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  • 1
    Language: English
    In: Behaviour Research and Therapy, April, 2014, Vol.55, p.40(8)
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2014.01.005 Byline: Eva-Maria Bonin, Jennifer Beecham, Naomi Swift, Shriti Raikundalia, June S.L. Brown Abstract: Around one in three of the UK population suffer from sleep problems, resulting in high costs to society. Cognitive behaviour therapy for insomnia (CBT-I) has been shown to be effective. Community-based workshops may be a cost-effective way to provide CBT-I to groups that are usually hard to reach or reluctant to seek treatment. A sample of 151 participants aged 18 or over from five London boroughs who self-referred were randomised into a group receiving workshops and a waiting list control group. 111 provided complete data on service use and outcome measures. Results from the cost-effectiveness and cost-utility analyses are presented using cost-effectiveness acceptability curves. At a maximum willingness to pay per quality-adjusted life-year (QALY) of A[pounds sterling]30,000, the probability of the intervention being cost-effective is 80%. If commissioners are willing to pay A[pounds sterling]150 per point improvement on the Insomnia Severity Index, which is approximately the cost of the intervention, there is a 97% probability of cost-effectiveness. Community-based CBT-I workshops are likely to be a cost-effective intervention to improve insomnia symptoms and are a promising low-level option to include within the panoply of interventions that are encouraged within the UK policy of increasing access to psychological therapies. Author Affiliation: (a) Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK (b) Personal Social Services Research Unit, University of Kent, Canterbury CT2 7NF, UK (c) Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK Article History: Received 1 August 2013; Revised 15 January 2014; Accepted 28 January 2014
    Keywords: Behavior Therapy -- Conferences, Meetings And Seminars ; Workshops (Educational programs) -- Conferences, Meetings And Seminars ; Insomnia -- Conferences, Meetings And Seminars ; Cost Benefit Analysis -- Conferences, Meetings And Seminars ; Cognitive-behavioral Therapy -- Conferences, Meetings And Seminars
    ISSN: 0005-7967
    Source: Cengage Learning, Inc.
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  • 2
    Language: English
    In: BMC Public Health, 01 October 2011, Vol.11(1), p.803
    Description: Abstract Background Conduct disorders are the most common psychiatric disorders in children and may persist into adulthood in about 50% of cases. The costs to society are high and impact many public sector agencies. Parenting programmes have been shown to positively affect child behaviour, but little is known about their potential long-term cost-effectiveness. We therefore estimate the costs of and longer-term savings from evidence-based parenting programmes for the prevention of persistent conduct disorder. Methods A decision-analytic Markov model compares two scenarios: 1) a 5-year old with clinical conduct disorder receives an evidence-based parenting programme; 2) the same 5-year old does not receive the programme. Cost-savings analysis is performed by comparing the probability that conduct disorder persists over time in each scenario, adopting both a public sector and a societal perspective. If the intervention is successful in reducing persistent conduct disorder, cost savings may arise from reduced use of health services, education support, social care, voluntary agencies and from crimes averted. Results Results strongly suggest that parenting programmes reduce the chance that conduct disorder persists into adulthood and are cost-saving to the public sector within 5-8 years under base case conditions. Total savings to society over 25 years are estimated at £16,435 per family, which compares with an intervention cost in the range of £952-£2,078 (2008/09 prices). Conclusions Effective implementation of evidence-based parenting programmes is likely to yield cost savings to the public sector and society. More research is needed to address evidence gaps regarding the current level of provision, longer-term effectiveness and questions of implementation, engagement and equity.
    Keywords: Public Health
    ISSN: 1471-2458
    E-ISSN: 1471-2458
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  • 3
    Language: English
    In: BMC Public Health, Oct 14, 2011, Vol.11, p.803
    Description: Background Conduct disorders are the most common psychiatric disorders in children and may persist into adulthood in about 50% of cases. The costs to society are high and impact many public sector agencies. Parenting programmes have been shown to positively affect child behaviour, but little is known about their potential long-term cost-effectiveness. We therefore estimate the costs of and longer-term savings from evidence-based parenting programmes for the prevention of persistent conduct disorder. Methods A decision-analytic Markov model compares two scenarios: 1) a 5-year old with clinical conduct disorder receives an evidence-based parenting programme; 2) the same 5-year old does not receive the programme. Cost-savings analysis is performed by comparing the probability that conduct disorder persists over time in each scenario, adopting both a public sector and a societal perspective. If the intervention is successful in reducing persistent conduct disorder, cost savings may arise from reduced use of health services, education support, social care, voluntary agencies and from crimes averted. Results Results strongly suggest that parenting programmes reduce the chance that conduct disorder persists into adulthood and are cost-saving to the public sector within 5-8 years under base case conditions. Total savings to society over 25 years are estimated at [pounds sterling]16,435 per family, which compares with an intervention cost in the range of [pounds sterling]952-[pounds sterling]2,078 (2008/09 prices). Conclusions Effective implementation of evidence-based parenting programmes is likely to yield cost savings to the public sector and society. More research is needed to address evidence gaps regarding the current level of provision, longer-term effectiveness and questions of implementation, engagement and equity.
