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IntroductionThe rate of preterm birth is increasing worldwide.1 2 3 In economically advantaged countries reported rates range from 6% to 12%.1 2 In England about 10000 babies born at or below 32 weeks’ gestation are admitted to National Health Service (NHS) neonatal units each year.4 The survival of preterm infants has also steadily increased over time,5 and the long term health implications are becoming increasingly apparent,6 7 emphasising the importance of high quality neonatal care. Delivery in specialist centres is associated with improved outcomes,8 and many countries have adopted highly regionalised systems of neonatal care.9 In the United Kingdom, neonatal services have developed largely in response to local needs. Historically most district general hospitals offered some level of specialist neonatal care, but there nike air shox all white
was considerable variation in the degree to which hospitals collaborated in the provision of intensive care.10

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In phase two of the intervention, a plan for change was developed. Where the person was open to change in substance use, cognitive behavioural techniques from both the psychosis and substance use evidence base were used to formulate a change plan and to help the patient implement and maintain changes such as reduction or abstinence in one or more substances. Components included identifying and increasing awareness of high risk situations and warning signs for substance use lapse or relapse; developing coping skills for handling such situations, with particular womens white leather nike shox
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or with depressed mood); coping with cravings and urges; making lifestyle changes as alternatives to substance use; and normalising and responding to lapses and relapses. For those who did not identify substance use as problematic, the intervention was sufficiently flexible to allow therapists to work with other patient led problems. In such cases, the therapist would use motivational interviewing techniques to help the patient to link substance use to their concerns. Three liaison meetings between the patient, the therapist, and the patient’s case manager were scheduled during therapy to communicate progress.