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An increasing focus in aged care policy is supporting older people to age at home. However, there is little recognition of the health and independence of older private renters living in a space they do not own or control. This paper draws on in-depth interviews and assessments undertaken in the homes of 27 older tenants in the Brisbane environs aiming to understand how renting privately influenced their ability to meet their basic needs. An analysis of the findings highlights the disadvantage experienced by many older private renters. Most older private renters were unable to meet their basic needs given unaffordable rent whilst reliant on the aged pension. Further, with limited access to community aged care including home modifications, the health and independence of older private renters was found to be at risk. IMPLICATIONS Community aged care is difficult for older private renters to utilise in Australia, with unaffordable services and tenancy law limiting access to community aged care services including home modifications. It is vital social workers advocate for the community aged care needs of older private renters in practice and policy settings. [ABSTRACT FROM AUTHOR]

Prevention of chronic diseases happens within systems of action across whole communities. In local communities, organisations play important roles that influence health, but many are in non-health sectors where health or 'prevention' is not their main remit. In this paper, we explore how organisations in communities perceive their role as part of a local system of chronic disease prevention. We use interview data from 'Prevention Tracker', an investigation undertaken with Australian communities that aimed to describe how local prevention systems are organised. Four communities participated – one regional, one remote, and two urban. In each, local advisory groups identified key informants for semi-structured interviews (n = 80). We applied the Ottawa Charter for Health Promotion as a sensitising framework to categorise responses; and undertook inductive thematic analysis to generate deeper insights into organisations' orientation to prevention. While some respondents clearly recognised and articulated linkages between their organisation's activities and prevention, sometimes drawing from health promotion principles to do so, many did not and were prompted by the interview to consider their contributions. A proportion explicitly distanced themselves from prevention despite their work directly addressing the social determinants that underscore health. For some, this distancing reflects a tactical decision to reduce competition and promote partnership between organisations, and to engage clients. This study demonstrates that diverse organisations make contributions to prevention – often outside of 'core business' – whether or not the organisations themselves realise, relate to and/or self-identify as playing this role. [ABSTRACT FROM AUTHOR]

Aims: The current study assesses the impact of youth drug treatment on substance use, offending and wellbeing in a sample of young people recruited from specialist youth alcohol and drug treatment. The paper examines the impact of treatment engagement on the size and substance use profile of the young person's social network and hypothesises that the best treatment outcomes are associated with maintaining the size of the young person's social network but changing its composition to reduce the representation of substance use in social networks. Methods: A cohort study of 112 young people (aged 16–21) engaged in specialist youth alcohol and drug treatment services in Victoria, Australia, were recruited at the beginning of treatment and re-interviewed six months later using a structured questionnaire. Findings: There were improvements in substance use, social functioning, mental health and life satisfaction from baseline to follow-up. While network size was associated with mental health and quality of life markers, only having a lower proportion of substance users in the social network was associated with lower substance use and offending at follow-up. Conclusions: Social networks are a key component of wellbeing in adolescence. This study suggests that through independent analysis of network size and network composition, both the size and the composition of social networks have an important role to play in developing interventions for adolescent substance users that will sustain behaviour changes achieved in specialist treatment. [ABSTRACT FROM AUTHOR]

This study aimed to describe how occupational therapists working in acute care settings in Australia assess cognitive function in patients with TBI, the influences on assessment choice, and clinician perceptions of performance-based assessment. An online survey was completed by 81 occupational therapists. The most common method of cognitive assessment was reported as non-standardized observation of functional tasks (94.7%), followed by carer-report / self-report (93%). Despite their being positive perceptions of performance-based assessment there was limited use in practice. Assessment use was impacted by practical and organizational constraints including access to assessment resources, time and the built environment in acute care. [ABSTRACT FROM AUTHOR]

BackgroundPeople who have profound intellectual and multiple disabilities face significant challenges to participating in their community and are reported to have few friends. In this paper, the issue of how this is addressed by parent-carers of young women with Rett syndrome is explored. MethodTranscripts of in-depth interviews with 6 families registered with the population-based Australian Rett Syndrome Database were examined, guided by a theory of social construction, for themes of participation. ResultsThe majority of parent-carers saw social participation as an unrealistic expectation due to their daughters’ difficulties with communication. At the same time, parent-carers spontaneously recounted details of their daughters’ social connections within their local communities. This was positively associated with the presence of siblings. ConclusionsYoung women with Rett syndrome participate socially in their community. Encouraging parent-carers to continue with small-scale strategies that pay heed to their concerns and fears has the potential to enhance their daughters’ access to the benefits associated with friendship. [ABSTRACT FROM PUBLISHER]

