Adapting low intensity CBT interventions for clients with severe mental illness

Many people with severe mental illness (SMI) such as schizophrenia, whose psychotic symptoms are effectively managed, continue to experience significant functional problems. This chapter argues that low intensity (LI) cognitive behaviour therapy (CBT; e.g. for depression, anxiety, or other issues) is applicable to these clients, and that LI CBT can be consistent with long-term case management. However, adjustments to LI CBT strategies are often necessary and boundaries between LI CBT and high intensity (HI) CBT (with more extensive practitioner contact and complexity) may become blurred. Our focus is on LI CBT's self-management emphasis, its restricted content and segment length, and potential use after limited training. In addition to exploring these issues, it draws on the authors' Collaborative Recovery (CR; Oades et al. 2005) and 'Start Over and Survive' programs (Kavanagh et al. 2004) as examples. ----- ----- Evidence for the effectiveness of LI CBT with severe mental illness is often embedded within multicomponent programs. For example, goal setting and therapeutic homework are common components of such programs, but they can also be used as discrete LI CBT interventions. A review of 40 randomised controlled trials involving recipients with schizophrenia or other sever mental illnesses has identified key components of illness management programs (Mueser et al. 2002). However, it is relatively rare for specific components of these complex interventions to be assessed in isolation. Given these constraints, the evidence for specific LI CBT interventions with severe mental ilnness is relatively limited.

Brief motivational interviewing for depression and anxiety

Motivational interviewing (MI)can be applied as a brief, low intensity (LI) intervention of 1-4 individualised sessions (typically 45-60 minutes in duration), including screening, assessment feedback, and psycho-education. MI is a client-centred, directive therapeutic style that enhances readiness for change by helping clients explore and resolve ambivalence (Miller and Rollnick 2002). A summary of the key components of brief MI interventions is provided in Table 16.1. There is a well-established evidence base for MI in the treatment of substance misuse (particularly alcohol misuse; Moyer et al. 2002), as well as a growing evidence for the use of MI in the treatment of other mental disorders (e.g. depression, PTSD, OCD), as well as suicidality and physical health problems (Hettema et al. 2005). Brief MI intervention can be delivered as a standalone treatment or as a motivational prelude to pharmacological and/or other psychological treatments (Hettema et al. 2005). MI has been used as an accompaniment to cognitive behavioural therapy (CBT) in the treatment of both depression and anxiety for resolving ambivalence about change and developing strategies for responding to resistance (e.g. treatment attendance, homework/medication compliance; Arkowitz et al. 2008a, 2008b). This chapter will describe how to apply brief MI interventions to the treatment of depression and anxiety as applied to the case of Megan (see Box 16.1) along with some of the challenges and potential solutions to applying MI in practice.

Ethical fashion : the human stories driving a fashion movement

This paper examines and compares two stories, the novel Helen Fleetwood (Elizabeth, 1841) and the film China Blue (Teddy Bear Films, 2005), in relation to the Ethical Fashion movement. In 2005, more than 50 designers from around the world took part in The Ethical Fashion Show in Paris. This movement dictates that designers ensure that their garments are produced in an ethical manner, rather than support the ‘sweatshop’ environments of some industrialists determined to make a profit at the expense of workers rights. The momentum of the Ethical Fashion movement suggests that it is possible for fashion to be ethical, desirable and profitable in the 21st century. In 1841, after extensive research, Charlotte Elizabeth Tonna (using the pseudonym Charlotte Elizabeth) began to write about the atrocities of the factory system in industrialised England. Her novel, Helen Fleetwood, is one of the earliest examples of this kind of work, providing the reader with an extensive insight into the life of English factory workers in the mid-19th century. The story is about the Widow Green and her orphan dependents who are led, through circumstance, to leave their rural home and take up employment in the cotton mills of Manchester, with the hope of having an independent existence. Instead they discover the realities of factory life – extremely long hours, unsafe conditions, poor wages and a steady decline into extreme poverty. In his film China Blue (Teddy Bear Films, 2005), director Micha X. Peled tells an alarmingly similar tale set in 21st century China. This ‘docu-drama’ (a recreation from actual interviews and diary entries) tells the story of ‘Little Jasmine’ who leaves her family’s farm to pursue an independent life in Southern China’s manufacturing district. It is not long before the realities of modern factory life are revealed to the teenage ‘heroine’ – crowded dormitories, long working hours, arbitrary fines and wages that do not compare with those of workers in the Western world. While much of the human story remains unchanged, there have been significant improvements in technology and safety in the last 165 years that result in the reality that not all clothing manufacture is performed in ‘sweatshop’ conditions. After a recent visit to a manufacturing plant in China, consultation with peers in the industry and having worked in the Australian fashion industry for many years, the author compares these stories with her own experiences.

