Showing papers in "Campbell Systematic Reviews in 2015"

Economic Self-Help group Programs for Improving Women's Empowerment: A Systematic Review

Abstract: s screened (n = 3498) Records excluded (n = 3136) Full-text articles assessed for eligibility (n = 362) Full-text articles excluded, with reasons (n = 257) Studies included in qualitative synthesis (n = 11) Studies included in quantitative synthesis (n = 23) Refined screening of remaining 107 full-text articles; 74 excluded with reasons

School-Based Education Programmes for the Prevention of Child Sexual Abuse : A Systematic Review

Abstract: This Campbell systematic review examines the effectiveness of school‐based education programmes for the prevention of child sexual abuse. The review summarises findings from 24 trials, conducted in the U.S., Canada, China, Germany, Taiwan and Turkey. Six metaanalyses are included assessing evidence of moderate quality. This study is an update to a previous review and covers publications up to September 2014. School‐based education programmes for the prevention of child sexual abuse are more effective than alternative programmes or no programme at all in strengthening children's knowledge about child sexual abuse prevention and their protective behaviours. Children retain the knowledge gained from programme participation, though no study has assessed retention over a period of longer than six months. No studies examined the retention of protective behaviours over time. Disclosures of previous and current occurrences of child sexual abuse increase for participants of school‐based education programmes. However, the evidence supporting this finding is weak and should be interpreted with caution. Abstract BACKGROUND Child sexual abuse is a significant global problem in both magnitude and sequelae. The most widely used primary prevention strategy has been the provision of school‐based education programmes. Although programmes have been taught in schools since the 1980s, their effectiveness requires ongoing scrutiny. OBJECTIVES To systematically assess evidence of the effectiveness of school‐based education programmes for the prevention of child sexual abuse. Specifically, to assess whether: programmes are effective in improving students' protective behaviours and knowledge about sexual abuse prevention; behaviours and skills are retained over time; and participation results in disclosures of sexual abuse, produces harms, or both. SEARCH METHODS In September 2014, we searched CENTRAL, Ovid MEDLINE, EMBASE and 11 other databases. We also searched two trials registers and screened the reference lists of previous reviews for additional trials. SELECTION CRITERIA We selected randomised controlled trials (RCTs), cluster‐RCTs, and quasi‐RCTs of school‐based education interventions for the prevention of child sexual abuse compared with another intervention or no intervention. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of trials for inclusion, extracted data, and assessed risk of bias. We summarised data for six outcomes: protective behaviours; knowledge of sexual abuse or sexual abuse prevention concepts; retention of protective behaviours over time; retention of knowledge over time; harm; and disclosures of sexual abuse. MAIN RESULTS This is an update of a Cochrane Review that included 15 trials (up to August 2006). We identified 10 additional trials for the period to September 2014. We excluded one trial from the original review. Therefore, this update includes a total of 24 trials (5802 participants). We conducted several meta‐analyses. More than half of the trials in each meta‐analysis contained unit of analysis errors. Meta‐analysis of two trials (n = 102) evaluating protective behaviours favoured intervention (odds ratio (OR) 5.71, 95% confidence interval (CI) 1.98 to 16.51), with borderline low to moderate heterogeneity (Chi2 = 1.37, df = 1, P value = 0.24, I2 = 27%, Tau2 = 0.16). The results did not change when we made adjustments using intraclass correlation coefficients (ICCs) to correct errors made in studies where data were analysed without accounting for the clustering of students in classes or schools. Meta‐analysis of 18 trials (n = 4657) evaluating questionnaire‐based knowledge favoured intervention (standardised mean difference (SMD) 0.61, 95% CI 0.45 to 0.78), but there was substantial heterogeneity (Chi2 = 104.76, df = 17, P value

Community-Based Rehabilitation for People With Disabilities in Low- and Middle-income Countries: A Systematic Review

Abstract: Review question: We reviewed the evidence about the impact of community-based rehabilitation on the lives of people with disabilities and their carers in low- and middle-income countries. Background: People with disabilities include those who have long-term physical, mental, intellectual or sensory impairments, which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others. There are estimated to be over one billion people with disabilities globally and 80% of them live in low- and middle-income countries. They are often excluded from education, health, and employment and other aspects of society leading to an increased risk of poverty. Community-based rehabilitation interventions are the strategy endorsed by the World Health Organization and other international organisations (e.g. ILO, IDDC) for addressing the needs of this group of people in low- and middle-income countries. These interventions aim to enhance the quality of life of people with disabilities and their carers, by trying to meet their basic needs and ensuring inclusion and participation using predominantly local resources. These interventions are composed of up to five components: health, education, livelihood, social and empowerment. Currently only few people who need them benefit from these interventions, and so it is important to assess the available evidence to identify how to best implement these programmes. Study characteristics: The evidence in this review is current to July 2012. This review identified 15 studies that assessed the impact of community-based rehabilitation on the lives of people with disabilities and their carers in low- and middle-income countries. The studies included in the review used different types of community-based rehabilitation interventions and targeted different types of physical (stroke, arthritis, chronic 7 The Campbell Collaboration | www.campbellcollaboration.org obstructive pulmonary disease) and mental disabilities (schizophrenia, dementia, intellectual impairment). Key results: Overall, randomised controlled trials suggested a beneficial effect of community-based rehabilitation interventions in the lives of people with physical disabilities (stroke and chronic obstructive pulmonary disease). Similar results were found for non-randomised studies for physical disabilities (stroke and arthritis) with the exception of one non-randomised study on stroke showing community-based rehabilitation was less favourable than hospital-based rehabilitation. Overall, randomised controlled trials suggested a modest beneficial effect of community-based rehabilitation interventions for people with mental disabilities (schizophrenia, dementia, intellectual impairment), and for their carers (dementia). Similar results were found for non-randomised studies for mental disabilities (schizophrenia). However, the methodological constraints of many of these studies limit the strength of our results. In order to build stronger evidence, future studies will need to adopt better study designs, will need to focus on broader clients group, and to include economic evaluations.

