Long-Term Use and Application of Systematic Tailored Assessment for Responding to Suicidality (STARS) Protocol Following Original Training

BACKGROUND

Understanding the use of Systematic Tailored Assessment for Responding to Suicidality protocol (STARS-p) in practice by trained mental health practitioners over the longer- term is critical to informing further developments. The study aim was to examine practitioners' experiences of STARS-p and factors associated with its use in practice over a 12-24-month period after training.

METHOD

Practitioners who undertook the STARS-p training completed an online survey 12-24 months post training. The survey focused on the frequency of use of STARS-p (in full and each section) as well as perceptions about STARS-p applied in practice. Analyses included correlations, logistic regression and content analysis.

RESULTS

67 participants (81% female, Mage = 43.2, SD = 10.3) were included in the analyses. A total of 80.6% of participants had used the entire STARS-p at some time-point in their practice and less than half (44.7%) frequently used the entire STARS-p (all components in one administration). Parts A, B and C were used frequently in suicide risk assessment (SRA) by 84%, 71% and 82% of participants, respectively. Use of the entire protocol and different sections was most related to male gender, perceived ease of administration and confidence in the use of the protocol. Qualitative results revealed three main themes.

CONCLUSIONS

STARS-p as a whole or its parts, is frequently used. Advantages of, and barriers to, using STARS-p in practice can inform further developments of STARS-p and STARS training.

Health practitioner beliefs regarding the impact of age-based stereotype threat on performance in the cognitive assessment of older adults

OBJECTIVES

Health practitioners' understanding of the impact of age-based stereotype threat (ABST) on the cognitive test performance of older adults is not well understood. This study aimed to investigate health practitioners' ability to recognize the influence of ABST in the cognitive assessment of older adults and their perceptions of its impact in practice.

METHODS

One-hundred and twenty-nine health practitioners (86% female; M age = 39.75, SD = 11.50) with experience in conducting cognitive assessments with older adults (mainly psychologists and occupational therapists) completed an online survey assessing demographic and practice characteristics, aging beliefs, a hypothetical cognitive assessment scenario, and perceived impact of ABST on practice.

RESULTS

Overall, health practitioners rated ABST factors in the assessment scenario as less detrimental to cognitive performance than internal and external factors. In a hierarchical regression model, lower recognition of ABST and negative aging beliefs significantly accounted for lower perceived impact of ABST on older adults' cognitive test performance in practice (R² = .37, p < .001).

CONCLUSION

Health practitioners may not recognize the influence of ABST on assessment findings, especially if they hold negative aging beliefs. The findings highlight the need to improve health practitioners' knowledge of ABST to increase the validity of cognitive testing in older adults.

Efficacy of Prospective Memory Rehabilitation Plus Metacognitive Skills Training for Adults With Traumatic Brain Injury: A Randomized Controlled Trial

BACKGROUND

Prospective memory (PM) failure can limit independence and productivity following traumatic brain injury (TBI). Compensatory strategy use may ameliorate the effect of PM impairment on daily life but requires sufficient self-awareness. Metacognitive skills training (MST) can facilitate self-awareness and strategy use and may improve the efficacy of PM rehabilitation.

OBJECTIVE

To evaluate the effectiveness of compensatory strategy training (COMP) with an MST component (COMP-MST) for reducing everyday PM failure and improving psychosocial integration in adults with moderate-severe TBI, compared to COMP alone and a control condition. Secondary aims were to evaluate the effect of training on psychometric PM test scores, strategy use, self-awareness, and level of care.

METHODS

Assessor and participant-blinded randomized controlled trial with 52 participants (77% male, mean age = 39.0. SD = 13.6) allocated to 3 groups: COMP-MST, COMP, and waitlist control. Interventions were delivered over 6 weekly sessions. Measures were collected pre- and post-intervention and 3-month follow-up. Data were analyzed using unstructured linear mixed-effects modeling for repeated measures and planned contrasts between time-points for each group.

