A Single-blinded, Randomized Clinical Trial of How to Implement an Evidence-based Treatment for Generalized Anxiety Disorder [IMPLEMENT] — Effects of Three Different Strategies of Implementation

BACKGROUND: Despite long-standing calls to disseminate evidence-based treatments for generalized anxiety (GAD), modest progress has been made in the study of how such treatments should be implemented. The primary objective of this study was to test three competing strategies on how to implement a cognitive behavioral treatment (CBT) for out-patients with GAD (i.e., comparison of one compensation vs. two capitalization models). METHODS: For our three-arm, single-blinded, randomized controlled trial (implementation of CBT for GAD [IMPLEMENT]), we recruited adults with GAD using advertisements in high-circulation newspapers to participate in a 14-session cognitive behavioral treatment (Mastery of your Anxiety and Worry, MAW-packet). We randomly assigned eligible patients using a full randomization procedure (1:1:1) to three different conditions of implementation: adherence priming (compensation model), which had a systematized focus on patients' individual GAD symptoms and how to compensate for these symptoms within the MAW-packet, and resource priming and supportive resource priming (capitalization model), which had systematized focuses on patients' strengths and abilities and how these strengths can be capitalized within the same packet. In the intention-to-treat population an outcome composite of primary and secondary symptoms-related self-report questionnaires was analyzed based on a hierarchical linear growth model from intake to 6-month follow-up assessment. This trial is registered at ClinicalTrials.gov (identifier: NCT02039193) and is closed to new participants. FINDINGS: From June 2012 to Nov. 2014, from 411 participants that were screened, 57 eligible participants were recruited and randomly assigned to three conditions. Forty-nine patients (86%) provided outcome data at post-assessment (14% dropout rate). All three conditions showed a highly significant reduction of symptoms over time. However, compared with the adherence priming condition, both resource priming conditions indicated faster symptom reduction. The observer ratings of a sub-sample of recorded videos (n = 100) showed that the therapists in the resource priming conditions conducted more strength-oriented interventions in comparison with the adherence priming condition. No patients died or attempted suicide. INTERPRETATION: To our knowledge, this is the first trial that focuses on capitalization and compensation models during the implementation of one prescriptive treatment packet for GAD. We have shown that GAD related symptoms were significantly faster reduced by the resource priming conditions, although the limitations of our study included a well-educated population. If replicated, our results suggest that therapists who implement a mental health treatment for GAD might profit from a systematized focus on capitalization models. FUNDING: Swiss Science National Foundation (SNSF-Nr. PZ00P1_136937/1) awarded to CF. KEYWORDS: Cognitive behavioral therapy; Evidence-based treatment; Implementation strategies; Randomized controlled trial

The Effect of Classmate Characteristics on Individual Outcomes: Evidence from the Add Health

We use data from the National Longitudinal Study of Adolescent Health (Add Health) to examine the effects of classmate characteristics on economic and social outcomes of students. The unique structure of the Add Health allows us to estimate these effects using comparisons across cohorts within schools, and to examine a wider range of outcomes than other studies that have used this identification strategy. This strategy yields variation in cohort composition that is uncorrelated with student observables suggesting that our estimates are not biased by the selection of students into schools or grades based on classmate characteristics. We find that increases in the percent of classmates whose mother is college educated has significant, desirable effects on educational attainment and substance use. We do not find much evidence that the percent of classmates who are black or Hispanic has significant effects on individual outcomes, on average. Additional analyses suggest, however, that an increase in the percent black or Hispanic may increase dropout rates among black students and post-high school idleness among males.

