Innovative approaches to intervention for problem drinking

Purpose of review: To critique the recent literature on telephone, correspondence-based, and computerized interventions for alcohol problems, which enhance or substitute for practitioner-delivered treatments. Recent findings: There is an unmet need for screening, assessment and intervention for alcohol problems, in part because of the difficulty in accessing such treatment within the current health care system. Research on the efficacy of correspondence or electronic (for example Internet-based) interventions is beginning to emerge. In the period 2003–2004 we identified nine acceptability or feasibility studies of these approaches and seven efficacy trials covering a wide range of settings. These modes of intervention are acceptable to patients and the public, and with careful planning, can be implemented in a variety of settings. Treatment trials demonstrate the efficacy of these interventions in reducing hazardous drinking by university students, in delaying initiation of heavy drinking in children and adolescents, and, intriguingly, in addressing insomnia among recovering alcoholics. Summary: There is strong support among potential users for alcohol interventions that employ telephone assistance, written correspondence, and the Internet. These new technologies offer the prospect of increasing the reach of interventions for problem drinking and being cost- effective alternatives or supplements to face-to-face health service delivery.

Exercise for health : a breast cancer recovery program - quality of life benefits [Conference Abstract]

Introduction: Five-year survival from breast cancer in Australia is 87%. Hence, ensuring a good quality of life (QOL) has become a focal point of cancer research and clinical interest. Exercise during and after treatment has been identified as a potential strategy to optimise QOL of women diagnosed with breast cancer.----- Methods: Exercise for Health is a randomised controlled trial of an eight-month, exercise intervention delivered by Exercise Physiologists. An objective of this study was to assess the impact of the exercise program during and following treatment on QOL. Queensland women diagnosed with unilateral breast cancer in 2006/07 were eligible to participate. Those living in urban-Brisbane (n=194) were allocated to either the face-to-face exercise group, the telephone exercise group, or the usual-care group, and those living in rural Queensland (n=143) were allocated to the telephone exercise group or the usual-care group. QOL, as assessed by the Functional Assessment of Cancer Therapy-Breast (FACT-B+4) questionnaire, was measured at 4-6 weeks (pre-intervention), 6 months (mid-intervention) and 12 months (three months post-intervention) post-surgery.----- Results: Significant (P<0.01) increases in QOL were observed between pre-intervention and three months post-intervention 12 months post-surgery for all women. Women in the exercise groups experienced greater mean positive changes in QOL during this time (+10 points) compared with the usual-care groups (+5 to +7 points) after adjusting for baseline QOL. Although all groups experienced an overall increase in QOL, approximately 20% of urban and rural women in the usual-care groups reported a decline in QOL, compared with 10% of women in the exercise groups.----- Conclusions: This work highlights the potential importance of participating in physical activity to optimise QOL following a diagnosis of breast cancer. Results suggest that the telephone may be an effective medium for delivering exercise counselling to newly diagnosed breast cancer patients.

A brief motivational intervention for substance misuse in recent-onset psychosis

Substance misuse is common in early psychosis, and impacts negatively on outcomes. Little is known about effective interventions for this population. We report a pilot study of brief intervention for substance misuse in early psychosis (Start Over and Survive: SOS), comparing it with Standard Care (SC). Twenty-five in-patients aged 18-35 years with early psychosis and current misuse of non-opioid drugs were allocated randomly to conditions. Substance use and related problems were assessed at baseline, 6 weeks and 3, 6 and 12 months. Final assessments were blind to condition. All 13 SOS participants who proceeded to motivational interviewing reported less substance use at 6 months, compared with 58% (7/12) in SC alone. Effects were well maintained to 12 months. However, more SOS participants lived with a relative or partner, and this also was associated with better outcomes. Engagement remained challenging: 39% (16/41) declined participation and 38% (5/13) in SOS only received rapport building. Further research will increase sample size, and address both engagement and potential confounds.

