Australian mental health consumers' contributions to the evaluation and improvement of recovery-oriented service provision

Background: one key component of recovery-oriented mental health services, typically overlooked, involves genuine collaboration between researchers and consumers to evaluate and improve services delivered within a recovery framework. Method: Eighteen mental health consumers working with staff who had received training in the Collaborative recovery Model (CrM) took part in in-depth focus group meetings, of approximately 2.5 hours each, to generate feedback to guide improvement of the CrM and its use in mental health services. Results: Consumers identified clear avenues for improvement for the CrM both specific to the model and broadly applicable to recovery-oriented service provision. Findings suggest consumers want to be more engaged and empowered in the use of the CrM from the outset. Limitations: improved sampling procedures may have led to the identification of additional dissatisfied consumers. Conclusions: Collaboration with mental health consumers in the evaluation and improvement of recovery-oriented practice is crucial with an emphasis on rebuilding mental health services that are genuinely oriented to support recovery

Increasing the effectiveness of coach education: evidence of a parallel process

The purpose of this study was to use the results of an exploratory case study to discuss the design and delivery of formal coach education pathways. Nine coaches completed qualitative and quantitative feedback on a formal transformational leadership training program. The theme that was consistently being presented by coaches was the need for learning to be situated within practical demonstrations and discussions where the coach learner and coach educator work collaboratively to facilitate understanding of the applications of program content to coaching practice. These results have been discussed in the light of the parallel processes that are evident in coach education. The relationship dynamics between athlete and coach are paralleled in the relationship between coach learner and coach educator. Formalising the parallel process in coach education is put forward as a conceptually sound approach to facilitate reflection in coaching practitioners through the use of practical demonstrations

Collaborative Recovery: An integrative model for working with individuals who experience chronic and recurring mental illness

Objectives: Recovery is an emerging movement in mental health. Evidence for recovery-based approaches is not well developed and approaches to implement recovery-oriented services are not well articulated. The collaborative recovery model (CRM) is presented as a model that assists clinicians to use evidencebased skills with consumers, in a manner consistent with the recovery movement. A current 5 year multisite Australian study to evaluate the effectiveness of CRM is briefly described. Conclusion: The collaborative recovery model puts into practice several aspects of policy regarding recovery-oriented services, using evidence-based practices to assist individuals who have chronic or recurring mental disorders (CRMD). It is argued that thismodel provides an integrative framework combining (i) evidence-based practice; (ii) manageable and modularized competencies relevant to case management and psychosocial rehabilitation contexts; and (iii) recognition of the subjective experiences of consumers

A cluster-randomised controlled trial of values-based training to promote autonomously held recovery values in mental health workers

The implementation and use of evidence-based practices is a key priority for recovery-oriented mental health service provision. Training and development programmes for employees continue to be a key method of knowledge and skill development, despite acknowledged difficulties with uptake and maintenance of behaviour change. Self-determination theory suggests that autonomy, or a sense that behaviour is self-generated, is a key motivator to sustained behaviour change, in this case practices in mental health services. This study examined the utility of values-focused staff intervention as a specific, reproducible method of autonomy support

Consumer and staff perspectives of the implementation frequency and value of recovery and wellbeing oriented practices

Background: Despite advances in our understanding of what mental health systems and services can do to enhance recovery and wellbeing outcomes for people seeking support, there is limited evidence demonstrating that this body of work has translated successfully into mental health service practice. The Collaborative Recovery Model (CRM) is a practice framework that has been designed to support application of recovery and wellbeing oriented principles and practices within mental health service delivery. The aims of this study were to assess consumer and staff perceptions of implementation frequency during service engagement and the value of this approach for assisting recovery within a setting where the CRM approach had been adopted. Methods: The setting was a large Australian community managed mental health organisation. The study involved a cross-sectional analysis of consumer (n = 116) and staff practitioner (n = 62) perspectives. A series of paired sample t-tests assessed for differences between consumer and staff perceptions of the: (i) importance of key practice elements for assisting recovery, and the (ii) frequency that key practice elements are utilised during engagement sessions. Spearman\u27s r correlational analysis explored associations between importance, frequency and helpfulness of sessions. Results: Key practice elements of the model were applied during service interactions at a high level and perceived by the majority of consumers and staff participants as being important or very important for assisting recovery. Significant moderate correlations were found between the extent that practice elements were valued and the level at which they were applied. Higher levels of implementation of CRM practices were associated with higher ratings of perceived session helpfulness. The strongest association was between \u27encouragement to set tasks to complete between support visits\u27 and perceived helpfulness. Conclusions: Consumer and staff responses revealed that the key practice elements of the CRM were frequently implemented during service engagement interactions and were seen as valuable for assisting recovery. The level of agreement between raters suggests firstly, that the key practice elements were apparent and able to be rated as occurring, and secondly that the CRM approach is seen as responsive to consumer needs. The results have implications for translating recovery and wellbeing oriented knowledge into mental health service practice

