Working with people who have killed: The experience and attitudes of forensic mental health clinicians working with forensic patients

Forensic mental health (FMH) clinicians sometimes feel unsupported and unprepared for their work. This article explores their experiences of working in a FMH setting in Australia. The research examined the clinical context of clinicians working with forensic patients (FP), particularly those individuals who have killed while experiencing a mental illness. A qualitative, exploratory design was selected. Data were collected through focus groups and individual interviews with hospital and community-based forensic clinicians from all professional groups: psychiatric medicine, social work, psychology, mental health nursing, occupational therapy, and psychiatric service officers. The main themes identified were orientation and adjustment to FMH, training in FMH, vicarious traumatization, clinical debriefing and clinical supervision, and therapeutic relationships. Participants described being frustrated and unsupported in making the transition to working with FP and felt conflicted by the emotional response that was generated when developing therapeutic relationships. Recommendations include the development of programmes that might assist clinicians and address gaps in service delivery, such as clinical governance, targeted orientation programmes, and clinical supervision.

Findings of the first ANZICS conference on the role of intensive care in Rapid Response Teams.

Rapid Response Teams (RRTs) are specialised teams introduced into hospitals to improve the outcomes of deteriorating ward patients. Although Rapid Response Systems (RRSs) were developed by the intensive care unit (ICU) community, there is variability in their delivery, and consultant involvement, supervision and leadership appears to be relatively infrequent. In July 2014, the Australian and New Zealand Intensive Care Society (ANZICS) convened the first conference on the role of intensive care medicine in RRTs in Australia and New Zealand. The conference explored RRSs in the broader role of patient safety, resourcing and staffing of RRTs, effect on ICU workload, different RRT models, the outcomes of RRT patients and original research projects in the area of RRSs. Issues around education and training of both ICU registrars and nurses were examined, and the role of team training explored. Measures to assess the effectiveness of the RRS and RRT at the level of health system and hospital, team performance and team effectiveness were discussed, and the need to develop a bi-national ANZICS RRT patient database was presented. Strategies to prevent patient deterioration in the 'pre-RRT' period were discussed, including education of ward nurses and doctors, as well as an overarching governance structure. The role of the ICU in deteriorating ward patients was debated and an integrated model of acute care presented. This article summarises the findings of the conference and presents recommendations on the role of intensive care medicine in RRTs in Australia and New Zealand.

The diversity and complexity of settings and arrangements forming the ‘experienced environments’ for doctoral candidates : some implications for doctoral education

A significant feature of contemporary doctoral education is the continuing trend for research and research education to migrate beyond discipline-based institutional teaching and research structures. The result is a more diverse array of settings and arrangements for doctoral education linked to an increasingly global research enterprise. Recognising the complexity of what is a distributed environment challenges some commonly held assumptions about doctoral education and its practice. Drawing on data gathered in an Australian study of PhD programme development in Australia carried out in 2006–2009, the article describes the fluid and complex arrangements forming the ‘experienced environments’ for doctoral candidates, an environment that can afford them varying opportunities and challenges for completing their candidacy. Some implications for doctoral education are discussed.

Evaluation of a comprehensive interactive training system for investigative interviewers of children

This article reports on the evaluation of an interactive interviewer training system with a large, heterogeneous sample of investigative interviewers of children. The system, delivered predominantly through computer-assisted learning activities, focused on how to elicit important evidential details from child witnesses in a narrative format. Two studies are reported, each adopting a pre-versus posttraining design. Study 1 examined the effect of the training on trainees' (N = 92) performance, using mock interviews where an actor played the role of the child in a highly controlled manner. Study 2 examined the effect of the training on field interviews (N = 156) conducted prior to and after the training. Five measures were analyzed: (a) proportion of interviewer question types, (b) proportion of desirable interviewer behaviors, (c) adherence to the interview protocol, (d) interview length, and (e) the quality of evidential information sought. Overall, the findings provide clear support for the utility of the training system. Irrespective of the type of interview or measure, adherence to best-practice interviewing increased from pre- to posttraining, with some evidence supporting sustained performance 12 months after there had been no intervening training or supervision. The implication is that there is now an evidence-based alternative to the traditional classroom-based training system for investigative interviewers. Suggestions for future research are also discussed.

