Does interpersonal psychotherapy improve clinical care for adolescents with depression attending a rural child and adolescent mental health service? Study protocol for a cluster randomised feasibility trial

Background: Depression amongst adolescents is a costly societal problem. Little research documents the effectiveness of public mental health services in mapping this problem. Further, it is not clear whether usual care in such services can be improved via clinician training in a relevant evidence based intervention. One such intervention, found to be effective and easily learned amongst novice clinicians, is Interpersonal Psychotherapy (IPT). The study described in the current paper has two main objectives. First, it aims to investigate the impact on clinical care of implementing Interpersonal Psychotherapy for Adolescents for the treatment of adolescent depression within a rural mental health service compared with Treatment as Usual (TAU). The second objective is to record the process and challenges (i.e. feasibility, acceptability, sustainability) associated with implementing and evaluating an evidence-based intervention within a community service. This paper outlines the study rationale and design for this community based research trial.

Methods/design: The study involves a cluster randomisation trial to be conducted within a Child and Adolescent Mental Health Service in rural Australia. All clinicians in the service will be invited to participate.  Participating clinicians will be randomised via block design at each of four sites to (a) training and delivery of IPT, or (b) TAU. The primary measure of impact on care will be a clinically significant change in depressive  symptomatology, with secondary outcomes involving treatment satisfaction and changes in other symptomatology. Participating adolescents with significant depressive symptomatology, aged 12 to 18 years, will complete assessment measures at Weeks 0, 12 and 24 of treatment. They will also complete a depression inventory once a month during that period. This study aims to recruit 60 adolescent participants and their parent/guardian/s. A power analysis is not indicated as an intra-class correlation coefficient will be calculated and used to inform sample size calculations for subsequent large-scale trials. Qualitative data regarding process implementation will be collected quarterly from focus groups with participating clinicians over 18 months, plus phone interviews with participating adolescents and parent/guardians at 12 weeks and 24 weeks of treatment. The focus group qualitative data will be analysed using a Fourth Generation Evaluation methodology that includes a constant comparative cyclic analysis method.

Discussion: This study protocol will be informative for researchers and clinicians interested in considering, designing and/or conducting cluster randomised trials within community practice such as mental health services.

Stakeholders and strategic planning in non-profit organisations : case studies in complexity and conflict

The experiences of two Australian non-profit member-benefit associations as they attempt to develop strategic plans are explored, with emphasis on the influence of the many stakeholders in this process. We conclude that
corporate strategic planning is a complex, conflict-ridden, and largely
unsuccessful process in non-profit member-benefit associations because of the number and commitment of stakeholders. Therefore we suggest that future research should focus on clarifying whether such corporate management techniques are actually appropriate for all non-profit organisations, and, if they are, how non-profit organisations can best manage the process, taking into account the values and needs of stakeholders.

Conflict resolution and policy making mediation in the Mekong River Basin

The Mekong River serves China, Myanmar, Thailand, Laos, Cambodia and Vietnam covering an area of approximately 795, 000 square kilometres and the Mekong River basin is a delicate eco-system rich in natural resources and bio-diversity. Competing demands for increasingly scarce supplies of water, the reciprocal impacts of land and water uses and inadequate governance arrangements have given rise to conflicts that has to be resolved by policy making to facilitate a process, whereby the main principles adopted in the Mekong River Agreement can be implemented.

Conflict resolution and sustainable water use in the Mekong River Basin

In this paper it is argued that increased demands for water use in the Mekong River Basin makes this region vulnerable to conflict. Strategies to both prevent and manage conflict are necessary for sustainable water use in this region. Community development is integral to sustainable development. Community development strategies are particularly useful in recognising knowledge and expertise within local communities. They also assist in involving local communities - particularly members of minority groups in collaborative efforts for sustainable natural resource use and conflict management. It is essential that local communities are active partners in the development of conflict resolution and sustainable development strategies. Active and meaningful participation of local communities in the planning, and management of local water use development activities will increase the likelihood of sustainable outcomes.

Psychological and interpersonal dimensions of sexual function and dysfunction.

To highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction; to offer a four-tiered paradigm for understanding the evolution and maintenance of sexual symptoms; and to offer recommendations for clinical management and research.

VELS versus CSF : replacement, conflict or harmony?

Sometimes VELS (Victorian Essential Learning Standards) is confusing. Part of the problem is that it is available only on-line as a web-browse-able collection of internet web pages. It is broadly true that the mathematics curriculum described by the Mathematics VELS is equivalent to curriculum described by the Mathematics CSF (Curriculum and Standards Framework).

Interpersonal trust and formal controls in low systemic trust societies

This study is concerned with the role of interpersonal trust in management control. On the basis of a questionnaire survey and interviews of senior managers from business organisations in sri lanka, the study explores the control behaviour of superior managers when they trust or distrust their subordinates. Sri lanka, a society in which the dependence on interpersonal trust is high, was chosen for the study to maximise the effect of interpersonal trust.

The findings of this study indicate that a superior's high trust in a subordinate is associated with a low level of monitoring, a high level of social interactions, and a low reliance on formal controls. In contrast, a superior's low level of trust in a subordinate is associated with a high level of monitoring, a low level of social interactions, and a high reliance on formal controls. Because the data emanate from experienced senior managers, these findings are at least indicative of control behaviour of superior managers in sri lanka and possibly of similar countries in asia. An understanding of the control behaviour of managers in this region is particularly important for designing and implementing effective controls systems for firms, subsidiaries, branches or joint-ventures operating in the region.