A controlled trial of implementing a complex mental health intervention for carers of vulnerable young people living in out-of-home care: the ripple project

BACKGROUND: Out-of-home care (OoHC) refers to young people removed from their families by the state because of abuse, neglect or other adversities. Many of the young people experience poor mental health and social function before, during and after leaving care. Rigorously evaluated interventions are urgently required. This publication describes the protocol for the Ripple project and notes early findings from a controlled trial demonstrating the feasibility of the work. The Ripple project is implementing and evaluating a complex mental health intervention that aims to strengthen the therapeutic capacities of carers and case managers of young people (12-17 years) in OoHC. METHODS: The study is conducted in partnership with mental health, substance abuse and social services in Melbourne, with young people as participants. It has three parts: 1. Needs assessment and implementation of a complex mental health intervention; 2. A 3-year controlled trial of the mental health, social and economic outcomes; and 3. Nested process evaluation of the intervention. RESULTS: Early findings characterising the young people, their carers and case managers and implementing the intervention are available. The trial Wave 1 includes interviews with 176 young people, 52% of those eligible in the study population, 104 carers and 79 case managers. CONCLUSIONS: Implementing and researching an affordable service system intervention appears feasible and likely to be applicable in other places and countries. Success of the intervention will potentially contribute to reducing mental ill-health among these young people, including suicide attempts, self-harm and substance abuse, as well as reducing homelessness, social isolation and contact with the criminal justice system. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12615000501549 . Retrospectively registered 19 May 2015

Predictors of exercise in individuals with schizophrenia: a test of the transtheoretical model of behavior change

Introduction: Mortality in individuals with schizophrenia, including deaths not attributable to accidents and suicide, is at least twice that of the general population. While increasing physical exercise could promote positive mental and physical health outcomes in individuals with schizophrenia, only one other study of the determinants of exercise within this population has been reported. Our study attempts to resolve this void in knowledge by testing the applicability of the transtheoretical model (TTM) of behavior change to predicting exercise behavior in those with schizophrenia. Methods: Forty-nine participants (42 with schizophrenia and 7 with schizoaffective disorder) from three community mental health centers in Melbourne, Australia, completed a series of questionnaires, an interview, physical health measures, and had their medical records examined. These measures were used: TTM exercise stage, TTM mediators of change, health status, health-risk behaviors, use of antipsychotic medications, psychopathology, psychiatric history, and demographic information. Variables found to be significantly correlated with exercise stage were then included in a series of regression analyses to determine their relative predictive power for exercise stage. Results: The results demonstrated that the TTM and its associated measures may be valid for integration into interventions for promoting exercise in individuals with schizophrenia, despite high levels of psychopathology symptoms. Conclusions: Routine clinical practice should promote exercise in people with schizophrenia and the TTM may be of benefit to this end. Strategies that promote exercise when self-perceived poor health is seen as a significant barrier are particularly important, as is the reduction of caffeine consumption and other health-adverse behaviors

Realist Review of Programs, Policies, and Interventions to Enhance the Social, Emotional, and Spiritual Well-Being of Aboriginal and Torres Strait Islander Young People Living in Out-of-Home Care

The child protection system in Australia includes out-of-home care (OoHC) for children and young people at risk of harm and neglect. In Australia, Aboriginal and Torres Strait Islander children and young people are 9 times more likely to be placed in care than non-Aboriginal young people (Australian Institute of Health and Welfare, 2015). Australia’s history of colonization and subsequent policies have caused trauma to individuals, families, and communities and resulted in poor physical and mental health and mistrust of services. This review was undertaken to identify programs and policies currently in place that aim to improve the mental health and well-being of this vulnerable population. It provides an analysis of both the strengths of the current system as well as what has been inadequately addressed based on literature in the area.By incorporating an Aboriginal perspective, this review focuses on social, emotional, and spiritual well-being (SESWB) and the aspects of a child’s life and community that promote this. A realist review of the academic and grey literature was conducted in 2014. It included an extensive search of government and non-government (NGO) publications. The review identified nine programs or policies that are designed to improve the SESWB of Aboriginal young people in OoHC in local and international settings. These are the Aboriginal and Torres Strait Islander Child Placement Principle, cultural support plans, Aboriginal Community Controlled Organisations (ACCOs), family group decision-making, therapeutic care, and Panyappi Mentoring Program. Given that culturally competent service provision is important to SESWB, the review concludes that an increase in monitoring and evaluation is necessary to determine the effectiveness of programs and ensure their implementation and sustainability when warranted. Policy and research work is needed to adapt and devise programs promoting the SESWB of Aboriginal young people (at both the individual and system levels), determine their effectiveness, and ensure they are sustained when warranted

People living with psychosocial disability: rehabilitation and recovery-informed service provision within the second Australian national survey of psychosis

Objective: People with psychosocial disability are an important, although often neglected, subgroup of those living with severe and persistent mental illness. Rehabilitation, provided through clinical and non-government organisations in Australia, may contribute to their personal recovery goals. We hypothesised that people with psychoses with the greatest disability and complex needs would receive services from both sectors, reflecting treatment and rehabilitation needs

Placement instability among young people removed from their original family and the likely mental health implications

BACKGROUND: Young people in out-of-home care are more likely to experience poorer mental and physical health outcomes related to their peers. Stable care environments are essential for ameliorating impacts of disruptive early childhood experiences, including exposure to psychological trauma, abuse and neglect. At present there are very few high quality data regarding the placement stability history of young people in out-of-home care in Australia or other countries. OBJECTIVES: To undertake the first systematic census of background, care type and placement stability characteristics of young people living in the out-of-home care sector in Australia. METHODS: Data was collected from four non-government child and adolescent community service organisations located across metropolitan Melbourne in 2014. The sample comprised 322 young people (females 52.8%), aged between 12 - 17 years (mean age=14.86 [SD=1.63] years). RESULTS: Most young people (64.3%) were in home-based care settings (i.e., foster care, therapeutic foster care, adolescent care program, kinship care, and lead tenant care), relative to residential care (35.7%). However, the proportion in residential care is very high in this age group when compared with all children in out-of-home care (5%). Mean age of first removal was 9 years (SD=4.54). No gender differences were observed for care type characteristics. Three quarters of the sample (76.9%) had a lifetime history of more than one placement in the out-of-home care system, with more than a third (36.5%) having experienced ≥5 lifetime placements. Relative to home-based care, young people in residential care experienced significantly greater placement instability (χ2=63.018, p<0.001). CONCLUSIONS: Placement instability is common in the out-of-home care sector. Given stable care environments are required to ameliorate psychological trauma and health impacts associated with childhood maltreatment, well-designed intervention-based research is required to enable greater placement stability, including strengthening the therapeutic capacities of out-of-home carers of young people