Usual care for trauma-exposed youth: Are clinician-reported therapy techniques evidence-based?

The current study examined the extent to which usual care interventions targeting childhood traumatic stress involved the application of practice elements (Chorpita, Daleiden, & Weisz, 2005) represented among the evidenced-based treatments (EBTs) for trauma. Youth age and the presence of conduct problems at intake were examined as potential predictors of differences in the presence of elements from EBTs. Data were obtained from archival records from 814 youth who received services from a large, community-based mental health system. Results showed that usual care clinicians reported a variety of practices, only some of which were common to the evidence base for traumatic stress. ‘Exposure’ stood out as the most common practice element among EBTs for treating traumatic stress, but it was reported in fewer than a quarter of usual care cases. For youth receiving out-of-home services, a diagnosis of PTSD predicted that fewer practice elements from EBTs for trauma were reported. Also, as youth age increased, clinicians reported using more practice elements from the evidence base. These findings point to possible opportunities for service improvement in usual care settings for trauma-exposed youth and at the same time call into question whether aspects of the context or population warrant increased use of techniques not associated with EBTs for traumatic stress (cf. Brookman-Frazee, Haine, Baker-Ericzén, Zoffness, & Garland, 2010; Southam-Gerow, Chorpita, Miller, & Gleacher, 2008).     

The “White Card” is grey: Survelliance,endurance and the Cashless Debit Card

Introduced in 2016, the Cashless Debit Card (CDC) is part of a welfare policy trial designed to restrict and direct the expenditure of Aboriginal people receiving a range of government benefits. In this article, I explain that the CDC, also referred to as the “White Card,” appeases the concerns of non-Aboriginal residents and broader Australia and that government is attempting to ameliorate Aboriginal dysfunction. I offer an account of income management in daily life from the perspective of those living with the Card in the East Kimberley town of Wyndham. I describe it as interconnected to a broader range of suite of government policies and enmeshed in broader social and political relations. Focused on participant observation and interviews undertaken with Wyndham residents in the period immediately after the introduction of the Card, this perspective is informed by longer-term research in the region since 2013. I show that the Card acts as a quotidian form of disciplining surveillance against Aboriginal people. It is also a site of reinterpretation and rearticulation through the development of subversive practices by Aboriginal people, what I describe as the labour of endurance: Card holders are trying to endure its effects and manage its invasiveness into their lives.