    Keywords: Parenting -- Analysis ; Public Sector -- Analysis ; Child Behavior -- Analysis ; Evidence-based Medicine -- Analysis ; Medical Research -- Analysis ; Conduct Disorder -- Prevention ; Conduct Disorder -- Analysis ; Markov Processes -- Analysis
    ISSN: 1471-2458
    Source: Cengage Learning, Inc.
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  • 4
    In: British Journal of Social Work, 2014, Vol. 44(6), pp.1508-1525
    Description: Adoption can provide stability and improved outcomes for looked after children, but the support needs of adoptive families range from financial support to managing difficult behaviours and attachment problems. This study looks at the use of services and associated costs over a six-month period through data collected from nineteen adoptive parents six months after a child (average age twenty-three months) had been placed with them for adoption and at the patterns of service needs, usefulness of services and satisfaction with services, supplemented with data from twenty-seven families who were interviewed about their experience of post-adoption support. In line with previous research findings, the core element of support was provided by social workers and over a third of families received financial support from social service departments. Involvement of specialist services such as mental health professionals and educational support was low, probably because of the children's young age. Satisfaction with the support provided by social workers varied and depended on their relationship with the parents. The mean public sector cost of services was £2,842 (range £980–£6,270) and most costs were borne by children's social services. These support costs compare favourably with other placement options such as children's homes or foster-care.
    Keywords: Adoption Support ; Costs ; Service Use ; Social Work
    ISSN: 0045-3102
    E-ISSN: 1468-263X
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  • 5
    Language: English
    In: Behaviour Research and Therapy, April 2014, Vol.55, pp.40-47
    Description: Around one in three of the UK population suffer from sleep problems, resulting in high costs to society. Cognitive behaviour therapy for insomnia (CBT-I) has been shown to be effective. Community-based workshops may be a cost-effective way to provide CBT-I to groups that are usually hard to reach or reluctant to seek treatment. A sample of 151 participants aged 18 or over from five London boroughs who self-referred were randomised into a group receiving workshops and a waiting list control group. 111 provided complete data on service use and outcome measures. Results from the cost-effectiveness and cost-utility analyses are presented using cost-effectiveness acceptability curves. At a maximum willingness to pay per quality-adjusted life-year (QALY) of £30,000, the probability of the intervention being cost-effective is 80%. If commissioners are willing to pay £150 per point improvement on the Insomnia Severity Index, which is approximately the cost of the intervention, there is a 97% probability of cost-effectiveness. Community-based CBT-I workshops are likely to be a cost-effective intervention to improve insomnia symptoms and are a promising low-level option to include within the panoply of interventions that are encouraged within the UK policy of increasing access to psychological therapies.
    Keywords: Cognitive Behaviour Therapy ; Insomnia ; Self Referral ; Group Intervention ; Costs and Cost Analysis ; Cost Effectiveness ; Medicine ; Psychology
    ISSN: 0005-7967
    E-ISSN: 1873-622X
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  • 6
    In: Bonin, Eva-Maria and Beecham, Jennifer and Dance, Cherilyn and Farmer, Elaine (2014) Support for adoption placements: the first six months. British Journal of Social Work, 44 (6). pp. 1508-1525.
    Description: Adoption can provide stability and improved outcomes for looked after children, but the support needs of adoptive families range from financial support to managing difficult behaviours and attachment problems. This study looks at the use of services and associated costs over a six-month period through data collected from nineteen adoptive parents six months after a child (average age twenty-three months) had been placed with them for adoption and at the patterns of service needs, usefulness of services and satisfaction with services, supplemented with data from twenty-seven families who were interviewed about their experience of post-adoption support. In line with previous research findings, the core element of support was provided by social workers and over a third of families received financial support from social service departments. Involvement of specialist services such as mental health professionals and educational support was low, probably because of the children’s young age. Satisfaction with the support provided by social workers varied and depended on their relationship with the parents. The mean public sector cost of services was £2,842 (range £980–£6,270) and most costs were borne by children’s social services. These support costs compare favourably with other placement options such as children’s homes or foster-care.
    Keywords: H Social Sciences (General)
    ISSN: 0045-3102
    Source: University of Kent
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  • 7
    In: European Eating Disorders Review, January 2013, Vol.21(1), pp.60-71
    Description: Experienced Carers Helping Others (ECHO) is a guided self‐help intervention for carers of people with eating disorders to reduce distress and ameliorate interpersonal maintaining factors to improve patient outcomes. The aim of this paper is to describe the theoretical background and protocol of a randomised controlled trial that will establish whether ECHO has a significant beneficial effect for carers and the person they care for. Individuals with anorexia nervosa and carers will be recruited from eating disorder inpatient/day patient hospital services in the UK. Primary outcomes are time until relapse post‐discharge (patient) and distress (carer) at 12 months post‐discharge. Secondary outcomes are body mass index, eating disorder symptoms, psychosocial measures and health economic data for patients and carers. Carers will be randomised (stratified by site and illness severity) to receive ECHO (in addition to treatment as usual) or treatment as usual only. Potential difficulties in participant recruitment and delivery of the intervention are discussed. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.
