The hippocampus and the flexible use and processing of language

Fundamental to all human languages is an unlimited expressive capacity and creative flexibility that allow speakers to rapidly generate novel and complex utterances. In turn, listeners interpret language “on-line,” incrementally integrating multiple sources of information as words unfold over time. A challenge for theories of language processing has been to understand how speakers and listeners generate, gather, integrate, and maintain representations in service of language processing. We propose that many of the processes by which we use language place high demands on and receive contributions from the hippocampal declarative memory system. The hippocampal declarative memory system is long known to support relational binding and representational flexibility. Recent findings demonstrate that these same functions are engaged during the real-time processes that support behavior in-the-moment. Such findings point to the hippocampus as a potentially key contributor to cognitive functions that require on-line integration of multiple sources of information, such as on-line language processing. Evidence supporting this view comes from findings that individuals with hippocampal amnesia show deficits in the use of language flexibly and on-line. We conclude that the relational binding and representational flexibility afforded by the hippocampal declarative memory system positions the hippocampus as a key contributor to language use and processing

The Quality And Developmental Pathways In Sibling Relationships: A Qualitative Study Of Norwegian Children Admitted To Child Welfare Service Care

Siblings are key actors in the social network of young people in care. This paper explores young people's perceptions of changes in the quality of sibling relationships and the pathways relationships follow during the transition from the biological family into care. A thematic analysis of interviews with young Norwegian people (n = 25) in care showed that, in the biological family, sibling relationships are characterized by alliances, parentification, conflicts or nonexistence. After admission to child welfare services care, sibling relationships developed along multiple pathways. Their sibling relationships reshaped into either close and supportive, conflictual or completely broken relationships. Sibling relationships were dynamic, complex, with the pathway, and its impact on well-being, being unique to each young person. Sibling relationship quality in the biological home did not predict relationship quality after admission to child welfare services. The implications for social worker practice are discussed.publishedVersio

Young, unaccompanied refugees’ expectations of social workers and social worker roles

Background: Young people who have travelled to another country, unaccompanied and with refugee status, are a both resilient and vulnerable group with specific needs. Supporting them is often challenging for social workers, and providing this support is mediated by the expectations that these young people have of social workers and social worker roles. Aim: In this study, we explore how young unaccompanied refugees (YURs) perceive the roles of social workers in the national context of Norway, where concerns about the quality of social work for this group have been highlighted. Method: Using the theoretical lens of role theory, semi-structured in-depth interviews were conducted with 11 Afghan boys between 16 and 23 years of age, living under the protection of the Child Welfare Services (CWS) in two municipalities in Norway. The interviews explored the boys’ positive and negative experiences of the social worker. A thematic analysis was conducted, in which the coding framework was informed by the premise that actual experience informs our expectations of other individuals’ behaviour and roles. Findings: YURs’ expectations are more than instrumental, and more than a task they expect the social worker to perform. They also expect the task to be performed in a person-centred, therapeutic alliance (e.g. with humour and trust), and that the social worker exhibits particular personal characteristics or competences, besides being culturally competent and sensitive. Conclusion: We find that YURs’ descriptions of the social worker’s roles of being a caregiver and practical helper are similar to what other young people in contact with the CWS expect. However, YURs expect an additional role, which is specific to this field of social work, namely that of an integration helper. However, the expectations that each individual young person has of social workers are individual, in flux and contextual, and not consistent over time. Therefore, we recommend prioritizing learning more about the young person’s individual expectations of the social worker roles, as well as a useful weighting of these roles for each individual young refugee.publishedVersio

Facilitating understanding of ex-prison service users needs : the utility of Q method as a means of representing service user voices in service development

Novel approaches are needed if the voices of prisoners as service users are to be heard in service development and organisational learning. In this chapter we introduce Q methodology and suggest how this research method can be applied in order to reveal the views of service users in contact with the criminal justice system. We illustrate this by describing the development of a set of Q statements used to elicit the perspectives of ex-prisoners’ experiences of service provisions in an UK mentorship organisation. We discuss how Q methodology can be applied to capture ex-prison service users’ views in research, in therapy or in dialogues between service user and mentor, as well as in including service users’ voices in service development.publishedVersio

Mentoring in practice : Rebuilding dialogue with mentees stories

The voluntary and community sector (VCS) is a key player in the support of prisoners and ex-prisoners in the English and Welsh criminal justice system. Organisational learning and innovation is urgently required in this sector to adapt to the current political and economic environment. The chapter describes exploratory efforts to introduce participatory methods drawn from Change Laboratory Methods and Clinics of Activity within a local VCS organisation that would help (re)build dialogue between stakeholders with the aim of promoting organisational learning and innovation. The intervention comprised an ethnographic phase of observing the staff, interviews with 19 key stakeholders, and a final developmental workshop with the staff. The analysis of these data by the researcher (first author) provided insight into the experience of mentors working in the voluntary sector as well as providing a trigger for dialogue in a subsequent workshop that used these data to establish dialogue between staff. These served as dialogical artefacts, introducing micro-dramas in the form of selected user stories. These dialogical artefacts triggered diverse reactions and analyses by the various participants, highlighting different elements than those anticipated by the researcher. We discuss the different readings of our research data by the researcher and staff members, presenting these two contrasting perspectives, and the implications this has for workplace development methods.publishedVersio

Reflecting on researcher practice relationships in prison research : A contact hypothesis lens

