scholarly journals Do young people not in education, employment or training experience long-term occupational scarring? A longitudinal analysis over 20 years of follow-up

2016 ◽  
Vol 11 (2-3) ◽  
pp. 203-221 ◽  
Author(s):  
Kevin Ralston ◽  
Zhiqiang Feng ◽  
Dawn Everington ◽  
Chris Dibben
Keyword(s):  
Young People ◽  
Longitudinal Analysis ◽  
Training Experience

“The ‘Impossible’ Child”

1978 ◽  
Vol 23 (1_suppl) ◽  
pp. 1-21 ◽  
Author(s):  
Philip Barker
Keyword(s):  
Young People ◽  
Residential Treatment ◽  
Family Life ◽  
Normal Family ◽  
Peer Group ◽  
Residential Programs ◽  
Treatment Centre ◽  
Youth Treatment

It is impossible to make any sort of comparative evaluation of the various treatment methods which have been recommended and tried for severe, chronic emotional and behavioural disorders in children and young people. Although many programs exist, and many more have existed and been reported, the case material has seldom been clearly defined, outcome studies have been limited and longer-term follow-up almost nil. To take simply the few programs which have been discussed in this paper, it is not known whether the young people treated in the California Youth Project, Aycliffe School, the Cotswold Community and the Alberta Parent Counsellors program are at all similar. All programs claim to be treating seriously disturbed children, but more detailed descriptions are needed. Achievement Place claims it deals with “pre-delinquent” youths, while clearly St. Charles Youth Treatment Centre, Aycliffe School and the California Youth Project treat serious established delinquents. So it may indeed be true, as Hoghughi (21) has suggested, that methods that work in certain situations are not readily transferred to others. Balbernie (8) seems to be on the right lines when he calls for precise diagnosis with an accurate definition of what the problem is and of who is supposed to be doing what about it, and with what aims. Similarly precise requirements seemed to be the policy of Hoghughi at Aycliffe School, when this was visited. Despite the problems of evaluating the different therapeutic approaches, certain points do seem clear from this review and from visits to centres. 1. In many cases treatment of the seriously disturbed, previously intractable, child is a very long-term proposition. A commitment to work with the boy, girl or family for several years, is often necessary. 2. Improvement achieved in residential settings, and while active treatment is in progress, is not always maintained subsequently. There is need for much more investigation of what determines whether improvement is maintained, but many programs provided little data about the aftercare given and the longer-term follow-up of the children treated. 3. Intensive treatment, whether residential or not, only makes sense in the context of a long-continuing program of management. Yet many programs, even the best ones, seem to work in relative isolation. 4. Sequential treatment seems to have much to recommend it, and is used, though in a somewhat different way, by all the four British programs that were visited. 5. Some severely disturbed children can be treated in alternative family settings, but which ones, and with what long-term results, is quite vague. These programs do however have several advantages: they keep children in the community, if not in their own homes; they avoid the dangers of institutionalization and the contaminant effects of living with a delinquent peer group; and they approximate more closely the sort of situation (that is, normal family life) which treatment should be helping children to adapt. They are also much less expensive than residential treatment. 6. There is a role for secure units. All who are familiar with the clinical group we are discussing are aware of the existence of a sub-group of very aggressive and violent children who must first be contained. Some of these children can only be constructively treated in a highly secure and very well-staffed unit, but in such a setting it seems that there is a prospect of providing them with some real help. The British “Youth Treatment Centre” concept does seem a useful one. Many points are unclear. These include the following: 1. Does family therapy have a significant part to play in these cases? There is suggestive evidence that it may in some, but many of these children have no families, or at least none with whom they are in contact, and often have been in institutions for much of their lives. 2. What future is there in “intermediate treatment” and community work? Is it in any way realistic to expect to help severely disturbed children by work in the community of which they are part? 3. Can a community approach like that of the California Youth Project make a real contribution to the problem? It seems that in many cases it is better than traditional institutional treatment, but that itself has great limitations. 4. Which of the many residential programs that have been tried is best for which type of problem? 5. How can residential programs be integrated with services in the child's own community to best advantage? 6. What should be the longer term aims of treatment? The various reports of different programs rarely consider this. In conclusion, two points stand out. The first is the need for properly planned and executed research into the treatment of these disorders. It is amazing that so much has been spent on treatment and so little on its evaluation. Perhaps residential treatment is often seen more as a way of getting difficult children out of their communities. The second conclusion is that surely more effort should be made to prevent these disorders. Relatively few of the children under consideration have been brought up in stable, loving homes by their two natural parents. The apparently progressive deterioration of family life, the abandonment of children to day care, the abrogation by many parents of real responsibility for their children and the loss of moral values and religious beliefs are alarming features of contemporary life. Bronfenbrenner (12) has recently commented on how “the American family is falling apart”, and expressed alarm about the current tendency of people to do their “own thing”, to the exclusion of the interests of others. While most children seem to be able to grow up healthily even in contemporary society, the number who become severely disturbed seems likely to increase as these changes in society occur. At the very least we should give a high priority to giving the very best alternative care to children deprived of normal family life.

