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Background: A priority area in the field of substance dependence treatment is reducing the rates of relapse. Previous research has demonstrated that telephone delivered continuing care interventions are both clinically and cost effective when delivered as a component of outpatient treatment. This protocol describes a NSW Health funded study that assesses the effectiveness of delivering a telephone delivered continuing care intervention for people leaving residential substance treatment in Australia. Methods/design: All participants will be attending residential alcohol and other drug treatment provided by The Salvation Army or We Help Ourselves. The study will be conducted as a randomised controlled trial, where participants will be randomised to one of three treatment arms. The treatment arms will be: (i) 12-session continuing care telephone intervention; (ii) 4-session continuing care telephone intervention, or (iii) continuing care plan only. Baseline assessment batteries and development of the participants' continuing care plan will be completed prior to participants being randomised to a treatment condition. Research staff blind to the treatment condition will complete follow-up assessments with participants at 3-months and 6-months after they have been discharged from their residential service. Discussion: This study will provide comprehensive data on the effect of delivering the continuing care intervention for people exiting residential alcohol and other drug treatment. If shown to be effective, this intervention can be disseminated to improve the rates of relapse among people leaving residential alcohol and other drug treatment.

2020 The Australian Psychological Society Objective: Accreditation guidelines for professional psychology training have shifted from specifying educational inputs to emphasising attainment of core competency outputs. However, attention to both inputs and outputs are needed. Clinical practicum logs represent a neglected source of information to help guide training program development. The present article describes the development and preliminary data from a purpose-built electronic web-based log application for recording practicum activities. Method: Participants were 76 university clinical psychology trainees who had completed at least 1,000 hr of practicum. Trainees recorded the time engaged in various practicum activities into the electronic log application. Results: Trainees recorded practicum hours across 74 different placements. Most (43%) of the 72,494 entries were for activities supporting direct client work such as preparation and case notes. Direct client contact (37%) and supervision (20%) were next most frequent. On average, each trainee saw 78 clients for individual work and the average number of contacts was 3.69. The most frequent primary problems treated were anxiety disorders (28%) and depressive disorders (16%). Treatment of substance use disorders was rare (2%) as was work with older adults (2.6%), despite high needs in communities. Conclusions: This descriptive study provides an example of an electronic log application and preliminary data from the application. The need to link such data to competency assessments is highlighted, as this will provide stronger evidence-based decision making regarding minimum training standards. Further, by allowing real-time monitoring of student progress, such applications can inform decisions about individual trainee's practicum progress and needs.

Background: Patient-centered care is strongly advocated as a key for improving the quality of healthcare. Research examining the impact of patient-centered care in healthcare has concluded that there are demonstrable albeit inconsistent relationships between patient experience, quality of care, and healthcare outcomes. Knowledge of the impact of patient-centered care in the treatment of substance use disorder is limited. The aim of this review was to assess relationships between indicators of patient-centered care (satisfaction and patient-reported experience measures) and patient outcomes (substance use, psychological wellbeing, and service use) among people attending treatment for substance use disorder. Methods: A systematic electronic literature search of a range of databases was conducted with variations of the search terms ‘patient-centered care’, ‘substance use disorders’, and residential or community specialist ‘treatment’. The populations, interventions and outcomes were summarized and described according to the PRISMA statement. Results: A total of 25 articles were identified, of which only five included a patient-centered indicator other than satisfaction. Indicators of patient-centered care showed a generally positive association with improved outcomes, particularly between satisfaction with treatment and substance use. Nonetheless, mixed and contradictory results were not uncommon, more so for psychological wellbeing outcomes. Conclusions: There were demonstrable relationships between patient-centered indicators and outcomes for people receiving treatment for substance use disorder. However, conclusions are limited due to underrepresentation of patient-reported experience measures. Further research in the area is needed involving comparisons of patient centered indicators with outcomes and use of patient-reported experience measures together with satisfaction.

Background: Patient-centered care is strongly advocated as a key for improving the quality of healthcare. Research examining the impact of patient-centered care in healthcare has concluded that there are demonstrable albeit inconsistent relationships between patient experience, quality of care, and healthcare outcomes. Knowledge of the impact of patient-centered care in the treatment of substance use disorder is limited. The aim of this review was to assess relationships between indicators of patient-centered care (satisfaction and patient-reported experience measures) and patient outcomes (substance use, psychological wellbeing, and service use) among people attending treatment for substance use disorder. Methods: A systematic electronic literature search of a range of databases was conducted with variations of the search terms ‘patient-centered care’, ‘substance use disorders’, and residential or community specialist ‘treatment’. The populations, interventions and outcomes were summarized and described according to the PRISMA statement. Results: A total of 25 articles were identified, of which only five included a patient-centered indicator other than satisfaction. Indicators of patient-centered care showed a generally positive association with improved outcomes, particularly between satisfaction with treatment and substance use. Nonetheless, mixed and contradictory results were not uncommon, more so for psychological wellbeing outcomes. Conclusions: There were demonstrable relationships between patient-centered indicators and outcomes for people receiving treatment for substance use disorder. However, conclusions are limited due to underrepresentation of patient-reported experience measures. Further research in the area is needed involving comparisons of patient centered indicators with outcomes and use of patient-reported experience measures together with satisfaction.

Previous research has reported on the benefits of mutual support groups. However, such groups do not routinely collect data on participant outcomes. Moreover, the effect of collecting outcomes measures on these groups is unknown. The objective of this mixed methods study was to elicit participant views on using a novel, purpose built digital platform for routine outcome monitoring (ROM) as a standard component of a mutual support group. SMART Recovery, or the Self-Management and Recovery Training program, is group-based and uses professional clinicians to facilitate discussion and foster mutual support for a range of addictive behaviours, alongside Cognitive Behavioural Therapy and Motivational Interviewing techniques. This paper reports on the qualitative component of this study and how participants perceive ROMs, and the potential shift to technological resources. Twenty semi-structured telephone interviews were conducted with participants from SMART Recovery groups across New South Wales, Australia. Participants discussed their use of mutual support within group meetings to manage their recovery, including: naming their goals in front of peers; learning from clinicians and group discussion; and developing reciprocal and caring relationships. They also described any previous experience with routine outcomes measures and how digital technologies might enhance or hinder group function. Participants valued mutual support groups and reported that digital technologies could be complementary to physical, weekly group meetings. They were also concerned that the introduction of technological resources might pose a threat to physical meetings, thereby risking their access to mutual support. Findings have implications for the implementation of ROM when delivered via digital mechanisms, and indicate threats and opportunities that warrant consideration for future initiatives.

