Australian dental policy reform and the use of dental therapists and hygienists

Oral diseases including dental caries and periodontal disease are among the most prevalent and costly diseases in Australia today. Around 5.4% of Australia’s health dollar is spent on dental services totalling around $2.6 billion, 84% of which are delivered through the private sector (AIHW 2001). The other 16% is spent providing public sector services in varied and inadequate ways. While disease rates among school children have declined significantly in the past 20 years the gains made among children are not flowing on to adult dentitions and our aging population will place increasing demands on an inadequate system into the future (AHMAC 2001). Around 50% of adults do not received regular care and this has implications for widening health inequalities as the greatest burden falls on lower income groups (AIHW DSRU 2001). The National Competition Policy agenda has initiated, Australia-wide, reviews of dental legislation applying to delivery of services by dentists, dental specialists, dental therapists and hygienists and dental technicians and prosthetists. The review of the Victorian Dentists Act 1972, was completed first in 1999, followed by the other Australian states with Queensland, the ACT and the Northern Territory still developing legislation. One of the objectives of the new Victorian Act is to ‘…promote access to dental care’. This study has grown out of the need to know more about how dental therapists and hygienists might be utilised to achieve this and the legislative frameworks that could enable such roles. This study used qualitative methods to explore dental health policy making associated with strategies that may increase access to dental care using dental therapists and hygienists. The study used a multiple case study design to critically examine the dental policy development process around the Review of the Dentists Act 1972 in Victoria; to assess legislative and regulatory dental policy reforms in other states in Australia and to conduct a comparative analysis of dental health policy as it relates to dental auxiliary practice internationally. Data collection has involved (I) semi-structured interviews with key participants and stakeholders in the policy development processes in Victoria, interstate and overseas, and (ii) analysis of documentary data sources. The study has taken a grounded theory approach whereby theoretical issues that emerged from the Victorian case study were further developed and challenged in the subsequent interstate and international case studies. A component of this study has required the development of indicators in regulatory models for dental hygienists and therapists that will increase access to dental care for the community. These indicators have been used to analyse regulation reform and the likely impacts in each setting. Despite evidence of need, evidence of the effectiveness and efficiency of dental therapists and hygienists, and the National Competition Policy agenda of increasing efficiency, the legislation reviews have mostly produces only minor changes. Results show that almost all Australian states have regulated dental therapists and hygienists in more prescriptive ways than they do dentists. The study has found that dental policy making is still dominated by the views of private practice dentists under elitist models that largely protect dentist authority, autonomy and sovereignty. The influence of dentist professional dominance has meant that governments have been reluctant to make sweeping changes. The study has demonstrated alternative models of regulation for dental therapists and hygienists, which would allow wider utilisation of their skills, more effective use of public sector funding, increased access to services and a grater focus on preventive care. In the light of theses outcomes, there is a need to continue to advocate for changes that will increase the public health focus of oral health care.

Investigative interviewing of children with intellectual disabilities

This research was designed to examine two broad issues in relation to the investigative interviewing of children (aged 9 to 13 years) with mild and moderate intellectual disabilities. First, how do children with intellectual disabilities perform (relative to children matched for chronological and mental age) when recalling an event in response to various questions? Second, what question types and interview strategies do police officers and caregivers use to elicit accurate and detailed accounts about an event from children with intellectual disabilities? The rationale for exploring each of these issues was to determine possible ways of improving the elicitation of evidence from children with intellectual disabilities. While children with intellectual disabilities constitute a high proportion of all child victims of abuse (Conway, 1994; Goldman, 1994; Morse, et ah, 1970), they rarely provide formal reports of abuse and of those incidents that are reported, few cases progress to court (Henry & Gudjonsson, 1999). Study 1 used a standard interview protocol containing a variety of questions and an interview structure commonly used in investigative interviews. Specifically, the memory and suggestibility of eighty children with either a mild and moderate intellectual disability (M age = 10.85 years) was examined when recalling an innocuous event that was staged at their school. The children's performance was compared with that of two control groups; a group of mainstream children matched for mental age and a group of mainstream children matched for chronological age. Overall, this study showed that children with both mild and moderate intellectual disabilities can provide accurate and highly specific event-related information hi response to questions recommended in best-practice guidelines. However, their recall was less complete and less clear in response to free-narrative prompts and less accurate in response to specific questions when compared to both mainstream age-matched groups. Study 2 provided an in-depth analysis of the types of questions and strategies used by twenty-eight police officers and caregivers when interviewing children with either mild or moderate intellectual disabilities (M age = 11.13 years) about a repeated event that was staged at their school. The results revealed that while the approach used by the police officers was generally consistent with best-practice recommendations (i.e., their interviews contained few leading, coercive or negative strategies), there were many ways in which their approach could be improved. This study also showed that the caregivers used a high proportion of direct and negative strategies to elicit information from their children. Even when caregivers used open-ended questions, their children provided less event-related information than they did to police interviewers. The results of both studies were discussed in relation to current 'best-practice' guidelines for interviewing children and recommendations were offered for improving the quality of field interviews with children who have intellectual disabilities.