Locus of control as a predictor of students dropping out of high school

Education is related to health. In cross-sectional data, education level has been associated with physical functioning. Also, lower levels of education have been associated with health behaviors including smoking, alcohol use, and greater body weight. In school, students may benefit from greater exposed to health-related messages, while students who have dropped out may be more susceptible to influences regarding negative health behaviors such as smoking. ^ Improved school retention might improve long-term health outcomes. However, there is limited evidence regarding modifiable factors that predict likelihood of dropping out. Two likely psychosocial measures are locus of control and parent-child academic conversations. In the current study, data from two waves of a population-based longitudinal survey, the National Education Longitudinal Survey, were utilized to evaluate whether these two psychosocial measures could predict likelihood of dropping out, for students (n = 16,749) in tenth grade at 1990, with dropout status determined at 1992, while controlling for recognized sociodemographic predictors including parental income, parental education level, race/ethnicity, and sex. Locus of control was measured with the Pearlin Mastery Scale, and parent-child academic conversations were measured by three questions concerning course selection at school, school activities and events, and things the student studied in class. ^ In a logistic regression model, with the sociodemographic control measures entered in a first step before entry of the psychosocial measures in a second step, this study determined that lower levels of locus of control were associated with greater likelihood of dropping out after two years (odds ratio (OR) = 1.11, 95% confidence interval (CI) 108 to 1.15, p < .001), and two of the three parent-child academic discussion items were associated with greater likelihood of dropping out after two years (OR = 1.69, CI 1.48-1.93, p < .001; OR = 1.22, CI 1.05-1.41, p = .01; OR = 1.01, CI .88-1.15, p = .94). ^ It is possible that interventions aimed at improving locus of control, and aimed at building parent-child academic conversations, could lower the likelihood of students dropping out, and this in turn could yield improved heath behaviors and health status in the child's future. ^

Association between ethnicity and treatment status in opioid dependence therapy using methadone and suboxone drugs

Opioids are drugs with opium-like qualities that are either derived from opiates (drugs created from opium, such as morphine or codeine) or chemically produced. In the U.S. opiate abuse and related deaths have been increasing and traditional maintenance treatment has been Methadone with variable success. However, since 2003 synthetic Buprenorphine has been used since it is prescribed daily by physicians in pill form and should improve outcomes. Comparative studies are limited and the effect of ethnicity on treatment outcome is unknown. ^ Data collected at one clinic from December 2005 through May 2009 were used to compare the association between ethnicity and other socioeconomic variables with treatment status, and to identify factors associated with the dropout among participants. Descriptive tables and multiple logistic regression models were used to examine the data on 1,295 total participants. Of the total, 875 participants (68%) were from the Methadone subsample and 420 participants (32%) from the Buprenorphine subsample; only about 15% stayed in treatment. ^ This study showed that with either Methadone or Buprenorphine maintenance therapy, only about 15% participants stay active over 3.5 years. Methadone treated patients that stayed active in treatment were associated with Caucasian ethnicity and were more likely to be employed. With Buprenorphine maintenance treatment only age over 40 years was associated with continuing activity in the program. Further studies that examine the reasons for the high dropout status and the implication of the socioeconomic and ethnic associations found in this data may help to improve treatment outcomes.^

Nonpurging binge eaters versus nonbinge eaters and treatment retention for adult obesity

Dropout from obesity treatment has been a major factor associated with weight control failure, with few reliable predictors of dropouts or completers. Previous studies have tended to treat obese people as a homogeneous group with standard behavior modification-based interventions. Current research indicates there may be subgroups within the obese population, binge eaters and nonbinge eaters, who have different dropout rates. Current studies also recommend focusing on the subset of this subgroup that does not engage in purging (vomiting, laxative abuse, or excessive exercise) to compensate for binge eating. This research uses a secondary dataset (N = 156) from a prospective study in which participants were randomized to a Food Dependency (FD) and a Behavioral Self-Management (BSM) group for weight reduction. Criteria for subjects in the original study included (1) scoring higher on the existing Binge Eating Scale (BES) in order to ensure enrollment of more binge eaters and (2) no compensatory purging behavior for binge eating. Subjects were then reclassified in this study as binge eaters or nonbinge eaters using the more stringent proposed 1994 DSM-IV criteria for Binge Eating Disorder (BED). Subjects were followed for dropout. Variables studied were binge status, age at obesity onset, age at study baseline, class instructor, number of previous weight loss attempts, race, marital status, body mass index (BMI kg/m$\sp2$), type of intervention, work status, educational level, and social support. Stepwise backward regression Cox survival analysis indicated binge status had a consistent, statistically significant protective effect on dropout in which binge eaters were half as likely to dropout versus nonbinge eaters (p = 0.04). Cox proportional hazards analysis indicated no statistical difference in dropout by type of intervention (FD, p = 0.13; BSM, p = 0.80) when controlling for binge status. All other variables did not reach significance, which is consistent with the literature. Implications of these findings suggest that (1) the proposed 1994 DSM-IV criteria for BED is a more useful classification that the existing DSM-III-R criteria, and (2) the identification of subgroups among obese subjects is an important step in dropout and weight loss intervention research. Future research can confirm this finding. ^

