Evidence-based advocacy. the Australian Research Alliance for Children and Youth (ARACY)

The Australian Research Alliance for Children and Youth (ARACY) was established in 2002 by leading stakeholders from three sectors - research, government policy, and professional practice - concerned to tackle the major issues affecting the wellbeing of Australia's children and young people. This is a network-based organisation, with major emphasis on collaboration across these three sectors. Strong emphasis is placed on promoting an evidence-based approach, focussing on a manageable number of key topics, building and disseminating the knowledge base, and translating knowledge into positive solutions that have support across these sectors. This network approach is making a difference in attracting support for evidence-based advice about effective early intervention in areas of particular concern for the wellbeing of young people, such as mental health, drugs and alcohol use, juvenile justice, and vocational skills training.     

Focus Groups: A Valuable Tool for Assessing Male and Female Adolescent Perceptions of School-Based Mental Health Services

Research documenting adolescents' perceptions about positive outcomes and quality care for students receiving school-based mental health services is needed. Information from focus groups examining the perceptions of students receiving and not receiving school-based mental health services is presented. High schools were located in urban areas. Students attending these schools were predominantly African-American and from low-income families. Results, based on qualitative analyses, provided information about how to improve service delivery, assess factors related to positive outcomes, and develop model programs. Important differences in focus group themes were found for males versus females. For example, females placed greater value on the relationship with the therapist, while males placed greater value on specific skills training. Focus groups yielded a great deal of information about services, were inexpensive, and were deemed an acceptable research tool by the adolescents themselves.     

The effects of family interventions for the patients with mental illness in health centers focusing on the relatives' own life

Recently, the burden on relatives of patients with mental illness has been recognized and the need for support to reduce such burden has increased. In Japan, family interventions have been conducted at Health Centers, most of them focusing on the family functioning as a caregiver. However, it is also important to focus on the relative's functioning to live their own life in family interventions. In this study, we executed a program focusing on relatives' life and health, and investigated the effects of this program on both family functioning. Family intervention programs were conducted at 10 Health Centers including both urban and rural areas in Japan. A total of 102 relatives responded to the self-administered questionnaire at the first and the last session of the family interventions. We measured functioning as a caregiver using the Support for the Disabled Score and Rejective Feeling Score, and functioning to live their own life by GHQ Distress in Daily life Score, Perceived Health Condition Score and Life Satisfaction Score. During interventions, GHQ score and Distress in Daily Life score which indicate the disfunction in living their own life decreased, and Support score increased in all sample. In the short-term illness group (n = 35), only the GHQ score decreased, while in long-term illness group (n = 44) Distress score decreased and Support Score increased. The intervention program focusing on relatives' life and health may improve both family functionings to give adequate care for patients, and to live their own daily life. Results suggested that the short-term illness group requires more intensive and personal advices, and the long-term illness group need continuous support focusing on the relative's own life. Expected roles of Health Centers are cooperation with family interventions provided at hospitals and coordination of the services in the community, as well as providing family interventions in terms of relatives' life.     

Relatives' opinions of IT support, perceptions of irritations and life satisfaction in dementia care

We studied relatives' opinions of IT support at a residential home for persons with dementia. We also investigated the relatives' perceptions of irritations and life satisfaction before and after increased IT support. This was accomplished using an experimental group (n = 14) and a control group (n = 8) of subjects in dementia care. The design was quasi-experimental with baseline assessments and three follow-ups. Data were collected using two questionnaires measuring opinions of the IT support: irritations in care (the Nursing Home Hassles Scale) and life satisfaction (the Life Satisfaction Questionnaire). Results showed that relatives' opinions of IT support were generally positive. In the experimental group, relatives' perceptions of practical/logistical irritations decreased between baseline and 12-month follow-up. In the control group, there was an increase in the total Nursing Home Hassles score between baseline and three-month follow-up. This difference did not persist at seven- and 12-month follow-ups. No significant differences were found for life satisfaction. We conclude that relatives had positive opinions of IT support, and their perceptions of practical/logistical irritations decreased after implementation of the IT support package.     

Perspectives of Treatment Providers and Clients with Serious Mental Illness Regarding Effective Therapeutic Relationships

This study explores the nature of clinical therapeutic relationships between mental health treatment providers and high-need clients with serious mental illness who had recently discontinued treatment. Semi-structured qualitative interviews of 56 clients with serious mental illness who had recently discontinued care and 25 mental health treatment providers were completed. Both clients with serious mental illness and treatment providers emphasized the importance of client-focused goal setting, time and availability of treatment providers, a caring approach, and trust and honesty in the relationship. However, clients with serious mental illness placed greater emphasis on goals involving tangible services, a notable area of discord between the two groups. Individuals with serious mental illness and treatment providers agreed regarding several key elements to a positive clinical relationship. Further attention to client goals related to tangible services may serve to improve relationships between treatment providers and high-need clients with serious mental illness.     