Long-term follow-up of all-cause and unnatural death in young people with first-episode psychosis

2014 ◽  
Vol 159 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Kally Yuen ◽  
Susy M. Harrigan ◽  
Andrew J. Mackinnon ◽  
Meredith G. Harris ◽  
Hok Pan Yuen ◽  
...  
Keyword(s):  
Young People ◽  
First Episode Psychosis ◽  
First Episode ◽  
Unnatural Death ◽  
Episode Psychosis ◽  
Long Term Follow Up

scholarly journals Long-term outcomes of obsessive–compulsive disorder: follow-up of 142 children and adolescents

2010 ◽  
Vol 197 (2) ◽  
pp. 128-134 ◽  
Author(s):  
N. Micali ◽  
I. Heyman ◽  
M. Perez ◽  
K. Hilton ◽  
E. Nakatani ◽  
...  
Keyword(s):  
Young People ◽  
Psychiatric Disorders ◽  
Obsessive Compulsive Disorder ◽  
Functional Impairment ◽  
Treatment Needs ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Persistence Rates

BackgroundObsessive–compulsive disorder (OCD) often starts in childhood and adolescence and can be a chronic disorder with high persistence rates. There are few prospective long-term follow-up studies.AimsTo follow up young people with OCD to clarify persistence rates and relevant predictors, presence of other psychiatric disorders, functional impairment, service utilisation and perceived treatment needs.MethodAll young people with OCD assessed over 9 years at the National and Specialist Paediatric OCD clinic, Maudsley Hospital, London, were included. Sixty-one per cent (142 of 222) of all contactable young people and parents completed computerised diagnostic interviews and questionnaires.ResultsWe found a persistence rate of OCD of 41%; 40% of participants had a psychiatric diagnosis other than OCD at follow-up. The main predictor for persistent OCD was duration of illness at assessment. High levels of baseline psychopathology predicted other psychiatric disorders at follow-up. Functional impairment and quality of life were mildly to moderately affected. Approximately 50% of participants were still receiving treatment and about 50% felt a need for further treatment.ConclusionsThis study confirms that paediatric OCD can be a chronic condition that persists into adulthood. Early recognition and treatment might prevent chronicity. Important challenges for services are ensuring adequate treatment and a smooth transition from child to adult services.

scholarly journals Multisystemic therapy compared with management as usual for adolescents at risk of offending: the START II RCT

2020 ◽  
Vol 8 (23) ◽  
pp. 1-114
Author(s):  
Peter Fonagy ◽  
Stephen Butler ◽  
David Cottrell ◽  
Stephen Scott ◽  
Stephen Pilling ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Young People ◽  
Multisystemic Therapy ◽  
Self Report ◽  
Second Phase ◽  
Secondary Outcomes ◽  
Start Trial ◽  
The Cost

Background The Systemic Therapy for At Risk Teens (START) trial is a randomised controlled trial of multisystemic therapy (MST) compared with management as usual (MAU). The present study reports on long-term follow-up of the trial (to 60 months). Objectives The primary objective was to compare MST and MAU for the proportion of young people in each group with criminal convictions up to 60 months post baseline. Secondary outcomes included group comparisons of psychological and behavioural factors. An economic analysis was carried out to determine the cost-effectiveness of MST compared with MAU. Two qualitative studies were conducted to better understand the subjective experiences of the participants. Design Primary outcomes (collected up to 60 months) were collected using a centralised police database. Secondary outcomes were evaluated using self-report questionnaires completed by both young people and parents or carers at the 24-, 36- and 48-month follow-ups. Research assistants were blind to treatment allocation. Setting Participants were recruited from participating MST sites in nine areas of England. Secondary outcomes were typically collected within the family home. Participants A total of 684 families were recruited into the START trial and allocated randomly to a treatment group. Of these, 487 remained in the second phase of the trial. Young people were aged, on average, 13.8 years at baseline, with 63% male and 37% female. Interventions MST is a manualised programme for young people exhibiting antisocial behaviour and their families that uses principles from cognitive–behavioural and family therapy to provide an individualised approach. MAU content was not prespecified, but consisted of the standard care offered to young people who met eligibility for the trial. Main outcome measures Young people’s offending was evaluated using the Police National Computer. Secondary measures included validated self-report measures completed by both the young person and their parent or carer. The economic evaluation took a broad perspective and outcomes were assessed in terms of quality-adjusted life-years and offending. Results No significant differences were found in the proportion of offending between the groups (hazard ratio 1.03, 95% confidence interval 0.84 to 1.26; p = 0.78). No differences were found between the groups on secondary outcome measures, with a few exceptions that did not hold up consistently across the follow-up period. The economic analysis did not find evidence to support the cost-effectiveness of MST compared with MAU. Outcomes from the qualitative studies suggest that families mostly felt positive about MST, and that MST was associated with greater maturity in young men. Limitations Some intended evaluations were not possible to deliver. Selective attrition may have influenced the nature of the sample size. It is also unclear how representative the MAU services were of reality. Future research Recommendations are made for the evaluation of MST in populations with more severe behavioural problems, as well as for identifying and testing new moderators. Conclusions The results of the second phase of the START trial do not support the long-term superiority of MST to MAU, but elements of the intervention may be adapted successfully. Trial registration Current Controlled Trials ISRCTN77132214 and London South-East REC registration number 09/H1102/55. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 23. See the NIHR Journals Library website for further project information.