Contrasting views and experiences of health professionals on the management of comorbid substance misuse and mental disorders

Objectives: To determine opinions and experiences of health professionals concerning the management of people with comorbid substance misuse and mental health disorders. Method: We conducted a survey of staff from mental health services and alcohol and drug services across Queensland. Survey items on problems and potential solutions had been generated by focus groups. Results: We analysed responses from 112 staff of alcohol and drug services and 380 mental health staff, representing a return of 79% and 42% respectively of the distributed surveys. One or more issues presented a substantial clinical management problem for 98% of respondents. Needs for increased facilities or services for dual disorder clients figured prominently. These included accommodation or respite care, work and rehabilitation programs, and support groups and resource materials for families. Needs for adolescent dual diagnosis services and after-hours alcohol and drug consultations were also reported. Each of these issues raised substantial problems for over 70% of staff. Another set of problems involved coordination of client care across mental health and alcohol and drug services, including disputes over duty of care. Difficulties with intersectoral liaison were more pronounced for alcohol and drug staff than for mental health. A majority of survey respondents identified 13 solutions as practical. These included routine screening for dual diagnosis at intake, and a range of proposals for closer intersectoral communication such as exchanging client information, developing shared treatment plans, conducting joint case conferences and offering consultation facilities. Conclusions: A wide range of problems for the management of comorbid disorders were identified. While solution of some problems will require resource allocation, many may be addressed by closer liaison between existing services.

Aligning school reform and teacher education reform in the middle years : an Australian case study

This paper discusses the development of a new Bachelor of Education (Middle Years of Schooling) at The University of Queensland, Australia. The middle years of schooling have increasingly been the focus of education reform initiatives in Australia, but this has not been accompanied by significant increases in the number of teacher education institutions offering specialised middle schooling-level teacher preparation programmes. Considering the rapidly changing social and economic context and the emergent state of middle schooling in Australia, the programme represented a conceptual and practical opportunity and challenge for The University of Queensland team. Working collaboratively, the team sought to design a teacher education preservice programme that was both responsive and generative: that is, responsive to local school contexts and to current education research and reform at national and international levels; and generative of cutting-edge theories and practices associated with middle schooling, teachers' work, and teacher education. This paper focuses on one component of the Middle Years of Schooling Teacher Education programme at The University of Queensland; namely, the practicum. We first present the underlying principles of the practicum programme and then examine "dilemmas" that emerged early in the practicum. These issues and tensions were associated with the ideals of "middle years" philosophy and the pragmatics of school reform associated with that approach. Within this context, we explore what it means to be both responsive and generative, and describe how we as teacher educators negotiated the extremes these terms implied.

Preliminary Results from Exercise for Health : A Breast Cancer Recovery Project [Abstract]

The Exercise for Health program is a telephone-delivered exercise intervention for women with breast cancer (BC) living in regional Queensland. The effect of the program is being evaluated in the context of a randomised controlled trial. Consenting, newly diagnosed BC patients, treated in one of 8 regional Queensland hospitals, were randomly allocated to telephone-based exercise counselling (EC) or usual care (UC) at 6-weeks post-surgery. EC participants received an exercise workbook and 16 calls from an exercise physiologist over 8 months. Physical activity levels (PA) (Active Australia & CHAMPS), quality-of-life (FACTB+4), upper-body function (DASH) and fatigue (FACIT-Fatigue) were assessed at baseline (4-6 weeks post-surgery), 6- and 12-months post-surgery. Preliminary analyses of available 6-month data were conducted using t-tests and repeated measures ANCOVAs. Participating women (n=143; EC n=73, UC n=70) were aged 53±9 years and 30% met PA guidelines at baseline. Up to two thirds of the women received adjuvant therapy during the first 6 months following surgery. Greater improvements (mean change+SD) occurred for the EC vs UC group in weekly sessions of walking (1.83±4.3 vs -0.5±5.5, p=0.029) moderate-vigorous PA (5.0±6.5 vs -1.1±6.1, p=0.005) and strength training (1.9±2.9 vs -0.5±4.2 p<0.001), and in upper-body function, reflected by lower log-transformed disability scores (-0.34±0.44 vs -0.17±0.28, p=0.038). More EC than UC participants met PA guidelines at 6 months (46.3% vs 32.7%). Preliminary findings from this ongoing trial suggest that the telephone is a feasible and effective medium for delivering exercise counselling to newly diagnosed BC patients living in regional areas.

