Compiling a caseload index for mental health case management

Objective: The purpose of this study was to explore methods of determining an appropriate caseload for mental health case managers. Method: Seven factors that may impinge on case manager performance and impact on caseload were identified, having reference to published literature and service practice in Victoria and Queensland. The advantages and disadvantages of including these factors in a caseload index were evaluated. Results: Three caseload index methodologies are presented. Each method makes use of different data and has advantages and disadvantages. There is a trade-off between simplicity and ease of application and the comprehensive use of relevant information. Methods vary in their implications for service efficiency and equity in workload distribution. Conclusions: Caseload is a key issue in service planning and staff management. Factors that have the potential to contribute to caseload can be readily identified. However, there is likely to be disagreement as to the weight assigned to any factor and the approach taken may depend on the purpose and context of the caseload calculation. A great deal more research is required to provide an empirical basis for algorithms used in caseload calculation.

The burden of major depression avoidable by longer-term treatment strategies

Background: Major depression is the largest single cause of nonfatal disease burden in Australia. Effective drug and psychological treatments exist, yet are underused. Objective: To quantify the burden of disease currently averted in people seeking care for major depression and the amount of disease burden that could be averted in these people under optimal episodic and maintenance treatment strategies. Design: Modeling impact of current and optimal treatment strategies based on secondary analysis of mental health survey data, studies of the natural history of major depression, and meta-analyses of effectiveness data. Monte Carlo simulation of uncertainty in the model. Setting: The cohort of Australian adults experiencing an episode of major depression in 2000 are modeled through "what if" scenarios of no treatment, current treatment, and optimal treatment strategies with cognitive behavioral therapy or antidepressant drug treatment. Main Outcome Measure: Disability-Adjusted Life Year. Results: Current episodic treatment averts 9% (95% uncertainty interval, 6%-12%) of the disease burden of major depression in Australian adults. Optimal episodic treatment with cognitive behavioral therapy could avert 28% (95% uncertainty interval, 19%-39%) of this disease burden, and with drugs 24% (95% uncertainty interval, 19%-30%) could be averted. During the 5 years after an episode of major depression, current episodic treatment patterns would avert 13% (95% uncertainty interval, 10%-17%) of Disability-Adjusted Life Years, whereas maintenance drug treatment could avert 50% (95% uncertainty interval, 40%-60%) and maintenance cognitive behavioral therapy could avert 52% (95% uncertainty interval, 42%-64%), even if adherence of around 60% is taken into account. Conclusions: Longer-term maintenance drug or psychological treatment strategies are required to make significant inroads into the large disease burden associated with major depression in the Australian population.

The mental health country profile: Background, design and use of a systematic method of appraisal

This article describes the construction and use of a systematic structured method of mental health country situation appraisal, in order to help meet the need for conceptual tools to assist planners and policy makers develop and audit policy and implementation strategies. The tool encompasses the key domains of context, needs, resources, provisions and outcomes, and provides a framework for synthesizing key qualitative and quantitative information, flagging up gaps in knowledge, and for reviewing existing policies. It serves as an enabling tool to alert and inform policy makers, professionals and other key stakeholders about important issues which need to be considered in mental health policy development. It provides detailed country specific information in a systematic format, to facilitate global sharing of experiences of mental health reform and strategies between policy makers and other stakeholders. Lastly, it is designed to be a capacity building tool for local stakeholders to enhance situation appraisal, and multisectorial policy development and implementation.

The employment of people with mental illness

People with a mental illness are among the most socially and economically marginalised members of the community. They experience high levels of unemployment and nonparticipation in the labour force. Unemployment has a number of negative effects including the loss of purpose, structure, roles and status and a sense of identity which employment brings. Employment enables social inclusion in the wider community and is an important way that people with a mental illness can meaningfully participate in the wider community. Australia has a mental health strategy, which guides the ongoing reform of mental health services. However, specific strategies to address the social and economic marginalisation of people with a mental illness have not been addressed. A recovery-oriented approach is recommended, which integrates the key sectors involved. To date there has been little intersectoral collaboration between the various sectors such as mental health services, housing, and vocational services. People require more role-specific assistance to enable them to participate in socially valued roles implicit with citizenship. There is a need to formulate improved pathways to assistance and more evidence-based forms of assistance to re-establish career pathways. This report aims to: 1) collect relevant overseas and Australian evidence about the employment of people with mental illness; 2) identify the potential benefits of employment; 3) describe patterns of labour force participation in Australia among people with mental illness; 4) identify how mental illness can cause barriers to employment; 5) outline the type of employment restrictions reported by people with mental illness; 6) identify the evidence-based ingredients of employment assistance; 7) identify relevant policy implications; and 8) suggest strategies to improve employment outcomes and career prospects for people with mental illness.

