Outcome measurement of community based mental health services in Western Australia: literature and concept summary

The paper aims to provide a brief overview of key ideas related to outcome measurement relevant to community based mental health services and their consumers in WA. Due to the breadth of scope of the paper, it is not an extensive or rigorous literature review but provides a scan of the literature that could shape a more thorough literature review in any of the content areas. The paper has been written with the aim of informing the sector of key ideas, issues, concepts and approaches.

Improving transfer of mental health care for rural and remote consumers in South Australia

In Australia, it is commonplace for tertiary mental health care to be provided in large regional centres or metropolitan cities. Rural and remote consumers must be transferred long distances, and this inevitably results in difficulties with the integration of their care between primary and tertiary settings. Because of the need to address these issues, and improve the transfer process, a research project was commissioned by a national government department to be conducted in South Australia. The aim of the project was to document the experiences of mental health consumers travelling from the country to the city for acute care and to make policy recommendations to improve transitions of care. Six purposively sampled case studies were conducted collecting data through semistructured interviews with consumers, country professional and occupational groups and tertiary providers. Data were analysed to produce themes for consumers, and country and tertiary mental healthcare providers. The study found that consumers saw transfer to the city for mental health care as beneficial in spite of the challenges of being transferred over long distances, while being very unwell, and of being separated from family and friends. Country care providers noted that the disjointed nature of the mental health system caused problems with key aspects of transfer of care including transport and information flow, and achieving integration between the primary and tertiary settings. Improving transfer of care involves overcoming the systemic barriers to integration and moving to a primary care-led model of care. The distance consultation and liaison model provided by the Rural and Remote Mental Health Services, the major tertiary provider of services for country consumers, uses a primary care-led approach and was highly regarded by research participants. Extending the use of this model to other primary mental healthcare providers and tertiary facilities will improve transfer of care.

Dynamic and diverse ways of knowing in mental health occupational therapy

This study focused on evidence based practice in mental health occupational therapy. It investigated the theoretical, evidentiary and practical knowledge that occupational therapists use to support consumers and understand the relationship between occupation and health.

Study protocol for a randomised controlled trial of internet-based cognitive-behavioural therapy for obsessive-compulsive disorder.

Obsessive-Compulsive Disorder (OCD) is a common chronic psychiatric disorder that constitutes a leading cause of disability. Although Cognitive-Behaviour Therapy (CBT) has been shown to be an effective treatment for OCD, this specialised treatment is unavailable to many due to access issues and the social stigma associated with seeing a mental health specialist. Internet-based psychological treatments have shown to provide effective, accessible and affordable treatment for a range of anxiety disorders, and two Randomised Controlled Trials (RCTs) have demonstrated the efficacy and acceptability of internet-based CBT (iCBT) for OCD, as compared to waitlist or supportive therapy. Although these initial findings are promising, they do not isolate the specific effect of iCBT. This paper details the study protocol for the first randomised control trial evaluating the efficacy of therapist-assisted iCBT for OCD, as compared to a matched control intervention; internet-based therapist-assisted progressive relaxation training (iPRT). It will aim to examine whether therapist-assisted iCBT is an acceptable and efficacious treatment, and to examine how effectiveness is influenced by patient characteristics.

Mental health service delivery : a profile of mental health non-government organisations in south-east Queensland, Australia.

Non-government organisations make a substantial contribution to the provision of mental health services; despite this, there has been little research and evaluation targeted at understanding the role played by these services within the community mental health sector. The aim of the present study was to examine the depth and breadth of services offered by these organisations in south-east Queensland, Australia, across five key aspects of reach and delivery.

Opportunity lost? The major in mental health nursing in Australia

The ongoing difficulty in educating and sustaining an adequate nursing workforce in mental health settings has been identified throughout the world. Different strategies have been implemented internationally to deal with this situation. In Australia major streams in mental health nursing were introduced in some Australian universities to promote mental health nursing as a viable career choice for nursing students. Fourteen universities had implemented or planned to implement a major stream in mental health nursing. From a survey of these programs a lack of consistency in the structure and content of programs was evident. For most programs the intakes had been relatively small, although retention rates appeared promising.

Working hours and mental health in Australia: evidence from an Australian population-based cohort, 2001-2012

Objectives: This paper assesses the impact of working less than or more than standard full-time hours on mental health, as well as possible differences in this relationship by gender and skill level. Methods: The study design was a longitudinal cohort with 12 annual waves of data collection over the period 2001-2012, yielding a sample of 90 637 observations from 18 420 people. Fixed effects within-person regression was used to control for time invariant confounding. The Mental Component Summary of the Short Form 36 (SF-36) measure was used as the primary outcome measure. Working hours over the preceding year was measured in five categories with standard full-time hours (35-40 h/week) as the reference. Results: Results indicated that when respondents were working 49-59 h (-0.52, 95% CI -0.74 to -0.29, p<0.001) and 60 h or more (-0.47, 95% CI -0.77 to -0.16, p=0.003) they had worse mental health than when they were working 35-40 h/week (reference). The difference in mental health when working 49-59 h was greater for women than for men. There were greater declines in mental health in relation to longer working hours among persons in higher compared to lower occupational skill levels. Conclusions: Study results suggest the need for employers and governments to regulate working hours to reduce the burden of mental ill health in the working population.