The Effects on Re‐offending of Custodial vs. Non‐custodial Sanctions: An Updated Systematic Review of the State of Knowledge

Abstract: As part of a broad initiative of systematic reviews of experimental or quasiexperimental evaluations of interventions in the field of crime prevention and the treatment of offenders, our work consisted in searching through all available databases for evidence concerning the effects of custodial and non-custodial sanctions on reoffending. For this purpose, we examined more than 3,000 abstracts, and finally 23 studies that met the minimal conditions of the Campbell Review, with only 5 studies based on a controlled or a natural experimental design. These studies allowed, all in all, 27 comparisons. Relatively few studies compare recidivism rates for offenders sentenced to jail or prison with those of offenders given some alternative to incarceration (typically probation).

Strategies to Increase the Ownership and Use of Insecticide-Treated Bednets to Prevent Malaria: A Systematic Review

Abstract: BACKGROUND Malaria is a life-threatening parasitic disease and 40% of the world's population lives in areas affected by malaria. Insecticide-treated bednets (ITNs) effectively prevent malaria, however, barriers to their use have been identified. OBJECTIVES To assess the evidence on the effectiveness of available strategies that focus on delivery and appropriate use of ITNs. SEARCH METHODS We searched the EPOC Register of Studies, CENTRAL, MEDLINE, EMBASE, HealthStar, CINAHL, PubMed, Science Citation Index, ProQuest Dissertations and Theses, African Index Medicus (AIM), World Health Organization Library and Information Networks for Knowledge (WHOLIS), LILACS, Virtual Health Library (VHL), and the World Health Organization Library Information System (WHOLIS). Initial searches were conducted in May 2011, updated in March 2012 and February 2013. Authors contacted organizations and individuals involved in ITN distribution programs or research to identify current initiatives, studies or unpublished data, and searched reference lists of relevant reviews and studies. SELECTION CRITERIA Randomized controlled trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series evaluating interventions focused on increasing ITN ownership and use were considered. The populations of interest were individuals in malaria-endemic areas. DATA COLLECTION AND ANALYSIS Two authors independently screened studies to be included. They extracted data from the selected studies and assessed the risk of bias. When consensus was not reached, any disagreements were discussed with a third author. The magnitude of effect and quality of evidence for each outcome was assessed. MAIN RESULTS Of the 3032 records identified, 10 studies were included in this review. Effect of ITN cost on ownership:Four studies including 4566 households and another study comprising 424 participants evaluated the effect of ITN price on ownership. These studies suggest that providing free ITNs probably increases ITN ownership when compared to subsidized ITNs or ITNs offered at full market price. Effect of ITN Cost on appropriate use of ITNs:Three studies including 9968 households and another study comprising 259 individuals found that there is probably little or no difference in the use of ITNs when they are provided free, compared to providing subsidized ITNs or ITNs offered at full market price. Education:Five studies, including 12,637 households, assessed educational interventions regarding ITN use and concluded that education may increase the number of adults and children using ITNs (sleeping under ITNs) compared to no education.One study, including 519 households, assessed the effects of providing an incentive (an undisclosed prize) to promote ITN ownership and use, and found that incentives probably lead to little or no difference in ownership or use of ITNs, compared to not receiving an incentive.None of the included studies reported on adverse effects. AUTHORS' CONCLUSIONS Five studies examined the effect of price on ITN ownership and found moderate-certainty evidence that ownership was highest among the groups who received the ITN free versus those who purchased the ITN at any cost. In economic terms, this means that demand for ITNs is elastic with regard to price. However, once the ITN is supplied, the price paid for the ITN probably has little to no effect on its use; the four studies addressing this outcome failed to confirm the hypothesis that people who purchase nets will use them more than those who receive them at no cost. Educational interventions for promoting ITN use have an additional positive effect. However, the impact of different types or intensities of education is unknown.