Cancer-related symptom clusters for symptom management in outpatients after commencing adjuvant chemotherapy, at 6 months, and 12 months

Goals of work: The aim of this secondary data analysis was to investigate symptom clusters over time for symptom management of a patient group after commencing adjuvant chemotherapy. Materials and methods: A prospective longitudinal study of 219 cancer outpatients conducted within 1 month of commencing chemotherapy (T1), 6 months (T2), and 12 months (T3) later. Patients' distress levels were assessed for 42 physical symptoms on a clinician-modified Rotterdam Symptom Checklist. Symptom clusters were identified in exploratory factor analyses at each time. Symptom inclusion in clusters was determined from structure coefficients. Symptoms could be associated with multiple clusters. Stability over time was determined from symptom cluster composition and the proportion of symptoms in the initial symptom clusters replicated at later times. Main results Fatigue and daytime sleepiness were the most prevalent distressing symptoms over time. The median number of concurrent distressing symptoms approximated 7, over time. Five consistent clusters were identified at T1, 2, and T3. An additional two clusters were identified at 12 months, possibly due to less variation in distress levels. Weakness and fatigue were each associated with two, four, and five symptom clusters at T1, T2, and T3, respectively, potentially suggesting different causal mechanisms. Conclusion: Stability is a necessary attribute of symptom clusters, but definitional clarification is required. We propose that a core set of concurrent symptoms identifies each symptom cluster, signifying a common cause. Additional related symptoms may be included over time. Further longitudinal investigation is required to identify symptom clusters and the underlying causes.

The ‘good’ parent in relation to early childhood literacy : symbolic terrain and lived practice

In this paper we consider the place of early childhood literacy in the discursive construction of the identity( ies) of ‘proper’ parents. Our analysis crosses between representations of parenting in texts produced by commercial and government/public institutional interests and the self-representations of individual parents in interviews with the researchers. The argument is made that there are commonalities and disjunctures in represented and lived parenting identities as they relate to early literacy. In commercial texts that advertise educational and other products, parents are largely absent from representations and the parent’s position is one of consumer on behalf of the child. In government-sanctioned texts, parents are very much present and are positioned as both learners about and important facilitators of early learning when they ‘interact’ with their children around language and books. The problem for which both, in their different ways, offer a solution is the ‘‘not-yet-ready’’ child precipitated into the evaluative environment of school without the initial competence seen as necessary to avoid falling behind right from the start. Both kinds of producers promise a smooth induction of children into mainstream literacy and learning practices if the ‘good parent’ plays her/his part. Finally, we use two parent cases to illustrate how parents’ lived practice involves multiple discursive practices and identities as they manage young children’s literacy and learning in family contexts in which they also need to negotiate relations with their partners and with paid and domestic work.

Children re-read and re-write their neighborhoods : critical literacies and identity work

This chapter considers the complex literate repertoires of 21st century children in multicultural primary classrooms in Adelaide South Australia. It draws on the curricular and pedagogical work of two experienced primary school teachers who explore culture, race and class, by positioning children as textual producers across a variety of media. In particular we discuss two child-authored texts – A is for Arndale – a local alphabet book co-authored by children aged between eight and ten, and – Cooking Afghani Style - a magazine style film produced by a multi-aged class of children (aged eight to thirteen) recently arrived in Australia. In the process of making these texts, primary children engaged in reading as a cultural practice – re-reading and re-writing their neighbourhoods and identities (both individual and collective). This involved frequent excursions to local key sites, both familiar and unfamiliar to the children. They investigated how diverse children experienced and lived their lives in particular places within changing communities.

