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Health literacy comprises an individual's ability to adequately access, understand and utilise health information, enabling effective navigation of the healthcare system. Low health literacy is a problem for people living with substance use disorders (SUDs). This study aims to examine whether health literacy changes for people discharged from specialist SUD treatment services. Two hundred thirty-one people recruited from residential SUD treatment services across New South Wales, Australia, completed a questionnaire upon entry into the service and again at 6 months post-treatment. Treatment outcomes were also measured. Three health literacy profiles were identified: lowest (n = 52, 22.5%), moderate (n = 111, 48.1%) and highest health literacy (n = 68, 29.4%). Lowest and moderate profiles showed improved health literacy at 6 months. However, the lowest profile still had significantly lower health literacy, quality of life and higher levels of psychological distress compared with participants in the highest profile at 6 months. People within the lowest health literacy profile improved, although they continued to experience lower health literacy and some poorer treatment outcomes. Health literacy interventions tailored for people within lowest health literacy profiles should be implemented and assessed for effectiveness within specialist SUD treatment services. [ABSTRACT FROM AUTHOR]

Introduction: To help reduce relapse rates following alcohol and other drug (AOD) treatment, continuing care interventions have been recommended. Previous continuing care interventions have incorporated telephone and face‐to‐face sessions to help promote participant engagement. The study was conducted as a randomised controlled feasibility study and examined a call centre delivered continuing care intervention for people leaving residential rehabilitation services. Methods: Participants were attending AOD residential treatment services in NSW, Australia (N = 154). Participants were randomised to either 12‐ or 4‐sessions of continuing care. Follow up assessments were completed at 6‐months. The primary outcomes were demand and implementation. Secondary outcomes were AOD use, mental health and physical health at 6‐months. Results: Interest in continuing care was high, with 93% of participants approached reporting an interest in being involved. Of the participants who completed the consent and baseline procedures, 29% of people were contacted post residential treatment and randomised. For those people randomised, the average number of sessions completed was 2.78 (SD = 1.65) for the 4‐session arm and 4.81 (SD = 4.46) for the 12‐session arm. Fidelity to the treatment manual was high. Both treatment arms showed higher complete abstinence at 6‐months compared to baseline (12‐session OR 28.57 [2.3, 353.8]; 4‐session OR 28.11 [3.6, 221.2]). Discussion and Conclusions: A major challenge associated with the call centre approach was re‐engaging participants once they left the residential facility and delivering the planned dose of treatment. Further work is required to promote greater uptake of these protocols once people leave residential treatment. [ABSTRACT FROM AUTHOR]

Unlicensed boarding houses provide low cost accommodation for many people who have mental health and/or alcohol or other drug problems. The present study explored the needs and experiences of owners and managers of unlicensed boarding houses who have residents with MH and AOD problems. Twenty-three boarding house managers (BHMs) from Illawarra and Sydney areas participated in semi-structured interviews which were recorded and transcribed. Content analysis revealed most BHMs had very limited understanding of different types of mental health and substance use disorders. Almost all reported problems with individuals who they believed had such problems. Several BHMs found themselves in the role of "accidental counsellors", but their responsiveness to residents needs was highly variable. BHMs' inconsistent reactions to rule violations may create high levels of uncertainty amongst residents. The discussion describes options for addressing residents' needs including educational strategies for BHMs and facilitating links with support agencies.

There is increasing emphasis on the use routine outcome assessment measures to inform quality assurance initiatives. The calculation of reliable and clinically significant change indices is one strategy that organizations could use to develop both internal and externally focused benchmarking processes. The current study aimed to develop reliable and clinically significant change indices for a range of commonly used outcome measures in the substance abuse field. Participants were attending Kedesh Rehabilitation Services, an Australian residential substance abuse service that also accepts people with co-occurring mental health problems (n = 595). A range of mental health and substance use measures were administered to participants at intake to the service, and just prior to discharge at 7-weeks. Participants demonstrated statistically significant improvement across each of the measures. Rates of clinically significant improvement varied from 44 % to 85 % dependent on the criteria and outcome measure used. The calculation of clinically significant change provides a low cost, and relatively straightforward approach to evaluating and benchmarking program activities. It is likely that the results from the current study will be beneficial for other residential substance abuse services looking to benchmark their own program activities.