RESULTS

The models showed no significant differences between the groups on primary or secondary outcome measures. Significant pre-post intervention improvements were found for significant other's ratings of everyday PM failure for both intervention groups but not the control group, with medium to large effect sizes. Clinically relevant improvements on primary outcomes were found for participants across all 3 groups.

CONCLUSIONS

This study found no significant benefits of combining MST with COMP for improving everyday PM and psychosocial integration.

CLINICAL TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry https://www.anzctr.org.au/ ACTRN12615000996561.

The effects of implementation intentions on prospective memory in young and older adults

Prospective memory (PM) is the ability to perform a planned action at a future time, while carrying on with other unrelated tasks. Implementation Intentions (II) is a promising metacognitive strategy for improving PM in older adults, though its generalization and longer-term effects are not well-understood. We examined the effects of II on PM in 48 community-dwelling older adults (77% female, M_age = 71.52) and 59 young adults (75% female, M_age = 19.86). Participants were randomly allocated to a conventional instruction or II group and administered a laboratory-based PM task in the first session. In the second session, participants returned to complete a similar but new laboratory-based PM task and an ecological PM task without prompts to use a strategy. We found strong age effects on PM performance whereby older adults performed worse than young adults across all PM tasks. While the overall facilitation effect of II was not statistically significant, there was a trend that this strategy facilitated PM performance on the laboratory-based PM task in the first session for older adults with a medium sized effect (d = 0.37). The generalization and longer-term effect of II were not significant for either the similar laboratory-based or the ecological PM task. These results suggest that a single-session II intervention may not be sufficient to elicit transfer to other similar new PM tasks in healthy populations.

Understanding the Neural Basis of Prospective Memory Using Functional Near-Infrared Spectroscopy

Prospective memory (PM) is the ability to perform a planned action at an intended future time. This study examined the neural correlates of PM using functional near-infrared spectroscopy (fNIRS). This study employed a within-participants design. A laboratory PM task was adapted for use with fNIRS to investigate regions of interest and levels of brain activation during task performance in 32 participants (63% female, M_age = 21.31 years, SD_age = 4.62 years). Participants first completed a working memory (WM) task (N-back ongoing task) followed by a WM plus PM task while neural activity was measured using fNIRS. Behavioral results revealed an interference effect for reaction time on the WM task, whereby participants were significantly slower to respond in the WM plus PM task compared to the WM task. Ongoing task accuracies did not differ between the two conditions. fNIRS results revealed a higher level of neural activity in the fronto-polar prefrontal cortex and dorsolateral prefrontal cortex in the WM plus PM task compared to the WM Condition. These findings highlight that fNIRS is a suitable tool for studying and understanding the neural basis of PM.

Supportive care of patients diagnosed with high grade glioma and their carers in Australia

Purpose

This study aimed to: determine the supportive care available for Australian patients with High Grade Glioma (HGG) and their carers; identify service gaps; and inform changes needed to implement guidelines and Optimal Care Pathways.

Methods

This cross-sectional online survey recruited multidisciplinary health professionals (HPs) who were members of the Cooperative Trials Group for Neuro-Oncology involved in management of patients diagnosed with HGG in Australian hospitals. Descriptive statistics were calculated. Fisher's exact test was used to explore differences between groups.

Results

42 complete responses were received. A majority of MDT meetings were attended by a: neurosurgeon, radiation oncologist, medical oncologist, radiologist, and care coordinator. Less than 10% reported attendance by a palliative care nurse; physiotherapist; neuropsychologist; or speech therapist. Most could access referral pathways to a cancer care coordinator (76%), neuropsychologist (78%), radiation oncology nurse (77%), or psycho-oncologist (73%), palliative care (93–100%) and mental health professionals (60–85%). However, few routinely referred to an exercise physiologist (10%), rehabilitation physician (22%), dietitian (22%) or speech therapist (28%). Similarly, routine referrals to specialist mental health services were not standard practice. Nearly all HPs (94%) reported HGG patients were advised to present to their GP for pre-existing conditions/comorbidities; however, most HPs took responsibility (≤ 36% referred to GP) for social issues, mental health, symptoms, cancer complications, and treatment side-effects.

