Treatment adherence

Angela has been spending a fair bit of time with Sam in recent months. She is a 29-year-old single mother with one child. She studies part-time at the local university and has managed to maintain acceptable grades. She has bipolar disorder that has been well managed with medication, in different combinations at different pOints in her illness. However, over the last month she has intermittently missed doses and is consequently becoming unwell. It is puzzling that she is missing doses because she is very attached to her child and last time she stopped medication her daughter was placed in care. The following information was obtained from her in order to undertake a functional analysis. Financially, Angela was managing well on her supporting parent benefit and the maintenance paid by the father of her child. However, her former partner was sent to jail 3 months ago and the maintenance money he was sending her dried up. As a consequence, she started falling behind in some bills about 8 weeks ago. She has told you that this worries her. On top of this, her daughter started experiencing stomach aches last week and is cranky most of the time. Angela has said that she thinks that her daughter may be lactose intolerant and believes that her local GP did not take her concerns about her daughter\u27s distress seriously enough when she took her to see him 10 days ago. Since becoming involved with Sam, Angela has struggled to keep a routine for her and her daughter and she says she forgets her medication from time to time. Sometimes Angela loses interest in sex and she thinks that her medication might reduce her libido. Angela has never received much help from her family because they don\u27t agree with her diagnosis. He father says that she is just an attention getter and that she puts it on. He says that is why she cut herself when she was a teenager. Her father states that if she just stopped \u27boozing\u27 she wouldn\u27t be so down and need the medication. Angela disagrees, stating that she has been drinking to help her sleep for years and is drinking no more or less now. Nonetheless, Angela has tried to cut down on her alcohol use over the last month and this has interfered with her sleep

Narrative identity reconstruction as adaptive growth during mental health recovery: A narrative coaching boardgame approach

Objective: The purpose of this paper is to construct a conceptual framework for investigating the reconstruction of narrative identity in mental health recovery from a complexity perspective. This conceptual framework provides the foundation for developing a health boardgame to facilitate narrative identity reconstruction. Methods: A selective integrative review of the theoretical and empirical literature relevant to narrative identity reconstruction in recovery was conducted. Sources included books, dissertations, internet resources, and professional journals. Findings: The reviewed material provides a conceptual framework that offers an enriched understanding of narrative identity reconstruction in recovery as a process of adaptive growth. It identifies the Hero\u27s Journey, the life story model of identity (LSMI), and intentional change theory (ITC) as particularly relevant in informing strategies for narrative identity reconstruction. The conceptual framework can be operationalized in a narrative coaching treatment approach using a boardgame. Conclusion and Implications for Practice: In practice, mental health professionals could use the narrative coaching boardgame to facilitate people\u27s adaptive change with a focus on building skills to reconstruct their preferred narrative identity and foster hope. Future research should explore what aspects of narrative identity and non-linear dynamic processes of change are most important in people\u27s recovery narratives and in particular these processes can be assessed in response to the use of the boardgame

The dual diagnosis capability of residential addiction treatment centres: Priorities and confidence to improve capability following a review process

Abstract Introduction and Aims. The Dual Diagnosis Capability of Addiction Treatment (DDCAT) index is used to assess the capacity of substance abuse services to work with individuals with co-occurring mental health problems. The current study aimed to: (i) examine the dual diagnosis capability of residential substance abuse programs in Australia; (ii) identify managers’ perceptions regarding both priorities and confidence for change following the completion of the DDCAT; and (iii) to examine the usefulness of the DDCAT to residential substance abuse programs. Design and Methods. The DDCAT was completed across 16 residential substance abuse units.An external researcher administered and scored the DDCAT.A Unit Manager from each site completed the Comorbidity Priorities and Confidence Survey following the completion of the DDCAT review. This survey examined the usefulness of the DDCAT, and the unit’s priorities to improve its capability, and confidence to improve its DDCAT score. Results. Across the services, program structure and staff training were the DDCAT domains that required the most improvement.While training was the highest endorsed priority area for improvement, program structure was the lowest priority. Overall the Unit Managers reported positive attitudes towards use of the DDCAT and were confident that their unit could improve their DDCAT scores. Discussion and Conclusions. DDCAT scores of Australian residential substance abuse programs are comparable with previous published results.However, there is still substantial work required to improve the capability of these programs. Future research should examine strategies to promote sustained improvements in the capability of residential substance abuse programs. [Matthews H, Kelly PJ, Deane FP. The dual diagnosis capability of residential addiction treatment centres: Priorities and confidence to improve capability following a review process. Drug Alcohol Rev 2010

