Helping someone with problem drinking: mental health first aid guidelines - a Delphi expert consensus study.

BACKGROUND: Alcohol is a leading risk factor for avoidable disease burden. Research suggests that a drinker's social network can play an integral role in addressing hazardous (i.e., high-risk) or problem drinking. Often however, social networks do not have adequate mental health literacy (i.e., knowledge about mental health problems, like problem drinking, or how to treat them). This is a concern as the response that a drinker receives from their social network can have a substantial impact on their willingness to seek help. This paper describes the development of mental health first aid guidelines that inform community members on how to help someone who may have, or may be developing, a drinking problem (i.e., alcohol abuse or dependence). METHODS: A systematic review of the research and lay literature was conducted to develop a 285-item survey containing strategies on how to help someone who may have, or may be developing, a drinking problem. Two panels of experts (consumers/carers and clinicians) individually rated survey items, using a Delphi process. Surveys were completed online or via postal mail. Participants were 99 consumers, carers and clinicians with experience or expertise in problem drinking from Australia, Canada, Ireland, New Zealand, the United Kingdom, and the United States. Items that reached consensus on importance were retained and written into guidelines. RESULTS: The overall response rate across all three rounds was 68.7% (67.6% consumers/carers, 69.2% clinicians), with 184 first aid strategies rated as essential or important by > or =80% of panel members. The endorsed guidelines provide guidance on how to: recognize problem drinking; approach someone if there is concern about their drinking; support the person to change their drinking; respond if they are unwilling to change their drinking; facilitate professional help seeking and respond if professional help is refused; and manage an alcohol-related medical emergency. CONCLUSION: The guidelines provide a consensus-based resource for community members seeking to help someone with a drinking problem. Improving community awareness and understanding of how to identify and support someone with a drinking problem may lead to earlier recognition of problem drinking and greater facilitation of professional help seeking.

Tackling risky alcohol consumption in sport: a cluster randomised controlled trial of an alcohol management intervention with community football clubs

BACKGROUND: An increased prevalence of risky alcohol consumption and alcohol-related harm has been reported for members of sporting groups and at sporting venues compared with non-sporting populations. While sports clubs and venues represent opportune settings to implement strategies to reduce such risks, no controlled trials have been reported. The purpose of the study was to examine the effectiveness of an alcohol management intervention in reducing risky alcohol consumption and the risk of alcohol-related harm among community football club members.

METHOD: A cluster randomised controlled trial of an alcohol management intervention was undertaken with non-elite, community football clubs and their members in New South Wales, Australia. Risky alcohol consumption (5+ drinks) at the club and risk of alcohol-related harm using the Alcohol Use Disorders Identification Test (AUDIT) were measured at baseline and postintervention.

RESULTS: Eighty-eight clubs participated in the trial (n=43, INTERVENTION; n=45, CONTROL) and separate cross-sectional samples of club members completed the baseline (N=1411) and postintervention (N=1143) surveys. Postintervention, a significantly lower proportion of intervention club members reported: risky alcohol consumption at the club ( INTERVENTION: 19%; CONTROL: 24%; OR: 0.63 (95% CI 0.40 to 1.00); p=0.05); risk of alcohol-related harm ( INTERVENTION: 38%; CONTROL: 45%; OR: 0.58 (95% CI 0.38 to 0.87); p<0.01); alcohol consumption risk ( INTERVENTION: 47%; CONTROL: 55%; OR: 0.60 (95% CI 0.41 to 0.87); p<0.01) and possible alcohol dependence ( INTERVENTION: 1%; CONTROL: 4%; OR: 0.20 (95% CI 0.06 to 0.65); p<0.01).

CONCLUSIONS: With large numbers of people worldwide playing, watching and sports officiating, enhancing club-based alcohol management interventions could make a substantial contribution to reducing the burden of alcohol misuse in communities.

