Search

Accessible Summary: What is known about the subject?: Most nurses who work in mental health in Australia have completed a comprehensive nursing programme at a university. This training has been widely criticized and has not produced "job‐ready" graduates. Public inquiries into mental health services have highlighted the need for transformation of mental health services and concern about future nursing shortages. What the paper adds to existing knowledge?: This survey highlights what service users and supporters perceive are useful nursing skills and capabilities. The characteristics of helpful encounters with nurses are also described. What are the implications for practice?: Helpful nursing practice is aligned with traditional nursing values and theory, rather than the performance of specific tasks. Improving the retention of nurses to this specialty area of practice requires educational processes to enable nurses to enact values, develop their therapeutic potential and undertake facilitative and supportive practices which are helpful to service users. Introduction: Successive inquiries into mental health services in Australia have identified the need for major reform of services and proposed a return to direct‐entry nursing training. Aim/Question: To identify what service users, family and supporters have found helpful in their encounters with nurses in mental health settings. Method: A survey of 95 service users and supporters rated the importance of the capabilities and competencies of nurses. They also shared examples of helpful encounters with nurses which were subject to thematic analysis. Results: The most highly rated competencies were around demonstrating caring, empathy and understanding, and responding effectively in crisis situations. Helpful encounters involved enacted values, highly skilful interpersonal and psychotherapeutic engagement and practices that were facilitative and supportive. Discussion: The process and content of pre‐registration nursing training needs to refocus on the nurse meeting the needs of service users and supporters, rather than the instrumental needs of services today. Implications for Practice: Educational reform may be necessary but insufficient to address anticipated nursing workforce shortages. Policymakers and health service directors need to align services with mental health nursing values and promote practices aligned with what service users and their supporters report as helpful. [ABSTRACT FROM AUTHOR]

Alcohol and other drug (AOD) nurse practitioners have an advanced scope of practice that allows them to diagnose, prescribe pharmacological treatments for alcohol and other substance use disorders, and monitor physical and mental health. The Behaviour Change Wheel (BCW) is used to understand barriers and facilitators to implementation by applying three conditions of behaviour change (capability, opportunity, and motivation—the COM‐B framework). The aim of this paper is to describe the current AOD nurse practitioner workforce, and to explore barriers and facilitators to AOD nurse practitioner uptake in Australia. A mixed method approach was used in this study: a survey to determine the current state of the AOD nurse practitioner workforce (n = 41) and qualitative interviews with 14 participants to determine barriers to endorsement and ongoing work as a nurse practitioner. Interview transcripts were analysed using thematic analysis and mapped to the COM‐B framework. The AOD nurse practitioner is a highly specialized provider of holistic care to people who use alcohol and other drugs, with AOD nurse practitioners performing advanced roles such as prescribing and medication management. However, there are several barriers to the further uptake of AOD nurse practitioners in Australia, including varied organizational support, a lack of support for the higher study required to become a nurse practitioner and a lack of available positions. Arguably, nurse practitioners are key to addressing prescriber shortages inherent in AOD treatment settings. In addition, they are equipped to provide true holistic care. We recommend that barriers are addressed to expand the AOD nurse practitioner workforce in Australia. [ABSTRACT FROM AUTHOR]

Internationally, while the interdisciplinary field of family therapy and systemic practices is well established and evidence for therapeutic impact is advanced, evaluation of training and measurement of its impact lags behind. This paper addresses this gap, utilising a single case study at the Bouverie Centre, the largest family therapy and workforce development service in Australia. We describe (a) the scope of workforce training and implementation at the Centre, (b) the development of our training research and evaluation framework, and (c) standardised data collection methodology, including a pre‐post training reflective survey. Collectively, this work comprises our current evaluation framework through which we will subsequently examine training impact. Future research and practice recommendations are offered to address challenges to workforce training evaluation and progress efficacy of family therapy training. [ABSTRACT FROM AUTHOR]

Little research has investigated professional identity in Australian clinical psychology postgraduate students. The current study examined potential predictors of professional identity for these students. Anonymous, self-report cross-sectional surveys for Australian postgraduate clinical psychology students were distributed via online survey links sent by their institution's Program Director. Respondents reported professional identity, motivation, engagement, satisfaction with program, resilience, burnout, demographics, and enrolment type. Data from 77 respondents were analysed. Students reported an average 4.25/5 for sense of professional identity as a psychologist. Age, work experience, and stage of program were not associated with professional identity. In multivariate analyses, higher student satisfaction, lower burnout, and lower engagement with "student" aspects of postgraduate study were associated with stronger professional identity. Levels of professional identity were relatively high and showed little influence of demographic variables. However, there is likely to be a reciprocal relationship between satisfaction with postgraduate study and professional identity for students, which would need to be evaluated in a different design to understand directions of association. Results also suggest that supporting postgraduate students in self-care and helping students to balance professional responsibilities and academic aspects of study are likely to assist in fostering postgraduates' professional identity. What is already known about this topic: Professional identity provides a sense of self in relation to membership of a specific profession. Students in health and social services professions, including psychology, have demonstrated emerging professional identities in their areas of study. In working professionals, professional identity has been found to be important for wellbeing and for relationships with colleagues and clients. What this paper adds: Professional identity amongst a sample of Australian postgraduate students in clinical psychology was independent of demographic variables such as age, gender, and previous work experience. Stronger professional identity in the current sample correlated with higher satisfaction with the program of study and lower level of burnout. In multivariate analysis, higher satisfaction with the program of study, lower burnout, and lower engagement with "academic" aspects of the program each independently predicted higher level of professional identity. From these cross-sectional findings, potential causal associations between predictors and professional identity remain to be clarified. [ABSTRACT FROM AUTHOR]

Background: Computer‐based assessment allows for the monitoring of reader behaviour. The identification of patterns in this behaviour can provide insights that may be useful in informing educational interventions. Objectives: Our study aims to explore what different patterns of reading activity exist, and investigates their interpretation and consistency across different task sets (units), countries, and languages. Three patterns were expected: on‐task, exploring and disengaged. Methods: Using log data from the PISA 2012 digital reading assessment (9226 students from seven countries), we conducted hierarchical cluster analyses with typical process indicators of digital reading assessments. We identified different patterns and explored whether they remained consistent across different units. To validate the interpretation of the identified patterns, we examined their relationship to performance and student characteristics (gender, socio‐economic status, print reading skills). Results and Conclusions: The results indicate a small number of transnational clusters, with unit‐specific differences. Cluster interpretation is supported by associations with student characteristics—for example, students with low print reading skills were more likely to show a disengaged pattern than proficient readers. Exploring behaviour tended to be exhibited only once across the three units: It occurred in the first unit for proficient readers and in later units for less skilled readers. Major Takeaways: Behavioural patterns can be identified in digital reading tasks that may prove useful for educational monitoring and intervention. Although task situations are designed to evoke certain behaviours, the interpretation of observed behavioural patterns requires validation based on task requirements, assessment context and relationships to other available information. Lay Description: What is already known about the subject matter?: Students differ in how they read, comprehend and use digital information.Indicators from process data provide insight about how students engage with digital reading tasks. What does this paper add to the subject matter?: Based on multiple process indicators, a small number of clusters indicating different behavioural activity can be distinguished.These clusters can be described as on‐task, passive, hasty, exploring, disengaged, persistent and lost interest.A meaningful interpretation of the clusters must consider the requirements of the underlying tasks. Implications for practice and/or policy: Knowledge of how students engage with digital resources may provide useful feedback for teachers to guide students' learning or intervene when they struggle.Educational monitoring: The high comparability of country‐specific results suggests an invariant set of solution strategies in the digital reading assessment. [ABSTRACT FROM AUTHOR]

Purpose: This qualitative research aims to explore staff perspectives on working effectively with people with intellectual disability who are in contact with the criminal justice system. Design/methodology/approach: Taking a case study approach, staff working for a third sector community organisation were interviewed about the components of effective work with their customers. The staff supported people engaged in the Community Justice Program. Findings: Staff consistently described relationship building as the most important part of their work. There were three components to relationship building: the process of relationship building, the elements of a high-quality staff–customer relationship and the staff skills needed to develop a good relationship. Originality/value: This paper makes two contributions to the literature. First, it focuses our attention on a third sector organisation supporting people in contact with the justice system as opposed to a formal criminal justice agency. Second, the paper seeks to understand the processes and skills staff deploy to build a high-quality relationship with criminal justice-involved people with intellectual disability. [ABSTRACT FROM AUTHOR]

