Action research with caseworkers: Responding to and reflecting on the impacts of COVID-19 on birth family contact

Social distancing due to COVID-19 forced changes to contact with birth relatives for children in out-of-home care. This required a shift to using technologies, which was previously underutilized and viewed as risky. In an action research study, 33 caseworkers in New South Wales, Australia, reflected upon adapting their practices. Three key themes characterized the changes in caseworker practices and how these impacted upon social interactions between children and their birth and carer families: communication, not location; shared not separate spaces and spontaneous not restricted interaction. First, caseworkers described how contact via technologies involved fewer logistical arrangements, shifting the focus on interactions among children and their two families and encouraging these to be flexible and child-centred. Second, caseworkers discussed how spending time together virtually could build trust, as carers and birth relatives could forge relationships around shared commitment to the child's wellbeing. Third, caseworkers noted that technology-facilitated communication enabled greater choice and control for children while requiring renegotiating boundaries. The findings reflect a shift in caseworker perceptions of technology-facilitated contact from a risk to opportunity framework as a result of COVID-19 conditions, consistent with social shaping of technology theory. Beyond the pandemic, contact with birth relatives can be enhanced through technology.

'I don't feel like I'm in this on my own': Peer support for mothers of children with intellectual disability and challenging behaviour

This article reports on the peer support experiences of mothers with a son or daughter with intellectual disability and challenging behaviour. Engagement in parent peer support programs can improve family quality of life and may have multifaceted benefits at the interpersonal, intra-individual self-change and sociopolitical levels. Thirteen mothers were interviewed about their experiences of participating in a parent peer support program. Thematic analysis focused on the process elements of the program that contributed to its effectiveness in providing support to parents. There were three process-related themes: the role of a paid coordinator, diversity of engagement strategies and matching of peer support partners. Mothers appreciated the opportunities provided to engage in a range of strategies tailored to individual preferences, time and capacity constraints, supported by the paid coordinator. One-to-one peer support proved difficult to sustain given the challenges mothers faced in their day-to-day lives.

The process of change for people with cognitive impairment in a residential rehabilitation program for substance problems: a phenomenographical analysis

Cognitive impairment is prevalent among people with substance problems and a factor affecting retention in treatment. Empirical phenomenography was used to systematically explore how people with cognitive impairment viewed a novel residential rehabilitation program - Project RE PIN - designed with cognitive compensatory behaviour change activities and from a strengths-based approach. Twelve participants took part in semi-structured interviews and cross-case analysis identified the overarching theme of change. Key program elements were the safe environment, structured routines, modified psycho-educational material and staff support. Critical changes that participants attributed to the program were in dealing with their own and others' emotions, experiencing daily life without drugs or alcohol and reframing their self-view. Fear and anxiety about relapse were common and few participants had strategies or support to cope in the future. This study demonstrates that program activities changed participants' thoughts, feelings and behaviours about themselves and their substance use. The results indicate that RE-PIN's modified content and processes can benefit people with cognitive impairments in treatment. The study highlights that some treatment users may be vulnerable to resumption of drug use despite gains made during a residential program and their desire to remain substance-free.

Parents with intellectual disabilities and their perspective of peer support: "It depends on how they give it"

BACKGROUND

Parents with intellectual disabilities face particular challenges, such as lack of sufficient support with their parenting. Peers can be an important source of support for parents in the general population; however, there is a limited knowledge about peer support for parents with intellectual disabilities. The aim of this study was to explore experiences of parents with intellectual disabilities with social support with a focus on the role of peers.

METHOD

Twenty-six parents with intellectual disabilities in New South Wales, Australia, took part in a semi-structured interview.

RESULTS

The inductive content analysis of data revealed three main themes; this article reports on one of them-Developing interdependence.

CONCLUSIONS

The source of support was less important than the way support was offered. Parents valued support offered by someone who respected them as a person and parent, and was interested in what they wanted and needed.

"Living the life I want": A framework for planning engagement with people with intellectual disability and complex support needs

BACKGROUND

Self-determination involves autonomy, agency, choice and control. This study investigated how these aspects of self-determination relate to engaging people with intellectual disability and complex support needs in setting goals and making plans.

METHOD

Body mapping was used to understand the planning experiences of 30 adults with intellectual disability and complex support needs. Each participant created two body maps using a guided group-based process. Visual and text data were thematically analysed and a framework for planning engagement developed.

RESULTS

The framework identifies the centrality of having a well-developed sense of self which includes insight, motivation and agency, and which is shaped by contextual barriers and facilitators and influenced by helpful and unhelpful support.

