Improving collaboration between private psychiatrists, the public mental health sector and general practitioners : evaluation of the Partnership Project

Objectives: We describe the evaluation of the Partnership Project, which was designed to improve linkages between public and private sector mental health services. We consider the Project's key elements: a Linkage Unit, designed to improve collaborative arrangements for consumers and promote systems-level and cultural change; and the expansion of private psychiatrists' roles to include supervision and training, case conferencing and secondary consultation. The evaluation aimed to describe the impacts and outcomes of these elements.

Method: The evaluation used de-identified data from the Linkage Unit database, the Project's billing system, and the Health Insurance Commission (HIC). It drew on consultations with key stakeholders (semistructured interviews with 36 key informants, and information from a forum attended by over 40 carers and a meeting of five public sector and three private sector psychiatrists) and a series of case studies.

Results: The Linkage Unit facilitated 224 episodes of collaborative care, many of which had positive outcomes for providers, consumers and carers. It had a significant impact at a systems level, raising consciousness about collaboration and influencing procedural changes. Thirty-two private psychiatrists consented to undertaking expanded roles, and the Project was billed $78 032 accordingly. Supervision and training were most common, involving 16 psychiatrists and accounting for approximately 80% of the total hours and cost. Commonwealth expenditure on private psychiatrists' participation in the expanded roles was not associated with a reduction in benefits paid by the HIC. Key informants were generally positive about the expanded roles.

Conclusions: The Project represented a considered, innovative approach to dealing with poor collaboration between the public mental health sector, private psychiatrists and GPs. The Linkage Unit achieved significant systems-level and cultural change, which has the potential to be sustained. Expanded roles for private psychiatrists, particularly supervision and training, may improve collaboration, and warrant further exploration in terms of costs and benefits.

Predictors of time spent outdoors among children : 5-year longitudinal findings

Background Given the importance of physical activity for health and age-related declines in physical activity, understanding influences on related behaviours, such as time outdoors, is crucial. This study aimed to understand individual, social and physical environmental influences on longitudinal changes in urban children’s time outdoors.

Methods The time children spent outdoors in 2001, 2004 and 2006 (aged 5e6 and 10e12 years at baseline) was reported by their parents (n¼421). In 2001, individual, social and physical environmental factors were self-reported by parents. Generalized estimating equations examined longitudinal relationships between baseline predictors and average change in time outdoors over 5 years.

Results Children’s time outdoors significantly declined over time. “Indoor tendencies” inversely predicted time outdoors among younger and older boys, and younger girls. Social opportunities positively predicted time outdoors among younger boys, while “outdoor tendencies” positively predicted time outdoors among older boys. Parental encouragement for activity positively predicted time outdoors among younger and older girls,while lack of adult supervision for active play outdoors after school inversely predicted time outdoors among older girls and older boys.

Conclusion Individual (indoor and outdoor tendencies) and social factors (social opportunities, parental encouragement and parental supervision) predicted children’s time outdoors over 5 years. Interventions targeting reduced indoor tendencies, increased outdoor play with others, and increased parental encouragement and supervision are warranted.

Retheorising doctoral supervision as professional work

A competitive higher education environment marked by increased accountability and quality assurance measures for doctoral study, including the structured training of doctoral supervisors, has highlighted the need to clearly articulate and delineate the work of supervising doctoral students. This article responds to this imperative by examining the question: in the contemporary university, what do doctoral supervisors do and how might their work be theorized? The response draws on life history interviews with doctoral supervisors in five broad disciplines/fields, working in a large metropolitan university in Australia. Based on empirical analyses, doctoral supervision is theorized as professional work that comprises five facets: the learning alliance, habits of mind, scholarly expertise, technê and contextual expertise. The article proposes that this model offers a more precise discourse, language and theory for understanding and preparing for the work of doctoral supervision in the contemporary university.

Team clinical supervision in acute hospital wards : a feasibility study

Clinical supervision provides a strategy to mitigate nurses’ workplace stress and enhance retention, but the literature provides little guidance about its implementation beyond mental health nursing. This study explored the feasibility of implementing and evaluating ward-based team clinical supervision for general nurses on two separate wards at one public and one private hospital. Nurses completed the Work Environment Questionnaire pre- (n = 36) and post intervention (n = 27), and focus groups (n = 20) explored their perceptions of supervision. Staff were unfamiliar with clinical supervision, so information sessions were required. The questionnaire may not have been suitable to evaluate this type of intervention. Focus group findings revealed that team supervision improved communication, enhanced working relationships, and empowered nurses to challenge existing practices, which had a positive impact on their perceived stress. This study provides insights to guide implementation and evaluation of clinical supervision in acute settings.