Conclusions

While certain services are accessible to HGG patients nationally, improvements are needed. Psychosocial support, specialist allied health, and primary care providers are not yet routinely integrated into the care of HGG patients and their carers despite these services being considered essential in clinical practice guidelines and optimal care pathways.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11060-022-03991-z.

Improving self-awareness of prospective memory function after TBI using experiential feedback on a board game activity: An observational study

This study investigated whether experiential and video feedback on performance of prospective memory (PM) tasks embedded within a board game activity improved self-awareness of PM function in adults with moderate-severe traumatic brain injury. An observational pre-post study design with 26 participants from a larger trial of a 6-session PM rehabilitation programme. Sessions 3 and 4 included a board game activity with embedded time-, event-, and activity-based PM tasks. Verbal feedback was provided by therapists during the game and video feedback afterwards. Self-ratings of performance were used to divide the sample into under-estimators (n = 7), accurate estimators (n = 9) and over-estimators (n = 10) of actual PM performance. The discrepancy between self- and therapist ratings of PM performance was measured before and after the game, and following video feedback, and compared between timepoints using non-parametric statistics. Post-task self-evaluations were more accurate than pre-task self-evaluations for the under- and over-estimator groups. Under-estimators showed significant improvement in accuracy of ratings for activity-based PM. Over-estimators showed improvement for event-based PM. Further improvements after video feedback were not significant. The board game activity provided a vehicle for experiential feedback and a means of engaging both those with impaired self-awareness and heightened self-awareness of PM in cognitive rehabilitation.

"Hey, I'm still here!": Maintaining, managing and rebuilding social connections after brain tumour

It is well recognized that social networks can buffer the adverse effects of chronic illness on psychological wellbeing. However, the functional impairments associated with brain tumour often affect social participation, which may reduce people's capacity to draw upon their social capital for support. This qualitative phenomenological study aimed to understand how brain tumour influences people's ability to manage, maintain, and rebuild their social networks. Participants were 20 individuals (65% female) aged 22-69 years with diverse types of primary brain tumour (50% high grade or malignant) who were on average 35 months post-diagnosis. Two semi-structured interviews, conducted three months apart, comprised a Social Identity Mapping exercise and questions exploring changes in social groups since diagnosis. Two overarching and interrelated themes emerged: engaging and connecting and then versus now. An interplay of barriers, facilitators and strategies influenced people's ability to engage and connect with their social groups, which in turn influenced whether they experienced stability; maintenance and expansion; loss and rebuilding; or loss and shrinkage of their social networks over time. These novel findings highlight the need to develop interventions that specifically focus on enhancing individuals' abilities to maintain or rebuild their social networks.

A systematic review of self-concept change in multiple sclerosis

Self-concept or sense of self is often altered in the context of neurological illness. Yet, these core aspects of subjective experience are poorly understood for people with multiple sclerosis (MS). This systematic review aimed to synthesize the findings of quantitative and qualitative studies investigating self-concept in MS. PsycINFO, MEDLINE (PubMed), CINAHL, Scopus, and Web of Science were last systematically searched in May 2021, with the Mixed Methods Appraisal Tool and Consolidated Criteria for Reporting Qualiatative Research used to appraise the quality of the eligible articles. Articles were included if they measured or explored self-concept in MS populations, were published in English and peer-reviewed. A total of 30 studies (11 quantitative, 19 qualitative) were identified. Quantitative studies were synthesized using a narrative approach, with results suggesting that MS is associated with some degree of self-concept change. Qualitative studies were synthesized using thematic synthesis, with results illustrating a complex process of self-concept change that is catalyzed by MS-related events and characterized by varying degrees of resistance to, or acknowledgement of, such changes. Future prospective longitudinal studies are needed to characterize the nature of self-concept change in MS using validated tools that measure relevant aspects of self-concept for the MS population.

