Does family intervention for adolescent substance use impact parental wellbeing?

Adolescent substance abuse is a prevalent problem and family interventions are increasingly used to prevent this problem and to assist family coping. The effectiveness of a prevention-focussed family intervention was evaluated within a randomised school trial for its secondary impacts on improving parental mental health and family functioning.

Policy framework for a knowledge society : families and knowledge

My thesis examines the link between families, harm and knowledge in a society where knowledge is increasingly the central organising principle (Bohme 1997: 449-450; Stehr 1994: 6), and represents the capacity for action (Stehr 1994: 8). I observed as a consultant in the 1990s that practitioners in family work were able to articulate what works but often unable to articulate why and therefore unable easily to replicate what works. This time coincided with increasing commentary on complexities of living, capacity of families to cope, identification of the scale of family harm, and use of the term 'the knowledge society'. My aim is to identify why what works, works with families exhibiting harmful behaviours and families acquiring knowledge from learning everyday life skills so as to lead less harmful and more fulfilling lives. And by such explanations inform, replicate and scale up practice to benefit more families exhibiting harm. I conceptualise the outcome as a sequence of family, community and policy work in an ecological framework (Bronfenbrenner 1979) within a knowledge society. My method was a year-long action research project with a family support service in New South Wales. I engaged in reflective practice with workers, and a parallel literature review that supported additional reflective practice. I found growing complexity of life requires growing knowledge. I found a distinction between everyday and abstract life worlds, and with families principally acting in the everyday life world. It is a world from which some families and their members seek to escape, often by means of harmful behaviours of neglect, abuse and violence. I substantiated the link that the family support service of my study sees between relationships, behaviours and affects; and I linked this in turn with its therapeutic engagement of the whole family — adults and children, male and female, victims and perpetrators. This engagement involves a process of learning (Rogers 1967: 280) to acquire fulfilling behaviours. It is a process of adult and experiential learning of relationship skills, drawing on under-used reserves of families. Relationship skills form a basis of acquiring other life skills since most require relationships with others to perform life skills. Combining the sequence of family, community and policy work with workers engaging in reflective practice of their work creates capacity for community institutions to replicate and scale up what works and why. Understanding this sequence may assist community institutions to inform policymakers of benefits common to all policy interests of such replication and scaling up. I conceptualise a policy framework of families and knowledge in a knowledge society and two lower level frameworks of process and content of life skills. Implications of these for practice, policy, and theory include a greater distinction between everyday and abstract knowledge and skills; recognition of a sequential process of information, learning, and knowledge; and inclusiveness and fluidity in learning in diverse adult learning settings and in family support professions.

Detecting and managing depressed patients : palliative care nurses' self-efficacy and perceived barriers to care

Background: Depression is a highly prevalent yet under-recognized and under-treated psychiatric illness in patients receiving palliative care. Nurses are the front-line health care professionals in these settings and are well-positioned to detect depressive symptoms and initiate pathways to care. Previous research suggests, however, that nurses' confidence and skills in relation to this task are low, and there appear to be a number of barriers within these settings that may impede nurses' engagement in this process.

Methods: To further investigate these factors, a quantitative study was carried out with 69 palliative care nurses from three palliative care services in Australia.

Results: A number of issues were identified, including the need for further training in the signs and symptoms of depression, issues around discussing depression with patients and their family members, and difficulty differentiating depressive symptoms from grief.

Conclusion: These findings provide insight into specific areas in which palliative care nurses would benefit from further training to improve detection rates for depression in this vulnerable population.

Genetic counseling for Indigenous Australians: an exploratory study from the perspective of genetic health professionals

Indigenous populations are thought to have particularly low levels of access to genetic health services, and cultural issues may be a contributing factor. This article presents the findings of the first study of genetic health service provision to Indigenous Australians. This qualitative study aimed to identify elements of culturally-competent genetic health service provision in Indigenous Australian contexts. Twelve semi-structured interviews were conducted with genetic counselors and clinical geneticists from around Australia who had delivered services to Indigenous Australians. Participants were asked to describe their experiences and identify any collective cultural needs of Indigenous clients, as well as comment on specific training and resources they had received or used. Interviews were audio-recorded and transcribed with thematic analysis conducted on the data. The findings show that participants were reluctant to generalize the needs of Indigenous peoples. Some participants asserted that Indigenous peoples have needs that differ from the general population, while others felt that there were no collective cultural needs, instead advocating an individualized approach. Being flexible and practical, taking time to build rapport, recognizing different family structures and decision-making processes, as well as socio-economic disadvantage were all identified as important factors in participants' interactions with Indigenous clients. Indigenous support workers and hospital liaison officers were seen as valuable resources for effective service provision. The implications of this study for training and practice are discussed.