Integrating policy : implementing organizational change

Includes diskette of document text in WP format in back pocke

Integrating policy : a matter of learning; report on the INTESEP Workshop, IDRC, Ottawa, May 1995

Includes diskette of document text in WP format in back pocke

Truthmakers and modality

This paper attempts to locate, within an actualist ontology, truthmakers for modal truths: truths of the form or . In section 1 I motivate the demand for substantial truthmakers for modal truths. In section 2 I criticise Armstrong’s account of truthmakers for modal truths. In section 3 I examine essentialism and defend an account of what makes essentialist attributions true, but I argue that this does not solve the problem of modal truth in general. In section 4 I discuss, and dismiss, a theistic account of the source of modal truth proposed by Alexander Pruss. In section 5 I offer a means of (dis)solving the problem

Service user and family participation in mental health policy making in Timor-Leste: a qualitative study with multiple stakeholders.

BACKGROUND: Participation in mental health system strengthening by people with mental health problems and their families is a cornerstone of people-centred mental health care, yet there is a dearth of research about participation from low- and middle-income countries (LMICs), particularly from the Asia Pacific region. Hence, this study aimed to assess the current situation, challenges, enabling factors and future actions for service user and family participation in mental health policy making in Timor-Leste. METHODS: In-depth interviews were conducted with 85 adults (≥18 years) who were: (1) mental health service users (n = 20) and their families (n = 10); (2) government decision makers (n = 10); (3) mental health and social service providers (n = 23); (4) civil society (n = 9); and (5) other groups (n = 13). Interview data was analysed using framework analysis. RESULTS: There was limited service user, family and community participation in mental health policy making in Timor-Leste. Perceptions that policy making is a technical exercise and that people with mental health problems lack cognitive capacity, and a lack of supportive mechanisms challenged participation. Enabling factors were a strong focus on human rights within the social sector, and existing mechanisms for advocacy and representation of people with disabilities in social policy making. Participants suggested bolstering civil society representation of people with mental health problems, and increasing mental health awareness and literacy, including government competencies to facilitate service user participation. CONCLUSION: The findings highlight the need for theoretical and practical focus on the role of family within mental health system development in LMICs. Global mental health research and practice should adopt a critical approach to mental health service user and family participation to ensure that the concept and strategies to achieve this are embedded in LMIC knowledge

Optimising allied health psychological treatments in primary health care: Piloting a randomised controlled trial of social worker training in focused psychological strategies (The SW-fps Study)

The SW-fps Study was part of a broader body of research which aims to improve access to evidence-based psychological treatments in primary health care. Over the last decade, major mental health reforms in Australia, such as the Better Outcomes and Better Access programs, have greatly increased community access to psychological treatments through a range of funding models designed to support provision of psychological treatments by allied health providers. More recently social workers, amongst other allied health professionals, are beginning to utilise the Medicare incentives to provide psychological treatments in primary mentalThe research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Children with developmental coordination disorder are less able to fine-tune muscle activity in anticipation of postural perturbations than typically developing counterparts

The majority of children with developmental coordination disorder (DCD) struggle with static and dynamic balance, yet there is limited understanding of the underlying neuromechanical mechanisms that underpin poor balance control in these children. Eighteen children with DCD and seven typically developing (TD) children aged 7–10 years stood with eyes open on a moveable platform progressively translated antero-posteriorly through three frequencies (0.1, 0.25 and 0.5 Hz). Myoelectric activity of eight leg muscles, whole-body 3D kinematics and centre of pressure were recorded. At each frequency, postural data were divided into transition-state and steady-state cycles. Data were analyzed using a linear mixed model with follow-up Tukey’s pairwise comparisons. At the slowest frequency, children with DCD behaved like age-matched TD controls. At the fastest frequency, children with DCD took a greater number of steps, had a greater centre of mass variability, had a greater centre of pressure area, and tended to activate their muscles earlier and for longer than TD children. Children with DCD did not alter their postural response following prolonged exposure to platform movement, however they made more, non-structured postural adjustments in the medio-lateral direction as task difficulty increased. At the faster oscillation frequencies, children with DCD adopted a different muscle recruitment strategy to TD children. Activating their muscles earlier and for longer may suggest that children with DCD attempt to predict and react to postural disturbances, however the resulting anticipatory muscle excitation patterns do not seem as finely tuned to the perturbation as those demonstrated by TD children. Future work should examine the impact of balance training interventions on the muscle recruitment strategies of children with DCD, to ensure optimal interventions can be prescribed

Intersectoral collaboration for people-centred mental health care in Timor-Leste: a mixed-methods study using qualitative and social network analysis.

BACKGROUND: Intersectoral collaboration is fundamental to the provision of people-centred mental health care, yet there is a dearth of research about how this strategy operates within mental health systems in low- and middle-income countries. This is problematic given the known attitudinal, structural and resource barriers to intersectoral collaboration in high-income country mental health systems. This study was conducted to investigate intersectoral collaboration for people-centred mental health care in Timor-Leste, a South-East Asian country in the process of strengthening its mental health system. METHODS: This study employed a mixed-methods convergent design. Qualitative data elicited from in-depth interviews with 85 key stakeholders and document review were complemented with quantitative social network analysis to assess understandings of, the strength and structure of intersectoral collaboration in the Timorese mental health system. RESULTS: There was consensus among stakeholder groups that intersectoral collaboration for mental health is important in Timor-Leste. Despite resource restrictions discussed by participants, interview data and social network analysis revealed evidence of information and resource sharing among organisations working within the health and social (disability and violence support) sectors in Timor-Leste (network density = 0.55 and 0.30 for information and resource sharing, respectively). Contrary to the assumption that mental health services and system strengthening are led by the Ministry of Health, the mixed-methods data sources identified a split in stewardship for mental health between subnetworks in the health and social sectors (network degree centralisation = 0.28 and 0.47 for information and resource sharing, respectively). CONCLUSIONS: Overall, the findings suggest that there may be opportunities for intersectoral collaborations in mental health systems in LMICs which do not exist in settings with more formalised mental health systems such as HICs. Holistic understandings of health and wellbeing, and a commitment to working together in the face of resource restrictions suggest that intersectoral collaboration can be employed to achieve people-centred mental health care in Timor-Leste

Using Co-Inquiry to Study Co-Inquiry: Community-University Perspectives on Research

In the context of a rapid development of interest in community-university research partnerships, this article argues for a greater focus on collaborative reflexivity to enhance learning from the research process and contribute toward developing sustainable and ethical research collaborations. Incorporating perspectives of community and university participants, the article offers a case study analysis of a UK-based co-inquiry action research group. This group not only studied examples of community-university research collaborations, but also reflected on its own workings as an example of collaborative research in action—scrutinizing relationships of power, responsibility, and boundaries in the group (collaborative reflexivity). This article argues that research projects might be designed with space designated for co-inquiry action research or similar inquiry groups. These co-inquiry groups would serve as replacements or supplements to more traditional steering or advisory groups