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Abstract: Open Dialogue is a resource‐oriented approach to mental health care that originated in Finland. As Open Dialogue has been adopted across diverse international healthcare settings, it has been adapted according to contextual factors. One important development in Open Dialogue has been the incorporation of paid, formal peer work. Peer work draws on the knowledge and wisdom gained through lived experience of distress and hardship to establish mutual, reciprocal, and supportive relationships with service users. As Open Dialogue is now being implemented across mental health services in Australia, stakeholders are beginning to consider the role that peer workers might have in this model of care. Open Dialogue was not, initially, conceived to include a specific role for peers, and there is little available literature, and even less empirical research, in this area. This discussion paper aims to surface some of the current debates and ideas about peer work in Open Dialogue. Examples and models of peer work in Open Dialogue are examined, and the potential benefits and challenges of adopting this approach in health services are discussed. Peer work in Open Dialogue could potentially foster democracy and disrupt clinical hierarchies, but could also move peer work from reciprocal to a less symmetrical relationship of ‘giver’ and ‘receiver’ of care. Other models of care, such as lived experience practitioners in Open Dialogue, can be conceived. However, it remains uncertain whether the hierarchical structures in healthcare and current models of funding would support any such models. [ABSTRACT FROM AUTHOR]

Family violence is becoming increasingly visible in Australia, with many state and federal governments taking on more responsibility to address family violence and its impacts on those affected. Current efforts are focused on practice frameworks, identifying and responding to risk factors, and social justice frameworks including legislating against family violence in a range of jurisdictions and addressing more broadly the structural and cultural forces that perpetuate violence and further oppress those victimised. Family violence is not unique to Australia, with prevalence rates internationally suggesting family violence occurs irrespective of country, race, age, culture, effectiveness of social policies or socioeconomic status. This paper explores relevant foundational concepts of Bowen family systems theory (BFST) as it relates to family violence and explores opportunities to evolve practice in this area. BFST offers a unique contribution towards addressing family violence, particularly in relation to the public health challenge of addressing family polyvictimisation. The paper also explores how BFST conceptualises family violence and the role of the professional in working with the family as a single emotional unit. The unique focus of BFST on observing and defining self within the emotional family unit through observation of the underlying multigenerational emotional patterns of functioning provides unique opportunities to evolve and develop both the capacity of clinicians and responses to families who are navigating the serious and challenging impacts of family violence. [ABSTRACT FROM AUTHOR]

Background: COVID‐19 necessitated emergency telepractice for student‐led speech‐language therapy clinical practicals in training institutions, with limited preparation and evidence‐based guidelines. Beyond the pandemic, practitioners and university training sites are likely to continue to offer telepractice necessitating thorough preparation for telepractice services underpinned by a comprehensive understanding of the complexities involved in online therapy. Aims: Adopting realist evaluation principles, our aim in this paper was to explore broadly what works and does not work in a set of student‐led telepractice sessions in a diverse, resource‐limited context. The broader goal of this project was to provide evidence‐based support to enhance the efficiency and success of telepractice sessions in student clinical training contexts. Methods & Procedures: We used qualitative observational methods with reflexive thematic analysis to analyse 28 video recordings and 61 observation notes of student‐led paediatric telepractice sessions from a South African university clinic as part of a pilot study. Outcomes & Results: We identified four overarching considerations for student‐led telepractice: (1) additional, specific preparation is required, (2) with greater management of technology and adaptation of tasks, especially during times of poor connectivity; (3) telepractice relies heavily on caregiver input and collaboration; and (4) promoting engagement online, holding a client's attention, building rapport and offering reinforcement are critical skills that are complicated by the lack of face‐to‐face contact. Conclusions & Implications: Our findings indicate that telepractice pedagogy needs to be explicitly taught and students require practical assistance as they learn how to use this service delivery approach effectively. There are some aspects peculiar to telepractice that require unique consideration and planning, especially in contexts where service providers and users may be unfamiliar with this form of service provision. The findings of this pilot study can be used by clinical educators and student clinicians to enhance clinical training opportunities involving telepractice. WHAT THIS PAPER ADDS: What is already known on this subject: Many speech‐language therapy (SLT) student clinicians had to transition quickly to telepractice service provision during COVID‐19 with limited existing guidelines and support, especially in contexts where teletherapy is typically non‐existent or difficult to access. Although there is some literature available on experiences of telepractice, there is very little evidence‐based research which explores the mechanics of such sessions in real‐time and which offers practical support to student clinicians and clinical educators engaging in this mode of service delivery. What this study adds: This pilot study examined video‐recorded, student‐led, paediatric, speech‐language teletherapy sessions to understand challenges and considerations involved in using telepractice as a clinical training tool. Findings show that additional preparation for telepractice sessions is required, particularly in contexts of poor digital literacy; students must learn to manage technology, especially when connectivity poses a challenge, and adapt therapy tasks for online work with clients; telepractice relies heavily on caregiver input and collaboration, more so than in in‐person consultations, and this relationship requires careful management; and promoting engagement online, holding a client's attention, building rapport and offering reinforcement are critical yet challenging skills in telepractice. What are the potential or actual clinical implications of this work?: Our findings highlight a need to teach telepractice pedagogy explicitly and support students practically in learning how to provide therapy effectively via this mode of service delivery. Observational methods for studying practices in recorded telepractice sessions can be used as part of a reflective approach to clinical training. Using already available data allowed us to unpack the 'messy reality' of clinical training using telepractice. [ABSTRACT FROM AUTHOR]

Background: Migrant and ethnic inequalities in maternal and perinatal mortality persist across high‐income countries. Addressing social adversity and inequities across the childbirth trajectory cannot be left to chance and the good intentions of practitioners. Robust, evidence‐based tools designed to address inequity by enhancing both the quality of provision and the experience of care are needed. Methods: An inductive modelling approach was used to develop a new evidence‐based conceptual model of woman–midwife relationships, drawing on data from an ethnographic study of relationships between migrant Pakistani women and midwives, conducted between 2013 and 2016 in South Wales, UK. Key analytic themes from early data were translated into social–ecological concepts, and a model was developed to represent how these key themes interacted to influence the woman–midwife relationship. Results: Three key concepts influencing the woman–midwife relationship were developed from the three major themes of the underpinning research: (1) Healthcare System; (2) Culture and Religion; and (3) Family Relationships. Two additional weaving concepts appeared to act as a link between these three key concepts: (1) Authoritative Knowledge and (2) Communication of Information. Social and political factors were also considered as contextual factors within the model. A visual representation of this model was developed and presented. Conclusions: The model presented in this paper, along with future work to further test and refine it in other contexts, has the potential to impact on inequalities by facilitating future discussion on cultural issues, encouraging collaborative learning and knowledge production and providing a framework for future global midwifery practice, education and research. Patient or Public Contribution: At the outset of the underpinning research, a project involvement group was created to contribute to study design and conduct. This group consisted of the three authors, an Advocacy Officer at Race Equality First and an NHS Consultant Midwife. This group met regularly throughout the research process, and members were involved in discussions regarding ethical/cultural/social issues, recruitment methods, the creation of participant information materials, interpretation of data and the dissemination strategy. Ideas for the underpinning research were also discussed with members of the Pakistani community during community events and at meetings with staff from minority ethnic and migrant support charities (BAWSO, Race Equality First, The Mentor Ring). Local midwives contributed to study design through conversations during informal observations of antenatal appointments for asylum seekers and refugees. [ABSTRACT FROM AUTHOR]

