Integrating theory and research into passionate practice of Grief Therapy

Conference Theme: Reframing Images of Grief: Identity Transformation Through LossEntering the era of evidence-based practice, there is a growing concern on efficacy of interventions. The modest results of grief intervention, as found in available meta-analyses of efficacy studies, call for systematic development and critical evaluation of grief support. Passionate clinicians are sometimes considered as extraterrestrial to research and theories. This presentation shares the journey of a passionate clinician exploring the new terrain through integrating the theories of bereavement into practice and using research to streamline the interventions. In particular, two main projects will be shared, concerning support of widowed older adults and bereaved persons with intellectual disabilities. A pilot group intervention based on the Dual Process Model of Coping was run for widowed older adults in Hong Kong …postprin

Mild Traumatic Brain Injury in Childhood: Injury Outcomes, Teacher Perspectives and Educating Educators

Paediatric mild traumatic brain injury (mTBI) has the potential to impact on a wide range of developmental functions in childhood. However, the relationship between mTBI and persistent developmental difficulties is controversial, with some suggestion that children’s post-injury difficulties may actually predate the injury. Regardless of cause, however, mTBI seems to be associated with developmental impairment in childhood that may impact on academic performance and overall school functioning. In spite of the high prevalence of mTBI amongst young people, educators and school services may not be aware of the implications of such injuries and how post-concussive symptoms should be managed in educational settings. It seems that the conflicting findings regarding mTBI outcomes in childhood may contribute to a lack of knowledge amongst educators about how to manage mTBI and associated difficulties in primary-school-aged students. There is a need to further clarify the existence and nature of developmental impairments after paediatric mTBI and consider their implications in educational settings. Furthermore, there is a need to understand more regarding the capacities of educators to address issues that may arise as a result of such impairments and consider how teaching practices in this area can be enhanced. In Study 1, the emotional, behavioural, social, intellectual, neuropsychological (comprised of memory, attention, and executive function) and academic functioning of 41 children who had sustained mTBI 14-months prior was investigated. The findings of those assessments were compared with those from a non-injured cohort of children matched on age, gender, ethnicity and school decile. Assessment measures included the Strengths and Difficulties Questionnaire (SDQ) as a measure of emotional, behavioural and social functioning, the Behavior Rating Inventory of Executive Function (BRIEF) as a measure of executive function, Woodcock Johnson Tests of Cognitive Abilities (WJ III COG) and CNS Vital Signs (CNSVS) as measures of global neuropsychological functioning, a short-form version of the Wechsler Intelligence Scale for Children (WISC-IV) as a measure of intelligence, the brief battery of the Woodcock Johnson Tests of Academic Achievement (WJ III ACH) as measure of academic achievement, and a teacher questionnaire regarding school functioning. Information obtained from parents and teachers regarding pre-injury diagnoses and learning problems did not reveal significant premorbid difficulties amongst the clinical group. The results of Study 1 showed that children who have sustained mTBI demonstrate higher rates of emotional and behavioural problems than those in a matched cohort, while executive function and social functioning was found to be similar across the two groups. Children with mTBI evidence significantly lower intellectual functioning and academic achievement, and are more likely to demonstrate learning disorders. Given the developmental impairments identified in the sample and the possible implications of such difficulties in school settings, it was considered important to evaluate teachers’ perceptions of childhood TBI and how such impairments might be managed at school. Study 2 looked at the perceptions of educators regarding childhood TBI. Nineteen primary school teachers in the Waikato and Bay of Plenty regions engaged in semi-structured interviews that covered their understanding of TBI, its mechanisms and consequences. Participants also discussed the use of programme adaptations for children with persistent difficulties after mTBI and perceived barriers to uptake. The majority of participants had a limited understanding of mTBI and its implications in childhood. None of the participants had received prior education regarding paediatric TBI and identified this as an area of weakness that they perceived could be addressed by professional development. However, participants were not aware of any available professional development opportunities specifically relating to paediatric TBI. Participants perceived significant barriers to the delivery of appropriate educational approaches for children with developmental impairments, including limited resourcing and funding for special education and poor communication between the education and health sectors, resulting in a lack of information and support for educators. Study 3 involved the development, delivery and evaluation of a professional development workshop and written information resource for teachers. The workshop and written information resource were delivered in three local primary schools to 38 participants. A knowledge quiz regarding mTBI was administered pre- and post-workshop. Participants also completed an evaluation of the workshop and brochure rating the usefulness of and their satisfaction with the materials. A repeated-measures experiment showed that knowledge levels significantly increased following participation in the workshop. The majority of participants were satisfied with the content of the workshop and expected to make changes to their practice with children who had experienced mTBI and were evidencing emotional, behavioural and/or cognitive symptoms. The results of this research indicate that while the cause of post-concussive difficulties may be ambiguous, children who have experienced mTBI are at higher risk of demonstrating developmental problems across a wide range of domains. These problems have the potential to impact on school functioning; however, teachers may not be aware of these issues and thus may not be well-placed to support children who are experiencing difficulties through the post-concussive period and beyond. On the other hand, teachers demonstrate insight into their limitations in this regard and appear keen to address their professional development needs in this area. A brief professional development approach that focuses on the epidemiology and possible consequences of mTBI in childhood, along with a range of programme adaptation strategies that teachers can opt to employ as necessary, may be useful in improving teacher knowledge, educational practice and, ultimately, functional outcomes for children who have experienced mTBI. The need for screening and intervention services for children with mTBI is highlighted, along with a reconceptualisation of how special needs are addressed in school settings

