was to update the Pelham and Fabiano (2008) review of evidence-based practices for children and adolescents with attention-deficit=hyperactivity disorder. We completed a systematic review of the literature published between 2007 and 2013 to establish levels of evidence for psychosocial treatments for these youth. Our review included the identification of relevant articles using criteria established by the Society of Clinical Child and Adolescent Psychology (see Southam-Gerow & Prinstein, in press) using keyword searches and a review of tables of contents. We extend the conceptualization of treatment research by differentiating training interventions from behavior management and by reviewing the growing literature on training interventions. Consistent with the results of the previous review we conclude that behavioral parent training, behavioral classroom management, and behavioral peer interventions are well-established treatments. In addition, organization training met the criteria for a well-established treatment. Combined training programs met criteria for Level 2 (Probably Efficacious), neurofeedback training met criteria for Level 3 (Possibly Efficacious), and cognitive training met criteria for Level 4 (Experimental Treatments). The distinction between behavior management and training interventions provides a method for considering meaningful differences in the methods and possible mechanisms of action for treatments for these youth. Characteristics of treatments, participants, and measures, as well as the variability in methods for classifying levels of evidence for treatments, are reviewed in relation to their potential effect on outcomes and conclusions about treatments. Implications of these findings for future science and practice are discussed. 1 The terms treatment and intervention are used synonymously throughout the article.

Introduction: Behavioral science provides the foundation for physical activity interventions. The mediating variable framework is used to assess the status of physical activity interventions and the roles that are, or could be played, by behavioral theory.

reviewed the treatment literature on attention-deficit=hyperactivity disorder (ADHD) and concluded behavioral parent training (BPT) and behavioral classroom management (BCM) were well-established treatments for children with ADHD. This review updates and extends the finding of the prior review. Studies conducted since the 1998 review were identified and coded based on standard criteria, and effect sizes were calculated where appropriate. The review reinforces the conclusions of Pelham, Wheeler, and Chronis regarding BPT and BCM. Further, the review shows that intensive peer-focused behavioral interventions implemented in recreational settings (e.g., summer programs) are also well-established. The results of this update are discussed in the context of the existing treatment literature on ADHD. Implications for practice guidelines are suggested, as are directions for future research.

indicating dementia) had to be present or presumed in at least 80% of the subjects. Evidence tables, meta-analysis and summaries of results were elaborated by the first author and reviewed by author subgroups. Methods for rating level of evidence and grading practice recommendations were adapted from the Oxford Center for Evidence-Based Medicine. Results: Grade A treatment recommendation was achieved for institutionalization delay (multicomponent interventions for the caregiver, CG). Grade B recommendation was reached for the person with dementia (PWD) for: improvement in cognition (cognitive training, cognitive stimulation, multicomponent interventions for the PWD); activities of daily living (ADL) (ADL training, multicomponent interventions for the PWD); behavior (cognitive stimulation, Abstract Introduction: Nonpharmacological therapies (NPTs) can improve the quality of life (QoL) of people with Alzheimer's disease (AD) and their carers. The objective of this study was to evaluate the best evidence on the effects of NPTs in AD and related disorders (ADRD) by performing a systematic review and meta-analysis of the entire field. Methods: Existing reviews and major electronic databases were searched for randomized controlled trials (RCTs). The deadline for study inclusion was September 15, 2008. Intervention categories and outcome domains were predefined by consensus. Two researchers working together detected 1,313 candidate studies of which 179 RCTs belonging to 26 intervention categories were selected. Cognitive deterioration had to be documented in all participants, and degenerative etiology principal author: J.O.

Self-management has become a popular term for behavioral interventions as well as for healthful behaviors. This is especially true for the management of chronic conditions. This article offers a short history of self-management. It presents three self-management tasks—medical management, role management, and emotional management—and six self-management skills—problem solving, decision making, resource utilization, the formation of a patient-provider partnership, action planning, and self-tailoring. In addition, the article presents evidence of the effectiveness of self-management interventions and posits a possible mechanism, self-efficacy, through which these interventions work. In conclusion the article discusses problems and solutions for integrating self-management education into the mainstream health care systems.

Increasing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity. Obes Res. 2001;9:171-178. Objective: The goal of this study was to evaluate the effect of a parent-focused behavioral intervention on parent and child eating changes and on percentage of overweight changes in families that contain at least one obese parent and a non-obese child.

