Classifying client goals in community-based ABI rehabilitation: a taxonomy for profiling service delivery and conceptualizing outcomes

Purpose: To develop, confirm and trial a framework for analysing the content of goals set within community-based rehabilitation. This framework (taxonomy) is proposed as a tool to assist in service evaluation and outcome exploration. Method: Qualitative thematic analysis and categorization of 1765 rehabilitation goal statements in a four phase process of synthesis, refinement, verification and application. Results: A taxonomy of goal content was developed comprising 21 categories within five domains, utilizing 125 descriptors. The taxonomy demonstrated good inter-rater consistency and was able to discriminate between similar but related data sets comprising goal statements. Conclusion: Structured analysis of the content of goal setting (particularly in community rehabilitation) utilizing a framework such as the proposed taxonomy has considerable potential as a 'window' into service delivery to broaden the parameters of existing service evaluation and to more clearly link outcome exploration to intervention.

Actual and preferred work activites of mental health Occupational Therapists: Congruence or Discrepancy

The reform of Australian mental health services has resulted in new models of care and changed work practices for all mental health professionals. Occupational therapists today are as likely to be working in multidisciplinary teams performing a range of generic clinical roles as they are to be working in specialist rehabilitation units. These kinds of changes have taken place in other countries, with anecdotal and some empirical evidence that the changes have resulted in concerns about loss of professional identity and roles. This study sought to identify the current work activities carried out by occupational therapists and to determine whether there was a discrepancy between their actual and desired work activities. It was expected that, overall, they would indicate a preference to do more specialist rehabilitation focused work and less generic case management work. A survey of 196 occupational therapists investigated their actual and preferred work activities in 55 specific roles across four broad categories (senior administration, specialist clinical, general clinical and community development). As expected, the participants indicated that they would prefer to be undertaking more specialist rehabilitation oriented work activities than they were actually doing. Contrary to expectations, they also wished to undertake more rather than less generic clinical work activities, to be more engaged in community development work and to take on more senior and administrative roles. They indicated a preference for less rather than more activity on only 5 of the 55 work roles examined. On examining a subset of 113 participants who reported that 50% or more of their time was spent in case management, there was greater evidence of resistance to generic clinical roles. It was therefore concluded that occupational therapists in Australia are seeking to deploy their specialist skills to a greater degree than the current practice environment permits. They have broadly accepted the generic roles required in multidisciplinary community case management, but those who are actually working in these roles are most likely to have reservations about this kind of work.

The experiences and perceptions of unit managers in facilitating oral health in adults with intellectual disability

This qualitative research investigated the experiences and perceptions of unit managers regarding their involvement with oral health management of adults with intellectual disability. Semi-structured individual interviews were conducted with eight participants working in four different area offices of a metropolitan disability service, whose experience as unit managers ranged from 1 to 17 years. Key themes identified in the interview data focused on unit managers' views of the oral health of this group, the support roles involved in the oral health of adults with intellectual disability, the priority of oral health, the experiences of the participants within the oral health system, and the strategies for supporting adults with intellectual disability in oral health management. Implications of the findings included the need to improve education for all persons involved in the oral health of adults with intellectual disability, to encourage a collaborative approach to oral health by workers within accommodation support services and the oral health system, and to enable adults with intellectual disability to maximally participate in their own oral health management.

Producing computer-generated tailored written information for stroke patients and their carers: System development and preliminary evaluation

Purpose: The aim of this project was to design and evaluate a system that would produce tailored information for stroke patients and their carers, customised according to their informational needs, and facilitate communication between the patient and, health professional. Method: A human factors development approach was used to develop a computer system, which dynamically compiles stroke education booklets for patients and carers. Patients and carers are able to select the topics about which they wish to receive information, the amount of information they want, and the font size of the printed booklet. The system is designed so that the health professional interacts with it, thereby providing opportunities for communication between the health professional and patient/carer at a number of points in time. Results: Preliminary evaluation of the system by health professionals, patients and carers was positive. A randomised controlled trial that examines the effect of the system on patient and carer outcomes is underway. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

Sources of stress experienced by occupational therapists and social workers in mental health settings

This study examined the sources of stress experienced by occupational therapists and social workers employed in Australian public mental health services and identified the demographic and work-related factors related to stress using a cross-sectional survey design. Participants provided demographic and work-related information and completed the Mental Health Professionals Stress Scale. The overall response rate to the survey was 76.6%, consisting of 196 occupational therapists and 108 social workers. Results indicated that lack of resources, relationships and conflicts with other professionals, workload, and professional self-doubt were correlated with increased stress. Working in case management was associated with stress caused by client-related difficulties, lack of resources, and professional self-doubt. The results of this study suggest that Australian occupational therapists and social workers experience stress, with social workers reporting slightly more overall stress than occupational therapists. Copyright © 2005 Whurr Publishers Ltd.

Smoking and parenting among males in low socio-economic occupations

The role of fatherhood in family life has been accentuated as a consequence of societal change. This change, combined with knowledge about the harmful consequences of passive smoking, has focused attention on males who smoke and are the partners of pregnant women. Of particular interest are low socio-economic groups because of their higher smoking rates. This study examines smoking and parenting in a sample of 561 males in semi-skilled and unskilled occupations (with pregnant partners) who were recruited into a self-help smoking cessation programme. Parenting related variables predicted smoking cessation, particularly knowledge about passive smoking. A high level of knowledge about the effects of passive smoking on a baby was associated with one or more quit attempts early in the partner's pregnancy and smoking cessation. Confidence to quit during the pregnancy was also associated with smoking cessation. These results could be incorporated into smoking cessation and antenatal programmes to improve the health of families.

