The voice characterisation checklist: psychometric properties of a brief clinical assessment of voices as social agents

Aim: There is growing interest in tailoring psychological interventions for distressing voices and a need for reliable tools to assess phenomenological features which might influence treatment response. This study examines the reliability and internal consistency of the Voice Characterisation Checklist (VoCC), a novel 10-item tool which assesses degree of voice characterisation, identified as relevant to a new wave of relational approaches. Methods: The sample comprised participants experiencing distressing voices, recruited at baseline on the AVATAR2 trial between January 2021 and July 2022 (n = 170). Inter-rater reliability (IRR) and internal consistency analyses (Cronbach’s alpha) were conducted. Results: The majority of participants reported some degree of voice personification (94%) with high endorsement of voices as distinct auditory experiences (87%) with basic attributes of gender and age (82%). While most identified a voice intention (75%) and personality (76%), attribution of mental states (35%) to the voice (‘What are they thinking?’) and a known historical relationship (36%) were less common. The internal consistency of the VoCC was acceptable (10 items, α = 0.71). IRR analysis indicated acceptable to excellent reliability at the item-level for 9/10 items and moderate agreement between raters’ global (binary) classification of more vs. less highly characterised voices, κ = 0.549 (95% CI, 0.240–0.859), p < 0.05. Conclusion: The VoCC is a reliable and internally consistent tool for assessing voice characterisation and will be used to test whether voice characterisation moderates treatment outcome to AVATAR therapy. There is potential wider utility within clinical trials of other relational therapies as well as routine clinical practice

The Voice Characterisation Checklist:Psychometric Properties of a Brief Clinical Assessment of Voices as Social Agents

Aim: There is growing interest in tailoring psychological interventions for distressing voices and a need for reliable tools to assess phenomenological features which might influence treatment response. This study examines the reliability and internal consistency of the Voice Characterisation Checklist (VoCC), a novel 10-item tool which assesses degree of voice characterisation, identified as relevant to a new wave of relational approaches. Methods: The sample comprised participants experiencing distressing voices, recruited at baseline on the AVATAR2 trial between January 2021 and July 2022 (n = 170). Inter-rater reliability (IRR) and internal consistency analyses (Cronbach’s alpha) were conducted. Results: The majority of participants reported some degree of voice personification (94%) with high endorsement of voices as distinct auditory experiences (87%) with basic attributes of gender and age (82%). While most identified a voice intention (75%) and personality (76%), attribution of mental states (35%) to the voice (‘What are they thinking?’) and a known historical relationship (36%) were less common. The internal consistency of the VoCC was acceptable (10 items, α = 0.71). IRR analysis indicated acceptable to excellent reliability at the item-level for 9/10 items and moderate agreement between raters’ global (binary) classification of more vs. less highly characterised voices, κ = 0.549 (95% CI, 0.240–0.859), p &lt; 0.05. Conclusion: The VoCC is a reliable and internally consistent tool for assessing voice characterisation and will be used to test whether voice characterisation moderates treatment outcome to AVATAR therapy. There is potential wider utility within clinical trials of other relational therapies as well as routine clinical practise

The voice characterisation checklist: psychometric properties of a brief clinical assessment of voices as social agents

AimThere is growing interest in tailoring psychological interventions for distressing voices and a need for reliable tools to assess phenomenological features which might influence treatment response. This study examines the reliability and internal consistency of the Voice Characterisation Checklist (VoCC), a novel 10-item tool which assesses degree of voice characterisation, identified as relevant to a new wave of relational approaches.MethodsThe sample comprised participants experiencing distressing voices, recruited at baseline on the AVATAR2 trial between January 2021 and July 2022 (n = 170). Inter-rater reliability (IRR) and internal consistency analyses (Cronbach’s alpha) were conducted.ResultsThe majority of participants reported some degree of voice personification (94%) with high endorsement of voices as distinct auditory experiences (87%) with basic attributes of gender and age (82%). While most identified a voice intention (75%) and personality (76%), attribution of mental states (35%) to the voice (‘What are they thinking?’) and a known historical relationship (36%) were less common. The internal consistency of the VoCC was acceptable (10 items, α = 0.71). IRR analysis indicated acceptable to excellent reliability at the item-level for 9/10 items and moderate agreement between raters’ global (binary) classification of more vs. less highly characterised voices, κ = 0.549 (95% CI, 0.240–0.859), p &lt; 0.05.ConclusionThe VoCC is a reliable and internally consistent tool for assessing voice characterisation and will be used to test whether voice characterisation moderates treatment outcome to AVATAR therapy. There is potential wider utility within clinical trials of other relational therapies as well as routine clinical practise

Digital AVATAR therapy for distressing voices in psychosis: the phase 2/3 AVATAR2 trial