Recognition of human rights on the basis of sexual orientation, gender identity and intersex status by the United Nations has led to the development of new policies concerning homophobia and transphobia in educational contexts. This paper examines new Australian education policies impacting gay, lesbian, bisexual, transgender, intersex and queer (GLBTIQ) teachers. A policy review uncovered a range of protections for GLBTIQ teachers in contexts such as the State of Victoria, alongside restrictions. Experiences of policy discussed in pilot study data from surveys of 63 Victorian GLBTIQ teachers, and in-depth interviews with nine Victorian GLBTIQ teachers, revealed that GLBTIQ teachers were relatively unaware of the protections available to them, compared to their awareness of protections for students. Many teachers were out as lesbian or gay to some staff members but fewer had come out to students. Teachers in religious schools had more difficulties, causing some to leave the sector. Further promotion of protections and more research are recommended. [ABSTRACT FROM AUTHOR]

Individuals with substance use disorders (SUDs) have consistently been shown to report elevated levels of anger and rates of violence perpetration. Given that heightened anger can increase risk for violence and also impede treatment for SUD, it is important to identify correlates of anger and violence among individuals in SUD treatment settings. While previous research has identified factors associated with anger and violence among individuals with SUD, these studies tend not to adequately address the role of comorbidity or trait aggression in their samples. This is particularly important given that comorbid mental health disorders, for example post traumatic stress disorder (PTSD), have been shown to be associated with anger and violence perpetration among individuals with SUD. This paper aims to examine demographic and mental health correlates of anger and violence among individuals in treatment for SUD. Structured interviews were carried out with 58 participants recruited from a residential detoxification clinic. Findings indicate that individuals with comorbid mental health symptoms, particularly symptoms of anxiety, are also likely to present with elevated levels of anger. In addition, a history of childhood trauma exposure and high levels of trait aggression were significantly associated with violence perpetration in the sample. This information can assist clinicians in identifying individuals prone to anger and violence and aid in the development of interventions designed to reduce anger and the likelihood of violence among individuals entering substance use treatment. [ABSTRACT FROM PUBLISHER]

Bondage/discipline, dominance/submission, and sadism/masochism (BDSM; "kink") are frequently pathologized as derivatives of abuse. Although the link is unsubstantiated, some kink-identified people who happen to be survivors of trauma may engage in kink, or trauma play, to heal from, cope with, and transform childhood abuse or adolescent maltreatment. The present study sought a thematic model (Braun & Clarke, Qualitative Research in Psychology, 3(2), 77–101, 2006) of trauma recovery through kink using a critical realist, inductive approach to inquiry. Participants were eligible if they had experienced early abuse, were adults, and practiced kink. Six superordinate themes were generated from semi-structured interviews with 20 participants from five countries: cultural context of healing (e.g. using BDSM norms and previous therapy to reframe kink and trauma), restructuring the self-concept (e.g. strengthening internal characteristics which had been harmed or distorted), liberation through relationship (e.g. learning to be valued by intimate others), reclaiming power (e.g. setting and maintaining personal boundaries), repurposing behaviors (e.g. engaging in aspects of prolonged exposure), and redefining pain (e.g. transcending painful memories through masochism). Notably, participants only reported retraumatizing experiences prior to learning about the structural safeguards of BDSM. Research and clinical implications are discussed by drawing on general models of trauma recovery. [ABSTRACT FROM AUTHOR]

Social workers play a pivotal role in addressing equity and diversity within Australia using both culturally responsiveness skills and knowledge. This article describes a research project that resulted in the development of the Continuous Improvement Cultural Responsive Tools that can be used by social workers in their practice. This was a large project conducted over three years, which involved engagement and consultation with Aboriginal and Torres Strait Islander community social workers. The community engagement and consultation process included the provision of cultural governance and participation in interviews. The tools developed are linked to seven key domains (Ngurras) that aim to increase the skills, knowledge, and overall confidence of social work practitioners in their culturally responsive practice. This article discusses the tools that provide a clear structure to guide social workers' critical engagement in becoming more culturally responsive social workers and individuals when working with Aboriginal and Torres Strait Islander Peoples. IMPLICATIONS Social work practices need to address the social injustices faced by Aboriginal Peoples by becoming more culturall responsive. The tools were developed to support social workers in their practice to self-assess their transformation in becoming culturally responsive social workers. Continuous improvement in collaborative and culturally responsive social work will improve services for Aboriginal and Torres Strait Islander Peoples. [ABSTRACT FROM AUTHOR]