A Pilot Study of Clinicians' Perceptions of Feasibility, Client-Centeredness, and Usability of the Systematic Tailored Assessment for Responding to Suicidality Protocol

Background: The Systematic Tailored Assessment for Responding to Suicidality (STARS) is a client-centered, psychosocial needs-based assessment protocol. This semistructured interview obtains client prioritized indicators that contribute to suicidality and informs commensurate care responses for preventing suicide. Aim: To pilot the feasibility, client-centeredness, and usability of the STARS protocol, including clinicians' perceptions of ease of use; content validity; and administration within the community setting. Method: A convenience sample of clinicians who undertook assessment and/or intervention with suicidal persons and had used STARS between mid-2016 and early 2017 completed an online survey assessing feasibility, client-centeredness, and usability of STARS. Results: Of the 51 clinicians who entered the survey, 42 (82.3%; aged 25-74; 69% female) completed it. Overall, perceptions of feasibility and usability of STARS were positive, particularly regarding client-centeredness of the protocol and confidence in information obtained for screening suicidality and informing needs-based priority responses. Limitations: The pilot findings are limited by the use of a small convenience sample and the low completion rate of clinicians with STARS training. Conclusion: STARS was perceived as a feasible and useful psychosocial needs-based assessment protocol. Suggestions for improving STARS, training requirements, and application to diverse populations are outlined.

Revisiting the Age-Prospective Memory Paradox Using Laboratory and Ecological Tasks

Prospective memory (PM) is the ability to perform a planned action at a future time. Older adults have shown moderate declines in PM, which are thought to be driven by age-related changes in the prefrontal cortex. However, an age-PM paradox is often reported, whereby deficits are evident in laboratory-based PM tasks, but not naturalistic PM tasks. The key aims of this study were to: (1) examine the age-PM paradox using the same sample across laboratory and ecological settings; and (2) determine whether self-reported PM and cognitive factors such as working memory and IQ are associated PM performance. Two PM tasks were administered (ecological vs. laboratory) to a sample of 23 community-dwelling older adults (M_age = 72.30, SD_age = 5.62) and 28 young adults (M_age = 20.18, SD_age = 3.30). Participants also completed measures of general cognitive function, working memory, IQ, and self-reported memory. Our results did not support the existence of the age-PM paradox. Strong age effects across both laboratory and ecological PM tasks were observed in which older adults consistently performed worse on the PM tasks than young adults. In addition, PM performance was significantly associated with self-reported PM measures in young adults. For older adults, IQ was associated with time-based PM. These findings suggest that the age-PM paradox is more complex than first thought and there are differential predictors of PM performance for younger and older adults.

Measuring domain-specific deficits in self-awareness in children and adolescents with acquired brain injury: Component analysis of the Paediatric Awareness Questionnaire

Self-awareness has been found to vary across different functional domains for adults with acquired brain injury (ABI); however, domain-specific self-awareness is yet to be investigated following paediatric ABI. This study aimed to validate the Paediatric Awareness Questionnaire (PAQ) as a multi-domain measure of self-awareness and to investigate domain-specific self-awareness in children with ABI. One hundred and ninety-seven children and adolescents (8-16 years, M = 12.44, SD = 2.62) with mixed causes of ABI (70% with traumatic brain injury) and their parents (n = 197) were recruited through consecutive rehabilitation appointments and completed the PAQ. The 37 items of the parent version of the PAQ were subjected to a principal component analysis with varimax rotation. A five-component solution (29 items) explained 64% of the variance in the PAQ items. Components revealed five domains of self-awareness: socio-emotional functioning, activities of daily living (ADLs), cognition, physical functioning, and communication. Internal consistency of the components ranged from acceptable to excellent (α = .70-.95). The analysis identified that children had poorer self-awareness of cognitive functioning than socio-emotional functioning, ADLs, and communication skills. Overall, the findings identify five components (i.e., functional domains) of self-awareness and provide some support that self-awareness varies across domains following paediatric ABI.

