Perceived barriers and facilitators to positive therapeutic change for people with intellectual disabilities: client, carer and clinical psychologist perspectives

Over the past 15 years psychological therapy for people with Intellectual Disabilities (ID) has been increasingly advocated (e.g., Linington, 2002) and successful treatment outcomes of psychological therapies for this population have been highlighted in a number of studies (e.g., Beail, 1998). However, the processes underlying these successful treatments are uncertain and some authors argue that success could be attributed to person-centred counselling rather than the specific approach adopted (e.g., Beail, 1998). Current literature highlights a substantial gap and an increasing need for research that identifies conditions under which the effects of therapy are optimised for people with ID through the exploration of barriers and facilitators to positive therapeutic change. This thesis explored the experiences of Clinical Psychologists (CPs), their clients with an ID and the client’s carers, with regards to the perceived barriers and facilitators to positive therapeutic change. Furthermore, this research aimed to develop a cohesive understanding from the multiple perspectives of the topic area. A triadic case design was utilised in which two triads of the CP, clients with ID and carers were nested by one CP. Therefore one ‘case’ constituted one CP, two of their clients (with ID) and two carers. Three of these cases were recruited and therefore this study had 15 participants and as the CPs were interviewed twice (once regarding each client separately) 18 interviews were completed. Thematic analysis was deemed to be an appropriate methodology to address the gap in qualitative research with people with ID. This methodology allowed the exploration of participant’s accounts whilst enabling the flexibility that is required to accommodate the varied abilities of people with ID. From the analysis of the transcripts of the 18 semi-structured interviews, five super-ordinate themes and one central theme were identified based on their frequency and salience from participants across all three participant groups. The first super-ordinate theme, ‘what the client brings’ encapsulated a number of factors related to the client that participants perceive to be initial barriers within therapy, namely, the ID itself (e.g., communication skills, memory) and the client’s engagement in therapy. A second super-ordinate theme that the client also brings to therapy is their ‘wider system’. This theme encompasses the facilitating role that a wider support network can play and also the barriers that the wider system can bring with regards to the negative influence of others on the client. A third super-ordinate theme related to ‘therapy factors’ that are generally perceived to be facilitators to overcome the barriers that clients bring to therapy. This included therapy adaptations and the therapeutic relationship. The fourth super-ordinate theme, namely ‘the mental health GP’ encompasses the concept that psychologists are required to coordinate the often extensive wider system of people with ID and this is because participants felt that in order to benefit from individual therapy, all of the client’s needs must be met, including physical health needs and ensuring that the client lives in an appropriate environment. Given the four super-ordinate themes noted above, all of these concepts foster the fifth super-ordinate theme ‘systemic dependency’. The mere presence of an ID means that naturally people are more dependent on others. As a result, therapy factors including the therapeutic relationship and adaptations to therapy (e.g., increased longevity of therapy) can foster strong attachments which can facilitate an unhelpful level of dependency. Additionally, the client’s wider system can also become dependent on services to help them facilitate care and coordinate the numerous services involved. All of these super-ordinate themes maintain the concept of the ‘revolving door’ into services. Additional subthemes noted in the extended paper are examples of barriers and facilitators to therapeutic change that are considered to have an important impact on therapy but were only noted by one group of participants (e.g., clients) and thus did not contribute to cohesive understanding of multiple perspectives aimed for within the journal paper. For example, clients reported confidentiality to be a barrier and CPs reported attachment difficulties of clients to be a barrier. The results of this study offer the first explorations of conditions under which therapy can be optimised for people with an ID through the awareness of barriers and facilitators to positive therapeutic outcomes. CPs are shown to be skilled at overcoming barriers within therapy; however there appeared to be a process of facilitators creating more barriers within therapy and the phenomenon of the revolving door needs to be fully considered. Given the potential impact of funding constraints on the role of CPs and access to psychological therapies for people with ID, this has important implications for the way psychologists working within this population market themselves and further evidence their work

Biological methods to assess unaccompanied asylum-seeking children's age

Report by the interim Age Estimation Science Advisory Committee (AESAC) on scientific methodologies for assessing the age of unaccompanied asylum-seeking children

Biological methods to assess unaccompanied asylum-seeking children's age

Report by the interim Age Estimation Science Advisory Committee (AESAC) on scientific methodologies for assessing the age of unaccompanied asylum-seeking children

Biological methods to assess unaccompanied asylum-seeking children’s age:Interim Age Estimation Science Advisory Committee

Report by the interim Age Estimation Science Advisory Committee (AESAC) on scientific methodologies for assessing the age of unaccompanied asylum-seeking children.<br/

Biological methods to assess unaccompanied asylum-seeking children’s age:Interim Age Estimation Science Advisory Committee