To evaluate a dog-walking program (called "Dog Buddies") designed to address the need for evidence-based programs that create opportunities for people with cognitive disabilities to be more socially included in mainstream society. The research question was: Does community dog walking foster social interaction for people with cognitive disabilities? Single-case experimental design was used with four individuals (three with intellectual disability; one with Acquired Brain Injury (ABI)) recruited via two disability service providers in Victoria. Target behaviours included frequency and nature of encounters between the person with disability and community members. Change was measured from baseline (five community meetings with a handler but no dog) to intervention period (five meetings minimum, with a handler and a dog). Semi-structured interviews, audio-recorded and transcribed verbatim, provided three participants' subjective experiences of the program. Dog Buddies increased the frequency of encounters for all participants. The presence of the dog helped to foster convivial encounters, community members were found to be more welcoming, and some participants were recognised or acknowledged by name over time in the intervention phase. The dog-walking program offered a simple means of influencing the frequency and depth of community-based social interactions for people with cognitive disabilities. The co-presence of people with disabilities in the community with the general population does not ensure social interaction occurs. Both disability policy, and the programs or support that is provided to people with disabilities, needs to have a strong commitment to the inclusion of people with disabilities in mainstream communities. Dog Buddies is a promising example of a program where the presence of a pet dog has been demonstrated to support convivial, bi-directional encounters of people with cognitive disabilities and other community members. Dog-walking offers a simple means of influencing the frequency and depth of community-based social interactions for people with cognitive disabilities. [ABSTRACT FROM AUTHOR]

Self-management can lead to increased self-efficacy and improved quality of life for individuals with chronic conditions; however, there is little research exploring how self-management approaches can be used for chronic communication disorders, such as aphasia. Modifications to self-management approaches would be required to accommodate for aphasia; therefore, the input of people with aphasia (PwA) should be sought. The aims of the present study were: (1) To investigate and document the experiences and perspectives of PwA regarding self-management; (2) To explore how technology can be used to support aphasia self-management. In-depth, semi-structured interviews were conducted with 26 PwA living in Australia. Qualitative content analysis was used to analyse interview data. Analysis resulted in six themes: (1) In self-management, PwA take control of life with aphasia and assume responsibility for engaging in opportunities to improve overall communication; (2) Community aphasia groups are important enablers of self-management because they facilitate peer support; (3) Communication partners (CPs) provide multifaceted support in aphasia self-management; (4) SLPs provide integrated support and coordination in aphasia self-management; (5) Technology supports PwA to self-manage speech therapy and communication in daily life; (6) Psychological and physical health issues and societal factors may impact aphasia self-management abilities. From the perspective of PwA, aphasia self-management involves enhancing skills enabling communication and life participation. PwA are central to aphasia self-management, with support provided by CPs, peers, and SLPs. Technology has a range of applications in aphasia self-management. PwA identified potential personal and contextual barriers that may impact self-management. For people with aphasia, engaging in conversation and social interaction are primary means of managing/improving communicative life participation; therefore, this should be a key focus of aphasia self-management programs. Aphasia self-management approaches should maximise the use of available support and provide tailored information, education, and training in the area of self-management to key stakeholders (people with aphasia, communication partners, and speech-language pathologists). People with aphasia should be supported to use technology for aphasia self-management, encompassing communication specific and daily life use. People with aphasia should be heavily involved in the development of structured aphasia self-management approaches. [ABSTRACT FROM AUTHOR]

To understand parents' experiences of evidence-based assessment by health professionals for their child with cerebral palsy. A qualitative interpretive description study was undertaken. Primary carers of children with cerebral palsy (aged 3–18 years) from south-eastern Australia were invited to participate. Face-to-face interviews were held using a semi-structured topic guide and data analyzed inductively. Credibility was ensured through: journal reflections; co-author review; audit trail; and, participant member-checking. Fourteen parents of children with cerebral palsy, representing Gross Motor Functional Classification System levels I–V, participated. Six themes emerged: (1) Protection; (2) Positively Framed; (3) Bridging the Gap; (4) Involvement; (5) Finding Worth; and (6) Trust. Central to parents' experience was protection of their child's identity and personal self. Assessment can be emotionally confronting, at any stage. Representing the child positively and highlighting possibilities was deemed essential. Parents' involvement ranged from being overlooked spectators to being instigators of assessment. Evidence-based assessment was worthwhile when relevant to parents' direction and family context. The researchers' interpretive description generated a schema and metaphor—the Steering Wheel for Collaborative Assessment. A strengths-based approach to diagnosis and assessment is essential. The resulting interpretive description may assist health professionals align evidence-based assessment practices with family-centred care. Parents of children who have cerebral palsy describe having to protect their child's identity and representation, and their own personal well-being, through evidence-based assessment and diagnostic processes. Involving parents in the process of evidence-based assessment and adopting a strengths-based approach is essential. The interpretive description developed—the Steering Wheel for Collaborative Assessment—may assist health professionals to implement evidence-based assessment tools in ways consistent with family-centred care principles. [ABSTRACT FROM AUTHOR]