Ischaemic Stroke in Young People: A Prospective and Long-Term Follow-Up Study

2003 ◽  
Vol 15 (1-2) ◽  
pp. 121-128 ◽  
Author(s):  
Rossella Musolino ◽  
Paolino La Spina ◽  
Antonio Granata ◽  
Giuseppe Gallitto ◽  
Nestore Leggiadro ◽  
...  
Keyword(s):  
Young People ◽  
Ischaemic Stroke ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
Stroke In Young

scholarly journals Long-term Follow-up of Patients With Lyme Disease: Longitudinal Analysis of Clinical and Quality-of-life Measures

2016 ◽  
Vol 62 (12) ◽  
pp. 1546-1551 ◽  
Author(s):  
Aprielle B. Wills ◽  
Alicen B. Spaulding ◽  
Jennifer Adjemian ◽  
D. Rebecca Prevots ◽  
Siu-Ping Turk ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lyme Disease ◽  
Longitudinal Analysis ◽  
Quality Of Life Measures ◽  
Long Term Follow Up

scholarly journals M22. IGG ANTIBODIES TO TOXOPLASMA GONDII ARE ASSOCIATED WITH INCREASED LONG-TERM RISK FOR PSYCHOSIS IN INDIVIDUALS AT ULTRA-HIGH RISK FOR PSYCHOSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S141-S142
Author(s):  
Maximus Berger ◽  
Eva Burkhardt ◽  
Alison Yung ◽  
Barnaby Nelson ◽  
Shona Francey ◽  
...  
Keyword(s):  
Risk Factor ◽  
High Risk ◽  
Toxoplasma Gondii ◽  
Young People ◽  
Igg Antibodies ◽  
Ultra High Risk ◽  
Antibody Titers ◽  
Parasitic Pathogens

Abstract Background The prevalence of antibodies to Toxoplasma gondii, a ubiquitous parasitic protozoan causing the infectious disease toxoplasmosis, is increased in patients with psychotic disorders compared to the general population. We have previously shown that antibody titers for T.gondii correlate with the severity of positive symptoms in young people at ultra-high risk (UHR) for psychosis, suggesting that infection with T. gondii may be relevant to the manifestation of psychosis. However, it is unclear if T. gondii antibodies represent a risk factor for psychosis onset or non-psychotic outcome in UHR individuals. The aim of the present study was to examine whether seropositivity for T.gondii is associated with transition to psychosis and other outcomes in young people at UHR for psychosis. Methods The study sample consisted of 96 individuals at UHR for psychosis who were referred to the Personal Assistance and Crisis Evaluation (PACE) clinic in Melbourne, Australia, between 2001 and 2004, consented to optional blood tests for infectious agents and were followed up for up to 10 years after baseline (median (interquartile range) duration of follow-up: 7.15 (3.14 – 7.72) years). Serum IgG antibodies to six viral and parasitic pathogens (Toxoplasma gondii, Herpes Simplex Virus Type 1 and 2, Cytomegalovirus, Epstein Barr Virus, Varicella-Zoster Virus) were measured at baseline. Outcome measures included transition to psychosis, general psychiatric symptomatology and positive psychotic symptoms (BPRS), negative symptoms (SANS), depressive symptoms (HAM-D), anxiety symptoms (HAM-A) and functioning (SOFAS and GAF). Cox proportional hazards regression and linear regression models were used to examine the associations of seropositivity and antibody titers at baseline and transition to psychosis and other outcomes at follow-up. Results A total of 17 individuals (17.7%) were seropositive for Toxoplasma gondii at baseline. The rate of transition to psychosis was higher among seropositive (35.7%) compared to seronegative participants (14.6%), although this was not statistically significant (p=0.101). Antibody titers (IgG) for Toxoplasma gondii were significantly higher at baseline in participants who later transitioned to psychosis (1.34 ± 1.36 vs. 0.79 ± 0.73, p=0.027). Seropositivity for T.gondii IgG at baseline significantly predicted transition to psychosis within the follow-up duration (hazard ratio [HR]=3.61, 95%CI 1.08 – 12.00, p=0.036). Toxoplasma IgG at baseline were significantly associated with higher BPRS scores at follow-up in participants who were seropositive at baseline (Beta=6.38, 95%CI 0.43 – 12.34, p=0.038). No significant associations were found between antibodies to other pathogens and outcome, or between antibodies to Toxoplasma gondii and any other outcomes. Discussion Our findings suggest that the presence of IgG class antibodies for Toxoplasma gondii is associated with a higher risk for psychosis transition in individuals at UHR for psychosis, but not with risk for other long-term outcomes. These observations provide support for the hypothesis that infection with Toxoplasma gondii may be an environmental risk factor for psychosis and suggest that IgG antibodies for Toxoplasma gondii in individuals at UHR for psychosis have prognostic relevance.

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