This paper reviews the evidence regarding the efficacy of behavioral treatments for bedtime problems and night wakings in young children. It is based on a review of 52 treatment studies by a task force appointed by the American Academy of Sleep Medicine to develop practice parameters on behavioral treatments for the clinical management of bedtime problems and night wakings in young children. The findings indicate that behavioral therapies produce reliable and durable changes. Across all studies, 94% report that behavioral interventions were efficacious, with over 80% of children treated demonstrating clinically significant improvement that was maintained for 3 to 6 months. In particular, empirical evidence from controlled group studies utilizing Sackett criteria for evidence-based treatment provides strong support for unmodified extinction and preventive parent education. In addition, support is provided for graduated extinction, bedtime fading/positive routines, and scheduled awake...

Biological, psychological, behavioral, and social factors are unable to fully explain or curtail the obesity epidemic. In this article we review research on the influence of the built environment on obesity. Studies were evaluated with regard to their methods of assessing the environment and obesity, as well as to their effects. Methods used to investigate the relationships between the built environment and obesity were found to be dissimilar across studies and varied from indirect to direct. Levels of assessment between and within studies varied from entire counties down to the individual level. Despite this, obesity was linked with area of residence, resources, television, walkability, land use, sprawl, and level of deprivation, showing promise for research utilizing more consistent assessment methods. Recommendations were made to use more direct methods of assessing the environment, which would include specific targeting of institutions thought to vary widely in relation to area characteristics and have a more influential effect on obesity-related behaviors. Interventions should be developed from the individual to the neighborhood level, specifically focusing on the effects of eliminating barriers and making neighborhood level improvements that would facilitate the elimination of obesogenic environments.

Background and objectives: Sexual behavior following voluntary HIV counseling and testing (VCT) is described in 963 cohabiting heterosexual couples with one HIV positive and one HIV negative partner ('discordant couples'). Biological markers were used to assess the validity of self-report.

A randomized comparison of group cognitive-behavioural therapy and group psychoeducation in patients with schizophrenia Bechdolf A, Knost B, Kuntermann C, Schiller S, Klosterko¨tter J, Hambrecht M, Pukrop R. A randomized comparison of group cognitive-behavioural therapy and group psychoeducation in patients with schizophrenia.

Cognitive-behavioral interventions are the most extensively researched form of psychological treatment and are increasingly offered through the Internet. Internetbased interventions may save therapist time, reduce waiting-lists, cut traveling time, and reach populations with health problems who can not easily access other more traditional forms of treatments. We conducted a systematic review of twelve randomized controlled or comparative trials. Studies were identified through systematic searches in major bibliographical databases. Three studies focused on patients suffering from pain, three on headache, and six on other health problems. The effects found for Internet interventions targeting pain were comparable to the effects found for face-to-face treatments, and the same was true for interventions aimed at headache. The other interventions also showed some effects, although effects differed across target conditions. Internet-delivered cognitivebehavioral interventions are a promising addition and complement to existing treatments. The Internet will most likely assume a major role in the future delivery of cognitive-behavioral interventions to patients with health problems.

To determine whether initial effects on metabolic control and quality of life associated with a behavioral intervention combined with intensive diabetes management (IDM) can be sustained over 1 year in youth implementing intensive therapy regimens. Study design: Seventy-seven patients (43 females, 95% white) 12 to 20 years (mean = 14.2 ± 1.9; duration, 8.7 ± 3.9) electing to initiate IDM were randomly assigned to one of two groups: with or without coping skills training (CST), which consists of 6 small group sessions and monthly follow-up to help youth cope with their lives in the context of diabetes management; skills included social problem solving, cognitive behavior modification, and conflict resolution. Data were collected before the intervention and at 3, 6, and 12 months after the intervention by using the Self-Efficacy for Diabetes Scale, Children's Depression Inventory, Issues in Coping with IDDM, and the Diabetes Quality of Life: Youth scales. Clinical data (glycosylated hemoglobin level, height, weight, adverse effects) were collected monthly. Results: The CST and IDM groups were comparable at baseline. CST subjects had lower glycosylated hemoglobin (P = .001) and better diabetes (P = .002) and medical (P = .04) self-efficacy, and less impact of diabetes on their quality of life (P = .005) than youth receiving IDM alone after 1 year. In males, CST did not affect adverse outcomes of IDM hypoglycemia, diabetic ketoacidosis, and weight gain, but CST decreased the incidence of weight gain (P = .05) and hypoglycemia in females (P = .03).