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Purpose: Aboriginal Australians are under-represented in stroke rehabilitation services and rehabilitation practices that are sensitive to the needs of Aboriginal people are not currently available. This project tested the feasibility and acceptability of a rehabilitation model and approach to therapy with Aboriginal people with acquired communication disorders post-stroke. Method: Eight Aboriginal people with acquired communication disorders post-stroke were recruited to this study. Sixteen treatment sessions were provided twice weekly at the person's place of residence by a speech-language pathologist and Aboriginal co-worker. Feasibility was measured by analysing the number of sessions conducted jointly by the speech-language pathologist and Aboriginal co-worker and participant attendance. Participant acceptability was measured through the analysis of a post-therapy questionnaire. The Aboriginal co-worker's and speech-language pathologists' perceptions of the acceptability were collected through semi structured interviews. Result: Across all sessions 84.2% were attended by the Aboriginal co-worker and speech-language pathologist and seven of the eight participants completed all prescribed sessions. Positive feedback was provided by participants, the Aboriginal co-worker and speech-language pathologist on the key components of the programme. Conclusion: The rehabilitation model used within Wangi appears to be feasible and acceptable to participants and therapists. It provides direction to improve the quality of care for Aboriginal stroke survivors. [ABSTRACT FROM AUTHOR]

The communication journey of a child with hearing loss is often a complex, interwoven process in which the child's use of language or method of communication may change numerous times. As there has been limited research exploring the caregiver decision-making process behind making such changes, this qualitative descriptive study aimed to explore the factors which influence the caregiver decision making-process to change the communication method of their child with hearing loss. Individual semi-structured in-depth interviews were conducted with seven caregivers of children with hearing loss in Australia. Thematic analysis revealed five key themes which influenced caregiver decisions regarding changes to their child's method of communication, including: (1) family characteristics; (2) family access to information; (3) family strengths; (4) family beliefs; and (5) family-centered practice. The overall finding that the family unit is at the core of decision-making has important clinical implications regarding early intervention professionals’ provision of family-centered services when working with the families of children with hearing loss. [ABSTRACT FROM AUTHOR]

Background: Understanding the characteristics of drug users in the night-time economy (NTE), and whether particular drugs are associated with risky practices and experience of harm, is necessary to inform targeted policy responses in this context. Objectives: To investigate the correlates of drugs used in the Australian NTE relating to demographics, alcohol use, and experience of harm. Methods: Patrons were interviewed in the NTE of five Australian cities in 2012–2013 (n = 7,028; 61.9% male, median age 22 years). A custom designed survey gathered demographic data, alcohol, and substance use on the current night, and experience of harm in/around licensed venues in the past 3 months. Multivariate logistic regression analyses examined the correlates of drug use. Results: Ecstasy was most commonly reported (4.0%), followed by cannabis (2.9%), methamphetamine (2.6%), and cocaine (1.6%). Ecstasy users were more likely to be younger and report energy drink consumption. Cannabis users were more likely to be male, and to have been involved in intoxication-related accidents/injuries and sexual aggression in/around licensed venues in the past 3 months. Methamphetamine users were more likely to have been interviewed later, and to have engaged in pre-drinking. Cocaine users were more likely to be male, aged 21 years or more, have a blood alcohol concentration of greater than 0.10%, and to have been involved in intoxication-related accidents/injuries in the past three months. Conclusions/Importance: We identified significant differences between types of drug users and the harms they experience, underscoring the need to develop innovative harm reduction policies in the NTE rather than blanket population-based approaches. [ABSTRACT FROM AUTHOR]