Objective: SMART Recovery provides cognitive behavior therapy based mutual support groups for addictions. The aim of the present study was to explore the impact of cognitive behavior skill use and the influence of a person's social network on psychological distress.Method: Paper based surveys were mailed out to 121 SMART Recovery groups across Australia. A sample of 75 SMART Recovery group members participated. Measures of social network size and composition, psychological distress and cognitive behavior skill use were collected.Results: There are high rates of self-reported mental illness within SMART Recovery respondents. Use of behavioral skills and social network influence was significantly associated with level of psychological distress.Discussion: The current results indicate that engaging in behavioral activation and having a social network of non-drinking or non-using people is associated with lower levels of psychological distress. Given the high rates of self-reported comorbid mental illness in this population, it is important research continues to explore the role of specific cognitive behavioral therapy components and social networks on recovery within mutual support groups.

2019 Elsevier Ltd Background: To reduce smoking and improve other health behaviours of people living with severe mental illness, healthy lifestyle interventions have been recommended. One approach to improving the availability of these types of interventions is to utilise the mental health peer workforce. The current study aimed to evaluate the feasibility of peer-workers facilitating a telephone delivered healthy lifestyle intervention within community based mental health settings. The study also examined preliminary outcomes of the intervention. Methods: The study was conducted as a randomised controlled feasibility trial. In addition to treatment as usual, participants randomised to the Treatment Condition were offered BHC. This was an 8-session telephone delivered coaching intervention that encouraged participants to decrease their smoking, increase their intake of fruit and vegetables, and reduce their leisure screen time. Participants in the waitlist Control Condition continued to complete treatment as usual. All participants were engaged with Neami National, an Australian community mental health organisation. Peer-workers were also current employees of Neami National. Results: Forty-three participants were recruited. The average number of sessions completed by participants in the Treatment Condition was 5.7 (SD = 2.6; out of 8-sessions). Seventeen participants (77%) completed at least half of the sessions, and nine participants (40%) completed all eight sessions. Participant satisfaction was high, with all participants followed up rating the quality of the service they received as 'good' or 'excellent'. When compared to the Control Condition, people in the Treatment Condition demonstrated greater treatment effects on smoking and leisure screen time. There was only a negligible effect on servings of fruit and vegetable. Conclusions: Results were promising regarding the feasibility of peer-workers delivering BHC. Good retention rates and high consumer satisfact

Objective: SMART Recovery provides cognitive behavior therapy based mutual support groups for addictions. The aim of the present study was to explore the impact of cognitive behavior skill use and the influence of a person's social network on psychological distress.Method: Paper based surveys were mailed out to 121 SMART Recovery groups across Australia. A sample of 75 SMART Recovery group members participated. Measures of social network size and composition, psychological distress and cognitive behavior skill use were collected.Results: There are high rates of self-reported mental illness within SMART Recovery respondents. Use of behavioral skills and social network influence was significantly associated with level of psychological distress.Discussion: The current results indicate that engaging in behavioral activation and having a social network of non-drinking or non-using people is associated with lower levels of psychological distress. Given the high rates of self-reported comorbid mental illness in this population, it is important research continues to explore the role of specific cognitive behavioral therapy components and social networks on recovery within mutual support groups.

Previous research has reported on the benefits of mutual support groups. However, such groups do not routinely collect data on participant outcomes. Moreover, the effect of collecting outcomes measures on these groups is unknown. The objective of this mixed methods study was to elicit participant views on using a novel, purpose built digital platform for routine outcome monitoring (ROM) as a standard component of a mutual support group. SMART Recovery, or the Self-Management and Recovery Training program, is group-based and uses professional clinicians to facilitate discussion and foster mutual support for a range of addictive behaviours, alongside Cognitive Behavioural Therapy and Motivational Interviewing techniques. This paper reports on the qualitative component of this study and how participants perceive ROMs, and the potential shift to technological resources. Twenty semi-structured telephone interviews were conducted with participants from SMART Recovery groups across New South Wales, Australia. Participants discussed their use of mutual support within group meetings to manage their recovery, including: naming their goals in front of peers; learning from clinicians and group discussion; and developing reciprocal and caring relationships. They also described any previous experience with routine outcomes measures and how digital technologies might enhance or hinder group function. Participants valued mutual support groups and reported that digital technologies could be complementary to physical, weekly group meetings. They were also concerned that the introduction of technological resources might pose a threat to physical meetings, thereby risking their access to mutual support. Findings have implications for the implementation of ROM when delivered via digital mechanisms, and indicate threats and opportunities that warrant consideration for future initiatives.

Background: A priority area in the field of substance dependence treatment is reducing the rates of relapse. Previous research has demonstrated that telephone delivered continuing care interventions are both clinically and cost effective when delivered as a component of outpatient treatment. This protocol describes a NSW Health funded study that assesses the effectiveness of delivering a telephone delivered continuing care intervention for people leaving residential substance treatment in Australia. Methods/design: All participants will be attending residential alcohol and other drug treatment provided by The Salvation Army or We Help Ourselves. The study will be conducted as a randomised controlled trial, where participants will be randomised to one of three treatment arms. The treatment arms will be: (i) 12-session continuing care telephone intervention; (ii) 4-session continuing care telephone intervention, or (iii) continuing care plan only. Baseline assessment batteries and development of the participants' continuing care plan will be completed prior to participants being randomised to a treatment condition. Research staff blind to the treatment condition will complete follow-up assessments with participants at 3-months and 6-months after they have been discharged from their residential service. Discussion: This study will provide comprehensive data on the effect of delivering the continuing care intervention for people exiting residential alcohol and other drug treatment. If shown to be effective, this intervention can be disseminated to improve the rates of relapse among people leaving residential alcohol and other drug treatment.

The Author(s) 2020. This quasi-experimental study explores the effects of a narrative coaching board game intervention aimed at enhancing participants' sense of self-mastery as part of facilitating narrative identity reconstruction. Three mixed analyses of variance compared differences between clinical (n = 31) and non-clinical (n = 31) groups over time on a measure of mastery. There were no significant group-by-time interaction effects, but both groups demonstrated a statistically significant improvement in mastery over time. From a complex adaptive system perspective, changes may indicate adaptive growth in recovery. A serious board game may be a useful way of facilitating narrative identity reconstruction in recovery.

2020, 2020 Informa UK Limited, trading as Taylor & Francis Group. Mental health carers frequently report interpersonal difficulties in their caring relationship. This exploratory study aims to examine the interpersonal problems of mental health carers from the perspective of the interpersonal circumplex. A cross-sectional survey design was utilised with 147 participants. Mental health carers displayed higher mean interpersonal problems than a community sample, and descriptive proportions indicated 17.7% experienced interpersonal problems of significant difficulty. Shorter-term carers obtained higher scores on the Overly Accommodating domain, longer-term carers scored higher on the Vindictive/Self-centred domain. The care-receivers' mental health diagnosis was not associated with domains of interpersonal problems. Severity of mental health was associated with lower scores on the Overly Accommodating domain. There were no differences between being a parent or spouse carer. Results highlight the importance of understanding mental health carers' interpersonal profiles in order to guide treatment planning.