Report by the interim Age Estimation Science Advisory Committee (AESAC) on scientific methodologies for assessing the age of unaccompanied asylum-seeking children.<br/

Underwater Video as a Tool to Quantify Fish Density in Complex Coastal Habitats

Habitat loss is a serious issue threatening biodiversity across the planet, including coastal habitats that support important fish populations. Many coastal areas have been extensively modified by the construction of infrastructure such as ports, seawalls, docks, and armored shorelines. In addition, habitat restoration and enhancement projects often include constructed breakwaters or reefs. Such infrastructure may have incidental or intended habitat values for fish, yet their physical complexity makes quantitatively sampling these habitats with traditional gears challenging. We used a fleet of unbaited underwater video cameras to quantify fish communities across a variety of constructed and natural habitats in Perdido and Pensacola Bays in the central northern Gulf of Mexico. Between 2019 and 2021, we collected almost 350 replicate 10 min point census videos from rock jetty, seawall, commercial, public, and private docks, artificial reef, restored oyster reef, seagrass, and shallow sandy habitats. We extracted standard metrics of Frequency of Occurrence and MaxN, as well as more recently developed MeanCount for each taxon observed. Using a simple method to measure the visibility range at each sampling site, we calculated the area of the field of view to convert MeanCount to density estimates. Our data revealed abundant fish assemblages on constructed habitats, dominated by important fisheries species, including grey snapper Lutjanus griseus and sheepshead Archosargus probatocephalus. Our analyses suggest that density estimates may be obtained for larger fisheries species under suitable conditions. Although video is limited in more turbid estuarine areas, where conditions allow, it offers a tool to quantify fish communities in structurally complex habitats inaccessible to other quantitative gears

Biochar-mediated reductions in greenhouse gas emissions from soil amended with anaerobic digestates

This investigation examines nitrous oxide (N2O) fluxes from soil with simultaneous amendments of anaerobic digestates and biochar. The main source of anthropogenic emissions of N2O is agriculture and in particular, manure and slurry application to fields. Anaerobic digestates are increasingly used as a fertiliser and interest is growing in their potential as sources of N2O via nitrification and denitrification. Biochar is a stable product of pyrolysis and may affect soil properties such as cation exchange capacity and water holding capacity. Whilst work has been conducted on the effects of biochar amendment on N2O emissions in soils fertilised with mineral fertilisers and raw animal manures, little work to date has focused on the effects of biochar on nitrogen transformations within soil amended with anaerobic digestates. The aim of the current investigation was to quantify the effects of biochar application on ammonification, nitrification and N2O fluxes within soil amended with three anaerobic digestates derived from different feedstocks. A factorial experiment was undertaken in which a sandy loam soil (Dunnington Heath series) was either left untreated, or amended with three different anaerobic digestates and one of three biochar treatments; 0%, 1% or 3%. Nitrous oxide emissions were greatest from soil amended with anaerobic digestate originating from a maize feedstock. Biochar amendment reduced N2O emissions from all treatments, with the greatest effect observed in treatments with maximum emissions. The degree of N2O production and efficacy of biochar amelioration of gas emissions is discussed in context of soil microbial biomass and soil available carbon

Calcium Handling Defects and Cardiac Arrhythmia Syndromes

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Collaborative care : primary health workforce and service delivery in Western New South Wales - a case study

Objective: To explore how four small towns in rural New South Wales known as the 4Ts are addressing challenges accessing quality care and sustainable health services through a collaborative approach to workforce planning using the collaborative care framework. Design: Descriptive case study approach. Setting: The collaborative care project was developed as a result of ongoing partnerships between 2 rural Local Health Districts, 2 Primary Health Networks and a non-governmental health workforce organisation. The collaboration works with 5 subregions each comprising 2 or more rural communities. This paper focuses on the 4Ts subregion. Participants: Stakeholders of the collaborative design including organisations and the community. Intervention: A place-based approach to co-designing health services with community in one sub-region of Western New South Wales. Main outcome measures: A synthesis of field observations and experiences of community and jurisdictional partners in implementation of the 4Ts subregional model. Mapping of implementation processes against the collaborative care framework. Results: The collaborative care framework is a useful planning and community engagement tool to build health workforce literacy and to impact on system change at the local level. We identify key elements of effectiveness in establishing the 4Ts model, including the need for coordinated health system planning, better integrating existing resources to deliver services, community engagement, building health workforce literacy and town-based planning. Conclusion: This study adds to the body of knowledge about how to successfully develop a collaborative primary health care workforce model in practice. The findings demonstrate that the implementation of a collaborative primary health care workforce model using the collaborative care framework can improve service access and quality, which in turn might facilitate workforce sustainability