Australian primary in-service teachers’ conceptions of geography

This paper reports on the second part of a two pronged qualitative investigation that examines the ways in which Australian primary teachers conceptualise geography and geography teaching. In the first part of the project, 47 pre-service primary teachers were surveyed. In this paper, I draw on interviews with six in-service primary teachers to explore their experiences, conceptions and perceptions of geography. The findings indicate a noticeable difference between the conceptions of geography held by experienced teachers and those of early career, in-service teachers. Similar to the pre-service teachers studied in part one of this study, the early career teachers had a narrow, information-oriented conception of geography and geography education. Conversely, the experienced teachers portrayed more complex, relational and process-oriented perspectives. The paper concludes by exploring some of the implications for the implementation of the new National geography curriculum in Australia.

Consumer issues in navigating health care services for type I diabetes

• Despite increasing interest in consumer awareness and participation in health care service delivery, there has been little exploration of consumer views in relation to services for people with type I diabetes. • The purpose of this qualitative exploratory study was to identify strategies people with type I diabetes used to access health services and the barriers they perceived in accessing the services they needed. • Data gathered in semi-structured interviews revealed that consumers experience significant barriers when navigating the health care system. • Three dominant themes were identified. They relate to access to specialist medical skill, to the transition from teenager to young adult and to pre-pregnancy and obstetric care. • Directions for change in service delivery and policy development are discussed.

`I like football when it doesn`t hurt`: factors influencing participation in Auskick

Auskick is the Australian Football League's (AFL) introductory program specifically designed to recruit and harness the interest of primary or elementary school-aged children between the ages of 5-12 years. As an induction program, Auskick is underpinned by a philosophy that foregrounds involvement and enjoyment as foundational to a pathway to an ongoing affiliation with Australian Rules football. Getting young people to identify with Australian Rules football from early on is a strategic aspect of growing or sustaining the game. Within its charter of mass recruitment, Auskick is more about promoting an interest in football than it is about talent identification. Indeed, only a tiny minority of the more than 110,000 children that partake in the Auskick program in 2004 will go on to compete at the highest level. Drawing on over 200 interviews conducted with parents and children attending Auskick sessions, this paper presents an overview of some of the factors that influence initial participation in Australian Rules football. Among other things the authors ask participants how they intend to negotiate the behaviours and practices required to play a body contact sport like Australian Rules football.

'I know I'm doing a good job': canonical and autobiographical narratives of teenage mothers

Teenage pregnancy is typically presented as a problem to be solved, if not as an epidemic in need of urgent intervention. This paper reports on Australian research that examined the phenomenon of teenage motherhood from the perspective of the young women themselves. The theoretical frame of narrative was adopted in order to understand both the way in which the young mothers were making sense of their own lives, and the way in which they interpreted the canonical narrative of teenage motherhood. Interviews with 20 young mothers demonstrated both their awareness of the canonical narrative, in which they are judged and condemned, and their contrasting autobiographical narratives, in which they are represented as good mothers who are capable of learning the skills of motherhood. Although the women refused to emphasise the disadvantages of teenage motherhood, they acknowledged difficulties. Throughout their autobiographical accounts, a 'consoling plot' was evident. Young women may be supported in their endeavour to emplot their lives to their own benefit by family narratives of teenage motherhood.

The effect of using trained versus untrained adult respondents in simulated practice interviews about child abuse

Objective
A single study tested the hypothesis that simulated practice interviews for investigative interviewers of children are more effective when the role of the child respondent is played by trained actors (i.e., postgraduate psychology students) than untrained fellow participants (i.e., child protection workers).
Method
The interviewers included 50 child protection service workers. Each interviewer received instruction in the use of open-ended questions and then engaged in two simulated practice interviews. The role of the child respondent in the practice interviews was played by either a trained psychology student or an untrained fellow participant. The key outcome measure was the proportion of open-ended questions, which was assessed immediately prior to and after the practice sessions, as well as 12 weeks post-training.
Results
Interviewers who had practiced with trained actors had higher post-training performance (M = .83, SD = .12) compared to those who had practiced with untrained fellow participants (M = .73, SD = .13, p < .05), even at the 12-week follow up (M actors = .66, SD = .25; M untrained actors = .49, SD = .23, p < .05).
Conclusions
Training programs that make better use of practice opportunities (e.g., by using trained respondents) will be more effective in improving the performance of investigative interviewers.
Practice implications
A single study investigated the relative effectiveness of two simulated practice exercises for professionals who interview children about abuse. This research is relevant to professionals who design investigative interviewer training programs because it indicates that practical exercises, which are currently chosen on an ‘ad hoc’ or convenience basis, can vary markedly in their effectiveness in encouraging adherence to open questions.

