PLAIN LANGUAGE SUMMARY

Functional Family Therapy is not consistently more (or less) effective than other services

Functional Family Therapy (FFT) is a family-based intervention for youth with behaviour problems. It is often described as an evidence-based programme with consistent, positive effects. This systematic review finds that FFT does not produce consistent benefits or harms. The positive or negative direction of results is inconsistent within and across studies.

What is this review about?

FFT is a prominent, short-term treatment for families of youth with behaviour problems that has been implemented in 45 states in the USA and in nine other high-income countries.Proponents claim that FFT is consistently more effective than treatment as usual (TAU) and other treatments in improving outcomes for youth and families.

This review assessed the effectiveness of FFT in reducing recidivism, out-of-home placements, youth behaviour problems, delinquency, and substance use; and improving peer relations, self esteem, school outcomes, parent functioning, and family functioning.

What is the aim of this review?

This review synthesized data from the best available studies to assess the effectiveness of FFT compared with other active treatments and with no treatment.

What studies are included?

The review included rigorous evaluations of the impacts of FFT, including: randomised controlled trials and non-randomised studies that used parallel cohorts and statistical controls for between-group differences at baseline.

Eligible studies involved families of young people aged 11-18 with behaviour problems, such as criminal offenses, delinquency, anti-social behaviour, and substance abuse.

What are the findings of this review?

Twenty studies met the review’s eligibility criteria, but only 15 provided valid data for meta-analysis. All included studies had high risks of bias on at least one indicator. Half of the studies had high risks of bias on at least four indicators, and most (75%) had incomplete reporting of outcomes and endpoints.

The review found that FFT is not consistently more or less effective than the other treatments to which it has been compared, including various forms of TAU and individual, family, and group therapies. There is insufficient evidence to draw conclusions about the effects of FFT compared with no treatment.

The direction of FFT effects is mixed, sometimes positive, sometimes negative. Confidence intervals show that almost all pooled estimates of effects of FFT are not statistically different from zero. Prediction intervals indicate that future evaluations of FFT are likely to show a wide range of negative and positive effects.

What are the implications for research and policy?

The best available evaluations of FFT are small controlled trials and quasi-experiments with incomplete reporting of outcomes and some high risks of bias. Future studies should have prospectively registered protocols, use larger samples and more rigorous research methods, and provide full reporting on all outcomes and end points.

Incomplete reporting of results of primary studies may have inflated overall estimates of positive effects of FFT.

Although FFT has been marketed as a “scientifically proven”, effective, evidence-based practice, policymakers and practitioners should be aware that the certainty of the evidence for FFT is very low. The direction of results is inconsistent within and across studies, and there is no empirical support for claims that FFT is consistently more effective than other treatments.

Information on the cost effectiveness of FFT appears to be based on inflated estimates of the effects of treatment. Therefore, claims about the cost effectiveness of FFT are not convincing.

How up-to-date is this review?

The review authors searched for studies that were reported through August 2020.

PLAIN LANGUAGE SUMMARY

Flipped classrooms may improve academic performance and satisfaction of undergraduate health professional students

Flipped classroom learning appears to improve academic performance and the evidence suggests student satisfaction with the innovative learning method, but the certainty of the evidence was low.

What is this review about?

Students face several challenges when learning through traditional teaching settings. They need to accumulate huge amounts of factual knowledge from the courses, and to keep up-to-date with the prolific growth in health knowledge.

Lack of awareness about digital technologies and non-exposure to digital-friendly environments have made learning even more challenging. Therefore, an innovative approach to the education delivery system is needed.

A flipped class includes two elements of education: a recorded lecture (off-campus learning as homework) and an active learning session (on-campus learning). Pre-recorded lectures are provided to the students as homework and as an aid to learning which is then interactively discussed later on campus.

This review aims to explore whether there is empirical evidence that supports this method of learning for undergraduate health professional students. Do flipped classrooms improve academic performance and are students satisfied with the flipped class learning method?

