Introduction The RAISE Connection Program Implementation and Evaluation study (RAISE-IES) developed tools necessary to implement and disseminate an innovative team-based intervention designed to promote engagement and treatment participation, foster recovery, and minimize disability among individuals experiencing early psychosis. This paper presents the treatment model and reports on service utilization and outcomes. Using a within-group analysis, it was hypothesized that individuals’ symptoms and functioning would improve over time. Methods A total of 65 individuals in RAISE Connection Program treatment across two sites, (Baltimore, MD and Manhattan, NY) were enrolled and received services for up to two years. Primary outcomes included social and occupational functioning as well as symptoms. Trajectories for individuals’ outcomes over time were examined using linear and quadratic mixed-effects models with repeated measures. Results Measures of occupational and social functioning improved significantly over time; symptoms declined, and rates of remission improved. Visits were most frequent during the first 3 months, with a mean of 23.1± 11.5 unduplicated staff encounters per quarter, decreasing to 8.8±5.2 such encounters in the final quarter of year 2. Conclusions The overall project was successful in that the treatment program was delivered and tools useful to other clinical settings were produced. The strengths of this study lie in the demonstrated feasibility of delivering the coordinated specialty care model and the associated high rates of engagement among individuals who are typically difficult to engage in treatment. Notwithstanding the lack of a built-in comparison group, participant outcomes were promising, with improvements comparable to those seen with other successful interventions.

ObjectiveThe aim of this systematic review was to assess the effect of interventions to reduce stress in pregnant women with a history of miscarriage.DesignA systematic review of randomised controlled trials (RCTs).Data sourceA total of 13 medical, psychological and social electronic databases were searched from January 1995 to April 2016 including PUBMED, CENTRAL, Web of Science and EMBASE.Eligibility criteriaThis review focused on women in their subsequent pregnancy following miscarriage. All published RCTs which assessed the effect of non-medical interventions such as counselling or support interventions on psychological and mental health outcomes such as stress, anxiety or depression when compared with a control group were included. Stress, anxiety or depression had to be measured at least preintervention and postintervention.ResultsThis systematic review found no RCT which met our initial inclusion criteria. Of the 4140 titles screened, 17 RCTs were identified. All of them were excluded. One RCT, which implemented a caring-based intervention, included pregnant women in their subsequent pregnancy; however, miscarriage was analysed as a composite variable among other pregnancy losses such as stillbirth and neonatal death. Levels of perceived stress were measured by four RCTs. Different types of non-medical interventions, time of follow-up and small sample sizes were found.ConclusionCohort studies and RCTs in non-pregnant women suggest that support and psychological interventions may improve pregnant women’s psychological well-being after miscarriage. This improvement may reduce adverse pregnancy-related outcomes in subsequent pregnancies. However, this review found no RCTs which met our criteria. There is a need for targeted RCTs that can provide reliable and conclusive results to determine effective interventions for this vulnerable group.

Mental health programs can address many components of fidelity with routinely available data. Information from client interviews can be used to corroborate these administrative data. In an application of this approach, data from these sources indicated that a team-based intervention for people experiencing early psychosis was implemented as intended, including program elements related to shared decision-making as well as a range of evidence-based clinical interventions.

Stillbirth remains a global health challenge which is greatly affected by social and economic inequality, particularly the availability and quality of maternity care. The International Stillbirth Alliance (ISA) exists to raise awareness of stillbirth and to promote global collaboration in the prevention of stillbirth and provision of appropriate care for parents whose baby is stillborn. The focus of this ISA conference was to share experiences to improve bereavement support and clinical care. These issues, relevant throughout the globe, are not discrete but closely interrelated, with both similarities and differences depending on the specific country and cultural context. Counting stillbirths and understanding the causes of stillbirth are essential not only for providing optimal care and support to parents whose babies die, but also for reducing the future burden of stillbirth. This summary highlights novel work from obstetricians, midwives, psychologists, parents and peer support organizations that was presented at the ISA meeting. It covers topics including the bereavement process, peer support for parents, support and training for staff, evidence for clinical care, and the need for accurate data on stillbirths and perinatal audits. Representatives from the maternity services of the region presented their outcome data and shared their experiences of clinical and bereavement care. Data and developments in practice within stillbirth and bereavement care must be widely disseminated and acted upon by those responsible for maternity care provision, both to prevent stillbirths and to provide high-quality care when they do occur.