Interactions between researchers and professionals need to be carefully managed in the criminal justice context. This chapter explores the utility of the theoretical lens of the contact hypothesis as a means to understand and improve these relations. The COLAB consortium is used as a case study of a typical partnership between professionals in practice and researchers in academia to illustrate this. We use the reflections of four of its members from both professional and researcher European institutions to explore how the conditions of contact proposed by the contact hypothesis may have impacted on the experiences of participants. Strategies through which these relations can be optimised in the interest of prison research, but also the care and management of people in contact with the criminal justice system, are proposed.publishedVersio

Seeing the person before the teeth: A realist evaluation of a dental anxiety service in Norway

Patients with a trauma history, whether sexual abuse or torture, or dental phobia, tend to avoid dental services due to severe dental anxiety. Subsequently, they experience poor oral health, lower quality of life, and poorer general health. In Norway, a specific service (torture, abuse, and dental anxiety [TADA]) targets these patients’ dental anxiety through cognitive behavioural therapy (CBT) prior to dental restoration. By exploring patients’ experiences with TADA services using a realist evaluation approach, this paper aims to increase our understanding of how this type of service addresses patients’ dental anxiety in terms of its mechanisms and contextual factors. Interviews with TADA patients (n = 15) were analysed through a template analysis driven by context-mechanism-outcome heuristics. The analysis revealed that patients value a dental practitioner who provides a calm and holistic approach, positive judgements and predictability elements that lean towards a person-centred care approach. Provided this, patients felt understood and cared for, their shame was reduced, self-esteem emerged, and control was gained, which led to alleviation of dental anxiety. Therefore, our findings suggest that combining CBT with a person-centred care approach helps alleviate patients’ dental anxiety. This provides insights into how dental services could be executed for these patients.publishedVersio

More than just a dental practitioner: A realist evaluation of a dental anxiety service in Norway

Patients with dental phobia or a history of trauma tend to avoid dental services, which may, over time, lead to poor oral health. In Norway, a specific service targets these patients by providing exposure therapy to treat their fear of attendance and subsequently enable oral restoration. Dental practitioners deliver the exposure therapy, which requires a role change that deviates from their traditional practice. This paper explores how – and under what circumstances – dental practitioners manage this new role of alleviating dental anxiety for patients with a history of trauma or dental phobia. Using a realist evaluation approach, this paper develops theory describing which contexts promote mechanisms that allow practitioners to alleviate dental anxiety for patients with trauma or dental phobia. A multi-method approach, comprising service documents (n = 13) and stakeholder interviews (n = 12), was applied. The data were then analysed through a content analysis and context-mechanism-outcome heuristic tool. Our findings reveal that dental practitioners must adopt roles that enable trust, a safe space, and gradual desensitisation of the patient to their fear triggers. Adopting these roles requires time and resources to develop practitioners' skills – enabling them to adopt an appropriate communication style and exposure pace for each patient.publishedVersio

Mentoring after prison : recognition as a tool for reflection

Many organisations offer mentoring schemes to support people leaving prison and resettle back into the community. Mentorship relationships are complex but despite this, there remains limited theoretical and/or research informed tools to guide mentorship practices and hereby the success of ex-prisoner mentorship. The aim of the paper is to contribute to this shortfall by presenting a theoretically informed framework to assist reflection on mentorship practices and the mentorship relationship: the Recognition Reflection Framework (RRF). The framework has potential to provide mentors with a tool to reflect on ex-prisoners´ need for recognition of worth if they are to desist from crime. The paper describes the theoretical development and preliminary validation of this reflection framework, underpinned by a strengths-based mentoring approach, and developed through the merger of concepts from recognition theory, person centred care and therapeutic alliances. We present this framework as a means through which mentors can reflect on how they may specifically contribute to secondary and tertiary desistance, as well as reflect on ways they can personally develop a constructive mentor-client relationship.Mentoring after prison : recognition as a tool for reflectionpublishedVersio

Brain activity measured by functional brain imaging predicts breathlessness improvement during pulmonary rehabilitation

Background Chronic breathlessness in chronic obstructive pulmonary disease (COPD) is effectively treated with pulmonary rehabilitation. However, baseline patient characteristics predicting improvements in breathlessness are unknown. This knowledge may provide better understanding of the mechanisms engaged in treating breathlessness and help to individualise therapy. Increasing evidence supports the role of expectation (ie, placebo and nocebo effects) in breathlessness perception. In this study, we tested functional brain imaging markers of breathlessness expectation as predictors of therapeutic response to pulmonary rehabilitation, and asked whether D-cycloserine, a brain-active drug known to influence expectation mechanisms, modulated any predictive model. Methods Data from 71 participants with mild-to-moderate COPD recruited to a randomised double-blind controlled experimental medicine study of D-cycloserine given during pulmonary rehabilitation were analysed (ID: NCT01985750). Baseline variables, including brain-activity, self-report questionnaires responses, clinical measures of respiratory function and drug allocation were used to train machine-learning models to predict the outcome, a minimally clinically relevant change in the Dyspnoea-12 score. Results Only models that included brain imaging markers of breathlessness-expectation successfully predicted improvements in Dyspnoea-12 score (sensitivity 0.88, specificity 0.77). D-cycloserine was independently associated with breathlessness improvement. Models that included only questionnaires and clinical measures did not predict outcome (sensitivity 0.68, specificity 0.2). Conclusions Brain activity to breathlessness related cues is a strong predictor of clinical improvement in breathlessness over pulmonary rehabilitation. This implies that expectation is key in breathlessness perception. Manipulation of the brain’s expectation pathways (either pharmacological or non-pharmacological) therefore merits further testing in the treatment of chronic breathlessness