Identifying Therapeutic Action in an Attachment-Centered Intervention with High Risk Families

This paper describes an attachment-based intervention for mothers known to Child Welfare Services where past and current trauma complicates family preservation and promotion of child well being. The first part of the paper describes the innovative Attachment-Centered Parent–Child Therapy service that has been delivered to high-risk families with children from 0 to 3 years of age. The intervention uses a group format that has the added benefits of enhancing social support and being highly cost effective. The intervention also integrates video filming both in terms of capturing essential features of the group intervention for review and supervision of clinical staff, and is fundamental in the observation-based empirical assessments. Quantitative data from an initial pilot study supporting the efficacy of the intervention is presented. As well, qualitative data is presented including a case study that highlights therapeutic action shown to positively impact the quality of the mother–child relationship.     

Austerity and the lives of people with learning disabilities. A thematic synthesis of current literature

Abstract

The Financial Crisis of 2008 resulted in many western economies implementing cuts in health and social care. This systematic review provides a holistic picture of the impact of austerity policy on the lives of people with learning disabilities (LD) and the collateral effects on the people who support them. Our review suggests that in the current climate of economic austerity, available funding to support people with LD is no longer aligned to their care needs. Cuts in disability services have adversely affected the well-being both of people with LD and their informal carers. Individuals with LD have lost social support and are experiencing increased social isolation. Heightened demands on family carers’ time have negatively influenced their wider roles, including parental functioning, and labour market participation. Our review provides the foundations for further discourse and research on the effects of austerity on people with LD and their family carers.     

Review and appraisal of guidelines for the management of asthma during pregnancy

Background

Asthma affects 12.7% of pregnancies in Australia. Poorly controlled asthma is associated with increased maternal and infant morbidity and mortality. Optimal antenatal management of asthma during pregnancy has the potential to reduce complications relating to asthma. Evidence-based clinical practice guidelines help to translate health research findings into practice and when implemented can improve health outcomes. National and International guidelines currently provide recommendations for optimal asthma care in pregnancy.

Client Perceptions of Professional Helpers

A questionnaire was administered to 77 employees of a large commercial organization and 61 paramedical workers to ascertain which of a number of professionals were likely to be approached for help with particular types of problems. The findings for this study indicated that for both groups social workers were the most preferred professionals by most subjects for most problems, although there were important and interesting preferences for other professionals also.     

Marginal regression models with a time to event outcome and discrete multiple source predictors

Information from multiple informants is frequently used to assess psychopathology. We consider marginal regression models with multiple informants as discrete predictors and a time to event outcome. We fit these models to data from the Stirling County Study; specifically, the models predict mortality from self report of psychiatric disorders and also predict mortality from physician report of psychiatric disorders. Previously, Horton et al. found little relationship between self and physician reports of psychopathology, but that the relationship of self report of psychopathology with mortality was similar to that of physician report of psychopathology with mortality. Generalized estimating equations (GEE) have been used to fit marginal models with multiple informant covariates; here we develop a maximum likelihood (ML) approach and show how it relates to the GEE approach. In a simple setting using a saturated model, the ML approach can be constructed to provide estimates that match those found using GEE. We extend the ML technique to consider multiple informant predictors with missingness and compare the method to using inverse probability weighted (IPW) GEE. Our simulation study illustrates that IPW GEE loses little efficiency compared with ML in the presence of monotone missingness. Our example data has non-monotone missingness; in this case, ML offers a modest decrease in variance compared with IPW GEE, particularly for estimating covariates in the marginal models. In more general settings, e.g., categorical predictors and piecewise exponential models, the likelihood parameters from the ML technique do not have the same interpretation as the GEE. Thus, the GEE is recommended to fit marginal models for its flexibility, ease of interpretation and comparable efficiency to ML in the presence of missing data.     

Starting to drink: the experiences of Australian lower secondary students with alcohol

This study describes Australian year eight students' (13-14 years old) experiences with alcohol in terms of communication with parents, initiation into drinking, patterns of consumption, context of use, and harms experienced. The sample comprised 521 year eight students from four state government secondary schools in the state of Victoria. Three of the schools are in Melbourne, the capital of Victoria; the fourth is in a rural center. Female and rural students were more likely to talk to parents about alcohol, but this was not associated with safer drinking. Initiation into drinking was higher among rural students. Rural students also drank more, were more likely to drink without adult supervision, to drink to get drunk, and drink more than planned. Student drinkers experienced just over four alcohol-related harms on average in 12 months, with some indication of greater harm among rural students. Higher levels of drinking by rural students, accompanied by more risky patterns of consumption and the possibility of greater harm, supports prioritizing interventions in rural schools.     

A photovoice study of older adults' conceptualizations of risk

Risk is a multifaceted and complex concept that mediates quality of life through the balance between risk taking and risk avoidance. Society expects older adults to identify and manage their personal risks yet little is known about the meaning of risk in their daily lives and how they balance the tensions between taking and avoiding risks. Therefore the purpose of this study was to explore how older adults construe risk. A qualitative exploratory study that incorporated photovoice methodology was used. Seventeen older adults, over a weeklong period, took pictures and kept a log of the places, spaces, events, activities, or situations that best represented risk. Subsequently, they participated in a follow-up individual interview. Older adults viewed risk both positively and negatively, judging the saliency of a risk according to criteria that related both to the risk itself and to personal characteristics. Although risk was avoided in specific situations, risk taking was participants' primary approach to risk, which assumed three forms: adaptive, opportunistic, and/or unjustifiable. Contrary to societal views, older adults view risk as constructive and personally relevant, and as something to be taken and need to be supported in risk taking rather than risk avoidance.