The co-occurrence of substance use and mental health problems, often referred to as dual diagnosis (DD), is increasingly recognised as commonplace within substance abuse treatment programs. Two-hundred and thirty-four individuals from 9 Australian Salvation Army drug and alcohol rehabilitation programs completed a 3-month post-discharge telephone follow-up. Using a cut-off score from the Psychiatric Subscale of the Addiction Severity Index (5th ed.), 66.7% were classified as likely to have DD and 33.3% as substance use disorder only (SUD). Both groups reported comparable and decreased substance use levels at follow-up, yet DD individuals perceived less improvement in substance use problems. Comparable improvements were reported in the areas of: symptom distress and recovery from symptoms. This was despite greater scope for improvement in individuals with DD. Duration of treatment and access to post treatment services were also assessed. Understanding factors effecting treatment outcomes is imperative for the implementation of effective, evidence based treatment programs.

Appropriate help-seeking is widely recognized as a protective factor, and vital for early treatment and prevention of mental health problems during adolescence. General medical practitioners (GPs), that is, family doctors, provide a vital role in the identification of adolescents with mental health problems and the provision of treatment as well as access to other specialists in mental health care services. The current study examined the association between suicidal ideation and intentions to seek help from a GP for suicidal thoughts, emotional problems and physical health problems, using a sample of 590 Australian high school students that was 56.7% female and aged 13-18 years (M = 15.56 years, SD = 0.66 years). Higher levels of suicidal ideation and general psychological distress were related to lower intentions to seek help from a GP for suicidal and physical problems. The results suggest that even at subclinical levels, increases in suicidal ideation or psychological distress may lead to help avoidance. School personnel and other gatekeepers need to be aware of this trend in order to be more assertive in encouraging and supporting appropriate help-seeking for mental health problems. School health promotion programs should consider including information to explicitly address the help-negation process.

Help-negation is expressed behaviorally by the refusal or avoidance of available help and cognitively by the inverse relationship between self-reported symptoms of psychological distress and help-seeking intentions. The current study examined the association between suicidal ideation and intentions to seek help from friends, family and professional mental health sources in a sample of 302 Australian university students. Participants were 77.5% female and aged from 18-25 years old, with 85.4% aged 21 years or younger. Higher levels of suicidal ideation were related to lower help-seeking intentions for family, friends, and professional mental health care, and higher intentions to seek help from no one. Moderation effects indicated that higher levels of depressive symptoms strengthen the help-negating effect of suicidal ideation for seeking help from friends, family and no one. The results indicate that, even at subclinical levels, suicidal ideation impedes the cognitive help-seeking process at the decision making stage. The results also highlight the importance of improving our understanding of why young people become reluctant to seek help as their levels of suicidal ideation and depressive symptoms increase. Raising awareness that the experience of suicidal ideation and depressive symptoms can promote intentions to avoid help might reduce the help-negation effect when symptoms are first recognized.

Adults who act as gatekeepers for young people may have the same barriers to help-seeking for mental health issues as young people. This study investigated the personal help-seeking practices of 47 Australian youth workers prior to and after a training workshop on youth mental health issues. Pre-post workshop evaluation revealed some increases in behaviour, intentions and problem-solving capacity but no changes in belief-based barriers, intentions to seek help for suicidal thoughts, or referral skills. The relationships between help-seeking variables and referral skills were explored to investigate the impact that personal help-seeking may have on professional practice. (Contains 2 notes and 2 tables.)

The "Building Bridges to General Practice" (BBGP) program is an outreach initiative. It aims to reduce young peoples' perceived knowledge- and belief-based barriers to engaging in treatment and to increase their behavioral intentions to consult a general medical practitioner (GP) for physical and psychological problems. By increasing intentions, the BBGP program aims to increase actual consultations with a GP for both types of problem. A quasi-experimental nested design was used to evaluate the effect of the intervention in three Australian high schools. A Treatment group (n = 173, M = 16 years) and Comparison group (n = 118, M = 15 years) completed questionnaires of perceived barriers, intentions and self-reported consultations with a GP. Questionnaires were completed 1 week before the intervention, 5 then 10 weeks post-intervention. The Treatment group, but not the Comparison group, showed reductions in perceived barriers over time, increased intentions to consult a GP for psychological problems and a significant correlation between intentions and subsequent GP consultations. Results support the utility of the intervention for improving adolescents' beliefs, intentions and behavior related to consulting a GP for physical and psychological problems.

