The development and evaluation of a culturally affirmative counselling model for deaf clients in Australia

In Australia, there is only one, newly established, dedicated mental health service catering specifically for the signing *Deaf community. It is staffed by four part-time hearing professionals and based in Brisbane. There are currently no Deaf psychologists or psychiatrists and there is no valid or reliable empirical evidence on outcomes for Deaf people accessing specialised or mainstream mental health services. Further compounding these issues, is the fact that there are no sign language versions of the most common standardised mental health or psychological instruments available to clinicians in Australia. Contemporary counselling literature is acknowledging the role of the therapeutic alliance and the impact of 'common factors' on therapeutic outcomes. However, these issues are complicated by the relationship between the Deaf client and the hearing therapist being a cross-cultural exchange. The disability model of deafness is contentious and few professionals in Australia have the requisite knowledge and understanding of deafness from a cultural perspective to attend to the therapeutic relationship with this in mind. Consequently, Deaf people are severely disadvantaged by the current lack of services, resources and skilled professionals in the field of deafness and psychology in this country. The primary aim of the following program of research has been to propose a model for culturally affirmative service delivery and to provide clinicians with tools to evaluate the effect of their therapeutic work with Deaf people seeking mental health treatment. The research document is presented as a thesis by publication and comprises four specific objectives formulated in response to the lack of existing services and resources. The first objective was to explore the use of social constructionist counselling techniques and a reflecting team with Deaf clients, hearing therapists and an interpreter. Following the establishment of a pilot counselling clinic, indepth semi-structured interviews were conducted with two long-term clients following the one year pilot of this service. These interviews generated recommendations for the development of a new 'enriched' model of counselling to be implemented and evaluated in later stages of the research program. The second objective was to identify appropriate psychometric measures that could be translated into Australian Sign Language (Auslan) for research into efficacy, effectiveness and counselling outcomes. Two instruments were identified as potentially suitable; the Outcome Rating Scale (ORS), a measure of global functioning, and the Session Rating Scale (SRS), a measure of therapeutic alliance. A specialised team of bi-lingual and bi-cultural interpreters, native signers and the primary researcher for this thesis, produced the ORS-Auslan and the SRS-Auslan in DVD format, using the translation and back-translation process. The third objective was to establish the validity and reliability of these new Auslan measures based on normative data from the Deaf community. Data from the ORS-Auslan was collected from one clinical and one non-clinical sample of Deaf people. Statistical analyses revealed that the ORS-Auslan is reliable, valid and adequately distinguishes between clinical and non-clinical presentations. Furthermore, construct validity has been established using a yet to be validated sign language version of the Depression, Anxiety and Stress Scale-21 items (DASS-21), providing a platform for further research using the DASS-21 with Deaf people. The fourth objective was to evaluate counselling outcomes following the implementation of an enriched counselling service, based on the findings generated by the first objective, and using the newly translated Auslan measures. A second university counselling clinic was established and implemented over the course of one year. Practice-based evidence guided the research and the ORS-Auslan and the SRS-Auslan were administered at every session and provided outcome data on Deaf clients' global functioning. Data from six clients over the course of ten months indicated that this culturally affirmative model was an effective approach for these six clients. This is the first time that outcome data have been collected in Australia using valid and reliable Auslan measures to establish preliminary evidence for the effectiveness of any therapeutic intervention for clinical work with adult, signing Deaf clients. The research generated by this thesis contributes theoretical knowledge, professional development and practical resources that can be used by a variety of mental health clinicians in the context of mental health service delivery to Deaf clients in Australia.

Address terms in turn beginnings: Managing disalignment and disaffiliation in telephone counselling

This paper examines use of address terms by counsellors on a telephone counselling service for children and young people. Drawing on conversation analytic findings and methods, we show how personal names are used in the management of structural and interpersonal aspects of counselling interaction. Focusing on address terms in turn-beginnings - where a name is used as, or as part of, a preface - the analysis shows that address terms are used in turns that are not fitted with prior talk in terms of either the activity or affective stance of the client. We discuss two environments in which this practice is observed: in beginning turns that initiate a new action sequence, and in turns that challenge the client’s position. Our focus is on the use of client names in the context of producing disaligning or disaffiliative actions. In disaligned actions, counsellors produced sequentially disjunctive turns that regularly involved a return to a counselling agenda. In disaffiliative actions counsellors presented a stance that did not fit with the affective stance of the client in the prior turn, for instance, in disagreeing with or complimenting the client. The paper discusses how such turns invoke a counselling agenda and how name use is used in the management of rapport and trust in counselling interaction.

