Religious diversity and social policy: an Australian dilemma

The increase in religious diversity produced by the global movement of people and cultures and the proliferation of internal difference within religious communities raises social policy issues. Consideration of these issues is facilitated by understanding that religious groups intersect with social policy in four basic ways: as objects, sources, critics and implementers of policy. A major issue is the challenge societies face in respecting freedoms of religion and belief on the one hand and providing services to all citizens on the other. Resolving these issues requires an awareness of the religious profile of a society and sensitivity to its religious diversity and to the ways services are delivered. Research into the current status of freedom of religion and belief in Australia is used as a case study to identify issues and potential ways to address them. This research reveals that there is a lack of mechanisms for considering and resolving these issues.     

A case study in identifying targeted patients population in major depressive disorder by enhanced enrichment design

Despite advances in clinical trial design, failure rates near 80% in phase 2 and 50% in phase 3 have recently been reported. The challenges to successful drug development are particularly acute in central nervous system trials such as for pain, schizophrenia, mania, and depression because high‐placebo response rates lessen assay sensitivity, diminish estimated treatment effect sizes, and thereby decrease statistical power. This paper addresses the importance of rigorous patient selection in major depressive disorder trials through an enhanced enrichment paradigm. This approach led to a redefinition of an ongoing, blinded phase 3 trial algorithm for patient inclusion (1) to eliminate further randomization of transient placebo responders and (2) to exclude previously randomized transient responders from the primary analysis of the double blind phase of the trial. It is illustrated for a case study for the comparison between brexpiprazole + antidepressant therapy and placebo + antidepressant therapy. Analysis of the primary endpoint showed that efficacy of brexpiprazole versus placebo could not be established statistically if the original algorithm for identification of placebo responders was used, but the enhanced enrichment approach did statistically demonstrate efficacy. Additionally, the enhanced enrichment approach identified a target population with a clinically meaningful treatment effect. Through its successful identification of a target population, the innovative enhanced enrichment approach enabled the demonstration of a positive treatment effect in a very challenging area of depression research.     

Improving the Mental Health Outcomes of LGBTQ Youth and Young Adults: A Longitudinal Study

ABSTRACT

The purpose of this groundbreaking study was to evaluate outcomes of 482 LGBTQ (lesbian, gay, bisexual, transgender, or questioning) youth and young adults who received services and supports through the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances Program (CMHI). This study was a secondary data analysis using data from a larger study of 3208 LGBTQ and non-LGBTQ youth ages 11 through 21 who had a serious emotional disturbance (SED). This study is significant in that it evaluates functional outcomes for young people identified as LGBTQ based on a specialized service framework (i.e., system of care approach). In essence, do LGBTQ youth with SED benefit from a specific approach to intervention? In addition, a comparison at intake on suicidality, bullying and victimization was conducted between the LGBTQ and non-LGBTQ identifying youth from the larger sample. The youth and a caregiver were interviewed face-to-face separately at intake, 6-months, and 12-months. Significant improvements were found across all of the dependent variables, supporting the viability of SOC for improving outcomes for LGBTQ youth. Future research should continue to build on this study by adding to the design a control group to improve internal validity of the findings.     

Imagined past,present and futures in Murray–Darling Basin communities

Over the past three decades, irrigation-dependent rural communities in Australia's Murray–Darling Basin have experienced profound economic, social and environmental changes, which they are attempting to accommodate through local government policy. As a contribution to participatory policy design research, in consultation with local governments we carried out focus groups to explore diversity of individuals’ imagined past and present in two rural communities. This was followed by group development of a diverse range of future scenarios and agreement to three likely scenarios. The research identified presence or absence of three underlying themes – irrigation, innovation and inflow of people – that plausibly drive change in these rural communities. These themes are likely to be common to many rural communities that have depended on irrigated agriculture. They provide an example of participatory policy-making, as distinct from the historically employed top-down policy development that has occurred in the Murray–Darling Basin. Because of the diversity of perceptions of past, present and futures, and the ultimate adoption of business-as-usual within the final local government plans, the research emphasises the need to put effort into community deliberations to build cohesion and share ownership of the process for delivering locally nuanced community policy.     

Dual-earner parents’ work-family time: the effects of atypical work patterns and non-parental childcare

Finding time to both earn money and raise children is demanding. Within the constraints and opportunities of their employment and social policies affecting work and family, parents seeking to manage their time may use a number of strategies. For example, they can outsource childcare or adopt atypical work patterns: non-standard work schedules, self employment, working from home. In this paper we compare the effects of these measures on the household time use and gender division of labour of dual-earner couples with children, using data from the Australian Bureau of Statistics Time Use Survey, 2006 (n?=?772 couples). We find that these strategies do help households manage their work and family time. However, this is almost exclusively a result of women changing their time use. Such measures generally enable mothers, not fathers, to adjust paid work around family commitments, and offer little amelioration of gendered divisions of labour. This reinforces normative gender-role expectations and is probably a result of institutional constraints, including sparse social policy and workplace support for mothers?? full-time employment and for fathers?? involvement in childcare.     

Gender,Culture and Intervention: Exploring Differences between Aboriginal and Non‐Aboriginal Children’s Responses to an Early Intervention Programme

Evaluation of a group parenting programme in the Northern Territory of Australia showed significant differences in benefits for Aboriginal and non‐Aboriginal boys and girls. The analysis considers whether boys and girls from different cultural backgrounds present with different problems; whether parental expectations for boys and girls differ and whether the intervention activates different responses in different settings. Conclusions suggest that there is a need to closely examine the ‘cultural logic’ of interventions, the appropriateness of their assumptions about child development and hypothesised mechanisms of change in different settings.     

Physiological Regulation at 9 Months of Age in Infants Prenatally Exposed to Cigarettes

The primary purpose of this study was to examine the association between prenatal cigarette exposure and physiological regulation at 9 months of age. Specifically, we explored the possibility that any association between prenatal cigarette exposure and infant physiological regulation was moderated by postnatal environmental tobacco smoke (ETS) exposure or infant gender. We evaluated whether male infants with prenatal cigarette exposure or infants who were also exposed to ETS after birth had the highest levels of physiological dysregulation. Respiratory sinus arrhythmia (RSA) was obtained from 206 (142 exposed and 64 nonexposed) infants during a baseline period and during procedures designed to elicit both positive and negative affect. There was a significant suppression of RSA during the negative affect task for nonexposed infants, but not for exposed infants. Postnatal ETS exposure did not moderate this association; however, gender did moderate this association such that boys with prenatal cigarette exposure had a significant increase in RSA rather than the suppression seen among both nonexposed boys and girls. These results provide additional support for the idea that boys are particularly vulnerable to the effects of prenatal cigarette exposure.     

The Emerging Problems of Alcohol and Substance Abuse in Late Life

Treatment of substance abuse among older adults will become increasingly important as the number of aged Americans increases. The abuse of psychoactive substances is a major contributor to excess morbidity, mortality, and homelessness among persons of all ages and socioeconomic strata regardless of race or ethnicity. Alcohol and tobacco accountfor the majority of substance abuse-related death and disability in the United States; the former through cerebrovascular and hepatic disease, accidents and violence, the latter through chronic pulmonary disease and malignancy. Patterns of substance abuse in late life are substantially different from those observed among younger adults. However, treatment may be less challenging. Effective diagnosis and treatment requires a nonpunitive, supportive, but persistent approach. This means the capacity to collect a substance intake history and the ability to formulate a treatment plan or referral strategy to an addiction specialist or residential treatment setting. It is also important for the practitioner to manage negative feelings toward patients who decline treatment or who are chronic abusers.