Crime-prevention jurisprudence? A response to Andrews and Dowden

Recently Andrews and Dowden (2007) published an article proposing that both offender and victim well-being could be enhanced by utilizing the risk–need–responsivity model to guide the legal and court systems in crime prevention (rather than therapy). Consequently, crime-prevention jurisprudence (defined as a law-and-justice objective reflecting the language of personality and social psychology) was proposed as an alternative to therapeutic jurisprudence (defined as a mental-health objective reflecting the clinical language of forensic mental health). The authors erroneously claim that therapeutic jurisprudence is a mental-health concept whose aim is to provide therapy that improves well-being in offenders rather than to demonstrate concern for victims. In fact, therapeutic jurisprudence is a legal concept that utilizes social-science knowledge to highlight the therapeutic and anti-therapeutic impacts of the law, legal procedures, and legal roles on all individuals, including victims. This article will respond to Andrews and Dowden by challenging three assumptions they make regarding the role of therapeutic jurisprudence. This response concludes that the focus of offender rehabilitation should be on enhancing community protection by balancing offender rights and victim rights. Therapeutic jurisprudence already provides such a framework and, therefore, the promise of crime-prevention jurisprudence fails to add value.

Managing the family`s health: preferences and experiences of women with different work and family arrangements.

Balancing the needs of work and family is a subject of much debate.The purpose of this research was to explore how families manage their children's health within the context of different work and family arrangements.In-depth interviews were conducted with women who were at home full time (8) or in paid work over 30 hours a week (7). Women had at least one child under the five years of age. Findings revealed there was no simple relationship between women's working arrangements and how they managed their children's health. All women, irrespective of their working arrangements, held similar preferences for managing their children's health.However, most women experienced either time or financial constraints that meant they had to compromise their original preferences. In some cases this meant children missed out on receiving health services. Workplace support, extended family support and general satisfaction with work and family arrangements appeared to be important factors for the small number of women who had no problems in managing their children's health. The implications of these findings are discussed.

From policy to practice: the development of an integrated health promotion plan for children's services at Plenty Valley Community Health Inc.

Current changes in the funding of health promotion in community health in Victoria require community health agencies to integrate health promotion with service delivery. This provides both opportunities and challenges for community health staff. Members of the Children’s Service Team at Plenty Valley Community Health Inc. addressed these changes by developing an integrated health promotion plan. The approach used involved identifying client pathways and then integrating opportunities for health promotion interventions into these pathways. Staff perceptions of the process involved in developing the plan were examined. The use of client pathways to integrate health promotion into everyday practice proved a successful approach for members of the Children’s Services Team, and provides a useful model for health promotion planning in community health that helps staff to see the relevance of health promotion to their practice, and engages staff in the planning process. Members of the Children’s Services Team reported that the process involved in developing their integrated health promotion plan was a very worthwhile experience that allowed them a strong sense of ownership of the plan.

Pain during mammography: implications for breast screening programmes

Pain experienced during mammography can deter women from attending for breast cancer screening. Review of the current literature on pain experienced during mammography reveals three main areas of interest: reports of the frequency of pain, identification of predictors of pain and strategies for responding to pain. Implications of this literature for breast screening programmes include the need for appropriate measurements of pain during mammography that are valid for screening populations, a further understanding of organizational factors involved in screening programmes that may be predictors of pain and for the development of valid strategies for responding to pain within breast screening programmes.

Performance of ventilated hollow core concrete panel systems in Australia

Performance of advanced fabric energy storage systems has not been reported for Australian conditions. The influence pf slab thickness and air flow rate on the annual thermal load, and maximum heating and cooling demands for a typical office module using a ventilated hollow core concrete slab system has been investigated by simulation. Performance results for Melbourne are presented and comments made on other locations.

Cost-effectiveness of cognitive-behavioural therapy and drug interventions for major depression

Objective: Antidepressant drugs and cognitive–behavioural therapy (CBT) are effective treatment options for depression and are recommended by clinical practice guidelines. As part of the Assessing Cost-effectiveness – Mental Health project we evaluate the available evidence on costs and benefits of CBT and drugs in the episodic and maintenance treatment of major depression.