From bricks to clicks : hybrid commercial spaces in the landscape of early literacy and learning

In their quest for resources to support children’s early literacy learning and development, parents encounter and traverse different spaces in which discourses and artifacts are produced and circulated. This paper uses conceptual tools from the field of geosemiotics to examine some commercial spaces designed for parents and children which foreground preschool learning and development. Drawing on data generated in a wider study I discuss some of the ways in which the material and virtual commercial spaces of a transnational shopping mall company and an educational toy company operate as sites of encounter between discourses and artifacts about children’s early learning and parents of preschoolers. I consider how companies connect with and ‘situate’ people as parents and customers, and then offer pathways designed for parents to follow as they attempt to meet their very young children’s learning and development needs. I argue that these pathways are both material and ideological, and that are increasingly tending to lead parents to the online commercial spaces of the world wide web. I show how companies are using the online environment and hybrid offline and online spaces and flows to reinforce an image of themselves as authoritative brokers of childhood resources for parents that is highly valuable in a policy climate which foregrounds lifelong learning and school readiness.

The 3D model of l(IT)eracy and the English curriculum

The field of literacy studies has always been challenged by the changing technologies that humans have used to express, represent and communicate their feelings, ideas, understandings and knowledge. However, while the written word has remained central to literacy processes over a long period, it is generally accepted that there have been significant changes to what constitutes ‘literate’ practice. In particular, the status of the printed word has been challenged by the increasing dominance of the image, along with the multimodal meaning-making systems facilitated by digital media. For example, Gunther Kress and other members of the New London Group have argued that the second half of the twentieth century saw a significant cultural shift from the linguistic to the visual as the dominant semiotic mode. This in turn, they suggest, was accompanied by a cultural shift ‘from page to screen’ as a dominant space of representation (e.g. Cope & Kalantzis, 2000; Kress, 2003; New London Group, 1996). In a similar vein, Bill Green has noted that we have witnessed a shift from the regime of the print apparatus to a regime of the digital electronic apparatus (Lankshear, Snyder and Green, 2000). For these reasons, the field of literacy education has been challenged to find new ways to conceptualise what is meant by ‘literacy’ in the twenty first century and to rethink the conditions under which children might best be taught to be fully literate so that they can operate with agency in today’s world.

Parents resourcing children’s early development and learning

Parents deal with a complex web of choices when seeking and using knowledge and resources related to their young children’s literacy development. Information about children’s learning and development comes in many forms and is produced by an increasingly diverse range of players including governments, nongovernment organisations and commercial businesses. This study used a survey, interview and artefact collection to investigate mothers’ and fathers’ reported activities in seeking, accessing, producing and circulating information and resources related to children’s learning and development. Differences were found relating to parent gender and level of education. Parents’ resourcing activities are also shaped by their particular goals for their children.

Critical reading comprehension in an era of accountability

This paper argues for the need for critical reading comprehension in an era of accountability that often promotes reading comprehension as readily assessable through students answering multiple choice questions of unseen texts. Based upon a 1 year study investigating literacy in Years 4–9 the ways strong-performing primary schools develop serious and in-depth reading for learning are explored. School and teacher features which allow for the development of sophisticated pedagogical repertoires and space for critical reading comprehension, without losing the complexity of curriculum offerings, are outlined. How one experienced middle primary teacher operates strategically, ethically and critically in supporting her ESL students to learn to read is illustrated. The teacher’s work is situated within the complex accountability demands faced by classroom teachers. This was accomplished by a teacher whose pedagogical repertoire has been assembled across a career teaching in low-SES high ESL communities in a school with a balanced literacy program and high level of collegial support. Risks for schools and teachers whose circumstances work against their capacities for prioritisation and strategic decision-making are identified and discussed.

New research literacies for contemporary research into literacy and new media?