Active Labour Market Programme Participation for Unemployment Insurance Recipients: A Systematic Review

Abstract: The objective of this systematic review was to study the effectiveness of Active Labour Market Programmes (ALMP) participation on employment status for unemployment insurance recipients. The primary outcome was measured as exit rate to work in a small time period and as the probability of employment at a given time. The two measures were analysed separately. We also investigated if participation effects differ with the type of ALMP programme and if participation in ALMP was associated with the quality of the job obtained as measured by employment duration and income. A total of 73 studies, consisting of 143 papers, met the inclusion criteria and were critically appraised by the review authors. The final selection comprised 73 studies from 15 different countries. Only 47 studies provided data that permitted the calculation of an effect size for the primary outcome. Of these, six studies could not be used in the data synthesis due to their high risk of bias. An additional two studies could not be used due to overlap of data samples. A total of 39 studies were therefore included in the data synthesis. Overall, ALMP programmes display a limited potential to alter the employment prospects of the individuals they intend to help. The available evidence does suggest that there is an effect of participating in ALMP, but the effect is small and we found no effect of being assigned to ALMP participation at a particular moment. It was not possible to examine a number of other factors which we had reason to expect as impacting on the magnitude of the effect and which may be crucial to policy makers. The results of this review, however, merely suggest that across a number of different programmes there is an overall small effect of ALMP participation on job finding rates, and no evidence of differential effects for different programmes. While additional research is needed, the review does however suggest that there is a small increase in the probability of finding a job after participation in ALMP Executive summary/Abstract BACKGROUND During the 1990s, many countries introduced Active Labour Market Programmes (ALMPs) in an effort to reduce unemployment. The introduction of ALMPs is often motivated by the need to upgrade the skills of especially those suffering long‐term unemployment to improve their productivity and, subsequently, their employability. Other ALMPs are designed to encourage the unemployed to return to work. Typically, compulsory programme participation is required after the individual has received unemployment benefits for a certain period of time. A large variety of different ALMPs exist among countries. They can consist of job search assistance, training, education, subsidized work and similar programmes. Some of the programmes (such as subsidized work, training and education) demand full‐time participation over a long time period (e.g. several months), while other programmes (such as job search assistance and education) are part‐time and have a short duration (e.g. few days/weeks). It is possible to classify these programmes into a set of four core categories: A: (labour market) training, B: Private sector programmes, C: direct employment programmes in the public sector and D: Job search assistance. The categories we use broadly correspond to classifications that have been suggested and used by the OECD and Eurostat (OECD, 2004 and Eurostat, 2005), even though there are differences between OECD and Eurostat in how they define and categorise these programmes. OBJECTIVES The objective of this systematic review was to study the effectiveness of ALMP participation on employment status for unemployment insurance recipients. The primary outcome was measured as exit rate to work in a small time period and as the probability of employment at a given time. The two measures were analysed separately. We also investigated if participation effects differ with the type of ALMP programme and if participation in ALMP was associated with the quality of the job obtained as measured by employment duration and income. SEARCH STRATEGY Relevant studies were identified through electronic searches of bibliographic databases, government policy databanks, internet search engines and hand searching of core journals. We searched to identify both published and unpublished literature. The searches were international in scope. Reference lists of included studies and relevant reviews were also searched. SELECTION CRITERIA All study designs that used a well‐defined control group were eligible for inclusion in this review. Studies that utilized qualitative approaches were not included due to the absence of adequate control group conditions. DATA COLLECTION AND ANALYSIS The total number of potential relevant studies constituted 16,422 hits. A total of 73 studies, consisting of 143 papers, met the inclusion criteria and were critically appraised by the review authors. The final selection comprised 73 studies from 15 different countries. Only 47 studies provided data that permitted the calculation of an effect size for the primary outcome. Of these, six studies could not be used in the data synthesis due to their high risk of bias. An additional two studies could not be used due to overlap of data samples. A total of 39 studies were therefore included in the data synthesis. Only five studies provided data that permitted the calculation of an effect size for secondary outcomes. Random effects models were used to pool data across the studies. We used the point estimate of the hazard ratio (the relative exit rate from unemployment to employment) and the risk difference (the difference in the probability of employment). Pooled estimates were weighted using inverse variance methods, and 95% confidence intervals were estimated. The impact of programme type was examined using meta regression and subgroup analysis. Sensitivity analysis was used to evaluate whether the pooled effect sizes were robust across study design, and to assess the impact of methodological quality and of the quality of data. Funnel plots were used to indicate the probability of publication bias. RESULTS The available evidence suggests that there is a general effect of participating in ALMP. The findings are mixed, however, depending on the approach used to investigate the effect, with no effect found of being assigned to ALMP participation at a particular moment. We found a statistically significant effect of ALMP post participation as measured by hazard ratios and risk difference in separate analyses. The overall impact of ALMP participation obtained using hazard ratios was 1.09, which corresponds to a 52 per cent chance that a treated unemployed person will find a job before a non‐treated unemployed person. The overall impact of ALMP participation was associated with a risk difference of 0.07, which corresponds to a number needed to treat of 15; i.e. for every 15 unemployed people who participate in ALMP, an additional unemployed person will be holding a job approximately one year after participation. The available evidence does not, however, suggest an effect of being assigned to ALMP participation at a particular moment. There was inconclusive evidence that participation in ALMP has an impact on the quality of the job obtained. Sensitivity analyses resulted in no appreciable change in effect size, suggesting that the results are robust. We found no strong indication of the presence of publication bias. The available evidence does not suggest that the effect of ALMP participation differs by type of programme. Other reviews by for example Kluve, 2010 and Card et al., 2010 conclude job search assistance programmes are relatively better, and direct employment programmes in the public sector relatively worse, than other programmes in terms of the likelihood of these different programmes to estimate a significant positive and a significant negative employment outcome. However, it should be kept in mind that the apparently different conclusions concerning relative effectiveness of type of ALMP are obtained based on very different inclusion criteria concerning participants and substantially different approaches and statistical methods. It was not possible to examine whether the participation effect varies with gender, age or educational group, or with labour market condition. AUTHORS' CONCLUSIONS To the best of our knowledge, this is the first systematic review analysing the magnitude (and not merely the statistical significance) of the effect of ALMP participation in unemployed individuals receiving unemployment insurance benefits. Overall, ALMP programmes display a limited potential to alter the employment prospects of the individuals they intend to help. The available evidence does suggest that there is an effect of participating in ALMP, but the effect is small and we found no effect of being assigned to ALMP participation at a particular moment. The four different types of ALMP (labour market training, private sector programmes, direct employment programmes in the public sector and job search assistance) were investigated. The available evidence does not suggest that the ALMP participation effect differs by type of ALMP. It was not possible to examine a number of other factors which we had reason to expect as impacting on the magnitude of the effect and which may be crucial to policy makers. The results of this review, however, merely suggest that across a number of different programmes there is an overall small effect of ALMP participation on job finding rates, and no evidence of differential effects for different programmes. While additional research is needed, the review does however suggest that there is a small increase in the probability of finding a job after participation in ALMP.