What doesn’t kill you makes you fitter: A systematic review of high-intensity interval exercise for patients with cardiovascular and metabolic diseases

High-intensity interval exercise (HIIE) has gained popularity in recent years for patients with cardiovascular and metabolic diseases. Despite potential benefits, concerns remain about the safety of the acute response (during and/or within 24 hours postexercise) to a single session of HIIE for these cohorts. Therefore, the aim of this study was to perform a systematic review to evaluate the safety of acute HIIE for people with cardiometabolic diseases. Electronic databases were searched for studies published prior to January 2015, which reported the acute responses of patients with cardiometabolic diseases to HIIE (≥80% peak power output or ≥85% peak aerobic power, VO2peak). Eleven studies met the inclusion criteria (n = 156; clinically stable, aged 27-66 years), with 13 adverse responses reported (∼8% of individuals). The rate of adverse responses is somewhat higher compared to the previously reported risk during moderate-intensity exercise. Caution must be taken when prescribing HIIE to patients with cardiometabolic disease. Patients who wish to perform HIIE should be clinically stable, have had recent exposure to at least regular moderate-intensity exercise, and have appropriate supervision and monitoring during and after the exercise session.

The implications of contractualism for the responsibilisation of higher education

Within the context of heightened perceptions of risk within thehigher education sector worldwide, responsibility for outcomes isincreasingly required not only of universities but, also, ofindividual academics. In turn, contracts have become a key formof governance for institutions in mediating and modulating thisrisk and responsibility. While much writing around the use ofcontracts in higher education has focused on market-based,competitive neoliberal conceptions of contractualism, thisarticle argues that there are, in fact, two largely antagonisticnew modes of contractualism – market contractualism andrelational contractualism – and a third, residual mode, paternalcontractualism. These three modes of contractualism coexistwithin universities, in tension. The article draws on two Australianexemplars to highlight how these tensions play out and tohighlight the potential for contractualism to create spaces forshared goals and projects and shared risks resulting from theways in which responsibility and individual agency are negotiated.

Organizational commitment in Chinese small- and medium-sized enterprises: the role of extrinsic, intrinsic and social rewards

This study investigates the relationship between organizational rewards and employee commitment in Chinese small- and medium-sized enterprises (SMEs). Hierarchical regression analysis was utilized to analyse survey data from 286 employees of 11 organizations. In line with what was hypothesized extrinsic rewards were found to be strongly related to both affective and continuance commitment, whereas satisfaction with supervision and role clarity positively influenced affective commitment. In contrast to previous empirical findings, autonomy and training provision were only found to influence continuance commitment. These findings have significant managerial implications regarding the utility of providing organizational rewards to enhance the commitment of Chinese employees. In order to promote employee commitment, SME managers could start by giving their employees greater autonomy and clarity regarding their role in the organization, as well as improving supervisor support. These are relatively inexpensive measures compared to the costly alternatives of improving extrinsic benefit packages and investing in employee training.

Tightening eligibility for bail for persons on supervision orders in Victoria: repairing a broken system?

Victoria Nourse has observed that political debates about crime legislation are predictable and invariably one-sided because ‘no-one is “for” crime.’1 This certainly appears to be the case with regard to recent proposed changes to the Bail Act 1977 (‘the Act’) by the government of Victoria. The reforms were triggered by the case of Sean Price, an offender with a history of mental disorder, serious offending and lengthy incarceration who was on bail and subject to a supervision order when he murdered Masa Vukotic, raped another woman and assaulted a third person in March 2015. The Premier of Victoria, Daniel Andrews, stated that a bail system that allowed Price to be free and unmonitored was failing the community and pledged to repair ‘a system that is broken.’