Mutual obligation? Regulating by supervision and surveillance in Australian income support policy

Through an analysis of speeches by government ministers, documents and regulations, this article examines the Australian national government’s surveillance of unemployed people through what is known as Activity Testing, and more specifically as Mutual Obligation. It seeks to merge the social policy analysis of Mutual Obligation with a surveillance perspective in order to delve deeper into the underlying nature of the policy and its implications for people who are unemployed. It does this by 1. Outlining the neo-liberal political theory underlying these policies; 2. Illustrating the nature and extent of surveillance of people in receipt of income support, and 3. Employing Foucault’s concepts of the technologies of domination and the self to highlight the controlling and coercive aspects of Mutual Obligation in achieving certain of the Government’s political and policy objectives. In doing so, the analysis will make visible something of the power exerted over the disadvantaged while subject to such surveillance.

Aspects of parenting and family functioning associated with obesity in adolescent refugees and migrants from African backgrounds living in Australia

Objective: To investigate the relationship between parenting style and family functioning, and BMI, among adolescent migrants and refugees from African countries.

Method: A total of 104 parents and their adolescent offspring completed questionnaires assessing the variables of interest, and anthropometric data were collected from them.

Results: Parents reported higher maternal involvement, lower levels of paternal involvement, higher levels of positive parenting, greater use of ‘other’ (non-corporal) discipline styles, greater satisfaction and better communication than did their offspring. Parents also reported greater family cohesion and flexibility than adolescents, and saw their families as more enmeshed and more rigid. Parenting style and family functioning were not strong predictors of BMI according to either report. For adolescents, inconsistent discipline and lack of parental supervision accounted for significant variance in BMI.

Conclusions: Inconsistent discipline and lack of parental supervision may be related to adolescent BMI. Further studies with larger samples are required to confirm these relationships with the view to informing obesity prevention programs for this target population.

Implications: Prevention or intervention programs aimed at reducing the prevalence of overweight and obesity need to consider parenting style in their design.

Professional supervision : a workforce retention strategy for social work?

Retaining social workers in the workforce is a significant challenge and a considerable amount of research has focused on identifying and examining the reasons why social workers choose to leave the profession. This paper presents findings collected as part of a small-scale exploratory study into why some social workers have chosen to remain in the social work profession for many years and who consider themselves to be passionate about their careers. In particular, the paper focuses on the potential of effective professional supervision as a factor that can facilitate social worker workforce retention. Supervision was mentioned by all participants in the study as being important for their wellbeing, either throughout their social work career or at particular points along the way, and supervision was also cited as one of the reasons they were still social workers. On the basis of this research, the authors argue that regular professional supervision can increase the retention rate of social worker employees; and it is, therefore, false economy not to allocate sufficient resources for effective supervision.

Dissemination of therapist-assisted internet cognitive behaviour therapy : development and open pilot study of a workshop

There is considerable research suggesting that therapist-assisted Internet cognitive behaviour therapy (ICBT) is efficacious in the treatment of depression and anxiety. Given this research, there is a growing interest in training students in therapist-assisted ICBT in order to assist with the dissemination of this emerging modality into routine clinical practice. In this study, we developed, delivered, and evaluated a therapist-assisted ICBT workshop for clinical psychology graduate students (n = 20). The workshop provided both research evidence and practical information related to the delivery of therapist-assisted ICBT. The workshop also incorporated an experiential component with students working on and discussing responses to client e-mails. Before and after the workshop, we measured knowledge of therapist-assisted ICBT research and professional practice issues, as well as attitudes towards and confidence in delivering therapist-assisted ICBT. Statistically significant changes were observed in all areas. Eighty-five per cent of students are now offering therapist-assisted ICBT under supervision. We conclude by discussing future research directions related to disseminating therapist-assisted ICBT.

Youth justice: challenges in responding to young people convicted of sexual offences

The clinical and criminological literature on adolescents who have committed sexual offences indicates that a pathologisation of young people and a labelling or overly punitive response is likely to be more harmful than rehabilitative. Accordingly, therapeutic counselling and diversionary schemes are seen as preferable to custodial terms in most instances. For adolescents convicted of sex offences, clinicians identify the benefits of comprehensive therapeutic care which involves family and is sensitive to the young person's context and culture. The benefits of this approach are documented and, although data are limited, indications are that recidivism is reduced where adolescents are provided with specialised counselling to encourage positive and non-abusive behaviours. Yet each jurisdiction experiences difficulties in ensuring the provision of equitable and comprehensive therapeutic services, particularly to regionally or remotely located youth. This paper draws on data from a national study of the services to children and adolescents with sexualised or sexual offending behaviours. With attention to the difficulty in providing services to regionally or remotely located adolescents, this paper identifies challenges around lengthy remand terms, the provision of pre-offence diversionary programs, and the provision of specialised services for young people serving community orders. For example, jurisdictions with the largest geographic service areas face enormous difficulties in providing specialised supervision for community-based orders. At present there are several jurisdictions where regionally and remotely located adolescents may serve the duration of a youth justice order without receiving sepcialised counselling to assist them in modifying their behaviours. The paper identifies the risks where specialised counselling cannot be provided, but also identifies specific initiatives designed to fill these gaps in service provision to youth justice clients. 

