The role of assisted self-help in services for alcohol-related disorders

Potentially harmful substance use is common, but many affected people do not receive treatment. Brief face-to-face treatments show impact, as do strategies to assist self-help remotely, by using bibliotherapies, computers or mobile phones. Remotely delivered treatments offer more sustained and multifaceted support than brief interventions, and they show a substantial cost advantage as users increase in number. They may also build skills, confidence and treatment fidelity in providers who use them in sessions. Engagement and retention remain challenges, but electronic treatments show promise in engaging younger populations. Recruitment may be assisted by integration with community campaigns or brief opportunistic interventions. However, routine use of assisted self-help by standard services faces significant challenges. Strategies to optimize adoption are discussed. ----- ----- Research Highlights: ► Many people with risky or problematic drinking do not currently receive treatment. ► Assisted self-help has a significant impact and can be delivered at low cost. ► Maximal effects from assisted self-help require engagement of potential users. ► Marketing campaigns and integration into existing service models may assist.

Low intensity CBT by mail

Introduction: There are many low intensity (LI) cognitive behavoural therapy (CBT) solutions to the problem of limited service access. In this chapter, we aim to discuss a relatively low-technology approach to access using standard postal services-CBT by mail, or M-CBT. Bibliotherapies including M-CBT teach key concepts and self-management techniques, together with screening tools and forms to structure home practice. M-CBT differs from other bibliotherapies by segmenting interventions and mailing them at regular intervals. Most involve participants returning copies of monitoring forms or completed handouts. Therapist feedback is provided, often in personal letters that accompany the printed materials. Participants may also be given access to telephone or email support. ----- ----- M-CBT clearly fulfills criteria for an LI CBT (see Bennett-Levy et al., Chapter 1, for a definition of LI interventions). Once written, they involve little therapist time and rely heavily on self-management. However, content and overall treatment duration need not be compromised. Long-term interventions with multiple components can be delivered via this method, provided their content can be communicated in letters and engagement is maintained.

Implementing low intensity CBT in case management of clients with severe mental illness

In a previous chapter (Dean and Kavanagh, Chapter 37), the authors made a case for applying low intensity (LI) cognitive behaviour therapy (CBT) to people with serious mental illness (SMI). As in other populations, LI CBT interventions typically deal with circumscribed problems or behaviours. LI CBT retains an emphasis on self-management, has restricted content and segment length, and does not necessarily require extensive CBT training. In applying these interventions to SMI, adjustments may be needed to address cognitive and symptomatic difficulties often faced by these groups. What may take a single session in a less affected population may require several sessions or a thematic application of the strategy within case management. In some cases, the LI CBT may begin to appear more like a high-intensity (HI) intervention, albeit simple and with many LI CBT characteristics still retained. So, if goal setting were introduced in one or two sessions, it could clearly be seen as an LI intervention. When applied to several different situations and across many sessions, it may be indistinguishable from a simple HI treatment, even if it retains the same format and is effectively applied by a practitioner with limited CBT training. ----- ----- In some ways, LI CBT should be well suited to case management of patients with SMI. treating staff typically have heavy workloads, and find it difficult to apply time-consuming treatments (Singh et al. 2003). LI CBT may allow provision of support to greater numbers of service users, and allow staff to spend more time on those who need intensive and sustained support. However, the introduction of any change in practice has to address significant challenges, and LI CBT is no exception. ----- ----- Many of the issues that we face in applying LI CBT to routine case management in a mnetal health service and their potential solutions are essentially the same as in a range of other problem domains (Turner and Sanders 2006)- and, indeed, are similar to those in any adoption of innovation (Rogers 2003). Over the last 20 years, several commentators have described barriers to implementing evidence-based innovations in mental health services (Corrigan et al. 1992; Deane et al. 2006; Kavanagh et al. 1993). The aim of the current chapter is to present a cognitive behavioural conceptualisation of problems and potential solutions for dissemination of LI CBT.