The ones that turn up are the ones that are responsible : key stakeholders perspectives on liquor accords

INTRODUCTION AND AIMS: Liquor accords were introduced as an intervention to reduce alcohol-related harm in and around licensed venues. There have been very few evaluations of the accords, made all the more difficult given the multitude of measures that are often implemented under their banner. This study provides perspectives on the effectiveness of the liquor accords from key stakeholders who were involved in the strategy. DESIGN AND METHODS: In-depth interviews were conducted with 97 key stakeholders as part of a larger study, of which 46 spoke about the effectiveness of liquor accords. Responses were analysed using thematic analysis. RESULTS: Stakeholders reported the greatest benefit of liquor accords to be their ability to improve communication. Many stakeholders recognised the need for mandatory attendance and discussed whether the accords are a waste of time of resources. Stakeholders did not generally view liquor accords as effective means of reducing alcohol-related harm. DISCUSSION: There was a lack of positive feedback about liquor accords provided by stakeholders, indicating a clear need to better understand the role of liquor accords, and what they aim to achieve. Responsive regulation theory suggests that the dual roles of communication and intervention are confused, leading to some of the inherent problems with accords. CONCLUSIONS: The role and aims of liquor accords need to be clearly defined. The findings suggest that separating the communication and regulatory functions from accords will lead to a clearer role for accords, and interventions and regulation might be better placed in the hands of regulators and enforcement. [Curtis A, Miller P, Droste N, McFarlane E, Martino F, Palmer D. 'The ones that turn up are the ones that are responsible': Key stakeholders perspectives on liquor accords.

Key stakeholder perspectives of drink restrictions in Newcastle, Australia

Background: The problems associated with alcohol consumption in or around licensed premises in the nighttime economy are extensive. One intervention designed to address these problems is drink restrictions. The aim of the current study is to gain different key stakeholder perspectives on drink restriction interventions, including their ability to reduce alcohol-related harms. Method: This study involves an analysis of key stakeholder perspectives on the introduction of drink restrictions. Interviews were conducted with 23 key stakeholders, including venue licencees, security, and police from Newcastle, Australia. Drink restrictions, including limits on shots and umber of drinks, were part of a mandatory set of interventions, which were implemented as a result of legislative change in New South Wales. As such, key stakeholders were able to provide insight into the implementation and practicality of the restrictions. All interviews were analyzed using thematic analysis.Results: Overall, key stakeholders were mixed in their support for drink restrictions, particularly because of the issues associated with customer preloading and practicality of enforcement. Stakeholders remained unconvinced of the impact of the restrictions on reducing harm. Conclusions: Key stakeholders believe that drink restrictions would almost certainly be more likely to reduce alcohol-related harm in the nighttime economy as part of a larger intervention. However, it is unclear how much impact they have as a standalone harm reduction measure.

The challenge of managing continence care in residential aged care settings : recommendations for research and practice

Incontinence-related problems are a major reason for placement in residential aged care facilities. Data from the Residential Classification Scale indicates that 86% of people in residential aged care facilities in Australia are dependent on others for bladder management, 77% require some support with bowel management and 78% require some support with toileting. In this paper, we present an overview of the literature on the issues that need to be considered for the management of incontinence in residential aged care settings. Based on this literature, we make recommendations for research and practice. Although residential care facilities are mandated to provide continence care, there is little research evidence on which to base care or to evaluate the effectiveness of current practices. Further research is required to address this gap in information to ensure delivery of residential aged care that meets the requirements of the Aged Care Act 1997.

Facets of the polytope of the asymmetric travelling salesman problem with replenishment arcs

The Asymmetric Travelling Salesman Problem with Replenishment Arcs (RATSP) is a new class of problems arising from work related to aircraft routing. Given a digraph with cost on the arcs, a solution of the RATSP, like that of the Asymmetric Travelling Salesman Problem, induces a directed tour in the graph which minimises total cost. However the tour must satisfy additional constraints: the arc set is partitioned into replenishment arcs and ordinary arcs, each node has a non-negative weight associated with it, and the tour cannot accumulate more than some weight limit before a replenishment arc must be used. To enforce this requirement, constraints are needed. We refer to these as replenishment constraints.

In this paper, we review previous polyhedral results for the RATSP and related problems, then prove that two classes of constraints developed in V. Mak and N. Boland [Polyhedral results and exact algorithms for the asymmetric travelling salesman problem with replenishment arcs, Technical Report TR M05/03, School of Information Technology, Deakin University, 2005] are, under appropriate conditions, facet-defining for the RATS polytope.