The Author(s) 2019. The issue of complex nonlinear change processes is one of the least understood aspects of recovery and one of the most difficult to apply in recovery-oriented health care. The purpose of this article is to explore the recovery stories of 17 mental health peer support workers to understand their narrative identity reconstruction in recovery using a complexity perspective. Using the Life Story Model of Identity (LSMI), a narrative thematic analysis of interviews suggests that self-mastery as part of personal agency is an important component of participants' narrative identity reconstruction. Self-mastery is particularly evident in redemptive story turning points (positive outcome follows negative experience). A complexity perspective suggests that participants realized their adaptive capacity in relation to self-mastery as part of recovery and that its use at story turning points critically influenced their recovery journey. Further exploring self-mastery as adaptive growth in narrative identity reconstruction appears to be a fruitful research direction.

2020 Australian Association of Family Therapy The evidence for efficacy of family-based approaches for psychological problems is extensive, although model-specific effects have not been established. However, implementation of family therapy approaches in tertiary mental health settings has been challenging due to factors such as negative staff attitudes and difficulties engaging families. Open Dialogue is an emerging network-based therapy that has a focus on genuine collaboration, flexibility, authenticity, and openness. This study describes the experiences and perspectives of clinicians, service users and families, following training in Open Dialogue, within a child and adolescent mental health service, and an adolescent inpatient unit in public mental health services. A total of 16 participants (11 clinicians and five service users and family members) took part in semi-structured interviews regarding their experiences with Open Dialogue. Interpretative phenomenological analysis was used to analyse interview transcripts. Four major themes were identified from interviews with clinicians: valuing responses from families, learning from families and privileging their expertise, hesitation about doing family therapy, and engaging with authenticity and flexibility. Three themes emerged from family interviews: hesitation about doing family therapy, valuing collaboration and openness, and opening space for more talk. These themes are relevant to challenges of family therapy in public mental health settings and future directions for implementation.

2020 Australasian Professional Society on Alcohol and other Drugs Issues: Despite the serious implications of loneliness on health and wellbeing, little is understood about this experience across people with substance use problems. This systematic review aimed to examine: (i) correlates and predictors of loneliness; (ii) theories underpinning loneliness; (iii) methods employed to measure loneliness; and (iv) loneliness interventions for people with substance use problems. Approach: Empirical sources were identified from key databases for all publications preceding February 2019. Overall, 41 studies met the eligibility criteria and were included in the review. Key Findings: Findings from this review suggest that loneliness is related to poor physical and mental health, substance use, the quality of relationships, stigma and perception of ill treatment by others. Although cognitive theories have proposed cognitive patterns underlying the onset and maintenance of loneliness, they had not been investigated in relation to measurement or intervention efforts. Just one loneliness measure (UCLA Loneliness Scale) is valid for use with this population. Finally, only a single loneliness intervention had been trialled and was not found to be efficacious in reducing loneliness for people with substance use problems. Implications: Understanding possible links between loneliness and substance use and how to alleviate loneliness is important for this population in terms of their wellbeing and recovery. Conclusion: Loneliness is prevalent and experienced as problematic among people with substance use problems. Future research should focus on employing longitudinal designs, using validated, multidimensional measures of loneliness and on developing and trialling loneliness interventions that meet the specific needs of people with substance use problems.

2020, 2020 Taylor & Francis Group, LLC. The objectives of the research are to describe the cultural activities offered in residential drug and alcohol rehabilitation for Aboriginal Australian men, along with client perceptions of the benefits associated with these cultural activities. Participants were 101 Australian Aboriginal male clients attending five residential drug and alcohol rehabilitation services in New South Wales. Participants completed a semi-structured interview and questionnaires that included the Growth and Empowerment Measure, the Aboriginal Cultural Engagement Survey, Clinical Global Impressions, and two questionnaires regarding cultural engagement while in treatment. Service users indicated that the most beneficial cultural activities offered within services were traditional art/craft, culturally-focused talks/meetings, and being on the land. Hierarchical multiple regression analysis indicated that cultural engagement in everyday life significantly predicted empowerment but not other measures of mental ill-health. The opinions of service users are presented, and recommendations are made regarding ways to enhance the effectiveness of cultural activities within drug and alcohol rehabilitation programs.

Health literacy comprises cognitive and social skills that enable people to understand health information and maintain good health. Research examining the health literacy of people living with mental illness is scarce. The aim of the present study was to identify distinct subgroups of health literacy in individuals attending mental health treatment and determine if profiles and health literacy levels differ from other populations accessing healthcare services and on health characteristics. Participants (N = 325) were attending Neami National Australia services. Participants completed the multidimensional Health Literacy Questionnaire. Latent profile analysis was conducted to identify health literacy profiles. Participants reported lowest health literacy scores in appraising health information, navigating the healthcare system, and finding good health information. Three health literacy profiles were identified; low (20.4%), moderate (61.3%), and high (18.3%). Compared to the other populations (i.e. private hospital patients, men with prostate cancer, older individuals with diabetes, general population, people attending substance dependence treatment), the current sample tended to have lower health literacy scores. The findings highlight the need to increase overall health literacy and consider an individualised approach to enhance specific health literacy domains.

Objective: It is common for people attending alcohol and other substance dependence treatment to present with multiple unhealthy lifestyle behaviors such as high rates of smoking, physical inactivity, and poor diet. Healthy lifestyle interventions are increasing in importance in the general population, but have been underexamined within alcohol and other substance use populations. The purpose of the current study was to pilot "Healthy Recovery," a group program that primarily aimed to help people attending alcohol or other substance dependence treatment to reduce or quit smoking. The program also encourages participants to increase physical activity and to eat more servings of fruit and vegetables. Methods: The current study was conducted as a non-randomized controlled pilot trial. All participants were attending residential substance dependence treatment provided by the Australian Salvation Army. In addition to treatment as usual, participants in the treatment condition completed Healthy Recovery (n = 50) and participants in the control group completed an online depression program (n = 27). The study examined the health outcomes of participants (i.e., smoking, physical activity, fruit and vegetable intake, and symptom distress) and the feasibility of running the group sessions within the residential facilities. Results: Within-treatment effects demonstrated medium to large positive effects for reductions in smoking and increases in physical activity, servings of fruit, and servings of vegetables for people completing Healthy Recovery. When compared to the control condition, there were medium effects in favor of the Healthy Recovery condition for reductions in smoking and increases in physical activity. There was a small effect for servings of fruit and no effect for servings of vegetables. Conclusions: Results from this study demonstrated that people attending residential substance dependence treatment are willing and capable of engaging in multiple health behavior

Health literacy comprises cognitive and social skills that enable people to understand health information and maintain good health. Research examining the health literacy of people living with mental illness is scarce. The aim of the present study was to identify distinct subgroups of health literacy in individuals attending mental health treatment and determine if profiles and health literacy levels differ from other populations accessing healthcare services and on health characteristics. Participants (N = 325) were attending Neami National Australia services. Participants completed the multidimensional Health Literacy Questionnaire. Latent profile analysis was conducted to identify health literacy profiles. Participants reported lowest health literacy scores in appraising health information, navigating the healthcare system, and finding good health information. Three health literacy profiles were identified; low (20.4%), moderate (61.3%), and high (18.3%). Compared to the other populations (i.e. private hospital patients, men with prostate cancer, older individuals with diabetes, general population, people attending substance dependence treatment), the current sample tended to have lower health literacy scores. The findings highlight the need to increase overall health literacy and consider an individualised approach to enhance specific health literacy domains.