Self-practice and self-reflection in training of psychological interventions and therapist skills development: A qualitative meta-synthesis review

© 2015 Australian Psychological Society. Objective: The use of self-practice and self-reflection has been proposed as an efficacious strategy in the training of therapists. It has been argued to enhance therapist skills, and a key factor in the development of expertise. This systematic literature review investigated the effect of self-practice and self-reflection on therapist skills development. Method: Studies were identified through Medline, Academic Search Complete, PsychINFO, PsycARTICLES, Proquest, ISI, CINAHL, Cochrane, and Scopus databases. Additional studies were identified through lateral searches of relevant papers' reference lists and direct correspondence with authors of unpublished material. The selection criteria were studies that investigated the effect of self-practice and/or self-reflection on therapist skill development. There was no restriction on sample sizes, design of studies, dates of publication, or peer-reviewed papers. All studies were published in English. Results: Ten studies were included in this review. A thematic analysis was undertaken to analyse qualitative data. Due to inconsistency in the variables investigated across the quantitative studies, quantitative results were not subject to a meta-analysis but simply reported. Finally, qualitative and quantitative data were juxtaposed in a meta-synthesis. Conclusion: The meta-synthesis revealed inconsistencies between the qualitative and quantitative literature and a gap in relation to declarative knowledge. Methodological limitations across studies are discussed and recommendations for future research provided.

Learning vector representation of medical objects via EMR-driven nonnegative restricted Boltzmann machines (eNRBM)

Electronic medical record (EMR) offers promises for novel analytics. However, manual feature engineering from EMR is labor intensive because EMR is complex - it contains temporal, mixed-type and multimodal data packed in irregular episodes. We present a computational framework to harness EMR with minimal human supervision via restricted Boltzmann machine (RBM). The framework derives a new representation of medical objects by embedding them in a low-dimensional vector space. This new representation facilitates algebraic and statistical manipulations such as projection onto 2D plane (thereby offering intuitive visualization), object grouping (hence enabling automated phenotyping), and risk stratification. To enhance model interpretability, we introduced two constraints into model parameters: (a) nonnegative coefficients, and (b) structural smoothness. These result in a novel model called eNRBM (EMR-driven nonnegative RBM). We demonstrate the capability of the eNRBM on a cohort of 7578 mental health patients under suicide risk assessment. The derived representation not only shows clinically meaningful feature grouping but also facilitates short-term risk stratification. The F-scores, 0.21 for moderate-risk and 0.36 for high-risk, are significantly higher than those obtained by clinicians and competitive with the results obtained by support vector machines.

Nonparametric discovery of movement patterns from accelerometer signals

Monitoring daily physical activity plays an important role in disease prevention and intervention. This paper proposes an approach to monitor the body movement intensity levels from accelerometer data. We collect the data using the accelerometer in a realistic setting without any supervision. The ground-truth of activities is provided by the participants themselves using an experience sampling application running on their mobile phones. We compute a novel feature that has a strong correlation with the movement intensity. We use the hierarchical Dirichlet process (HDP) model to detect the activity levels from this feature. Consisting of Bayesian nonparametric priors over the parameters the model can infer the number of levels automatically. By demonstrating the approach on the publicly available USC-HAD dataset that includes ground-truth activity labels, we show a strong correlation between the discovered activity levels and the movement intensity of the activities. This correlation is further confirmed using our newly collected dataset. We further use the extracted patterns as features for clustering and classifying the activity sequences to improve performance.

What factors contribute to failure of fieldwork placement? Perspectives of supervisors and university fieldwork educators

Failing a fieldwork placement can be a challenging and emotional experience. This study aimed to explore the perspectives of placement supervisors and university fieldwork educators (UFEs) of the factors that contribute to occupational therapy students failing placement. Twenty placement supervisors and four UFEs participated, and completed single instance surveys and interviews. Failure of a placement was noted to be a stressful experience for all stakeholders. Reasons identified for student failure included poor communication and reflection skills; non-disclosure of health issues and an inability to accept feedback. Placement supervisors highlighted that although failing a student was difficult, there was a need to uphold the values and standards of the profession. Strategies to facilitate placement success were identified.