Psychosocial Interventions for School Refusal with Primary and Secondary School Students: A Systematic Review

Abstract: BACKGROUND School refusal is a psychosocial problem characterized by a student’s difficulty attending school and, in many cases, substantial absence from school (Heyne & Sauter, 2013). It is often distinguished from truancy, in part because of the severe emotional distress associated with having to attend school and the absence of severe antisocial behavior. Truancy, on the other hand, is not typically associated with emotional distress and is commonly associated with severe externalizing behavior. The emotional distress associated with school refusal is often in the form of fear or anxiety, and sometimes in the form of depression. School refusal occurs for about 1-2% of young people, and estimates among clinically referred youth are considerably higher.

Preventive Interventions to Reduce Youth Involvement in Gangs and Gang Crime in Low- and Middle-Income Countries: A Systematic Review

Abstract: BACKGROUND Youth gangs are frequently associated with high levels of crime and violence in low- and middle-income countries – creating fear, reducing social cohesion, costing billions of dollars in harm and many thousands of lives diverted to criminality. However, youth gangs are also seen to fill a void, as a means of overcoming extreme disadvantage and marginalization. Preventive interventions focus on capacity building and social prevention, and are designed to work proactively to stop crime before it occurs, either by preventing youth from joining gangs or by reducing recidivism by rehabilitating gang members outside of the criminal justice system. By addressing the causes of youth gang membership, these interventions seek to reduce or prevent gang violence...

Behavioral, Psychological, Educational and Vocational Interventions to Facilitate Employment Outcomes for Cancer Survivors: A Systematic Review

Abstract: In the United States, an estimated 1.5 million people are diagnosed annually with some type of cancer (American Cancer Society, 2011). Work is an important stabilizing factor for cancer survivors (Arnold, 1999). De Boer and colleagues (2009) identified a rate of 33.8% unemployment among cancer survivors beyond the age of 18 compared to 15.2% among a healthy international control population. Greater awareness of the job-related and workplace issues that cancer survivors face can lead to more comprehensive rehabilitation plans and recovery (Centers for Disease Control, 2011; Nathan, Hayes-Lattin, Sisler, & Hudson, 2011). Although various recent interventions have been developed to address unemployment among cancer survivors, these have not yet been systematically evaluated.

Cognitive-behavioural therapies for young people in outpatient treatment for non-opioid drug use: a systematic review.

