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An Axis for Risk Management as a Contribuiton to Efficient Clinical Logic 风险管理轴是对高效临床逻辑的贡献
Pub Date : 2024-09-08 DOI: 10.1080/14401614070410s192
Graham Mellsop, Shailesh Kumar
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引用次数: 0
KEYNOTE SPEAKER ABSTRACTS (SORTED BY SURNAME) 主旨发言人摘要(按姓氏排序)
Pub Date : 2024-05-09 DOI: 10.1177/00048674241241938
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引用次数: 0
Replacing universal anti-neuronal antibody screening with clinical assessment and testing of high probability cases in psychotic disorders 以临床评估和检测精神病高概率病例取代普遍的抗神经元抗体筛查
Pub Date : 2024-04-29 DOI: 10.1177/00048674241249575
Nicola Warren, Gemma McKeon, James G Scott
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引用次数: 0
A longitudinal study of the impacts of a stay in a Prevention and Recovery Care service in Victoria, Australia 澳大利亚维多利亚州预防和康复护理服务对住院影响的纵向研究
Pub Date : 2024-04-29 DOI: 10.1177/00048674241242943
Lisa Brophy, Justine Fletcher, Shrinkhala Dawadi, John Reece, Vrinda Edan, Joanne Enticott, John Farhall, Ellie Fossey, Bridget Hamilton, Carol Harvey, Graham Meadows, Cathrine Mihalopoulos, Emma Morrisroe, Richard Newton, Victoria Palmer, Ruth Vine, Shifra Waks, Jane Pirkis
Background:Prevention and Recovery Care services are residential sub-acute services in Victoria, Australia, guided by a commitment to recovery-oriented practice. The evidence regarding the effectiveness of this service model is limited, largely relying on small, localised evaluations. This study involved a state-wide investigation into the personal recovery, perceived needs for care, well-being and quality-of-life outcomes experienced by Prevention and Recovery Care services’ consumers.Methods:A longitudinal cohort design examined the trajectory of self-reported personal recovery and other outcomes for consumers in 19 Victorian Prevention and Recovery Care services over 4 time points (T1 – 1 week after admission; T2 – within 1 week of discharge; T3 – 6 months after discharge; T4 – 12 months after discharge). T2–T4 time frames were extended by approximately 3 weeks due to recruitment challenges. The Questionnaire about the Process of Recovery was the primary outcome measure.Results:At T1, 298 consumers were recruited. By T4, 114 remained in the study. Participants scored higher on the Questionnaire about the Process of Recovery at all three time points after T1. There were also sustained improvements on all secondary outcome measures. Improvements were then sustained at each subsequent post-intervention time point. Community inclusion and having needs for care met also improved.Conclusion:The findings provide a consistent picture of benefits for consumers using Prevention and Recovery Care services, with significant improvement in personal recovery, quality of life, mental health and well-being following an admission to a Prevention and Recovery Care service. Further attention needs to be given to how to sustain the gains made through a Prevention and Recovery Care service admission in the long term.