Social Integration of People with Severe Mental Illness: Relationships Between Symptom Severity, Professional Assistance, and Natural Support

Reducing dependency on professionals and social integration has been a major goal of recovery-oriented mental health services. This cross-sectional study examined 531 male outpatients at three public mental health centers in Southern Connecticut. Hierarchical multiple regression analyses were conducted to answer: (1) Do clients who have more severe clinical problems rely more on professional support and mental health services, and rely less on natural supports? (2) Do clients who have greater natural supports rely less on professional support and mental health services? Results found clients with more severe clinical problems do not rely more on professional support and report less natural social support. Natural support was also found to be a complement, rather than a substitute for professional support. These findings suggest the social integration of male clients with severe mental illness may include being more connected to mental health providers even as they develop increasing natural supports.     

The health and wellbeing of mental health professionals

We examine dimensions of job satisfaction, occupational burnout and general health of a sample of 123 mental health care professionals (psychiatric nurses and nursing assistants, and smaller professional groups such as social workers, occupational and recreational therapists and psychologists) employed at a large Canadian psychiatric hospital. Psychiatric nursing assistants exhibit more of the consequences of job-related stress (less job satisfaction, greater occupational burnout, greater incidence of negative physical and psychological symptoms of stress) relative to the other professional groups in the sample. This may be linked with their position within the hospital organization (having less authority and professional autonomy relative to the other groups), affecting their ability to cope with job-related problems and stresses experienced by all direct care workers. We examine attitudes of mental health professionals towards organized support groups at the hospital, which could provide one forum for the open discussion (and potential resolution) of job-related stresses and problems experienced in hospital settings.     

Patient satisfaction with transgender health services

Measuring patient satisfaction (i.e., patients' subjective evaluation of health care services received) is increasingly important in assessing health care outcomes because of the current emphasis on greater partnership between providers (therapist, doctor, staff) and consumers (patients) in health care. In care of transgender persons, achieving good patient satisfaction is particularly challenging given the primary role mental health professionals play as arbiters of who has access to sex reassignment and when such candidates are ready. Dependence on a mental health professional in this "gate-keeping" role is perceived by some members of the transgender community as unnecessarily pathologizing. This study compared satisfaction ratings of 180 transgender and 837 other sexual health patients with psychotherapeutic, psychiatric, and sexual medicine services provided at a university-based sexual health clinic. Five consecutive surveys conducted during 1993-2002 showed high patient satisfaction. We found few significant differences between transgender and other sexual health patients, except that in 1995, transgender patients had higher satisfaction on their perceived ability to handle the problems that originally had led them to therapy. Survey results helped target areas in need of improvement (e.g., friendliness and courtesy of staff, handling of phone calls), and efforts by the providers to improve services resulted in significant increases in patient satisfaction. These findings put individual complaints in perspective and showed that despite the challenges inherent in providing transgender care good satisfaction can be achieved. We encourage providers to implement quality assurance and improvement procedures to give patients the opportunity to provide feedback and have a voice in shaping their own health care.     

“It's Not Like a Job Now; It's Part of Me”: Exploring African Women's Experiences in the Irish Childcare Sector

A small-scale qualitative research study was recently carried out in the West of Ireland to explore the experiences of African childminders who had established new childcare services. The intention of the study was to explore the issues, concerns and challenges of this group of providers given their unique position as recently settled, ethnic minority women in Ireland. Twelve women were interviewed as part of this study, all of whom had arrived with considerable educational and employment experiences from their home countries in West Africa. The research illustrates a number of key processes and characteristics within this sub-sector of childminding. It reveals that, in terms of pathways to work, these women had struggled to find employment in their new communities such that childcare provided a viable route that the women pursued with enthusiasm and commitment. Most had developed their services in a largely unintentional way to begin with. Having made a conscious decision to set up their services, this group appeared to demonstrate a strong determination to succeed by seeking out formal support, through advice and training, in order to enhance their services and adhere to professional regulations. They also encountered the need to proactively develop strategies that would overcome perceived barriers and broaden their appeal. While the women placed much emphasis on providing a high-quality service and adopting a professional approach, the group claimed to offer broader support and encouragement to parents in practical and emotional ways. In discussing the relationship the participants had with the families, the childminders felt that they provided a range of supportive services to the families with whom they worked. In documenting the reported experience and perspectives of these childminders, this research seeks to add to our understanding of what we conclude is a valuable yet potentially marginalised sector of childcare provision.     