Preliminary development and content validity of a measure of Australian Aboriginal cultural engagement

Objectives. Aboriginal people form one of the populations most in need of mental health and substance abuse services within Australia, although many services are not adequately sensitive to, or inclusive of, relevant aspects of Aboriginal culture in their programmes. The Aboriginal Cultural Engagement Survey (ACES) was developed with the objective of assessing the level of cultural engagement of Aboriginal clients. A measure of cultural engagement is an important step in establishing an association between culture and health benefits, so that future interventions may be designed which better meet the cultural needs of Aboriginal Australians within health services. Design. The process of development of the ACES involved four stages of scale development utilising a series of group discussions and reviews with Aboriginal consultants. Assessment of content validity is conducted using the Content Validity Index (CVI). Results. The ACES was found to have excellent content validity with CVIs over 0.80 for all items in the final version. Conclusion. The ACES shows promise for being a useful tool in assessing the cultural engagement of Australian Aboriginal clients. There is a need for further psychometric assessment and field trials to assess its utility

Acceptance and commitment therapy delivered in a dyad after a severe traumatic brain injury: a feasibility study

Objective: There is a high prevalence of complex psychological distress after a traumatic brain injury but limited evidence of effective interventions. We examined the feasibility of Acceptance and Commitment Therapy after a severe traumatic brain injury using the criteria, investigating a therapeutic effect, and reviewing the acceptability of measures, treatment protocol, and delivery method (in a dyad of two clients and a therapist). Method: Two male outpatients with severe traumatic brain injury and associated psychological distress jointly engaged in a seven session treatment program based on Acceptance and Commitment Therapy principles. Pre- and post-treatment measures of mood, psychological flexibility, and participation were taken in addition to weekly measures. Results: The intervention showed a therapeutic effect with one participant, and appeared to be acceptable for both participants with regard to program content, measures, and delivery mode by in a dyad. One participant showed both significant clinical and reliable change across several outcome measures including measures of mood and psychological flexibility. The second participant did not show a reduction in psychological inflexibility, but did show a significant drop in negative affect. Significant changes pre- to post-treatment for measures of participation were not indicated. Qualitatively, both participants engaged in committed action set in accordance with their values. Conclusions: This study suggests that Acceptance and Commitment Therapy may be feasible to be delivered in a dyad with individuals who have a severe traumatic brain injury. A further test of its potential efficacy in a phase II clinical trial is recommended

Predicting clinically signficant change in an inpatient program for people with severe mental illness

Objective: The first aim of this study was to assess the proportion of patients who achieved reliable and clinically significant change over the course of treatment in an inpatient psychosocial rehabilitation program. The second aim was to determine whether age, gender, length of stay, and diagnosis and co-morbid diagnosis predicted those who were classified as improved or not improved, using clinical significance criteria. Method: Three hundred and thirty-seven patients from inpatient units at Bloomfield Hospital, Orange, New South Wales, Australia were assessed at admission, 3-month reviews and discharge using the expanded Brief Psychiatric Rating Scale, the Health of the Nation Outcome Scales and the Kessler 10. Results: Reliable and clinically significant improvement was found for 32.4% of inpatients on psychiatric symptomatology, 19.5% on psychosocial functioning and 20.2% on psychological distress. Logistic regression analyses found that the predictor variables collectively predicted those who made reliable and clinically significant improvement on psychiatric symptomatology, but not on psychosocial functioning or psychological distress. Those with a primary diagnosis of schizoaffective disorder had higher rates of improvement in psychiatric symptomatology compared to those with a diagnosis of schizophrenia. Those with co-morbid substance abuse disorders showed a trend towards greater improvement. Conclusions: Inpatient treatment is associated with clinically significant improvements for some patients with a severe mental illness. Patients with schizo-affective disorders are proportionally more likely to make improvement