The raison d'être for psychotherapy1 is to address individual suffering and distress. The sustainable development goals address suffering and distress on a global scale in the context of threats to the survival of our communities and planet. Objective: We propose scaling up therapeutic principles for collective impact and nurturing therapist commitment beyond the therapy room, to activate and sustain compassion‐in‐action at the community system level. Design: The SDGs represent the strength of collective human concern and action coming together. At the half‐way point, we are falling dangerously short of our targets, requiring an urgent response. The tenet of this paper is that the weakest link in our journey is not technical capability or finances, or even the impact of multiple intersecting crises, but our ability to collaborate for sustained action—it is the human factor—hence, we need a psychologically informed response. Method: Notably, least 'visible' is SDG17, the umbrella goal designated means of implementation, through partnership. Partnership has been treated as a transactional element of SDG projects, rather than the vital heartbeat connecting daily actions to the 2030 vision. Partnership is about investing in relationships and a commitment to working together with a common purpose—the bailiwick of psychological therapists. Results: We propose an architecture to support the development of courageous partnerships and compassionate systems. Conclusion: Compassion uniquely potentiates global action on wicked problems. [ABSTRACT FROM AUTHOR]

This paper uses critical realism to identify mechanisms that activate successful relationships. It draws data from a longitudinal, mixed‐methods study of youth who used multiple services. It examines functionality of four relational mechanisms: power, recognition, responsiveness and mutuality that lead to positive change and explores the implications of these for practice with youth with complex needs. [ABSTRACT FROM AUTHOR]

Therapy process research focuses on understanding how therapy is conducted by professionals in the field. It is a nascent field of psychotherapy enquiry in India. This paper explores how novice therapists in India perceive their clients, and how this influences the process of therapy. In depth interviews were conducted with ten novice therapists, with less than six years of practice experience, from Mumbai, India. The data was thematically analysed. The data revealed that therapists' perceptions of their clients were defined by socio‐demographic features of age and gender, along with presenting complaints and personal attributes. Participants had defined beliefs about good clients as contrasted with difficult ones. Distinct preferences for particular client types were identified. The antecedents to these beliefs were attributed to the therapist's worldview, their training and the supervision received. These views, and the conceptualisation of the client, influenced the choice of client, the process of therapy and how they proceeded with sessions, and their methods of referral. The data from the study has implications for therapist training, supervision and further research. [ABSTRACT FROM AUTHOR]

Aim: Routine outcome monitoring (ROM), including the use of feedback, has become a much vaunted method in psychological therapies but is little used in university/college counselling and mental health services, perhaps because its adoption raises questions for many practitioners and service leaders. There is a need for both clinical‐ and research‐based statements to clarify the reasoning and rationale for ROM. This paper aims to present and respond to common challenges of and reservations about using ROM in student counselling and/or mental health services. Method: The article poses 15 questions and issues about the adoption of ROM drawn from the literature on this topic and further refined by practitioner‐ and researcher‐members of a consortium comprising service leads, practitioners, and researchers working in the field of student counselling in the UK. The questions address nine themes: (1) the purpose and yield of ROM; (2) the burden of measurement; (3) the impact on clients and process of therapy; (4) consistency with therapeutic theory; (5) client groups and settings; (6) concern from practitioners; (7) equality, diversity, and inclusion; (8) implementation; and (9) relationship with the paradigm of practice‐based evidence. Findings: Responses to each of the 15 questions are provided from a methodological, evidence‐based, and clinical perspective. Conclusions: The responses provide practitioners with the necessary information to enable them to make informed decisions as to the value, or otherwise, of adopting ROM, including feedback, in the delivery of counselling interventions, and generating evidence created from clinical practice. [ABSTRACT FROM AUTHOR]

Background: In Canada, Ontario midwives provide care to sexual and gender minority (SGM) people. Published literature shows how midwives' attitudes shape the experiences of lesbians, but research examining midwives' attitudes toward SGM people is lacking. Our study measured the attitudes of Ontario midwives toward SGM clients, hypothesizing that attitudes would be positive overall and that there would be no difference in attitudes across practice settings. Methods: Paper surveys (n = 926) with an option to respond online were sent to Ontario midwifery practices. We measured midwives' attitudes toward sexual minorities (11 questions, scores ranged from 11 to 55) and gender minorities (9 questions, scores ranged from 9 to 45), with higher scores indicating more positive attitudes. Overall and subgroup analyses were performed. Results: The 268 completed surveys indicated that midwives' attitudes were positive toward both sexual (mean score 49.2, maximum possible score of 55, ie, 89.4%) and gender minorities (mean score 38.9, maximum possible score of 45, ie, 86.4%). Analyses showed that attitudes toward SGM were associated with midwives' sexual identity and route of entry into the profession (ie, university‐based vs bridging programs), but not practice setting. Conclusions: Although attitudes of this subset of midwives toward SGM clients were positive, volunteer bias could account for this finding since 32.6% of respondents identified as sexual minorities. Since the attitudes of midwives who entered the profession through the university‐based education program were significantly more positive than those who entered through international bridging programs, future research should examine how SGM‐related content is integrated into midwifery education and training curricula. [ABSTRACT FROM AUTHOR]