Recovery and exercise interventions following breast cancer [Abstract]

Over 13,000 women are diagnosed with breast cancer each year in Australia and approximately 90% of these women will survive longer than 5-years. However, survival following treatment for breast cancer is often associated with adverse physical and psychosocial side effects, which persist beyond treatment cessation. As incidence and survival rates associated with breast cancer continue to rise, there is an imperative need to understand the extent of treatment-related concerns and ways in which these concerns can be minimized and/or overcome. A growing body of scientific evidence demonstrates that extensive quality of life benefits can be attained through exercise during and following breast cancer treatment. Such benefits observed include improvements in psychosocial and physical outcomes, as well as better compliance with treatment regimens and reduced impact of disease symptoms and treatment-related side effects. There is also evidence to suggest that post-diagnosis physical activity can improve survival. However, the majority of women newly diagnosed with breast cancer in Australia are not sufficiently active and the majority experience further declines in their physical activity levels during treatment. Throughout the course of this presentation, which draws on data from cohort studies and randomized trials of exercise interventions conducted in Queensland, the potential benefits of exercising during and following breast cancer treatment, the exercise prescription recommended for breast cancer survivors, the limits of our evidence-based knowledge and the issues faced by clinicians and patients with respect to exercise following a cancer diagnosis will be discussed. The question is no longer whether people with breast cancer should be active during and following their treatment, but is how do health care professionals best assist people to become and stay active in an endeavor to live healthy lives beyond their cancer experience.

Risk-assessment practices in the private rental sector : implications for low-income renters (Final Report)