'I don't really care about what someone else's studied' : Drinking guidelines and the government of pleasure

This paper examines data from a Drinkwise Australia funded research project that investigated the cultural drivers of drinking in 14-24 year-old Australians. The research included two studies. In one we conducted interviews and focus groups with administrators and young people in a range of sporting clubs and in the other we interviewed 60 young people aged 20-24 about their drinking biographies. The drinking biographies study is the focus of this paper. At the time of interviewing the draft guidelines on low-risk drinking were released by the NH&MRC and we asked our participants what they knew about them and if they would affect their drinking patterns. The responses to these questions are examined in light of O’Malley and Valverde’s claim that pleasure is silenced and/or deployed strategically in liberal governance discourses about drugs and alcohol (2004: 25). This is despite the fact that research indicates that pleasure is an important motivation for drinking.

A controlled analysis of professionals' contemporaneous notes of interviews about alleged child abuse

Objective : The current study investigated (under optimal conditions) the accuracy and completeness of professionals’ contemporaneous written notes of child abuse interviews.
Method : Participants included 107 experienced child abuse investigators who were all trained to adhere to best-practice interview guidelines and who routinely took notes as records of interviews. The interviews documented for this study were read live for 15 min duration, and at a pace of 2.2 words (on average)/s. The professionals’ notes of the interviews were analyzed for completeness and accuracy. Key outcome measures were the prevalence and discernability of the questions (i.e., whether the structure of questions was recorded accurately) as well as the child responses.
Results : Despite the omission of 39% of abuse-related details, recording of content details was clearly prioritized over interviewer questions. This was revealed irrespective of the measure of note taking quality or the quality of the interview being recorded. Of the various layout styles employed, scrutiny of interviewer questions was maximized by: (a) using symbols or spacing to delineate questions and responses, (b) capturing the first two words of a question, and (c) using abbreviations.
Conclusions : Although note taking could potentially improve with further research, training and instruction, this form of documentation does not provide full scrutiny of the interview process, even under optimal conditions.
Practice implications : Electronic recording is strongly recommended for all interviews, especially considering global concerns about interviewers’ adherence to best-practice interview guidelines. If notes continue to be used as a record of interview, further research and training are urgently warranted to improve note taking competency.

'I'm your new teacher' : the impact of teacher mobility on educational opportunities for marginalised students

This article provides an alternative perspective on what it means to 'do school' in a disadvantaged community, particularly in the way that disadvantage is reproduced for marginalised students. It explores the mobility of teachers (temporarily) working in a small secondary school located in an economically depressed regional community in Australia, characterised by high levels of unemployment, high welfare dependency and a significant indigenous population. Like many disadvantaged schools, the school has difficulty attracting and retaining high ability teachers, instead relying on a high turnover of often-reluctant staff who are sent to (or feel compelled to) fill positions unable to be resourced through teacher choice procedures. Drawing on parent, student, and teacher interviews, we ask: how does teacher mobility in this context influence the educational opportunities of students who are 'on the margins' of school success and of the socio-economic structure? Specifically, we explore the ways that teacher mobility can reproduce disadvantage by limiting students' access to the dominant cultural capital. We argue that educational policies and politics that reward teacher mobility for moving out of these communities, work to disadvantage students. What is needed is a transformation in policies governing staff placements to establish alternatives that redefine the reward system for teachers in ways that permit these students to succeed.

"I don't eat a hamburger and large chips every day!" A qualitative study of the impact of public health messages about obesity on obese adults

Background
We are a society that is fixated on the health consequences of 'being fat'. Public health agencies play an important role in 'alerting' people about the risks that obesity poses both to individuals and to the broader society. Quantitative studies suggest people comprehend the physical health risks involved but underestimate their own risk because they do not recognise that they are obese.

Methods
This qualitative study seeks to expand on existing research by exploring obese individuals' perceptions of public health messages about risk, how they apply these messages to themselves and how their personal and social contexts and experiences may influence these perceptions. The study uses in depth interviews with a community sample of 142 obese individuals. A constant comparative method was employed to analyse the data.

