‘Somebody Else's Roadmap’: Lived Experience of Maudsley and Family‐based Therapy for Adolescent Anorexia Nervosa

The Maudsley and more recent family‐based therapy manualised approaches are positioned by some as the gold standard, evidence‐based therapy for adolescent anorexia nervosa (AN). However, a significant proportion of adolescents and their families either discontinue this therapy and/or find that it simply does not work for them. These adolescents and families are under‐represented in the literature on therapeutic interventions for adolescent AN. This paper begins to address this gap with an in‐depth qualitative case study that explores the lived experience of Maudsley family therapy (MFT)/family‐based therapy (FBT) for one female adolescent (age 14 years) and her family over the period of 3 years (ages 11–14). Although initially handing over the responsibility for her eating was comforting and reinstated a sense of control in the family system, these experiences were not maintained. When she did not progress past the first phase of FBT, she and her family experienced the approach as blaming. She felt silenced and family alliances were weakened. This paper analyses how the family members negotiated and preserved their identities within this disabling context.     

Traumatic brain injury and suicide

A number of psychiatric and neurological problems may occur following traumatic brain injury (TBI). Anxiety and depression are common. There is evidence that there may be a correlation between TBI and increased risk of suicide. This article will explore current literature on the risk of suicidal behavior in people who have experienced TBI. Risk factors for suicide, recognition and assessment of suicidal behavior, and treatment issues will be discussed.     

Challenges to care coordination posed by the use of multiple health IT applications

Coordinating care for hospitalized patients requires the use of multiple sources of information. Using a macroergonomic framework (i.e. the work system model), we conducted interviews and observations of care managers involved in care coordination across transitions of care. When information is distributed across multiple health IT applications, care managers experience a range of challenges, including organizational barriers, technology design problems, skills and knowledge issues, and task performance demands (i.e. issues related to individual information processing and management and sharing of information). These challenges can be used as a checklist to evaluate the proposed IT infrastructure that will allow the integration of multiple health IT applications and, therefore, support coordination across transitions of care.     

Understanding the roles of subjective and objective aspects of time in the work-family interface

The experience of time has been posited as an important predictor of work-family conflict; however, few studies have considered subjective and objective aspects of time conjointly. This study examined the reported number of hours dedicated to work and family as indices of objective aspects of time, and perceived time pressure (in the work and family domains respectively) as an important feature of the subjective nature of temporal experiences within the work-family interface. Results indicate that the stress of having insufficient time to fulfill commitments in one domain (i.e., perceived time pressure) predicts work-family conflict, and that perceived time pressures predict the amount of time allocated to a domain. Additionally, findings suggest that domain boundaries are not symmetrical, with work boundaries being more rigidly constructed than family boundaries. Work-to-family and family-to-work conflict were generally related to overall health, turnover intentions, and work performance, as expected.     

A survey of disabled children and young people’s views about their quality of life

This study aimed to explore disabled children and young people’s perspectives about their quality of life, in terms of physical, mental and social well-being. Ninety-one disabled children, recruited through voluntary organisations in Scotland, completed KIDSCREEN-27, a validated measure of health-related quality of life for children. Findings were compared with those from a European study of predominantly non-disabled children. The children gave largely positive reports about school, family relationships and their physical health. However, one in three reported often feeling ‘sad’ and many were excluded from social activities with their peers. Expectations of achieving academic qualifications, and moving into further or higher education, were generally low. The children’s perceived quality of life was lower than their European counterparts, less so in relation to school but particularly for friendships and peer support. The findings are discussed in the light of the social relational understanding of disability. Policy and practice implications are identified.     

The relationships among the big 5 personality factors and negative career thoughts

College students may present with career concerns that are interrelated with personality and psychological factors. Various authors have highlighted the need for career practitioners to take a holistic approach with clients seeking assistance. This research examined the intersection of personal and career characteristics, specifically personality and negative career thoughts. A total of 128 undergraduate students in five career course sections completed the NEO-Five Factor Inventory and the Career Thoughts Inventory. A hierarchical multiple regression showed that 27.1% of the variability in negative career thoughts was explained by the combined effect of Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness. Personality factors had significant moderate correlations with specific aspects of negative thinking, including Decision-Making Confusion (DMC) and Neuroticism and Conscientiousness. Commitment Anxiety (CA) was significantly correlated with Neuroticism and Conscientiousness. We discuss how the findings highlight the intersection of career and personality factors, and the implications for theory, practice, and future research     

Structured risk assessment procedures: instruments of abuse?

Child protection services in Australia and elsewhere face increasing internal and external demands. As a response to these pressures, in part at least, services are increasingly implementing some form of risk assessment procedures. This article examines the practice implications of the increasing use of risk assessment instruments in child protection services. It highlights the complexity of the concept of risk as the basis for a future‐oriented assessment activity. The authors suggest that this change of time frame (from what has happened to what might happen) may be detrimental to children. Through a critical review of the literature, the authors question whether risk prediction is possible and discuss the limitations of risk assessment instruments which omit some risk factors and may ignore the perspective of the child. The authors challenge the validity of risk assessment instruments in statutory settings and suggest that the protection of the organization may be a major objective in their implementation. Copyright © 1999 John Wiley & Sons, Ltd.     

Family and country: accounting for fractured connections under colonisation in Victoria,Australia

The Koori Health Research Database (KHRD) began in 2000, as a partnership between the Bunjilaka Aboriginal Cultural Centre at Museum Victoria and the Onemda Koori Health Unit at the University of Melbourne. Its purpose is to reconstitute the Aboriginal population of Victoria under colonisation, using family histories, genealogies, civil registrations, and other historical records of the colonising state. The KHRD is unique internationally as a cradle-to-grave dataset documenting from the mid-nineteenth century the demography and health of an indigenous people under colonisation. This paper discusses the historical context of the database, our changing understanding based on recent enhancement of the data and new research by other scholars, and the light it sheds on the official strategies of alienation from country and family and their demographic consequences. It demonstrates the paradox, that while concentration of the remnant Aboriginal people into government reserves was destructive to their health and wellbeing, it enabled those Victorian Aboriginal people to preserve the knowledge of their lineages, languages and culture.     

Changes in the health status of newly housed chronically homeless: the Alaska Housing First program evaluation

The Housing First (HF) model is an evidence-based supportive housing initiative that provides permanent housing for the homeless without preconditions such as sobriety or treatment compliance. This three-year longitudinal study investigated the effects of Alaska's inaugural Housing First projects in Anchorage and Fairbanks on local service usage, costs and tenant quality of life (QoL). A total of 94 tenants participated at baseline in the QoL study and 68 continued to follow-up. Cost data was collected from local municipalities, Alaska Department of Corrections, and local hospitals, health care clinics, behavioral health providers, and detox facilities. Emergency services use by tenants decreased from the year before moving into Housing First to the year after. Changes in health care costs were more variable depending on site and type of service.