Purpose The aim of this review was to propose and describe the design and delivery of an attachment-informed general mental health service. Method We systematically searched the Psyc INFO, MEDLINE, Web of Knowledge, COPAC, CINAHL, and Science Direct databases from 1960 to 2013. We also searched reference lists of relevant papers and directly contacted authors in the field. Literature describing attachment theory and its applicability in designing and delivering general mental health services was synthesized using thematic analysis. Papers published in English, books or chapters in edited books that described applying attachment theory in designing and delivering mental health services for adults and adolescents were included in the review. Of the 1,105 articles identified, 14 met inclusion criteria for the review. Eight key themes, and four subthemes, were extracted and organized to reflect the experience of a service user moving through the mental health system. Results Key themes extracted were as follows: service policy and evaluation; referrals; assessment and formulation; intervention; support for staff; support for carers; moving on; and potential service benefits. Papers reviewed suggested that service users with severe mental health problems have attachment needs that should be met in general mental health services. Conclusions Attachment theory provides a useful framework to inform the design and delivery of general mental health services. The resource implications for services are discussed, as are limitations of the review and recommendations for future research. Practitioner points Attachment theory should be used to inform the design and delivery of general mental health services., Mental health services should evaluate the extent to which they meet service users' attachment needs., Attachment-informed mental health services should assess outcomes, including cost-effectiveness over time., Papers included in this review focus on long-stay residential care or secure services and there is a limited experimental evidence base to show that providing an attachment-informed service improves patient outcomes. [ABSTRACT FROM AUTHOR]

Treating anorexia nervosa is one of the greatest challenges faced by current health policies. This paper reflects on the social and cultural aspects of this type of eating disorder and proposes an intervention approach based on narrative therapy as a complement to existing treatments. This type of therapy requires a holistic and coordinated vision of the socio‐cultural and community aspects that surround both the person dealing with anorexia and their closest social circle of friends and family. The effects of anorexia, when it becomes the dominant voice in a person's narrative, need to be understood within a broader and more inclusive social context without putting all the responsibility on the person who is being bullied by anorexia. Based on the qualitative results of the Archive of Resistance presented by the Anti‐Anorexia League, narrative therapy is shown to have great potential for transforming the current approach to treating anorexia in English. This paper recommends use of the poststructuralist approach of narrative therapy to collaborate with the person affected by anorexia in Spanish‐speaking cultures. At the same time, it opens a discussion on the need to establish a document database, an Archive of Resistance, in Spanish, to help mitigate the effects of anorexia. [ABSTRACT FROM AUTHOR]

This paper considers what concept of accommodation is necessary to identify and address discrimination, disadvantages and disparities in such a way that the plurality of religious people with their beliefs, values and practices may be justly accommodated in healthcare. It evaluates threats to the possibility of such accommodation pertaining by considering what beliefs and practices might increase the risk of unjust discrimination against and disadvantage for religious people, whether as individuals or as groups; and the risk of disparities between the care provided to religious people. The claim is that there is an important cluster of risks that are political in kind and emergent within philosophical bioethics. While not amounting (yet) to a trend, they are sufficiently threatening to a just civic life for patients and healthcare staff as to warrant scrutiny. After an Introductory Section 1, Section 2 evaluates a criticism of 'accommodation' and the apparently additional health‐related requirements that those of religious faith demand, when compared with other people. It does so by comparing Lori Beaman's idea of agonism with that of a distinct and somewhat complementary approach in Jonathan Chaplin's political philosophy, before examining the role of established religion in setting the conditions for the accommodation of religion and belief in healthcare. Section 3 examines risks to such accommodation by engaging critically with three health‐related instantiations of political philosophy that differ radically from both Beaman and Chaplin. A concluding Section 4 focusses on appropriate modes of communicating about religious and other beliefs in healthcare. [ABSTRACT FROM AUTHOR]

This paper addresses the investor's decision to employ multiple managers for the management of investment funds. Under conditions such that specialization of managers and diversification among managers are not motives for the use of multiple managers, the paper shows that risk sharing considerations may be sufficient. A model is developed in which the decision to use multiple managers is explicitly treated, and conditions are studied such that an increase or decrease in the number of managers would be desirable. Under some conditions, a multiple manager solution is preferred over a single manager solution. [ABSTRACT FROM AUTHOR]

Background A range of interventions have been developed to treat stuttering in recent years. The effectiveness of these interventions has largely been assessed in studies focusing on the impact of specific types of therapy on patient outcomes. Relatively little is known about the factors that influence how the delivery and impact of different types of intervention may be experienced from the perspective of both people who deliver as well as those who receive interventions. Aims To synthesize the available evidence in relation to factors that might enhance or mitigate against successful outcomes following interventions for stuttering by identifying and synthesizing relevant qualitative research that explored the experiences of people delivering and receiving interventions that aim to improve fluency. Methods & Procedures We carried out a systematic review including research that had used in-depth interviews and focus groups and conducted a substantive qualitative analysis of the data collected. Included study populations were either adults or children affected by a diagnosed stutter and/or providers of therapy for stuttering. An iterative approach was used to search for published qualitative evidence in relevant databases from 1990 to 2014. Retrieved citations were sifted for relevance and the data from articles that met the inclusion criteria were extracted. Each included paper was assessed for quality and a thematic analysis and synthesis of findings was carried out. Main Contribution Synthesized qualitative evidence highlights the changing experiences for people who stutter both historically and, for individuals, over the life course. Barriers and facilitators to the implementation of interventions for stuttering are encountered at the individual, intervention, interpersonal and social levels. Interventions may be particularly pertinent at certain transition points in the life course. Attention to emotional as well as practical aspects of stuttering is valued by people receiving therapy. The client-therapist relationship and support from others are also key factors in achieving successful outcomes. Conclusions & Implications A synthesis of qualitative findings from published papers has added to the effectiveness data reported in an accompanying paper in understanding how stuttering impacts on people across the life course. Evidence suggests that a client-centred and individually tailored approach enhances the likelihood of successful intervention outcomes through attention to emotional, situational and practical needs. [ABSTRACT FROM AUTHOR]

Metaphors are popular in human interaction as a means to make relevant associations, convey complex ideas, and even dramatize reality or introduce humour in conversations. Metaphors, if leveraged effectively, can be a powerful tool for management consultants in their client engagement process. Chosen with a sensitive and empathetic rationale, metaphors can not only help fathom highly complex problem situations, they can also bring in an element of light‐heartedness in consulting conversations that may otherwise be stale and unexciting. Metaphorical associations can enable informality, trust, and long‐term engagement between consultants and their clients. This paper presents a first person narrative of how the author has used metaphors as a tool for creative consulting. A reflection is provided on how the experiences narrated in this paper align with the conceptual lens of holistic flexibility introduced by Rajneesh Chowdhury in his latest book on systems thinking for management consultants in 2019. [ABSTRACT FROM AUTHOR]