Whether the help-negation effect as demonstrated for suicidal thoughts was also evident for depressive symptoms was investigated in three studies of young people from diverse urban areas. The studies involved a large sample of younger high school students (years 7-10), a sample of older high school students (years 8-12), and first year university students. A self-report questionnaire that measured help-seeking intentions, prior help-seeking experiences, and depression was administered. It was found that the strongest inverse association between level of depressive symptoms was with intentions to seek help from parents across all three samples. There was a consistent trend for students to report being more likely to seek help from no one as depressive symptoms increased. Evidence of the help-negation effect being present for depressive symptoms is discussed in terms of ways to encourage appropriate and effective help-seeking in young people. (Contains 5 tables.)

The study examined mental health case managers' attitudes toward the use of homework and explored the relationship between clinician attitudes and systematic homework administration practices. A survey examining attitudes toward the use of homework was completed by 122 Australian mental health case managers. Case managers who held more positive attitudes reported better client responses to homework. Systematic homework administration was predicted by the degree to which case managers felt that homework enhanced client outcomes and the importance that case managers placed on the use of homework for severe psychiatric disabilities. The use of training and supervision programs to promote systematic homework administration practice is discussed.

This study explored psychologists' use of homework with clients in general and specifically for clients with schizophrenia. A survey of 48 Australian psychologists confirmed patterns of homework use found in a New Zealand study of practitioners. Ninety-six percent of the Australian psychologists reported using homework and whilst homework was used in an average of 59% of sessions it was not administered systematically. Homework was viewed as least important for the problems of delusions and hallucinations. Psychologists reviewed their homework use with 38 clients who had schizophrenia and reported low motivation as the highest obstacle to homework adherence. Suggestions are made for addressing these barriers when working with clients who have schizophrenia. (Contains 2 tables.)

It is important to explore the types of conceptualisations and causes presented in online mental health promotion given the implications that these presentations may have on mental health stigma. This study systematically reviewed 92 Australian webpages focused on either mental health, mental illness, depression, or schizophrenia, to explore the types of conceptualisations and aetiologies presented. A minority of mental health and mental illness webpages (n = 8, 8.70%) explicitly presented continuum conceptualisations, with none providing explicit categorical conceptualisations. No depression or schizophrenia webpages presented explicit conceptualisations of any kind. All four webpage foci had a greater proportion of continuum than categorical conceptualisations. Moreover, both depression and schizophrenia webpages presented many mixed conceptualisations which included both continuum and categorical messaging. Most webpages mentioned biological and social causes equally across webpage foci. These findings suggest that Australian mental health websites predominantly present continuum conceptualisations of mental health and mental illness. [ABSTRACT FROM AUTHOR]

The role of a practicing psychologist often involves uncertainty and ambiguity, and individuals differ in their ability to manage or "tolerate" this uncertainty. This study investigated the relationship between tolerance of uncertainty, pluralism and confidence in case formulation in a sample of Australian psychologists. The sample consisted of 190 Australian psychologists, aged between 22 and 69 years (M = 30.48, SD = 8.04) and comprising mostly females (77.9%). This study had a cross-sectional survey design in which participants completed measures of uncertainty tolerance, pluralism and confidence in case formulation. Hierarchical multiple regression was used to predict tolerance to uncertainty. The final regression model was significant and explained 39.1% of the variance in tolerance of uncertainty. The predictor variables that contributed significantly to the model were therapeutic orientation, age, pluralistic practice and confidence in case formulation. Stage of career and pluralistic philosophy did not contribute significantly to the model. Higher pluralistic practice and confidence in case formulation skills are related to higher tolerance of uncertainty. Training in pluralistic models of therapy and the hypothesis generation approach to case formulation may offer the potential to increase uncertainty tolerance in practicing psychologists. [ABSTRACT FROM AUTHOR]