Results
Personal and contextual factors influenced the ways in which individuals interpreted and applied public health messages, including their own health and wellbeing and perceptions of stigma. Individuals felt that messages were overly focused on the physical rather than emotional health consequences of obesity. Many described feeling stigmatised and blamed by the simplicity of messages and the lack of realistic solutions. Participants described the need for messages that convey the risks associated with obesity while minimising possible stigmatisation of obese individuals. This included ensuring that messages recognise the complexity of obesity and focus on encouraging healthy behaviours for individuals of all sizes.

Conclusion
This study is the first step in exploring the ways in which we understand how public health messages about obesity resonate with obese individuals in Australia. However, much more research - both qualitative and quantitative - is needed to enhance understanding of the impact of obesity messages on individuals.

I could have called it violence! : a conversation with Maria Takolander

Kate Middleton interviews Maria Takolander for Sydney City Poet

“I call it the blame and shame disease”: a qualitative study about perceptions of social stigma surrounding type 2 diabetes

Abstract
Objectives While health-related stigma has been the subject of considerable research in other conditions (obesity and HIV/AIDS), it has not received substantial attention in diabetes. The aim of the current study was to explore the social experiences of Australian adults living with type 2 diabetes mellitus (T2DM), with a particular focus on the perception and experience of diabetes-related stigma.

Design A qualitative study using semistructured interviews, which were audio recorded, transcribed and subject to thematic analysis.

Setting This study was conducted in non-clinical settings in metropolitan and regional areas in the Australian state of Victoria. Participants were recruited primarily through the state consumer organisation representing people with diabetes.

Participants All adults aged ≥18 years with T2DM living in Victoria were eligible to take part. Twenty-five adults with T2DM participated (12 women; median age 61 years; median diabetes duration 5 years).

Results A total of 21 (84%) participants indicated that they believed T2DM was stigmatised, or reported evidence of stigmatisation. Specific themes about the experience of stigma were feeling blamed by others for causing their own condition, being subject to negative stereotyping, being discriminated against or having restricted opportunities in life. Other themes focused on sources of stigma, which included the media, healthcare professionals, friends, family and colleagues. Themes relating to the consequences of this stigma were also evident, including participants’ unwillingness to disclose their condition to others and psychological distress. Participants believed that people with type 1 diabetes do not experience similar stigmatisation.

Conclusions Our study found evidence of people with T2DM experiencing and perceiving diabetes-related social stigma. Further research is needed to explore ways to measure and minimise diabetes-related stigma at the individual and societal levels, and also to explore perceptions and experiences of stigma in people with type 1 diabetes

An examination of "don't know" responses in forensic interviews with children

Most experimental studies examining the use of pre-interview instructions (ground rules) show that children say "I don't know" more often when they have been encouraged to do so when appropriate. However, children's "don't know" responses have not been studied in more applied contexts, such as in investigative interviews. In the present study, 76 transcripts of investigative interviews with allegedly abused children revealed patterns of "don't know" responding, as well as interviewers' reactions to these responses. Instructions to say "I don't know" when appropriate did not affect the frequency with which children gave these responses. Interviewers rejected "don't know" responses nearly 30% of the time, and typically continued to ask about the same topic using more risky questions. Children often answered these follow-up questions even though they had previously indicated that they lacked the requested information. There was no evidence that "don't know" responses indicated reluctance to talk about abuse. Implications for forensic interviewers are discussed.

The use of ground rules in investigative interviews with children : a synthesis and call for research

Guidelines for conducting investigative interviews with children often include instructions that explain the conversational rules of the interview. Despite the widespread and international use of such instructions (also referred to as "ground rules"), the body of research characterizing children's understanding of these rules and documenting the impact of instruction on memory reports is relatively small. We review the use of ground rules in investigative interviews, the developmental differences that likely underlie children's ability to make sense of these rules, and research pertaining to the effects of the ground rules commonly included in interview guidelines on the reports of 3- to 13-year-old children. We then present a study space analysis concerning the five ground rules reviewed: (a) a statement about interviewer na&iuml;veté regarding the target events, (b) instructions to tell the interviewer when a mistake has been made, (c) cautions that some questions may be repeated, and instructions to say (d) "I don't understand" and (e) "I don't know." The results demonstrate obvious gaps in this body of literature, with only the "I don't know" ground rule having received significant attention. In addition to exploring how individual rules impact interview performance, we encourage more process-oriented studies that relate developmental differences in ground rules benefits to the cognitive processes that underlie rule understanding and implementation. Optimally, this research should identify the most suitable format and placement of instruction in interviews and broaden to more often include field studies of child witnesses.