The relationship between abdominal obesity and depression in the general population : a systematic review and meta-analysis

Obesity has been widely regarded as a public health concern because of its adverse impact on individuals’ health. Systematic reviews have been published in examining the effect of obesity on depression, but with major emphasis on general obesity as measured by the body mass index. Despite a stronger effect of abdominal obesity on individuals’ physical health outcomes, to our best knowledge, no systematic review was undertaken with regard to the relationship between abdominal obesity and depression. This paper reports the results of a systematic review and meta-analysis of cross-sectional studies examining the relationship between abdominal obesity and depression in a general population. Multiple electronic databases were searched until the end of September 2009. 15 articles were systematically reviewed and meta-analyzed. The analysis showed that the odds ratio of having depression for individuals with abdominal obesity was 1.38 (95% CI, 1.22–1.57) as compared to those who are not obese. Furthermore, it was found that this relationship did not vary with potential confounders including gender, age, measurement of depression and abdominal obesity, and study quality.

The role of anxiety and perspective-taking strategy on affective empathic responses

Empathy is an important pro-social behaviour critical to a positive clientetherapist relationship. Therapist anxiety has been linked to reduced ability to empathise and lower client satisfaction with therapy. However, the nature of the relationship between anxiety and empathy is currently unclear. The current study investigated the effect of experimentally-induced anxiety on empathic responses elicited during three different perspective-taking tasks. Perspective-taking was manipulated within-subjects with all participants (N¼ 52) completing imagine-self, imagine-other and objective conditions. A threat of shock manipulation was used to vary anxiety between-subjects. Participants in the threat of shock condition reported higher levels of anxiety during the experiment and lower levels of empathyrelated distress for the targets than participants in the control condition. Perspective-taking was associated with higher levels of empathy-related distress and concern compared to the objective condition. The present results suggest that perspective-taking can to a large extent mitigate the influence of heightened anxiety on an individual’s ability to empathise.

The relationship between self-reported animal fear and ERP modulation : Evidence for enhanced processing and fear of harmless invertebrates in snake- and spider-fearful individuals

The present study used ERPs to compare processing of fear-relevant (FR) animals (snakes and spiders) and non-fear-relevant (NFR) animals similar in appearance (worms and beetles). EEG was recorded from 18 undergraduate participants (10 females) as they completed two animal-viewing tasks that required simple categorization decisions. Participants were divided on a post hoc basis into low snake/spider fear and high snake/spider fear groups. Overall, FR animals were rated higher on fear and elicited a larger LPC. However, individual differences qualified these effects. Participants in the low fear group showed clear differentiation between FR and NFR animals on subjective ratings of fear and LPC modulation. In contrast, participants in the high fear group did not show such differentiation between FR and NFR animals. These findings suggest that the salience of feared-FR animals may generalize on both a behavioural and electro-cortical level to other animals of similar appearance but of a non-harmful nature.

Online counselling for enhancing relationships

Most young people are students attending school where their peer relationships impact on their educational outcomes. At the end of the first decade of the twenty-first century, young people also depend on the communication technologies to assist them with their developing relationships. Increasingly this connectedness to the peer group is being carried out both in the physical and virtual worlds as evidenced by the rapid increase in the membership of social network internet sites. However, schools seem reluctant to implement educational processes that utilize the social networking sites that young people inhabit. In fact, schools seem to be only emphasizing the dangers of enhancing peer relationships do not seem to be acknowledged. Online school counselling could be one way for schools to promote the positive uses of technology to contribute to young people's education and to enhance their social relationships and connectedness.

Dietetic confidence working with clients with depression/anxiety is associated with client-focused practice and advocacy skills

Confidence in a professional role is a key element in the successful transition to competent practice. New graduate dietitians report that whilst they are confident about their general dietetic ability, they are not as confident when working with clients experiencing depression or anxiety. This study aimed to develop and validate a scale which measured confidence about working with clients with depression/anxiety. The 21-item Dietetic Collaborative Practice Scale was developed using research about dietetic practice in mental health (Dowding et al., 2011), coping self-efficacy literature (Chesney et al., 2006) and collaboration with industry experts. A convenience sample of 189 Australian dietitians completed the questionnaire. Exploratory factor analysis suggests that dietetic confidence is best represented by a two-dimensional solution consisting of (a) Client-focused practice (CFP, 50.8% variance); and (b) Advocacy for self and client care (ASC, 9.7% variance). The alpha coefficient of both dimensions (CFP α=.95, ASC α=.84) demonstrates the internal consistency of components. Combined, these two components account for 60.5% of variance. The scale components were not related to years of practice or working with mental health clients but were significantly related to overall dietetic confidence (ODC). Correlation coefficients between ODC and CFP were .501 (p<.01), ODC and ASC were correlated at .465 (p<.01) and CFP and number of years as a dietitian were weakly correlated at 0.24 (p<.05). Results have implications for dietetic training and professional development. Client focus and advocacy for self and client appear to be important factors in overall confidence as a dietitian.