Young people living in families impacted by familial mental illness are at increased risk of various negative mental and physical health outcomes. Prevention and early intervention programmes are useful in mitigating the risk of transgenerational transmission of mental illness. Therapeutic recreation camps constitute a novel approach to mental health early intervention and prevention for these young people, incorporating educational experiences within a peer‐based environment. This study assessed the outcomes of attending the Australian Kookaburra Kids Foundation camps for young people living in families impacted by familial mental illness. A pre‐post design was used with 237 young people between 8 and 18 years old. Mixed analyses of variance (ANOVAs) found significant improvements in young people's mental health knowledge and intentions to seek help using an anonymous telephone helpline after attending the programme. Results also revealed that males became more likely to seek help from regular contacts within their established networks after attending the programme. These findings contribute towards an increased understanding of the extant help‐seeking processes involved among an at‐risk population, with focused attention on subgroups who are less likely to seek help for their issues. [ABSTRACT FROM AUTHOR]

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Borderline personality disorder (BPD) is associated with paradoxical trust behaviours, specifically a faster rate of trust growth in the face of trust violations. The current study set out to understand whether attachment style, self-protective beliefs, and feelings of rejection underpin this pattern. Young adults (N=234) played a 15-round trust game in which partner cooperation was varied to create three phases of trust: formation, dissolution, and restoration. Discontinuous growth modelling was employed to observe whether the effect of BPD trait count on trust levels and growth is moderated by fearful or preoccupied attachment style, self-protective beliefs, and feelings of rejection. Results suggest that the slower rate of trust formation associated with BPD trait count was accounted for by feelings of rejection or self-protective beliefs, both of which predicted a slower rate of trust growth. The faster rate of trust growth in response to trust violations associated with BPD trait count was no longer significant after self-protective beliefs were accounted for. Interventions targeting self-protective beliefs and feelings of rejection may address the trust-based interpersonal difficulties associated with BPD. [ABSTRACT FROM AUTHOR]

Objective: Postgraduate psychology programmes are required to maintain a formal record of individual trainee placement hours in the format of placement logbooks. Anecdotal reports suggest there is substantial variability in the way practicum logbooks are configured and utilised across Australian institutions. This study aimed to provide benchmarking information on the practicum logbooks of Australian-based postgraduate psychology programmes. Method: Postgraduate psychology training programmes across Australia were invited to share their logbook instructions and templates. Results: Templates from 40 postgraduate psychology programmes delivered across 27 higher education providers were received. There was consistency across programmes in some elements of logbooks such as recording the date and duration of placement activities, and a placement supervisor signature. Almost all logbooks included a tally of placement hours (97.5%) and specified individual (92.5%) and group (95%) supervision hours. There was high variability in relation to all other entries. For example, only a third included space for supervisee reflections and inclusion of different sub-categories of types of direct client work ranged from 8% to 85.7% dependent on the programme. Conclusions: Findings highlight the need for standardisation of logbook processes to increase confidence in the accuracy of recorded placement hours. Key Points What is already known about this topic: Postgraduate psychology programmes are required to maintain a formal record of placement hours and experiences of each trainee in the format of placement logbooks. Anecdotal reports suggest there is substantial variability in the way practicum logbooks are configured and utilised across Australian institutions. The functionality of logbooks differs substantially dependent on the type and depth of information recorded, with potential utility for competency gevaluations, placement planning and reflective practice. What this topic adds: Benchmarking of 40 postgraduate psychology programme logbooks indicated that programmes are reasonably consistent in data collected that meets minimal accreditation standards. There were significant discrepancies in terms of the amount and depth of information recorded (e.g., client information and sub-categories of client hours) and the utility of logbooks for reflection and competency assessments. Findings highlight the need to reconsider current placement logbook practices, with a view to optimising and extending beyond the traditional accounting and oversight functions. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) can lead to significant psychological distress, but few psychologists in Australia are trained in working with this complex clinical group. Despite government funding to provide video-consulting (VC) services in Australia, uptake before COVID-19 was limited. This mixed methods study evaluated whether training in eHealth and evidence based TBI psychological therapies increased provider uptake of VC in clinical practice, and delivery of mental health services to individuals with TBI. Mental health professionals completed a range of self-report measures before (n = 50), after (n = 48), and four months following (n = 30) a one-day workshop. Participants' TBI knowledge, client-base and levels of access, confidence, motivation and attitudes toward VC were assessed. Knowledge did not increase after training but participants had significant increases in their confidence and motivation to using VC at follow up. Significant reductions in pragmatic barriers to using VC were reported post training and at follow up, all barrier categories indicated significant reductions. There was no significant change in clinical practice of the participants. Training to increase TBI knowledge requires specific assessment tools and although training appears to reduce barriers to using VC, uptake in clinical practice may require additional supervision and warrants further research. [ABSTRACT FROM AUTHOR]