Informational Practices of Postacute Brain Injury Patients During Personal Recovery: Qualitative Study

Background: The effects of brain injury, structural damage, or the physiological disruption of brain function last far beyond initial clinical treatment. Self-tracking and management technologies have the potential to help individuals experiencing brain injury in their personal recovery—helping them to function at their best despite ongoing symptoms of illness. However, current self-tracking technologies may be unsuited for measuring the interconnected, nonlinear ways in which brain injury manifests. Objective: This study aimed to investigate (1) the current informational practices and sensemaking processes used by postacute brain injury patients during personal recovery and (2) the potential role of quality-of-life instruments in improving patient awareness of brain injury recovery, advocacy, and involvement in care used outside the clinical context. Our objective was to explore the means of improving awareness through reflection that leads to compensatory strategies by anticipating or recognizing the occurrence of a problem caused by impairment. Methods: We conducted a qualitative study and used essentialist or realist thematic analysis to analyze the data collected through semistructured interviews and questionnaires, 2 weeks of structured data collection using brain injury–specific health-related quality of life instrument, quality of life after brain injury (QoLIBRI), and final interviews. Results: Informational practices of people with brain injury involve data collection, data synthesis, and obtaining and applying the insights to their lifestyles. Participants collected data through structured tools such as spreadsheets and wearable devices but switched to unstructured tools such as journals and blogs as changes in overall progress became more qualitative in nature. Although data collection helped participants summarize their progress better, the lack of conceptual understanding made it challenging to know what to monitor or communicate with clinicians. QoLIBRI served as an education tool in this scenario but was inadequate in facilitating reflection and sensemaking. Conclusions: Individuals with postacute brain injury found the lack of conceptual understanding of recovery and tools for making sense of their health data as major impediments for tracking and being aware of their personal recovery. There is an urgent need for a better framework for recovery and a process model for choosing patient-generated health data tools that focus on the holistic nature of recovery and improve the understanding of brain injury for all stakeholders involved throughout recovery

Mental health handbook for schools

As the government strives for a more inclusive education policy, more and more teachers find themselves in the frontline when dealing with children with mental health problems. Many have not had training in such matters and so feel unprepared and uncertain when faced with difficult situations. The Mental Health Handbook for Schools provides valuable information on a comprehensive range of mental health problems with which teachers are often confronted. Drawing on up-to-date research and practice in these areas the book considers what schools can do, within the special needs framework, to help pupils with these problems. It usefully reflects on the role of the mental health services in relation to schools and how schools can adopt a whole-school preventative approach to mental health problems. The authors address an extensive range of mental health problems including Attention Deficit/Hyperactivity Disorder, eating disorders, substance abuse, obsessive-compulsive disorders and schizophrenia. They also cover situations that can often lead to the development of mental health problems including bullying, divorce and marital conflict, bereavement and physical, sexual and emotional abuse

Eye quietness and quiet eye in expert and novice golf performance: an electrooculographic analysis

Quiet eye (QE) is the final ocular fixation on the target of an action (e.g., the ball in golf putting). Camerabased eye-tracking studies have consistently found longer QE durations in experts than novices; however, mechanisms underlying QE are not known. To offer a new perspective we examined the feasibility of measuring the QE using electrooculography (EOG) and developed an index to assess ocular activity across time: eye quietness (EQ). Ten expert and ten novice golfers putted 60 balls to a 2.4 m distant hole. Horizontal EOG (2ms resolution) was recorded from two electrodes placed on the outer sides of the eyes. QE duration was measured using a EOG voltage threshold and comprised the sum of the pre-movement and post-movement initiation components. EQ was computed as the standard deviation of the EOG in 0.5 s bins from –4 to +2 s, relative to backswing initiation: lower values indicate less movement of the eyes, hence greater quietness. Finally, we measured club-ball address and swing durations. T-tests showed that total QE did not differ between groups (p = .31); however, experts had marginally shorter pre-movement QE (p = .08) and longer post-movement QE (p < .001) than novices. A group × time ANOVA revealed that experts had less EQ before backswing initiation and greater EQ after backswing initiation (p = .002). QE durations were inversely correlated with EQ from –1.5 to 1 s (rs = –.48 - –.90, ps = .03 - .001). Experts had longer swing durations than novices (p = .01) and, importantly, swing durations correlated positively with post-movement QE (r = .52, p = .02) and negatively with EQ from 0.5 to 1s (r = –.63, p = .003). This study demonstrates the feasibility of measuring ocular activity using EOG and validates EQ as an index of ocular activity. Its findings challenge the dominant perspective on QE and provide new evidence that expert-novice differences in ocular activity may reflect differences in the kinematics of how experts and novices execute skills