Distressing voices are a core symptom of psychosis, for which existing treatments are currently suboptimal; as such, new effective treatments for distressing voices are needed. AVATAR therapy involves voice-hearers engaging in a series of facilitated dialogues with a digital embodiment of the distressing voice. This randomized phase 2/3 trial assesses the efficacy of two forms of AVATAR therapy, AVATAR-Brief (AV-BRF) and AVATAR-Extended (AV-EXT), both combined with treatment as usual (TAU) compared to TAU alone, and conducted an intention-to-treat analysis. We recruited 345 participants with psychosis; data were available for 300 participants (86.9%) at 16 weeks and 298 (86.4%) at 28 weeks. The primary outcome was voice-related distress at both time points, while voice severity and voice frequency were key secondary outcomes. Voice-related distress improved, compared with TAU, in both forms at 16 weeks but not at 28 weeks. Distress at 16 weeks was as follows: AV-BRF, effect −1.05 points, 96.5% confidence interval (CI) = −2.110 to 0, P = 0.035, Cohen’s d = 0.38 (CI = 0 to 0.767); AV-EXT −1.60 points, 96.5% CI = −3.133 to −0.058, P = 0.029, Cohen’s d = 0.58 (CI = 0.021 to 1.139). Distress at 28 weeks was: AV-BRF, −0.62 points, 96.5% CI = −1.912 to 0.679, P = 0.316, Cohen’s d = 0.22 (CI = −0.247 to 0.695); AV-EXT −1.06 points, 96.5% CI = −2.700 to 0.586, P = 0.175, Cohen’s d = 0.38 (CI = −0.213 to 0.981). Voice severity improved in both forms, compared with TAU, at 16 weeks but not at 28 weeks whereas frequency was reduced in AV-EXT but not in AV-BRF at both time points. There were no related serious adverse events. These findings provide partial support for our primary hypotheses. AV-EXT met our threshold for a clinically significant change, suggesting that future work should be primarily guided by this protocol. ISRCTN registration: ISRCTN55682735

Screening for Posttraumatic Stress Disorder in Young Children Following Hospitalisation for Injury Using the Pediatric Emotional Distress Scale Early Screener

Screening for posttraumatic stress disorder (PTSD) among children hospitalised for injury is vital in ensuring that children at risk of experiencing persistent symptoms are identified for referral to intervention. Currently there is a paucity of research investigating screening among children under the age of 6 years, with only one screening tool specifically designed for use with this population: the Pediatric Emotional Distress Scale Early Screener (PEDS-ES). The current study aimed, firstly, to investigate the impact of the timing of screening on the predictive performance of the PEDS-ES and, secondly to further validate the PEDS-ES by examining its predictive performance among 1 to 2 year old and 3 to 6 year old children. Based on trajectory analyses it was expected that the predictive performance of the PEDS-ES would increase as the time between injury and screening increased. Furthermore, it was expected that the measure would display greater predictive performance among the 3 to 6 year old children than among the 1 to 2 year old children. The sample consisted of 98 caregivers of children between the ages of 1 and 6 years that presented with a burn or other injury to the Royal Children’s Hospital (RCH) in Brisbane, Australia. Caregivers completed the PEDS-ES within 2 weeks of the child’s injury and were followed up at 6 months post-injury with a PTSD diagnostic interview. Analyses of the predictive performance of the PEDS-ES when administered within 72 hours, at 1week and 2 weeks post-injury revealed that the measure performed better than chance at predicting PTSD only when administered at 2 weeks following injury. Additionally, a cut-off of 13 maximised sensitivity (100%) and specificity (100%). Furthermore, results supported the validity of the PEDS-ES at predicting PTSD among both the 1 to 2 year old and 3 to 6 year old children. Based on these results, it was recommended that hospitals implement screening at 2 weeks post-injury and utilise the PEDS-ES for screening all children between the ages of 1 and 6 years

Pathways to increasing the use of psychosocial care with hospitalized children

Trauma-informed care or psychosocial care can prevent or reduce the long-term impacts of hospitalization on children and their families, but few hospital staff members receive formal training in the optimal delivery of this care. This study aimed to (a) identify predictors of staff knowledge, confidence, use, and barriers regarding psychosocial care, and investigate whether these differed by profession; (b) identify pathways to increasing the use of psychosocial care; and (c) understand the association between psychosocial care and staff stress and burnout. Surveys were conducted with staff members (N = 180) within a large pediatric hospital. Questions were based on those used in similar research, and stress and burnout were assessed using the Professional Quality of Life scale. The study found that although all staff members reported using psychosocial care, only 27.2% had received training in these skills. There were no substantial differences in knowledge, confidence, and use of psychosocial care between different professions (medical, nursing, allied health, and administration staff), although nursing staff members reported a higher number of barriers to using psychosocial care. Training was indirectly associated with greater use via greater confidence and greater knowledge. Low confidence and a higher number of barriers were associated with staff burnout, and greater skill use and a higher number of barriers were associated with staff stress. Overall, these findings suggest that training that improves confidence and knowledge may support staff to deliver psychosocial care, with potential benefits for staff well-being. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Schools and natural disaster recovery: the unique and vital role that teachers and education professionals play in ensuring the mental health of students following natural disasters