Adapting low intensity CBT interventions for clients with severe mental illness

Many people with severe mental illness (SMI) such as schizophrenia, whose psychotic symptoms are effectively managed, continue to experience significant functional problems. This chapter argues that low intensity (LI) cognitive behaviour therapy (CBT; e.g. for depression, anxiety, or other issues) is applicable to these clients, and that LI CBT can be consistent with long-term case management. However, adjustments to LI CBT strategies are often necessary and boundaries between LI CBT and high intensity (HI) CBT (with more extensive practitioner contact and complexity) may become blurred. Our focus is on LI CBT's self-management emphasis, its restricted content and segment length, and potential use after limited training. In addition to exploring these issues, it draws on the authors' Collaborative Recovery (CR; Oades et al. 2005) and 'Start Over and Survive' programs (Kavanagh et al. 2004) as examples. ----- ----- Evidence for the effectiveness of LI CBT with severe mental illness is often embedded within multicomponent programs. For example, goal setting and therapeutic homework are common components of such programs, but they can also be used as discrete LI CBT interventions. A review of 40 randomised controlled trials involving recipients with schizophrenia or other sever mental illnesses has identified key components of illness management programs (Mueser et al. 2002). However, it is relatively rare for specific components of these complex interventions to be assessed in isolation. Given these constraints, the evidence for specific LI CBT interventions with severe mental ilnness is relatively limited.

meso-Porphyrinylphosphine Oxides: Mono- and Bidentate Ligands for Supramolecular Chemistry and the Crystal Structures of Monomeric [10,20-Diphenylporphyrinatonickel(II)-5,15-diyl]-bis-[P(O)Ph2] and Polymeric Self-Coordinated ([10,20-Diphenylporphyrinatozinc(II)-5,15-diyl]-bis-[P(O)Ph2])

A series of porphyrins substituted in one or two meso-positions by diphenylphosphine oxide groups has been prepared by the palladium catalysed reaction of diphenylphosphine or its oxide with the corresponding bromoporphyrins. Compounds {MDPP-[P(O)Ph2]n} (M = H2, Ni, Zn; H2DPP = 5,15-diphenylporphyrin; n = 1, 2) were isolated in yields of 60-95%. The reaction is believed to proceed via the conventional oxidative addition, phosphination and reductive elimination steps, as the stoichiometric reaction of η1-palladio(II) porphyrin [PdBr(H2DPP)(dppe)] (H2DPP = 5,15-diphenylporphyrin; dppe = 1,2-bis(diphenylphosphino)ethane) with diphenylphosphine oxide also results in the desired mono-porphyrinylphosphine oxide [H2DPP-P(O)Ph2]. Attempts to isolate the tertiary phosphines failed due to their extreme air-sensitivity. Variable temperature 1H NMR studies of [H2DPP-P(O)Ph2] revealed an intrinsic lack of symmetry, while fluorescence spectroscopy showed that the phosphine oxide group does not behave as a "heavy atom" quencher. The electron withdrawing effect of the phosphine oxide group was confirmed by voltammetry. The ligands were characterised by multinuclear NMR and UV-visible spectroscopy as well as mass spectrometry. Single crystal X-ray crystallography showed that the bis(phosphine oxide) nickel(II) complex {[NiDPP-[P(O)Ph2]2} is monomeric in the solid state, with a ruffled porphyrin core and the two P=O fragments on the same side of the average plane of the molecule. On the other hand, the corresponding zinc(II) complex formed infinite chains through coordination of one Ph2PO substituent to the neighbouring zinc porphyrin through an almost linear P=O---Zn unit, leaving the other Ph2PO group facing into a parallel channel filled with disordered water molecules. These new phosphine oxides are attractive ligands for supramolecular porphyrin chemistry.

Humanitarianism or self-serving hypocrisy? : the provision of aid to South Africa under the Hawke-Keating and Howard governments

General perceptions of foreign aid commonly engender images of humanitarianism and altruism, whereby the humanitarian needs of the recipient of development assistance are of the utmost priority of the aid donor. However, the Australian governments led by Hawke, Keating and Howard often gave humanitarianism a low emphasis, frequently placing Australia’s own foreign policy and economic concerns at the forefront of aid allocation – often unashamedly. This self-interest met through aid meant that most was provided to Australia’s regional neighbourhood, neglecting some of the poorest, most struggling states, including South Africa. Other issues and events, including the Cold War, apartheid, terrorism and HIV/AIDS also affected Australia’s aid policy; mostly, they were used as excuses to limit aid to states like South Africa.

Expression and connection : the integration of the reflective learning process and the writing process into social network sites

A number of instructors have recently adopted social network sites (SNSs) for learning. However, the learning design of SNSs often remains at a preliminary level similar to a personal log book because it does not properly include reflective learning elements such as individual reflection and collaboration. This article looks at the reflective learning process and the public writing process as a way of improving the quality of reflective learning on SNSs. It proposes a reflective learning model on SNSs based on two key pedagogical concepts for social networking: individual expression and collaborative connection. It is expected that the model would be helpful for instructors in designing a reflective learning process on SNSs in an effective and flexible way.

