Occupational therapy practitioners should integrate CR, SE/E, and FPE into early intervention with youth with or at risk for SMI. In addition, CBT is an effective modality for use with this population.

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Young people with CHR demonstrate active avoidance, heightened sensitivity, reduced seeking, and reduced registration of sensations in everyday life compared to typical peers. This pattern of differences may be a valuable marker for identifying individuals who are at high risk for developing a psychotic illness, and may also inform interventions designed to prevent or minimize the illness process and accompanying dysfunction.

Purpose Dual Diagnosis Anonymous (DDA) is a peer-led programme developed in the USA, which aims to address mental and addictive disorders in an integrated manner. This study is part of a mixed-methods evaluation of the first DDA pilot in the UK, and the purpose of this study is to explore the impact and mechanism of change of the programme through the perspective of DDA attendees, facilitators and the funding commissioners. Design/methodology/approach Six DDA members were interviewed three times over a period of 12 months, the facilitators were interviewed twice and the commissioner was interviewed once. The qualitative longitudinal data were analysed using a trajectory thematic analysis. Findings DDA attendance was perceived to have had a positive impact on five main areas: acceptance of self, of others and from others; social functioning; self-development; recovery progression; and feeling of hope. The possibility of addressing both mental health and addiction at the same time was a key factor in the recovery process. The facilitators observed that DDA had contributed to integrate members into employment and education, while the commissioner stressed the importance of joint commissioning and sustainability. Originality/value The longitudinal approach provided a unique insight into the recovery process of DDA members. Being able to address the mental health as well as the substance use problems was considered to be a fundamental strength of DDA in comparison to the single purpose peer-support fellowships.

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The COVID-19 pandemic has been particularly challenging for individuals with concurrent mental health and addiction problems. Like other mutual aid groups, Dual Diagnosis Anonymous (DDA) of Oregon in the US and DDA-UK were forced to suspend face to face meetings during the pandemic. To continue to support its members, DDA began offering online meetings. Objectives: this study explored attendees' perceived effectiveness, strengths, and limitations of online support within the context of the pandemic. Methods: A total of 92 DDA members from the US (n = 71) and the UK (n = 18) completed an online survey, which included quantitative scales and open questions. Feelings of inclusion in online versus in-person meetings were assessed using an adaptation of the Work Group Inclusion Test (Chung et al., 2020). A supplementary interview was conducted with a DDA facilitator. The open survey questions and the interview were independently thematically analyzed by two investigators. Results: Attendance of meetings significantly increased after the introduction of online meetings (p < 0.001). Approximately half of the participants (51.09%) indicated that DDA online support was the most helpful form of support they received during lockdown; 98.77% of participants agreed that online support should continue after the lockdown. There was no significant difference regarding feelings of inclusion in online versus in-person meetings. Conclusions: Online meetings allowed DDA to go global and provided effective support to people with complex needs during the COVID-19 lockdown. Participants experienced a continuity of inclusion and accessibility due to the online provision. Implications: It is suggested that going forward, online support should continue alongside traditional face to face meetings due to its potential to increase convenience, accessibility, and inclusivity.

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