CONCLUSIONS

A well-developed sense of self and ability to harness resources and people is fundamental to the ability of individuals with intellectual disability and complex support needs articulating goals, identifying aspirations, and attaining valued outcomes.

Home and the social worlds beyond: exploring influences in the lives of children of mothers with intellectual disability

BACKGROUND

Mothers with intellectual disability are likely to raise their children in socially disadvantaged circumstances, and many face social isolation; however, the impact of a potentially restricted home context on children's social worlds has not been examined. This study was conducted to explore influences in the social worlds of children of mothers with intellectual disability from a child's perspective.

METHODS

Seven children aged 7 to 11 years took part in at least two semi-structured interviews over a year. Narrative accounts of each child's social interactions were analysed to ascertain if a pattern was present across the group.

RESULTS

Home was found to influence the children's social interactions elsewhere by providing (or not) predictable routines and rules, and support from a significant adult other than a mother. Home environments were found to influence other social worlds by establishing a foundation for children's expectations about social interactions.

CONCLUSIONS

The social worlds of school-aged children of mothers with intellectual disability are shaped by influences in the home that cannot be attributed exclusively to having a parent with intellectual disability. Significant adults provide an important support role and can be fulfilled by social service workers when a family-centred approach is applied.

The role of formal support in the lives of children of mothers with intellectual disability

BACKGROUND

Mothers with intellectual disability face socioeconomic disadvantage and social isolation, which is associated with poorer child outcomes. Social services feature prominently in the lives of mothers with intellectual disability especially those without informal support; however, the role of formal support in the lives of their children has not been explored.

METHODS

Seven children aged 7-11 years took part in semi-structured interviews to explore their social experiences. Stories about interactions at home, school and with peers were analysed to illuminate influences, including social support, in their lives.

RESULTS

Formal support can provide an enduring relationship for children from socially restricted homes when it focuses on the child's abilities, interests and needs as distinct from those of their mother. Child-focused support can be from a paid worker or volunteer.

CONCLUSIONS

Family support services need to apply a child focus to improve the well-being of children in vulnerable families.

Unpacking the complexity of planning with persons with cognitive disability and complex support needs

BACKGROUND

Planners will engage with people with cognitive disability and complex support needs in the Australian National Disability Insurance Scheme, but the specific skills needed to build sustainable plans with this group are not yet known.

METHOD

A qualitative study was conducted to explore the barriers and facilitators to planning with people with cognitive disability and complex support needs. Focus groups were held with 99 planning practitioners across metropolitan and regional locations in New South Wales, Australia.

RESULTS

Thematic analysis showed planners need to build a partnership based on mutual trust and respect with a person with complex support needs and harness a range of skills to respond to individual support needs, learning capacity, systemic hurdles and life challenges.

CONCLUSIONS

Planner skills can be used to address barriers to planning for people with cognitive disability and complex support needs. Gaining skills took professional support and personal commitment.

Motivational interviewing to enhance adolescent mental health treatment engagement: a randomized clinical trial

BACKGROUND

The prevalence of anxiety and mood disorders in adolescents is a growing public health concern worldwide. Given the high rates of drop-out and limited resources available in psychiatric settings, the importance of engaging adolescents in evidence-based treatments cannot be understated. The aim of the study was to determine the efficacy of motivational interviewing (MI), as a brief pre-treatment intervention, to enhance treatment engagement in a standard therapy setting (group cognitive behavioral therapy; gCBT) for adolescents with anxiety and mood disorders.

METHOD

Ninety-six adolescents (13-18 years) with a principal diagnosis of an anxiety or mood disorder participated in a trial conducted at two publicly funded outpatient services. Participants were randomly assigned to individual MI for treatment engagement prior to gCBT (MI + gCBT), or to an individually administered active control (befriending) prior to gCBT (befriending + gCBT). Eight pairs of gCBT were run in parallel. Outcome measures were the mean number of gCBT sessions attended, treatment initiation, and ratings of readiness for treatment.

RESULTS

Participants randomized to MI as a pretreatment intervention attended significantly more group therapy sessions compared to those in the active control condition. The MI group also demonstrated greater treatment initiation, and ratings of treatment readiness were significantly higher for those randomized to MI.

CONCLUSIONS

MI, used as a pre-treatment intervention, enhanced group treatment engagement in adolescents diagnosed with anxiety and mood disorders compared to the active control condition. MI is a promising intervention to facilitate engagement in adolescent mental health settings.