The role of mother-centered factors influencing the complex social behaviour of breastfeeding : social support and self-efficacy

This research investigated the role of mother-centred issues that influence breastfeeding behaviours. The need for social marketing research for breastfeeding is indicated by the fact that despite evidence of the health benefits to both the infant and mother of longer breastfeeding duration, rates in developed countries have failed to increase in recent decades. Breastfeeding is a complex behaviour that for many women involves barriers that influence their commitment to continue breastfeeding. Structural equation modelling was used on a sample of 405 respondents to an online survey. The analysis revealed that personal social support had a significant impact on breastfeeding self-efficacy, which in turn had a significant impact on breastfeeding behaviour. The findings and implications for both social marketing theory and practice are discussed.

Hysteresis modeling of Magneto-Rheological (MR) fluid damper by self tuning fuzzy control

Magneto-rheological (MR) fluid damper is a semi-active control device that has recently received more attention by the vibration control community. But inherent nonlinear hysteresis character of magneto-rheological fluid dampers is one of the challenging aspects for utilizing this device to achieve high system performance. So the development of accurate model is necessary to take the advantage their unique characteristics. Research by others [3] has shown that a system of nonlinear differential equations can successfully be used to describe the hysteresis behavior of the MR damper. The focus of this paper is to develop an alternative method for modeling a damper in the form of centre average fuzzy interference system, where back propagation learning rules are used to adjust the weight of network. The inputs for the model are used from the experimental data. The resulting fuzzy interference system is satisfactorily represents the behavior of the MR fluid damper with reduced computational requirements. Use of the neuro-fuzzy model increases the feasibility of real time simulation.

Aurora : an illustrated novella

Aurora, an illustrated novella, is a retelling of the classic fairytale Sleeping Beauty, set on the Australian coast around the grounds of the family lighthouse. Instead of following in the footsteps of tradition, this tale focuses on the long time Aurora is cursed to sleep by the malevolent Minerva; we follow Aurora as she voyages into the unconscious. Hunted by Minerva through the shifting landscape of her dreams, Aurora is dogged by a nagging pull towards the light—there is something she has left behind. Eventually, realising she must face Minerva to break the curse, they stage a battle of the minds in which Aurora triumphs, having grasped the power of her thoughts, her words. Aurora, an Australian fairytale, is a story of self-empowerment, the ability to shape destiny and the power of the mind. The exegesis examines a two-pronged question: is the illustrated book for young adults—graphic novel—relevant to a contemporary readership, and, is the graphic novel, where text and image intersect, a suitably specular genre in which to explore the unconscious? It establishes the language of the unconscious and the meaning of the term ‘graphic novel’, before investigating the place of the illustrated book for an older readership in a contemporary market, particularly exploring visual literacy and the way text and image—a hybrid narrative—work together. It then studies the aptitude of graphic literature to representing the unconscious and looks at two pioneers of the form: Audrey Niffenegger, specifically her visual novel The Three Incestuous Sisters, and Shaun Tan, and his graphic novel The Arrival. Finally, it reflects upon the creative work, Aurora, in light of three concerns: how best to develop a narrative able to relay the dreaming story; how to bestow a certain ‘Australianess’ upon the text and images; and the dilemma of designing an illustrated book for an older readership.

Critical literacy finds a "Place": Writing and social action in a low-income Australian grade 2/3 classroom

In a study of socioeconomically disadvantaged children's acquisition of school literacies, a university research team investigated how a group of teachers negotiated critical literacies and explored notions of social power with elementary children in a suburban school located in an area of high poverty. Here we focus on a grade 2/3 classroom where the teacher and children became involved in a local urban renewal project and on how in the process the children wrote about place and power. Using the students' concerns about their neighborhood, the teacher engaged her class in a critical literacy project that not only involved a complex set of literate practices but also taught the children about power and the possibilities for local civic action. In particular, we discuss examples of children's drawing and writing about their neighborhoods and their lives. We explore how children's writing and drawing might be key elements in developing "critical literacies" in elementary school settings. We consider how such classroom writing can be a mediator of emotions, intellectual and academic learning, social practice, and political activism.