    Keywords: Anorexia Nervosa ; Eating Disorders ; Carers ; Family Intervention ; Treatment ; Inpatient ; Randomised Controlled Trial ; Skills Training ; Motivational Interviewing
    ISSN: 1072-4133
    E-ISSN: 1099-0968
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  • 8
    In: Leijten, Patty and Gardner, Frances and Landau, Sabine and Harris, Victoria and Mann, Joanna and Hutchings, Judy and Beecham, Jennifer and Bonin, Eva-Maria and Scott, Stephen (2017) Harnessing the Power of Individual Participant Data in a Meta-Analysis of the Benefits and Harms of the Incredible Years Parenting Program. Journal of Child Psychology and Psychiatry, .
    Description: Background: Parenting programs aim to reduce children’s conduct problems through improvement of family dynamics. To date, research on the precise benefits and possible harms of parenting programs on family well-being has been unsystematic and likely to be subject to selective outcome reporting and publication bias. Better understanding of program benefits and harms requires full disclosure by researchers of all included measures, and large enough numbers of participants to be able to detect small effects and estimate them precisely. Methods: We obtained individual participant data for 14 out of 15 randomized controlled trials on the Incredible Years parenting program in Europe (total N = 1799). We used multilevel modeling to estimate program effects on thirteen parent-reported outcomes, including parenting practices, children’s mental health, and parental mental health. Results: Parental use of praise, corporal punishment, threats and shouting improved, whilst parental use of tangible rewards, monitoring, or laxness did not. Children’s conduct problems and ADHD symptoms improved, whilst emotional problems did not. Parental mental health (depressive symptoms, self-efficacy, stress) did not improve. There was no evidence of harmful effects. Conclusions: The Incredible Years parenting program improves the aspects of family well-being that it is primarily designed to improve: parenting and children’s conduct problems. It also improves parent-reported ADHD symptoms in children. Wider benefits are limited: the program does not improve children’s emotional problems or parental mental health. There are no signs of harm on any of the target outcomes.
    ISSN: 0021-9630
    Source: University of Kent
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  • 9
    Language: English
    Description: Background Conduct disorders are the most common psychiatric disorders in children and may persist into adulthood in about 50% of cases. The costs to society are high and impact many public sector agencies. Parenting programmes have been shown to positively affect child behaviour, but little is known...
    Keywords: H Social Sciences (General) ; HC Economic History and Conditions ; RA Public aspects of medicine
    ISSN: 1471-2458
    Source: London School of Economics and Political Science
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  • 10
    Language: English
    In: Journal of Consulting and Clinical Psychology, 2015, Vol.83(4), pp.796-807
    Description: Objective: Anorexia nervosa (AN) in adults has poor outcomes, and treatment evidence is limited. This study evaluated the efficacy and acceptability of a novel, targeted psychological therapy for AN (Maudsley Model of Anorexia Nervosa Treatment for Adults; MANTRA) compared with Specialist Supportive Clinical Management (SSCM). Method: One hundred forty-two outpatients with broadly defined AN (body mass index [BMI] ≤ 18.5 kg/m 2 ) were randomly allocated to receive 20 to 30 weekly sessions (depending on clinical severity) plus add-ons (4 follow-up sessions, optional sessions with dietician and with carers) of MANTRA ( n = 72) or SSCM ( n = 70). Assessments were administered blind to treatment condition at baseline, 6 months, and 12 months after randomization. The primary outcome was BMI at 12 months. Secondary outcomes included eating disorders symptomatology, other psychopathology, neuro-cognitive and social cognition, and acceptability. Additional service utilization was also assessed. Outcomes were analyzed using linear mixed models. Results: Both treatments resulted in significant improvements in BMI and reductions in eating disorders symptomatology, distress levels, and clinical impairment over time, with no statistically significant difference between groups at either 6 or 12 months. Improvements in neuro-cognitive and social–cognitive measures over time were less consistent. One SSCM patient died. Compared with SSCM, MANTRA patients rated their treatment as significantly more acceptable and credible at 12 months. There was no significant difference between groups in additional service consumption. Conclusions: Both treatments appear to have value as first-line outpatient interventions for patients with broadly defined AN. Longer term outcomes remain to be evaluated. ; This study shows that both MANTRA and SSCM have promise as first-line outpatient treatments of AN in adults. MANTRA, a novel, targeted treatment based on experimental medicine principles, may have advantages in terms of overall acceptability and credibility, and weight outcomes in more severely ill patients.
    Keywords: Anorexia Nervosa ; Psychological Treatment ; Randomized Controlled Trial
    ISSN: 0022-006X
    E-ISSN: 1939-2117
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