Method: The cost-effectiveness is modelled from a health-care perspective as the cost per disability-adjusted life year. Interventions are targeted at people with major depression who currently seek care but receive non-evidence based treatment. Uncertainty in model inputs is tested using Monte Carlo simulation methods.

Results: All interventions for major depression examined have a favourable incremental cost-effectiveness ratio under Australian health service conditions. Bibliotherapy, group CBT, individual CBT by a psychologist on a public salary and tricyclic antidepressants (TCAs) are very cost-effective treatment options falling below $A10 000 per disability-adjusted life year (DALY) even when taking the upper limit of the uncertainty interval into account. Maintenance treatment with selective serotonin re-uptake inhibitors (SSRIs) is the most expensive option (ranging from $A17 000 to $A20 000 per DALY) but still well below $A50 000, which is considered the affordable threshold.

Conclusions: A range of cost-effective interventions for episodes of major depression exists and is currently underutilized. Maintenance treatment strategies are required to significantly reduce the burden of depression, but the cost of long-term drug treatment for the large number of depressed people is high if SSRIs are the drug of choice. Key policy issues with regard to expanded provision of CBT concern the availability of suitably trained providers and the funding mechanisms for therapy in primary care.

Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder

Objective: To assess from a health sector perspective the incremental cost-effectiveness of interventions for generalized anxiety disorder (cognitive behavioural therapy [CBT] and serotonin and noradrenaline reuptake inhibitors [SNRIs]) and panic disorder (CBT, selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]).

Method: The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analyses of randomised controlled trials. An assessment on second stage filters ('equity', 'strength of evidence', 'feasibility' and 'acceptability to stakeholders') is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are calculated for a period of one year for the eligible population (prevalent cases of generalized anxiety disorder/panic disorder identified in the National Survey of Mental Health and Wellbeing, extrapolated to the Australian population in the year 2000 for those aged 18 years and older). Simulation modelling techniques are used to present 95% uncertainty intervals (UI) around the incremental cost-effectiveness ratios (ICERs).

Results: Compared to current practice, CBT by a psychologist on a public salary is the most cost-effective intervention for both generalized anxiety disorder (A$6900/DALY saved; 95% UI A$4000 to A$12 000) and panic disorder (A$6800/DALY saved; 95% UI A$2900 to A$15 000). Cognitive behavioural therapy results in a greater total health benefit than the drug interventions for both anxiety disorders, although equity and feasibility concerns for CBT interventions are also greater.

Conclusions: Cognitive behavioural therapy is the most effective and cost-effective intervention for generalized anxiety disorder and panic disorder. However, its implementation would require policy change to enable more widespread access to a sufficient number of trained therapists for the treatment of anxiety disorders.

Cost-effectiveness of dexamphetamine and methylphenidate for the treatment of childhood attention deficit hyperactivity disorder

Objective: To analyze from a health sector perspective the cost-effectiveness of dexamphetamine (DEX) and methylphenidate (MPH) interventions to treat childhood attention deficit hyperactivity disorder (ADHD), compared to current practice.

Method: Children eligible for the interventions are those aged between 4 and 17 years in 2000, who had ADHD and were seeking care for emotional or behavioural problems, but were not receiving stimulant medication. To determine health benefit, a meta-analysis of randomized controlled trials was performed for DEX and MPH, and the effect sizes were translated into utility values. An assessment on second stage filter criteria ('equity', 'strength of evidence', 'feasibility' and 'acceptability to stakeholders') is also undertaken to incorporate additional factors that impact on resource allocation decisions. Simulation modelling techniques are used to present a 95% uncertainty interval (UI) around the incremental costeffectiveness ratio (ICER), which is calculated in cost (in A$) per DALY averted.

Results: The ICER for DEX is A$4100/DALY saved (95% UI: negative to A$14 000) and for MPH is A$15 000/DALY saved (95% UI: A$9100-22 000). DEX is more costly than MPH for the government, but much less costly for the patient.

Conclusions: MPH and DEX are cost-effective interventions for childhood ADHD. DEX is more cost-effective than MPH, although if MPH were listed at a lower price on the Pharmaceutical Benefits Scheme it would become more cost-effective. Increased uptake of stimulants for ADHD would require policy change. However, the medication of children and wider availability of stimulants may concern parents and the community.