Beef carcasses with larger eye muscle areas, lower ossification scores and improved nutrition have a lower incidence of dark cutting

This study evaluated the effect of eye muscle area (EMA), ossification, carcass weight, marbling and rib fat depth on the incidence of dark cutting (pH u > 5.7) using routinely collected Meat Standards Australia (MSA) data. Data was obtained from 204,072 carcasses at a Western Australian processor between 2002 and 2008. Binomial data of pH u compliance was analysed using a logit model in a Bayesian framework. Increasing eye muscle area from 40 to 80 cm 2, increased pH u compliance by around 14% (P < 0.001) in carcasses less than 350 kg. As carcass weight increased from 150 kg to 220 kg, compliance increased by 13% (P < 0.001) and younger cattle with lower ossification were also 7% more compliant (P < 0.001). As rib fat depth increased from 0 to 20 mm, pH u compliance increased by around 10% (P < 0.001) yet marbling had no effect on dark cutting. Increasing musculature and growth combined with good nutrition will minimise dark cutting beef in Australia.

Folate degradation due to ultraviolet radiation : possible implications for human health and nutrition

Folate is essential for human health in the prevention of megaloblastic anaemia and neural tube birth defects as well as roles in cardiovascular disease and cancer. Therefore research into environmental factors that may impact folate status, such as solar ultraviolet radiation, is of great health significance. In vitro studies have shown that ultraviolet (UV) radiation can degrade folate and folic acid in human blood and this has been confirmed in several human studies. Despite these findings, there is a dearth of epidemiological research into investigating the relationship between folate status and the links to solar UV exposure.

The provision of online counselling for young people

A substantial group of young people experience mental health problems which impact on their educational development and subsequent wellbeing. Of those who do suffer from mental health issues, a minority of these seek appropriate professional assistance. This paucity of help seeking behaviours among young people is a challenge for counsellors. Whereas adults who suffer mental health issues have increasingly turned to the internet for assistance, it is interesting that when young people whose social lives are increasingly dependent on the communication technologies, are not catered for as much as adults by online counselling. One small online counselling pilot program conducted at a Queensland secondary school for three years from 2005-2007 (Glasheen & Campbell, 2009) offered anonymous live-time counselling from the school counsellor (via a secure chat room) to students through the school’s website. Findings indicated that boys were more likely to use the service than girls. All participants transitioned to face-to-face counselling, and all reported it was beneficial. This pilot study attested to the potential of an online counselling. However, school counsellors as a professional group have been hesitant to utilise online counselling as part of their service delivery to young people in schools. This chapter concludes by identifying reasons for this reluctance and the possible initiatives to increase online support for young people in schools.

Malnutrition screening tools : comparison against two validated nutrition assessment methods in older medical inpatients

Objective Although several validated nutritional screening tools have been developed to “triage” inpatients for malnutrition diagnosis and intervention, there continues to be debate in the literature as to which tool/tools clinicians should use in practice. This study compared the accuracy of seven validated screening tools in older medical inpatients against two validated nutritional assessment methods. Methods This was a prospective cohort study of medical inpatients at least 65 y old. Malnutrition screening was conducted using seven tools recommended in evidence-based guidelines. Nutritional status was assessed by an accredited practicing dietitian using the Subjective Global Assessment (SGA) and the Mini-Nutritional Assessment (MNA). Energy intake was observed on a single day during first week of hospitalization. Results In this sample of 134 participants (80 ± 8 y old, 50% women), there was fair agreement between the SGA and MNA (κ = 0.53), with MNA identifying more “at-risk” patients and the SGA better identifying existing malnutrition. Most tools were accurate in identifying patients with malnutrition as determined by the SGA, in particular the Malnutrition Screening Tool and the Nutritional Risk Screening 2002. The MNA Short Form was most accurate at identifying nutritional risk according to the MNA. No tool accurately predicted patients with inadequate energy intake in the hospital. Conclusion Because all tools generally performed well, clinicians should consider choosing a screening tool that best aligns with their chosen nutritional assessment and is easiest to implement in practice. This study confirmed the importance of rescreening and monitoring food intake to allow the early identification and prevention of nutritional decline in patients with a poor intake during hospitalization.