Who thinks I need a perfect body? Perceptions and internal dialogue among adolescents about their bodies

The main aim of this study was to provide a detailed examination of the nature of the messages that adolescent boys and girls receive about their bodies. Forty adolescent boys and 40 adolescent girls participated in an in-depth interview to gain an understanding of the range of potential ‘sources’ of body-related messages. Messages were organized around the source of these messages (self, mother, father, brother, sister, female friends, male friends, media). There were consistent gender differences in the way that adolescents received and interpreted messages about their bodies. Overall girls received more positive and more negative messages than boys did. Boys reported having received virtually no negative messages from most people. The content of internal dialogue among adolescents revealed that messages about the body could be interpreted, distorted, and deflected. The implications of these findings for preventing body image-related problems and disordered eating among adolescents are discussed.

Measuring moral judgement and the implications of cooperative education and rule-based learning

The Defining Issues Test (DIT), developed by Rest (1986), measures a person's level of moral development using hypothetical social dilemmas. Although the DIT is useful for measuring moral development in social settings, it might not adequately capture an individual's moral judgement abilities in solving work-related problems (Weber, 1990; Trevino, 1992; Welton et al., 1994). In the present study, the moral judgement levels of 97 accounting students were measured over a 1 year period using two separate test instruments, the DIT and a context-specific instrument developed by Welton et al. (1994). The test scores are significantly higher on the DIT than the Welton instrument (between the instruments and over time), suggesting that accounting students use higher levels of moral reasoning in resolving hypothetical social dilemmas and lower levels of moral reasoning in resolving context-specific dilemmas. The difference in test scores was highest during cooperative education (work placement programme), implying that the environment is a significant determinant on students' test scores.

A social identity approach to party drug use and associated harm minimisation

This project investigated party (club) drug use and associated harm minimisation strategies of party drug users (N = 72), by gender and sexual
orientation, to determine whether drug use and harm minimisation behaviours differ in particular social groups.Adopting a social identity approach, this project also explored the existence of a party drug user social identity in relation to harmful party drug behaviours and harm minimisation
strategies.Results indicated that males and females showed similar patterns of harmful party drug use and harm minimisation, whilst heterosexuals and homosexuals differed slightly in their patterns of harmful party drug use, and more substantially in their patterns of harm minimisation.Furthermore, results showed some evidence for the existence of a party drug user social identity, which was related to party drug use within a clear social context, and to experiencing fewer party drug related problems.The authors conclude that harm minimisation initiatives need to be designed for particular social groups, such as heterosexuals or homosexuals, targeting their particular patterns of party drug use, and
suggest that effective harm minimisation strategies should incorporate both the social context in which the behaviour occurs, and the social norms of party drug use by particular social groups.

It starts with the parents and ends with the parents

Alcohol is the most popular recreational drug in Australia. Despite the fact that many people gain enjoyment from alcohol related industries, alcohol is also implicated in much personal trauma and social damage. Parents play a key role in influencing alcohol use and driver behaviour in young people. The aim of this study was to gain an understanding of the attitudes and concerns of parents in Melbourne in relation to their teenage children's use of alcohol and how they educate and/or provide role models for their adolescents with respect to alcohol usage. A convenience sample of parents with adolescent children participated in focus groups. Parents described patterns of alcohol use and perceived influences on consumption. They reported that they wanted to create safe environments for adolescents to consume alcohol but that they needed more support and information on which to base these decisions. There i, an opportunity for public health policy makers to specifically address parents and enhance their role in alcohol related road safety.

Challenging behaviour profiles of people with acquired brain injury living in community settings

Primary objective: To determine the type and severity of challenging behaviours among a cohort of brain-injured persons referred to a community-based behaviour management service; and to determine whether different behaviour profiles were associated with aetiology of brain injury.
Methods and procedures: A sample of clients (n= 190) referred to the ABI Behaviour Consultancy for assessment and treatment of challenging behaviours was evaluated using the Overt Behaviour Scale (OBS) and other measures of disability and support needs.
Main outcomes and results: The most common challenging behaviour categories were, in order of frequency: verbal aggression, inappropriate social behaviours and lack of initiation. Clients typically exhibited four categories of challenging behaviour and multiple kinds of the behaviours represented by each category. There was some evidence of differences in occurrence of specific behaviours associated with aetiology of brain injury, particularly for hypoxia and alcohol-related brain injury.
Conclusions: A systematic assessment of challenging behaviours in community settings has revealed the profiles of broad behavioural disturbance that can occur following ABI. Assessing the breadth of disturbance is important in understanding a client's presentation and thus planning appropriate behaviour management interventions.

