Social and professional participation of individuals who are deaf : utilizing the psychosocial potential maximization framework

This article documents a strength-based understanding of how individuals who are deaf maximize their social and professional potential. This exploratory study was conducted with 49 adult participants who are deaf (n ¼ 30) and who have typical hearing (n ¼ 19) residing in America, Australia, England, and South Africa. The findings support a systematic and comprehensive framework of proactive psychosocial attributes and tactics. Statistical analysis showed no significant differences between the groups across four variables of psychosocial competencies. Qualitative data further suggests that participants who are deaf maximize their potential using two types of proactive psychosocial attributes and tactics: 1) skills that individuals with typical hearing use and 2) specialized skills for identifying, circumventing, or mastering deafness-related difficulties. These findings contribute to understandings of how individuals who are deaf can achieve social and professional success.

The conversational skills of school-aged children with cochlear implants

Children with cochlear implants have been shown to have language skills on a par with children with severe hearing losses who have hearing aids. Earlier implants, bilateral implantation, and focused intervention programmes may result in some children with cochlear implants displaying similar language skills to their hearing peers. The development of pragmatic skills is central to communication competence and underpins the development of friendships. Although some studies of pragmatic skills in children with cochlear implants have been reported, most have used a contrived referential communication task rather than free conversation.

Method: This study investigated the conversational skills of 20 children with cochlear implants, aged between 9 and 12 years, in free conversation with their hearing peers. The pragmatic skills of these 20 deaf/hearing pairs or dyads were compared with the pragmatic skills of 20 hearing/hearing dyads. Pragmatic skills were analysed in terms of conversational balance, conversational turn types, and conversational maintenance. The impact of the participants’ level of speech intelligibility was also investigated.

Results: Children with cochlear implants tend to dominate conversations with their hearing peers. They initiated more topics, took longer turns, asked more questions, and tended to make more personal comments while their hearing friends tended to use more conversational devices and minimal answers. In contrast, pairs of matched hearing children were very balanced in all of these aspects of conversation. Speech intelligibility did not appear to impact consistently on the pragmatic skills of the children with cochlear implants but all children had a relatively high level of speech intelligibility.

Discussion: Rather than being characterized by frequent conversational breakdown as in older studies, children with cochlear implants had a strong grasp of basic conversational rules. They conversed in a similar way to some deaf adults who also have been shown to take control of the conversation. Findings are discussed for their implications for intervention and future research.

Comparison of optimised MDI versus pumps with or without sensors in severe hypoglycaemia (the Hypo COMPaSS trial)

Background
Severe hypoglycaemia (SH) is one of the most feared complications of type 1 diabetes (T1DM) with a reported prevalence of nearly 40%. In randomized trials of Multiple Daily Injections (MDI) and Continuous Subcutaneous Insulin Infusion (CSII) therapy there is a possible benefit of CSII in reducing SH. However few trials have used basal insulin analogues as the basal insulin in the MDI group and individuals with established SH have often been excluded from prospective studies. In published studies investigating the effect of Real Time Continuous Glucose Monitoring (RT-CGM) benefit in terms of reduced SH has not yet been demonstrated. The primary objective of this study is to elucidate whether in people with T1DM complicated by impaired awareness of hypoglycaemia (IAH), rigorous prevention of biochemical hypoglycaemia using optimized existing self-management technology and educational support will restore awareness and reduce risk of recurrent SH.

Methods/design
This is a multicentre prospective RCT comparing hypoglycaemia avoidance with optimized MDI and CSII with or without RT-CGM in a 2×2 factorial design in people with type 1 diabetes who have IAH. The primary outcome measure for this study is the difference in IAH (Gold score) at 24 weeks. Secondary outcomes include biomedical measures such as HbA1c, SH incidence, blinded CGM analysis, self monitored blood glucose (SMBG) and response to hypoglycaemia in gold standard clamp studies. Psychosocial measures including well-being and quality of life will also be assessed using several validated and novel measures. Analysis will be on an intention-to-treat basis.

Discussion
Most existing RCTs using this study’s interventions have been powered for change in HbA1c rather than IAH or SH. This trial will demonstrate whether IAH can be reversed and SH prevented in people with T1DM in even those at highest risk by using optimized conventional management and existing technology.

Do we need both cognitive and behavioural components in interventions for depressed mood in people with mild intellectual disability?

