Thai family support (TFS) : working with families of young substance users in primary health care

Living with substance users negatively impacts upon family members in many ways, and distress is common. Despite these deep and wide-ranging impacts, supportive interventions for family members in their own right are rarely available. Thailand has substantial and growing problems with substance use, and there is very little support or family members of drug users, especially in community setting. The Thai Family Support (TFS) program was designed for implementation in primary health care units (PCUs) in Thailand. TFS was based on two approaches with existing empirical support in Western contexts—the 5-step method and CRAFT—with adaptations to a Thai setting that included integration with Buddhist practices. Its aims were to increase well-being of family members, reduce mental distress, improve family relationships between family members, and engage substance users in behaviour change. A small-scale randomised controlled trial on TFS with a Delayed Treatment control was conducted, with assessments at 8 weeks (Post 1) and 20-24 weeks (Post 2). Structured interviews with participants and PCU staff and an examination of five case studies augmented the quantitative results. Mixed Model Analyses were applied to quantitative outcomes, and thematic analysis was used for qualitative data. Thirty-six participants (18 in each of Immediate and Delayed Conditions) were recruited. A significant difference at Baseline between the two conditions was observed on the Thai GHQ-28 and Gender, but it was not possible to statistically control for these effects. There was a significant Time by Condition interaction on the Thai GHQ-28, WHOQOL-BREF-THAI and FAS, reflecting greater improvements in the Immediate condition by Post 1, but with the Delayed condition meeting or exceeding that effect by Post 2. On FES Cohesion and Conflict, there were falls across conditions at Post 2, but only Cohesion also showed a Time by Condition interaction, and that effect was consistent with a delayed impact of treatment. Overall, TFS by PCU staff in the Delayed Condition gave similar results to TFS conducted by the researcher, supporting the viability of its dissemination to standard health services. Qualitative data also confirmed the quantitative results. Most participants reported physiological and psychological improvements even though their substance-using relative did not change their drug use behaviour. After completing TFS, participants reported increased knowledge, group support and sharing feeling, having positive patient-professional relationship, having greater knowledge of substance abuse and social support. In particular, they changed their behaviour towards the substance user, resulting in improvements to family relationships. PCU staff gave similar responses on the efficacy of TFS, and saw it as feasible for routine use, although some implementation challenges were identified. The cultural adaptation and in particular the religious activities, were recognised by participants and PCU staff as an important component of TFS to support psychological health and well-being. Findings from this study showed the impact of substance use on family members and difficulties that they experienced when living with the substance users, resulting distresses and burden that may develop severe mental health disease. Drug use policies should be modified to support family members and response to their needs effectively for early prevention. This study also gave preliminary support for application of the TFS program in rural primary care settings and identified some policies that will be required for it to be disseminated more broadly.

Working with refugee survivors of torture and trauma : an opportunity for vicarious posttraumatic growth

Clinical work with people who have survived trauma carries a risk of vicarious traumatisation for the service provider, but also the potential for vicarious posttraumatic growth. Despite growing interest in this area, the effects of working with survivors of refugee-related trauma have remained relatively unexplored. The aim of the current study was to examine the lived experiences of people working on a daily basis with survivors of torture and trauma who had sought refuge in Australia. Seventeen clinical, administrative, and managerial staff from a not-for-profit organisation participated in a semi-structured interview that was later analysed using interpretive phenomenological analysis. Analysis of the data demonstrated that the entire sample reported symptoms of vicarious trauma (e.g., strong emotional reactions, intrusive images, shattering of existing beliefs) as well as vicarious posttraumatic growth (e.g., forming new relationships, increased self-understanding, greater appreciation of life). Moreover, effortful meaning making processes appeared to facilitate such positive changes. Reduction in the risks associated with this work, enhancement of clinician well-being, and improvement of therapeutic outcomes is a shared responsibility of the organisation and clinician. Without negating the distress of trauma work, clinicians are encouraged to more deeply consider the unique positive outcomes that supporting survivors can provide.

‘Working with the team’ : an exploratory study of improved type 2 diabetes management in a new model of integrated primary/secondary care

This study aimed to explore how a new model of integrated primary/secondary care for type 2 diabetes management, the Brisbane South Complex Diabetes Service (BSCDS), related to improved diabetes management in a selected group of patients. We used a qualitative research design to obtain detailed accounts from the BSCDS via semi-structured interviews with 10 patients. The interviews were fully transcribed and systematically coded using a form of thematic analysis. Participants’ responses were grouped in relation to: (1) Patient-centred care; (2) Effective multiprofessional teamwork; and (3) Empowering patients. The key features of this integrated primary/secondary care model were accessibility and its delivery within a positive health care environment, clear and supportive interpersonal communication between patients and health care providers, and patients seeing themselves as being part of the team-based care. The BSCDS delivered patient-centred care and achieved patient engagement in ways that may have contributed to improved type 2 diabetes management in these participants.