Challenges in implementing routine cardiopulmonary exercise testing in cystic fibrosis clinical practice: a single centre review

This is the final version. Available on open access from Springer via the DOI in this recordCardiopulmonary exercise testing (CPET) is viewed by many as the gold standard for assessing exercise capacity in CF, being recommended on an annual basis. However, not all patients undergo CPET for varying reasons. This service evaluation retrospectively reviewed data from 179 (92 male) patients in a single CF centre in the UK to identify such reasons. 75/179 patients underwent CPET, whilst 104/179 did not. Of these 104, 41 patients were ≤ 11 years of age. Of the remaining 63 patients, 26 did not undergo CPET for clinical reasons including needing IV antibiotics, musculoskeletal issues and obesity. 17 refused to undergo CPET because of reasons such as an unwillingness to travel and dislike of CPET. 20 did not undergo CPET for miscellaneous reasons including difficulty contacting patients. Individuals with FEV1 <40%predicted were 85.7% less likely to undertake a CPET than individuals with FEV1 ≥70%predicted. Understanding these challenges will assist clinical teams with future implementation of CPET into routine care, by identifying areas for improvement and establishing strategies for enhancing future provision of the test

Parallel processes in clinical supervision: Implications for coaching mental health practitioners

This paper outlines the potential of parallel processes to enhance experiential learning opportunities in coaching for mental health practitioners. Traditional views of parallel processes in clinical supervision are examined in relation to how they can be applied to enhance coaching mental health practitioners. For example, parallel relationship patterns refer to repetitive interpersonal relationship patterns that are transferred from client interactions with mental health practitioners into the coaching sessions for these mental health practitioners. In addition, experiential learning strategies that utilize parallel process concepts might include the use of equivalent protocols for staff development coaching as are used by mental health practitioners in their work with clients experiencing mental health problems. Two coaching approaches (skills acquisition and transformational coaching) to support the implementation and use of a practice model for mental health staff and clients are presented to exemplify the potential advantages of purposeful use of parallel processing in coaching mental health practitioners

High loading of polygenic risk for ADHD in children with comorbid aggression

Objective: Although attention deficit hyperactivity disorder (ADHD) is highly heritable, genome-wide association studies (GWAS) have not yet identified any common genetic variants that contribute to risk. There is evidence that aggression or conduct disorder in children with ADHD indexes higher genetic loading and clinical severity. The authors examine whether common genetic variants considered en masse as polygenic scores for ADHD are especially enriched in children with comorbid conduct disorder. Method: Polygenic scores derived from an ADHD GWAS meta-analysis were calculated in an independent ADHD sample (452 case subjects, 5,081 comparison subjects). Multivariate logistic regression analyses were employed to compare polygenic scores in the ADHD and comparison groups and test for higher scores in ADHD case subjects with comorbid conduct disorder relative to comparison subjects and relative to those without comorbid conduct disorder. Association with symptom scores was tested using linear regression. Results: Polygenic risk for ADD, derived from the meta-analysis, was higher in the independent ADHD group than in the comparison group. Polygenic score was significantly higher in ADHD case subjects with conduct disorder relative to ADHD case subjects without conduct disorder. ADHD polygenic score showed significant association with comorbid conduct disorder symptoms. This relationship was explained by,the aggression items. Conclusions: Common genetic variation is relevant to ADHD, especially in individuals with comorbid aggression. The findings suggest that the previously published ADHD GWAS meta-analysis contains weak but true associations with common variants, support for which falls below genome-wide significance levels. The findings also highlight the fact that aggression in ADHD indexes genetic as well as clinical severity