The circumplex version of the Impact Message Inventory (IMI-C) is one of the few existing diagnostic devices for the assessment of 'objective' (inter-subjective) countertransference. The IMI-C purports to assess eight categories of countertransference reactions along the circumference of the interpersonal circle, conceptualized as blends of the two basic dimensions of affiliation (AFF) and control (CON): dominant (D), hostile-dominant (HD), hostile (H), hostile-submissive (HS), submissive (H), friendly-submissive (FS), friendly (F) and friendly-dominant (FD). As a measure of objective (or 'inter-subjective') countertransference, a crucial test for the IMI-C is its ability to produce scores that are generalizable across different therapists involved with the same patients. In four previous psychometric studies, the 'objectivity' of countertransference reactions was examined with a Dutch paper-and-pencil IMI-C version. In the present study, the generalizability of countertransference reactions across therapists was tested with a computer-delivered IMI-C. Results obtained with the electronic IMI-C format were compared with the findings of the paper-and-pencil version. Similar to the four prior studies, D and HD were the comparatively most generalizable classes of countertransference reactions among the eight categories. Both the AFF and CON main dimensions scores were substantially generalizable across therapists. From different perspectives of analysis, more favorable results were obtained with the computer-delivered IMI-C in comparison to the paper-and-pencil-version for (a) five of the eight countertransference classes (D, HD, F, FS, FD) and also for (b) the AFF main dimension. The computer-based IMI-C appears to be a promising tool for assessing objective countertransference reactions. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: • Your countertransference reactions are likely to be partly patient-induced ('objective'). • Countertransference reactions can conveniently be classified in terms of the interpersonal circle. • The computer-based IMI-C is a user-friendly clinical instrument for the assessment of patient-induced countertransference reactions. [ABSTRACT FROM AUTHOR]

The cognitive–developmental theory of 'levels of emotional awareness' (LEA) addresses an individual's capacity to experience and express emotion, a capacity highly relevant to psychotherapy. Previous papers on LEA and psychotherapy addressed the aspect of LEA theory pertaining to the 'trait' (i.e. enduring) aspects of an individual's emotional functioning over time. LEA theory also applies to the construction of emotional experience at any given moment, in which levels emerge or disappear in a process of microgenetic construction as a function of arousal and other variables. This state‐related perspective is supported by recent research showing that people vary in their LEA from moment to moment. Momentary changes in LEA correspond to the variations in lived experience that occur in relationships, including the therapy relationship, and provide the context for corrective emotional experiences that promote change. In this paper, the construction of emotional experience at different levels of organisation is discussed separately in relation to clients and therapists. Key phenomena relevant to psychotherapy include the transition from bodily sensations to specific differentiated emotional feelings, the ability to be aware of multiple feelings that may be contradictory or counter‐intuitive, and the appreciation of how complex combinations of feelings may differ in self and other. This perspective adds to the literature on how the integration of emotion and cognition contributes to change in psychotherapy. The clinical and research implications of this perspective are discussed. [ABSTRACT FROM AUTHOR]

Background: Achieving activity participation goals is a key factor in quality of life (QOL) for people with aphasia (PWA), but expressing participation goals can be difficult for many of them. Proxy reports by caregivers may not accurately reflect the interests and participation goals of PWA, and discrepancies in these goals between PWA and their caregivers may affect QOL, based on the assumption that caregivers' awareness of their loved ones' unique participation goals may be important to increasing PWA activity participation. Aims: To examine everyday activities valued by PWA using the Life Interests and Values (LIV) Cards; to measure congruence between PWA and their caregivers on life participation goals; and to measure how congruence of PWA–caregiver participation goals related to QOL. Methods & Procedures: A convenience sample of 25 PWA completed the LIV Card assessment and the Stroke Aphasia Quality of Life Scale—39 to assess participation goals and QOL. Participation goals were also evaluated with respect to age, time post‐onset and aphasia severity. A total of 12 caregivers were administered the LIV Cards to calculate agreement between PWA–proxy activity reports and the relationship between agreement and QOL. Outcomes & Results: PWA endorsed wanting to participate more in a wide range of activities, with common interests in walking/running, going to the beach and eating out, among others. PWA–caregiver activity agreement was fair to moderate with point‐to‐point agreement averaging 70%. However, no relationship between degree of congruence in PWA–proxy pairs and QOL was found. Conclusions & Implications: PWA have a variety of activity participation goals that can be integrated into intervention plans. Dependence on proxy respondents should be reduced as much as possible to support self‐determination for PWA. What this paper addsWhat is already known on the subjectAchieving activity participation goals is a key factor in QOL for PWA, but communicating about participation goals can be difficult for many of them. Because proxy reports by caregivers may not accurately reflect the interests and participation goals of PWA, this study examined how both PWA and their caregivers responded to an aphasia‐friendly assessment for determining participation goals, and then compared level of agreement about these goals to QOL. Because activity participation is known to be an important factor in QOL, the reason for investigating how agreement relates to QOL is that caregivers' awareness of their loved ones' unique participation goals likely facilitates increased participation by PWA in their ongoing desired activities. The relationship between PWA–caregiver agreement regarding participation goals and QOL in PWA had not yet been investigated before this study.What this paper adds to existing knowledgeThis study adds additional as well as confirmatory information to the existing literature about life participation goals of community‐dwelling individuals with chronic aphasia. Top activities endorsed by a group of 25 PWA are reported within four activity domains (home and community activities, creative and relaxing activities, physical activities, and social activities). Results indicated that agreement between PWA and their caregiver proxies on PWA's most desired activities was < 50%. However, the level of agreement between caregivers and proxies on participation goals was not significantly related to QOL in this sample.What are the potential or actual clinical implications of this work?PWA have a variety of participation goals that can be integrated into intervention plans to be carried out with clinicians, caregivers and family members. The use of proxy respondents when determining participation goals should be reduced as much as possible to support self‐determination for PWA. Use of the LIV Cards, a picture‐based sorting‐task assessment, reduces the need for proxy responders and guesswork about the specific participation goals of PWA. [ABSTRACT FROM AUTHOR]

The professed aim of any social welfare or legal intervention in family life is often to bring about "better outcomes for the children." But there is considerable ambiguity about "outcomes," and the term is far too often used in far too simplistic a way. This paper draws on empirical research into the outcomes of care proceedings for a randomly selected sample of 616 children in England and Wales, about half starting proceedings in 2009–2010 and the others in 2014–2015. The paper considers the challenges of achieving and assessing "good outcomes" for the children. Outcomes are complex and fluid for all children, whatever the court order. One has to assess the progress of the children in the light of their individual needs and in the context of "normal" child development, and in terms of the legal provisions and policy expectations. A core paradox is that some of the most uncertain outcomes are for children who remain with or return to their parents; yet law and policy require that first consideration is given to this option. Greater transparency about the uncertainty of outcomes is a necessary step towards better understanding the risks and potential benefits of care proceedings. [ABSTRACT FROM AUTHOR]