Skating on Olympic ice: working with winter Olympians

Working as a sport psychologist with Olympic athletes requires a clear understanding of a broad range of multifaceted individual, group, situational, and environmental issues, all of which have the ability to impact upon performance. This article provides an overview of some of the common yet vital issues that have been observed to arise when working with Olympic Winter Games athletes and teams; what to expect, how to recognise them when they occur, and why they are important to prepare for in the context of supporting athletes to achieve the best performance they can at an Olympic Games. Aimed at the emerging sport psychology practitioner, discussion of issues such as performing under pressure, dealing with distractions, adjusting to external factors, team culture, and servicing models creates an informal set of “practical guidelines” based upon real-world experiences that can also be applied to other major sporting competitions.

Working with Behavioural and Emotional Problems in Young People

This chapter outlines specific issues relating to behavioural and emotional problems in Aboriginal and Torres Strait Islander young people. It describes the most common disorders and their consequences, and how young Aboriginal people are at higher risk for developing such problems than other young Australians. The chapter also discusses the importance of psychosocial, cultural and environmental issues that need to be recognised in assessing and treating Aboriginal young people with behavioural and emotional problems. Issues concerning the delivery of both universal and culturally responsive prevention and intervention programs to address social and emotional wellbeing and mental health are discussed and possible interventions to enhance student engagement at school are provided. Finally, a range of mental health services for Aboriginal families which offer a culturally responsive approach to mental health treatment are listed.

The decision-making processes of early childhood teachers when working with children experiencing parental separation and divorce

In this study, the pedagogical decision-making processes of 21 Australian early childhood teachers working with children experiencing parental separation and divorce were examined. Transcripts from interviews and a focus group with teachers were analysed using grounded theory methodology. The findings showed that as teachers interacted with young children experiencing parental separation and divorce, they reported using strategic, reflexive pedagogical decision-making processes. These processes comprised five stages: (1) teachers constructing their knowledge; (2) teachers thinking about their knowledge; (3) teachers using decision-making schemas; (4) teachers taking action, and; (5) teachers monitoring action and evaluating. This understanding of teachers’ reflexive pedagogical decision-making is useful for identifying how teachers and educational leaders can support children experiencing parental separation and divorce or other life challenges.

Identifying opportunity spaces for design research in South America: Working with grassroots and community groups

As design research continues to gain momentum in South America, design researchers and practitioners in the region have begun to consider how to the field may address regionally-specific issues, including on-going political struggles. By bringing approaches such as Participatory Design and Adversarial Design that consider political aspects of design, local researchers have explored various forms that these two approaches could take that are tailored to the needs and values of different communities across the region. This paper focuses on identifying opportunities for developing design research projects in community-based and grassroots-oriented contexts. The paper presents the findings of our study about the understanding and experience of design researchers and experts who have been working closely with community groups and grassroots organisations in South America. Five themes emerged, highlighting opportunities and challenges related to positioning contemporary design research in the region, integration of adversarial perspectives into design processes, leveraging local obstacles through creativity, and the potential of building capacity within community groups and grassroots organisations for sustainability and autonomy.

Unidentified women working with files; Reichsvertretung der Juden in Deutschland Portraits; Groups; Women

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Working with Identities Promoting Student Teachers Professional Development

The starting point of the study was that good teaching requires a teacher to be aware of the sources of his or her pedagogical decisions; that is, personal values, beliefs and understandings. From this perspective, a teacher s professional development refers to a process of extending one s self-knowledge. The aim of this study was to promote student teachers' professional development with the help of identity work. Identity work refers to reflecting on both personal and professional experiences. Identity work consists of student teachers self-reflection on their life experiences (self-identity) and video diary-based reflection on their classroom practice (professional identity). The research questions of the study were 1) how is identity work manifested by the participants? and 2) what is the potential of identity work in promoting student teachers professional development? The research data was collected from four student teachers in the academic year 2007-2008; the research group had 24 meetings during the research process. Student teachers take part in a multimode teacher education programme, where students work as ordinary teachers in schools during their university studies. The data collection was conducted by using two methods: participants narratives based on autobiographical writings and video diaries based on participants lessons. Narrative research data was analysed by employing qualitative methods and strategies as they were needed in the research. The research results revealed four different ways of working with identities, each of them revealing different aspects of and approaches to identity work. The results also showed that identity work has the potential to promote professional development. As the research progressed, there were visible changes in the participants reflection. However, despite encouraging results, some issues should be critically questioned. Although reflection sounds attractive and fruitful as a tool for promoting professional development, there are also difficulties and obstacles. On the basis of the results, a proposal for promoting student teachers professional development is offered. Keywords: Teacher identity, identity work, reflection, teacher professional development