© 2019 Dietitians Association of Australia Aim: Meaningful client-dietitian relationships are central to effective dietetic practice. The chronic disease management setting provides an opportunity to examine what is meaningful and how these relationships are constructed, because the dietitian and client generally have multiple interactions over an extended period of time. This study aimed to explore dietitians' perspectives of how they develop meaningful relationships with clients managing lifestyle-related chronic diseases. Methods: Study design and analysis were guided by Charmaz's constructivist grounded theory. Dietitians working in Australia with clients managing chronic diseases were recruited through initial, snowball and theoretical sampling. Online videoconference and telephone semi-structured interviews were conducted. Recorded interview transcripts were analysed using repeated reviews comprising initial, focused and theoretical coding and memoing. Results: Twenty-two dietitians were recruited. A conceptual model developed from the data showed the dietitian's role in developing the client-dietitian relationship is complex. Key elements were identified and described as ‘Sensing a Professional Chemistry’, and the dietitian's skills in ‘Balancing Professional and Social Relationships’ and ‘Managing Tension with Competing Influences’. Influences were categorised as relating to the client and dietitian as individuals (eg, their values), their support network and external contextual factors (eg, working with interpreters). Conclusion: Developing relationships with clients in the chronic disease context appears complex due to the dietitian's role of managing multiple interrelated elements and influential factors simultaneously. To deepen understanding, research should explore clients' perspectives of relationship development and how knowledge of practitioner-client relationships in other disciplines may be utilised to enhance dietetic service delivery.

2019, 2019 Taylor & Francis Group, LLC. Objectives: Physical health conditions cause significant disability and mortality among people living with alcohol and other drug problems. There has been limited research on the prevalence of health problems among clinical samples of people with substance use disorders, particularly among those in residential treatment. Yet residential settings provide unique opportunity for responding to health needs. To better understand the health of people attending treatment for substance use disorders, this study conducted a file review to examine the prevalence of physical health problems as identified during routine residential care. Methods: A retrospective review of client files collected between 2013 and 2017 (N = 172) was completed at a residential treatment service in NSW, Australia. Data were extracted to examine the prevalence of physical health problems recorded at entry into treatment. Correlates of health problems were estimated using bivariate descriptive analyses and logistic regression. Results: The majority of clients in treatment for substance use had a comorbid physical health problem (80.7%). Musculoskeletal problems were the most frequently reported medical issue (38.6%). Odds for some physical health problems were related to client gender, age, and primary substance of concern. Male gender remained the strongest predictor of dental health problems when controlling for age and substance type (odds ratio [OR] = 3.60). Primary alcohol use remained the strongest predictor of nutritional deficiencies when controlling for client age (OR = 4.43). Among clients with a physical health problem and who had a treatment episode of at least 14 days (n = 110), just over half (55.5%) were referred to a health-related practitioner or service during their treatment episode. Conclusions: This study contributes to the literature by reporting on the incidence of physical health problems among people in residential treatment for substanc

2019 The Australian Psychological Society Objective: This study aimed to explore the experiences of supervisees who completed a metacommunication intervention in supervision. Methods: Forty-eight supervisees completed the supervisory intervention and gave post-intervention written feedback. Their responses were thematically analysed. Results: Overall, supervisees responded positively to the intervention, with high willingness to engage in metacommunication again in supervision. Thematic analysis of the reflective written responses completed post-intervention revealed a rich array of supervisee experiences of the metacommunication exercise. Supervisees spoke of anticipated/intended impacts on supervision and their therapy practice, including: greater depth of reflection, attending to parallel process, discussion of roles, increased closeness, improved openness, and increased confidence in metacommunication. In regard to challenges associated with the supervisory intervention, participants reflected on difficulties with timing, experiences of discomfort and concerns about potential negative reactions from the supervisor, and consideration of power dynamics in supervision. Conclusion: This study shows promising preliminary results of the acceptability and perceived impacts of an experiential intervention involving the use of metacommunication in supervision.

2019 The Author(s). Background: Over the past decade there has been increasing attention to implementing recovery-oriented approaches within mental health service practice and enhancing fidelity to such approaches. However, as is often the case with evidence-based practices, less attention has been paid to the sustainability of recovery-oriented approaches over time. This study sought to investigate whether fidelity to a recovery-oriented practice framework - the Collaborative Recovery Model could be sustained over time. Method: The study setting was an Australian community managed mental health organisation. A file audit of consumer support plans was undertaken using the Goal and Action Plan Instrument for Quality audit tool (GAP-IQ). The audit tool assessed 17 areas for quality. Consumers (n = 116) from a large community managed mental health organisation participated in the study. Sustained fidelity to the Collaborative Recovery Model (CRM) was determined by comparing results from the file audit to a similar audit conducted 3 years earlier. Results: The file audit revealed a significant increase in fidelity to CRM practices between 2011 and 2014. Fidelity to individual audit items that comprise the GAP-IQ was also found to significantly increase across 16 of the 17 GAP-IQ audit items, with the exception of the 'Action Plan Review' audit item. Conclusions: A comparison of file audit data across different time points within the same setting can provide useful feedback about whether or not a practice is being sustained over time. Although fidelity increased overtime the study design does not allow conclusions that training and coaching practices implemented by the organisation were responsible.

2019, 2019 Association for Applied Sport Psychology. Adolescents are at increased risk of mental illness and prefer to seek help from informal supports. By increasing knowledge and skills, peers may act as gatekeepers to mental health services. The aim of the current study was to assess the effects of a brief sports-based mental health literacy program to increase competencies and intentions to both provide and seek help for mental health problems among adolescent male sports participants. A cluster-randomized controlled trial was conducted with measures taken at 3 time points: baseline (2 weeks prior to intervention), immediately postintervention, and at 1-month follow-up. Adolescents were randomized to either the intervention group (n = 47) or a waitlist control group (n = 55) at a team level (nteams = 9). Participants were 102 male adolescents 12-18 years of age (M = 14.30, SD = 1.75) from a community football club in New South Wales, Australia. A 45-min Help Out a Mate (HOAM) workshop was delivered around a usual team practice session. Compared to the waitlist control, participants in the HOAM condition reported significant increases in knowledge of signs and symptoms of mental illness, intentions to provide help to a friend who may be experiencing a mental health problem, and attitudes that promote problem recognition and help-seeking. There were no between-group differences in confidence to provide help, personal help-seeking intentions, and psychological distress. The results suggest that a brief intervention can be effective at improving the mental health literacy of young men when delivered within a sports context. Lay summary: Compared to a waitlist control, the Help Out a Mate group showed improvements in mental health literacy for depression and anxiety and intentions to provide help along with sustained improvements in attitudes that promote help-seeking and reduce stigma. Personal help-seeking intentions did not change as a result of the program.