Dysphagia (impaired swallowing) is known to contribute to decreased quality of life, and increased length of hospital stay and mortality post‐stroke. Despite the advancements in stroke treatment with the introduction of thrombolysis and endovascular clot retrieval (ECR), patients continue to present with high rates of dysphagia. Speech and language therapists and stroke teams should consider the presence of haemorrhagic transformation, success of reperfusion and presence of communication deficits as risk factors for dysphagia post‐ECR and/or thrombolysis. Purpose: To establish incidence rates and patterns of dysphagia following the administration of reperfusion therapies in acute ischaemic stroke management. Method: A retrospective review of 193 patients admitted with acute ischaemic stroke to a quaternary stroke unit in Australia over a three year period was completed. Clinical information extracted included demographics, type (thrombolysis and/or endovascular clot retrieval) and success of reperfusion therapy, and the progression of dysphagia and related factors. Results: Over half of all patients treated with reperfusion therapies presented with dysphagia on initial assessment by speech‐language pathology (SLP). The type of reperfusion therapy administered was not significantly correlated with the presence of dysphagia. Dysphagia on initial assessment was significantly correlated with the presence of aphasia on initial assessment, the presence of haemorrhagic transformation, and the success of reperfusion. Increased rates of enteral feeding were also found in this study compared to figures reported in literature. Conclusion: This study identified ongoing high rates of dysphagia amongst this patient population regardless of treatment type, demonstrating the need for ongoing SLP management post stroke. Further research is required in this area to develop an evidence‐base for SLPs and the wider medical team and to inform clinical practice guidelines. What this paper adds: What is already known on the subject: Stroke is one of the leading causes of disability and death internationally. Dysphagia (impaired swallowing), a common sequalae of stroke, is known to contribute to decreased quality of life, increased length of hospital stay and mortality. With advancements in technology, treatments for acute ischaemic stroke (endovascular clot retrieval and thrombolysis) are increasing in popularity. However, limited research exists exploring the impact of these therapies on dysphagia. What this paper adds: Despite the advancements in stroke treatment, patients continue to present with high rates of dysphagia. Dysphagia following thrombolysis and/or ECR was found to be significantly correlated to the presence of aphasia, haemorrhagic transformation, and the success of reperfusion (regardless of treatment type). Additionally, increased rates of enteral feeding were found amongst this patient population compared to figures reported in the literature for patients following traditional stroke management. Clinical implications of this study: Speech‐language pathologists and the wider medical team should consider dysphagia as an ongoing consequence of stroke following reperfusion therapies, with consideration for success of reperfusion and adverse outcomes i.e., haemorrhagic transformation. Further research is required to provide an evidence‐base and specific guidelines for the management of dysphagia post reperfusion therapies, including use of enteral feeding. [ABSTRACT FROM AUTHOR]

Background: Despite emerging evidence of validity and reliability, speech and language therapists' (SLT) uptake of telehealth has been limited and barriers remain to the effective and confident use of this service model. The COVID‐19 pandemic has caused significant disruption to essential health services, including speech and language therapy assessment and intervention, meaning that telehealth must now be considered as part of the suite of service delivery options for all clinicians. Aims: To explore the perceived barriers and facilitators of telehealth among community paediatric SLTs before and after their use of a telehealth platform with an embedded standardised assessment tool. Methods & Procedures: Mixed‐methods questionnaires were developed for this study and completed by SLTs before and after the 3‐month trial of the telehealth platform. A total of 38 SLTs completed the pre‐trial questionnaire and training in the use of telehealth platform (Coviu), including instruction in using a standardised, norm referenced language test as an integrated tool within the Coviu platform. A total of 27 SLTs went on to use the telehealth platform, and 25 of these completed the post‐trial questionnaire on which subsequent qualitative and quantitative analysis was completed. Outcomes & Results: Prior to using the platform, perceived barriers included technology issues, limited clinician experience and concerns around parent acceptance of the service. Potential facilitators included access to appropriate platforms, tools and resources as well as increased clinician confidence with telehealth. Following the trial, barriers to telehealth use continued to include technology barriers, particularly internet stability, and client issues, including suitability for telehealth services. Facilitators for future telehealth use included access to appropriate platforms for telehealth, stable and appropriate internet connectivity, and more extensive telehealth resources for both assessment and intervention for this mode of service delivery. Conclusions & Implications: This study provides insights into the perceptions of the barriers and facilitating factors for telehealth use among community‐based SLTs. This information will be useful in developing strategies to promote uptake and effective and confident use of telehealth as a mode of service delivery beyond the pandemic. What this paper adds: What is already known on the subject: Research about telehealth has shown that it is a reliable and valid way of delivering speech pathology services, yet many clinicians have been wary of its use and uptake of telehealth prior to COVID‐19 had been limited. We wanted to know what SLTs thought about using telehealth before and after participating in a 3‐month trial of a telehealth platform with an embedded formal language assessment. What this study adds to existing knowledge: This study indicates that technology issues including internet stability are a barrier to effective telehealth services, but that appropriate telehealth platforms, resources and experience are facilitators of uptake and successful use of telehealth. What are the potential or actual clinical implications of this work?: This information will be useful in developing strategies to promote uptake and effective and confident use of telehealth as a mode of service delivery for children during and beyond the pandemic, including those isolated by geographical or transport barriers. [ABSTRACT FROM AUTHOR]

Background: Research suggests that some speech–language pathologists are uncomfortable treating people who stutter. Accessing quality clinical education experiences in stuttering is difficult given the ongoing rise in students enrolled in speech–language pathology programmes and the limited number of stuttering‐specific placements available. Simulation‐based learning is a viable option for providing speech–language pathology students with practical experience in a safe learning environment. Whilst research has found that simulation‐based learning experiences in stuttering assist in the development of students' clinical skills, students' perceptions of participating in stuttering simulation‐based learning are yet to be explored. Aims: To investigate speech–language pathology students' comfort, anxiety, knowledge and confidence in the management of stuttering at the commencement of an academic stuttering course and before and following participation in a stuttering simulation‐based learning programme. Methods & Procedures: This study used a cross‐sectional survey design. Participants were 105 undergraduate and graduate entry masters speech–language pathology students enrolled at an Australian university. Students engaged in a stuttering simulation‐based learning programme embedded within an existing academic course on the management of stuttering. A purposefully developed survey was administered at three time points: pre‐course (T1), pre‐simulation (T2) and post‐simulation (T3) in order to explore students' comfort and anxiety levels, and perceptions of their knowledge and confidence in stuttering management. Descriptive statistics were used to report the medians and range of students' responses. Changes across all time points and between each of the time points were determined using the Friedman test and the Wilcoxon signed rank test, respectively. Outcomes & Results: Statistically significant differences (p < 0.001) were observed on all matched survey items (n = 96) across all time points. Between each time point, a significant difference in students' perceived knowledge levels was found with small to large effect sizes. However, there was no difference in students' perceived comfort and anxiety levels between the time points of pre‐course and pre‐simulation. Open‐ended responses on the post‐simulation survey revealed that students valued learning about stuttering within a simulation‐based learning environment. Conclusions & Implications: Simulation‐based learning experience in stuttering management was valued by students. When accompanied by theoretical content, participation in a stuttering simulation‐based learning programme supported students to feel more comfortable and less anxious about working with people who stutter. This finding has implications for the development of clinical skills in the assessment and treatment of adults who stutter. WHAT THIS PAPER ADDS: What is already known on this subject: Simulation is a teaching approach used within speech–language pathology to support the development of students' clinical skills. Simulation provides a safe learning environment for students, an opportunity for repeated practice and is valued by students. What this paper adds to existing knowledge: This study explored students' perceptions of their comfort, anxiety, knowledge and confidence in working with people who stutter before and following participation in a simulation‐based learning programme. It describes a stuttering simulation‐based learning programme that can be embedded into speech–language pathology programme curricula. What are the potential or actual clinical implications of this work?: The stuttering simulation‐based learning programme detailed in this study can be applied and embedded in speech–language pathology curricula. It can be used to support the development of students' confidence in the assessment and management of stuttering. [ABSTRACT FROM AUTHOR]

Objective: Many cancer care services (CCS) provide pragmatic models of emergent care for their patients as part of 'business as usual' without understanding the scope of this work. We aimed to describe an Australian CCS-led model of emergent care and quantify and profile emergent care provided over a 6-month period to understand scope and demand. Methods: This prospective cohort study was performed at a large tertiary hospital on the eastern coast of Australia in 2016. The study explored emergent care provided during business hour and after-hours, including telephone advice, unplanned care and unplanned admissions. Data were collected via electronic hospital records and clinical nurses regarding who accessed care, why care was accessed, what care was provided and how the episode of care ended. Results: Between March and September 2016, 1412 episodes of unplanned care were provided in the CCS-led model of care, including 307 episodes of telephone advice (237 patients; min max 1–4 episodes per patient; 825 episodes of unplanned care (484 patients; min max 1–9 episodes per patient) and 280 unplanned admissions (233 patients; min max 1–6 episodes per patient). During the same time, an additional 459 unplanned admissions (361 patients) occurred via the emergency department (ED), of which 125 (27.2%) occurred during business hours which could have been managed by the CCS. Most people who received care experienced issues associated with disease or treatment and had received systemic anticancer therapy in the past 30 days. Conclusions: The data demonstrate that a significant volume of emergent care was provided within the CCS over the study period, in addition to planned cancer treatment. Due to the ever-increasing demands on EDs and the significant need for emergent care for people with cancer, there is need for CCS-led models of care to provide specialist emergent care specifically for people who are receiving systemic anticancer therapy. Such models must be adequately resourced to meet the needs of patients, carers and healthcare professionals. What is known about the topic?: There is increasing focus on innovative models of emergent care for people with cancer in the out-patient setting to relieve pressure on EDs and improve patient experiences. Limited literature has focused on such models in the Australian context. What does this paper add?: This paper describes, quantifies and profiles care provided in a pragmatic CCS-led model of emergent care in a large tertiary hospital in Australia over 6 months. The data demonstrate significant demand for emergent care within business hours, as well as out of hours, predominantly for people undergoing systemic anticancer therapy. What are the implications for practitioners?: The findings of this study highlight the need for CCS to develop pragmatic models of emergent care. Appropriate resources, infrastructure, policies and procedures are required to adequate meet the needs of patients and carers. [ABSTRACT FROM AUTHOR]