The WHO START Study

Background: The World Health Organization (WHO) study entitled Suicide Trends in At-Risk Territories (START) is an international multisite initiative that aims to stimulate suicide research and prevention across different areas of the globe. A central component of the study is the development of registration systems for fatal and nonfatal suicidal behaviors. Aims: This paper provides an overview of the data collected on suicidal behaviors from the participating locations in the START study. Method: Descriptive statistics on the data are presented in terms of age, sex, and method. Results: A greater proportion of suicide deaths occurred among males. In all areas except the Philippines more females than males engaged in nonfatal suicidal behaviors. Compared to Australia, Italy, New Zealand, the Philippines, and Hong Kong SAR, in the Pacific Islands suicide most often occurs in younger age groups. Results indicate notable variations between countries in choice of method. A greater proportion of suicides occurred by hanging in Pacific Islands, while inhalation of carbon monoxide, use of firearms, ingestion of chemicals and poisons, and drug overdose were the most frequent methods of choice in other areas. Conclusion: The information drawn from this study demonstrates the enormous variation in suicidal behavior across the areas involved in the START Study. Further research is needed to assess the reliability of the established data-recording systems for suicidal behaviors. The baseline data established in START may allow the development of suicide prevention initiatives sensitive to variation in the profile of suicide across different locations.

Children of parents with intellectual disability: facing poor outcomes or faring okay?

BACKGROUND

Children of parents with intellectual disability are assumed to be at risk of poor outcomes but a comprehensive review of the literature has not previously been undertaken.

METHOD

A database and reference search from March 2010 to March 2011 resulted in 26 studies for review.

RESULTS

Two groups of studies were identified. The first investigated an association between parental intellectual disability and child outcomes where there was significant disadvantage. Some findings suggest low parental intellectual capacity can negatively impact child outcomes, but others indicate child development approaches population norms. A second, small group of studies explored narrative accounts of childhood to find that social exclusion, bullying, and stigma are commonplace. Removal from parental care emerged as a significant risk for this group of children.

CONCLUSIONS

Studies focusing on child development represent 85% of the literature but reach no consensus about likely developmental or behavioural outcomes. Children studied usually come from clinical populations or other high-risk groups, and are typically young children.

Authorship issues at a New Zealand academic institution

BACKGROUND

Authorship of peer-reviewed publications can create conflict among academics.

OBJECTIVE

To document authorship conflicts of academics at a tertiary faculty.

METHODS

An anonymous questionnaire eliciting authorship conflicts and knowledge of authorship criteria was administered online to 154 academic staff members at a New Zealand university.

RESULTS

43 academics responded, a response rate of 27.9%. About half of the academics reported authorship conflicts, mainly regarding ownership of data, gift authorship and academic competition. Of the 43 academics, 31 were aware of formal authorship criteria but only 21 could identify the appropriate source. 23 academics correctly identified all the appropriate criteria for authorship according to the International Committee of Medical Journal Editors guidelines.

CONCLUSION

Authorship conflicts are prevalent in a New Zealand university that may be related to lack of knowledge of authorship criteria.

New Zealand general practice nurses' roles in mental health care

AIM

To examine the roles of nurses in general practice interdisciplinary teams caring for people with mild to moderate mental health conditions.

BACKGROUND

Supporting mental health and well-being is an important aspect of primary care. Until now nurses in general practice settings have had variable roles in providing mental health care. The New Zealand Primary Mental Health Initiatives are 26 government-funded, time-limited projects using different service delivery models.

METHODS

An analysis was undertaken of a qualitative data set of interviews, which included commentary about nurses mental health work collected from the different project stakeholders throughout a 29-month external evaluation.

FINDINGS

Two main groups of roles for nurses within the general practice interdisciplinary team were identified: specialist mental health nurses working in newly created roles and practice nurses working in existing roles. Barriers exist to the development of the latter roles.

CONCLUSIONS

Mental health care is a key role in general practice as this is where people frequently present. Internationally, nurses represent a large workforce with the potential to provide effective mental health care. This study found that attitudinal, structural and professional barriers are restricting New Zealand practice nurse role development in the care of those with mild to moderate mental health conditions. There is potential to develop their role within a structured pathway by workforce development and recognition of the value of interdisciplinary care. Given the shortage of mental health professionals this will be an important aspect of the improvement of primary mental health care.

What is the association between wealth and mental health?

BACKGROUND

Socioeconomic inequalities in mental health have been shown in a number of populations. This study aims to investigate the association between asset wealth and psychological distress in New Zealand and whether it is independent of other socioeconomic measures and baseline health status.

METHODS

Data for this study were from the first three waves of the Survey of Families, Income and Employment (SoFIE) conducted in New Zealand (2002-2004/05) (n = 15 340). The Kessler-10 was used as a measure of psychological distress. The association of quintiles of wealth with psychological distress was investigated using logistic regression, controlling for confounders, socioeconomic variables and prior health status.