The FMR1 mutations can cause a variety of disabilities, including cognitive deficits, attention-deficit/ hyperactivity disorder, autism, and other socioemotional problems, in individuals with the full mutation form (fragile X syndrome) and distinct difficulties, including primary ovarian insufficiency, neuropathy and the fragile X-associated tremor/ataxia syndrome, in some older premutation carriers. Therefore, multigenerational family involvement is commonly encountered when a proband is identified with a FMR1 mutation. Studies of metabotropic glutamate receptor 5 pathway antagonists in animal models of fragile X syndrome have demonstrated benefits in reducing seizures, improving behavior, and enhancing cognition. Trials of metabotropic glutamate receptor 5 antagonists are beginning with individuals with fragile X syndrome. Targeted treatments, medical and behavioral interventions, genetic counseling, and family supports are reviewed here.

This study evaluated the effectiveness of a 7-month cognitive behavioral intervention for the facilitation of the social-emotional understanding and social interaction of 15 high-functioning children (8 to 17 years old) with autism. Intervention focused on teaching interpersonal problem solving, affective knowledge, and social interaction. Preintervention and postintervention measures included observations of social interaction, measures of problem solving and of emotion understanding, and teacher-rated social skills. Results demonstrated progress in three areas of intervention. Children were more likely to initiate positive social interaction with peers after treatment; in particular, they improved eye contact and their ability to share experiences with peers and to show interest in peers. In problem solving after treatment, children provided more relevant solutions and fewer nonsocial solutions to different social situations. In emotional knowledge, after treatment, children provi...

effect size, 0.40-1.10). Three-year follow-up analyses of MBSR participants indicated sustained benefits for these same measures (effect size, 0.50-0.65). Conclusions: Based upon a quasi-randomized trial and long-term observational follow-up, results indicate mindfulness intervention to be of potential long-term benefit for female fibromyalgia patients.

Lyles et al. | Peer Reviewed | Research and Practice | 133  RESEARCH AND PRACTICE  Objectives. The Centers for Disease Control and Prevention's HIV/AIDS Prevention Research Synthesis Team conducted a systematic review of US-based HIV behavioral intervention research literature from 2000 through 2004 to identify interventions demonstrating best evidence of efficacy for reducing HIV risk.

In 2002, the Society of Behavioral Medicine's special interest group on Multiple Health Behavior Change was formed. The group focuses on the interrelationships among health behaviors and interventions designed to promote change in more than one health behavior at a time. Growing evidence suggests the potential for multiple-behavior interventions to have a greater impact on public health than single-behavior interventions. However, there exists surprisingly little understanding of some very basic principles concerning multiple health behavior change (MHBC) research. This paper presents the rationale and need for MHBC research and interventions, briefly reviews the research base, and identifies core conceptual and methodological issues unique to this growing area. The prospects of MHBC for the health of individuals and populations are considerable.

Children with autism exhibit significant deficits in imitation skills which impede the acquisition of more complex behaviors and socialization, and are thus an important focus of early intervention programs for children with autism. This study used a multiple-baseline design across five young children with autism to assess the benefit of a naturalistic behavioral technique for teaching object imitation. Participants increased their imitation skills and generalized these skills to novel environments. In addition, participants exhibited increases in other social-communicative behaviors, including language, pretend play, and joint attention. These results provide support for the effectiveness of a naturalistic behavioral intervention for teaching imitation and offer a new and potentially important treatment option for young children who exhibit deficits in social-communicative behaviors.

Technology-based self-help and minimal contact therapies have been proposed as effective and low-cost interventions for addictive disorders, such as nicotine, alcohol, and drug abuse and addiction. The present article reviews the literature published before 2010 on computerized treatments for drug and alcohol abuse and dependence and smoking addiction. Treatment studies are examined by disorder as well as amount of therapist contact, ranging from self-administered therapy and predominantly self-help interventions to minimal contact therapy where the therapist is actively involved in treatment but to a lesser degree than traditional therapy and predominantly therapist-administered treatments involving regular contact with a therapist for a typical number of sessions. In the treatment of substance use and abuse it is concluded that selfadministered and predominantly self-help computer-based cognitive and behavioral interventions are efficacious, but some therapist contact is important for greater and more sustained reductions in addictive behavior.