背景:预防和康复护理服务是澳大利亚维多利亚州的一种住院亚急性服务,以致力于康复为导向的实践为指导。有关这种服务模式有效性的证据很有限,主要依赖于小规模的本地化评估。本研究在全州范围内调查了预防和康复护理服务的消费者所经历的个人康复、感知到的护理需求、福祉和生活质量成果。方法:采用纵向队列设计,在 4 个时间点(T1 - 入院后 1 周;T2 - 出院后 1 周内;T3 - 出院后 6 个月;T4 - 出院后 12 个月)检查了 19 个维多利亚预防和康复护理服务的消费者自我报告的个人康复轨迹和其他成果。由于招募方面的困难,T2-T4 时间框架延长了约 3 周。结果:在 T1 阶段,共招募了 298 名患者。结果:在 T1 阶段,共招募了 298 名消费者,到 T4 阶段,仍有 114 人参与研究。在 T1 之后的三个时间点,参与者在康复过程问卷上的得分都有所提高。在所有次要结果测量中,参与者的得分都有持续提高。在干预后的每个时间点,改善情况都得到了保持。结论:研究结果一致表明,使用预防和康复护理服务的患者在个人康复、生活质量、心理健康和幸福感方面都有显著改善。需要进一步关注的是,如何长期保持预防和康复护理服务所带来的收益。
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引用次数: 0
Exploring the association of Indigeneity, social adversity status and externalizing symptoms in children and adolescents 探究儿童和青少年的原住民身份、社会逆境状况与外化症状之间的关联
Pub Date : 2024-04-20 DOI: 10.1177/00048674241246441
Alasdair Vance, Janet McGaw, Angel O’Meara, Joseph P Gone, Sandra Eades
Objective:The relationship between Indigeneity, social adversity status and externalizing symptoms is complex and unclear. This study investigates how Indigeneity, social adversity status and externalizing symptoms are related in young people.Methods:A total of 132 Indigenous and 247 non-Indigenous young people aged 6–16 years were recruited from a hospital mental health outpatient service. Normality plots with statistics for social adversity status and parent-reported externalizing symptoms were completed for the two groups, matched for age, gender, mental disorder symptom severity, symptom-linked distress and impairment. Standard multiple regression was used to examine how Indigeneity moderates the relationship between social adversity status and parent-reported externalizing symptoms. A scatterplot investigated the association between Indigeneity and social adversity status in young people with parent-reported externalizing symptoms.Results:The distributions of the two groups and (1) social adversity status and (2) parent -reported externalizing symptoms were non-normal but acceptable for a moderator analysis. Indigeneity and social adversity status made independent significant positive contributions to externalizing symptoms. In contrast the interaction between Indigeneity and social adversity status made a nonsignificant negative trend to externalizing symptoms. A scatterplot revealed Indigeneity moderated the link between social adversity status and externalizing symptoms.Conclusions:High social adversity status is linked to externalizing symptoms in non-Indigenous young people but despite higher social adversity, Indigenous young people don’t necessarily externalize. Potential protective resilience factors for externalizing symptoms in the Indigenous young people need to be ascertained and nurtured. Future systematic investigations of the contribution of these protective factors to Indigenous referral pathways and management are needed. It is also crucial that increased social adversity status is addressed and managed in all young people, regardless of Indigeneity.
目的:土著身份、社会逆境状况和外化症状之间的关系既复杂又不明确。方法:从一家医院的心理健康门诊服务机构招募了 132 名 6-16 岁的原住民青少年和 247 名非原住民青少年。在年龄、性别、精神障碍症状严重程度、与症状相关的痛苦和损伤等方面进行匹配后,对两组青少年的社会逆境状况和家长报告的外化症状进行统计,并绘制了正态曲线图。我们使用标准多元回归法来研究 "土著性 "如何调节社会逆境状况与家长报告的外化症状之间的关系。散点图研究了在父母报告的外化症状的青少年中,印度血统与社会逆境状况之间的关联。结果:两组的分布以及(1)社会逆境状况和(2)父母报告的外化症状的分布都是非正态分布,但对于调节分析来说是可以接受的。原住民身份和社会逆境对外化症状有独立的显著正向影响。相比之下,"原籍 "和 "社会逆境 "之间的交互作用对外化症状的影响呈不显著的负向趋势。散点图显示,"土著性 "调节了社会逆境状况与外化症状之间的联系。需要确定和培养土著青少年外化症状的潜在保护性复原因素。今后需要对这些保护性因素对土著转介途径和管理的贡献进行系统调查。同样至关重要的是,无论原住民身份如何,所有青少年的社会逆境状况都应得到解决和管理。
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引用次数: 0
Walking together in friendship: Learning about cultural safety in mainstream mental health services through Aboriginal Participatory Action Research 在友谊中同行:通过原住民参与式行动研究了解主流心理健康服务中的文化安全问题
Pub Date : 2024-04-20 DOI: 10.1177/00048674241246444
Helen Milroy, Shraddha Kashyap, Jemma Collova, Michael Mitchell, Angela Ryder, Zacharia Cox, Mat Coleman, Michael Taran, Beatriz Cuesta Briand, Graham Gee
Objective:Culturally safe service provision is essential to improving social and emotional wellbeing among Aboriginal and Torres Strait Islander communities, and to eliminating health inequities. Cultural safety is about ensuring that all people have a safe and healing journey through services, regardless of their cultural background. In this project, we aim to (1) understand how Aboriginal and Torres Strait Islander peoples conceptualise cultural safety, and (2) co-design a qualitative interview for the next phase of this project, where we plan to learn about experiences of cultural safety within mental health services.Methods:We conducted six focus groups (in one metro and two regional areas, Western Australia). Following an Aboriginal Participatory Action Research methodology, we yarned with Aboriginal and Torres Strait Islander mental health service users, carers, community members, mental health professionals and Cultural Healers about cultural safety.Results:Participants described a culturally safe service as one where Aboriginal cultural knowledges, life experiences, issues and protocols are understood and acknowledged, and reported that mainstream mental health services are not currently culturally safe. Participants emphasised the importance of building trust, rapport, reciprocity and following appropriate relational processes when designing a qualitative interview for the next phase.Conclusions:A lack of cultural safety in mental health services is likely to contribute to the disparity in outcomes between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Embedding cultural safety into research design allows for authentic community engagement and facilitates knowledge sharing around ways to improve cultural safety in mental health services.
目标:提供文化安全的服务对于改善土著居民和托雷斯海峡岛民社区的社会和情感福祉以及消除健康不公平现象至关重要。文化安全就是要确保所有人,无论其文化背景如何,都能在服务过程中获得安全和康复。在本项目中,我们的目标是:(1)了解土著居民和托雷斯海峡岛民是如何看待文化安全的;(2)为本项目的下一阶段共同设计一个定性访谈,我们计划在该访谈中了解心理健康服务中的文化安全经验。按照原住民参与式行动研究方法,我们与原住民和托雷斯海峡岛民心理健康服务使用者、护理者、社区成员、心理健康专业人员和文化治疗师就文化安全问题进行了讨论。结果:参与者将文化安全的服务描述为原住民的文化知识、生活经验、问题和规程得到理解和认可的服务,并表示主流心理健康服务目前在文化安全方面并不完善。参与者强调了在设计下一阶段的定性访谈时建立信任、融洽关系、互惠和遵循适当的关系流程的重要性。结论:精神健康服务中缺乏文化安全很可能会导致土著居民和托雷斯海峡岛民与非土著澳大利亚人之间的结果差异。将文化安全纳入研究设计可实现真正的社区参与,并促进围绕如何改善心理健康服务中的文化安全的知识共享。
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引用次数: 0
A taxonomy of regulatory and policy matters relevant to psychedelic-assisted therapy in Australia 澳大利亚与迷幻药辅助疗法有关的监管和政策事项分类法
Pub Date : 2024-04-17 DOI: 10.1177/00048674241240597
Samuel P Hatfield, Nicollette LR Thornton, Kayla Greenstien, Nick Glozier
Objectives:The Australian government recently rescheduled psilocybin and 3,4-methylenedioxymethamphetamine for limited clinical uses. This change has raised various regulatory concerns and challenges for the field of psychedelic-assisted therapy. To provide clarity, we aimed to comprehensively catalogue the matters relating to psychedelic-assisted therapy that are or could be regulated.Methods:We conducted a desktop review of the literature and current regulatory sources, semi-structured interviews with professionals who had expertise in fields relating to psychedelic-assisted therapy and a framework analysis to generate a taxonomy of relevant regulatory matters. In relation to each matter, we further identified what type of regulation (if any) currently applies to that matter, any uncertainty as to how the matter should be addressed in clinical practice in the context of current regulation and whether there are conflicting views as to how the matter could or should be further regulated.Results:The taxonomy is structured into six main regulatory domains, three of which have a substantial proportion of matters with uncertainty or conflicting views: Service Establishment, Practitioner, and Treatment Delivery. Key examples of such matters include the location of services and facilities required, which professionals are eligible to become psychedelic therapists, and with what qualifications and experience. Matters in the remaining three domains, Patient Evaluation, Drug Supply and Service Oversight, appear by comparison relatively settled, with regulation either well-established or thought unnecessary.Conclusions:The taxonomy provides a roadmap for health services establishing and implementing a psychedelic-assisted therapy program, or for government and other policymakers when determining areas that may require further regulation.