Objective: In Australian hospitals, a central distribution system is often utilised to supply medication to clinical areas. This study investigated the impact of automated dispensing cabinets (ADCs) and inventory robots in medication distribution within an Australian hospital. Methods: A prospective observational study of pharmacy technician medication supply to clinical areas was conducted over a 2-week period pre- and post-implementation of ADCs and inventory robots. Information was collected on the time taken to perform all tasks required to provide a weekly medication supply service for medication other than drugs of addiction. Results: There was no significant reduction of total duration for medication supply, pre-implementation mean 73.08 min versus post-implementation 68.59 min (P = 0.567). An instance of automation downtime occurred during the post-implementation period for which manual downtime procedures were implemented. Without downtime, a significant reduction in overall time taken was observed, 74.25 min versus 63.18 min (P = 0.019). Pre-restocking medication selection errors were reduced non-significantly after implementation of inventory robots, 11 (0.43%) versus 4 (0.21%) errors (P = 0.090). Conclusions: Implementation of ADCs and robots did not significantly reduce the total time to provide a weekly medication supply service when downtime occurred, although a significant reduction was observed when downtime did not occur. Pharmacy medication selection errors were non-significantly lower. What is known about the topic?: Australian hospitals are increasingly implementing automated technology such as ADCs and inventory robotics in an attempt to improve efficiency and accuracy of medication supply; however, limited literature is available in an Australian setting. What does this paper add?: This paper describes the impact of implementing ADCs in clinical areas (e.g. inpatient wards) and inventory robots in a main store pharmacy on the medication supply process. This paper highlights the benefit of improved efficiency and accuracy in selecting medication in pharmacy for distribution and identifies time to restock the ADCs is significantly increased. What are the implications for practitioners?: Implementing ADCs and inventory robotics in Australian hospitals can provide benefits in efficiency and accuracy; however, robust downtime procedures are essential. [ABSTRACT FROM AUTHOR]

Objective: MindStep™ is an Australian low-intensity cognitive behaviour therapy (LICBT) program for individuals with mild-to-moderate symptoms of anxiety and depression. UK-produced LICBT guided self-help (GSH) materials were originally used in the MindStep™ program. In 2017, Australian LICBT GSH materials were developed to better suit Australian users. This study explored whether the Australian-produced materials continued to achieve the benchmark recovery rates established in the UK and maintained in recent Australian studies. Methods: Binomial logistic regression was conducted using retrospective client data, including the Patient Health Questionnaire-9 and the Generalised Anxiety Disorder 7-item scale, between 2016 and 2019. Results: During time periods in which the Australian-produced materials were used, equivalent rates of reliable recovery and improvement were achieved compared with time periods in which the UK-produced materials were used. Australian-trained LICBT coaches, using Australian-produced LICBT GSH materials, achieve client recovery rates of up to 60%, reliable improvement rates of 58% and reliable recovery rates of 46% (with the probability of recovery increasing with client age). Conclusions: These findings are particularly pertinent with COVID-19 changing the landscape of mental health service delivery, requiring greater flexibility in the use of teleservices to ensure access to effective mental health care for populations that may already experience problems with isolation, access and service engagement. What is known about the topic?: LICBT is an acceptable, feasible and effective treatment approach for people experiencing mild-to-moderate anxiety and depression in Australia. LICBT GSH materials used with clients in Australia originated from the UK. However, according to guidelines, LICBT GSH materials should be contextualised to suit the audience they are being used with. What does this paper add?: This paper demonstrates that LICBT GSH materials tailored to an Australian context can be used in place of UK-produced materials because they yield equivalent and consistent therapeutic outcomes. Although contextualising the LICBT GSH materials for health services users was important, it is likely that the evidence-based cognitive behaviour therapy techniques sitting 'under the hood' of these materials are most important to ensure successful therapeutic outcomes. What are the implications for practitioners?: As we face unprecedented challenges following 2020, the physical, social, psychological and economic impacts of life-changing events must not inhibit access to treatments for common mental health conditions. It is anticipated that more non-traditional, alternative providers of mental health services will be needed to scale-up and respond to increasing demand. This paper shows that the provision of telephone-based LICBT in Australia, by trained coaches using Australian-produced GSH materials, is an evidenced-based support pathway that can reduce the access gap to treatments. [ABSTRACT FROM AUTHOR]

Annual turnover of home care workers represents a huge loss of revenue and is a key source of inefficiency in the home health care industry. In this article, we propose a data-driven approach to monitor employee churn and to capture the evolution of employee intent to leave. Unlike most papers in the literature, we use machine learning techniques to analyze over 2 million visits in the US, Canada, and Australia between 2016 and 2019. Results show that the gap between the number of hours worked and in the contract is the most important factor to predict employee intent to leave, which means an employee should be given as many hours as requested in the contract to improve retention. Secondary results show that having diverse shift lengths and continuity in services and patients seem to be associated with less turnover. [ABSTRACT FROM AUTHOR]

Background: Social media is increasingly used by young people, including those with communication disability. To date, though, little is known about how speech–language therapists (SLTs) support the social media use of young people with communication disability. Aims: To explore what services SLTs provide to facilitate the social media use of young people with communication disability, including what these services look like, and the factors that impact SLTs' professional practices. Methods & Procedures: A sequential mixed methods approach was employed including an online survey and in‐depth semi‐structured interviews. Participants were qualified practising SLTs in Australia with a caseload that included clients aged 12–16 years. Quantitative data were analysed with SPSS. A thematic analysis of qualitative data was conducted with NVivo. Outcomes & Results: Survey responses from 61 SLTs were analysed. Interviews were conducted with 16 participants. Survey data indicated that SLTs do not systematically assess or treat young people's use of social media as part of their professional practice. Interview data revealed that where SLTs do support young people's use of social media, they transfer knowledge and practices typically used in offline contexts to underpin their work supporting clients' use of social media. In terms of factors that affect SLTs' practices, three major themes were identified: client/family factors, SLT factors, and societal factors. Conclusions & Implications: While young people with communication disability may desire digital participation in social media spaces, SLTs' current professional practices do not routinely address this need. Professional practice guidelines would support SLTs' practices in this area. Future research should seek the opinions of young people with communication disability regarding their use of social media, and the role of SLTs in facilitating this. WHAT THIS PAPER ADDS: What is already known on the subject: Young people with communication disability use social media, but digital inequality means that they may not do so to the same extent as their typically developing peers. Services targeting a young person's social media use is within the SLT scope of practice. Whether or not SLTs routinely address the social media use of young people with communication disability as part of their professional practice is unknown. What this study adds to existing knowledge: This study found that SLTs in Australia do not systematically provide professional services targeting young people's use of social media. When services do address a young person's use of social media, knowledge and practices typically used by SLTs in offline contexts are adapted to support their work targeting online social media contexts. What are the potential or actual clinical implications of this work?: This study indicates that SLTs should consider a range of factors when deciding whether to address a young person's social media use. Adapting existing offline professional practices to online environments could support SLTs' work in providing services targeting social media use. Professional practice guidelines would support SLTs' work facilitating the social media use of young people with communication disability. [ABSTRACT FROM AUTHOR]

Introduction: Patient safety has been an undervalued component of quality healthcare but is a challenging area of research. Ultrasound is the most common imaging modality in the world. Research on patient safety in ultrasound is generally focused on bioeffects and safe operation of ultrasound equipment. However, other safety issues exist in practice that warrant consideration. This paper forms the first part of a PhD study exploring patient safety in medical diagnostic ultrasound, beyond the notion of bioeffects. The ultimate aim of the study is to inform the final phase of the research study which will consider the next steps in improving the quality and safety of healthcare experienced by patients. Methods: A qualitative study using semi-structured, one-on-one interviews. A thematic analysis categorised data into codes and generated final themes. Results: A heterogeneous mix of 31 sonographers, who reflected the profile of the profession in Australia, were interviewed between September 2019 and January 2020. Seven themes emerged from the analysis. These were bioeffects, physical safety, workload, reporting, professionalism, intimate examinations and infection control. Conclusion: This study presents a comprehensive analysis of sonographers' perceptions of patient safety in ultrasound imaging, not previously available in the literature. Consistent with the literature, patient safety in ultrasound tends to be viewed in technical terms through the potential for bioeffects of tissue damage or physical harm to the patient. However, other patient safety issues have emerged, and while not as well recognised, have the potential to negatively impact on patient safety. [ABSTRACT FROM AUTHOR]