Feasibility of modifying the hospital environment to reduce the length of amnesia after traumatic brain injury: a pilot randomized controlled trial

BACKGROUND

Reorientation programmes have been an important component of neurotrauma rehabilitation for adults who suffer from post-traumatic amnesia (PTA) after traumatic brain injury (TBI); however, research testing the efficacy of acute programmes is limited.

OBJECTIVE

This study aimed to determine if it is feasible to provide a standardized environmental reorientation programme to adults suffering from PTA after TBI in an acute care hospital setting, and whether it is likely to be beneficial.

METHODS

We conducted a randomized controlled trial with concealed allocation and intention-to-treat analysis. A total of 40 participants suffering from PTA after TBI were included. The control group received usual care; the experimental group received usual care plus a standardized orientation programme inclusive of environmental cues. The primary outcome measure was time to emergence from PTA measured by the Westmead PTA Scale, assessed daily from hospital admission or on regaining consciousness.

RESULTS

Adherence to the orientation programme was high, and there were no study-related adverse responses to the environmental orientation programme. Although there were no statistically significant between-group differences in time to emergence, the median time to emergence was shorter for those who received the standardized reorientation programme (9.0 (6.4-11.6) versus 13.0 (4.5-21.5) days). Multivariate analysis showed that the Glasgow Coma Scale (GCS) at scene (P = 0.041) and GCS at arrival at hospital (P = 0.0001) were significant factors contributing to the longer length of PTA.

CONCLUSION

Providing an orientation programme in acute care is feasible for adults suffering from PTA after TBI. A future efficacy trial would require 216 participants to detect a between-group difference of 5 days with an alpha of 0.05 and a power of 80%.

Impaired Self-Awareness after Pediatric Traumatic Brain Injury: Protective Factor or Liability?

Children and adolescents with traumatic brain injury (TBI) can experience impaired self-awareness, or difficulty in accurately perceiving their personal abilities. This study aimed to identify the neuro-developmental and socio-environmental factors associated with self-awareness impairment and determine how self-awareness is associated with psychosocial functioning. Parents and their children age 8-16 years with TBI (n = 107, 65.4% male, mean [M] age = 12.66 years, standard deviation [SD] = 2.6 years) were consecutively recruited from an outpatient clinic over a 4-year period. Children completed the Paediatric Awareness Questionnaire (PAQ) to report their functional abilities, and the Beck Youth Inventories to report their self-concept, and anxiety and depression symptoms. Parents completed the PAQ and measures of family functioning, parenting style, and children's emotional and behavioral problems. Self-awareness impairments were defined as more negative parent-child discrepancy scores on the PAQ. Younger age at injury, more severe injury, and more family dysfunction were significantly associated with poorer self-awareness. Poorer self-awareness was associated with worse parent-rated child adaptive functioning and emotional and behavioral problems. However, poorer self-awareness was also significantly associated with more positive self-concept and fewer symptoms of depression and anxiety as rated by children. Overall, impaired self-awareness seems to be both a liability and a benefit depending on the reporter (parent or child) and outcome of interest (adaptive function/behavior or self-concept/mood).

Impact of Systematic Tailored Assessment for Responding to Suicidality (STARS) Protocol Training on Mental Health Professionals' Attitudes, Perceived Capabilities, Knowledge, and Reluctance to Intervene

BACKGROUND AND AIMS

Systematic Tailored Assessment for Responding to Suicidality (STARS) protocol and associated training were developed with the key objectives of supporting clinicians to conduct a suicide enquiry, obtaining a comprehensive account of psycho-social factors contributing to suicidality, and collaboratively developing a safety plan with clients. STARS training aims to address knowledge, attitudes and capabilities that influence intervention behavior/skills. This study aimed to examine associations between clinician characteristics and pre-training competencies in suicide risk assessment (SRA), as well as the impact of STARS training workshop on clinician competencies; and to determine the predictors of SRA training outcomes.