目的:澳大利亚政府最近将迷幻药和 3,4-亚甲二氧基甲基苯丙胺重新列入限制临床使用的目录。这一变化给迷幻药辅助治疗领域带来了各种监管问题和挑战。方法:我们对文献和当前监管来源进行了桌面审查,对在迷幻辅助疗法相关领域拥有专业知识的专业人士进行了半结构化访谈,并进行了框架分析,从而对相关监管事项进行了分类。对于每个事项,我们进一步确定了目前适用于该事项的监管类型(如果有的话)、在当前监管背景下临床实践中应如何处理该事项的不确定性,以及对于该事项可以或应该如何进一步监管是否存在相互冲突的观点:服务机构、从业人员和治疗提供。这些事项的主要例子包括服务地点和所需设施、哪些专业人员有资格成为迷幻治疗师、具备哪些资格和经验。结论:分类法为医疗服务机构建立和实施迷幻辅助治疗项目提供了路线图,也为政府和其他政策制定者确定可能需要进一步监管的领域提供了参考。
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引用次数: 0
Distinct profiles of mental health need and high need overall among New Zealand adolescents – Cluster analysis of population survey data 新西兰青少年心理健康需求和总体高需求的不同特征--人口调查数据的聚类分析
Pub Date : 2024-04-11 DOI: 10.1177/00048674241243262
Kylie Sutcliffe, Marc Wilson, Terryann C Clark, Sue Crengle, Terry (Theresa) Fleming
Objective:The objective was to identify clinically meaningful groups of adolescents based on self-reported mental health and wellbeing data in a population sample of New Zealand secondary school students.Methods:We conducted a cluster analysis of six variables from the Youth19 Rangatahi Smart Survey ( n = 7721, ages 13–18 years, 2019): wellbeing (World Health Organization Well-Being Index), possible anxiety symptoms (Generalized Anxiety Disorder 2-item, adapted), depression symptoms (short form of the Reynolds Adolescent Depression Scale) and past-year self-harm, suicide ideation and suicide attempt. Demographic, contextual and behavioural predictors of cluster membership were determined through multiple discriminant function analysis. We performed cross-validation analyses using holdout samples.Results:We identified five clusters ( n = 7083). The healthy cluster ( n = 2855, 40.31%) reported positive mental health across indicators; the anxious cluster ( n = 1994, 28.15%) reported high possible anxiety symptoms and otherwise generally positive results; the stressed and hurting cluster ( n = 667, 9.42%) reported sub-clinical depression and possible anxiety symptoms and some self-harm; the distressed and ideating cluster ( n = 1116, 15.76%) reported above-cutoff depression and possible anxiety symptoms and high suicide ideation; and the severe cluster ( n = 451; 6.37%) reported the least positive mental health across indicators. Female, rainbow, Māori and Pacific students and those in higher deprivation areas were overrepresented in higher severity clusters. Factors including exposure to sexual harm and discrimination were associated with increasing cluster severity.Conclusion:We identified high prevalence of mental health challenges among adolescents, with distinct clusters of need. Youth mental health is not ‘one size fits all’. Future research should explore youth behaviour and preferences in accessing support and consider how to best support the mental health of each cluster.