Insomnia is a pervasive problem for many patients suffering from medical and psychiatric conditions. Even when the comorbid disorders are successfully treated, insomnia often fails to remit. In addition to compromising quality of life, untreated insomnia may also aggravate and complicate recovery from the comorbid disease. Cognitive behavior therapy for insomnia (CBT-I) has an established efficacy for primary insomnia, but less is known about its efficacy for insomnia occurring in the context of medical and psychiatric conditions. The purpose of this article is to present a rationale for using CBT-I in medical and psychiatric disorders, review the extant outcome literature, highlight considerations for adapting CBT-I procedures in specific populations, and suggest directions for future research. Outcome studies were identified for CBT-I in mixed medical and psychiatric conditions, cancer, chronic pain, HIV, depression, posttraumatic stress disorder, and alcoholism. Other disorders discussed include: bipolar disorder, eating disorders, generalized anxiety, and obsessive compulsive disorder. The available data demonstrate moderate to large treatment effects (Cohen's d, range = 0.35-2.2) and indicate that CBT-I is a promising treatment for individuals with medical and psychiatric comorbidity. Although the literature reviewed here is limited by a paucity of randomized, controlled studies, the available data suggest that by improving sleep, CBT-I might also indirectly improve medical and psychological endpoints. This review underscores the need for future research to test the efficacy of adaptations of CBT-I to disease specific conditions and symptoms. D

Methods. This randomized controlled trial examined effects of the 8-week MBSR intervention on depressive symptoms in 91 women with fibromyalgia who were randomly assigned to treatment (n ‫؍‬ 51) or a waiting-list control group (n ‫؍‬ 40). Eligible patients were at least 18 years old, willing to participate in a weekly group, and able to provide physician verification of a fibromyalgia diagnosis. Of 166 eligible participants who responded to local television news publicizing, 49 did not appear for a scheduled intake, 24 enrolled but did not provide baseline data, and 2 were excluded due to severe mental illness, leaving 91 participants. The sample averaged 48 years of age and had 14.7 years of education. The typical participant was white, married, and employed. Patients randomly assigned to treatment received MBSR. Eight weekly 2.5-hour sessions were led by a licensed clinical psychologist with mindfulness training. Somatic and cognitive symptoms of depression were assessed using the Beck Depression Inventory administered at baseline, immediately postprogram, and at followup 2 months after the conclusion of the intervention. Results. Change in depressive symptoms was assessed using slopes analyses of intervention effects over time. Depressive symptoms improved significantly in treatment versus control participants over the 3 assessments. Conclusion. This meditation-based intervention alleviated depressive symptoms among patients with fibromyalgia.

A 3-part comprehensive synthesis of the early intensive behavioral intervention (EIBI) for young children with autism based on the University of California at Los Angeles Young Autism Project method (Lovaas in Journal of Consulting and Clinical Psychology, 55, 3-9, 1987) is presented. The three components of the synthesis were: (a) descriptive analyses, (b) effect size analyses, and (c) a meta-analysis. The findings suggest EIBI is an effective treatment, on average, for children with autism. The conditions under which this finding applies and the limitations and cautions that must be taken when interpreting the results are discussed within the contextual findings of the moderator analyses conducted in the meta-analysis. I 2 = Q/(df -1)/(Q/df) Q = Rw i (ES i -ES) 2 df = Degrees of freedom = (n -1) J Autism Dev Disord (2009) 39:23-41 27

An intervention group (n ϭ 23) of preschool children with autism was identified on the basis of parent preference for early intensive behavioral intervention and a comparison group (n ϭ 21) identified as receiving treatment as usual. Prospective assessment was undertaken before treatment, after 1 year of treatment, and again after 2 years. Groups did not differ on assessments at baseline but after 2 years, robust differences favoring intensive behavioral intervention were observed on measures of intelligence, language, daily living skills, positive social behavior, and a statistical measure of best outcome for individual children. Measures of parental well-being, obtained at the same three time points, produced no evidence that behavioral intervention created increased problems for either mothers or fathers of children receiving it.

There is increasing international interest in intensive home-based behavioral intervention for children with autism. In the present study, 141 UK parents conducting such interventions completed a questionnaire addressing issues of stress, coping, and support. Regression analyses showed that parents' stress levels were predicted mainly by psychological rather than demographic variables. In particular, adaptive coping strategies, informal social support sources, and beliefs about the efficacy of the intervention were associated with lower reported stress and higher levels of autism symptomatology were associated with higher reported stress. There was also evidence that the use of Passive Appraisal coping and beliefs about the efficacy of the interventions moderated the effects of autism symptomatology on parents' pessimism. Implications of these findings for future research and for the support of families engaged in intensive home-based behavioral intervention are discussed.