Abstract: Youth drug use is a severe problem worldwide. This review focuses on Cognitive-Behavioural Therapy (CBT) as a treatment for young people who misuse non-opioid drugs, such as cannabis, amphetamines, ecstasy and cocaine, which are strongly associated with a range of health and social problems. CBT is an individualized and multicomponent intervention that combines behavioural and cognitive therapy. While behavioural therapy mainly focuses on external settings and observable behaviour, cognitive therapy is concerned with internal cognitive processes. The primary focus of CBT is to reduce usersâ?T positive expectations about drug use, to enhance their self-confidence to resist drugs, and to improve their skills for problem-solving and for coping with daily life stressors. The objective of this review is to assess the effectiveness of CBT for young people (aged 13-21) in outpatient treatment for non-opioid drug use and to explore any factors that may moderate outcomes. The literature search yielded a total of 18,514 references, of which 394 were deemed potentially relevant and retrieved for eligibility determination. Of these, 360 did not fulfil the screening criteria and were excluded. Four records were unobtainable. A total of seven unique studies, reported in 17 papers, were included in the review. Meta-analysis was used to examine the effects of CBT on drug use reduction, social and family functioning, school problems, treatment retention and criminal activity compared to a group of other interventions (Adolescent Community Reinforcement Approach (ACRA), Chestnut Bloomington Outpatient (CBOP) (+Assertive Continuing Care (ACC)), Drugs Harm Psychoeducation curriculum (DHPE), Functional Family Therapy (FFT), Interactional Therapy (IT), Multidimensional Family Therapy (MDFT), and Psychoeducational Therapy (PET)). Our main objective was to evaluate the current evidence on the effect of CBT on abstinence and drug use reduction for young people in outpatient treatment for non-opioid drug use. Seven randomised trials, involving 953 participants, were included in this review. Each of the seven included studies compared CBT to another intervention. We analysed the effects in the short term (from the start of treatment to up to 6 months thereafter), medium term (from 6 months to less than 12 months after the start of treatment), and long term (12 months or more after the start of treatment). We analysed CBT that was delivered with an add-on component such as motivational interviewing (four studies) separately from CBT that was delivered without an add-on component (three studies). Based on meta-analysis of data from the four included studies analysing CBT with an add-on component, there was no evidence of a relative effect of CBT for the reduction of youth drug use frequency compared to other interventions (ACRA, CBOP (+ACC), DHPE, FFT and MDFT). The random effects standardized mean difference was -0.14 (95% CI -0.64, 0.36) for the short term based on four studies, -0.06 (95% CI -0.44, 0.32) for the medium term based on four studies and -0.15 (95% CI -0.36, 0.06) for the long term based on two studies. Based on meta-analysis of data from the four included studies analysing CBT without an add-on component, there was no evidence of a relative effect of CBT for the reduction of youth drug use frequency compared to other interventions (IT, MDFT, and PET ). The random effects standardized mean difference was -0.13 (95% CI -0.68, 0.42) for the short term based on two studies, -0.08 (95% CI -0.48, 0.31) for the medium term based on three studies and 0.02 (95% CI -0.48, 0.52) for the long term based on two studies. Thus, the available data does not support the hypothesis that there is a drug use reduction effect from using CBT with young drug users compared to other interventions (ACRA, CBOP (+ACC), DHPE, FFT, IT, MDFT, and PET ). Statistically significant heterogeneity was present in the short term. In the medium term statistically significant heterogeneity was present between studies analysing CBT with an add-on component. In the analysis of studies without an add-on component there was no statistically significant heterogeneity in the medium term. Due to the low power of detecting heterogeneity with only two studies included in the analysis, this result should be interpreted with caution. There was no heterogeneity between studies in the long term; however, with only two studies included in the analyses the power to detect heterogeneity was low. The primary outcome measured as recovery could only be analysed in the long term. The meta-analysis of CBT with an add-on component was inconclusive as the eight different comparison combinations analysed showed different results. Only one study analysing CBT without an add-on component provided data on recovery status. The reported effect was not statistically significant.

Interventions to Improve the Labour Market Situation of Adults with Physical and/or Sensory Disabilities in Low- and Middle-Income Countries: A Systematic Review

Abstract: Disability is a development issue, with widespread poverty, inequality and violation of human rights. Recent estimates suggest that more than one billion people are living with some form of disability. Persons with disabilities are over-represented among the world’s poor, and significant labour market disadvantage helps maintain the link between poverty and disability in many country contexts. The costs of disability are particularly acute in low- and middle-income countries (those with gross national income per capita of less than $12,616), where up to 80% of people with disabilities of working age can be unemployed, around twice that for their counterparts in high-income countries. When people with disabilities do work, they generally do so for longer hours and lower incomes, have fewer chances of promotion, are more likely to work in the informal labour market, and are at greater risk of becoming unemployed for longer periods. The barriers faced by people with disabilities globally in accessing and sustaining paid work is a profound social challenge. There is now growing recognition of employment as a key factor in the process of empowerment and inclusion into society, and the role of interventions to improve labour market outcomes for disabled people is receiving increased international attention. It is therefore both vital and timely to increase understanding of the impacts of available programmes, in order to ensure that they are effective in delivering positive outcomes for people with disabilities and provide value for money. Although several reviews have attempted to summarise the existing research in this area, there are a number of substantive and methodological limitations to these reviews. Thus, there is a need to systematically examine the evidence base to provide an overview of the types of interventions being used to improve employment outcomes, to identify those that are effective and ineffective, and to identify areas in which more research needs to be conducted.

Multidimensional Family Therapy (MDFT) for young people in treatment for non-opioid drug abuse: a systematic review .