One of the key challenges that counsellors and psychotherapists may now find themselves encountering is that of working with clients whose native language is not English. This is of particular importance when using psychological assessment tools published in English to ascertain difficulties in a client's native language and utilising these tools to help in assessing the level of risk, whether this be done through an interpreter or a multilingual therapist delivering therapy in their native language. This paper takes the reader through the process of translating the YP‐CORE assessment tool from English (original version) to Arabic; it draws on the crucial personal involvements and experiences vital to good translation work and how a good translation must be informed by the challenges of delivering therapies in multicultural settings. The process illustrates some of the cultural (and possibly religious) influences that were at play during the translation process for the young people and their families. This article highlights the importance of cultural sensitivity and competence, as well as religious implications, that some individuals from an Arab or Muslim background might experience in relation to accessing counselling/psychotherapy or even just being seen to support such psychological services (as was the case for translating the YP‐CORE). The crucial outcome of successfully creating an Arabic version of YP‐CORE, which is now published online and available for use by professionals, also brings with it a cultural awareness of Arabic‐speaking cultures and the possible implications of these when delivering counselling or psychotherapy and when constructing policies. [ABSTRACT FROM AUTHOR]

This paper takes the opportunity of the current child welfare system change in Ireland to promote the value of learning from history to better understand the interface between family support and child protection. The paper draws from the histories of child protection and family support to illuminate the commonalities and differences that have come to define the two practices. Using findings from two historical studies - one on family support and the other on child protection - the paper demonstrates the unique features and the many integrated elements of family support and child protection in Ireland. It is argued that students and practitioners need to be provided with a stronger sense of the historical developments that have shaped the present. This will enable comprehension of the complex context within which current relations between 'protection' and 'support' are negotiated and help to avoid operating in a vacuum of a present only viewpoint. The paper concludes with reference to the need for students and practitioners to navigate the complex relationship between family support and child protection at practice, policy and organizational level through a well-informed knowledge of the historical as well as the present context. [ABSTRACT FROM AUTHOR]

Issues of power are often neglected in information systems (IS) studies and under‐theorised in IS research. Systems development methods (SDMs) are commonly used in the IT industry to coordinate the activities between developers and clients. The role of power in the relationship between clients and systems developers remains an important topic of research in information systems development (ISD). Yet, despite the importance of understanding this relationship better, there has only been a limited number of studies exploring the role that an SDM can play in influencing this relationship. What is not widely acknowledged or researched is how different forms of power are inscribed in and enacted through an SDM. The aim of this paper is to advance our understanding of different forms of power—here, obtrusive and unobtrusive power—to show how ISD concepts provide structures during the enactment of an SDM and thereby influence relationships between developers and clients. We present qualitative results from an exploratory case study within an IT division of a large international bank and interpret the results using Clegg's (1989) circuits of power (CoP). Our analysis shows that developers feel disempowered in relation to the client, with developers playing a cooperative but submissive role. Prior SDM enactment studies have either not encountered or not recognised cases where obtrusive and unobtrusive forms of power inscribed within the SDM directly determine the relationship between developers and the client. Our results are presented as a set of propositions explaining how obtrusive and unobtrusive power is inscribed in the SDM and the effect such inscription has on the enactment of the SDM. [ABSTRACT FROM AUTHOR]

Like many family therapists today my approach to therapy can be described as integrative; it utilises various therapy frameworks and models and combines individual and family therapy approaches in response to the needs of clients and the nature of the work. This paper begins with a brief professional retrospective that illustrates the integrative therapy challenge. It then describes integrative therapy as systemic in the sense of bringing together multiple conversations about therapy based on the idea of an ethic of hospitality. Integration as an ethics of practice is grounded in a finely honed attunement between therapist and client as well as an openness to considering multiple perspectives and frameworks of therapy. This is discussed in relation to the contemporary family therapy literature and illustrated by a practice example. [ABSTRACT FROM AUTHOR]

This article discusses the settler colonial roots of family therapy, positing that much of what is considered the standard or ideal family form comes from colonialism. Utilising settler colonial theory as a guide, I identify how the colonial nations, built through the violent exclusion of Indigenous and exogenous peoples, utilised the family to further their goals. Rather than suggest settler colonialism was an historic event, I consider how it continues today, privileging white families of European descent. To move the conversation forward on how white therapists from majoritised cultures can engage with racialised clients, I describe the negotiated spaces as a meeting ground where therapists and clients navigate differing worldviews. In these negotiations, our clients trust us, and to be accountable to this trust, we can unsettle the influence of settler colonialism. To conclude this paper, I discuss four possible pathways to begin the complicated process of unsettling. Practitioner PointsSettler colonialism contributed to the standardisation of the nuclear family, informing the foundations of family therapy.Establishing a 'negotiated space' in therapy can encourage ethical engagement between therapist and client as they navigate differences in culture, knowledge and meaning.To ethically be in the negotiated spaces, therapists from majoritised cultures can 'unsettle' settler colonialism's influence.Learning personal and disciplinary relationships to settler colonialism, developing cultural humility and attending to power is the first step in unsettling. [ABSTRACT FROM AUTHOR]

This paper critiques the Safewards model through the lens of lived experiences of psychiatric hospitalization, diagnosis of mental illness, and distress. Special focus is given to the model's tested 10 interventions and to five lesser known interventions, identifying the impact they can have on hospitalized consumers. We highlight the role and prevalence of trauma, as well as the need to prevent harm in hospital settings. We draw upon notions of hospital as a sanctuary for people and the importance of providing a safe ward. 'Sanctuary harm' and 'Sanctuary trauma' are thus defined, with emphasis placed on the Safewards interventions as means by which sanctuary can be achieved. Finally, the consumer‐perspective authors propose expansions to the model, critiquing the defining literature and moving towards a consumer experience of safety that is beyond the model's original intention: to reduce seclusion and restraint practices. Throughout the paper, the term 'consumer' is used in this context to mean people who have experienced or are experiencing psychiatric inpatient care. [ABSTRACT FROM AUTHOR]

Background The researcher's reflexive use of self forms part of a well-established tradition in counselling and psychotherapy research. This paper reviews that tradition briefly, with particular reference to an approach known as 'practitioner-based research' that has developed from it. In this approach, researcher-practitioners use their therapeutic skills and judgement and thereby enrich their understanding of research participants, themselves and their relationship. Aim The paper aims to contribute to the practitioner-based approach by showing how it can impact on data collection, using an example from a qualitative interview. Methodology A moment of interaction between a participant and a therapy researcher in a qualitative interview is examined, framed within psychotherapeutic intersubjectivity theory. The researcher's reflexive awareness of micro-aspects of the relationship with the participant is reviewed, captured in their language and the split-second daydreams or reveries that arose as they interacted. Findings The authors argue that the approach enhanced this small-scale study by intensifying the researcher's engagement with the participant and enriching her understanding of their relationship and the subject under investigation. Implications The paper highlights the unique value and contribution that this approach offers to therapy research and practice. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including mental health; single session thinking; and therapeutic models.