2019 Wiley Periodicals, Inc. Objective(s): Psychologists' experiences of an online training tool in metacommunication as well as an in-supervisory metacommunication exercise were examined. Method: A total of 101 participants completed a training tool in metacommunication and changes in self-efficacy (SE) to use metacommunication with clients, the proportion of metacommunication used in vignette-responses, and their willingness to use metacommunication in supervision were assessed pre- and posttraining and at 6-week follow-up. A total of 48 participants elected to undertake the in-supervision exercise. Results: Participants reported significantly higher willingness and self-efficacy after completing the online training. They also showed a higher proportion of metacommunicative statements in their posttraining vignette responses compared with pretraining. The increase in willingness was retained at 6-week follow-up. There was an increase in self-efficacy from pre- to postonline-training, and this increased at follow-up. Conclusions: This opens the door to better developing metacommunication skills in supervisees through both online training and the metacommunication supervisory exercise. Areas for continued research are outlined.

Objective: This review explored psychological responses and coping among loved ones left behind when a person is missing. Method: A systematic search identified 42 studies that reported data gathered among people with a missing loved one regarding psychological symptoms and/or coping strategies. Studies were arranged according to context of disappearance: forced (a result of war/conflict, abduction, forced separation) or unclear (reason unknown)/unspecified circumstances. Results: The most consistent findings for psychological symptoms were reports of depression, anxiety, posttraumatic stress, and prolonged grief reactions. When the disappearance was unclear/unspecified, people more often reported use of cognitive avoidance and continuing a bond as coping strategies. When the disappearance was forced, people more often reported use of informal support seeking. Conclusions: Further research is warranted to clarify (a) the generalizability of findings to those left behind under circumstances where the ambiguity may be greater and (b) the acceptability of various targeted psychological interventions.

Objective: The purpose of this paper is to construct a conceptual framework for investigating the reconstruction of narrative identity in mental health recovery from a complexity perspective. This conceptual framework provides the foundation for developing a health boardgame to facilitate narrative identity reconstruction. Methods: A selective integrative review of the theoretical and empirical literature relevant to narrative identity reconstruction in recovery was conducted. Sources included books, dissertations, internet resources, and professional journals. Findings: The reviewed material provides a conceptual framework that offers an enriched understanding of narrative identity reconstruction in recovery as a process of adaptive growth. It identifies the Hero's Journey, the life story model of identity (LSMI), and intentional change theory (ITC) as particularly relevant in informing strategies for narrative identity reconstruction. The conceptual framework can be operationalized in a narrative coaching treatment approach using a boardgame. Conclusion and Implications for Practice: In practice, mental health professionals could use the narrative coaching boardgame to facilitate people's adaptive change with a focus on building skills to reconstruct their preferred narrative identity and foster hope. Future research should explore what aspects of narrative identity and non-linear dynamic processes of change are most important in people's recovery narratives and in particular these processes can be assessed in response to the use of the boardgame.

The relationship between mental well-being and distress in young people is unclear but important for both theoretical and practical reasons. This study tests these relationships using both dimensional and categorical measures of mental well-being and distress. Two thousand and eighty-two Australians' (16-25 years) completed an online survey. A subsample (n = 389) completed diagnostic telephone interviews to identify 12-month DSM-IV mood, anxiety and substance use disorders. Five competing models of the relationship between mental well-being and distress were compared. Only the bifactor model fit the data, indicating both mental well-being and distress are important subcomponents of a young person's overall level of mental health. Over 90% of young people had flourishing or moderate well-being and only 6% were languishing. Those with past year mental disorders were only 15% less likely to be flourishing and 4% more likely to be languishing. These findings highlight the well-being potential of young people living with and without mental disorders.

Objective: It is common for people attending alcohol and other substance dependence treatment to present with multiple unhealthy lifestyle behaviors such as high rates of smoking, physical inactivity, and poor diet. Healthy lifestyle interventions are increasing in importance in the general population, but have been underexamined within alcohol and other substance use populations. The purpose of the current study was to pilot "Healthy Recovery," a group program that primarily aimed to help people attending alcohol or other substance dependence treatment to reduce or quit smoking. The program also encourages participants to increase physical activity and to eat more servings of fruit and vegetables. Methods: The current study was conducted as a non-randomized controlled pilot trial. All participants were attending residential substance dependence treatment provided by the Australian Salvation Army. In addition to treatment as usual, participants in the treatment condition completed Healthy Recovery (n = 50) and participants in the control group completed an online depression program (n = 27). The study examined the health outcomes of participants (i.e., smoking, physical activity, fruit and vegetable intake, and symptom distress) and the feasibility of running the group sessions within the residential facilities. Results: Within-treatment effects demonstrated medium to large positive effects for reductions in smoking and increases in physical activity, servings of fruit, and servings of vegetables for people completing Healthy Recovery. When compared to the control condition, there were medium effects in favor of the Healthy Recovery condition for reductions in smoking and increases in physical activity. There was a small effect for servings of fruit and no effect for servings of vegetables. Conclusions: Results from this study demonstrated that people attending residential substance dependence treatment are willing and capable of engaging in multiple health behavior

Adolescents experience high rates of mental health problems but are reluctant to seek professional help. Parents play an integral role in the help seeking process for their adolescent children. Parental authoritativeness and support have been identified as contributing to better mental health outcomes and a reduction in help seeking barriers in their children. The current study examined the influence of parental authoritativeness and support on help seeking intentions and behaviors in 1582 students (49% female) in 17 schools (mean age = 17.7, range 16-18). All data was available for 1032 participants across two time points collected one year apart. Concurrent indices of positive parenting were associated with greater help seeking intentions from professional sources, even when gender and psychological distress were controlled. Parental authoritativeness and parental support did not predict actual help seeking assessed one year later. The study highlights the potential role of parents in influencing help seeking and suggests further research is needed on other parent variables and the social antecedents to help-seeking.

Purpose: The purpose of this paper is to examine how a peer mentoring relationship may support provisional psychologists engaged in postgraduate education in Australia. The theoretical lens for this study draws from the real relationship framework and significant events literature. Design/methodology/approach: Quantitative and qualitative data were obtained via a web survey from a sample of 23 mentors and 41 mentees. Participants had engaged in a one-year peer mentoring program on a volunteer basis. The survey contained measures of functions of mentoring, perceived genuineness and realism in the relationship, and overall satisfaction with peer mentoring. Participants also provided accounts of helpful events, hindering events and open feedback. Findings: Perceived satisfaction was significantly correlated with greater genuineness and realism in the relationship. Satisfaction was associated with psychosocial and clinical functions of mentoring for both mentors and mentees, and career functions for mentees only. Qualitative findings indicated that the most helpful events included psychosocial support, mutual understanding and skill development. The most frequent hindering events were logistics/time, lack of structure and mentor technique/activity. Practical implications: Peer mentors show great promise for supporting provisional psychologists. Recommendations for higher education providers include providing peer mentors with guidance regarding the importance of psychosocial support, clinical skill development and creating genuine and real relationships. Peer mentor training would also benefit from the inclusion of career development strategies and psychoeducation on transference. Originality/value: This study is the first to apply the real relationship framework and significant events analysis to the psychology peer mentoring context.