METHOD

Australian mental health professionals working with suicidal persons who undertook the STARS 2-day face-to-face workshop between 2018 and 2020 completed an online survey at pre- and post-training. Of the 222 participants who completed the pre-training questionnaire, 144 (64.9%) also completed the post-training questionnaire. Participants were mostly female (75.7%), had completed a university degree (86.4%), had <10 years of experience in suicide prevention (71.7%), and were allied and mental health professionals (78.1%). We used linear mixed-effects regression for statistical analyses.

RESULTS

STARS participants who reported higher perceived capability at baseline had significantly greater formal and informal training, more years of experience in suicide prevention, and were more likely to have experienced client suicide and/or suicide attempt and to report fewer SRA related fears. We found overall significant positive impacts of STARS training on clinician competencies (attitudes, perceived capability, declarative knowledge) from pre- to post-training. The most distinct changes following STARS training were for perceived capability and declarative knowledge. Participants who had more positive attitudes after training were significantly more likely to have had less prior supervision/mentoring. Reluctance to intervene was not found to significantly change after training.

CONCLUSIONS

We found evidence that attitudes, perceived capability and declarative knowledge changed positively from pre- to post-STARS training among mental health professionals. Underpinned by the minimum standardized SRA competencies, STARS training may be critical for informing evidence-based knowledge and skills in SRA and safety planning.

Overcoming Age-Based Stereotypes to Optimise Cognitive Performance in Older Adults: A Systematic Review of Methodology and Existing Evidence

BACKGROUND AND OBJECTIVES

Age-based stereotype threat (ABST) poses serious risks for the cognitive screening of older adults. This review aimed to identify and critically appraise the methodology and existing evidence of studies investigating the use of threat-removal (TR) strategies to overcome the effects of ABST on the cognitive performance of older adults. The types of strategies, their effectiveness in optimising cognitive performance, and factors influencing their effectiveness were examined.

RESEARCH DESIGN AND METHODS

A systematic review was conducted following PRISMA guidelines. PsycINFO, PubMed, Embase, Web of Science, and Scopus were searched from 1st January 1995 to 6th November 2019. Two authors independently assessed article eligibility and appraised methodological quality of eligible articles using an adaptation of the STROBE guidelines. Narrative synthesis was used to summarise results.

RESULTS

Thirty articles, reporting on 36 studies, were eligible and included. Overall, evidence for the effectiveness of TR was mixed and varied according to the explicitness of strategies and comparison conditions used. Studies examining blatant TR strategies, and those using a combination of blatant and subtle TR strategies, provided limited support for their effectiveness in overcoming ABST. However, studies evaluating subtle TR strategies provided preliminary support for their effectiveness in overcoming ABST.

DISCUSSION AND IMPLICATIONS

Existing studies provide limited evidence regarding the effectiveness of TR strategies in overcoming ABST due to methodological limitations. Recommendations are made for the design of future studies to differentiate the benefits of TR strategies from the detrimental effects of ABST, thus potentially informing their use in clinical practice.

Feasibility and acceptability of a telehealth platform for delivering the Making Sense of Brain Tumour programme: A mixed-methods pilot study

ABSTRACTGlioma is a common type of brain tumour that is associated with neurocognitive and psychosocial impairments. This study primarily aimed to investigate the feasibility and acceptability of a videoconferencing format of the Making Sense of Brain Tumour (Tele-MAST) programme. Recruited from a multidisciplinary brain tumour clinic, participants were randomly allocated to the 10-session Tele-MAST programme or standard care, with the latter group offered Tele-MAST after re-assessment. Semi-structured interviews explored participants' experiences of receiving psychological support via the videoconferencing platform. Measures of mental health and quality of life were administered at pre-intervention and post-intervention assessments. Of the 35 patients deemed eligible for the study, 14 (40% accrual) with high grade (71%) or low grade (29%) glioma participated. They were randomized to the Tele-MAST condition (n = 8) or standard care/waitlist (n = 6). Ten individuals commenced the Tele-MAST programme, of whom eight completed ≥8 sessions. The major themes that depicted their experience of the Tele-MAST programme were ease of access and benefits of remote delivery, tailored support and immediacy, and sense of connection versus disconnection. Most participants (63%) demonstrated clinically reliable improvement at post-intervention. These preliminary findings support the feasibility and acceptability of remote delivery of psychological support and highlight the need for a larger-scale evaluation of the Tele-MAST programme.