Introduction: Media-based physical activity interventions include a variety of print, graphic, audiovisual, and broadcast media programs intended to influence behavior change. New information technology allows print to be delivered in personalized, interactive formats that may enhance efficacy. Media-based interventions have been shaped by conceptual models from health education, Social Cognitive Theory, the Transtheoretical Model, and Social Marketing frameworks.

The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial is a randomized, controlled, single-masked trial designed to determine whether cognitive training interventions (memory, reasoning, and speed of information processing), which have previously been found to be successful at improving mental abilities under laboratory or small-scale field conditions, can affect cognitively based measures of daily functioning. Enrollment began during 1998; 2-year follow-up will be completed by January 2002. Primary outcomes focus on measures of cognitively demanding everyday functioning, including financial management, food preparation, medication use, and driving. Secondary outcomes include health-related quality of life, mobility, and health-service utilization. Trial participants (n = 2832) are aged 65 and over, and at entry into the trial, did not have significant cognitive, physical, or functional decline. Because of its size and the carefully developed rigor, ACTIVE may serve as a guide for future behavioral medicine trials of this nature.

Purpose: To review adolescent sexual risk-reduction programs that were evaluated using quasi-experimental or experimental methods and published in the 1990s. We describe evaluated programs and identify program and evaluation issues for health educators and researchers.

Objective: The Research Triangle Institute-University of North Carolina Evidence Based Practice Center (RTI-EPC) systematically reviewed evidence on efficacy of treatment for binge eating disorder (BED), harms associated with treatments, factors associated with treatment efficacy, and differential outcome by sociodemographic characteristics.

... were determined every month, using rate data that were standardized across schools of different sizes into a measure ... about the sequences of interactions between teachers and students leading to the child being sent out of the classroom, either to the principal's office or to ...

Objective: The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) systematically reviewed evidence on efficacy of treatment for anorexia nervosa (AN), harms associated with treatments, factors associated with treatment efficacy, and differential outcome by sociodemographic characteristics.

Background-The increasing prevalence of overweight and obesity underscore the need for evidence-based, easily disseminable interventions for weight management that can be delivered on a population basis. The Transtheoretical Model (TTM) offers a promising theoretical framework for multiple behavior weight management interventions.

Sensation seeking, anxiety sensitivity, and hopelessness are personality risk factors for alcohol use disorders, each associated with specific risky drinking motives in adolescents. We developed a set of interventions and manuals that were designed to intervene at the level of personality risk and associated maladaptive coping strategies, including alcohol misuse. Manuals contained psychoeducational information on the target personality risk factor and how it is associated with maladaptive coping, as well as exercises targeting maladaptive cognitions and behaviors specific to each personality type. We tested the efficacy of these novel interventions on reducing drinking behavior by randomly assigning 297 Canadian high school students (56% girls, mean age 16, mean grade 11) to personality-targeted interventions (group format; 2 sessions) or to a no-treatment control group. Intent-to-treat analyses indicated beneficial effects of the intervention and Intervention × Personality interactions on drinking rates, drinking quantity, binge drinking, and problem drinking symptoms at 4-month follow-up.

The CDATE project coded studies of treatment/intervention programs in prison, jail, probation, or parole settings reported from 1968 through 1996. Meta-analyses were conducted on the 69 primary research studies on the effectiveness of behavioral and cognitive-behavioral treatment in reducing recidivism for offenders. Results on this heterogeneous collection of studies show that this treatment is associated with reduced recidivism rates. However, this effect is mainly due to cognitive-behavioral interventions rather than to standard behavior modification approaches. The specific types of programs shown to be effective include cognitive-behavioral social skills development programs and cognitive skills (Reasoning and Rehabilitation) programs.

sphere areas typically engaged in tasks of reading (Adair 1 Georgetown University Medical Center et al., 2000) and comprehension (Musso et al., 1999). 4000 Reservoir Road Another pattern of plasticity was reported by Small and Building D, Suite 150 colleagues, who found a shift from the left inferior pari-Washington, District of Columbia 20057 etal cortex to the left fusiform gyrus in a patient following 2 Wake Forest University Medical Center phonologically based reading intervention 17 years after at Bowman Gray her stroke (Small et al., 1998). In contrast, studies of Winston-Salem, North Carolina 27157 developmental dyslexia in children who received phonologically based reading remediation have demonstrated that reading improvement is associated with the "nor-Summary malization" of previously underactivated left hemisphere brain regions (Aylward et al., 2003; Richards et al., 2000; Brain imaging studies have explored the neural mech-Shaywitz et al., 2004; Simos et al., 2002)