What is the aim of this review?

This Campbell systematic review examines the effects of flipped class teaching compared to the traditional method. The review summarises evidence from 45 studies, including 11 randomised controlled trials.

What studies are included?

This review includes studies that have evaluated the effect of flipped classes compared to traditional classes on the academic performance and course satisfaction of health professional undergraduate students.

Forty-five studies were identified, involving 8,426 undergraduate students in medicine, pharmacy, nursing and other health professional courses.

Of these, 44 studies involving 7,813 undergraduate students examined the outcome of academic performance, measured by examination scores/final grade). Only eight studies, involving 1,696 undergraduate students, examined the outcome of students’ satisfaction.

Studies spanned the period 2013 to 2021. Sixteen studies were conducted in the USA, and only three studies were from lower-middle-income countries, including India. All the studies had important methodological weaknesses.

Does the flipped class method of learning improve students’ academic performance?

Yes, low certainty of evidence shows an overall improvement in academic performance when flipped classroom interventions were implemented compared to traditional lecture-based classes.

Are students satisfied with flipped class learning?

Yes, low certainty of evidence shows that students’ satisfaction with the flipped classroom method of learning is positive. Therefore, further research may change the estimate in either direction (that is, a larger difference, or no difference, in satisfaction).

What do the findings in this review mean?

The review shows that flipped classroom learning may improve academic performance and satisfaction of undergraduate health professional students. Well-designed studies with larger samples that rigorously evaluate the outcomes are needed.

How up-to-date is this review?

The literature searches were last conducted in April 2022.

PLAIN LANGUAGE SUMMARY

Most COVID-19 studies looked at the influence of sex, age and our perception of COVID-19 on social distancing, handwashing and face covering

Over the course of the COVID-19 pandemic there have been huge volumes of research looking at how different factors influence COVID-19 health protective behaviours: social distancing, face covering and handwashing. The majority of this research is focused on factors that cannot be altered through intervention, such as demographics (age and sex).

The interactive evidence and gap map (EGM) is available here.

What is this evidence and gap map (EGM) about?

In the early stages of the COVID-19 pandemic, health protective behaviours such as distancing and handwashing were the first line of defence to help limit the spread of COVID-19. Understanding why people do or do not engage in recommended behaviours is important to developing successful public health messaging, and to increase the number of people engaging in these behaviours.

This EGM summarises studies that measured one or more factors that might influence health protective behaviours, including handwashing, use of face coverings, social or physical distancing, and isolation or quarantine.

What is the aim of this EGM?

The aim of this EGM is to map the current research on different factors and health protective behaviours, such as social distancing, handwashing and face covering.

What studies are included?

The current map includes 1,034 pieces of evidence. This consists of 25 reviews (including 17 systematic reviews) and 1,009 primary studies. Of these, 860 were cross-sectional studies, 68 were longitudinal, and 78 were qualitative studies.

What are the main findings of this EGM?

There was lots of evidence on some behaviours (social distancing, handwashing, face covering) and very little on others (not touching your face, cleaning surfaces).

Social distancing had the most evidence (487 studies), followed by use of face coverings (382 studies) and handwashing (308 studies). Fewer studies looked at behaviours such as avoiding the T-zone (not touching your face), cleaning surfaces and respiratory hygiene practices (coughing into your elbow or tissue).

A large number of studies (333 studies) combined two or more protective behaviours within the one study. This makes it difficult to use these studies to look at how different factors may influence individual behaviours.

Across the studies there are significant differences in how different behaviours are defined. Some studies described social distancing as minimising contacts outside of the home, whereas others used the term to mean physical distancing from others (for example, keeping at least two metres apart).

In relation to the different factors influencing these behaviours, demographics was the most reported (730 studies), followed by cognitive factors (how people might perceive or think about COVID-19; 496 studies).