Including the siblings of youth substance abusers in a parent-focused intervention : a pilot test of the best plus program

Substance use is common among young people and can escalate into significant problems for affected individuals and their families. Family responses can influence the course of youth substance use and its consequences for family members, including parents and siblings. Family-level interventions developed to date have neglected the important role that siblings can play. This article describes a pilot test of an intervention designed to assist parents and siblings affected by youth substance use and related problems. The BEST Plus intervention consisting of professionally-led, multifamily groups sequenced over eight sessions is described with reference to the intended therapeutic processes. Professionally observed and self-reported changes for family participants including siblings suggested that the program had a beneficial therapeutic impact. This evaluation of early impacts suggests the BEST Plus program
offers a promising means of assisting families to respond to substance use problems in young people.

The impact of childhood conditions and concurrent morbidities on child health and well-being

Background. Understanding the impact of illnesses and morbidities experienced by children and adolescents is essential to clinical and population health programme decision making and intervention research. This study sought to: (1) examine the population prevalence of physical and mental health conditions for children and quantify their impact on multiple dimensions of children's health and well-being; and (2) examine the cumulative effect of concurrent conditions.

Methods. We conducted a cross-sectional school-based epidemiological study of 5414 children and adolescents aged 5–18 years, and examined parental reports of child health and well-being using the parent-report Child Health Questionnaire (CHQ) PF50 13 scales are scored on a 0–100 pt scale with clinically meaningful differences of five points and the presence of childhood conditions (illnesses and health problems).

Results. Asthma, dental, vision and allergies are the most commonly identified health problems for children and adolescents, followed by attention- and behaviour-related problems (asthma 17.9–23.2%, dental 11.9–22.7%, vision 7.2–14.7%, chronic allergies 8.8–13.9%, attention problems 5.1–13.8% and behaviour problems 5.7–12.0%). As the number of concurrent health problems increase, overall health and well-being decreases substantively with mean differences in CHQ scale scores of 14 points (−7.69 to −21.51) for physical health conditions, and 28 points (−5.15 to −33.81) for mental health conditions.

Conclusions. Children's health and well-being decreases linearly with increasing presence and frequency of health problems. Having three or more conditions concurrently significantly burdens children's health and well-being, particularly for family-related CHQ domains, with a greater burden experienced for mental health conditions than physical health conditions.

Longitudinal examination of physical and relational aggression as precursors to later problem behaviors in adolescents

Research has addressed the consequences of being a victim of physical and relational aggression but less so the consequences of being an aggressor during adolescence. Consequently, relatively little is known about the extent to which aggression in early adolescence increases the risk of later aggression and other psychosocial problems. This study involves a representative sample of seventh- and ninth-grade students from Washington State ( N = 1,942). Students were surveyed on recruitment and then again 1 and 2 years later to learn about ongoing behavior problems, substance use, depression, and self-harm behaviors. Surveys also included measures of several hypothesized promotive factors: attachment to family, school commitment, and academic achievement. Findings suggest that being physically and/or relationally aggressive in grades 7 to 9 increases the risk of aggression and possibly other problem behaviors after accounting for age, gender, race, and a prior measure of each outcome. Independent promotive effects were observed in most analyses, although family attachment appeared a less robust predictor overall. Implications for prevention include acting on the behavior itself and enhancing promotive influences to lessen the risk of agression and other related problems.

The development of CBT programmes for anger : the role of interventions to promote perspective-taking skills

Although the emotion of anger has, in recent years, been the subject of increasing theoretical analysis, there are relatively few accounts of how interventions designed to reduce problematic anger might be related to cognitively oriented theories of emotion. In this review of the literature we describe how a cognitive-behavioural approach to the treatment of those with anger-related problems might be understood in relation to conceptualizations of anger from a cognitive perspective. Three additional interventions (visual feedback, chair-work, forgiveness therapy) are identified that aim to improve the perspective-taking skills of angry clients. It is concluded that such interventions might be considered for use within the context of cognitive-behavioural treatment.