Aim: Comorbid drug and alcohol and mental health disorders are highly prevalent. Significant gaps in service provision make this problem particularly difficult to address in regional Australia. The Pathways to Comorbidity Care (PCC) program was designed to improve management of comorbidity by outpatient drug and alcohol clinicians in New South Wales, Australia. This paper uses the Consolidated Framework for Implementation Research (CFIR) to evaluate variations in implementation outcomes across geographically diverse services. Methods: Twenty clinicians across three drug and alcohol services from metropolitan, outer metropolitan and regional geographic locations were engaged at multiple levels of influence (directors, managers, clinicians) during the implementation of the multimodal PCC training package. The CFIR guided the development of self-report measures and semi-structured interviews evaluating implementation of the PCC training, and disparities in implementation barriers and facilitators were determined. Results: Metropolitan clinicians identified less barriers than regional clinicians on several intervention characteristics (adaptability, complexity, design quality and packaging), as well as outer setting (peer pressure), inner setting (implementation climate, staff incentives, leadership engagement, available resources) and process (planning, opinion leaders, executing) domains. Regional clinicians evaluated the networks and communications construct more favourably. Conclusions: Specific barriers identified more strongly by regional clinicians included the importance of communication with local clinicians and leadership about the practicalities of incorporating the approach into routine practice (allocation of time, increased accessibility of implementation team). Metropolitan clinicians provided more favourable evaluations of the package design, implementation climate and specific implementation processes such as a clear and informative implementation plan. [ABSTRACT FROM AUTHOR]

Objectives: This paper evaluates an Australian curriculum of health administration postgraduate program and its applicability to the workplace. Methods: This study adopted a cross-sectional design. Between January and April 2020, invitations to complete an anonymous online survey were emailed to a total of 250 Master of Health Administration (MHA) alumni who completed their course at an Australian University between 2014 and 2019. Results: A total of 44 alumni participated in the survey. Half (50%) of the respondents were female, the majority of whom (77%) were under the age of 45 years, while 63% of the participants were enrolled part time and undertook their studies in a blended mode. More than half of those responding indicated that MHA improved their strategic thinking (54%), planning (52%), and process development (48%), in addition to their ability to meet goals (48%) and perform data interpretation (45%). Resilience (39%), emotional thinking (36%), and flexibility (27%) scored lower. More than 80% of those who responded stated that they received a promotion (89%) or secured an increased income (86%) as a result of their MHA completion. Conclusion: This study finds that a mix of basic and advanced knowledge of subjects such as project management, health resources management, data analysis, and human resources management to be relevant and highly applicable to the workplace. Provision of flexibility of subjects' delivery for health administration should be encouraged to allow for the diversity and the changes in health services while maintaining the core requirements needed for health managers' competencies. [ABSTRACT FROM AUTHOR]

Objective: Studies of Australian health workforce demographics tend to be limited to single professions, a set geographic area, or based on incomplete data. This study aims to comprehensively describe changes to the demographic characteristics of Australia's regulated health professions over 6 years. Methods: Data were sourced from the Australian Health Practitioner Regulation Agency (Ahpra) registration database, and a retrospective analysis of 15 of the 16 regulated health professions between 1 July 2015 and 30 June 2021 was conducted. Variables including profession, age, gender and state/territory locations for the practitioners' principal places of practice were analysed descriptively and via appropriate statistical tests. Results: Changes in age, gender representation, and place of practice varied significantly and in different ways across the 15 professions. The total number of registered health practitioners increased by 141 161 (22%) from 2016 to 2021. The number of registered health practitioners per 100 000 population increased by 14% from 2016, with considerable variation across the professions. In 2021, women accounted for 76.3% of health practitioners across the 15 health professions, a significant increase of 0.5% points since 2016. Conclusions: Changes to demographics, especially in ageing workforces and feminising professions, can have implications for workforce planning and sustainability. Future research could build on this demographic trend data by investigating causes or undertaking workforce supply or demand modelling. What is known about the topic? Several studies have demonstrated changes in the demography of the Australian health workforce, they tend to focus on individual professions, prescribed geographic areas, or are based on data that are dated or incomplete. What does this paper add? This study presents a national picture of 15 regulated health professions' demographic changes in Australia across a 6-year period and allows for comparisons between professions. What are the implications for practitioners? Future research could build on this demographic trend data by investigating causes or undertaking workforce supply or demand modelling. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate how healthcare practitioners use real-time prescription monitoring tools in clinical practice. Methods: An online survey was distributed to Australian prescribers and pharmacists who use a real-time prescription monitoring tool. Data were analysed and descriptive statistics summarised participant characteristics and responses. A Chi-squared test was conducted to test the difference between prescribers and pharmacists. Results: The majority of participants agreed that real-time prescription monitoring (RTPM) information is useful (92.2%) and the tool is valuable for informing clinical decisions (90.2%); however, just over half reported that they had changed their prescribing or dispensing practices as a result of RTPM information (51.0%), and they employed evidence-based clinical interventions to varying degrees. No statistically significant differences were detected between pharmacists and prescribers and perceptions on tool use. Conclusions: This is the first known study to investigate practitioner use of RTPM tools in Australia, and is a starting point for further research. What constitutes 'success' in the clinical application of RTPM tools is yet to be realised. What is known about the topic? Real-time prescription monitoring tools have been implemented in most states and territories across Australia to reduce the harms of prescription medication misuse. What does this paper add? This is the first study to explore pharmacists' and prescribers' perspectives on tool use in clinical practice, and the impact of these tools on clinical decision-making and clinical interventions. What are the implications for practitioners? Practitioners can optimise tool use in clinical practice to provide patients with best quality health care. [ABSTRACT FROM AUTHOR]

Objectives: To describe the quantity and cost of in-person and telehealth exercise physiology (EP) reimbursed under the Medicare Benefits Schedule (MBS) in Australia before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This study uses publicly available MBS data to describe EP services (in-person and telehealth) reimbursed by Medicare between January 2020 and December 2021. Data were extracted at state and national levels. Results: Despite a reduction in quantity and cost in quartile (Q) 2 2020 (41% reduction), MBS-reimbursed EP services have remained relatively constant at a national level through the 2-year observation period. Service claims averaged 88 555 per quarter in 2020 and 95 015 in 2021. The proportion of telehealth consultations relative to total quarterly claims for EP was <1% in Q1 2020, 6.0% in Q2 2020, 2.4% in Q3 2020 and 1.7% in Q4 2020. This dropped to an average of 1.4% across 2021 (Q1–Q4). States undergoing lockdown periods reported decreased service rates relative to February 2020 (i.e. pre-lockdown). EP services were associated with a Medicare expenditure of AUD17.9M in 2020 (telehealth = 2.4% of total) and AUD19.7M (telehealth = 1.5% of total) in 2021. Conclusions: Quantity and cost of MBS-reimbursed EP services remained relatively constant throughout the height of service disruption due to COVID-19 (2020/21). Telehealth uptake during this time has been minimal for EP. What is known about the topic? Telehealth item numbers were introduced to the Medicare Benefits Schedule (MBS – part of Australia's health scheme) in response to the COVID-19 pandemic to facilitate continued access to health services, including exercise physiology (EP). What does this paper add? The uptake of telehealth service modalities has been minimal for EP through 2020–21. What are the implications for practitioners? The minimal uptake telehealth suggests that further research, advocacy and promotion is needed to ensure that telehealth can be a viable option for patients to consider when accessing EP services. [ABSTRACT FROM AUTHOR]

Objective: To retrospectively analyse the key factors associated with listing decisions by the Pharmaceutical Benefits Advisory Committee (PBAC) for medicines for diabetes and its complications on the Pharmaceutical Benefits Scheme. Methods: The clinical and economic evidence were retrieved from public summary documents (PSD) of all major submissions between July 2005 and March 2020. A multivariate binary logit regression analysis was conducted to assess the relationship between the categorical explanatory variables and PBAC recommendations. Results: We identified a total of 211 PSD of which 118 (56%) were recommended for listing. Clinical and economic uncertainty were significantly and inversely associated with the PBAC recommendation. Submissions with high clinical and economic uncertainty were less likely to be recommended. Conclusion: Our findings will enhance the understanding of medical professionals, pharmaceutical companies, and other stakeholders about the rationale of PBAC reimbursement decisions for these medicines and assist prospective applicant sponsor companies in preparing their submissions. What is known about the topic? Most studies on Pharmaceutical Benefits Advisory Committee (PBAC) decisions focused mainly on the cost-effectiveness, while some assessed only the financial impact of medicines. A few PBAC studies analysed the reimbursement decisions for medicines targeting specific disease groups, e.g. oncology, orphan disease, and multiple sclerosis. What does this paper add? This study presents an in-depth retrospective analysis of the PBAC decisions for listing medicines related to diabetes and its complications on the Pharmaceutical Benefits Scheme and contributes to the existing evidence-based knowledge of health technology assessment. What are the implications for practitioners? Our findings will enhance the understanding of medical professionals, pharmaceutical companies, and other stakeholders about the rationale of PBAC reimbursement decisions for these medicines and assist prospective applicant sponsor companies in preparing their submissions. [ABSTRACT FROM AUTHOR]