Abstract: This paper adopts a qualitative case study on the generalist service delivery model of I‐Care, a Durban‐based non‐governmental organization that works with male street children. Fifteen face‐to‐face interviews were conducted with 10 I‐Care employees and 5 former street children. A focus group was set up with I‐Care employees. Although existing literature is forthright about a generalist approach for children at risk, it remains unclear how to implement this approach in practice. This paper reviews a continuity of 5 fundamental social work practices for working with street children: (a) outreach work, (b) child–family and child–community mediation, (c) transitory care centres and programmes, (d) brokerage, and (e) mentorship and follow‐ups. The study analyses how these practices contribute to the capability and agency expansion of the street children and outlines challenges that service providers and former street children experience. The main challenges acknowledged are balancing between the agency and protection of street children and the adaptation of children to street life. The study proposes intervention strategies to overcome these challenges. [ABSTRACT FROM AUTHOR]

Nursing work increasingly demands forms of expertise that complement specialist knowledge. In child and family nursing, this need arises when nurses work in partnership with parents of young children at risk. Partnership means working with parents in respectful, negotiated and empowering ways. Existing partnership literature emphasises communicative and relational skills, but this paper focuses on nurses’ capacities to facilitate parents’ learning. Referring to data from home visiting, day‐stay and specialist toddler clinic services in Sydney, a pedagogical framework is presented. Analysis shows how nurses notice aspects of children, parents and parent–child interactions as a catalyst for building on parents’ strengths, enhancing guided chance or challenging unhelpful constructs. Prior research shows the latter can be a sticking point in partnership, but this paper reveals diverse ways in which challenges are folded into learning process that position parents as agents of positive change. Noticing is dependent on embodied and communicative expertise, conceptualised in terms of sensory and reported channels. The framework offers a new view of partnership as mind‐expanding for the parent and specifies the nurse's role in facilitating this process. [ABSTRACT FROM AUTHOR]

Background: Evaluations of health interventions for Indigenous peoples rarely report outcomes that reflect participant and community perspectives of their experiences. Inclusion of such data may provide a fuller picture of the impact of health programmes and improve the usefulness of evaluation assessments. Aim: To describe stakeholder perspectives and experiences of the implementation and impact of Indigenous health programmes. Methods: We conducted a systematic review of qualitative studies evaluating complex health interventions designed for Indigenous communities in high‐income countries. We searched 6 electronic databases (through to January 2020): MEDLINE, PreMEDLINE, Embase, PsycINFO, EconLit and CINAHL and hand‐searched reference lists of relevant articles. Results: From 28 studies involving 677 stakeholders (mostly clinical staff and participants), six main themes were identified: enabling engagement, regaining control of health, improving social health and belonging, preserving community and culture, cultivating hope for a better life, and threats to long‐term programme viability. Conclusion: The prominence of social, emotional and spiritual well‐being as important aspects of the health journey for participants in this review highlights the need to reframe evaluations of health programmes implemented in Indigenous communities away from assessments that focus on commonly used biomedical measures. Evaluators, in consultation with the community, should consistently assess the capacity of health professionals to meet community needs and expectations throughout the life of the programme. Evaluations that include qualitative data on participant and community‐level outcomes can improve decision‐makers' understanding of the impact that health programmes have on communities. Patient or public contribution: This paper is a review of evaluation studies and did not involve patients or the public. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a study examining adult disclosures of childhood sexual abuse to child protection social work services in the Republic of Ireland. Limited literature indicates that adults can have negative experiences when disclosing childhood abuse; this is primarily owing to a lack of training, policy and guidance for practitioners, and legal complexities regarding allegations of abuse. This study used a biographic‐narrative interpretive method (BNIM) to gather the experiences of adults who engaged with child protection social work services. The findings were analysed using both BNIM panel analysis and open, axial and selective coding. Six main themes were identified, and the findings are discussed under three headings: (1) the system as a barrier presents the various influences that acted as barriers for adults coming forward to disclose; (2) issues of power examines the influence of power from the time of abuse throughout the adults' life courses and their interactions with services; and (3) the system as a facilitator presents practice and policy recommendations based on participants' narratives and the wider research literature. Implications for child protection practice in this extremely sensitive and sometimes controversial area are considered. 'This study used a biographic‐narrative interpretive method (BNIM) to gather the experiences of adults who engaged with child protection social work services' Key Practitioner Messages: A number of complex socioecological factors need to be considered when receiving and assessing adult disclosures of childhood sexual abuse.Dynamics of abuse and disclosure may be similar; any understanding of an experience of childhood sexual abuse should also involve an understanding of experiences of disclosure.Basic practices such as providing information, clarity and frequent communication may address potentially harmful dynamics of power and control that can exist in respect of disclosure of childhood trauma. [ABSTRACT FROM AUTHOR]

The working relationship is considered a central feature of direct practice with human services clients. There are many challenges when it comes time to end a working relationship, yet limited guidance for workers on successful relationship ending. This paper aims to increase understanding of the process of the ending phase of the working relationship for parents and workers working with families where child neglect is an issue. The paper draws on data from a small-scale qualitative Australian study of perceptions of parents, family workers, and supervisors involved in eight parent-worker relationships. Using semistructured interviews, participants were asked to explore how they experienced the relationship. The findings illuminate important aspects about the ending phase of the relationship; in particular, challenging the idea that parents' returning to services for support is a sign that the service has not provided a successful intervention. The paper challenges social workers to consider recurring parent-worker relationships similar to other professional relationships where there are episodes of service but the relationship is there to be reactivated where needed. [ABSTRACT FROM AUTHOR]

Aggression and violence ( A/V) in mental health care are all too frequent occurrences; they produce a wide range of deleterious impacts on the individual client, staff, organizations, and the broader community. A/V is a multifaceted and highly-complex problem, and is associated empirically with a wide range of phenomena. However, most attempts to reduce A/V in mental health care have invariably focused on one or two aspects of the problem at the expense of a more comprehensive, systemic approach; these have produced inconclusive results. As a result, this two-part paper seeks to: (i) recognize the wide range of phenomena that have been found to have an association with A/V in mental health care; (ii) synthesize these propositions according to fit or congruence into a systemic model of A/V; (iii) explore empirical evidence pertaining to these propositions; and (iv) begin to consider the application of this model to better inform our individual and/or organizational responses to A/V in mental health care. The paper advances a systemic model of these phenomena comprised of four thematic categories, with Part 1 of this paper focusing on the first two categories: environmental and intrapersonal (client-related) phenomena. [ABSTRACT FROM AUTHOR]