Saberes de professores que ensinam matemática para alunos surdos incluídos numa escola de ouvintes

Com esta pesquisa objetivou-se investigar os saberes em ação na prática docente no ensino de Matemática a alunos surdos incluídos em uma escola com alunos ouvintes. Direcionados pela pergunta norteadora que saberes os professores desenvolvem para incluir o aluno surdo nas aulas de Matemática com alunos ouvintes na Escola Regular? Buscaram-se respostas nos dados coletados em uma escola que atua nas séries iniciais, no Município de Belém-Pa, em uma turma de 4ª série, com 25 alunos, 20 ouvintes e 05 surdos incluídos. Os sujeitos informantes foi a professora regente da turma (PR), a professora itinerante que atende a turma (PI) e 03 futuros professores de Matemática (FP), alunos da Licenciatura em Matemática da UFPA também envolvidos no processo a partir de um trabalho colaborativo com a pesquisadora e o orientador da pesquisa. Trata-se de um estudo de caso do tipo etnográfico em que foram realizadas: observação participante sistemática e assistemática durante 08 meses, entrevista não estruturada com os 05 sujeitos e análise documental de plano anual, livro didático de Matemática, atividades de aula e diário de bordo dos futuros professores, que foram trianguladas originando eixos de análises para cada sujeito e seus saberes e ainda 03 episódios de sala de aula durante as aulas de fração dos quais foram extraídas 03 categorias que subsidiaram as análises sendo elas: (1) o saber da Língua nas aulas de matemática para alunos surdos incluídos com alunos ouvintes em que os resultados apontam para a importância dos saberes disciplinares / específicos, os curriculares, os experienciais e o saber da reflexão – na - ação como saber público validado evidenciando o saber da língua de sinais como o diferencial da cultura surda, gerou-se 02 subcategorias: 1ª a Língua de Sinais como saber necessário e a Língua Portuguesa Oral como imposição de saber e poder cultural e assim foi possível sinalizar para o conflito de culturas no processo de ensino de Matemática para alunos surdos incluídos na escola de ouvintes; (2) o saber inclusivo, o impacto entre a cultura surda e a cultura ouvinte no mesmo ambiente de aprendizagem, o que sinalizou para a existência de duas escolas no mesmo espaço e situações de aulas que propiciaram a inclusão e a exclusão dos alunos surdos no contexto; (3) o saber da reflexão – na - ação durante as aulas de Matemática a alunos surdos com alunos ouvintes enquanto o constituinte do habitus profissional desde a formação inicial como forma de propiciar a assimilação da diversidade cultural na prática docente.

Trajectory and outcomes of speech language therapy in the Prader-Willi syndrome (PWS): case report

The aim of this study was to describe the trajectory and the outcomes of speech-language therapy in Prader-Willi syndrome through a longitudinal study of the case of an 8 year-old boy, along four years of speech-language therapy follow-up. The therapy sessions were filmed and documental analysis of information from the child's records regarding anamnesis, evaluation and speech-language therapy reports and multidisciplinary evaluations were carried out. The child presented typical characteristics of Prader-Willi syndrome, such as obesity, hyperfagia, anxiety, behavioral problems and self aggression episodes. Speech-language pathology evaluation showed orofacial hypotony, sialorrhea, hypernasal voice, cognitive deficits, oral comprehension difficulties, communication using gestures and unintelligible isolated words. Initially, speech-language therapy had the aim to promote the language development emphasizing social interaction through recreational activities. With the evolution of the case, the main focus became the development of conversation and narrative abilities. It were observed improvements in attention, symbolic play, social contact and behavior. Moreover, there was an increase in vocabulary, and evolution in oral comprehension and the development of narrative abilities. Hence, speech-language pathology intervention in the case described was effective in different linguistic levels, regarding phonological, syntactic, lexical and pragmatic abilities.

Presentation, microsurgical therapy, and clinical outcomes in three cases of expanding melanonychia of the nail unit in children

The management of expanding melanonychia in childhood is controversial. Here, we present three cases and discuss their operating indications and reconstruction. Between January 1, 1995 and December 31, 2007, one boy and two girls, were operated for expanding melanonychia, involving the thumb, index finger or the middle finger. They were 2, 4, and 7 years at the time of surgery. A complete resection of the nail plate was performed followed by a direct finger reconstruction using a free short-pedicle vascularized nail flap of the toe. Histology showed a junctional nevus in all cases. The follow-ups were after 2, 3, and 5 years and without any complications or recurrence. Regarding reconstruction, the mean Foucher and Leclère score were, respectively, 17 and 16 points. It is concluded that for expanding melanonychia, in case of doubt, an examination of the entire lesion is necessary. Reconstruction of the nail unit after wide excision with nail plate ablation can be performed using microsurgery as discussed below. However, new guidelines on shave biopsy can make this microsurgical procedure obsolete.

Anti-infective therapy of peri-implantitis with adjunctive local drug delivery or photodynamic therapy: six-month outcomes of a prospective randomized clinical trial

To compare the adjunctive clinical effects in the non-surgical treatment of peri-implantitis with either local drug delivery (LDD) or photodynamic therapy (PDT).