Understanding and Assessing the Therapeutic Relationship in Community Mental Health Care

PhDThe clinician-patient relationship is at the core of community mental health care and impacts on outcome, but no instrument has been specifically developed for its assessmentE. xisting scalesh ave either unproven psychometric properties in community mental health care settings, or have been designed for other therapeutic settings, or both. My aim in this thesis is to develop a scale to assess the therapeutic relationship in community mental health care (STAR) that has both clinician and patient versions. In part one, understanding the therapeutic relationship in community care, I considered the rationale for mental health care in the community and explore theoretical presuppositions, pre-existing measures, and influences on the therapeutic relationship. In part two, assessing the therapeutic relationship in community care, I developed an assessment tool in four stages. In stage one I generated an item pool using semi-structured interviews and existing scales. In stage two I administered this item pool to 133 community care patients and their 26 clinicians. I constructed subscales based on principal components analyses. In stage three, for final item selection, I assessed retest-reliability. In stage four the scales were administered to a new sample of 180 patients and their 84 clinicians. The factorial structure of the scale was confirmed with a good fit. The end result is both a patient and clinician version of STAR which has 12 items comprising 3 subscales: positive collaboration (6 items) and positive clinician input (3 items) in both versions, non-supportive clinician input in the patient version and emotional difficulties in the clinician version (3 items each). Psychometric properties are satisfactory. STAR is a specifically developed, brief scale to assess therapeutic relationships in community care. The two versions cover three similar factors each, and may be used in research and routine care

A new scale to assess the therapeutic relationship in community mental health care: STAR

Background. No instrument has been developed specifically for assessing the clinician-patient therapeutic relationship (TR) in community psychiatry. This study aimed to develop a measure of the TR with clinician and patient versions using psychometric principles for test construction. Method. A four-stage prospective study was undertaken, comprising qualitative semi-structured interviews about TRs with clinicians and patients and their assessment of nine established scales for their applicability to community care, administering an amalgamated scale of more than 100 items, followed by Principal Components Analysis (PCA) of these ratings for preliminary scale construction. test-retest reliability of the scale and administering the scale in a new sample to confirm its factorial structure. The sample consisted of patients with severe mental illness and a designated key worker in the care of 17 community mental health teams in England and Sweden. Results. New items not covered by established scales were identified, including clinician helpfulness in accessing services, patient aggression and family interference. The new patient (STAR-P) and clinician scales (STAR-C) each have 12 items comprising three subscales: positive collaboration and positive clinician input in both versions, non-supportive clinician input in the patient version, and emotional difficulties in the clinician version. Test-retest reliability was r = 0(.)76 for STAR-P and r = 0(.)68 for STAR-C. The factorial structure of the new scale was confirmed with a good fit. Conclusions. STAR is a specifically developed, brief scale to assess TRs in community psychiatry with good psychometric properties and is suitable for use in research and routine care

Activated Cyclopropanes: A Remarkable Breadth of Recent Chemistry

The reactions of cyclopropanes activated by electron-withdrawing groups and electron-donating groups – donor–acceptor (DA) cyclopropanes – and with alkenyl or alkylidene substituents has been an area of recent intense research activity. This Cluster contains contributions from many of the leading research groups in this area, and provides a concise introduction to the rich ring-opening, ring-expansion, dimerization, and cycloaddition chemistry of these compounds

Attachment Aware Schools

‘Attachment Aware Schools’ is a collaborative program of support which is promoting public understanding of the underlying causes of children’s behavior, stimulating political debate about inclusive educational provision and is helping to transform professional practice within schools and community settings. The program hinges upon attachment theory and attachment-based strategies for supporting children’s social and emotional development. This paper documents the positive impact of pilot programs within the UK on national policy and in developing sustainable improvements in systemic school-wide practices relating to children’s behavior and well-being. It illustrates collaborative research evidence between practitioners and academics, generating civic participation and engagement, which has also informed policy directives within national and local government, and public and private sector organisations

Attachment Aware Schools:Working with Families to Enhance Parental Engagement and Home-School Relationships

Background:- Application of attachment theory in school contexts lacks empirical evidence. The Attachment Aware Schools pilot project was commissioned by two Local Authorities in England to improve the educational outcomes of Looked After Children, and to build an evidence base. Informed by attachment research, Attachment Aware Schools programs provide a coherent and integrated theoretical framework, discourse, and practice for all practitioners working with children and young people. Objective:- The primary focus was to provide whole school and targeted attachment-based strategies to support children’s well-being, behaviour, and academic attainment. This paper; however, documents a secondary objective, which was to facilitate collaborative partnerships with families. Method:- As part of the mixed methods approach to the Attachment Aware Schools project, a series of case studies were collected and thematically coded. The case studies were generated by practitioners using an outcomes-based framework. Results:- Although the case study sample size is small (N=10), the case studies presented here illustrate how Attachment Aware Schools programs can promote increased home-school engagement and shared practice between home and school. Outcomes include improved home-school relationships, reductions in behavioral incidents, and improved family dynamics. Conclusion:- Attachment Aware Schools can be a vehicle for facilitating supportive home-school collaborative partnerships with positive outcomes for vulnerable children and young people