This report focuses on risk-assessment practices in the private rental market, with particular consideration of their impact on low-income renters. It is based on the fieldwork undertaken in the second stage of the research process that followed completion of the Positioning Paper. The key research question this study addressed was: What are the various factors included in ‘risk-assessments’ by real estate agents in allocating ‘affordable’ tenancies? How are these risks quantified and managed? What are the key outcomes of their decision-making? The study builds on previous research demonstrating that a relatively large proportion of low-cost private rental accommodation is occupied by moderate- to high-income households (Wulff and Yates 2001; Seelig 2001; Yates et al. 2004). This is occurring in an environment where the private rental sector is now the de facto main provider of rental housing for lower-income households across Australia (Seelig et al. 2005) and where a number of factors are implicated in patterns of ‘income–rent mismatching’. These include ongoing shifts in public housing assistance; issues concerning eligibility for rent assistance; ‘supply’ factors, such as loss of low-cost rental stock through upgrading and/or transfer to owner-occupied housing; patterns of supply and demand driven largely by middle- to high-income owner-investors and renters; and patterns of housing need among low-income households for whom affordable housing is not appropriate. In formulating a way of approaching the analysis of ‘risk-assessment’ in rental housing management, this study has applied three sociological perspectives on risk: Beck’s (1992) formulation of risk society as entailing processes of ‘individualisation’; a socio-cultural perspective which emphasises the situated nature of perceptions of risk; and a perspective which has drawn attention to different modes of institutional governance of subjects, as ‘carriers of specific indicators of risk’. The private rental market was viewed as a social institution, and the research strategy was informed by ‘institutional ethnography’ as a method of enquiry. The study was based on interviews with property managers, real estate industry representatives, tenant advocates and community housing providers. The primary focus of inquiry was on ‘the moment of allocation’. Six local areas across metropolitan and regional Queensland, New South Wales, and South Australia were selected as case study localities. In terms of the main findings, it is evident that access to private rental housing is not just a matter of ‘supply and demand’. It is also about assessment of risk among applicants. Risk – perceived or actual – is thus a critical factor in deciding who gets housed, and how. Risk and its assessment matter in the context of housing provision and in the development of policy responses. The outcomes from this study also highlight a number of salient points: 1.There are two principal forms of risk associated with property management: financial risk and risk of litigation. 2. Certain tenant characteristics and/or circumstances – ability to pay and ability to care for the rented property – are the main factors focused on in assessing risk among applicants for rental housing. Signals of either ‘(in)ability to pay’ and/or ‘(in)ability to care for the property’ are almost always interpreted as markers of high levels of risk. 3. The processing of tenancy applications entails a complex and variable mix of formal and informal strategies of risk-assessment and allocation where sorting (out), ranking, discriminating and handing over characterise the process. 4. In the eyes of property managers, ‘suitable’ tenants can be conceptualised as those who are resourceful, reputable, competent, strategic and presentable. 5. Property managers clearly articulated concern about risks entailed in a number of characteristics or situations. Being on a low income was the principal and overarching factor which agents considered. Others included: - unemployment - ‘big’ families; sole parent families - domestic violence - marital breakdown - shift from home ownership to private rental - Aboriginality and specific ethnicities - physical incapacity - aspects of ‘presentation’. The financial vulnerability of applicants in these groups can be invoked, alongside expressed concerns about compromised capacities to manage income and/or ‘care for’ the property, as legitimate grounds for rejection or a lower ranking. 6. At the level of face-to-face interaction between the property manager and applicants, more intuitive assessments of risk based upon past experience or ‘gut feelings’ come into play. These judgements are interwoven with more systematic procedures of tenant selection. The findings suggest that considerable ‘risk’ is associated with low-income status, either directly or insofar as it is associated with other forms of perceived risk, and that such risks are likely to impede access to the professionally managed private rental market. Detailed analysis suggests that opportunities for access to housing by low-income householders also arise where, for example: - the ‘local experience’ of an agency and/or property manager works in favour of particular applicants - applicants can demonstrate available social support and financial guarantors - an applicant’s preference or need for longer-term rental is seen to provide a level of financial security for the landlord - applicants are prepared to agree to specific, more stringent conditions for inspection of properties and review of contracts - the particular circumstances and motivations of landlords lead them to consider a wider range of applicants - In particular circumstances, property managers are prepared to give special consideration to applicants who appear worthy, albeit ‘risky’. The strategic actions of demonstrating and documenting on the part of vulnerable (low-income) tenant applicants can improve their chances of being perceived as resourceful, capable and ‘savvy’. Such actions are significant because they help to persuade property managers not only that the applicant may have sufficient resources (personal and material) but that they accept that the onus is on themselves to show they are reputable, and that they have valued ‘competencies’ and understand ‘how the system works’. The parameters of the market do shape the processes of risk-assessment and, ultimately, the strategic relation of power between property manager and the tenant applicant. Low vacancy rates and limited supply of lower-cost rental stock, in all areas, mean that there are many more tenant applicants than available properties, creating a highly competitive environment for applicants. The fundamental problem of supply is an aspect of the market that severely limits the chances of access to appropriate and affordable housing for low-income rental housing applicants. There is recognition of the impact of this problem of supply. The study indicates three main directions for future focus in policy and program development: providing appropriate supports to tenants to access and sustain private rental housing, addressing issues of discrimination and privacy arising in the processes of selecting suitable tenants, and addressing problems of supply.

Behaviour disorders and teacher negligence

The purpose of this paper is to examine the legal implications of the continuing rise in the number of school children diagnosed with behaviour disorders. Not only are teachers now subject to a dense grid of legal regulation, they are also increasingly vulnerable to actions in tort. It will be argued here that as more and more children are labelled ‘disordered’, the duty of care become more onerous, and hence harder for teachers to meet. As a consequence, teachers are more likely to face claims of negligence. It is concluded that while the schooling system needs to retain a healthy scepticism about each new pathologising disorder that seeks special status for its sufferers, it also needs to provide greater training and resources for teachers regarding disorder management. It is also concluded that recent changes to negligence law regarding the issue of ‘reasonable foreseeability’ within breach of duty of care, may not be as significant as might have been hoped by the teaching community. Indeed, the elevated standard of care required by the increasing numbers of disordered pupils, places teachers in an ever more difficult legal position.