The increasing demand for treatment for cannabis dependence in Australia and internationally has led to the identification of significant gaps in knowledge of effective interventions. A randomized controlled trial of brief cognitive -behavioral interventions (CBT) for cannabis dependence was undertaken to address this issue. A total of 229 participants were assessed and randomly assigned to either a six-session CBT program (6CBT), a single-session CBT intervention (1CBT), or a delayed-treatment control (DTC) group. Participants were assisted in acquiring skills to promote cannabis cessation and maintenance of abstinence. Participants were followed-up a median of 237 days after last attendance. Participants in the treatment groups reported better treatment outcomes than the DTC group. They were more likely to report abstinence, were significantly less concerned about their control over cannabis use, and reported significantly fewer cannabis-related problems than those in the DTC group. Those in the 6CBT group also reported more significantly reduced levels of cannabis consumption than the DTC group. While the therapist variable had no effect on any outcome, a secondary analysis of the 6CBT and 1CBT groups showed that treatment compliance was significantly associated with decreased dependence and cannabis-related problems. This study supports the attractiveness and effectiveness of individual CBT interventions for cannabis use disorders and the need for multisite replication trials. D 0740-5472/01/$ -see front matter D 2001 Elsevier Science Inc. All rights reserved. PII: S 0 7 4 0 -5 4 7 2 ( 0 1 ) 0 0 1 7 9 -9

Although schools can improve children's access to mental health services, not all school-based providers are able to successfully deliver evidence-based practices. Indeed, even when school clinicians are trained in evidence-based practices (EBP), the training does not necessarily result in the implementation of those practices. This study explores factors that influence implementation of a particular EBP, Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Semi-structured telephone interviews with 35 site administrators and clinicians from across the United States were conducted 6-18 months after receiving CBITS training to discuss implementation experiences. The implementation experiences of participants differed, but all reported similar barriers to implementation. Sites that successfully overcame such barriers differed from their unsuccessful counterparts by having greater organizational structure for delivering school services, a social network of other clinicians implementing CBITS, and administrative support for implementation.

HIV is frequently transmitted in the context of partners in a committed relationship, thus couplesfocused HIV prevention interventions are a potentially promising modality for reducing infection. We conducted a systematic review of studies testing whether couples-focused behavioral prevention interventions reduce HIV transmission and risk behavior. We included studies using randomized controlled trial designs, quasi-randomized controlled trials and nonrandomized controlled studies. We searched five electronic databases and screened 7628 records. Six studies enrolling 1,084 couples met inclusion criteria and were included in this review. Results across studies consistently indicated that couples-focused programs reduced unprotected sexual intercourse and increased condom use compared with control groups. However, studies were heterogeneous in population, type of intervention, comparison groups, and outcomes measures, and so meta-analysis to calculate pooled effects was inappropriate. Although couples-based approaches to HIV prevention appear initially promising, additional research is necessary to build a stronger theoretical and methodological basis for couples-based HIV prevention, and future interventions must pay closer attention to homosexual couples, adolescents and young people in relationships.

Recent research elucidates many aspects of the problem of co-occurring substance use disorder (SUD) in patients with severe mental illness, which is often termed dual diagnosis. This paper provides a brief overview of cur- rent research on the epidemiology, adverse conse- quences, and phenomenology of dual diagnosis, followed by a more extensive review of current approaches to ser- vices, assessment,

Clinical research and public policy reviews that have emerged in the past several years now make it possible to estimate the cost±bene®ts of early intervention for infants, toddlers, and preschoolers with autism or pervasive development disorderÐnot otherwise speci®ed (PDDÐNOS). Research indicates that with early, intensive intervention based on the principles of applied behavior analysis, substantial numbers of children with autism or PDDÐNOS can attain intellectual, academic, communication, social, and daily living skills within the normal range. Representative costs from Pennsylvania, including costs for educational and adult developmental disability services, are applied in a cost±bene®t model, assuming average participation in early intensive behavioral intervention (EIBI) for three years between the age of 2 years and school entry. The model applied assumes a range of EIBI eects, with some children ultimately participating in regular education without supports, some in special education, and some in intensive special education. At varying rates of eectiveness and in constant dollars, this model estimates that cost savings range from $187,