La educación media superior en México ante el reto de su universalización

En México, se legisló en octubre del 2011 la universalización de la educación media superior. En este contexto el artículo aborda los retos que presenta esta decisión desde la perspectiva de la oferta educativa en sus diferentes modalidades pero también los sentidos del bachillerato para los estudiantes, el nuevo público rural y los problemas de abandono escolar. Discute el tema de la diversificación necesaria y la desigualdad que la acompaña. Caracteriza la Reforma de la Educación Media Superior y la instauración del Sistema Nacional de Bachillerato desde un enfoque administrativo de la gestión y termina apuntando aspectos que habría que fortalecer desde una perspectiva pedagógica y de los sujetos. El escrito se sustenta por un lado en documentos oficiales y en datos del Instituto Nacional para la Evaluación de la Educación y por el otro en hallazgos de la línea de investigación cualitativa "Jóvenes y bachillerato"

Novos formatos escolares para novas demandas sociais : O Ensino Médio Integrado

When it comes to reflecting on the Brazilian educational system , secondary education is what causes the most controversial debates . For a long time , enrollment rates in secondary school were embarrassing , what has changed in recent decades . It became mandatory and expanded significantly the enrollment , but keep the high level of failure and dropout . Historically, the definition of options for secondary education and particularly vocational education , has been in Brazil for conflict of interests and positions , which is expressed in the diversity of curricular proposals presented throughout the twentieth century and the beginning of this XXI century. Currently, the line adopted by the federal government is to encourage states and municipalities to implement the method of integrated secondary school , thus seeking to establish links between the academic and professional learning . The topic of this article is precisely this choice of integrated education . It is within the framework of the Brazilian educational scenario and its late development compared to other countries in the region under review debate and educational policies aimed to integrate the high school and the working world

School counsellor's roles in minimising adolescents' attrition from schools

Counselling ways (rendering financial advice, providing encouragement, reassurances and support), which the school counselllors could adopt to help the school system minimize the increasing incidence of school dropout, were advanced.

Aportes para examinar las desigualdades educativas en los grandes centros urbanos : El uso del coeficiente de Gini para analizar la distribución del abandono escolar entre las escuelas secundarias de la Ciudad Autónoma de Buenos Aires

La Ley de Educación Nacional promulgada en 2006 en Argentina establece la obligatoriedad de la educación secundaria en todo el país, la Ciudad Autónoma de Buenos Aires ha sido pionera al respecto estableciendo esta meta en el año 2002. En este marco, se propone analizar los desafíos que este tipo de política enfrenta en la actualidad, centrando la atención en la capacidad de los sistemas e instituciones educativas para garantizar este derecho en términos de acceso, permanencia y promoción de los alumnos en el nivel secundario. Este trabajo tiene por objeto plantear un ejercicio de análisis del abandono escolar que ocurre durante el ciclo lectivo en las escuelas a partir de la consideración del análisis del porcentaje de alumnos "salidos sin pase", e incorporar, a la vez, una medida de dispersión (coeficiente de Gini) que permita visibilizar las desigualdades entre escuelas a nivel territorial en la Ciudad Autónoma de Buenos Aires