Structural elaboration of the surprising ortho-zincation of benzyl methyl ether

Breaking with convention, the reaction of the sodium zincate, [(TMEDA)Na(μ-TMP)(μ-tBu)Zn(tBu)] with benzyl methyl ether (PhCH2OMe) produces exclusively an ortho-zincated intermediate [(TMEDA)Na(μ-TMP)(μ-C6H4CH2OMe)Zn(tBu)] instead of the expected 'thermodynamic' α-metallated product

Adding a structural context to the deprotometalation and trans-metal trapping chemistry of phenyl-substituted benzotriazole

Organometallic bases are becoming increasingly complex, because mixing components can lead to bases superior to single-component bases. To better understand this superiority, it is useful to study metalated intermediate structures prior to quenching. This study is on 1-phenyl-1H-benzotriazole, which was previously deprotonated by an in situ ZnCl2• TMEDA/LiTMP (TMEDA=N,N,N′,N′-tetramethylethylenediamine; TMP=2,2,6,6-tetramethylpiperidide) mixture and then iodinated. Herein, reaction with LiTMP exposes the deficiency of the single-component base as the crystalline product obtained was [{4-R-1-(2-lithiophenyl)-1H-benzotriazole• 3THF}2], [R=2-C6H4(Ph)NLi], in which ring opening of benzotriazole and N2 extrusion had occurred. Supporting lithiation by adding iBu2Al(TMP) induces trans-metal trapping, in which C-Li bonds transform into C-Al bonds to stabilise the metalated intermediate. X-ray diffraction studies revealed homodimeric [(4-R′-1-phenyl-1H-benzotriazole)2], [R′=(iBu)2Al(μ-TMP)Li], and its heterodimeric isomer [(4-R′-1-phenyl-1H-benzotriazole){2-R′-1-phenyl-1H-benzotriazole}], whose structure and slow conformational dynamics were probed by solution NMR spectroscopy

Attachment Aware Schools: the impact of a targeted and collaborative intervention

The Attachment Aware Schools (AAS) project was a targeted and collaborative intervention between academics and school-based practitioners. The aim of the project was to promote practitioner awareness of attachment in relation to child behaviours and learning. It focused on using relational-based strategies and interventions to address the needs of children and young people. The AAS framework promoted Emotion Coaching as a universal, relational-based practice approach, with specialised targeted support for children with additional needs. Supportive managerial strategies and setting policies sustained the integration and maintenance of attachment-informed practice and school ethos. This article reports the findings from the project which included over 200 participants (107 teaching and support staff and 94 pupils aged 5 to 16 years), from 40 schools, in two different Local Authorities within the UK. Adopting a mixed methods approach, qualitative and quantitative data provided hard and soft indicators of improved pupil and adult outcomes. Findings demonstrated significant improvements in pupils’ academic achievement in reading, writing and maths. There were significant decreases in sanctions, exclusions and overall difficulties. Practitioners reported a positive impact on professional practice, adult self-regulation and emotional self-control, and were more confident when talking with children about emotions. This project contributes to the growing evidence based on the effectiveness of whole school attachment-based strategies and is already demonstrating policy implications at a national level

Human alpha-actinin-3 genotype association with exercise-induced muscle damage and the repeated-bout effect

Alpha-actinin-3 (ACTN3) is an integral part of the Z line of the sarcomere. The ACTN3 R577X (rs1815739) polymorphism determines the presence or absence of functional ACTN3, which may influence the extent of exercise-induced muscle damage. This study aimed to compare the impact of, and recovery from, muscle-damaging eccentric exercise on subjects with or without functional ACTN3. Seventeen young men (20-33 years old), homozygous for the R (n = 9) or X (n = 8) alleles, performed two bouts of stretch-shortening exercise (50 drop jumps) two weeks apart. Muscle soreness, plasma creatine kinase (CK) activity, jump height, maximal voluntary isometric torque (MVC), peak concentric isokinetic torque (IT), and electrically stimulated knee extension torques at 20 and 100 Hz were measured at baseline and at a number of time points up to 14 days after each bout. There were no significant baseline differences between the groups. However, significant time point × genotype interactions were observed for MVC (p = 0.021) and IT (p = 0.011) for the immediate effect of eccentric exercise in bout 1. The RR group showed greater voluntary force decrements (RR vs. XX: MVC, -33.3% vs. -24.5%; IT, -35.9% vs. -23.2%) and slower recovery. A repeated-bout effect was clearly observed, but there were no differences by genotype group. The ACTN3 genotype modulates the response of muscle function to plyometric jumping exercise, although the differences are modest. The ACTN3 genotype does not influence the clearly observed repeated-bout effect; however, XX homozygotes recover baseline voluntary torque values faster and thus may be able to undertake more frequent training sessions