Use of telehealth platforms for delivering supportive care to adults with primary brain tumors and their family caregivers: A systematic review

OBJECTIVE

Telehealth platforms have potential utility for providing remote access to supportive care to people with brain tumour. This systematic review aimed to evaluate the feasibility, acceptability and efficacy of delivering supportive care via telehealth platforms to adults with primary brain tumour and family caregivers.

METHODS

A systematic search of PsycINFO, MEDLINE, CINAHL, Embase, Scopus and Cochrane Library was conducted from 1980 to 1st June 2020 to identify eligible studies. Methodological quality was assessed by two independent reviewers.

RESULTS

Seventeen articles, reporting on 16 studies, evaluated telephone-based support (5 studies), videoconferencing (3 studies), web-based programs and resources (7 studies) or combined use of videoconferencing and web-based modules (1 study) to deliver supportive care remotely. Caregivers were involved in 31% of interventions. Mean rates of accrual (68%) and adherence (74%) were moderate, whereas acceptability or satisfaction for those completing the interventions was typically high (M satisfied or very satisfied = 81%). Adherence rates were generally higher and clinical gains were more evident for interventions involving real-time interaction as opposed to self-guided interventions.

CONCLUSIONS

Telehealth delivery of supportive care is feasible and acceptable to a high proportion of individuals with primary brain tumour and their caregivers. It is recommended that future research focuses on implementation outcomes, including factors influencing the uptake and sustainability of telehealth platforms in practice.

Evaluation of an occupation-based metacognitive intervention targeting awareness, executive function and goal-related outcomes after traumatic brain injury using single-case experimental design methodology

Self-awareness is commonly impaired after traumatic brain injury and impacts on rehabilitation engagement and community re-integration outcomes. Interventions which incorporate metacognitive strategy instruction have the potential to improve rehabilitation engagement and outcomes. This study aimed to determine whether an occupation-based intervention incorporating metacognitive strategy instruction resulted in goal achievement and improved online awareness and executive function performance during goal-related tasks. A single-case experimental design using a multiple-baseline design across behaviours was used with two participants with severe traumatic brain injury to evaluate the effectiveness of the 6-week intervention. Repeated measures of goal-related performance, percentage of self-corrected errors and executive function were made via independent analysis of video footage and documentation logs. Data analysis involved 2SD bandwidth analysis and overlap data, reliable change index and evaluation of goal achievement across phases. There were improvements in self-corrected errors for one participant, which were maintained. Significant reductions in anxiety (RCI = ±5.98) were evident for both participants, with a significant reduction in stress (RCI = ±7.05) for one participant following the intervention. The occupation-based intervention incorporating metacognitive strategy instruction led to improvements compared to baseline performance in some targeted goals, online awareness and executive function performance during goal-related tasks and reduced stress and anxiety.