Online video-based resistance training improves the physical capacity of junior basketball athletes

Junior basketball athletes require a well-designed resistance training program to improve their physical development. Lack of expert supervision and resistance training in junior development pathways may be overcome by implementing an online video-based program. The aim of this study was to compare the magnitude of improvement (change) in physical performance and strength and functional movement patterns of junior basketball athletes using either a fully supervised or an online video-based resistance training program. Thirty-eight junior basketball athletes (males, n = 17; age, 14 ± 1 year; height, 1.79 ± 0.10 m; mass, 67 ± 12 kg; females, n = 21; age, 15 ± 1 year; height, 1.70 ± 0.07 m; mass, 62 ± 8 kg) were randomly assigned into a supervised resistance training group (SG, n = 13), video training group (VG, n = 13) or control group (CG, n = 12) and participated in a 6-week controlled experimental trial. Pre- and posttesting included measures of physical performance (20-m sprint, step-in vertical jump, agility, sit and reach, line drill, and Yo-Yo intermittent recovery level 1), strength (15 s push-up and pull-up), and functional movement screening (FMS). Both SG and VG achieved 3-5% ± 2-4% (mean ± 90% confidence limits) greater improvements in several physical performance measures (vertical jump height, 20-m sprint time, and Yo-Yo endurance performance) and a 28 ± 21% greater improvement in push-up strength compared with the CG. The SG attained substantially larger gains in FMS scores over both the VG (12 ± 10%) and CG (13 ± 8%). Video-based training appears to be a viable option to improve physical performance and strength in junior basketball athletes. Qualified supervision is recommended to improve functional movement patterns in junior athletes.

Clinical supervision training across contexts.

BACKGROUND: Clinicians require specific skills to teach or supervise students in the workplace; however, there are barriers to accessing faculty member development, such as time, cost and suitability. The Clinical Supervision Support Across Contexts (ClinSSAC) programme was designed to provide accessible interprofessional educator training to clinical supervisors across a wide range of clinical settings. CONTEXT: In Australia there are increasing numbers of health care students, creating pressure on existing placements. Students are now increasingly learning in community settings, where clinicians have traditionally had less access to faculty member development. INNOVATION: An interprofessional team collaborated in the development and implementation of ClinSSAC. A total of 978 clinicians participated in a face-to-face, interactive, introductory module to clinical supervision; 672 people accessed the equivalent online core module, with 23 per cent completing all activities. Additional profession-and discipline-specific modules were also developed. IMPLICATIONS: Formal project evaluation found that most participants rated the workshops as helpful or very helpful for their roles as clinical supervisors. Interdisciplinary learning from the workshops was reported to enable cross-discipline supervision. Large participant numbers and favourable ratings indicate a continuing need for basic training in education. Key factors to workshop success included expert facilitators, the interprofessional context and interactive model. The online modules were an important adjunct, and provided context-specific resources, but the low online completion rate suggests protected face-to-face time for faculty member development is still required. Programmes such as ClinSSAC have the capacity to promote interprofessional education and practice. There are barriers to accessing faculty member development, such as time, cost and suitability.

Desistance: The “other side” of change and implications for maintenance programs

How offenders cease offending and engage in the desistance process is a key consideration for effective rehabilitation. While attention is increasing on desistance and its utility in the supervision and case management of offenders postrelease, it’s yet to be integral to postrelease programs. This paper considers the implications of the desistance process for psychological postrelease programs, such as community maintenance programs. There will be a brief review of some of the theories of desistance, consideration of the interrelationship between desistance theory and community maintenance programs and discussion about the implications of desistance theory for the delivery of community maintenance programs.