Study designs: Part 4 Interventional studies PMC

Drugs also may be used prophylactically for treatment of preclinicalinfection (for example, during the incubation period before theonset of symptoms, as for the gambiense type oftrypanosomiasis) or for treatment of subclinical infection (forexample, ivermectin against onchocerciasis, and praziquantel againstschistosomiasis). Mindfulness is often seen as a cure-all approach, but as with other clinical approaches, counselors should carefully consider when and how they integrate this practice into sessions. Counselors are using happiness interventions to help clients redefine happiness and live a more fulfilling life. If an effort is made to ensure that other factors are similar across groups, then the availability of data from the comparator group allows a stronger inference about the effect of the intervention being tested than is possible in studies that lack a control group. The use of randomization is a major distinguishing feature and strength of this study design. A well-implemented randomization procedure is expected to result in two groups that are comparable overall, when both measured and unmeasured factors are taken into account.

Psychodynamic psychotherapy

As an example, a study in Greece looked at the effect of providing meals in schools on household food security.[6] The 51 schools in this study were randomly allocated to provide or not provide a healthy meal every day to students; schools in both the groups provided an educational intervention. Sometimes, an intervention cannot be easily administered to individuals but can be applied to groups. In such cases, a trial can be done by assigning “clusters” – some logical groups of participants – to receive or not receive the intervention. Some believe that the before-after design is comparable to observational design and that only studies with a “comparator” group, as discussed above, are truly interventional studies. Some additional methodological features are often added to this study design to further improve the validity of a trial. These include allocation concealment, blinding, intention-to-treat analysis, measurement of compliance, minimizing the dropouts, and ensuring appropriate sample size.

Hospital and residential treatment programs

• Many intervention products, and especially drugs and vaccines, are likely tooriginate from basic research in laboratories.
• There is something unique regarding the first contact between the child and the therapist.
• The committee also recognizes thatevidence-based psychosocial interventions comprise therapeutic strategies,activities, and techniques (i.e., elements) that are nonspecific to most ifnot all interventions, as well as those that are specific to a particulartheoretical model and approach to intervention.
• In this design, a variable of interest is measured before and after an intervention in the same participants.

Figure 3-1depicts nonspecific elements and specific elements that are sharedversus unique for different approaches for the treatment ofposttraumatic stress disorder. Integrated treatment of dual disorders often involves an interdisciplinary team, including social workers in various roles, such as psychotherapists, student counselors, and case managers. Social workers are often at the forefront of every mode of treatment that focuses on the services critical to the reduction of substance abuse and mental impairment. It is important for social workers to understand how comorbid disorders interact because social workers often work directly with substance abusers in residential settings and with hospitalized mental health patients and are the health care workers most likely to be responsible for patient discharge planning.

Effectiveness

• Brain-stimulation treatments are sometimes used for depression and other mental health disorders.
• For some purposes, prophylaxis may be usedby permanent residents of endemic areas (for example, anti-malarialsin pregnancy).
• In previous articles in this series, we introduced the concept of study designs[1] and have described in detail the observational study designs – descriptive[2] as well as analytical.[3] In this and another future piece, we will discuss the interventional study designs.
• Knowledge of mechanisms can be used to honepsychosocial interventions to be optimally effective (Kazdin, 2014).

Sometimes, the use of drugsfor prophylaxis or to reduce disease progression does not involveindividual diagnosis, but community or group diagnosis is needed toidentify groups that should receive the treatment. For example, massadministration of anti-helminthic treatment to schoolchildren issometimes administered in this way. Mass treatment of school-age children inareas highly endemic for the infection with an anti-schistosomaldrug every year Top 5 Advantages of Staying in a Sober Living House or two may be sufficient to virtually eliminateserious disease consequences of infection with Schistosomamansoni. One other interesting finding from the Randall et al. (2001) study should be noted. Although attendance at AA meetings was not encouraged, data on AA meeting attendance during the treatment was collected. AA attendance increased in both groups during active treatment and decreased again following the active phase of the study.

