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.     

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.     

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.     

Assertive Community Treatment as Community Change Intervention

Individuals with severe mental illnesses (SMI) are a vulnerable population, struggling to cope with fragmented and often unwelcoming community service systems. Research has examined Assertive Community Treatment (ACT) as an intervention for SMI individuals, but little research has explored ACT's potential as a community system change intervention. Using focus groups with ACT teams, we explored changes in community service systems as a result of ACT teams' presence. Changes identified included increased understanding of SMI; increased access to services; and increased collaboration across service systems. Processes by which these changes occurred included knowledge communication, negotiation, renaming by association, and ongoing relationships.     

A big hole with the wind blowing through it: Aboriginal women's experiences of trauma and problem gambling

Although studies have shown a link between social trauma and problem gambling (PG), there is little research involving Aboriginal women in this area, despite Aboriginal women being potentially at higher risk for both social trauma and problem gambling. This article describes the results of a qualitative phenomenology study asking seven Aboriginal women living in Western Canada to describe their experiences of social trauma and gambling problems. Results suggest four main themes, describing: (1) the Aboriginal women's experiences of social trauma (‘the three tigers’); (2) their use of gambling to cope with these experiences (‘a big hole with the wind blowing through it’); (3) their experience of problem gambling (‘I'm somebody today’); and (4) their process of healing from social trauma and gambling problems (‘a letter to John’). Participants described what they felt was a clear link between social trauma and problems with gambling, and how gambling helped to change their mood and block out the past. The results raise the possibility that Aboriginal women with gambling problems may need support to heal from social trauma – including racism and colonization – and that upstream initiatives to reduce the incidence of social traumas may be an important response to problem gambling among Aboriginal women.     

Shifting Loyalties: Support for a Global State and Nationalism

It has been suggested that the increasing power and prominence of global organizations may be undermining the nation state as an organizational form. In an attempt to understand how these dynamics may play out at the individual level a sample of US social movement actors were surveyed to measure support for nationalism and support for the creation of a global state. Support for a global state is hypothesized to be negatively associated with support for national governments. Multivariate binary and ordinal logistic regressions show a number of demographic and attitudinal variables are positively associated with nationalism and, generally, are negatively associated with support for a global state.

Se ha sugerido que el creciente poder y la importancia de las organizaciones globales pueden estar debilitando la nación estado como una forma organizacional. En un intento para entender la manera como estas dinámicas pueden interpretarse a un nivel individual, se realizó una encuesta a una muestra de actores del movimiento social estadounidense para medir el respaldo al nacionalismo y el apoyo a la creación de un estado global. El respaldo a un estado global de estar asociado negativamente con el apoyo a los gobiernos nacionales, es una hipótesis. Las regresiones logísticas ordinales, binares y multivariantes, que muestran un número de variables demográficas y de actitud, están asociadas positivamente con el nacionalismo y generalmente asociadas negativamente con el respaldo a un estado global.

有观点认为,全球性组织日益增长的权力和声望可能正在动摇作为一种组织形式的民族国家的地位。为求了解这种动势如何在个人层面上演变,本文选取了美国社会运动参与者作为样本进行调查,测量其对国家主义的支持程度和对建立全球性国家的支持程度。本文的假设是,对全球性国家的支持与对各国政府的支持负相关。多元二进制逻辑回归分析和有序逻辑回归分析结果显示,若干人口和态度变量与支持国家主义正相关,与支持全球性国家负相关。

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Sexual Rehabilitation After Prostate Cancer Through Assistive Aids: A Comparison of Gay/Bisexual and Heterosexual Men

The use of assistive aids in sexual rehabilitation after prostate cancer (PCa) was examined in 124 gay, bisexual, and other men who have sex with men (GBM) and 225 heterosexual men. GBM were significantly more likely to use assistive aids (79% versus 56%), to try multiple assistive aids (M = 1.65 versus M = 0.83) including medication, penile injection, penile implant, vacuum pump, and nonmedical sex aids, and to seek information about sexual rehabilitation on the Internet, through counseling, or in a support group. There were no differences between the groups in satisfaction with the use of assistive aids. However, use of aids was a significant negative predictor of sexual functioning for GBM and a significant positive predictor for heterosexual men. Interview accounts described satisfaction with assistive aids in terms of maintaining erectile functioning and relationships. The majority of men in the study also described hindrances, both physical and social, resulting in discontinuation of assistive aids, including perceived artificiality, loss of sexual spontaneity, side effects, failure to achieve erectile response, cost, and lack of access to information and support. It is concluded that the specific needs and concerns of GBM and heterosexual men regarding sexual rehabilitation after PCa need to be addressed by clinicians.