There is growing evidence that children are vulnerable to poor psychological outcomes following exposure to a range of potentially traumatic events. Teachers are in a unique and well-placed position to provide vital support to children following potentially traumatic events and to also provide a vital role in helping to identify children who may be experiencing ongoing psychosocial difficulties. We present a review of mental health trauma resources available for use in educational settings within Australia and New Zealand, with a primary focus on post-disaster resources. We describe the design, development, and dissemination of our resources and training package, Childhood Trauma Reactions: A Guide for Educators from Preschool to Year 12, and present data on how these resources were received. Trauma-informed practices within the school and classroom will enable better outcomes in the immediate post-trauma environment and beyond for all children. Our model focuses on: (1) increasing awareness and understanding of children’s post-trauma reactions, (2) exploring effective strategies for teachers within the classroom, and (3) developing policy and procedures for the identification and referral of children who may be at risk. More funding is required to help distribute training and resources and to make mental health following trauma a higher priority

Anti-platelet factor 4 immunoglobulin G levels in vaccine-induced immune thrombocytopenia and thrombosis:persistent positivity through 7 months

BACKGROUND: Anti‐platelet factor 4 (PF4) antibodies that activate platelets via FcγRIIA drive the pathophysiology of vaccine‐induced immune thrombocytopenia and thrombosis (VITT). Evolution of these antibodies and their ability to activate platelets after initial treatment remains unknown. OBJECTIVES: To assess how clinical and platelet parameters, anti‐PF4 antibody levels, and patient serum reactivity changes during follow‐up after VITT presentation. METHODS: We describe cases of seven discharged VITT patients that were followed from diagnosis up to 280 days (range 199–280) after vaccination. We measured anti‐PF4 antibodies and PF4 levels in patient serum during follow‐up and tested the ability of patient serum to activate healthy donor platelets and patient platelets over time. RESULTS: Anti‐PF4 immunoglobulin G antibody levels are very high at diagnosis (0.9–2.6 OD) and remain relatively high (>1.0 OD) in all patients, except one treated with rituximab, at 7 months post vaccination. All patients were on direct oral anticoagulants throughout follow‐up and no patients had recurrent thrombosis. Patients’ platelets during follow‐up have normal FcγRIIA levels and responsiveness to platelet agonists. Patient diagnostic serum strongly activated control platelets, either alone or with PF4. Most follow‐up serum alone was weaker at stimulating donor and patient platelets. However, follow‐up serum beyond 150 days still strongly activated platelets with PF4 addition in three patients. Patient serum PF4 levels were lower than controls at diagnosis but returned within normal range by day 50. CONCLUSIONS: Explanations for reduced platelet activation during follow‐up, despite similar total anti‐PF4 antibody levels, remains unclear. Clinical implications of persistent anti‐PF4 antibodies in VITT require further study

Trauma-informed care in practice: observed use of psychosocial care practices with children and families in a large pediatric hospital

Hospitalization for illness or injury can be experienced by children and their families as traumatic, which can impede recovery and lead to ongoing problems. The provision of quality trauma-informed or psychosocial care by hospital staff may mitigate trauma-related problems; however, there is great variability in the use of psychosocial care practices. Most previous research is based on self-report data and focuses primarily on nurses and physicians. The current study aimed to investigate the use of psychosocial care practices among a range of staff in a large urban pediatric hospital, using observations and interviews. A coding matrix of practices and a set of interview questions were developed based on previous research. Participants included 18 direct care hospital staff and 10 patients. Trained observers observed 13 staff and 10 patients, and coded instances of psychosocial care; 17 staff participated in interviews. A large number of instances of psychosocial care were observed but there was substantial variability in overall use and the use of individual practices. Interviewed staff reported many benefits of psychosocial care for patients and staff, although there were some costs, including emotional fatigue. Contrary to current evidence, most staff reported they rely on visible triggers of distress or need before providing psychosocial care. Future research could investigate the optimal ratio of psychosocial to physical care practices, taking into account patient feedback and psychosocial and medical outcomes. To improve the consistency of psychosocial care, training could incorporate the practice examples documented here, include staff self-care, and encourage informal avenues of learning. (PsycINFO Database Record (c) 2019 APA, all rights reserved)