Parental perceptions of barriers to mental health services for young people

Aim: This study explores a range of barriers that parents encountered in accessing mental health services. The study also explored whether parents experienced similar barriers to accessing services in 2003 and 2013. Methods: One hundred and thirty-four parents of young people attending an initial assessment at a Child and Adolescent Mental Health Service (CAMHS) or headspace centre completed a questionnaire assessing 10 general barriers to care. These data were compared to those collected from 129 participants at CAMHS in 2003. Results: The ranking of barriers to mental health care for their children was similar for both survey years, with \u27wait time being too long\u27 and \u27help being too expensive\u27 the two highest ranked barriers. Cost factors were related to not knowing that the services did not charge fees and having to take time off work to attend appointments. Multiple referral steps and uncertain wait times were the main concerns regarding wait times. The overall strength with which barriers were endorsed remained relatively low; however, at least 40% of the sample agreed they had experienced four of the barriers in both years. Conclusions: Despite relatively low endorsement of barriers, there are substantial proportions of parents who experienced some barriers to services, and services should continue working to reduce them to facilitate timely access. There is a particular need for more service-related information to clarify that public sector mental health services do not charge fees. Methods such as rapid initial assessment and actively managing wait lists may go some way to reducing perceived wait time barriers

The effect of Cichorium intybus and Lotus corniculatus on nematode burdens and production in grazed lambs

This report was presented at the UK Organic Research 2002 Conference. The study was designed to examine the hypothesis that chicory (Cichorium intybus) and Lotus sp. (Lotus corniculatus) have the potential to affect the naturally acquired nematode burden in grazed lambs. Organic male castrate lambs (48) with a naturally acquired parasite burden grazed replicate combination plots (0.6 ha) of chicory, Lotus corniculatus, perennial ryegrass (Lolium perenne) and white clover (Trifolium repens). Lamb performance was determined by weekly weight gain and condition score assessments. Nematode burden was assessed by individual lamb faecal egg count (FEC) before and after drenching (levamisole). The range of parasitic helminths present was assessed by faecal culture and by total worm counts performed on a proportion of the lambs at slaughter. Weekly pasture larval counts (PLCs) were conducted on the trial plots. A concurrent small plot study (6 x 1m2 replicates) of each of the forages used in the grazing trial was run to assess the potential effect of forage type on the development and survival of Teladorsagia circumcincta assessed by weekly PLCs. Preliminary data suggest that lambs grazing chicory or a combination of lotus and chicory had lower FECs than those grazing PRG/WC, however there was no significant difference in the total worm counts

File audit to assess sustained fidelity to a recovery and wellbeing oriented mental health service model: An Australian case study

2019 The Author(s). Background: Over the past decade there has been increasing attention to implementing recovery-oriented approaches within mental health service practice and enhancing fidelity to such approaches. However, as is often the case with evidence-based practices, less attention has been paid to the sustainability of recovery-oriented approaches over time. This study sought to investigate whether fidelity to a recovery-oriented practice framework - the Collaborative Recovery Model could be sustained over time. Method: The study setting was an Australian community managed mental health organisation. A file audit of consumer support plans was undertaken using the Goal and Action Plan Instrument for Quality audit tool (GAP-IQ). The audit tool assessed 17 areas for quality. Consumers (n = 116) from a large community managed mental health organisation participated in the study. Sustained fidelity to the Collaborative Recovery Model (CRM) was determined by comparing results from the file audit to a similar audit conducted 3 years earlier. Results: The file audit revealed a significant increase in fidelity to CRM practices between 2011 and 2014. Fidelity to individual audit items that comprise the GAP-IQ was also found to significantly increase across 16 of the 17 GAP-IQ audit items, with the exception of the \u27Action Plan Review\u27 audit item. Conclusions: A comparison of file audit data across different time points within the same setting can provide useful feedback about whether or not a practice is being sustained over time. Although fidelity increased overtime the study design does not allow conclusions that training and coaching practices implemented by the organisation were responsible

Benchmarking across sectors: Comparisons of residential dual diagnosis and mental health programs

[extract] A Question to Ponder: How does your service compare to other similar services in the industry? How would knowing this help your organisation