Objectives: This study explored publicly funded health system and patient expenditure in the post-acute phase following discharge from inpatient acquired brain injury (ABI) or spinal cord injury (SCI) rehabilitation. The secondary aim was to explore sociodemographic and injury characteristics associated with high costs. Methods: This was a prospective cohort study. 153 patients (ABI: n = 85; SCI: n = 68) who consented to the use of their Medicare data were recruited between March 2017 and March 2018, at the point of discharge from ABI or SCI specialist rehabilitation units. The main outcome measure involved linkage of the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data for the 12 months following discharge from rehabilitation. Bayesian penalised regression was used to determine characteristics associated with high costs. Results: The median number of MBS items used in the 12 months after discharge was 33 (IQR: 21–52). General practitioners and allied health services were accessed by 100% and 41% of the cohort, respectively. The median MBS system cost (in Australian dollars) was $2006 (IQR: $162–$3090). Almost half (46%) of the participants had no MBS patient expenditure. The median PBS system cost was $541 (IQR: $62–$1574). For people with ABI, having a traumatic injury or one comorbidity was associated with lower PBS system costs by on average $119 and $134, respectively. We also found that hospitalisation in ABI was associated with higher PBS system costs, by on average $669. Conclusion: There was evidence of high and variable MBS and PBS costs, raising concerns about financial hardship. Future research should focus on identifying any unmet service and prescription needs in the post-acute rehabilitation phase for these populations. What is known about the topic? Acquired brain injury and spinal cord injury incur high long-term health costs, yet little is known about Medicare service use and costs in the early post-acute phase. What does this paper add? This study provides insight into service use and the burden of injury on Medicare Benefits Schedule and Pharmaceutical Benefits Scheme systems in the 12 months after hospital discharge. High and variable system and patient expenditure are most notable. What are the implications? Highly variable patient costs raise concerns about the access and affordability of sufficient healthcare services in the post-acute rehabilitation period. [ABSTRACT FROM AUTHOR]

In Australia, like many high-income countries, food insecurity is associated with increased risks of chronic diseases, sub-optimal development outcomes in children, and mental health conditions including depression and anxiety. Food insecure households employ a range of strategies, including the use of food charity, to help alleviate hunger and meet cost of living pressures. The aim of this paper is to investigate the lived experience of food insecurity for welfare-dependent households, and to examine these experiences within a structural violence framework. Structural violence investigations seek to understand the distal causal factors that can help explain poor health patterns and inequities. Semi-structured interviews were conducted with customers (n = 78) of food pantries, soup kitchens, and community development programs (June 2018 to January 2019) in the state of Victoria, Australia. Thematic analysis established evidence of controlling, demeaning and depriving practices in the interactions between the participants and the services and staff at national welfare providers and food charities. The same providers and charities nominally set up to address the exact situations in which participants found themselves. The findings of this study suggest that food and social services are an on-the-ground setting through which structural violence is enacted and experienced. [ABSTRACT FROM AUTHOR]

Objective: Farmers are prone to poor well‐being and are at higher risks of suicide than the general population. The aim of this study was to understand whether the negative impact of daily stressors on Australian farmers' well‐being could be buffered through a strong internal locus of control – a strong sense of control over what happens in life. Methods: Australian farmers self‐reported their well‐being, daily stress, and locus of control. Design: Cross‐sectional via pen‐and‐paper survey. Setting: Participants completed the surveys at the beginning of agricultural management training courses. Participants: Australian farmers (N = 129, M age = 39 ± 12 years, 54.7% male). Main Outcome Measures Internal and external locus of control, daily stress, and subjective well‐being. Results: More daily stressors were associated to poorer well‐being, regardless of external locus of control; however, farmers with a stronger internal locus of control were buffered from the negative impacts of daily stressors. That is, daily stressors were not significantly associated with well‐being for farmers with a strong internal locus of control. Conclusions: Internal locus of control may be a significant factor in supporting good well‐being for farmers. Further research should investigate how to enhance internal locus of control amongst this population. It may be that interventions to enhance internal locus of control in farmers could improve their well‐being and productivity, good outcomes for the individual farmers, and global society overall. [ABSTRACT FROM AUTHOR]

Consistency of word production contributes to carers' ability to understand children's speech. Reports of the proportion of words produced consistently by typically developing preschool children, however, vary widely from 17% to 87%. This paper examines the quantitative (consistency count) and qualitative (e.g. phonemic analysis) characteristics of word consistency in 96 children aged 36–60 months. Children named 15 pictures twice, in separate trials, in the same assessment session. The mean consistency of the production for the whole group was 82%. Older children were more consistent than younger children. Girls were more consistent than boys. Words produced correctly in one trial and in error in another may indicate resolving error patterns. Words produced in error in two different ways provided useful evidence about the nature of inconsistent word production in typically developing children. The clinical and theoretical implications are discussed. [ABSTRACT FROM AUTHOR]

Evaluate the utility of brief online training for facilitating mental health professionals' perceived knowledge, confidence, and comfort in working with non-binary clients, and building positive attitudes. Baseline participants were 79 Australian registered mental health professionals, of whom 38 completed online training and a one-week follow-up assessment. Participants completed an assessment of attitudes, comfort, confidence, and perceived knowledge pertaining to non-binary people before and after completing online training. The training (30-minute average completion time) provided information on non-binary people's lives using text, images, embedded video, and links to optional resources. Follow-up measures completed one-week post-intervention indicated engagement in the training may lead to increased perceived knowledge, confidence and comfort. Attitudes were positive at baseline and were not significantly different at follow-up. Providing brief online training for working with non-binary people in mental health might improve practitioner perceived knowledge, confidence and competence at low cost and with easy access. Future research is required to account for limitations and build on current outcomes. Key Points What is already known on this topic: Little is known about the effects of brief online training regarding non-binary genders on mental health practitioner's attitudes, confidence, comfort, and perceived knowledge. Previous research has shown that brief training can increase positive attitudes for, knowledge of, behavioural intent, and cultural competence for working with sexual and gender minorities, though has not specifically focused on non-binary people. Previous literature has highlighted positive associations between practitioner knowledge and the well-being of non-binary people accessing health services. What this paper adds: This paper adds to the ongoing genesis of options for training mental health practitioners about non-binary people and relevant issues. Findings suggest beneficial outcomes from both prior professional training in this area and the brief training used in the study. The brief online training used in the study was associated with higher perceived knowledge, confidence, and comfort for working with non-binary clients, but further research is needed to understand reasons for change in these variables. [ABSTRACT FROM AUTHOR]

Background: Individuals with speech, language and communication needs (SLCN) are at greater risk of contact with the criminal justice system. Diagnosis and appropriate treatment of SLCN reduces these risks, leading to better life outcomes for the individual as well as broader social and economic benefits. These youth represent a particularly high‐priority group for research into language deficits, as the juvenile justice system involves situations with a high risk or serious consequences that rely upon the application of effective language skills. Whilst some studies have established some gains in speech and communication from speech pathology (SP) interventions during custody, there is limited evidence on the long‐term impact of these gains following release from custody. Similarly, few studies have directly measured the cost savings associated with early SP on subsequent youth antisocial behaviour and crime. Aims: To estimate the youth antisocial behaviours, youth justice (YJ) contacts and associated costs (from a justice perspective) of childhood SLCN. Methods & Procedures: Using 12 years of data from a longitudinal study of Australian children and young people, we employ a panel fixed‐effects model to explore the relationship between SLCN and youth antisocial behaviour and youth offending between 12 and 17 years of age. Using these results, we estimate the cost of SLCN and subsequent cost savings associated with identification of SLCN. Outcomes & Results: The results showed that the annual cost of SLCN to the YJ system (exchange rate as at 9 December 2020) is A$875 (95% confidence interval (CI) = A$195, A$1916) (US$$649, €536, £485) per person who participates in youth crime, which is due to higher rates of youth antisocial behaviour and youth offending. Identification of SLCN (defined by SP treatment) appears to have a positive impact on youth antisocial behaviour and crime, mediated through improved language and communication. On average, young people with a history of 'identified' SLCN incur A$188 (95% CI = A$42, A$412) lower YJ costs (US$$140, €105, £115), compared with the same individual, before identification. Over the lifetime of the individual, this equates to A$9.2 million (95% CI = A$2.05 million, A$20.2 million) (US$$6.8 million, €5.6 million, £5.1 million) cost savings to the YJ system (A$3389 per person with SLCN) (2020 Australian dollars) (US$2513, €2074, £1880). Conclusions & Implications: Overall, the findings revealed that young people with SLCN have an elevated risk of youth antisocial behaviour and crime. However, the identification of SLCN (and subsequent treatment) leads to changes in the offending risk trajectory for these individuals, resulting in lower rates of youth antisocial behaviour and consequently lower rates of crime and its associated justice costs. What this paper adds: What is already known on the subject: It is well documented in the literature that young people in contact with the justice system have much higher rates of previously undiagnosed SLCN than those of the general population. There is less known about whether the identification of SLCN (and subsequent treatment) leads to changes in the offending risk trajectory for these individuals, leading to lower rates of youth antisocial behaviours and crime. What this paper adds to existing knowledge: This study uses a longitudinal survey of 5000 children and young people to track the antisocial behaviour and crime‐risk trajectory of children and young people with SLCN. The study finds evidence that young people with 'identified' SLCN report less juvenile antisocial behaviour and lower YJ contacts after intervention. The potential lifetime cost savings associated with intervention is A$9.2 million (95% CI = A$2.05 million, A$20.1 million) (US$$6.8 million, €5.6 million, £5.1 million). What are the potential or actual clinical implications of this work?: The findings of this study can quantify the effects (in terms of cost savings to the justice system) of the early identification and subsequent intervention for young people with SLCN. [ABSTRACT FROM AUTHOR]