Routine measurement of outcomes in Australia's public sector mental health services

OBJECTIVE: This paper describes the Australian experience to date with a national 'roll out' of routine outcome measurement in public sector mental health services. METHODS: Consultations were held with 123 stakeholders representing a range of roles. RESULTS: Australia has made an impressive start to nationally implementing routine outcome measurement in mental health services, although it still has a long way to go. All States/Territories have established data collection systems, although some are more streamlined than others. Significant numbers of clinicians and managers have been trained in the use of routine outcome measures, and thought is now being given to ongoing training strategies. Outcome measurement is now occurring 'on the ground'; all States/Territories will be reporting data for 2003-04, and a number have been doing so for several years. Having said this, there is considerable variability regarding data coverage, completeness and compliance. Some States/Territories have gone to considerable lengths to 'embed' outcome measurement in day-to-day practice. To date, reporting of outcome data has largely been limited to reports profiling individual consumers and/or aggregate reports that focus on compliance and data quality issues, although a few States/Territories have begun to turn their attention to producing aggregate reports of consumers by clinician, team or service. CONCLUSION: Routine outcome measurement is possible if it is supported by a co-ordinated, strategic approach and strong leadership, and there is commitment from clinicians and managers. The Australian experience can provide lessons for other countries.

Introducing evidence-based family assessment and therapy in child and youth mental health services: Applying systemic principles to maintain, sustain and build capacity

The purpose of this article is to overview the context of the mental health service in which we work, and family therapy's status prior to and after the impact of changes wrought by the introduction of the National Mental Health Policy. We then explore some key issues that we think contribute to the persistence of the occlusion of family therapy in child psychiatric services; and the strategies that we developed and are continuing to develop to support change, finally, we describe the use of a family assessment instrument that we believe is central to our change strategy.

Instruction to support mental computation development in young children of diverse ability

Fostering young children's mental computation capacity is essential to support their numeracy development. Debate continues as to whether young children should be explicitly taught strategies for mental computation, or be afforded the freedom to develop their own. This paper reports on teaching experiments with two groups of students in their first year of schooling: those considered 'at-risk', and those deemed mathematically advanced. Both groups made considerable learning gains as a result of instruction. Importantly, the gains of the at-risk group are likely to renew both their own, and their teacher's confidence in their ability to learn. In this paper, the instructional programs are documented, highlighting the influence of instruction upon the children's development.

COMUNICAÇÃO E SAÚDE MENTAL: Estudo de Caso da TV Pinel no Brasil e do Espaço de Comunicação no Hospital Psiquiátrico de Havana

O presente estudo refere-se a uma investigação analítica e descritiva sobre a TV Pinel no Brasil, um programa de televisão desenvolvido no Hospital Psiquiátrico Philippe Pinel, no Rio de Janeiro. E, como trabalho complementar, apresentamos uma análise das atividades culturais, artísticas e esportivas desenvolvidas no Hospital Psiquiátrico de Havana, em Cuba. Este estudo refere-se à busca da compreensão do espaço de comunicação das pessoas que padecem de transtornos mentais, a partir das experiências desses hospitais psiquiátricos os quais se apóiam em estratégias comunicacionais e artísticas para promover a reabilitação psicossocial. As reflexões conceituais sobre o espaço de comunicação estão centradas no conceito de espaço, a partir dos estudos do geógrafo Milton Santos. As discussões teóricas foram sustentadas na Teoria da Complexidade, com base no pensamento do teórico francês Edgar Morin. Apresentamos uma reflexão sobre o modelo de tratamento psiquiátrico a partir dos trabalhos da psiquiatra Nise da Silveira, da artista Lygia Clark, e do médico e artista Lula Wanderley. Esta investigação aborda a importância da arte e da comunicação no processo da ressocialização da pessoa enferma mental.(AU)

Consumer responses to really new products: examining the impacts of learning strategies and presentation formats on product comprehension and attitude formation