Abstract: This is a Campbell Systematic Review of the effect of Multidimensional Family Therapy (MDFT) for treating abuse of cannabis, amphetamine, ecstasy or cocaine (referred to here as non-opioid drugs) among young people aged 11-21 years. The misuse of prescription drugs and the use of ketamine, nitrous oxide and inhalants such as glue and petrol are not considered in this review. Youth drug abuse is a severe problem worldwide and recent reports describe ominous trends of youth drug abuse and a lack of effective treatment. This review is concerned with drug abuse that is severe enough to warrant treatment. It focuses on young people who are receiving MDFT specifically for non-opioid drug abuse. MDFT is a manual-based, family-oriented treatment, designed to eliminate drug abuse and associated problems in young peopleâ?Ts lives. MDFT takes a number of risk and protective factors into account; the approach acknowledges that young peopleâ?Ts drug abuse is linked to dimensions such as home life, friends, school and community (Liddle et al., 2004). MDFT aims to modify multiple domains of functioning by intervening with the young person, family members, and other members of the young personâ?Ts support network (Austin et al., 2005). MDFT is thus based on a number of therapeutic alliances, with the young drug abuser, his or her parents and other family members, and sometimes with school and juvenile justice officials. After a rigorous search of the literature, five randomized controlled studies with samples of 83-450 participants were identified. Three studies were conducted by MDFT program developers, one study was conducted by an independent investigator with the program developer as a co-author, and one study was conducted by independent investigators. Four studies were performed in the US, while the other was performed across five European countries. We used meta-analytic procedures to summarise the available evidence on the effects of MDFT in comparison with other interventions on drug abuse, education, family functioning, risk behavior and retention in treatment. In this review, we interpret a value of the standardised mean difference, SMD=0.20 as a small effect size, in line with the general practice (Cohen, 1988). We note, however, the possibility that such a value might actually represent a larger effect if it is equivalent to a large reduction in the percentage of days a youth uses drugs, but we cannot comment further as we were unable to analyse the absolute effect of MDFT given that no studies comparing MDFT to no other treatment were available. The findings are as follows: - On drug abuse: Based on the available evidence we conclude that MDFT has an effect on drug abuse reduction compared to other treatments, although the difference is small. - On education: There is insufficient evidence to conclude whether MDFT has an effect on education compared to other treatments. - On family functioning: There is no available evidence to conclude whether MDFT has an effect on family functioning compared to other treatments. - On risk behavior and other adverse effects: There is no available evidence to conclude whether MDFT has an effect on risk behavior and other adverse effects compared to other treatments. - On treatment retention: MDFT may result in improved treatment retention in young drug abusers compared to other interventions The evidence found was limited as only five studies were included, and two studies had significant amounts of missing data. The evidence was very limited in terms of the outcomes reported on education, family functioning and risk behavior, and was insufficient for firm conclusions to be drawn on the effectiveness of the treatment with regard to such outcomes. There is evidence that MDFT is slightly more effective in treating young peopleâ?Ts drug abuse than other treatments; however, the difference is small. Furthermore, none of the five included studies could be characterised as a robust RCT with a low risk of bias on all assessed domains. One study provided insufficient information on core issues for the risk of bias to be assessed and therefore we find reason to question the validity of this study. Well-designed, randomized controlled trials within this population are needed. More research is also required to identify factors which modify the effect of MDFT and to identify which particular youth subgroups may be most likely to respond.

Family Behavior Therapy (FBT) for Young People in Treatment for Non‐opioid Drug Use: A Systematic Review

Abstract: This publication is a systematic Campbell review of the effect of the family therapy approach Family Behavior Therapy (FBT) for treatment for non-opioid drug use (e.g., cannabis, amphetamine, ecstasy or cocaine) among young people aged 11-21 years.Youth drug use is a severe problem worldwide. Recent reports describe concerning trends in the use of drugs by young people and a lack of available treatment. FBT is a manual-based family therapy approach that seeks to reduce drug use among youth by identifying stimuli and triggers for drug taking, and teaching self-control and other skills to correct the problem behaviors related to drug use. This approach is based on the therapeutic premise that the family carries a profound influence on child and youth development and that interventions need to be flexible and tailored to the unique characteristics of the families. It is also argued that there is a need for interventions to be problem-focused, targeting first those patterns of behavior that most directly influence the youth’s drug use.

Parent‐infant Psychotherapy for Improving Parental and Infant Mental Health: A Systematic Review