Child abuse and neglect is a complex problem that needs to be addressed through a multidisciplinary approach. Nurses internationally have frequent contact with children and are ideally placed to respond to children experiencing abuse and neglect. Nurses' roles can include reporting abuse to child protection services (CPS). This paper reports on one aspect of the findings of a qualitative study exploring Australian nurses' perceptions and experiences of keeping children safe from abuse. Specifically, this paper reports on the theme relating to nurses' experiences of communicating their concerns to CPS and the family when reporting abuse and neglect. This qualitative study was underpinned by social constructionism, with data collected through semi‐structured interviews with 21 nurses working with children in Australia. Key findings reported are: (1) being heard; (2) [feeling] disappointed, discouraged and disenfranchised; and (3) managing tensions between engagement and reporting. Nurses at times perceived that they were not taken seriously by CPS and felt powerless to enact change for children. Nurses subsequently had to decide how, and if, to discuss their report with families to mitigate negative reactions and maintain engagement. This study highlights the need for more effective multidisciplinary collaboration between nurses and CPS to promote change for children affected by abuse in Australia. 'This paper reports on... nurses' experiences of communicating their concerns to CPS and the family' Key Practitioner Messages: Nurses often perceived that they were not taken seriously by CPS and felt powerless to make a difference for children.Nurses experienced a tension between openly discussing their intention to report with families and minimising negative reactions such as disengagement and mistrust.This study highlights the need for greater collaboration between CPS and nurses to promote shared understanding and effective action to promote the wellbeing of children experiencing abuse and neglect. [ABSTRACT FROM AUTHOR]

Aim: To inform future training and professional development for individuals who measure, analyse and interpret dietary intake data. Methods: A cross‐sectional online survey was distributed via e‐newsletter to members of Dietitians Australia, Dietitian Connection and Nutrition Society Australia. The survey included 37 questions on three key areas of practice: (a) methods used to assess dietary intake, (b) barriers faced when conducting dietary intake assessment and (c) resources needed to optimise collection, analysis and interpretation of dietary intake data. Results: Of 173 responses, 103 respondents provided complete data over 2 weeks. Of these, 76% were APDs. The majority (90%) indicated that dietary assessment was important in their role. Respondents (63%) undertook dietary assessments to inform individual/patient care. When assessing intakes, the majority (79%) were interested in examining food/food group intakes. Paper based methods were most commonly used and diet histories, food frequency questionnaires and 24‐hour recalls were the most frequently used methods. The biggest barrier identified to implementing dietary assessment methods into practice was participant burden. Over a third of respondents reported they had received specific training on selecting an appropriate dietary assessment method. The majority of respondents (83%) believed having access to a dietary assessment methods toolkit would be useful. Conclusion: Survey findings provide insight into the need for further capacity building strategies, including professional development to improve collection, analysis and interpretation of dietary intake for Australian nutritionists and dietitians. The creation of online resources could help overcome identified barriers and provide a link to best practice methodologies and contemporary tools. [ABSTRACT FROM AUTHOR]

Background: Non‐communicable diseases (NCDs), also known as chronic diseases, now constitute a major proportion of ill‐health across most adult and older populations including in people with intellectual disability. The current paper is a comparative analysis of prevalence of NCDs across mid‐aged and older‐aged people with mild intellectual disability. Method: Comparative data comes from two cross‐sectional surveys using similar methodology and timeframes. The analysis sample comprises mid‐aged group (30–50 years, N = 291) and older‐aged group (≥60 years, N = 391). Results: People with mild intellectual disability start developing NCDs in early to mid‐adulthood and increases with age. The mean number of NCDs in mid‐aged group was 0.86 (SD, 0.84) compared to 3.82 in older group (SD, 2.67). Conclusion: There needs to be early identification and management of NCDs using relevant health promotion and preventative measures at optimal intervention points. The training of healthcare professionals needs improvement. [ABSTRACT FROM AUTHOR]

Studies of children's consistency of word production allow identification of speech sound disorder. Inconsistent errors are reported for two groups of children: childhood apraxia of speech (CAS) due to difficulty with the motoric precision and consistency of speech movements; and inconsistent phonological disorder (IPD) attributed to impaired phonological planning. This paper describes the inconsistent productions of children with IPD in comparison to typically developing children. In two studies of suspected SSD (N = 135), 22 children pronounced ≥40% of 25 words inconsistently on three repeated trials. No participant had symptoms of CAS. They were monolingual and spoke Australian- or Irish-English. Assessment determined the proportions of words said consistently (i.e. the same across productions: all correct or with the same error) or inconsistently (i.e. differently across productions: at least one correct and one error or different errors in productions). Qualitative analyses examined error types and explored the effect of target words' characteristics on inconsistency. Children with IPD produced 52% of words with different errors. While 56% of all phoneme errors were developmental (age appropriate or delayed), atypical errors typified inconsistency: default sounds and word structure errors. Words with more phonemes, syllables and consonant clusters were vulnerable to inconsistency, but their frequency of occurrence had no effect. TD children and those with IPD had different quantitative and qualitative error profiles, confirming IPD as a diagnostic category of SSD. Qualitative analyses supported the hypothesised deficit in phonological planning of words' production for children with IPD. [ABSTRACT FROM AUTHOR]

Given that the number of children and young people needing care keeps rising and fewer people are becoming foster carers, efforts to support carers and workers in foster caring are essential. This paper considers the experiences of carers and foster care agency workers involved in Australia's piloting of the Mockingbird Family. With a view understanding experience, data were collected via focus groups with carers and agency workers (n = 20) involved in piloting, implementation and evaluation. Deductive analysis applied the theory of experience to generate understanding of experience, as both intrinsic and extrinsic dimensions to capture strengths in the Mockingbird Family's foster caring networks. These dimensions of experience included collective passions of carers and workers; experiential change over time; collective experiences as a moving force; and experiences as transformational. Understanding of experience associated with the perceived strengths of the Mockingbird Family, including strategies to promote strong professional relationships between carers and workers, is an important element in strengthening environments of children and young people in care. Safe and stable environments are crucial for wellbeing. [ABSTRACT FROM AUTHOR]

Introduction: Commercial tobacco use was systematically embedded as a valuable commodity through colonisation that continues to be exploited for profit by the Tobacco Industry. There have been significant declines in current smoking prevalence among Aboriginal and Torres Strait Islander peoples 18 years and over, from 55% in 1994 to 43% in 2018–2019. This paper seeks to better understand smoke‐free behaviours, and to systematically quantify associations between a range of SDOH and non‐smoking/never‐smoking among Aboriginal and Torres Strait Islander adults (≥18) living in regional Australia. Objective: To explore the social determinants of health (SDOH) related to non‐ and never‐smoking among Aboriginal and Torres Strait Islander peoples in regional Australia. Design: Cross‐sectional analysis of the NATSIHS, weighted to the Aboriginal and Torres Strait Islander adult population living in regional Australia, was conducted. Participants were characterised as people who were current smokers, never‐smokers and non‐smokers (ex‐ and never‐smokers). The social determinants of health exposures related to socioeconomic position, well‐being and access to healthcare. Setting: Regional Australia is distinct from urban and remote areas, based on the ASGS Remoteness Structure (ABS) 2018–2019. Participants: Aboriginal and Torres Strait Islander adults (≥18 years) who were selected, consented and asked questions about smoking in the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS 2018/19). Results: High income was associated with non‐smoking (Prevalence Ratio [PR] = 2.07; 95% CI: 1.66–2.57) and never‐smoking (PR = 2.02; 1.46–2.79), as was completing year 10 (non‐smoking PR = 1.34; 1.12–1.61 and never‐smoking PR = 1.56; 1.20–2.03). Better food security was associated with a higher prevalence of never‐smoking (PR = 2.42; 1.48–3.98). Lower psychological distress scores were associated with non‐smoking (PR = 1.30; 1.10–1.53) and never‐smoking (PR = 1.56; 1.21–2.01). Never‐smoking was more frequent in participants reporting no experiences of unfair treatment (PR = 1.59; 1.22–2.06). Having a usual healthcare provider was associated with non‐smoking (PR = 1.38; 1.02–1.86). Positive exposure to the SDOH were associated with non‐ and never‐smoking among Aboriginal and Torres Strait Islander adults in regional Australia. Structural and systemic changes to address the SDOH, including discrimination and racism, are expected to accelerate non‐smoking behaviours and improve health outcomes for Aboriginal and Torres Strait Islander peoples. [ABSTRACT FROM AUTHOR]

To investigate determinants of willingness to adopt telerehabilitation, willingness of technology use, core affect regarding using telerehabilitation, and digital competencies in rehabilitation professionals in Austria and Germany before and during the COVID-19 pandemic. A cross-sectional paper-based and online survey was conducted before and during COVID-19, respectively, with three cohorts of rehabilitation professionals. Outcomes were the willingness to adopt telerehabilitation evaluated using the extended Unified Theory of Acceptance and Use of Technology; willingness of technology use using the short scale for assessing the willingness of technology use; digital competencies and core affect using the Digital Competence Framework and semantic differential, respectively. Multivariate ordinal regression analysis was performed to determine predictors. Included were 603 rehabilitation professionals. Analysis revealed differences between Austria and Germany and before and during the pandemic for most outcomes. German residency, the pandemic, and a higher educational level were most important predictors of higher willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. The pandemic increased most aspects of willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. Results confirm that rehabilitation professionals with higher degrees are more prone to adopt innovations in healthcare.Registration: German Clinical Trials Register (DRKS00021464) The willingness to adopt telerehabilitation is associated with external factors increasing the need for alternative rehabilitation delivery, such as COVID-19, and with financial facilitators, such as reimbursement. As the willingness to adopt telerehabilitation is higher among speech and language therapists and dietitians, efforts are necessary to enhance its use in physiotherapists and occupational therapists. As a higher willingness to adopt telerehabilitation was observed in younger rehabilitation professionals and those with higher education, increasing the importance of telerehabilitation in education curricula and further knowledge transfer into practice for those already working in the field seems necessary. [ABSTRACT FROM AUTHOR]