This is the second of a two part paper which seeks to explore a wide range of phenomena that have been found to have an association with aggression and violence ( A/ V) in inpatient mental health care, synthesize these propositions according to fit or congruence into a systemic model of A/ V, explore the empirical evidence pertaining to these propositions, and begin to consider application of this model to better inform our individual and/or organizational responses to A/ V in mental health care. The systemic model is comprised of four thematic categories with part two of the paper focusing on the final two categories: mental health-care system-related phenomena and clinician-related phenomena. The paper then discusses a number of implications arising out of embracing a more systemic model of A/ V in mental health care. In broadening our understanding to include all the phenomena that contribute increased risk of A/ V incidents, we are able to move away from inaccurate views that disproportionately assign 'responsibility' to clients for causing A/ V when the evidence indicates that the client-related phenomena may only account for a small portion of these incidents. [ABSTRACT FROM AUTHOR]

ABSTRACT This paper presents findings from qualitative interviews with 24 young people (11-17 years) who have been referred to Children's Social Care Services in England. The paper explores young people's experiences of help seeking and their experiences of receiving help for maltreatment through statutory agencies. A central finding is the importance of relationships for young people when seeking and receiving help. It is through trusting relationships with professionals that young people are most likely to disclose maltreatment and/or engage with services. The paper concludes that young people's expectations and needs are not always met by the current safeguarding system and that the system needs to become more child-centred if it is to address the concerns maltreated young people have consistently voiced through research. [ABSTRACT FROM AUTHOR]

Copyright of Family Process is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper explores the provision of family support services for young mothers within a Sure Start Children's Centre, drawing on data collected within a larger study. It identifies how the family support team attempted to build supportive relationships with young mothers between the ages of 16 and 19 years. The findings presented here draw on narrative interviews ( n = 10) and focus group interviews ( n = 2) with the family support team that included early years workers, family support workers and their managers. The findings captured how the participants actively resisted the stigma (Goffman 1963) of teenage motherhood in order to support young mothers in gaining the necessary skills and knowledge to care for their child. Drawing on the findings, this paper argues that the building of a supportive relationship enables a young mother to construct positive counter-narratives about her parenting experience. This suggests that the family \to offer informal early support to young mothers who are at risk of more formal intervention. However, the complexity of this task should not be underestimated because in doing this, the family support team must at all times ensure the well-being and safety of the child. [ABSTRACT FROM AUTHOR]

Although the importance of including fathers in child welfare services has been increasingly recognized, social workers' engagement with fathers is still limited and sometimes fraught with negative bias. This paper attempts to lay some needed foundation to meet the challenge of working with fathers. It presents in succinct form the existing knowledge on how fathers experience and manifest their distress and on how they view the social services and social workers. It discusses, in some detail, three main issues – power relations, mutual fear and communication differences – in the interactions between female social workers and the fathers in the social welfare services. And it emphasizes the need for social workers to be aware of how their experiences with their own fathers may affect their interventions with men. It ends with observations and recommendations for developing the gender awareness that is necessary for effective practice with fathers. [ABSTRACT FROM AUTHOR]

One of the key lessons learnt in the UK from the Laming Inquiry into the death of Victoria Climbié was the importance of social workers developing consistent and long-term relationships with young children in whose lives they are involved. This issue is now informing policy developments, including the proposed Social Work Practices which, based on a similar model to General Practitioner practices, aim to provide a lead professional to act as a parental figure and an advocate for every child in care. This paper begins by confirming the importance of developing relationships between social workers and young children, but questions the ability of the new policy developments to facilitate these. Drawing upon data from research involving interviews with social workers, the paper outlines the factors which hinder social workers’ relationships with young children and argues that while the new proposals address some of the more surface structural and organizational factors, they do not address the deeper factors regarding attitudes, values and emotional competence which are crucial if social workers are to successfully build relationships with young children in care. [ABSTRACT FROM AUTHOR]

The terms 'Single‐Session Therapy' (SST) and 'One‐At‐A‐Time' (OAAT) therapy are both used to indicate a situation where the therapist and client set out with the expressed intention of helping the client in one session while acknowledging that additional sessions are available to the client. Both terms have their advantages and disadvantages and thus the author uses the blended term 'Single‐Session One‐At‐A‐Time' (SST/OAAT) therapy to highlight the advantages of both. It is a core feature of SST/OAAT therapy that it is client‐centred especially where the session's focus and goal are concerned. However, in an attempt to avoid SST/OAAT therapy being highjacked by therapists who operate from the 'expert' source of influence, the field has downplayed the contribution of the therapist's expertise. In this paper, I make clear that the expertise of the therapist when allied to the expertise of the client can be a potent force for good in SST/OAAT therapy. My main task, however, is to outline my own approach to SST/OAAT therapy which is a blend of general principles that are likely to be held by the majority of SST/OAAT therapist and specific ideas that are derived from working alliance theory, pluralism and Rational Emotive Behaviour Therapy. [ABSTRACT FROM AUTHOR]

Single session therapy (SST) postulates that one session can be sufficient for a client to take charge of the process and work toward their own solutions. Research has been conducted worldwide corroborating SST assumptions with several mental health conditions, but not in Italy. For the first time in Italy, this paper aims to explore: (1) if the most frequent number of sessions in traditional psychotherapy (not SST) is one (Study 1); and (2) the satisfaction of clients who attend SST services and the number who consider one session sufficient to address their presenting problem (Study 2). In Study 1, the records of 476 voluntary clients referred to three different traditional (not SST) psychological services in the west‐central region of Latium, Italy, were retrospectively screened, and the number of sessions attended by each client recorded. In Study 2, 85 consecutive clients who voluntarily asked for SST with seven mental health professionals across Italy received a link to an online ad hoc survey, 1–3 weeks after the consultation, evaluating their experience. Study 1 found that the most frequent number of traditional psychotherapeutic (not intentionally SST) sessions was one (124 out of 476 clients (26%). Study 2 found that 44 out of 85 clients (52%) considered one session to be enough, as they felt better or much better and chose not to attend further sessions. Of those who asked for a second session (41 clients), 33 clients (80.5%) indicated that the first session was not enough and 8 clients (19.5%) wanted to address a new problem. These results converge with previous international studies and provide encouragement for the use of SST in both private and public psychological services to address the demand for timely mental health services in Italy. Further research is needed to support the efficacy of SST and to evaluate its cost‐effectiveness. [ABSTRACT FROM AUTHOR]