Abstract: BACKGROUND Parent-infant psychotherapy (PIP) is a dyadic intervention that works with parent and infant together, with the aim of improving the parent-infant relationship and promoting infant attachment and optimal infant development. PIP aims to achieve this by targeting the mother’s view of her infant, which may be affected by her own experiences, and linking them to her current relationship to her child, in order to improve the parent-infant relationship directly. OBJECTIVES 1. To assess the effectiveness of PIP in improving parental and infant mental health and the parent-infant relationship. 2. To identify the programme components that appear to be associated with more effective outcomes and factors that modify intervention effectiveness (e.g. programme duration, programme focus). SEARCH METHODS We searched the following electronic databases on 13 January 2014: Cochrane Central Register of Controlled Trials (CENTRAL, 2014, Issue 1), Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, BIOSIS Citation Index, Science Citation Index, ERIC, and Sociological Abstracts. We also searched the metaRegister of Controlled Trials, checked reference lists, and contacted study authors and other experts. SELECTION CRITERIA Two review authors assessed study eligibility independently. We included randomised controlled trials (RCT) and quasi-randomised controlled trials (quasi-RCT) that compared a PIP programme directed at parents with infants aged 24 months or less at study entry, with a control condition (i.e. waiting-list, no treatment or treatment-as-usual), and used at least one standardised measure of parental or infant functioning. We also included studies that only used a second treatment group. DATA COLLECTION AND ANALYSIS We adhered to the standard methodological procedures of The Cochrane Collaboration. We standardised the treatment effect for each outcome in each study by dividing the mean difference (MD) in post-intervention scores between the intervention and control groups by the pooled standard deviation. We presented standardised mean differences (SMDs) and 95% confidence intervals (CI) for continuous data, and risk ratios (RR) for dichotomous data. We undertook meta-analysis using a random-effects model. MAIN RESULTS We included eight studies comprising 846 randomised participants, of which four studies involved comparisons of PIP with control groups only. Four studies involved comparisons with another treatment group (i.e. another PIP, video-interaction guidance, psychoeducation, counselling or cognitive behavioural therapy (CBT)), two of these studies included a control group in addition to an alternative treatment group. Samples included women with postpartum depression, anxious or insecure attachment, maltreated, and prison populations. We assessed potential bias (random sequence generation, allocation concealment, incomplete outcome data, selective reporting, blinding of participants and personnel, blinding of outcome assessment, and other bias). Four studies were at low risk of bias in four or more domains. Four studies were at high risk of bias for allocation concealment, and no study blinded participants or personnel to the intervention. Five studies did not provide adequate information for assessment of risk of bias in at least one domain (rated as unclear). Six studies contributed data to the PIP versus control comparisons producing 19 meta-analyses of outcomes measured at post-intervention or follow-up, or both, for the primary outcomes of parental depression (both dichotomous and continuous data); measures of parent-child interaction (i.e. maternal sensitivity, child involvement and parent engagement; infant attachment category (secure, avoidant, disorganised, resistant); attachment change (insecure to secure, stable secure, secure to insecure, stable insecure); infant behaviour and secondary outcomes (e.g. infant cognitive development). The results favoured neither PIP nor control for incidence of parental depression (RR 0.74, 95% CI 0.52 to 1.04, 3 studies, 278 participants, low quality evidence) or parent-reported levels of depression (SMD -0.22, 95% CI -0.46 to 0.02, 4 studies, 356 participants, low quality evidence). There were improvements favouring PIP in the proportion of infants securely attached at post-intervention (RR 8.93, 95% CI 1.25 to 63.70, 2 studies, 168 participants, very low quality evidence); a reduction in the number of infants with an avoidant attachment style at post-intervention (RR 0.48, 95% CI 0.24 to 0.95, 2 studies, 168 participants, low quality evidence); fewer infants with disorganised attachment at post-intervention (RR 0.32, 95% CI 0.17 to 0.58, 2 studies, 168 participants, low quality evidence); and an increase in the proportion of infants moving from insecure to secure attachment at post-intervention (RR 11.45, 95% CI 3.11 to 42.08, 2 studies, 168 participants, low quality evidence). There were no differences between PIP and control in any of the meta-analyses for the remaining primary outcomes (i.e. adverse effects), or secondary outcomes. Four studies contributed data at post-intervention or follow-up to the PIP versus alternative treatment analyses producing 15 meta-analyses measuring parent mental health (depression); parent-infant interaction (maternal sensitivity); infant attachment category (secure, avoidant, resistant, disorganised) and attachment change (insecure to secure, stable secure, secure to insecure, stable insecure); infant behaviour and infant cognitive development. None of the remaining meta-analyses of PIP versus alternative treatment for primary outcomes (i.e. adverse effects), or secondary outcomes showed differences in outcome or any adverse changes. We used the Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) approach to rate the overall quality of the evidence. For all comparisons, we rated the evidence as low or very low quality for parental depression and secure or disorganised infant attachment. Where we downgraded the evidence, it was because there was risk of bias in the study design or execution of the trial. The included studies also involved relatively few participants and wide CI values (imprecision), and, in some cases, we detected clinical and statistical heterogeneity (inconsistency). Lower quality evidence resulted in lower confidence in the estimate of effect for those outcomes. AUTHORS' CONCLUSIONS Although the findings of the current review suggest that PIP is a promising model in terms of improving infant attachment security in high-risk families, there were no significant differences compared with no treatment or treatment-as-usual for other parent-based or relationship-based outcomes, and no evidence that PIP is more effective than other methods of working with parents and infants. Further rigorous research is needed to establish the impact of PIP on potentially important mediating factors such as parental mental health, reflective functioning, and parent-infant interaction.

Multidimensional Family Therapy (MDFT) for Young People in Treatment for Non-opioid Drug Use: A Systematic Review