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

Introduction and Aims: The collection of routine outcome measurement (ROM) data provides an opportunity for service providers to conduct benchmarking to inform quality assurance practices. To conduct comparative benchmarking, it is important that services have access to comparative data. This paper aims to establish effectiveness indicators for ROM data collected within the alcohol and other drug (AOD) sector.Design and Methods: ROM data were collected by specialist non-government AOD treatment services within the Network of Alcohol and other Drugs Agencies online database (i.e. NADAbase). All participants were attending treatment within New South Wales, Australia (N = 21 572). Effectiveness indicators were calculated by using effect sizes, standard error of measurement, and rates of reliable and clinically significant change. The study focused on quality of life (EUROHIS Quality of Life Scale), psychological distress (Kessler-10) and substance dependence (Substance Dependence Scale).Results: Since 2010, 21 572 unique people have completed at least one NADAbase Client Outcome Measure. Amphetamines (36%) and alcohol (32%) were the most commonly reported primary substances of concern. Effectiveness indicators were established for the total sample, as well as for people attending residential rehabilitation (n = 8161) and community-based (n = 10 306) treatment services. Standard error of measurement was the least stringent effectiveness indicator (i.e. a higher proportion of people demonstrated improvement), while the clinically significant change was the most stringent approach.Discussion and Conclusions: The study demonstrated the utility of the NADAbase to establish effectiveness indicators for benchmarking purposes. Recommendations are provided for the use of benchmarking to inform quality assurance activities in the sector. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Clinical practice guidelines recommend physical health be addressed when treating substance use disorders. Yet, the integration of alcohol and other drug (AOD) treatment and physical health care is seldom actualised. This is particularly the case in the non‐government sector. Using the socio‐ecological model as a framework, this study aimed to examine the facilitators and barriers to integrating physical health in non‐government AOD services. Design and Methods: Interviews were conducted with residential and outpatient AOD services across New South Wales, Australia. Qualitative data were collected from service users (n = 20) and clinicians (n = 13). Interview data were transcribed then systematically coded and analysed using iterative categorisation. Results: Most staff recognised physical health care as a fundamental component of treatment for substance use even when there were personal, professional and structural barriers for doing so. Service users reported a diverse range of health and social benefits when physical health care was incorporated in to AOD treatment. An exception to this was some negative experiences with health‐care providers that were not identified by staff. Discussion and Conclusions: Findings highlight the importance of developing resources to enhance the health literacy and capacity of non‐government AOD services to address the physical health of clients. Given some clients reported negative experiences with health‐care providers that were not identified by staff, services should seek regular feedback from clients regarding their experiences with external providers. The effectiveness of existing and new physical health initiatives within non‐government organisation AOD services needs more formal evaluation. [ABSTRACT FROM AUTHOR]

Aim: How dietitians are trained to develop relationships with clients is not clearly articulated despite its importance being well‐documented. This study aimed to describe how this relationship is expressed and addressed in curriculum documents of Australian dietetics education programs, and to explore program coordinators' perspectives of this description and how relationship development is actually taught. Methods: Data extracted from subject outlines included subject descriptions, learning outcomes, assessments, readings and the mode of delivery (eg, lectures). Guided by a pre‐existing coding framework, deductive thematic analysis was utilised to explore qualitative themes from subject outline data. Semi‐structured telephone interviews were conducted with 10 program coordinators and analysed using inductive thematic analysis. Results: Subject outlines for 122 subjects across all 21 accredited Australian programs were analysed. The over‐arching theme was the wide "variability" in the ways that the client‐dietitian relationship was expressed across subject outlines. Program coordinators perceived that findings from the analysis of subject outlines made sense, however, acknowledged limitations of analysing data from curriculum documents. The relationship appeared ambiguously defined amongst programs and was described as occurring mostly in communication, counselling and medical nutrition therapy subjects and through theoretical and practical learning. Conclusion: The client‐dietitian relationship appears inconsistently embedded in the curriculum of Australian dietetics education programs despite widespread acceptance of its importance to practice. Further research is needed to investigate if training programs should embed more consistent language around therapeutic relationships, and how this might be achieved to reflect current competency standards. [ABSTRACT FROM AUTHOR]