Research involving a wide range of disciplines isneeded to develop, deploy, and assess these interventions, ranging frommolecular biology and immunology to social sciences, epidemiology, andstatistics. Field trials are required to assess how interventions,both old and new, may be best applied in populations and to determine theirimpact on improving the health of the population. The committee recognizes the major gains that have been made to date indemonstrating the efficacy of manualized psychosocial interventions throughrandomized controlled clinical trials. The committee also recognizes thatevidence-based psychosocial interventions comprise therapeutic strategies,activities, and techniques (i.e., elements) that are nonspecific to most ifnot all interventions, as well as those that are specific to a particulartheoretical model and approach to intervention. Furthermore, some elementsdenoted as specific are actually shared among certain manualizedpsychosocial interventions, although not always referred to using the sameterminology, whereas others are unique. The committee suggests the need for research todevelop a common terminology that elucidates the elements of evidence-basedpsychosocial interventions, to evaluate the elements’ optimalsequencing and dosing in different populations and for different targetproblems, and to investigate their mechanisms.

At the same time, assessment of moderators ofelements (i.e., which element is most effective for a particular patientsubgroup) may provide useful information for clinicians andpractitioners, enabling them to select from among the array of elementsfor a given individual. Such investigation could include moderators ofelements alone (e.g., for whom exposure to trauma reminders or cognitivereappraisal of trauma is most effective) and of sequences of elements(e.g., for whom cognitive reappraisal is more effective before thanfollowing exposure to trauma reminders). Moderator variables mightinclude (1) the disorder or target problem and (2) socioculturalvariables such as age, gender, socioeconomic status, and race/ethnicity.It might also be possible to study biomarkers and “aspects ofmotivation, cognition, and social behavior that predict clinicalresponse” (NIMH,2015). The elements that make up evidence-based psychosocial interventions areclearly specified in measures of fidelity, which are used to ascertainwhether a given intervention is implemented as intended in researchstudies and to ensure that practitioners are demonstrating competency inan intervention in both training and practice. This chapter addresses the elements—therapeutic activities, techniques, orstrategies—that make up psychosocial interventions.

Some of these interventions havebeen evaluated through RCTs, and there is further scope for usingsuch approaches. A mother’s health and well-being during pregnancy and around the timeof delivery, including access to appropriate care, are criticaldeterminants of maternal mortality and neonatal and child health inthe early years of life, and possibly for much longer. Preventiveinterventions before or during pregnancy include family planning,treatment of infections, such as syphilis and malaria, goodnutrition, including micronutrients, good antenatal monitoring andcare, and access to skilled care at the time of delivery andpost-partum.

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Casefinding and treatment may also reduce transmission of an agent ifcases are the main reservoirs of infection, if case detectionmethods locate a high proportion of prevalent cases, and if thetreatment is sufficiently effective. Drugs or other interventions may be used for the prevention ofinfection (prophylaxis) or disease consequent on infection. Anexample of the former would be isoniazid prophylaxis to HIV-infectedindividuals to reduce their risk of TB, and of the latter, thetreatment of HIV-infected individuals with antiretroviral drugs toslow the progression of their disease.

However, all social workers, no matter their specialty, will do well to remember that the history of our profession is based on providing tangible services in helping meet the needs of our clients in their environment. This mission emphasizes our continuing attention to making referrals to effective treatments and case management. Aase, Jason, and Robinson (2008) reviewed the literature and found that 12-Step participation was effective for reducing substance use and mental illness because the social https://megapolisnews.com/top-5-advantages-of-staying-in-a-sober-living-house/ support provided by the 12-Step programs helped the patient stay in recovery. Twelve-step participation has been found to be very effective for patients with dual diagnoses, and findings suggest that the best approach may be to encourage 12-Step participation to assist with sobriety while providing other needed services. Donovan and Floyd (2008) discussed methods for improving 12-Step participation and indicate that 12-Step Facilitation (TSF) should be routinely integrated into treatment of addiction.