Copyright of Family Process is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Collaboration and conversations are important in meeting vulnerable children's needs in the context of Child Welfare Services (CWS). Building on 10 qualitative interviews with parents of children in Norwegian Child Welfare Services, this paper discusses parents' views on collaboration between children and child welfare professionals. The parents stated that a constructive collaborative relationship depends on professionals' attitudes towards the child, their ability to connect with the child and their awareness of how the child's emotions and how the parents influence the child–professional relationship. A collaborative relationship is essential for child welfare professionals to meet the child's needs and to help improve relations between the child and the parents. The parents asked for more collaboration between children and child welfare professionals. The findings call for more discussion of child welfare workers' tasks and competence. [ABSTRACT FROM AUTHOR]

Copyright of Family Process is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The purpose of this study is to analyze the experience of hope that appears in a parent's blog presenting everyday life while caring for a child with Trisomy 18 (Edwards syndrome). The author, Rebekah Peterson, began her blog on 17 March 2011 and continues to post information on her son Aaron's care. The analysis of hope in the blog is carried out using a mixed methodology: initial and focused coding using Charmaz's constructed grounded theory and elements of Colaizzi's method. Each aspect of hope is coded through the blog author's statements, from which three main aspects of hope emerge: hope for the longest possible presence of Aaron with his family, hope for control over situations, pain, and symptoms, and existential facets of hope. These various aspects reveal to what extent the experience of hope is unique. Additionally, analyzing the experience of parental hope uncovers the additional problem of inappropriate communication by health care professionals (HCPs) in intensive care units, particularly when discussing the termination of causal treatment. The problem may be solved through proper education for HCPs and serious consideration of parental involvement in order to properly elaborate guidelines on this issue. The three main aspects of parental hope discussed in this paper might expand knowledge on the issue, helping HCPs to better understand the parents' experience of care and to help sustain parental hope in pediatric palliative care. [ABSTRACT FROM AUTHOR]

Understanding how children experience social work interventions is an important part of gauging whether what is provided is genuinely helpful. In this paper, we describe the findings from a research project using Q‐method, aimed at understanding what children involved with statutory services think about their social workers and how they experience the time they spend together. Using a pre‐existing practice framework, we explored skills including empathy, collaboration, and purposefulness from the point of view of children and young people. The participants in our study (n = 22) were insightful observers of social work practice, able to describe not only how they experienced time spent with their workers but also inferring differences in motivation and approach. In addition, workers who were described in similar terms by different young people were nevertheless experienced differently. This suggests not an archetypal "good social worker"—instead, there are skills that are good for specific children at specific times within the context of specific relationships. [ABSTRACT FROM AUTHOR]

This paper draws on the work of Giorgio Agamben to understand how the social organisation of care transitions can reduce people to their 'bare' life thereby making harmful and degrading treatment seemingly legitimate. The findings of a 2‐year ethnographic study show how some people experience hospital discharge as undignified, inhumane and unsafe process, expressed through their lack of involvement in care planning, delayed discharge from hospital and poorly coordinated care. Our analysis explores how these experiences stem from the way patients are constituted as 'unknown' and 'ineligible' subjects and, in turn, how professionals become 'not responsible' for their care. The result being that the person is reduced to their 'bare' life with limited value within the care system. We suggest that the social production of 'bare life' is an inadvertent consequence of reconciling and aligning multiple disciplines within a complex care system. [ABSTRACT FROM AUTHOR]

Shared decision‐making involves health professionals and patients/clients working together to achieve true person‐centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision‐making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence in maternity care. Discussion between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision‐making for caesarean section. The team concluded that shared decision‐making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision‐making (defeaters) are disclosed. Informed consent is not shared decision‐making. Key barriers include existing cultural norms of "the doctor knows best" and "patient acquiescence" that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision‐making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required. [ABSTRACT FROM AUTHOR]

This paper argues that a core skill needed to be an effective therapist is to have developed an awareness of one's own ontological and epistemological positions in relation to one's work as a therapist. In the same way that researchers need to develop reflexive awareness of their assumptions about what there is to know (ontology) and how they can come to know about it (epistemology), therapists need to be aware of their fundamental assumptions about human beings and the world they live in (ontology), as well as their beliefs about how best to develop an understanding of their clients and the meaning(s) of their experiences (epistemology). Regardless of which therapeutic model is adopted, the language used to talk about (and in) therapy, the kinds of questions asked of clients and the comments/interpretations offered, all presuppose and reinforce particular versions of human being and experiencing, which are themselves not usually questioned or challenged during the course of therapy. It is essential that therapists are aware of their own fundamental assumptions about what it means to be human and that they recognise their ontological and epistemological positions as positions that they are taking (rather than perceiving them to be self‐evident truths). This is important for two reasons: (a) if clients do not share the therapist's assumptions, the therapeutic work cannot proceed and be effective; and (b) without such an awareness, therapists are at risk of unwittingly imposing their own model of the person upon the client which raises ethical issues. [ABSTRACT FROM AUTHOR]

Aim: Competency‐based Education (CBE) has underpinned the education of dietitians in Australia since the first Competency Standards (CS) were published; however, little is known about how CBE has influenced dietetic practice. The aim of this paper is to explore how a CBE framework and the CS have influenced dietetic practice in Australia since 1990. Methods: A qualitative investigation explored concepts of dietetic practice. Data analysed were original interviews previously undertaken with recent graduate dietitians during 1991 (n = 26), 1998 (n = 23) and 2007 (n = 19) and seven guided discussions with dietitians and employers (n = 28) conducted in 2014 to identify themes. The DAA Competency Standards and Accreditation Manuals/Standards since 1990 were also analysed to triangulate the interview data and to investigate how the CS were interpreted. Results and Conclusions: Themes identified from interviews included: (i) communicating for better care, (ii) scientific enquiry for effective practice, (iii) critical thinking and evidence‐based practice and (iv) professionalism, which remained core to dietetic practice over time, but leadership, advocacy, business management and entrepreneurial skills have emerged more strongly as the scope of practice has diversified. The landscape in which dietitians' practice showed increasing complexity and clear boundaries separating professional roles were disappearing. The 2015 CS and the 2017 Accreditation Standards highlighted that competency remains a shifting construct and that professional behaviours change depending on economic and political reasons in the play of power. Accreditation policy and current standards have successfully maintained a standard of dietetic practice across a diverse country but have the potential to constrain innovation. [ABSTRACT FROM AUTHOR]