Professional views on the management of sex offenders in the community

Sex offender registration and community notification schemes form an increasingly important part of public policy relevant to the management of known sex offenders in the community. Critics of these policies not only point to the lack of empirical evidence that is currently available to support their impact on reoffending, but also the disproportionate and potentially iatrogenic effects that they have on offenders. However, there have been few attempts to understand these issues from the perspective of those practitioners who work on a daily basis with sex offenders in the community. These professionals are uniquely placed to contribute to an understanding of effective risk management and, as such, this article presents an analysis of the perspectives of a group of experienced practitioners and how this practice-based wisdom might inform the development of sex offender public policy.

Effectiveness of interventions for convicted DUI offenders in reducing recidivism: a systematic review of the peer-reviewed scientific literature

Abstract Background: Driving under the influence (DUI) is a major cause of death and disability. Although a broad array of programs designed to curb DUI incidents are currently offered to both first-time and recidivist DUI offenders, existing evaluations of the effectiveness of these programs have reported mixed results. Objective: To synthesize the results of DUI program evaluations and determine the strength of the available evidence for reducing recidivism for different types of programs. Methods: A systematic review of all EBSCO databases, EMBASE, PubMed, ProQuest, Sociological Abstracts and TRIS was conducted to identify evaluations of treatments/interventions to prevent DUI offenses. Additional articles were identified from reference lists of relevant articles. Results: A total of 42 relevant studies were identified by the search strategy. Of these, 33 utilized non-experimental evaluation designs or reported insufficient data to allow effect sizes to be calculated, making meta-analysis unfeasible. Evaluations of several different program types reported evidence of some level of effectiveness. Conclusion: Because of the general lack of high quality evidence assessing the effectiveness of DUI prevention programs, it is not possible to make conclusive statements about the types of programs that are likely to be most effective. Nonetheless, there was some evidence to support the effectiveness of programs that utilize intensive supervision and education. There is a need for future evaluations to adopt more scientifically rigorous research designs to establish the effects of these programs.

A model for predicting clinician satisfaction with clinical supervision

Clinical supervision can improve staff satisfaction and reduce stress and burnout within the workplace and can be a component of organizational readiness to implement evidence-based practice. This study explores clinical supervision processes in alcohol and drug counselors working in telephone and online services, assessing how their experiences of supervision link to workplace satisfaction and well-being. Standardized surveys (Manchester Clinical Supervision Scale and the TCU Survey of Organizational Functioning) were completed by 43 alcohol and drug telephone counselors. Consistency of supervisors and good communication were the strongest predictors of satisfaction with clinical supervision, and satisfaction with supervision was a good predictor of overall workplace satisfaction. © 2014 Copyright Taylor and Francis Group, LLC.

A decade of change in Australia’s DBA landscape

Purpose – The purpose of this paper is to examine the dynamics of the Doctorate of Business Administration (DBA) in Australia through the lens of a changing higher education landscape. The paper reflects on issues raised in a previous analysis of DBA programmes undertaken a decade ago, and highlights persistent challenges and emerging opportunities for professional Doctorate programmes in the Australian context.Design/methodology/approach – Interviews were undertaken with higher degree research directors, deans of graduate schools, and DBA programme directors from all 18 Australian institutions offering the DBA in 2013. Quantitative data on enrolments, accreditation requirements, course structures; and demographics are contextualised within a qualitative view of programme purposes, student and institutional motivations, rationales and concerns. Particular focus is given to perceptions of the difference between traditional research doctorates (PhDs) and professional doctorates, especially the DBA.Findings – In the decade from 2003 to 2013 DBA enrolments are down but enquiries are up, indicating unmet demand. There is a shift in the players, with some smaller, regional universities dramatically increasing their enrolments, and larger, traditional institutions exiting the space altogether. Significant changes in accreditation criteria have generated a perceptual shift: where DBAs previously suffered from “academic snobbery” regarding their legitimacy, this perception is being challenged by standards which require DBA equivalence with a PhD. This shift in standards has also created some confusion amongst supervisors and candidates.Originality/value – There is limited research into the DBA award or its candidates, and academic literature is generally silent on DBA supervision. This piece of research, one of very few that specifically examine the DBA, reflects on the past decade, analyses the present context and identifies emerging issues for the delivery of DBA programmes in Australia.