A systematic review of siblings' psychosocial outcomes following traumatic brain injury

Purpose: To investigate the psychosocial impact of TBI on siblings and to identify the factors associated with their psychosocial functioning.Methods: A systematic search of six databases (CINAHL, Medline, Scopus, PsychINFO, Web of Science and Embase) was conducted from 1980 to May 1st, 2020. Studies involving siblings of a child or adult with TBI that employed validated self-report measures of psychosocial functioning were included. Quality of methodology was appraised by two reviewers.Results: Thirteen articles were identified, reporting on 11 cross-sectional studies. Although there were mixed findings overall, siblings typically reported greater mood symptoms and distress related to family functioning as compared to the norms and control samples. Siblings' psychosocial functioning was comparable to other family members, although they were less likely to be primary caregivers. Having a brother or sister with behavioural problems and low levels of social support were the factors most consistently related to poor psychosocial functioning in siblings.Conclusions: Siblings of individuals with TBI may experience negative changes in psychosocial functioning. They are at greater risk of poor psychosocial functioning when their brother or sister with TBI has behavioural problems and when they perceive low social support. Longitudinal studies on siblings' adjustment trajectory over time and research on support interventions for siblings are recommended.Implications for RehabilitationTraumatic brain injury can have a negative impact on siblings' psychosocial functioning with respect to mood and distress related to family functioning.As siblings experience similar impacts on their psychosocial functioning to other family members, specific focus on their adjustment to role changes may be needed.Siblings with a brother or sister with behavioural problems and those perceiving lower social support may particularly benefit from monitoring and support.

How I See and Feel About Myself: Domain-Specific Self-Concept and Self-Esteem in Autistic Adults

Few studies have examined the self-perceptions of autistic adults. This study aimed firstly to investigate domain-specific self-concepts and global self-esteem in autistic adults. The second aim was to examine associations between autism self-appraisals, perceived social support and global self-concept and self-esteem. The third was to determine which domains of self-concept were most closely associated with self-esteem. Participants included 71 autistic adults aged 18-70 years and 65 age, sex and education matched typically developing individuals. Participants completed an online survey of autism characteristics, global self-esteem and domain-specific self-concepts (i.e. likeability, task accomplishment, power, giftedness, invulnerability, and morality), self-appraisals about autism, and perceived social support. Autistic participants reported significantly lower power and global self-esteem than typically developing individuals after controlling for autism characteristics. More positive self-appraisals about autism (i.e. greater perceived benefits and lower helplessness) were significantly related to better global self-concept and self-esteem. Global self-esteem was significantly and positively associated with perceptions of giftedness, emotional resilience and power. These findings suggest that autistic adults may perceive themselves as having a low sense of power in their relationships and have negative global perceptions of their self-worth. However, those able to find positive meaning or benefits associated with autism are likely to have more positive global self-perceptions. This study provides new insights into how autistic adults perceive themselves which may guide the focus of psychosocial interventions that seek to recognize and promote unique talents and emotional resilience.

[Formula: see text] Investigation of children and adolescents' mood and self-concept after acquired brain injury

Few studies have examined the self-reported mental health of children with an acquired brain injury (ABI). The current study aimed to: 1) identify levels of child-reported depressive and anxiety symptoms and poor self-concept, 2) investigate demographic and injury-related factors associated with children's mood and self-concept, and 3) examine associations between children's self-reported mental health and parents' reports of children's emotional and behavioral functioning in children specifically with traumatic brain injury (TBI). 122 children (66% male) aged 8-16 years with ABI of mixed etiology were consecutively recruited through an outpatient rehabilitation clinic. Children were administered the Beck Youth Inventories - Second Edition, and parents completed the Adaptive Behavior Assessment System and the Child Behavior Checklist (CBCL). Relative to the norms, 16.4% of children scored in the clinical range for the depression and anxiety scales, and 24.6% reported clinically low self-concept. Children with lower functional status had greater anxiety symptoms. Older children (13-16 years) reported significantly higher depressive and anxiety symptoms and lower self-concept than younger children (8-12 years). A significant interaction between age and sex indicated that older girls reported greater depressive and anxiety symptoms than younger girls whereas no age-based differences were found for boys. Parent-reported total emotional and behavioral problems were positively associated with children's self-reported depressive and anxiety symptoms and were negatively correlated with self-concept. These findings indicate that adolescents, particularly girls, may be at heightened risk of poor mental health following ABI. Further research investigating the reasons for these demographic differences may inform developmentally sensitive interventions.