Background: Dysarthria, aphasia and executive processes have been examined for their role in producing impaired communicative competence post traumatic brain injury (TBI). Less understood is the role of emotional dysregulation, that is, apathy and disinhibition, and social cognition, that is, reading and interpreting social cues. Methods & Procedures: In this study, we examined 49 adults with moderate to severe TBI and 18 neurologically healthy adults. We hypothesised that apathy and disinhibition would predict communication outcomes as would social cognition. We also predicted that apathy and disinhibition would influence social cognition. Communication outcomes were measured by the La Trobe Communication Questionnaire (LCQ) and the Social Skills Questionnaire‐TBI (SSQ‐TBI). Apathy and disinhibition were measured by the Frontal Systems Behavior Scale (FrSBe). We measured four aspects of social cognition: emotion perception and theory of mind using The Awareness of Social Inference Test (TASIT) and the Complex Audio‐Visual Evaluation of Affect Test (CAVEAT), empathy using the Questionnaire of Cognitive and Affective Empathy (QCAE) and the Balanced Emotional Empathy Scale (BEES), and alexithymia using the Toronto Alexithymia Scale (TAS‐20) and the Bermond–Vorst Alexithymia Questionnaire. Outcomes & Results: Consistent with predictions, the LCQ and SSQ‐TBI were associated with disinhibition and the LCQ was also associated with apathy. The LCQ was associated with the full range of social cognition constructs although the SSQ‐TBI was not. Finally, apathy and disinhibition predicted a number of social cognition measures. Conclusions and Implications: These results are discussed in relation to understanding the nature of communication disorders following TBI and how they are measured, as well as the interrelation between emotion dysregulation and social cognition. What this study adds: What is already known on this subject: The role of emotional dysregulation and social cognition in producing impaired communicative competence post traumatic brain injury (TBI) is not well understood. Although most adults with severe TBI have minimal or possibly no language impairment, they often struggle with functional communication in everyday situations. Many have been reported to be overtalkative, insensitive, childish and self‐centred, displaying an inappropriate level of self‐disclosure and making tangential and irrelevant comments. Conversely, some speakers with TBI have been noted to have impoverished communication, producing little language either spontaneously or in response to the speaker's questions and prompts. What this paper adds to existing knowledge: We found that both apathy and disinhibition were strongly associated with the Latrobe Communication Questionnaire both empirically and conceptually, despite the LCQ being developed from a different, pragmatic orientation. Disinhibition was also associated with the Social Skills Questionnaire for TBI. We also found that poor social cognition scores predicted communication difficulties. Finally, we found that behavioural dysregulation itself, i.e., both apathy and disinhibition, predicted poor social cognition. What are the potential or actual clinical implications of this work?: Our findings highlight the central role that apathy and disinhibition play in both communication and social cognition. These insights point to the importance of remediation to target behavioural and autonomic dysregulation as a means to improve everyday social function. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Little is known about adolescent inpatient units, key features which define them, and how these essential services operate and deliver care. What the paper adds to existing knowledge?: Adolescent inpatient unit studies are limited in their descriptions of settings in terms of how they operate and key features.The proposed preliminary checklist is a practical tool to assist clinicians, policy makers, and researchers when reporting to ensure comprehensive descriptions of adolescent inpatient settings. What are the implications for practice?: This could be used to inform service design processes for inpatient and other mental health service models which is of critical importance in the context of reforms and implementation of these in Australia currently.Greater attention to operational models, services, and philosophies of practice will improve reporting and allow for the advancement of knowledge, comparison of study results, and a clearer direction for mental health nursing clinicians and researchers. Introduction: Adolescent inpatient units care for vulnerable population groups; however, little is known about how these essential services operate and deliver care. Aims: To examine the descriptions of adolescent mental health inpatient units in Australian and international research publications and to identify key features which were used to define them. A secondary aim was to develop a checklist to improve consistency when reporting on the operations and services delivered within adolescent mental health inpatient units (both public and private). Methods: Five electronic databases (CINAHL, MEDLINE, ERIC, EMBASE, and PsycINFO) were systematically searched. We included studies that provided descriptions of operations and services within adolescent inpatient units where participants had a mean age between 12 and 25. Narrative synthesis was used to explore the similarities and differences between descriptions of settings. Results: Twenty‐eight studies were identified, which varied in their descriptions of adolescent inpatient units, providing inconsistent information to inform best practice. Discussion: Studies lack consistency and comprehensive detail when describing the operational models within inpatient units, making interpretation challenging. Consequently, a preliminary checklist is proposed to improve reporting of adolescent inpatient units. [ABSTRACT FROM AUTHOR]

This paper explores the environmental, interpersonal, and personal outcomes of music performance in a hospital oncology setting. An original, qualitative research study examined the impact of live music for staff, patients, and carers. Data were collected using a multi-method approach of observations and semi-structured interviews and were analysed using inductive and theory-driven theming that was shaped by a determinants of health framework. The research found that live music promoted stronger relationships and calmer environments, among other environmental, social and individual outcomes. Improved communication between staff through the creation of a more supportive environment was a pertinent finding of the research. No negative effects were reported. We discuss research findings in the context of relevant literature and suggest recommendations for future hospital-based live music programs. Results of this study indicate that live music interventions impacted individual, interpersonal, social and environment factors that led to health and wellbeing outcomes for participants. [ABSTRACT FROM AUTHOR]

This paper examines how antiretroviral therapy (ART) use and fears towards the onward transmission of HIV have changed among people living with HIV (PLHIV) in Australia between 1997 and 2018. Participants were recruited as part of the HIV Futures study, a large cross-sectional survey of PLHIV in Australia, in 1997, 2003, 2012 and 2018 (total n = 3889). ART use, viral load detectability, and fear of onward HIV transmission were compared between years. Predictors of onward transmission fear were assessed among the 2018 subsample. While ART use within our sample decreased between 1997 and 2003, it subsequently increased to 97% in 2018. Self-reported viral load undetectability steadily increased over time, up to 88% in 2018. Notably, fewer PLHIV reported being fearful of transmitting HIV in 2018 compared to all other years. Being unfamiliar with the undetectable = untransmissible health movement, and having a detectable or uncertain viral load at last test, were significant predictors of being fearful of onward HIV transmission. Beyond the immediate medical considerations of HIV treatment, these results suggest that the undetectable = untransmissible movement may play a critical role in attenuating burdens experienced by PLHIV in Australia and that such messaging, in tandem with early and consistent ART use, should remain a salient feature of heath messaging among this population. [ABSTRACT FROM AUTHOR]

To examine the need, feasibility and acceptability of speech-language pathologists (SLPs) implementing a systematic, routine, unmet social needs identification and referral pathway, as a means of promoting health equity and addressing Sustainable Development Goals (SDGs). Quality Improvement methodologies were used to adapt and pilot an unmet social needs identification and referral pathway for use with parents/carers of children with communication disabilities referred to an urban Australian speech-language pathology service. SLPs were surveyed about the acceptability and feasibility of this practice. The majority of parents/carers, 289 of 293 (99%), agreed to participate in the study, with 31 of the 289 (11%) reporting concerns about unmet social needs. The most common unmet need related to household bills (n = 17, 28%), followed by childcare (n = 12, 20%), employment (n = 10, 16%), food (n = 8, 13%), housing (n = 7, 11%), and parent/carer education (n = 7, 11%). The majority of these families, 26 of 31 (84%), requested referral to, or information about, local community services/resources. SLPs reported high levels of acceptability (93%) and feasibility (98%). This study demonstrates the need, feasibility and acceptability of SLPs implementing an unmet social needs identification and referral pathway, and the potential to scale this initiative across other speech-language pathology services and allied health contexts. This paper focusses on SDG 1, SDG 2, SDG 3, SDG 4, SDG 8, SDG 10, SDG 11, SDG 16, and also addresses SDG 17. [ABSTRACT FROM AUTHOR]

The Foundations of Early Literacy Assessment – Northern Territory (FELA-NT) was funded, developed, and implemented as part of a strategy designed to address the English literacy learning needs of the Northern Territory's Aboriginal student population. In this paper we question whether the FELA-NT English literacy learning benchmarks are representative of remote and very remote Aboriginal students since many speak English as an Additional Language (EAL) or Dialect (EAD). Using a new data set of scores from 72 Aboriginal students from remote, very remote, and outer-regional communities on the FELA-NT, we demonstrate that it is the student's experience with Standard Australian English, not their remoteness, that impacts their early literacy development. We use this example to illustrate how current practices and policies homogenise the Australian Aboriginal student population, silencing linguistic diversity in the process. We call for clinical practitioners and educators to shift their practices to assessments and tools that recognise children and youths' diverse linguistic skills and pathways. We talk about what empowerment, participation, and inclusion might really mean in current Australian educational and clinical contexts. We argue here that we need to fundamentally rethink how we work with children with diverse language and literacy knowledge, skills, and backgrounds if we are to reduce inequalities (SDG 10), honour quality education (SDG 4), and support sustainable communities (SDG 11). [ABSTRACT FROM AUTHOR]