Community perceptions of adequate levels and reasons for skin protection

In this study the authors addressed whether or not community members use relevant risk factors to determine an appropriate level of skin protection behavior in the prevention of skin cancer. The authors conducted a postal survey with a community sample of 3,600 Queensland residents that they randomly selected from the Commonwealth electoral roll. The predictors of perceptions of doing enough skin protection included intrapersonal, social, and attitudinal influences. People protected themselves from the sun primarily out of a desire for future good health and on other occasions did not protect themselves from the sun because they were not out there long enough to get burnt. The predictors of perceptions of doing enough skin protection indicated that participants were aware of relevant risk factors. The main reasons that people protect themselves from the sun suggest that they are acting on many health promotion messages. However, skin cancer prevention programs need to move beyond increasing awareness and knowledge of the disease to providing a supportive environment and enhancing individual skills. Health promotion campaigns could reinforce appropriate risk assessment and shape an individual's decision about how much sun protection is needed.

Assessing cost-effectiveness in mental health: vocational rehabilitation for schizophrenia and related conditions

Objective: Existing evidence suggests that vocational rehabilitation services, in particular individual placement and support (IPS), are effective in assisting people with schizophrenia and related conditions gain open employment. Despite this, such services are not available to all unemployed people with schizophrenia who wish to work. Existing evidence suggests that while IPS confers no clinical advantages over routine care, it does improve the proportion of people returning to employment. The objective of the current study is to investigate the net benefit of introducing IPS services into current mental health services in Australia. Method: The net benefit of IPS is assessed from a health sector perspective using cost-benefit analysis. A two-stage approach is taken to the assessment of benefit. The first stage involves a quantitative analysis of the net benefit, defined as the benefits of IPS (comprising transfer payments averted, income tax accrued and individual income earned) minus the costs. The second stage involves application of 'second-filter' criteria (including equity, strength of evidence, feasibility and acceptability to stakeholders) to results. The robustness of results is tested using the multivariate probabilistic sensitivity analysis. Results: The costs of IPS are $A10.3M (95% uncertainty interval $A7.4M-$A13.6M), the benefits are $A4.7M ($A3.1M-$A6.5M), resulting in a negative net benefit of $A5.6M ($A8.4M-$A3.4M). Conclusions: The current analysis suggests that IPS costs are greater than the monetary benefits. However, the evidence-base of the current analysis is weak. Structural conditions surrounding welfare payments in Australia create disincentives to full-time employment for people with disabilities.

Caregiver burden, time spent caring and health status in the first 12 months following stroke

Objective: To quantify time caring, burden and health status in carers of stroke patients after discharge from rehabilitation; to identify the potentially modifiable sociodemographic and clinical characteristics associated with these outcomes. Methods: Patients and carers prospectively interviewed 6 (n = 71) and 12 (n = 57) months after discharge. Relationships of carer and patient variables with burden, health status and time analysed by Gaussian and Poisson regression. Results: Carers showed considerable burden at 6 and 12 months. Carers spent 4.6 and 3.6 hours per day assisting patients with daily activities at 6 and 12 months, respectively. Improved patient motor and cognitive function were associated with reductions of up to 20 minutes per day in time spent in daily activities. Better patient mental health and cognitive function were associated with better carer mental health. Conclusions: Potentially modifiable factors such as these may be able to be targeted by caregiver training, support and education programmes and outpatient therapy for patients.

Ototoxicity and tolerance assessment of a TrisEDTA and polyhexamethylene biguanide ear flush formulation in dogs

Clinically healthy mixed breed dogs (n = 20) were used to determine if a Tris (tromethamine)-buffered test solution, Otinide((R)) (Trademark of Dermcare-Vet Pty-Ltd, Australia), containing disodium ethylenediamine tetraacetic acid (EDTA; 1.21 g/L) and polyhexamethylene biguanide (PHMB; 0.22 g/L) caused ototoxicity or vestibular dysfunction. The dogs were randomly assigned to either a control group (group A, n = 10) receiving saline, or a treatment group (group B, n = 10) receiving the test solution. Phase 1 of the study consisted of applying 5.0 mL of saline to both ears of the control group (group A) and 5 mL of test solution to both ears of the test group (group B), for 21 days. A bilateral myringotomy was then performed on each dog under deep sedation. Phase 2 of the study then consisted of applying 2.0 mL of the saline to both ears of the control group (group A) and 2.0 mL of the test solution to both ears of the test group (group B), for 14 days. Throughout the study, dogs were examined for clinical health, and underwent otoscopic, vestibular and auditory examinations. The auditory examinations included brainstem auditory evoked potential (BAEP) threshold and supra-threshold assessments using both click and 8 kHz tone burst stimuli. The absence of vestibular signs and effects on the BAEP attributable to the test solution suggested the test solution could be applied safely to dogs, including those with a damaged tympanic membrane.