“癌症”的诊断对患者及其亲属的影响调查

目的：研究“癌症”诊断对居澳华裔患者及其亲属 的影响。方法：采用定性研究策略,对象在悉尼3所主要教学医院和1个华裔肿瘤病人支持机构随机选择、并不断补充直至没有新信息出现为止,完成了4个聚焦小组和26个个别电话会谈,共调查了36位癌症患者和12位亲属。结果：结果发现“癌症”诊断对患者及其亲属的情绪、日常生活、事业、家庭与社会关系、患者的自身形象及亲属的心身健康均造成负面影响。大部分人的心理调节存在一些问题。结论：提示肿瘤医学应注重将生物－心理－社会医学模式切实应用于临床,各专业机构各社区应帮助该人群进行有效的心理调节。     

Perspectives of relatives and health care workers on care of terminally ill patients in the UK

Two parallel questionnaires were used to explore perceptions of healthcare workers (HCWs) and the relatives of terminally ill patients on the quality of care received by the patients. There was general agreement between the two groups of respondents in most of the assessed areas. The relatives, however were more satisfied with the control of pain and psychological symptoms than the HCWs, and the HCWs perceived the control of diarrhea, skin problems, and swallowing problems more positively than did the relatives. There also was some variation between the two groups in their perception of the care received by the relatives during visits at the hospital, with the relatives' group being more positive. Although HCWs reported that time to deal with patients and their families was inadequate, the relatives' group was generally satisfied with the standards in place.     

What do cancer support groups provide which other supportive relationships do not? The experience of peer support groups for people with cancer

This qualitative study examined the questions of what cancer support groups provide that other supportive relationships do not, and what the self perceived consequences are of support group attendance. Nine representative Australian cancer peer support groups, consisting of a total of 93 interviewees, 75 women, and 18 men, with a mean age of 62, took part in participant observation and focus group interviews, with the data analysed using positioning theory. Support groups were positioned by participants as providing a unique sense of community, unconditional acceptance, and information about cancer and its treatment, in contrast to the isolation, rejection, and lack of knowledge about cancer frequently experienced outside the group. Groups were also positioned as occasionally emotionally challenging, in contrast to the experience of normalising support from family and friends. Increased empowerment and agency were positioned as the most significant consequences of group support, consisting of increased confidence and a sense of control in relation to self, living with cancer, and interactions with others, in particular the medical profession. The support group was also positioned as facilitating positive relationships with family and friends because of relieving their burden of care, by providing a safe space for the expression of emotion. No difference was found between professionally led and peer led support groups, suggesting that it is not the professional background of the leader which is of importance, but whether the group provides a supportive environment, mutuality, and a sense of belonging, and whether it meets the perceived needs of those attending. It is suggested that future research should examine the construction and experience of social support in those who drop out of, or who do not attend, cancer support groups, in order to provide further insight into the contrast between social support within groups and support in other contexts.     

Caregivers of Children With Disabilities: A Comparison of Those Managing "OK" and Those Needing More Help

A survey was mailed to caregivers of children with disabilities to ascertain how they were managing caregiving. Caregivers reporting they were managing "OK" were compared to those who reported they needed more help or could not manage much longer ("not OK"). Results showed the not OK group of caregivers had children who were more severely impaired and functionally dependent. Their mothers were in poorer physical and mental health, had greater demands placed on their time and finances, and received less emotional support from friends and family. Special programs provided some assistance but not enough to meet their needs.     

The Use of Support Groups by Parents of Children with Dyslexia

This paper describes an interview-based study that identified the principal reasons for attending support groups by parents of dyslexic children. Parents could be classified on the basis of the interview responses. One group were information seekers and attended support groups for the purpose of education and research about the learning difficulties of their child. These parents' integrated advice and information obtained through the meetings into their home lives in order to offer educational and emotional support to their children. A second group of parents attended support groups on the basis of a professional recommendation only. A third group of parents attended group meetings for the purpose of emotional support. The informationseeking parents reported greater satisfaction with their experience of attending support groups compared with other parents. Recommendations for further research are made on the basis of this study.     

Are mothers a source of support for women entering fertility treatment?