Fewer studies looked at the influence of factors such as interventions (for example, providing access to hand sanitiser), information on COVID-19 (for example, the different sources of information people received) and the impact of engaging in other protective behaviours (for example, if someone covered their face, would they be more or less likely to also social distance).

What do the findings of the map mean?

This EGM shows the available evidence on the different factors that may influence health protective behaviours such as distancing, face coverings and handwashing.

This EGM can be used to help guide future areas of research and public health policy during the current COVID-19 pandemic and any future outbreaks of respiratory viruses with pandemic potential.

Current evidence is largely focused on social distancing and the use of face coverings; and primarily on the influence of factors such as age or sex (demographics) on these behaviours. There are major gaps in the evidence base on other important health protective behaviours and the influence of factors other than age or sex.

How up-to-date is this EGM?

The authors searched for studies up to October 2021.

PLAIN LANGUAGE SUMMARY

Case management interventions improve housing stability for people experiencing homelessness and the effects may be increased with intensive support

Homelessness is an important problem and case management support may provide part of the solution. This review includes some guidance for current practice and policy and recommendations for future research, including an expansion of the research base outside North America.

What is this review about?

Many millions of people experience homelessness, potentially leading to poorer health and wellbeing outcomes, and a lower life expectancy. We present evidence on a wide range of interventions that include a case manager to help the individual client to find stable housing.

What is the aim of this review?

This Campbell systematic review examines studies of case management programmes for people experiencing homelessness to help identify the components most likely to increase the chances of improvements in housing, health and wider outcomes.

What studies are included?

We looked, specifically, for any findings to help identify the individual components of case management such as the period over which support is provided, the number of clients per case manager, and whether there are conditions attached to this support from the client’s point of view.

We explored the effects of these interventions on homelessness and other outcomes such as mental health, substance use, physical heath, wellbeing and employment.

What are the main findings of this review?

Case management effectiveness overall:

Any type of case management clearly improves homelessness outcomes for people with additional support needs, and this may be more effective for people who also have greater levels of additional need for support. Case management also increases wellbeing for the population in the included studies, at least in the short term.

Across the full body of evidence, it does not appear that the included interventions improve mental health, and there is no evidence of improvement in employment, physical health or substance use.

Time spent in stable housing may be increased when case management is more intensive. The multi-component Housing First approach may be more effective than other types of intensive case management.

Case management components:

In terms of housing outcomes, support for up to three years leads to improvements in stable housing. These benefits may be reduced over the longer term but still persist, suggesting that very long-term support should be provided.

In-person meetings with the case manager appear to be beneficial when compared with remote or mixed (remote/in-person) meetings but many studies did not describe meeting location(s).

Although there was not enough evidence from the intervention studies, there is consistent evidence from the implementation studies that any barriers attached to case management support (i.e. conditions that must be met to receive that support) should be minimised.

Supporting case managers:

A number of themes arise from the implementation studies that are relevant to the components of a case management programme. These include the importance of a close working relationship across agencies; provision for the non-housing support and training needs of clients experiencing homelessness; community support and development for the newly-housed; providing for the emotional support and training needs of case managers; and giving clients choice in relation to the type of housing provided.

Cost effectiveness:

The available studies vary in their findings. It is likely that case management is more costly than usual care but may be cost-effective if society is ‘willing to pay’ a certain amount to support people experiencing homelessness into stable housing.

What do the findings of this review mean?

Case management helps people experiencing homelessness who have additional support needs to obtain stable accommodation, and is even more helpful for those with higher levels of support needs.

High intensity multicomponent approaches such as Housing First may lead to greater benefits. There is also some evidence for improvements to capabilities and wellbeing but, notably, they do not appear to impact mental health outcomes any more than usual care.

There is some evidence that case management support should be long term, that meetings in person with clients are beneficial, and any conditions associated with provision of the service should be minimised.

How up-to-date is this review?

The review authors searched for studies that were reported up to March 2021.