RESULTS

The odds ratio (OR) of reporting high psychological distress were greater in the lowest wealth quintile compared with the highest (OR 3.06, 95% CI 2.68 to 3.50). Adjusting for age and sex did not alter the relationship; however, adjusting for income and area deprivation attenuated the OR to 1.73 (95% CI 1.48 to 2.04). Further controlling for baseline health status reduced the OR to 1.45 (95% CI 1.23 to 1.71), although the confidence interval still excluded the null.

CONCLUSIONS

Inequalities in wealth are strongly associated with psychological distress, over and above other confounding demographic variables and baseline health status. Much, but not all, of that association is confounded by adult socioeconomic position. This suggests that policy measures to improve asset wealth, through savings and home ownership, may have positive health implications and help to reduce health inequalities.

How much do mental disorders contribute to New Zealand's tobacco epidemic?

OBJECTIVE

To quantify the share of tobacco consumed by people with 12-month mental disorders in New Zealand.

METHODS

Estimates of current smoking prevalence and the 12-month prevalence of three groups of mental disorders--anxiety, mood and substance use disorders--were derived from the New Zealand Mental Health Survey, a nationally representative survey of almost 13,000 adults (16+ years) fielded in 2003-4. Estimates of the smoking intensity ratio (comparing smokers with mental disorders to those without mental disorders) were derived from the 2006-7 New Zealand Health Survey.

RESULTS

Approximately 33% of all cigarettes are consumed by people with 12-month mental disorders (males 27%, females 39%), using an estimated smoking intensity ratio of 1.21. Among this group, anxiety disorders account for almost one-half of consumption, mood disorders for over one-quarter and substance use disorders for about one-fifth.

CONCLUSION

This study quantifies for the first time the contribution of mental disorders to tobacco consumption in New Zealand. In particular, it identifies anxiety disorders as an important risk factor for tobacco use. People with mental disorders are an important target group for tobacco control. Enhanced collaboration and sharing of expertise between smoking cessation service providers and community mental health services are urgently needed.

Have the most recent Pap smear guidelines affected GP practices?

OBJECTIVE

To assess the attitudes and knowledge of a sample of NSW general practitioners on issues concerning Papanicolaou (Pap) smear tests after the 1991 National Guidelines were established.

DESIGN

During January-March 1994, a sample of Sydney general practitioners obtained from a list from the Department of General Practice, Royal North Shore Hospital, were asked to complete a questionnaire based on Pap smear screening. Issues explored included the perceived value of Pap smears, views on recommended screening intervals and the type of patients believed to be at highest risk of developing cervical cancer.

SETTING

Northern Sydney metropolitan area.

RESULTS

Seventy of 104 general practitioners from the Department of General Practice, Royal North Shore Hospital, returned completed questionnaires. Ninety-five per cent of respondents rated the Pap-smear as an extremely valuable screening test for cervical cancer prevention. The majority of GPs surveyed tended to overscreen younger patients and underscreen both older women and those at highest risk of developing cervical cancer. Seventy-seven per cent of doctors indicated the use of a patient reminder system, in most cases provided by a pathology laboratory but 43% were unaware of the NSW Cancer Council's reminder service.

CONCLUSION

Our study suggests that Pap smears are viewed as an important means of cervical cancer prevention. Unfortunately the majority of respondents did not adhere to the recommended guidelines of 2-yearly screening. Possible changes to the current system include improved awareness of the 1991 National Guidelines, greater public awareness of the NSW Cancer Council reminder service, and the establishment of a state cytology registry.

Ten-year follow-up of 50 patients with bulimia nervosa

Long-term outcome studies for people suffering from bulimia nervosa are few. Ten years after presentation, we followed up 50 patients (49 women, 1 man) who were originally involved in a double-blind, controlled trial of the antidepressant mianserin. Standardised interviews and questionnaires were used to assess eating attitudes and behaviour, psychiatric status and social functioning. A DSM-III-R diagnosis was given where appropriate. Sufficient information to make a diagnosis was obtained for 44 subjects (88%). Of patients traced, 52% had recovered fully and only 9% continued to suffer the full syndrome; 39% continued to experience some symptoms. Significant predictors of favourable outcome were younger age at onset, higher social class and a family history of alcohol abuse. Outcome for bulimia nervosa continues to improve over ten years with the majority of patients eventually making a full recovery or suffering only moderate abnormalities in eating attitudes. Although predictors of recovery were few, it would appear that intervention has a significant impact on ultimate outcome.

