Optimising care for people with chronic disease : foreword

Chronic disease self-management emerged as an organised, formal entity in Australia in the 1980s, when a specific group-based program was introduced from the United States. This program, the Stanford Arthritis Self-Management Course, was promulgated in Australia and other countries by its creator, Professor Kate Lorig of Stanford University. The program showed much early promise, particularly with its dissemination and uptake by an enthusiastic non-government sector. Over subsequent years it has matured, and many other programs endeavouring to support patients to engage in self-management have been developed. In some ways, chronic disease self-management has become mainstream.1-3

Relevance of health literacy models for people with severe mental illness

People with severe mental illness experience elevated levels of impairment, morbidity and health-risk behaviours compared with the general population. Despite this, it is consistently reported that they do not visit health professionals, including preventative health professionals, as regularly as the general population. Their poor health suggests that current health promotion efforts have been largely ineffective in addressing their specific needs. Barriers that might explain this include lack of motivation, expense and lack of access. Health literacy is also a potentially important factor. As a part of a programme of work to develop appropriate and effective health promotion for this group, we have explored existing health-literacy models and their relevance to marginalized populations, in particular, people experiencing severe mental illness. A comprehensive search of the literature was undertaken. Models of health literacy identified were analyzed to determine the source population, underpinning theory/frameworks, supporting research evidence and to consider their potential generalisability. This paper presents an analysis of existing health-literacy models in the context of severe mental illness. We propose that because existing models of health literacy were developed through consultation with people experiencing challenges to specific health and social issues, for example, cancer, low income and limited education, this raises questions as to the applicability of these models to people experiencing severe and ongoing mental illness. Whilst such individuals were not actively excluded in the development of the existing models, we propose the development of an alternative model which considers this population's needs and limitations in accessing effective health-promotion campaigns/programs.

Use of drugs to manage the behaviour of individuals with intellectual disability

Provides a detailed description and analysis over time of the use of medication to manage the behaviour of individuals with intellectual disability. Drug use was extensive and reasons provided were commonly outside those permitted by legislation. The findings enabled critical appraisal of current monitoring procedures and recommendations regarding policy and practice.

Momentary lives : supporting people with acquired brain injury

Personal adjustment following an acquired brain injury is influenced by a comprehensive, complex, and dynamic range of factors. This study found that a useful approach to service provision in the ABI sector would involve a holistic approach that addresses all life domains of the individual within an ecological systems framework.

Reconstructing the mosaic of inclusion for children with intellectual disabilities

This thesis proposes new thinking about educational inclusion for children with disabilities. It examines current policies and practices alongside experiences of teachers, parents, aides, students and children with intellectual disabilities. It elaborates the value of (inter)dependence as a guiding principle and identifies 'chinks of possibility' to drive inclusion efforts.

Visual discrimination and reproduction of movement by individuals with an intellectual disability

This study investigates the capacity of individuals with an intellectual disability to make accurate discriminations of computer-generated displays and also to reproduce the characteristics of those displays. The findings suggest that the learning of everyday motor skills in this population may be hampered by difficulties in visually perceiving important characteristics of the demonstration. Procedures, employed for teaching these skills to intellectually disabled, are being reassessed in the light of these findings.

Subjective quality of life of people with MS and their partners

The findings of this thesis supported a model proposed to explain the influence of psychological factors on subjective quality of life. In comparison with their partners, and with a control group, people with MS reported a lowered subjective quality of life and self-esteem, an increased need for social support, and maladaptive use of control. Recommendations for interventions were made based on these findings.

Detecting and treating depression in people with mild intellectual disability : the views of key stakeholders

There is a pressing need for the development of programs for the early identification and treatment of depression in individuals with mild intellectual disability. The aim of this study was to ascertain the perspective of 64 key stakeholders (people with intellectual disability, healthcare professionals, family/caregivers & support workers) regarding the risk factors and characteristics of depression, the support and service needs of individuals with intellectual disability/depression and those who care for them. Findings enhance our understanding of depression and its risk factors in people with mild intellectual disability and endorse the need for the development of screening and intervention programs suitable for delivery by staff in agencies providing services to people with mild intellectual disability.

Police officers' note-taking of interviews with alleged child abuse victims

The field and experimental studies for this thesis revealed that: the quality of documentation of 'disclosure' (initial) interviews with child abuse witnesses was poor; under optimal note-taking conditions, verbatim records of interview were still not provided, and considerable variability was observed in the quality of notes and strategies employed to document content and structure. The portfolio presents four case studies to illustrate similarities and/or differences between offence behaviour in child sex offenders with impairment, and the offence behaviours that characterise Canter et al.'s intimate, criminal-opportunistic and aggressive type offenders.

A naturalistic study of treatment outcomes with aripiprazole in young people with first episode psychosis

Objective: Adequate treatment of a first psychotic episode in young people is a difficult challenge but may be of critical importance for changing the course of psychotic illness. Pharmacotherapy is the standard treatment of psychosis, however there is a paucity of data specific to first-episode psychosis.
Methods: In this study 12 young people who presented with a psychotic episode at a specialised early intervention service were commenced on treatment with aripiprazole. They were assessed at baseline and weeks 4, 6, 24 and 48 using a broad battery of outcome measures. Case notes were also examined.
Results: Data was available for 6 participants at week 48, and of those, one remained on treatment with Aripiprazole at endpoint. Case histories were typified by presentations that included illicit substance use and treatments characterised by several changes in medications. No single treatment choice predominated. Most participants tolerated treatment and showed symptomatic improvement with individualised therapy.
Conclusion: Most participants showed improvement during the treatment period. Aripiprazole was one of many medications used in this study and may have been useful for the treatment of some individuals with first episode psychosis.