Abstract: This is a Campbell Systematic Review of the effect of Multidimensional Family Therapy (MDFT) for treating abuse of cannabis, amphetamine, ecstasy or cocaine (referred to here as non-opioid drugs) among young people aged 11-21 years. The misuse of prescription drugs and the use of ketamine, nitrous oxide and inhalants such as glue and petrol are not considered in this review. Youth drug abuse is a severe problem worldwide and recent reports describe ominous trends of youth drug abuse and a lack of effective treatment. This review is concerned with drug abuse that is severe enough to warrant treatment. It focuses on young people who are receiving MDFT specifically for non-opioid drug abuse. MDFT is a manual-based, family-oriented treatment, designed to eliminate drug abuse and associated problems in young peopleâ?Ts lives. MDFT takes a number of risk and protective factors into account; the approach acknowledges that young peopleâ?Ts drug abuse is linked to dimensions such as home life, friends, school and community (Liddle et al., 2004). MDFT aims to modify multiple domains of functioning by intervening with the young person, family members, and other members of the young personâ?Ts support network (Austin et al., 2005). MDFT is thus based on a number of therapeutic alliances, with the young drug abuser, his or her parents and other family members, and sometimes with school and juvenile justice officials. After a rigorous search of the literature, five randomized controlled studies with samples of 83-450 participants were identified. Three studies were conducted by MDFT program developers, one study was conducted by an independent investigator with the program developer as a co-author, and one study was conducted by independent investigators. Four studies were performed in the US, while the other was performed across five European countries. We used meta-analytic procedures to summarise the available evidence on the effects of MDFT in comparison with other interventions on drug abuse, education, family functioning, risk behavior and retention in treatment. In this review, we interpret a value of the standardised mean difference, SMD=0.20 as a small effect size, in line with the general practice (Cohen, 1988). We note, however, the possibility that such a value might actually represent a larger effect if it is equivalent to a large reduction in the percentage of days a youth uses drugs, but we cannot comment further as we were unable to analyse the absolute effect of MDFT given that no studies comparing MDFT to no other treatment were available. The findings are as follows: - On drug abuse: Based on the available evidence we conclude that MDFT has an effect on drug abuse reduction compared to other treatments, although the difference is small. - On education: There is insufficient evidence to conclude whether MDFT has an effect on education compared to other treatments. - On family functioning: There is no available evidence to conclude whether MDFT has an effect on family functioning compared to other treatments. - On risk behavior and other adverse effects: There is no available evidence to conclude whether MDFT has an effect on risk behavior and other adverse effects compared to other treatments. - On treatment retention: MDFT may result in improved treatment retention in young drug abusers compared to other interventions The evidence found was limited as only five studies were included, and two studies had significant amounts of missing data. The evidence was very limited in terms of the outcomes reported on education, family functioning and risk behavior, and was insufficient for firm conclusions to be drawn on the effectiveness of the treatment with regard to such outcomes. There is evidence that MDFT is slightly more effective in treating young peopleâ?Ts drug abuse than other treatments; however, the difference is small. Furthermore, none of the five included studies could be characterised as a robust RCT with a low risk of bias on all assessed domains. One study provided insufficient information on core issues for the risk of bias to be assessed and therefore we find reason to question the validity of this study. Well-designed, randomized controlled trials within this population are needed. More research is also required to identify factors which modify the effect of MDFT and to identify which particular youth subgroups may be most likely to respond.

Protocol for a Systematic Review: Effects of Certification Systems for Agricultural Commodity Production on Socio-economic Outcomes in Low and Middle-Income Countries

Abstract: and full-text screening The screening of studies for inclusion and the subsequent data extraction (coding) will proceed in three distinct stages. Initially, the titles and abstracts of studies identified during the search process will be screened for relevance. Thereafter, studies found to be of relevance to the review will be downloaded in full text and screened against the sets of inclusion criteria set out in this protocol. Lastly, studies selected for inclusion will be coded according to a detailed coding manual. The first screening for relevance on titles and abstracts will be done by research assistants working under the oversight of team members, against clearly defined exclusion criteria. The code sheet for this stage will be piloted and we will test for agreement amongst coders. Screening on title and abstract will not be double-coded, but pilot screening until consistency is reached among coders will ensure uniformity. A coding manual for screening on title and abstract will be put in place to support the coders, while ongoing communication with the rest of the review team will ensure that screening consistency is maintained. Moreover, coders are instructed to be over-inclusive at this stage and will work under close supervision by more senior team members. All exclusions will be logged in an electronic form in EPPI Reviewer 4. Studies will generally not be disregarded on methodological grounds at this stage, as a serious assessment of study quality cannot normally be based on abstracts only. Exceptions are studies where the abstract clearly indicates an unsuitable study type or design, for example, book reviews, literature reviews with no primary evidence or advocacy/policy documents, as listed in section 3.1. Reviewers, when in doubt, will choose to include studies at this stage, so as not to lose relevant evidence. The reports selected for further screening based on their titles and abstracts will then be downloaded as full text into a database to be evaluated in greater detail against the inclusion criteria set out above. We will undertake independent, double-coding at this stage, and the coding sheet will be trialled and refined. A database will be created in EPPI Reviewer 4. Reviewers will complete an electronic form for each study reviewed. The forms will be retained both to ensure transparency and to allow for the creation (and possibly analysis) of an excluded studies table later in the review. The broad range of interventions relevant to the review questions pursued necessitate the inclusion of an equally wide variety of studies in terms of method. Different inclusion criteria will be deployed for both quantitative and qualitative studies. Studies may be excluded from the review on grounds of study design at this stage (see section above). For each study an inclusion/exclusion checklist will be filled in and retained. These checklists will be more detailed than is perhaps common, as this review is the first systematic review following Campbell criteria to target this particular area of the literature.