Mental simulations and analogies have been identified as powerful learning tools for RNPs. Furthermore, visuals in advertising have recently been conceptualized as meaningful sources of information as opposed to peripheral cues and thus may help consumers learn about RNPs. The study of visual attention may also contribute to understanding the links between conceptual and perceptual analyses when learning for a RNP. Two conceptual models are developed. the first model consists of causal relationships between the attributes of advertising stimuli for RNPs and consumer responses, as well as mediating influences. The second model focuses on the role of visual attention in product comprehension as a response to advertising stimuli. Two experiments are conducted: a Web-Experiment and an eye-tracking experiment. The first experiment (858 subjects) examines the effect of learning strategies (mental simulation vs. analogy vs. no analogy/no mental simulation) and presentation formats (words vs. pictures) on individual responses. The mediating role of emotions is assessed. The second experiment investigates the effect of learning strategies and presentation formats on product comprehension, along with the role of attention (17 subjects). The findings from experiment 1 indicate that learning strategies and presentation formats can either enhance or undermine the effect of advertising stimuli on individual responses. Moreover, the nature of the product (i.e. hedonic vs. utilitarian vs. hybrid) should be considered when designing communications for RNPs. The mediating role of emotions is verified. Experiment 2 suggests that an increase in attention to the message may either reflect enhanced comprehension or confusion.

Investigating the process of translation:humour translation norms, strategies and approaches in children's literature

Research in the present thesis is focused on the norms, strategies,and approaches which translators employ when translating humour in Children's Literature from English into Greek. It is based on process-oriented descriptive translation studies, since the focus is on investigating the process of translation. Viewing translation as a cognitive process and a problem soling activity, this thesis Think-aloud protocols (TAPs) in order to investigate translator's minds. As it is not possible to directly observe the human mind at work, an attempt is made to ask the translators themselves to reveal their mental processes in real time by verbalising their thoughts while carrying out a translation task involving humour. In this study, thirty participants at three different levels of expertise in translation competence, i.e. tn beginner, ten competent, and ten experts translators, were requested to translate two humourous extracts from the fictional diary novel The Secret Diary of Adrian Mole, Aged 13 ¾ by Sue Townsend (1982) from English into Greek. As they translated, they were asked to verbalise their thoughts and reason them, whenever possible, so that their strategies and approaches could be detected, and that subsequently, the norms that govern these strategies and approaches could be revealed. The thesis consists of four parts: the introduction, the literature review, the study, and the conclusion, and is developed in eleven chapters. the introduction contextualises the study within translation studies (TS) and presents its rationale, research questions, aims, and significance. Chapters 1 to 7 present an extensive and inclusive literature review identifying the principles axioms that guide and inform the study. In these seven chapters the following areas are critically introduced: Children's literature (Chapter 1), Children's Literature Translation (Chapter 2), Norms in Children's Literature (Chapter 3), Strategies in Children's Literature (Chapter 4), Humour in Children's Literature Translation (Chapter 5), Development of Translation Competence (Chapter 6), and Translation Process Research (Chapter 7). In Chapters 8 - 11 the fieldwork is described in detail. the piolot and the man study are described with a reference to he environments and setting, the participants, the research -observer, the data and its analysis, and limitations of the study. The findings of the study are presented and analysed in Chapter 9. Three models are then suggested for systematising translators' norms, strategies, and approaches, thus, filling the existing gap in the field. Pedagogical norms (e.g. appropriateness/correctness, famililarity, simplicity, comprehensibility, and toning down), literary norms (e.g. sound of language and fluency). and source-text norms (e.g. equivalence) were revealed to b the most prominent general and specific norms governing the translators'  strategies and approaches in the process of translating humour in ChL. The data also revealed that monitoring and communication strategies (e.g. additions, omissions, and exoticism) were the prevalent strategies employed by translators. In Chapter 10 the main findings and outcomes of a potential secondary benefit (beneficial outcomes) are discussed on the basis of the research questions and aims of the study, and implications of the study are tackled in Chapter 11. In the conclusion, suggestions for future directions are given and final remarks noted.

'Listen to my madness':understanding the experiences of people with serious mental illness

This article explores the salience of disability theory for understanding the experiences of people with serious mental illness. Drawing on data from a focus group study, we suggest that users experience both impairment (as embodied irrationality) which can, in itself, be oppressive, and also have to manage their lives within a largely disabling society. We outline some of the strategies adopted by users to manage their situation and ensure they access and receive health services, and illustrate how these are a result of the complex relationship between disability and impairment. We suggest that using a framework of the social model of disability provides a useful way of understanding and making sense of the experience of users with serious mental illness. © Blackwell Publishing Ltd/Foundation for the Sociology of Health & Illness 2005.