Work organisation has well-established associations with health. This study compares the associations of Pressure, Disorganisation and Regulatory Failure (PDR) and effort–reward imbalance (ERI) with health and well-being among older workers. Participants were 714 Australian workers aged 45–65 (56.3% female), with a mean age of 54.6 years (SD= 5.0) and a mean of 34.7 working hours per week (SD= 13.9). Hierarchical regression analyses tested the strengths of the associations of both ERI and PDR with work–life conflict and mental health. Independent variables were entered in blocks: demographic characteristics (age and gender), working hours and then ERI or PDR (measured using the four subscales: financial pressure, reward pressure, disorganisation and regulatory failure). Compared to ERI, the PDR subscales collectively accounted for slightly less variance in work–life conflict and slightly more variance in mental health. The PDR subscales also accounted for extra variance in both dependent variables when ERI was included in the model. These findings indicate that PDR is a promising construct that includes elements of work organisation not addressed by ERI. [ABSTRACT FROM PUBLISHER]

Depression represents an increasing global health epidemic with profound effects in the workplace. Building a business case via the quantification of potentially avertable costs is essential to convince organizations to address depression at work. Our study objectives were to: (1) demonstrate a process path whereby job strain and bullying are related to productivity loss via their effects on depression; (2) estimate the costs to employers of sickness absence and presenteeism that are associated with depression; (3) investigate the relationship between depression severity and costs; and (4) estimate the contribution of job strain and bullying to depression-related productivity loss. A population-based telephone survey was conducted across two Australian states (N = 2074), with a one-year follow-up (cohort design). Results confirmed job strain and bullying affected productivity via depressive symptoms. Total national annual employer costs for lost productivity due to depression were estimated at $AUD8 billion per annum, most of which was due to mild depression. We calculated a population-attributable risk (PAR) estimate of 8.7% for depression attributable to bullying and job strain, equating to $AUD693 million in preventable lost productivity costs per annum. Findings suggest that even sub-clinical levels of depression represent a significant productivity and economic burden not previously recognized. [ABSTRACT FROM AUTHOR]

The study used publicly available data on post-traumatic stress disorder in a sample of the Australian population with a history of sexual abuse to demonstrate how this evidence can inform economic analyses. The 2007 Australian Mental Health Survey revealed that 8.3% of 993 adolescents experienced childhood sexual abuse, of which 40.2% were diagnosed with post-traumatic stress disorder. Post-traumatic stress disorder diagnosis corresponded to a significant loss of quality of life. Survival analysis was used to estimate the lifetime persistence of post-traumatic stress disorder symptoms. The average time between post-traumatic stress disorder onset and remission was 11.4 years. Results suggest that successful treatment of post-traumatic stress disorder will save 2.05 quality adjusted life years per child or adolescent with post-traumatic stress disorder. [ABSTRACT FROM AUTHOR]

Previous research has consistently documented high rates of tobacco smoking and substance use disorders among people with serious mental illness. However, limited studies have been conducted outside traditional clinical settings. In an attempt to address this shortfall and to better understand the needs of people accessing its services, a national community managed mental health service (Neami) examined the prevalence and impact of substance use among 489 consumers from across Australia. Results indicated extremely high rates of tobacco use, with 64.8% of participants identified as daily smokers. Approximately 86% of participants met abuse or dependence criteria for their caffeine use. In addition, 27.6% met criteria for an alcohol use disorder, whilst 28% met criteria for a cannabis use disorder. Overall rates of other illicit substance use were low. This study reinforces the need for routine alcohol and drug screening and assessment across all mental health settings, as well as appropriate support strategies that address high level smoking and caffeine intake. [ABSTRACT FROM PUBLISHER]

Given the range of needs and competencies among children whose parents have a mental illness, it is crucial that such children are identified and provided with appropriate support. The first aim of this Australian national study was to ascertain how and by whom children already in a support program were identified for program selection. The second aim was to identify the manner in which children were assessed prior to program entry. In this study, 20 program coordinators, responsible for 19 intervention programs, were asked a series of questions related to referral and assessment practices. Audio transcripts from the interviews were content analysed, along with interrater reliability and member checks. Primarily, children were identified for program intervention from adult mental health agencies and schools. All coordinators cited parental mental illness as the main reason for referral. Coordinators relied on self-constructed questionnaires, referral information, or interviews with children and parents to ascertain children's suitability to programs, their individual needs, and to build rapport. It was found that coordinators did not totally subscribe to a “one size fits all” model of intervention, as a number of otherwise eligible children were excluded and some process refinements were made to programs. Actively listening to children and matching participants’ needs to program goals is strongly encouraged, prior to program entry. [ABSTRACT FROM PUBLISHER]