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]

Objectives: We set out to examine the volume, scope and quality of research related to First Nations peoples' perceptions of, and experiences with, child rearing and/or parenting programs. Methods: We systematically reviewed the literature published between 2000 and 2020. Sixty-eight studies identified through electronic databases and references lists met inclusion criteria. Results: The study found an 8% increase in publications in the field each year (P -value = 0.002), mostly conducted in Australia with Aboriginal and Torres Strait Islander people (n = 29, 41%). Scope included positive and negative experiences relating to: parenting from adult (n = 19 studies) and teenager (n = 4) perspectives; and pregnancy, antenatal and postnatal care from the perspective of adults (n = 23) and teenagers (n = 2). Descriptive studies included qualitative (n = 40; 58%), quantitative (n = 8, 12%) or mixed methods (n = 7, 10%). Thirteen experimental studies reported the development, acceptability and/or effectiveness of programs (19%), of which three met the Cochrane Effective Practice and Organisation of Care design criteria. Conclusions: Despite an overall increase in volume, research efforts do not demonstrate a clear scientific progression. Further methodologically rigorous studies examining child rearing and/or parenting programs developed in collaboration with First Nations populations are needed. What is known about the topic? Examining research output, effectiveness and acceptability of existing existing parenting and child rearing programs for First Nations parents can inform research priorities and service development.. What does this paper add? Rigorous research to inform the development and evaluation of parenting programs is limited. Strengths-based, community-wide approaches should integrate community identities, expertise and resources, encourage ownership and engagement, and build capacity.. What are the implications for practitioners? Continued efforts are necessary to develop programs uniquely informed by, and tailored to, First Nations parents. [ABSTRACT FROM AUTHOR]

Policy and research acknowledge that the quality of end-of-life care in hospitals can be poor, with families reporting significant concerns regarding physical and psychosocial care. In order to design appropriate evidenced-based care approaches, we conducted qualitative research examining the perspectives of bereaved families of patients who received end-of-life care in our health network. This paper reports on ethical dilemmas facing practitioner-researchers conducting interviews with bereaved families. We recruited 40 bereaved family members to participate in semi-structured interviews discussing the care a loved one received while a patient under the general medicine units. Bereaved participants expressed grief, humour and anger regarding their experience, and several reported perceptions of negligent and harmful care. Irrespective of the protocols in place to mitigate distress, this posed an ethical dilemma for the practitioner-researcher as a member of the health network, who needed to balance clinical and research roles when responding to distress. The practitioner-researcher's own bias and assumptions emerged when analysing families' distressing recollections. More broadly, the issues discussed have clinical implications for models of hospital bereavement support. Participants' use of photos and mementos jointly served to include the presence of the deceased in the research interview, but also highlighted the potential to utilise visual methods to examine sensitive research issues. It helps every practitioner-researcher to distinguish between research-oriented goals and clinical responsibilities to care provision as they consider their human research ethics application before beginning any research. [ABSTRACT FROM AUTHOR]

It is well documented that lower socio-economic status is associated with poorer health outcomes, while health literacy is considered important for improving health. What is less clear, is the extent to which greater health literacy can improve health outcomes among people for whom poverty or financial insecurity are important barriers to health. The paper presents findings from an Australian survey of people living with HIV (PLHIV) (N = 835) in which we explored the relationship between financial insecurity and health outcomes, looking at the extent to which health literacy mediates this relationship. The study drew on a comprehensive definition of health literacy, measuring participant's confidence to communicate with healthcare providers, navigate the health system and take an active stance in relation to their health. Findings showed that financial insecurity was associated with lower health literacy and poorer self-reported physical and mental health. Health literacy mediated 16.2% of the effect of financial insecurity on physical health scores and 16.6% of the effect of financial insecurity on mental health scores. This suggests that programmes which seek to build health literacy among PLHIV may improve health outcomes among PLHIV who are struggling financially. Health literacy programmes are likely to be effective if they build confidence and resourcefulness among people to engage with health information, decision-making and care. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of the Paediatric International Nursing Study was to explore the utility of key performance indicators in developing person-centred practice across a range of services provided to sick children. The objective addressed in this paper was evaluating the use of these indicators to benchmark services internationally. Background This study builds on primary research, which produced indicators that were considered novel both in terms of their positive orientation and use in generating data that privileges the patient voice. This study extends this research through wider testing on an international platform within paediatrics. Design The overall methodological approach was a realistic evaluation used to evaluate the implementation of the key performance indicators, which combined an integrated development and evaluation methodology. Methods The study involved children's wards/hospitals in Australia (six sites across three states) and Europe (seven sites across four countries). Qualitative and quantitative methods were used during the implementation process, however, this paper reports the quantitative data only, which used survey, observations and documentary review. Results The findings demonstrate the quality of care being delivered to children and their families across different international sites. The benchmarking does, however, highlight some differences between paediatric and general hospitals, and between the different key performance indicators across all the sites. Conclusions The findings support the use of the key performance indicators as a novel method to benchmark services internationally. Whilst the data collected across 20 paediatric sites suggest services are more similar than different, benchmarking illuminates variations that encourage a critical dialogue about what works and why. Relevance to clinical practice The transferability of the key performance indicators and measurement framework across different settings has significant implications for practice. The findings offer an approach to benchmarking and celebrating the successes within practice, while learning from partners across the globe in further developing person-centred cultures. [ABSTRACT FROM AUTHOR]

To explore antimicrobial management processes in Australian residential aged care facilities (RACFs), including antimicrobial prescribing, supply, administration, and documentation to inform surveillance activities. Voluntary, online cross-sectional survey. The survey was disseminated to all South Australian RACFs (n = 237) seeking participation from an infection prevention and control lead (preferred respondent), a nurse or senior RACF staff member, or an aged care pharmacist. The survey was open during May-June 2023. Questions aimed to understand clinical and medication management systems, sources of antimicrobial prescription and supply, management by external health care providers and documentation of antimicrobial administration. A process map of antimicrobial management in RACFs was developed. Of the 54 RACFs included in the analysis (29.5% response rate), most used an electronic clinical documentation system (74.1%) or a hybrid electronic paper-based system (22.2%). Medication charts were either electronic (81.0%), hybrid (5.6%), or paper-based (13.0%). Antimicrobials were prescribed by the resident's usual general practitioner, but also by locums, hospital or specialist physicians, nurse practitioners, virtual care physicians, and dentists. Oral, topical, and inhaled antimicrobial formulations were usually supplied by community pharmacies, and intravenous formulations were predominately supplied by hospitals for administration by outreach nurses. Almost all RACFs (96.2%) had imprest stock of antimicrobials that included both oral and intravenous formulations. Antimicrobials were predominately administered by an enrolled nurse or a registered nurse. Antimicrobial management in RACFs is complex, particularly during care transitions. Multiple prescribers and sources of antimicrobials, use of different systems for clinical documentation, particularly by external health care providers, and clinical governance relating to imprest supplies were identified as key areas where medication management could be improved. Addressing these gaps will facilitate comprehensive, real-time antimicrobial surveillance in Australian RACFs. [ABSTRACT FROM AUTHOR]

Objective: The study examined if, when and how select allied health professional standards currently articulate the Health LEADS Australia themes. Methods: Eighteen allied health professional standards were searched to locate references to leadership. Data were extracted and analysed inductively, deductively and thematically as a meta-synthesis. Frequencies were counted, with subanalysis by professional area, classification level, competency type and level of cognition. Results: There were 953 direct and indirect leadership statements. Only two leadership definitions were located, for pharmacists and dentists. The principal theme 'Leadership' only appeared in 18 (2%) statements from the total dataset that made direct references to leadership, which were mostly vague and unclear. The remaining indirect references to leadership are reported as four overarching themes: Self-leadership (n = 289 statements; 30%); Leadership With and of Others (n = 263; 28%); Improvement and Change Leadership (n = 223; 23%); and Health Reform Leadership (n = 139; 15%). Conclusion: Health leadership was not easily recognisable in the allied health practice standards examined. With some refinement and alignment with a contemporary leadership framework, professional standards could play a critical role in preparing allied health graduates to support the ongoing health system reform required to improve health and well-being outcomes in the future. What is known about the topic?: Leadership is essential at all health system levels, and leadership frameworks can usefully guide leadership development. However, little is known about allied health leadership compared with other clinical groups, and their contributions to directional changes in health system reform may be overlooked. What does this paper add?: This paper presents results of an analysis of where and how 18 allied health disciplines align with the Australian Health LEADS framework, and where greater clarity or alignment is needed. What are implications for practitioners?: Reinstatement of a national health leadership framework, such as the Australian Health LEADS framework, to articulate the need for and capabilities of leadership to enable innovation and support reform across all professional groups working in health care, including medical, nursing and allied health is required. A recognised national leadership framework could guide the revisions to allied health practice standards and coupled with a co-design process involving practitioners and professional associations, further development and incorporation of leadership competencies in a consistent manner would be enabled. Furthermore, alignment of allied health education and professional development with a national health leadership framework may strengthen allied health leadership graduate outcomes. [ABSTRACT FROM AUTHOR]