Portrayal of librarians in Australian creative writing

An exploration is made of the ways in which librarians have been depicted in Australian creative writing. Reference is made to characters in novels, short stories, drama and poetry. With respect to novels, there is some consideration of characterisation and its relationship to plot.

Development and pilot test of a peer-support based Cardiac-Diabetes Self-Management program : a study protocol

Background: People with cardiac disease and type 2 diabetes have higher hospital readmission rates (22%)compared to those without diabetes (6%). Self-management is an effective approach to achieve better health outcomes; however there is a lack of specifically designed programs for patients with these dual conditions. This project aims to extend the development and pilot test of a Cardiac-Diabetes Self-Management Program incorporating user-friendly technologies and the preparation of lay personnel to provide follow-up support. Methods/Design: A randomised controlled trial will be used to explore the feasibility and acceptability of the Cardiac-Diabetes Self-Management Program incorporating DVD case studies and trained peers to provide follow-up support by telephone and text-messaging. A total of 30 cardiac patients with type 2 diabetes will be randomised, either to the usual care group, or to the intervention group. Participants in the intervention group will received the Cardiac-Diabetes Self-Management Program in addition to their usual care. The intervention consists of three faceto- face sessions as well as telephone and text-messaging follow up. The face-to-face sessions will be provided by a trained Research Nurse, commencing in the Coronary Care Unit, and continuing after discharge by trained peers. Peers will follow up patients for up to one month after discharge using text messages and telephone support. Data collection will be conducted at baseline (Time 1) and at one month (Time 2). The primary outcomes include self-efficacy, self-care behaviour and knowledge, measured by well established reliable tools. Discussion: This paper presents the study protocol of a randomised controlled trial to pilot evaluates a Cardiac- Diabetes Self-Management program, and the feasibility of incorporating peers in the follow-ups. Results of this study will provide directions for using such mode in delivering a self-management program for patients with both cardiac condition and diabetes. Furthermore, it will provide valuable information of refinement of the intervention program.

Using user-friendly telecommunications to improve cardiac and diabetes self-management programme : a pilot study

Previous studies exploring the incidence and readmission rates of cardiac patients admitted to a coronary care unit (CCU) with type 2 diabetes [1] have been undertaken by the first author. Interviews of these patients regarding their experiences in managing their everyday conditions [2] provided the basis for developing the initial cardiac–diabetes self-management programme (CDSMP) [3]. Findings from each of these previous studies highlighted the complexity of self-management for patients with both conditions and contributed to the creation of a new self-management programme, the CDSMP, based on Bandura’s (2004) self-efficacy theory [4]. From patient and staff feedback received for the CDSMP [3], it became evident that further revision of the programme was needed to improve self-management levels of patients and possibility of incorporating methods of information technology (IT). Little is known about the applicability of different methods of technology for delivering self-management programmes for patients with chronic diseases such as those with type 2 diabetes and cardiac conditions. Although there is some evidence supporting the benefits and the great potential of using IT in supporting self-management programmes, it is not strong, and further research on the use of IT in such programmes is recommended [5–7]. Therefore, this study was designed to pilot test feasibility of the CDSMP incorporating telephone and text-messaging as follow-up approaches.

Pedagogy of feedback on student academic writing : research supervisor practices for the end of the research degree candidature

All academic writing is advanced with the benefit of feedback about the writing. In the case of the academic writing genres of the research proposal and the dissertation, feedback is usually provided by the research supervisor. Given that academic writing development is a process, and in the case of the research proposal and dissertation, writing which develops over time, it seems likely that the nature of feedback on drafts written early in the candidature may be different from feedback provided by the research supervisor later in a student’s candidature. ----- ----- When a research supervisor has been reading a student’s writing over a period of time, their own familiarity with the writing generates a risk to their ability to provide critical and objective feedback. Particularly by the end of a student’s candidature, the research supervisor’s familiarity with the work may cause them to miss elements of writing improvement. ----- ----- The author, as a research supervisor, has developed a feedback grid to facilitate feedback on the final drafts of a dissertation. This feedback grid is generated by the embedded promises in the early sections of the dissertation, which are then used to audit the content of the final sections of the dissertation to ascertain whether promises made have been fulfilled. This provides a strategy for the research supervisor to step back from the work and read the dissertation with the agenda of a dissertation examiner. ----- ----- The grid is one strategy within a broader pedagogy of providing feedback on writing samples.