Further studies on some physical and biochemical characteristics of asaccharolytic pigmented Bacteroides of feline origin

The ultrastructure of the appendages of 24 strains of asaccharolytic pigmented Bacteroides spp. of cats was studied by transmission electron microscopy. All strains examined by thin section showed abundant fimbriae, outer membrane vesicles and capsules. Negative staining showed fimbriae which varied from long, fine and wavy in Bact. salivosus and cat Group 2 to shorter, less abundant and thicker fimbriae in cat strains of Bact. gingivalis as well as type strains of Porphyromonas gingivalis and P. asaccharolytica. Capsular material was very thick amorphous in human P. gingivalis, cat strains of Bact. gingivalis and in P. assaccharolytica but fine and fibrillary in preparations of Bact. salivosus and cat Group 2 organisms. Wet india ink preparations showed a large capsule although those of Bact. salivosus and Group 2 appeared largest. Five-day Group 2 broth cultures featured a thick ropy growth consistent with a large accumulation of extracellular slime. Enzymatic activities of the 24 strains measured by API ZYM system as well as the conventional biochemical tests showed it was possible to differentiate reliably Bact. salivosus from the other cat strains of asaccharolytic pigmented Bacteroides species and from human P. gingivalis and P. endodontalis by a combination of these tests. These tests suggest that Bact. salivosus is unlikely to belong to the genus Prevotella. Its place within the genus Porphyromonas is still to be determined.

Description of Porphyromonas circumdentaria sp. nov. and reassignment of Bacteroides salivosus (Love, Johnson, Jones, and Calverley 1987) as Porphyromonas (Shah and Collins 1988) salivosa comb. nov

A new species, Porphyromonas circumdentaria, is proposed for pigmented, asaccharolytic strains that were isolated from the gingival margins or mouth-associated diseases of cats. This bacterium is an obligately anaerobic, gram-negative, brown- or black-pigmented, asaccharolytic, nonmotile, nonsporing, rod-shaped organism which does not grow in bile and has a guanine-plus-cytosine content of 40 to 42 mol%. It produces major amounts of acetic, butyric, and isovaleric acids and minor amounts of propionic, isobutyric, and phenylacetic acids as end products of metabolism in cooked meat medium. Glutamate and malate dehydrogenases are present, while 6-phosphogluconate and glucose-6-phosphate dehydrogenases are absent. The major cellular fatty acid is 13-methyltetradecanoic acid (iso-C15:0 acid). P. circumdentaria strains are catalase positive and produce ammonia, and colonies fluoresce under short-wavelength UV light. These strains do not hemagglutinate erythrocytes, exhibit trypsinlike activity, or produce chymotrypsin or alpha-fucosidase. They are heavily piliated and produce a capsule. The type strain is strain VPB 3329 (= NCTC 12469). Bacteroides salivosus (D. N. Love, J. L. Johnson, R. F. Jones, and A. Calverley, Int. J. Syst. Bacteriol. 37:307-309, 1987) is an obligately anaerobic, gram-negative, pigmented, asaccharolytic, nonmotile, rod-shaped organism which does not grow in bile and has a guanine-plus-cytosine content of 42 to 44 mol%. This organism produces major amounts of acetic, butyric, and phenylacetic acids and minor amounts of isobutyric and isovaleric acids as end products of metabolism in cooked meat medium.(ABSTRACT TRUNCATED AT 250 WORDS)

The obligate and facultatively anaerobic bacterial flora of the normal feline gingival margin

Samples from the gingival margins of 14 cats considered normal on clinical examination were cultured for facultative and obligate anaerobic bacteria. All mouths were free from any gingival marginal inflammation and tartar build-up; all cats were between 6 and 12 months of age. A mixed growth was obtained from all samples. The mean number of bacterial species per sample was 10.7 with a range of 7-16 isolates. Of the 150 isolates processed, 109 (72.66%) were obligate anaerobes. Of the facultatively anaerobic species, Actinomyces (including A. viscosus, A. hordeovulneris and A. denticolens) comprised 12%, Pasteurella multocida 9.33% of isolates and Propionibacterium species 6% of all isolates. Gram-negative bacilli belonging to the genera Bacteroides and Fusobacterium were isolated from 12 of the 14 samples, and comprised 77% of the obligate anaerobes isolated. Clostridium villosum comprised 10.1% of obligately anaerobic isolates, Wolinella species made up 6.42%, while 4.58% were Peptostreptococcus anaerobius. The most commonly isolated obligately anaerobic species was C. villosum and the most commonly isolated facultatively anaerobic species was P. multocida. These findings show a bacterial flora of the normal feline mouth which is very similar in composition to that of cat fight abscesses and feline pyothorax.