Adolescents experience high rates of mental health problems but are reluctant to seek professional help. Parents play an integral role in the help seeking process for their adolescent children. Parental authoritativeness and support have been identified as contributing to better mental health outcomes and a reduction in help seeking barriers in their children. The current study examined the influence of parental authoritativeness and support on help seeking intentions and behaviors in 1582 students (49% female) in 17 schools (mean age = 17.7, range 16-18). All data was available for 1032 participants across two time points collected one year apart. Concurrent indices of positive parenting were associated with greater help seeking intentions from professional sources, even when gender and psychological distress were controlled. Parental authoritativeness and parental support did not predict actual help seeking assessed one year later. The study highlights the potential role of parents in influencing help seeking and suggests further research is needed on other parent variables and the social antecedents to help-seeking.

Objectives: Formative evaluation is critical in maximising the implementation strategies and processes of interventions. It is also critical to both providing contextual explanations for and maximising the success of such interventions. The purpose of this study was to undertake a comprehensive formative evaluation of the implementation process of a multi-component, sports-based mental health program for adolescent males ("Ahead of the Game"). Methods: Primary outcomes included program reach, dose, fidelity and cost during initial piloting and two distinct implementation phases. The iterative formative evaluation process provided opportunities to adapt the program and its implementation strategy to optimise reach, dose and fidelity relative to implementation cost. Results: Formative evaluation data showed that the program failed to achieve optimal reach in the initial pilot phase (Phase I), with low doses of the program received by stakeholders, and moderate fidelity. Bottom up implementation strategies improved dose and club ownership during Phase II but resulted in high costs and lower fidelity and was associated with implementation staff retention and management issues. Phase III with more streamlined staffing and club integrated implementation resulted in high reach, dose, fidelity and club ownership and an associated reduction in implementation cost per participant. Conclusion: Formative evaluation succeeded in maximising the Ahead of the Game program engagement over three distinct phases. Results are salient for informing cost-effective implementation strategies for sports-based health promotion.

Undertaking a caregiving role at end of life can have enduring psychological consequences for carers, including poor adjustment in bereavement. Acceptance and commitment therapy–based interventions have demonstrated effectiveness in helping people cope with a range of life challenges. This article presents the protocol of a feasibility randomised controlled trial of an acceptance and commitment therapy selfhelp intervention for psychological distress and grief in carers of patients in palliative care. We will assess feasibility and acceptability of the trial procedures and intervention as well as preliminary effectiveness of the intervention on carer well-being outcomes.

This study aimed to explore clinical supervisors' perspectives on the components of the relationship competency. The constituents of relational competence have been articulated by expert committees, and the present study sought to add to this literature through understanding these competencies from Australian field supervisors' perspectives. In the present study, supervisors were asked to provide relational competence definitions and specific behavioral markers they use in assessing supervisee competence within their supervision practice. They were then asked to describe the developmental trajectory of relational competence among their supervisees, ranging from novice to intermediate and expert stages. Similarities and notable differences between previous expert panels and the current sample were observed in comparing data on the development of relational competence. A unique aspect of this study is that compared with previous expert panels, the current sample greatly emphasized the ability to understand relational data in the moment and to speak directly about the therapeutic relationship with the client. The results of this study offer useful, in-depth descriptions of supervisee progress in the development of relational competence. Consideration of competence markers within a sequential trajectory offers a useful map for the ongoing development and evaluation of these abilities.

Objectives: Loneliness is a distressing emotional experience that is likely to be prevalent among people accessing treatment for substance dependence problems. The first aim of the current study was to report on the validity of the Social and Emotional Loneliness Scale for Adults-Short Version (SELSA-S), a multidimensional measure of loneliness, for use in substance-dependent treatment populations. In order to further the understanding of loneliness among this population, loneliness was examined in relation to demographic, physical, and mental health variables. Methods: Participants were attending Australian residential substance dependence treatment services provided by two nongovernmental organizations (The Salvation Army and We Help Ourselves). Participants completed cross-sectional surveys (N = 316) consisting of measures of demographics, substance use, loneliness, and physical and mental health. Results: Confirmatory factor analysis revealed high factor loadings and a moderate degree of concurrent and discriminant validity and internal consistency for the SELSA-S; however, model fit indices did not meet prespecified cutoff criteria. Loneliness was deemed to be a serious problem for 69% of respondents, and 79% reported feeling lonely at least once per month. Conclusions: Findings of this study suggest the need for further research into the validity of the SELSA-S for use with substance-dependent populations. In addition, it may be beneficial to test a range of loneliness measures in order to determine whether other measures of loneliness may be more favorable for use across this population.

Objective: Nicotine replacement therapy (NRT) is recommended as a frontline smoking cessation tool for people attending mental health and substance dependence treatment services. Previous research suggests that NRT is underutilized in these settings. To improve the use of NRT among people attending residential treatment for substance use disorders, it is important that the factors influencing smokers' decisions to use NRT are understood. The study aimed to examine (1) smoking cessation strategies used by participants in previous quit attempts, (2) participants' attitudes toward NRT (i.e., safety concerns and perceived efficacy), and (3) the predictors of participants' intention to use NRT to support future quit attempts. Methods: Participants completed a cross-sectional survey that examined their smoking behaviors, previous experiences using smoking cessation strategies, attitudes and beliefs regarding NRT, and intention to use NRT as part of future quit attempts (N = 218). All participants were attending residential treatment for substance use disorders provided by We Help Ourselves, a large provider of specialist alcohol and other drug treatment in Australia. Results: The majority of respondents (98%) reported that they had smoked regularly in their lifetime, and 89% were current smokers. Forty-five percent of the current smokers reported that they had previously used NRT to support a quit attempt, with 54% reporting that they intended to use NRT to support a future quit attempt. Intentions to use NRT were not related to the participants' mental health status or the participants' perceptions regarding the safety or potential drawbacks associated with using NRT. However, participants were more likely to report that they would use NRT to support future quit attempts if they were female, had previously used NRT, and perceived NRT to be effective. Conclusions: Improving the use of evidence-based smoking cessation strategies within substance use treatment continues to

Background Consumer feedback identifies a new challenge in the treatment of borderline personality disorder (BPD) is to address the discrepancy between clinical treatment targets and the more personally meaningful goals people are seeking in treatment. This highlights the need to increase clarification of people’s values and link these to therapy goals. The current study explores ways in which individuals with BPD identify with values across key life domains. Methods At initial assessment 106 consumer participants attending an outpatient clinic for the treatment of BPD completed the Personal Values Questionnaire by Blackledge and colleagues. This 90-item measure asks participants to respond to different value appraisals such as importance, commitment, desire to improve, success and, motivation across nine life domains. These included: relationships, health & wellbeing, education & personal development, work & career, spirituality, recreation & leisure, and community involvement. Results A consistent pattern of value appraisals was found across all life domains. Specifically, life domains were endorsed as highly important but participants reported significantly lower levels of value commitment, desire to improve and success. Successful value pursuit also related differentially to value motivations (internal vs. external) depending on the particular life domain. Relationships with family, friends and romantic partners, as well as health & wellbeing were most important compared to other life domains. Conclusions The findings suggest that people with BPD identify with values and prioritise different life domains in terms of importance. Our results show discrepancies between higher importance and lower commitment, desire to improve and success at living in line with what is valued. Identification of such discrepancies provides opportunities to more effectively support consumers with BPD to prioritise goals that are consistent with valued domains. These findings offer new

Background: Routine outcome monitoring (ROM) is an important component of service provision and qualitity assurance procedures. However, a major logistical and financial challenge for organizations is successfully following up participants once they have left residential alcohol and other drug treatment. The aim of the current study was to assess the impact and effectiveness of an "early" follow-up contact and brief interview on subsequent 3-month ROM follow-up success. Methods: Participants were 800 clients attending specialist residential alcohol and other drug treatment provided by The Salvation Army. As part of routine outcome assessment procedures, all people attending these programs are asked to complete a 3-month follow-up assessment. Participants were randomly allocated either to the early contact condition (i.e., "early" 2-week follow-up contact prior to the 3-month follow-up assessment) or to the control condition (i.e., no "early" 2-week follow-up prior to the 3-month follow-up assessment). The primary outcomes were the proportion of participants who were followed up and surveyed at 3 months. Results: There were significantly higher follow-up rates at 3 months post discharge for participants in the early contact group (55.6%) compared with the control condition (46.1%). Although there were higher rates of 3-month follow-up for participants in the early contact group, rates of successful survey completion were not significantly different between the 2 groups. Conclusions: Including an early 2-week telephone call prior to the 3-month assessment increased the number of participants we were able to follow up at 3 months post discharge but did not improve the rate of survey participation at 3 months. The additional costs associated with this activity and the modest increase in follow-up rates need to be considered prior to organizations investing in these follow-up enhancement activities.

Worldwide, more than 1 million people take their life every year. In Australia, 3027 deaths by suicide were reported in 2015, the highest rate reported in 10 years. There is an alarming disparity between suicide rates across Indigenous and non-Indigenous people documented in many countries around the world. Between 2001 and 2010, the overall suicide rate for Indigenous Australians was twice that for non-Indigenous individuals. Compared to the general population, those with substance abuse disorders are almost 10 times more likely to die from suicide. In alcohol and other drug treatment (AOD) services, one in seven (15%) clients are Indigenous, despite representing only 3% of the entire Australian population. In order to better understand the current status of research in the field, a systematic review was completed aimed at identifying studies that reported the prevalence of suicidal behaviour in substance abuse treatment settings, with the additional aim of comparing rates and risk profiles across Indigenous and non-Indigenous Australians. We identified 20 studies reporting rates of suicidal behaviour in individuals who have attended AOD treatment. Rates of suicidal ideation, suicide attempts and death by suicide were reported across multiple studies. Eleven studies reported rates of lifetime suicide attempts with prevalence rates ranging from 17.1 to 47% (median = 30.2%; mean = 29.2%). No studies were identified reporting Australian Indigenous rates of suicidal behaviour in substance abuse treatment settings, highlighting a significant gap in the literature.

Objective: This study examined the use of metacommunication in supervision from supervisees' perspectives. Method: A total of 129 supervisees completed the Metacommunication in Supervision Questionnaire-MSQ, a measure devised for the purpose of this study to explore the frequency and willingness to use various forms of metacommunication in clinical supervision. Measures of the nature of the supervisory relationship (also from the supervisee's perspective) were taken to explore whether a relationship exists between the nature of supervision and supervisees' perspectives on the use of metacommunication. Results: There was general concordance between supervisee ratings of their own willingness and their perception of their supervisor's willingness to use various forms of metacommunication in supervision. There were significant differences in the reported frequency with which the different types of metacommunication are actually used. A factor analysis elicited a two-factor structure underlying the MSQ and significant correlations with measures of the nature of the supervision relationship were observed. It appears that metacommunication around difficult or uncomfortable feelings in the supervisory relationship occurs less often than other components of metacommunication. Conclusion: Future research needs to further validate the MSQ and assess whether the frequency of metacommunication in the supervisory relationship is related to metacommunication in supervisees' psychotherapy with clients.

Objective: There is a high prevalence of complex psychological distress after a traumatic brain injury but limited evidence of effective interventions. We examined the feasibility of Acceptance and Commitment Therapy after a severe traumatic brain injury using the criteria, investigating a therapeutic effect, and reviewing the acceptability of measures, treatment protocol, and delivery method (in a dyad of two clients and a therapist). Method: Two male outpatients with severe traumatic brain injury and associated psychological distress jointly engaged in a seven session treatment program based on Acceptance and Commitment Therapy principles. Pre‐ and post‐treatment measures of mood, psychological flexibility, and participation were taken in addition to weekly measures. Results: The intervention showed a therapeutic effect with one participant, and appeared to be acceptable for both participants with regard to program content, measures, and delivery mode by in a dyad. One participant showed both significant clinical and reliable change across several outcome measures including measures of mood and psychological flexibility. The second participant did not show a reduction in psychological inflexibility, but did show a significant drop in negative affect. Significant changes pre‐ to post‐treatment for measures of participation were not indicated. Qualitatively, both participants engaged in committed action set in accordance with their values. Conclusions: This study suggests that Acceptance and Commitment Therapy may be feasible to be delivered in a dyad with individuals who have a severe traumatic brain injury. A further test of its potential efficacy in a phase II clinical trial is recommended.

Aim: The psychological construct of 'therapeutic alliance' can be used to better understand the effectiveness of consultations, particularly goal setting for weight management. We analysed audio-recorded health coaching sessions during a weight loss trial to explore relationships between therapeutic alliance and various contextual factors. Methods: Audio recordings of 50 health coaching sessions were analysed. After assessing fidelity to the protocol, therapeutic alliance was measured using an adapted Working Alliance Inventory Observer-rated Short Version (WAI-O-S), and examined by (i) identifying relationships between contextual factors and WAI-O-S scores (Spearman's coefficients); (ii) testing the impact of preparatory exercises and body mass index on WAI-O-S scores (one-way analysis of variance and least-squared differences tests) and (iii) comparing differences in WAI-O-S scores based on relationship status, gender and follow-up session completion (independent samples t-tests). Results: Fidelity was high (mean 88%). WAI-O-S total scores ranged from 55 to 70 (out of 84). Session duration was significantly correlated with WAI-O-S component of 'Bond' (r=0.42, P=0.002). Those who completed preparatory exercises had significantly higher total WAI-O-S scores, 'Goal' and 'Task' scores. Participants who completed the follow-up session scored significantly higher for 'Goal' compared to no follow-up. Conclusions: Spending more time in a session appears related to increased bonding, a key component of therapeutic alliance. Preparatory work may help build therapeutic alliance and agreement on goals appears to influence follow-up completion. These exploratory findings provide directions for research addressing the professional relationship in dietetic consultations for weight loss.

Substance-abusing fathers have reported parenting difficulties and there is a need for interventions that address these concerns and support these men. The present study conducted a feasibility trial of the Black Box Parenting Program for fathers in residential substance abuse treatment settings. The study had a mixed methods design that assessed for demand, implementation, preliminary efficacy, and acceptability. Measures included pre- and post-questionnaires on parenting self-efficacy and satisfaction, perceived closeness in the parent-child relationship, feelings of guilt and engagement, and satisfaction with treatment. In addition, semi-structured interviews were conducted with participants post-treatment. Across four groups, the 19 fathers successfully completed the program. Following the intervention, there was a significant decrease in feelings of guilt and a strong motivation to continue to seek help with parenting. Parental self-efficacy and perceived closeness in the parent-child relationship did not significantly improve from pre to post-treatment. Qualitative data indicate that fathers were very satisfied with the program. Satisfaction with treatment was strongly related to parental self-efficacy. Systemic barriers prevented delivery of the program at some treatment sites and parts of the program could not be implemented at multiple sites. Overall, the program shows promise in being able to reduce the barriers to help-seeking such as guilt and poor retention. However, it requires the right service structure to achieve successful implementation.

Objectives: Limited studies have examined the utility of short message service (SMS) for outcome data collection, and none have examined its feasibility within a realistic alcohol and other drug (AoD) treatment environment. The objective of this study was to investigate SMS outcome data collection with limited resources within an Australian residential AoD treatment setting. Methods: A total of 153 clients engaging in residential AoD treatment completed the study; 137 completed feasibility surveys and 19 residents completed a 16-week SMS trial utilizing an automated web-based application, which sent 4 single-items by SMS each week. Feasibility was evaluated by willingness ratings, reasons for nonengagement, proportion of consenting participants, response rates, cost and ease of implementation. The validity of single-item measures was assessed using correlational analyses. Results: Totally, 64.6% of participants were unwilling to engage in SMS monitoring, with the main reasons for not engaging being cost and disinterest in research. Twelve percent of participants engaged in the SMS trial, with 90.5% providing at least 1 SMS response. Although initial responses took up to 6 hours on average, subsequent items were completed within 1 to 5 minutes. Conclusions: In its present form, this method of data collection was not feasible within these AoD residential services. Greater resources are likely required to improve the utility and acceptability of this method.

Background: Despite advances in our understanding of what mental health systems and services can do to enhance recovery and wellbeing outcomes for people seeking support, there is limited evidence demonstrating that this body of work has translated successfully into mental health service practice. The Collaborative Recovery Model (CRM) is a practice framework that has been designed to support application of recovery and wellbeing oriented principles and practices within mental health service delivery. The aims of this study were to assess consumer and staff perceptions of implementation frequency during service engagement and the value of this approach for assisting recovery within a setting where the CRM approach had been adopted. Methods: The setting was a large Australian community managed mental health organisation. The study involved a cross-sectional analysis of consumer (n = 116) and staff practitioner (n = 62) perspectives. A series of paired sample t-tests assessed for differences between consumer and staff perceptions of the: (i) importance of key practice elements for assisting recovery, and the (ii) frequency that key practice elements are utilised during engagement sessions. Spearman's r correlational analysis explored associations between importance, frequency and helpfulness of sessions. Results: Key practice elements of the model were applied during service interactions at a high level and perceived by the majority of consumers and staff participants as being important or very important for assisting recovery. Significant moderate correlations were found between the extent that practice elements were valued and the level at which they were applied. Higher levels of implementation of CRM practices were associated with higher ratings of perceived session helpfulness. The strongest association was between 'encouragement to set tasks to complete between support visits' and perceived helpfulness. Conclusions: Consumer and staff responses revealed that the

The term ‘mental health carer’ refers to any person who voluntarily provides ongoing care and assistance to another person because of mental health issues (Carers Recognition Act, 2010).

The Author(s) 2018. Weight stigma is related to lower levels of motivation to exercise in overweight and obesity. This study explored the nature of the relationship between stigma, motivation to exercise and physical activity while accounting for gender differences. Participants were 439 adults with overweight and obesity (mean body mass index = 32.18 kg/m2, standard deviation = 4.09 kg/m2). Females reported significantly more frequent stigma experiences than males. Mediation models found a conditional direct effect of weight stigma for males, with higher frequency of stigma experiences related to higher levels of walking and vigorous physical activity. A conditional indirect effect was found for females for walking, moderate and vigorous levels of physical activity, with higher weight stigma related to lower autonomous motivation, and lower levels of physical activity. Findings suggest that males and females are affected differently by weight-stigma experiences.

2018 Elsevier Inc. Quality of Life (QOL) is increasingly being recognised as an important indicator of recovery from substance use treatment. The current study aimed to determine if there are distinct subclasses of QOL among a broad range of people attending specialist non-government alcohol and other drug treatment services, and how QOL might be associated with substance use, mental health, treatment and demographic characteristics of these individuals. The sample included 9958 individuals attending specialist non-government treatment for alcohol or other substance use in New South Wales, Australia. Cross sectional data on quality of life, drug use, treatment variables, psychological distress and substance dependence severity was collected. Latent class analysis was conducted to identify quality of life classes within the sample. Regression analyses were then performed to identify which individual, treatment and health outcomes were associated with these classes. Three distinct quality of life classes were identified, and termed low (n = 3048), moderate (n = 4211) and high quality of life (n = 2699). Classes differed across individual characteristics, substance use and psychological distress. As hypothesised, greater substance use and higher distress was evident in the lowest quality of life class. Quality of life is an important measure of an individuals' level of functioning during recovery from substance use. The identification of subgroups of individuals with substance use disorders based on their quality of life classes may help guide interventions to improve their overall global functioning and treatment outcomes.

2018 Wiley Periodicals, Inc. Objective: This research aimed to describe the developmental trajectories of clinical psychology trainees across competency domains over multiple placements. Method: Competency reviews of 252 trainees were completed at mid-placement and end-placement for up to four consecutive placements by 143 field supervisors. Competency was measured across multiple domains using the Clinical Psychology Practicum Competencies Rating Scale. Results: There was an overall ascending stepped pattern occurring across all competency domains from early to late placements. The starting point of competency ratings varied across domains with the largest discrepancy between Response to supervision (highest) and Intervention competencies (lowest). There were significant increases from mid-placement to end-placement for all competencies within each of the four placements. There were few significant decreases in competency between different placements and these were largely restricted to the transition from placement one to placement two. Conclusions: This research has the potential to be used as a benchmark to indicate expected levels of competency attainment for trainees across their training, allowing for early identification of difficulties and more targeted remediation plans.