目的:根据新西兰中学生群体样本中自我报告的心理健康和幸福感数据,确定具有临床意义的青少年群体。方法:我们对青年19 Rangatahi智能调查(n = 7721,13-18岁,2019年)中的六个变量进行了聚类分析:幸福感(世界卫生组织幸福指数)、可能的焦虑症状(广泛性焦虑症2项,改编版)、抑郁症状(雷诺兹青少年抑郁量表简表)以及过去一年的自残、自杀意念和自杀企图。通过多重判别函数分析确定了群组成员的人口、环境和行为预测因素。结果:我们确定了五个聚类(n = 7083)。健康群组(n = 2855,40.31%)报告了积极的心理健康指标;焦虑群组(n = 1994,28.15%)报告了较高的可能焦虑症状,但在其他方面总体上是积极的;压力和伤害群组(n = 667,9.42% )报告了亚临床抑郁症和可能的焦虑症状,并有一些自残行为;苦恼和意念群组( n = 1116,15.76% )报告了高于临界值的抑郁症和可能的焦虑症状,并有较高的自杀意念;严重群组( n = 451;6.37% )报告了各项指标中最不积极的心理健康情况。女生、彩虹学生、毛利学生和太平洋裔学生以及贫困程度较高地区的学生在严重程度较高的群组中所占比例较高。包括遭受性伤害和歧视在内的因素与群组严重程度的增加有关。青少年心理健康并非 "一刀切"。未来的研究应探索青少年在获取支持方面的行为和偏好,并考虑如何为每个群组的心理健康提供最佳支持。
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引用次数: 0
Evaluating Aboriginal and Torres Strait Islander Social and Emotional Wellbeing services: A collective case study in Far North Queensland 评估土著居民和托雷斯海峡岛民的社会和情感福利服务:远北昆士兰州的集体案例研究
Pub Date : 2024-04-09 DOI: 10.1177/00048674241242935
Mary Anne Furst, Tina McDonald, Janya McCalman, Jose Salinas-Perez, Ruth Fagan, Anita Lee Hong, Merrissa Nona, Vicki Saunders, Luis Salvador-Carulla
Background:Access to a coordinated range of strengths-based, culturally appropriate community-led primary mental health and Social and Emotional Wellbeing services is critical to the mental health and wellbeing of young Aboriginal and Torres Strait Islander people, and is a policy commitment of the Australian government. However, complex and fragmented service networks and a lack of standardised service data are barriers in identifying what services are available and what care they provide.Method:A standardised service classification tool was used to assess the availability and characteristics of Social and Emotional Wellbeing services for young Aboriginal and Torres Strait Islander people in two regions in Queensland, Australia.Results:We identified a complex pattern of service availability and gaps in service provision. Non-Indigenous non-governmental organisations provided a significant proportion of services, particularly ‘upstream’ support, while Aboriginal Community Controlled Organisations were more likely to provide ‘downstream’ crisis type care. Most services provided by the public sector were through Child Safety and Youth Justice departments.Conclusions:Our findings demonstrate the complexity of current networks, and show that non-Indigenous organisations are disproportionately influential in the care received by young Aboriginal and Torres Strait Islander people, despite community goals of self-determination, and government commitment to increasing capacity of Aboriginal Community Controlled Organisations to support their local communities. These findings can be used to support decision making and planning.
背景:获得一系列协调的、以优势为基础的、与文化相适应的、由社区主导的初级心理健康和社会与情感福利服务,对于年轻的土著居民和托雷斯海峡岛民的心理健康和福利至关重要,这也是澳大利亚政府的一项政策承诺。方法:使用标准化的服务分类工具来评估澳大利亚昆士兰州两个地区为年轻原住民和托雷斯海峡岛民提供的社会和情感福利服务的可用性和特点。非原住民非政府组织提供了很大一部分服务,尤其是 "上游 "支持,而原住民社区控制组织更有可能提供 "下游 "危机类型的护理。结论:我们的研究结果表明了当前网络的复杂性,并显示出非土著组织对土著居民和托雷斯海峡岛民青少年所接受的护理具有极大的影响力,尽管社区的目标是自决,而且政府也致力于提高土著社区控制组织支持当地社区的能力。这些研究结果可用于支持决策和规划。
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引用次数: 0
‘Country giving you a thing of it’: Elder-governed cultural therapy for Indigenous young people 国家给你的东西":长老为土著年轻人提供的文化疗法
Pub Date : 2024-04-06 DOI: 10.1177/00048674241243256
Alasdair Vance, Janet McGaw, Jo Winther, Angel O’Meara, Sandra Eades
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引用次数: 0
期刊
Australian & New Zealand Journal of Psychiatry
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