The term literacy remains highly contested and debates continue about how literacy might best be researched and to what ends. For some, literacy is simply a matter of acquiring the technical competence which enables people to read and write. Literacy research conducted from this point of view does not usually concern itself with the new media but rather focuses on how people learn to code and decode print text. For others, however, literacy is more complex and involves learning a repertoire of practices for communicating and getting things done in particular social and cultural contexts. Literacy research conducted from this sociocultural point of view accepts that the new media are central to the field because in everyday cultural practice people are using the new media to make meaning, to express themselves and to communicate and work with others. Socio-cultural approaches to literacy research have already provided rich material which has assisted educators to understand literacy practices in everyday use (e.g. Barton & Hamilton, 1998; Barton, Hamilton and Ivanic, 2000) including children’s appropriation of the media in school-based writing (Dyson, 1997). However, the changing semiotic and cultural practices associated with new media and online participation have less frequently been the object of study...

New media pathways : navigating the links between home, school and the workplace

The terms ‘literacy’ and ‘technology’ remain highly contentious within the field of education. What is meant by ‘literacy’ and the methods used to measure it vary quite markedly in educational and historical contexts across the world. Similarly, while there is a shared concern to research the potential impact of new information and communication technologies (ICTs) on patterns of teaching and learning, there are major discrepancies about which aspects and uses of these technologies should be incorporated into formal learning environments and how this can be accomplished. While government policy makers tend to regard ICTs in relation to ideas of ‘smartness’, efficiency, and the ‘knowledge’ (or ‘new’) economy, educators and educational researchers promote them as offering new tools for learning and critical thinking and the development of new literacies and socio-cultural identities. This clearly has ramifications for the ways literacy is taught and conceptualised throughout the years of schooling, K-12. Outside school, meanwhile, students engage with ICTs on another level entirely, as tools for the maintenance of social networks, for leisure, and for learning and participating in the cultures of their peers. Whatever the differences in perspective, it remains the case that a society’s dominant understandings about literacy and technology will have significant implications for the development of school curriculum.

Development of a workplace wellness promotion pilot framework : a case study of the Blue Care Staff Wellness Program

Workplace wellness initiatives are currently unreflective of the multidimensional and holistic nature of the wellness construct. There exists an opportunity for promoters of health to move toward models of workplace wellness promotion that more fully appreciate the interconnected nature of health dimensions and promote them even-handedly. The Blue Care Staff Wellness Program framework was developed in response to a recognised need for consistent and wellness-focused constructs for workplace wellness promotion and dissemination. The framework promotes and supports the individual and organisational wellness of the Blue Care employee population by providing a comprehensive and sustainable employee wellness program. This has been achieved by the adoption of consistent wellness principles to guide the framework conception and theory based development. The use of the framework in a pilot program will provide insight into the frameworks effectiveness in promoting a comprehensive workplace wellness program, and go further to establish the relationship between wellness and productivity in the workplace.

School-based strategies to address cyber bullying

Bullying and victimisation among school age children is recognised as a major public health problem. The Australian Covert Bullying Prevalence Study (ACBPS) reports that just over one quarter (27%) of school students aged 8 to 14 years were bullied and 9% bullied others on a frequent basis (every few weeks or more often) (Cross et al., 2009). Bullying is associated with a host of detrimental effects, including loneliness (Nansel, Overpeck, Pilla, & Ruan, 2001), low self‐esteem (Jankauskiene, Kardelis, Sukys, & Kardeliene, 2008; Salmivalli, Kaukiainen, Kaistaniemi, & Lagerspetz, 1999), anxiety, depression (Kaltiala‐Heino, Rimpela, Rantanen, & Rimpela, 2000), suicide ideation (Kaltiala‐Heino, Rimpela, Marttunen, Rimpela, & Rantanen, 1999), impaired academic achievement (Nansel et al., 2001), and poorer physical health (Wolke, Woods, Bloomfield, & Karstadt, 2001).

Tangible programming elements for young children

Tangible programming elements offer the dynamic and programmable properties of a computer without the complexity introduced by the keyboard, mouse and screen. This paper explores the extent to which programming skills are used by children during interactions with a set of tangible programming elements: the Electronic Blocks. An evaluation of the Electronic Blocks indicates that children become heavily engaged with the blocks, and learn simple programming with a minimum of adult support.