The significance of the mother–daughter dyad in coping with stressful circumstances led us to examine (a) the associations between the mental health of women entering fertility treatment (n = 137; 76 aged 20–34; 61 aged 35–44) and the perceived type of support they receive from their mothers; (b) whether mental health is associated with age, and whether this association is moderated by the type of mother's support. We found that women perceiving more active engagement from their mothers reported greater well-being and less distress, whereas higher mothers' overprotection was associated with greater distress. Active engagement and protective buffering moderated the association between age and mental health.     

Effect of gender composition of school on body concerns in adolescent women.

OBJECTIVE: This study aimed to investigate the role of gender composition of school on body figure preferences, eating disorder symptomology, and role concerns. METHOD: Questionnaires were completed by 261 Australian adolescent girls in two private single-sex and two private coeducational school environments. RESULTS: There was no difference in nominated ideal figure or eating disorder scores between the schools. However, girls in the single-sex schools placed a greater emphasis on achievement than their counterparts at the coeducational schools. These role concerns had a differential impact on prediction of the ideal figure, whereby the importance placed on intelligence and professional success predicted the choice of a thinner ideal figure for the single-sex schools, but a larger ideal for the coeducational schools. DISCUSSION: It was concluded that the motivation for thinness differs between single-sex and coeducational schools.     

Can social support matter? The relationship between social support and mental health among bereaved parents in an only-child society: Evidence from China

Shidu parents (parents who lost their only child) experience poor mental health, and social support is expected to alleviate mental stress and facilitate mental adaptation of bereaved parents. However, the literatures on the effects of social support on mental health of bereaved parents have yield mixed outcomes, and the relationship between social support and mental health among Shidu parents has been unexplored in China. The purpose of this study was to examine the relationship between social support and mental health among Shidu parents in China. Multistage stratified random sampling was conducted to collect data in 2017, and a total of 1,750 Shidu parents were employed as the analytical sample. The Ordinary Least Squares Model and Instrumental Variables (IV) Method were both employed. The variable of community services for the aged provided by the market was employed as the IV of the study considering death taboo inveterately rooted in philosophies and religions in Chinese culture. The results indicated that there was a positive relationship between social support and mental health among Shidu parents, specifically, objective social support and social support utilisation were significantly related to mental health of Shidu parents, while subjective social support was not. Implications of the study include the following: First, it is crucial to help spouse and friends gain appropriate social support skills. Mutual associations can be an important source of social support. Second, objective social support should be given a top priority, and suitable amount, timing, source and structure of social support should be paid more attention to strengthen the ‘goodness of fit’ between the needs of Shidu parents and support provided. Third, some other social services such as community care, social work services and professional consulting services can be appropriate alternatives to alleviate mental stress of Shidu parents.     

The Use of Support Groups by Parents of Children with Dyslexia

This paper describes an interview-based study that identified the principal reasons for attending support groups by parents of dyslexic children. Parents could be classified on the basis of the interview responses. One group were information seekers and attended support groups for the purpose of education and research about the learning difficulties of their child. These parents' integrated advice and information obtained through the meetings into their home lives in order to offer educational and emotional support to their children. A second group of parents attended support groups on the basis of a professional recommendation only. A third group of parents attended group meetings for the purpose of emotional support. The informationseeking parents reported greater satisfaction with their experience of attending support groups compared with other parents. Recommendations for further research are made on the basis of this study.     

An experimental study of the influence of individual participant characteristics on formal consensus development

OBJECTIVES: The aim of this study was to examine the influence of participants' characteristics on the results produced by formal consensus methods. METHODS: The approach was an experimental study of 346 participants in 20 groups rating the appropriateness of four mental health interventions for the treatment of chronic fatigue syndrome, irritable bowel syndrome, and chronic back pain. There were four factors in the design: systematic literature review provided or not, decisions made under realistic or "ideal" resource assumptions, clinically mixed (general practitioners and mental health professionals) or homogenous group (general practitioners only), convened or mail-only group. A group's rating was defined as the median of participants' ratings. The influence of participants' characteristics (age, sex, and specialty) was examined using multilevel models. RESULTS: The largest differences were between the GPs and mental health professionals, both in their initial ratings of the different interventions, and in how much they altered their ratings between rounds. There were smaller but statistically significant (p<.05) differences between specialty and age groups in initial ratings for the treatment (by whatever means) of different conditions, and for certain conditions women increased their ratings more than men. Women rated intervention more favorably when assuming "ideal" rather than realistic levels of resources, but men did not. CONCLUSIONS: Our findings support the practice of treating professional specialty as an important determinant of the results in consensus panels.