La educación media superior en México ante el reto de su universalización

En México, se legisló en octubre del 2011 la universalización de la educación media superior. En este contexto el artículo aborda los retos que presenta esta decisión desde la perspectiva de la oferta educativa en sus diferentes modalidades pero también los sentidos del bachillerato para los estudiantes, el nuevo público rural y los problemas de abandono escolar. Discute el tema de la diversificación necesaria y la desigualdad que la acompaña. Caracteriza la Reforma de la Educación Media Superior y la instauración del Sistema Nacional de Bachillerato desde un enfoque administrativo de la gestión y termina apuntando aspectos que habría que fortalecer desde una perspectiva pedagógica y de los sujetos. El escrito se sustenta por un lado en documentos oficiales y en datos del Instituto Nacional para la Evaluación de la Educación y por el otro en hallazgos de la línea de investigación cualitativa "Jóvenes y bachillerato"

Novos formatos escolares para novas demandas sociais : O Ensino Médio Integrado

When it comes to reflecting on the Brazilian educational system , secondary education is what causes the most controversial debates . For a long time , enrollment rates in secondary school were embarrassing , what has changed in recent decades . It became mandatory and expanded significantly the enrollment , but keep the high level of failure and dropout . Historically, the definition of options for secondary education and particularly vocational education , has been in Brazil for conflict of interests and positions , which is expressed in the diversity of curricular proposals presented throughout the twentieth century and the beginning of this XXI century. Currently, the line adopted by the federal government is to encourage states and municipalities to implement the method of integrated secondary school , thus seeking to establish links between the academic and professional learning . The topic of this article is precisely this choice of integrated education . It is within the framework of the Brazilian educational scenario and its late development compared to other countries in the region under review debate and educational policies aimed to integrate the high school and the working world

School counsellor's roles in minimising adolescents' attrition from schools

Counselling ways (rendering financial advice, providing encouragement, reassurances and support), which the school counselllors could adopt to help the school system minimize the increasing incidence of school dropout, were advanced.

Aportes para examinar las desigualdades educativas en los grandes centros urbanos : El uso del coeficiente de Gini para analizar la distribución del abandono escolar entre las escuelas secundarias de la Ciudad Autónoma de Buenos Aires

La Ley de Educación Nacional promulgada en 2006 en Argentina establece la obligatoriedad de la educación secundaria en todo el país, la Ciudad Autónoma de Buenos Aires ha sido pionera al respecto estableciendo esta meta en el año 2002. En este marco, se propone analizar los desafíos que este tipo de política enfrenta en la actualidad, centrando la atención en la capacidad de los sistemas e instituciones educativas para garantizar este derecho en términos de acceso, permanencia y promoción de los alumnos en el nivel secundario. Este trabajo tiene por objeto plantear un ejercicio de análisis del abandono escolar que ocurre durante el ciclo lectivo en las escuelas a partir de la consideración del análisis del porcentaje de alumnos "salidos sin pase", e incorporar, a la vez, una medida de dispersión (coeficiente de Gini) que permita visibilizar las desigualdades entre escuelas a nivel territorial en la Ciudad Autónoma de Buenos Aires

Novos formatos escolares para novas demandas sociais : O Ensino Médio Integrado

When it comes to reflecting on the Brazilian educational system , secondary education is what causes the most controversial debates . For a long time , enrollment rates in secondary school were embarrassing , what has changed in recent decades . It became mandatory and expanded significantly the enrollment , but keep the high level of failure and dropout . Historically, the definition of options for secondary education and particularly vocational education , has been in Brazil for conflict of interests and positions , which is expressed in the diversity of curricular proposals presented throughout the twentieth century and the beginning of this XXI century. Currently, the line adopted by the federal government is to encourage states and municipalities to implement the method of integrated secondary school , thus seeking to establish links between the academic and professional learning . The topic of this article is precisely this choice of integrated education . It is within the framework of the Brazilian educational scenario and its late development compared to other countries in the region under review debate and educational policies aimed to integrate the high school and the working world

School counsellor's roles in minimising adolescents' attrition from schools

Counselling ways (rendering financial advice, providing encouragement, reassurances and support), which the school counselllors could adopt to help the school system minimize the increasing incidence of school dropout, were advanced.