Re-assessing streetkids : a critique of subculture theory

Focusing on the notion of street kids, the paper suggests that youth be viewed in an alternative way to the subculture theory associated with the Center for Contemporary Cultural Studies in Birmingham (CCCS). It is argued that not only is subculture theory an unsuitable mechanism for understanding homeless youth but also, and more importantly, is itself fundamentally problematic. It is suggested that the work of Michel Foucault necessitates a reevaluation of the domain assumptions underlying subculture theory and offers in its place a model that relocates street kids, and youth itself, as artifacts of a network of governmental strategies.

Mainstreamed students with learning difficulties : failing and underachieving in the secondary school

Despite the rhetoric that students with learning difficulties are adequately supported within schools, the evidence suggests that they continue to experience school failure with devastating consequences. Students with learning difficulties are disproportionately represented as juvenile delinquents, as the unemployed and in mental health statistics. However, the defining of this group remains confused and imprecise and has not been a national priority. This has repercussions for both secondary schools and for the students themselves. This paper highlights research related to teaching practices, policies and school structure and their effects on the academic outcomes and emotional well being of students with learning difficulties. Finally, it makes a number of recommendations to change the status quo for these students.

Behaviour disorders and the negligent teacher

The purpose of this paper is to examine the legal implications of the continuing rise in the number of school children diagnosed with behaviour disorders. Not only are teachers now subject to a dense grid of legal regulation, they are also increasingly vulnerable to actions in tort. It will be argued here that as more and more children are labelled ‘disordered’, then the concomitant duty of care requirements for teachers becomes more onerous. As a consequence, teachers are less likely to be able to defend themselves against claims of negligence. It is concluded that while the schooling system needs to retain a healthy scepticism about each new pathologising disorder that seeks special status for its sufferers, it also needs to provide greater training and resources for teachers regarding disorder management. It is also concluded that recent changes to negligence law regarding the issue of ‘reasonable foreseeability’ within breach of duty of care, may not be as significant as might have been hoped by the teaching community. Indeed, the elevated standard of care, as required by increasing numbers of disordered pupils, place teachers in an ever more difficult legal position.

Serious playground : using Second Life to engage high school students in urban planning

Virtual world platforms such as Second Life have been successfully used in educational contexts to motivate and engage learners. This article reports on an exploratory workshop involving a group of high school students using Second Life for an urban planning project. Young people are traditionally an under-represented demographic when it comes to participating in urban planning and decision making processes. The research team developed activities that combined technology with a constructivist approach to learning. Real world experiences and purposes ensured that the workshop enabled students to see the relevance of their learning. Our design also ensured that play remained an important part of the learning. By conceiving of the workshop as a ‘serious playground’ we investigated the ludic potential of learning in a virtual world.

Assessment by interview and portfolio in a Graduate School Program

Assessment plays an integral role in teaching and learning in Higher Education and teachers have a strong interest in debates and commentaries on assessment as and for learning. In a one-year graduate entry teacher preparation program, the temptation is to emphasize assessment in an attempt to ensure students “cover” everything as part of a robust preparation for the profession. The risk is that, for students, assessment drives curriculum, and time spent in the completion of assignments is no guarantee of either effective learning or authentic preparation for teaching. Interviews as assessment provide an opportunity for a learning experience as well as an authentic task, since students will shortly be interviewing for employment in a “real world” situation. This paper reports on a project experimenting with interview panels as authentic assessment with pre-service early childhood teachers. At the end of their first semester of study, students enrolled in the Graduate Diploma of Education program at the Queensland University of Technology in Australia were required to participate in a panel interview where they were graded by a panel made up of three faculty staff and one undergraduate student enrolled in the four-year Bachelor of Education program. Students and panel members completed a questionnaire on their experience after the interview. Results indicated that both students and staff valued the experience and felt it was authentic. Results are discussed in terms of how the assessment interview and portfolio presentation supports graduating students in their preparation for employment interviews, and how this authentic assessment task has benefits for both students and teaching staff.