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

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

Introduction and Aims: Guided by cognitive theory of loneliness, this study sought to explore the experience of loneliness among people accessing treatment for substance use disorders. Specifically, contributors to, consequences and alleviators of loneliness were explored.Design and Methods: Individual semi-structured interviews were conducted with 20 participants. Interviews were conducted onsite at two residential treatment facilities in New South Wales, Australia. Interviews were audio recorded and transcribed and an iterative categorisation approach was used to guide data analysis and reporting.Results: Four key themes emerged as contributors to and consequences of loneliness: cognitions (mistrust, perceived support from others, low self-worth and fear of negative evaluation), quality and authenticity of relationships, unhelpful interpersonal behaviours and the role of substance use. Participants indicated that overcoming the cognitive and behavioural perpetuators helped to alleviate loneliness and also described the utility of support groups, pursuit of authentic relationships and activities that provide a sense of purpose as helpful.Discussion and Conclusions: Cognitions related to mistrust, lack of perceived support, low self-worth, fear of negative evaluation and identification and pursuit of meaningful relationships supportive of recovery should be key treatment targets for this population. [ABSTRACT FROM AUTHOR]

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

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

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

Objective: Comorbid eating disorders (EDs) and ED symptoms are highly prevalent among women with substance use disorders and may be a barrier to recovery. Higher rates of psychiatric illness are common when more than one disorder is present. Yet little is known about the rates and risk factors for EDs/ED symptoms in women attending treatment centers in Australia. The primary aim is to examine the prevalence of ED symptoms among women attending treatment centers. This study also examines past physical and sexual abuse and mental health as specific predictors of EDs/ED symptoms. Methods: Participants were 1,444 women attending residential treatment for substance use issues provided by the Salvation Army in Australia. Measures included the Addiction Severity Index, the Eating Disorder Screen for Primary Care, medication use, hospitalization, mental health, and past abuse. Results: Alcohol was the primary substance of concern for 53.3% of the women, followed by amphetamines (17.5%), and the mean age was 37.83 years (SD = 10.8). Nearly 60% of women screened positive for ED symptoms and 32% reported a previous or current ED. Women with a history of sexual abuse had significantly greater odds (1.96) of positive screening for an ED compared to those without a history of sexual abuse. Similarly, compared to women without a history of physical abuse, those who did have a history had significantly higher odds (1.59) of a positive screen for an ED. These women were also significantly more likely to have had a health care provider recommend they take medications for psychological or emotional problems in the past 30 days, χ2(1) = 8.42, p =.004, and during their lifetime, χ2(1) = 17.89, p <.001. They also had a significantly greater number of overnight hospitalizations for medical problems compared to those who screened negative, t(137) = −2.19, p =.03. Conclusions: Women with comorbid substance use issues and EDs are highly likely to have a history of past abuse. This combination of comorbidities makes treatment and recovery difficult. Increased awareness and research are required to explore integrated approaches to treatment that accommodate these vulnerabilities and improve long-term outcomes. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Insight is a multi-dimensional construct that predicts treatment outcomes of people with mental illness. Research into insight in substance dependent populations is limited and measures of cognitive insight have not been validated for this population.Design and Methods: A cross sectional survey was conducted with residents of nine residential substance dependence treatment facilities in Australia. Cognitive insight was assessed using the Beck Cognitive Insight Scale (BCIS). Psychological distress was assessed using the Kessler 6 (K6).Results: Participants (N = 312) were primarily male (68.6%), with an average age of 37.51 years (SD = 9.85). Methamphetamine (45.2%) and alcohol (35.9%) were the primary substances of use. A confirmatory factor analysis confirmed the two-factor model of the BCIS (CMIN/DF = 2.91, CFI = 0.84). Removing two items from the Self-Reflection subscale improved model fit (CMIN/DF = 2.71, CFI = 0.84, Χ 2[22, n = 312] = 76.43, P < 0.02). Internal consistency analyses indicated acceptable internal reliability (Self-Reflection α = 0.73, Self-Certainty α = 0.72, composite α = 0.75). Self-Certainty scores were significantly higher for participants with a self-reported psychotic disorder (M = 14.95 vs. M = 13.04, P = 0.007). Self-Reflection scores were higher for people experiencing psychological distress (M = 17.57 vs. M = 15.95, P = 0.001).Discussion and Conclusions: We found that a 12-item version of the BCIS had good psychometric properties in this substance-using population. Further research is needed to explore whether insight can predict treatment outcomes for substance use. [ABSTRACT FROM AUTHOR]