The political economy of poverty alleviation strategies. The initiative for heavily indebted poor countries in Bolivia: More of the same

In the year 2000, approximately 1.1 billion people lived in extreme poverty while developed countries spent US$600 billion a year on defense. The Heavily Indebted Poor Countries (HIPC) Initiative is a recent component of a larger poverty reduction strategy supported by the International Financial Institutions, as well as many developed and developing countries. By implementing lessons of the past fifty years, this program attempts to diminish misery around the globe. As such, it provides debt relief while seeking to enable the poorest countries to simultaneously attain sustainable debt and promote human development. Interest in poverty reduction around the globe reemerged in the 1990s. This study contributes directly to this recent effort by presenting a nuanced approach that builds on the stepping-stones generated by other poverty scholars. To fulfill its goal, this investigation applies a political economy framework. Within this framework, the author conducts an actor-specific analysis. This dissertation addresses the following question: How do domestic and international actors respond to the implementation of poverty alleviation strategies? The author assumes actors desire to maximize their utility calculation and suggests these calculations are based on the player's motivations and external influences. Based on their motivations, the external influences, and the initiative's guidelines, each actor develops a set of expectations. To fulfill those expectations, stake holders utilize one or several strategies. Finally, the actors' ability to achieve their expectations determines each player's assessment of the initiative. The framework described is applied in an in-depth, actor-specific analysis of the HIPC in Bolivia. Bolivia's National Revolution represents the country's first attempt at reducing poverty. Since then, all governments have taken specific steps to combat poverty at the local and national levels. The Initiative for Heavily Indebted Poor Countries (HIPC) is one of the most recent macro strategies of this kind. The case study demonstrated that three factors (national ownership, effective sponsorship and the local context) determine the success levels of poverty reduction strategies from abroad. In addition, the investigation clearly shows that poverty reduction is not the sole motivation in the implementation of poverty alleviation strategies. All actors, however, share the dream of poverty reduction.

Examining a proposed job retention model for adult workers with mental retardation in supported employment

This quantitative study investigated the predictive relationships and interaction between factors such as work-related social behaviors (WRSB), self-determination (SD), person-job congruency (PJC), job performance (JP), job satisfaction (JS), and job retention (JR). A convenience sample of 100 working adults with MR were selected from supported employment agencies. Data were collected using a survey test battery of standardized instruments. The hypotheses were analyzed using three multiple regression analyses to identify significant relationships. Beta weights and hierarchical regression analysis determined the percentage of the predictor variables contribution to the total variance of the criterion variables, JR, JP, and JS. ^ The findings highlight the importance of self-determination skills in predicting job retention, satisfaction, and performance for employees with MR. Consistent with the literature and hypothesized model, there was a predictive relationship between SD, JS and JR. Furthermore, SD and PJC were predictors of JP. SD and JR were predictors of JS. Interestingly, the results indicated no significant relationship between JR and JP, or between JP and JS, or between PJC and JS. This suggests that there is a limited fit between the hypothesized model and the study's findings. However, the theoretical contribution made by this study is that self-determination is a particularly relevant predictor of important work outcomes including JR, JP, and JS. This finding is consistent with Deci's (1992) Self-Determination Theory and Wehmeyer's (1996) argument that SD skills in individuals with disabilities have important consequences for the success in transitioning from school to adult and work life. This study provides job retention strategies that offer rehabilitation and HR professionals a useful structure for understanding and implementing job retention interventions for people with MR. ^ The study concluded that workers with mental retardation who had more self-determination skills were employed longer, more satisfied, and better performers on the job. Also, individuals whose jobs were matched to their interests and abilities (person-job congruency) were better at self-determination skills. ^

The influence of spirituality, race/ethnicity and religion on parent grief and mental health at one and three months after their infant's/child's death in the neonatal or pediatric intensive care unit

The death of an infant/child is one of the most devastating experiences for parents and immediately throws them into crisis. Spiritual and religious coping strategies may help parents with their loss. The purposes of this longitudinal study were to: (1) describe differences in bereaved parents' use of spiritual coping strategies across racial/ethnic and religious groups, mother/father dyads, and time—one (T1) and three (T2) months after the infant's/child's death in the neonatal (NICU) or pediatric intensive care unit (PICU), and (2) test the relationship between spiritual coping strategies and grief, mental health, and personal growth for mothers and fathers at T1 and T2. A sample of 126 Hispanic, Black/African American, and White parents of 119 deceased children completed the Spiritual Coping Strategies scale, Beck Depression Inventory-II, Impact of Events-Revised, Hogan Grief Reaction Checklist, and a demographic form at T1 and T2. Controlling for race and religion, spiritual coping was a strong predictor of lower grief, better mental health, and greater personal growth for mothers at T1 and T2 and lower grief for fathers at T1. The findings of this study will guide bereaved parents to effective strategies to help them cope with their early grief.