 Background: A growing literature suggests that people with mild intellectual disability (ID) who have depressed mood may benefit from cognitive-behavioural interventions. There has been some speculation regarding the relative merit of the components of this approach. The aim of this study was to compare (i) cognitive strategies; (ii) behavioural strategies; and (iii) combined cognitive-behavioural (CB) strategies on depressed mood among a sample of 70 individuals with mild ID. Methods: Staff from three participating agencies received training in how to screen individuals with mild ID for depressive symptoms and risk factors for depression. Depressive symptoms and negative automatic thoughts were assessed prior to and at the conclusion of the intervention, and at 6-month follow-up. The interventions were run in groups by the same therapist. Results: A post-intervention reduction in depression scores was evident in participants of all three interventions, with no significant difference between groups. A significant reduction in negative automatic thoughts post-intervention was evident in the CB combination group and was maintained at follow-up. Examination of clinical effectiveness suggests some advantage of the CB combination in terms of improvement and highlights the possible short term impact of behavioural strategies in comparison with the longer-term potential of cognitive strategies. Conclusions: The findings support the use of group cognitive-behavioural interventions for addressing symptoms of depression among people with ID. Further research is necessary to determine the effectiveness of components. © 2013 John Wiley & Sons Ltd.

Excessive alcohol use and its association with risky sexual behaviour: a cross-sectional analysis of data from Victorian secondary school students

Objective
Estimate the prevalence of sexual behaviour and alcohol use and examine the association between excessive alcohol use and risky sexual behaviour in late secondary students in Victoria, Australia.

Method
The sample of Year 11 students from government and independent schools participating in the 2008 International Youth Development Study (n=450) was representative of the Victorian school population. Logistic regression analyses examined the associations between sexual behaviour, binge and compulsive drinking, adjusting for socio-demographic, school and family factors.

Results
Under half (44%) the students had experienced sex in the past year, half (50%) had engaged in binge drinking in the past two weeks and 26% reported compulsive drinking in the past year. Of those who reported sex in the past year (n=197), 34% had sex without a condom at the last sexual encounter and 28% later regretted sex due to alcohol. The likelihood of experiencing sex was increased by binge (OR=2.44, 95%CI 1.44-4.12) and compulsive drinking (OR=2.15, 95%CI 1.29-3.60). For those sexually active, binge drinking increased the risk of having three or more sexual partners (OR=3.37, 95%CI 1.11-10.26) and compulsive drinking increased the likelihood of regretted sex due to alcohol (OR=4.43, 95%CI 2.10-9.31). Excessive drinking was not associated with condom non-use.

Conclusion and implications
Risky sex – multiple sexual partners and regretted sex due to alcohol – and excessive drinking are highly prevalent and co-associated among Victorian late secondary students.

Living with suicidal thoughts

The dominant understandings of suicide have privileged the professional observations of health professionals and sociologists over the lived experiences of persons who have reported feeling suicidal. The current study explores what it is like to feel suicidal by examining comments posted voluntarily in an online forum. Adopting an inductive thematic analysis, a number of themes were uncovered which shed light on the following questions: Who has suicidal thoughts? What triggers suicidal thoughts? What is it like to feel suicidal? Also drawn from the data, was information relating to the types of treatments that people received, as well as ongoing survival strategies that people have relied on. The fi ndings indicated people with suicidal thoughts form a heterogeneous group with mixed opinions about the causes of suicidal thoughts. The findings also highlighted a variety of experiences, descriptions and means for survival highlighting the depth of insight that those with fi rst-hand experience have about suicidal thoughts, highlighting also the deep gap in knowledge and understanding in the existing literature about suicide and suicidal ideation. The recommendations for future direction in practice and research include, listening to, and valuing more, the voices and perspectives of suicidal people themselves.

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. 

Improving access to the justice system for people with communication difficulties : a training program for people working in the justice system

This training package is provided as a guide and resource to promote awareness and understanding of people who have complex communication needs and give people who work in law and justice system strategies to facilitate successful communication interactions. Complex communication needs are defined as communication problems associated with a wide range of physical, sensory and environmental causes which restrict/limit an individual's ability to participate independently in society. They and their communication partners may benefit from using Alternative and Augmentative Communication (AAC) methods. Alternative and Augmentative Communication (AAC) is an approach or communication system that makes it possible for a person without speech to communicate. AAC includes gestures and sign language, picture and alphabet boards and high technology electronic communication devices that produce computerised speech. Many people with complex communication needs use a combination of AAC communication to express themselves. It is hoped that this package will facilitate access to the justice system for a group of people who may experience social disadvantage as a result of their complex communication needs. The information included in the package is not exhaustive. It is designed to : provide the trainer and staff with a general understanding of complex communication needs; challenge misconceptions about people who have little or no functional speech; provide practical strategies and guidelines to assist staff to more successfully communicate with people with complex communication needs.

Group cognitive behavioural therapy program shows potential in reducing symptoms of depression and stress among young people with ASD

We examined the efficacy of cognitive behavioural therapy (CBT) delivered in groups on the reduction of symptoms of depression, anxiety and stress in young people on the autism spectrum. Utilising a quasi-experimental design, comparisons were made between individuals allocated to a group intervention program and individuals allocated to a waitlist. Following the intervention program, participants who were initially symptomatic reported significantly lower depression and stress scores on the Depression Anxiety Stress Scales in comparison to individuals on the waitlist. There was no significant change in anxiety related symptoms. The benefits were maintained at 3 and 9 month follow-up. Our findings demonstrate the potential of CBT in a small group setting for assisting young people with ASD who have symptoms of depression and stress.

Looking for a needle in the haystack: arsonists with intellectual disability in Australia

Arson attracts substantial penalties in Australia, reflecting the serious consequences of the crime. It is often asserted that people with intellectual disability are particularly likely to commit arson offences, and yet it is difficult to establish the prevalence in this population. This study sought to describe the characteristics of those people appearing in Australian Courts who have an intellectual disability and have been charged with arson. A search of the AustLII, LexisNexisAU and WestLawAU databases over the 10-year period from 2003 to 2013 identified 50 arson convictions reported in case law. Of these, six involved an offender with an identified intellectual disability. These offenders were likely to have committed other crimes at the time, or to have prior offences and were likely to receive longer sentences of imprisonment than their non-intellectually disabled counterparts. These findings are discussed in terms of the barriers that exist to understanding more about this under-researched population.

Barriers and enablers to learning during team-based clinical simulations: reflective interviews with final year undergraduate nursing students

Background: Contemporary approaches to clinical simulation can enhance educational outcomes. However, simulation approaches do have limitations with possible compromises for learning and teaching. This paper aims to identify barriers
and enablers to learning in simulated clinical settings.
Methods: A generic qualitative design was applied. Semi-structured group video debriefing interviews were held with Australian final-year nursing students who completed three patient deterioration scenarios with a standardized patient.
Audio-recorded interviews were transcribed and analysed to identify emergent themes.
Results: Interviews with 15 teams of three students (n = 45) from three universities were analysed. Learning enablers were ‘Realism of the simulated environment’; ‘Practicing: we should do this at uni’; ‘Learning from reflection and expert feedback’, and ‘How to become competent: know the gaps’. Barriers to learning included ‘Increased stress from inexperience; ‘Expectations when pretending’ and ‘Lack of assistance’. Skills practice in team-based settings with applicable reflection and debriefing was regarded as beneficial. Simulated patients enhanced fidelity but were unable to replicate actual clinical signs. High stress levels were perceived as a barrier to learning.
Conclusions: Applicably designed high fidelity simulations with video-based reflective review offer repeated rehearsal of clinical situations to enable learning. This educational strategy may reduce the time it takes undergraduate students to
reach competency.

First-time offender, productive offender, offender with dependents: why the profile of offenders (sometimes) matters in sentencing

Should a single mother of four young children who commits theft be sentenced to a lesser sanction than a woman who commits the same crime but has no dependents? Should a billionaire philanthropist be sentenced to a lesser penalty than the average citizen for assaulting a random bystander? Should a first-time thief receive a lighter sanction than a career thief for the same theft? The relevance of an offender’s profile to sentencing is unclear and is one of the most under-researched and least coherent areas of sentencing law. Intuitively, there is some appeal in treating offenders without a criminal record, those who have made a positive contribution to society, or who have dependents more leniently than other offenders. However, to allow these considerations to mitigate penalty potentially licenses offenders to commit crime and decouples the sanction from the severity of the offense, thereby undermining the proportionality principle. This article analyzes the relevance that an offender’s profile should have in sentencing. We conclude that a lack of prior convictions should generally reduce penalty because the empirical data shows that, in relation to most offenses, first-time offenders are less likely to reoffend than recidivist offenders. The situation is more complex in relation to offenders who have made worthy social contributions. They should not be given sentencing credit for past achievements given that past good acts have no relevance to the proper objectives of sentencing and it is normally not tenable, even in a crude sense, to make an informed assessment of an individual’s overall societal contribution. However, offenders should be accorded a sentencing reduction if they have financial or physical dependents and if imprisoning them is likely to cause harm to their dependents. Conferring asentencing discount to first-time offenders and those withdependents does not license them to commit crime or unjustifiablyencroach on the proportionality principle. Rather, it recognizes thedifferent layers of the legal system and the reality that sentencinglaw should not reflexively overwhelm broader maxims of justice,including the principle that innocent people should not suffer. Thisarticle argues that fundamental legislative reform is necessary toproperly reflect the role that the profile of offenders should have inthe sentencing regime.

Cocos Malay language since integration with Australia

The Cocos (Keeling) Islands are a remote Australian territory in the Indian Ocean and arehome to the Cocos Malay people, who have developed a distinct dialect. It waspredicted over 30 years ago that the Cocos Malay language faced extinction, perhapseven within the timeframe of one generation. Two possible threats to the Cocos Malaylanguage were identified. It was felt that English, as the language of power, may replacethe Cocos Malay language. The other possibility was language convergence, whereCocos Malay would be subsumed by another, larger Malay dialect. With these issues inmind, I explore developments in the Cocos Malay language since the Islands’ fullintegration with Australia in 1984. Drawing from extensive ethnographic work andlinguistic research into Cocos Malay I also refer to the work of other researchers toanalyse how the Cocos Malay language has developed over the past 30 years, in a timeof great social change. I argue that integration with Australia and attempts atassimilation have resulted in social dynamics where Cocos Malay language remains adefining marker of Cocos Malay identity positioning. In this social environment, CocosMalay therefore remains viable and, despite language change, does not face immediateextinction.

A critical ethnography of communication processes involving the management of oral chemotherapeutic agents by patients with a primary diagnosis of colorectal cancer: study protocol.

AIM: To describe the protocol used to examine the processes of communication between health professionals, patients and informal carers during the management of oral chemotherapeutic medicines to identify factors that promote or inhibit medicine concordance. BACKGROUND: Ideally communication practices about oral medicines should incorporate shared decision-making, two-way dialogue and an equality of role between practitioner and patient. While there is evidence that healthcare professionals are adopting these concordant elements in general practice there are still some patients who have a passive role during consultations. Considering oral chemotherapeutic medications, there is a paucity of research about communication practices which is surprising given the high risk of toxicity associated with chemotherapy. DESIGN: A critical ethnographic design will be used, incorporating non-participant observations, individual semi-structured and focus-group interviews as several collecting methods. METHODS: Observations will be carried out on the interactions between healthcare professionals (physicians, nurses and pharmacists) and patients in the outpatient departments where prescriptions are explained and supplied and on follow-up consultations where treatment regimens are monitored. Interviews will be conducted with patients and their informal carers. Focus-groups will be carried out with healthcare professionals at the conclusion of the study. These several will be analysed using thematic analysis. This research is funded by the Department for Employment and Learning in Northern Ireland (Awarded February 2012). DISCUSSION: Dissemination of these findings will contribute to the understanding of issues involved when communicating with people about oral chemotherapy. It is anticipated that findings will inform education, practice and policy.

Assisting Australians with mental health problems and financial difficulties: a Delphi study to develop guidelines for financial counsellors, financial institution staff, mental health professionals and carers

BACKGROUND: There is a strong association between mental health problems and financial difficulties. Therefore, people who work with those who have financial difficulties (financial counsellors and financial institution staff) need to have knowledge and helping skills relevant to mental health problems. Conversely, people who support those with mental health problems (mental health professionals and carers) may need to have knowledge and helping skills relevant to financial difficulties. The Delphi expert consensus method was used to develop guidelines for people who work with or support those with mental health problems and financial difficulties.

METHODS: A systematic review of websites, books and journal articles was conducted to develop a questionnaire containing items about the knowledge, skills and actions relevant to working with or supporting someone with mental health problems and financial difficulties. These items were rated over three rounds by five Australian expert panels comprising of financial counsellors (n = 33), financial institution staff (n = 54), mental health professionals (n = 31), consumers (n = 20) and carers (n = 24).

RESULTS: A total of 897 items were rated, with 462 items endorsed by at least 80 % of members of each of the expert panels. These endorsed statements were used to develop a set of guidelines for financial counsellors, financial institution staff, mental health professionals and carers about how to assist someone with mental health problems and financial difficulties.

CONCLUSIONS: A diverse group of expert panel members were able to reach substantial consensus on the knowledge, skills and actions needed to work with and support people with mental health problems and financial difficulties. These guidelines can be used to inform policy and practice in the financial and mental health sectors.