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

Objective: Our goal was to develop and pilot a methodology that could reliably identify therapeutic homework tasks that are coherent with the goals of individuals receiving mental health recovery support. Method: The content of goals and therapeutic homework tasks of 66 clients were classified using the Camberwell Assessment of Need Goal-Action Plan (CAN-GAP) taxonomy. Goal-homework pairs were considered coherent if the content of the homework and goal were both independently assigned the same content domain. Results: The content of the goals and homework tasks were found to be highly coherent, with a 75% match in categories. Conclusions and Implications for Practice: It is possible to simply, and reliably, determine whether the content of goals and homework tasks are coherent. Lower coherence would require support workers to spend more time making the connection between homework and goals more explicit. Future research should determine whether higher coherence leads to greater goal attainment. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Methamphetamine (MA) use has increased markedly over the past decade, during which time there has been an increase in children in out of home care. This study explores whether MA use in parents attending residential treatment services for substance use issues is associated with higher proportions of children living out of the home.Design and Methods: Data were collected from individuals attending residential treatment centres provided by the Australian Salvation Army between 2009 and 2016. Centres provide residential alcohol and other substance use treatment in a modified therapeutic community. Trained staff administered sections of the Addiction Severity Index measuring substance use, legal and parenting status, and the Mental Health Screening Form-III at intake. Data were limited to those who had at least one child under 18 years; final sample size was 2964.Results: Of the 2964 parents, 36.3% nominated MAs use as a primary or secondary substance of use. Between 2011 and 2016, a significantly greater proportion of parents using MAs (86.1%), had at least one child not living at home compared to those using other substances (81.3%; χ2 =7.95, P = 0.005). The proportion of female parents increased significantly 14.7% (2009) to 37.9% (2016; χ2 = 51.54, P < 0.001). Also, more males (83.7%) than females (79.6%) had a child living out of home (χ2 = 11.23, P = 0.01).Discussion and Conclusions: Given that MA use can result in increased risks of violence and neglect the increase in parents using the substance is concerning. The growing number of mothers in treatment warrants further investigation, particularly as women face inherent difficulties in seeking treatment with dependent children. [ABSTRACT FROM AUTHOR]

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

Purpose The purpose of this paper is to investigate the relationships between clinicians’ and managers’ risk aversion and a range of variables related to the implementation of the Collaborative Recovery Model (CRM). Positive risk taking is an integral component of the recovery process. Clinicians’ risk aversion has the potential to negatively impact on their implementation of recovery-oriented practices. The CRM provides an evidence-based framework to assist consumers to participate in the recovery process. However, there is a need for research to clarify the factors related to recovery that have impact on managers’ and clinicians’ risk aversion, and ultimately on implementation of recovery practices.Design/methodology/approach A cross-sectional survey assessed clinicians’ (n=174) and managers’ (n=48) risk aversion and their self-reported learning experiences, commitment to using CRM, goal setting attitudes and CRM implementation behaviour.Findings Clinicians who reported more risk aversion were significantly more likely to report positive attitudes towards goal setting. Stepwise regression revealed that training experiences, goal setting attitudes and commitment to CRM significantly predicted an increase in CRM implementation. Over and above this, risk aversion predicted a small but significant increase in the self-reported use of CRM. Managers experienced significantly less risk aversion than clinicians, with a negative relationship between risk aversion and commitment to CRM principles.Originality/value This paper suggests that clinicians’ risk aversion impacts upon their implementation of the CRM, with managers less risk averse than clinicians. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to investigate Keyes’ (2007) model of mental health, the presence (flourishing) or absence (languishing) of social, emotional and psychological wellbeing, in the context of drug and alcohol misuse and the frequency and pattern of community participation (engaging in society).Design/methodology/approach Participants were 1,815 individuals (70 per cent male) who entered residential substance misuse treatment provided by The Salvation Army. Questionnaires were completed at intake assessments with The Salvation Army staff. The data were compared with population norms of community participation utilising t-tests, while multiple linear regression was used to examine continuous mental health.Findings Although participants have lower levels of community participation compared to Australian population norms, those participants who were experiencing flourishing mental health had higher rates of community participation than Australian norms. Keeping in touch with friends and family was the most common form of participation. