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Objectives. To examine: 1) whether a single brief pre-clinic educational session improved the wellbeing and quality of life of individuals entering the wait-list for a tertiary chronic pain (CP) service; and 2) the impact of waiting for services on these outcomes. Methods. Participants were 346 adults, with basic English skills and non-urgent triage codes, who were recruited on referral to a tertiary Australian metropolitan CP unit. Participants were randomized across two conditions: "treatment as usual" (normal wait-list) and "experimental" (normal wait-list plus a 3-hour CP educational session). The educational session encouraged self-management and life engagement despite pain. Multiple outcomes (pain acceptance, pain-related interference, psychological distress, health care utilization [frequency, types], quality of life, health knowledge/beliefs), as well as pain severity and symptom exaggeration, were assessed at intake and again at 2 weeks and 6 months post-educational session (or equivalent for the wait-list group). Results. Satisfaction with the educational session was moderate-to-high, but attendance was not associated with improved outcomes. At 2 weeks, all study participants reported significant improvements in pain acceptance (willingness, overall acceptance), health care utilization (frequency) and quality of life (physical), which were maintained/ enhanced at 6 months. Use of psychological and physical therapies increased significantly by 6 months. There was no functional deterioration while wait-listed. Conclusions. Attending a brief pre-clinic education session did not improve function. There was no deterioration in wait-listed participants who agreed to be involved in research and who completed study measures at 2 and 6 months, but referral was associated with short-term functional improvements. This is the first study to link positive change with referral to, rather than treatment by, a tertiary CP service. [ABSTRACT FROM AUTHOR]

This paper reports on leadership program participants' experience of, and readiness for, stage transition (when one adult developmental stage gives way to another-as in Loevinger's (Ego development. Jossey-Bass, San Francisco, ) stage theory of consciousness, or ego, development). This appears to be the first study reporting the subjective experience of recent shifts in consciousness specifically within the context of leadership development programs. Using qualitative thematic methods to analyse survey responses from 84 individuals graduating from three Australian community leadership programs, we compared the accounts of those who had shifted a stage of consciousness ('shifters'), those who had changed but not transitioned ('movers'), and those who had not experienced change ('non-shifters'). We found support for theoretical predictions concerning the types of changes shifters noticed in themselves, consistent with the small but growing body of research showing positive associations between consciousness development and better leadership performance and organisational outcomes. The data additionally provide support for the conceptual framework of consciousness development articulated by Manners and Durkin (Dev Rev 20:475-513, . doi:), and contextual information which may help explain and predict the differing responses to leadership training of people with Myers Briggs Type Indicator Sensing and Intuition preferences-thus contributing to program selection and design. An important, if preliminary, finding was that when selecting candidates for developmental training programs, people who are experiencing significant work or other life changes and challenges should arguably be prioritised rather than sidelined: our shifters cited such challenges as influences promoting readiness for change. Although these conclusions are based on an analysis of survey data, they provide direction for future in-depth qualitative and quantitative research. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To document staffing (medical, nursing, allied health [AH], administrative) in Australian multidisciplinary persistent pain services and relate them to clinical activity levels. Methods Of the 68 adult outpatient persistent pain services approached (Dec'08-Jan'10), 45 agreed to participate, received over 100 referrals/year, and met the contemporaneous International Association for the Study of Pain criteria for Level 1 or 2 multidisciplinary services. Structured interviews with Clinical Directors collected quantitative data regarding staff resources (disciplines, amount), services provided, funding models, and activity levels. Results Compared with Level 2 clinics, Level 1 centers reported higher annual demand (referrals), clinical activity (patient numbers) and absolute numbers of medical, nursing and administrative staff, but comparable numbers of AH staff. When staffing was assessed against activity levels, medical and nursing resources were consistent across services, but Level 1 clinics had relatively fewer AH and administrative staff. Metropolitan and rural services reported comparable activity levels and discipline-specific staff ratios (except occupational therapy). The mean annual AH staffing for pain management group programs was 0.03 full-time equivalent staff per patient. Conclusions Reasonable consistency was demonstrated in the range and mix of most disciplines employed, suggesting they represented workable clinical structures. The greater number of medical and nursing staff within Level 1 clinics may indicate a lower multidisciplinary focus, but this needs further exploration. As the first multidisciplinary staffing data for persistent pain clinics, this provides critical information for designing and implementing clinical services. Mapping against clinical outcomes to demonstrate the impact of staffing patterns on safe and efficacious treatment delivery is required. [ABSTRACT FROM AUTHOR]

Background: Community-based rehabilitation can help to maximize function following acquired brain injury (ABI); however, data on treatment outcome is limited in quantity. Objective: To describe and evaluate client outcomes of an outpatient programme for adults with moderate-to-severe traumatic and non-traumatic ABI. Methods: Two phase design involving retrospective and longitudinal study of programme completers with ABI ( n = 47). Changes in functioning were measured with the Mayo-Portland Inventory (MPAI-4), administered pre- and immediately post-rehabilitation and at 3 years follow-up. Self-ratings were supplemented with MPAI-4 data from significant others ( n = 32) and staff ( n = 32). Results: Injured individuals and informants reported improved physical and psychosocial functioning immediately following the completion of community rehabilitation, with medium-to-large and significant treatment gains noted on the MPAI-4 ability, adjustment and participation sub-scales (Cohen's d range = 0.31-1.10). A deterioration in individuals' adjustment was further reported at follow-up, although this was based on limited data. Issues with longer-term rehabilitation service provision were additionally noted. Conclusions: The data support the need for continuity of care, including ongoing emotional support, to cater to the complex and dynamic needs of the ABI population. However, these results need to be considered in the context of a small sample size and quasi-experimental design. [ABSTRACT FROM AUTHOR]

We aimed to explore how refugee people utilised their coping resources and strategies to find meaning in their past and present experiences. Using an experience-centred narrative approach, we analysed the stories of 24 former refugees from two African countries resettled in South Australia. Data analysis revealed altruism and helping behaviour as a prominent and recurring theme of participants' narrated lives. This meta-theme encompassed four subthemes: (a) surviving war and exile, (b) adapting to Australian society, (c) reaching back home, and (d) meaning making through religious beliefs. Helping, cooperating, and sharing were entwined with participants' coping strategies and meaning making of experience. Participants' socio-historical, cultural, and religious context influenced the interpretations of their experiences. Taken together, our findings identified a counter narrative in refugee mental health research beyond trauma and psychopathology. Specifically, we have shown that when the refugee experience is also accompanied by situational contingencies such as receiving help and being called upon to help, together with evaluations such as empathy, identification with suffering, and gratitude, people can be motivated to help others. Future research is needed to explore how altruism and helping behaviour can promote healing from trauma, alleviate distress of separation, and ameliorate acculturation stress among diverse refugee populations. [ABSTRACT FROM AUTHOR]

This study highlights psychosocial needs of gynecological cancer survivors, contributing to evaluation of the Cancer Survivors Unmet Needs measure. Of the 45 participants, 28.9% reported clinical anxiety, 20.0% mild-to-severe depression, and 15.6% had probable posttraumatic stress disorder. Strength of unmet needs was associated with anxiety, depression, posttraumatic stress, poorer quality of life, younger age, and greater time since diagnosis. Linear regressions showed clinical measures, quality of life, optimism, and self-blaming coping style explained 56.4% of strength of unmet needs. Anxiety, functional well-being, posttraumatic stress, and emotional well-being accounted for 40.7% of variance in fear of recurrence, with emotional well-being the strongest predictor. [ABSTRACT FROM PUBLISHER]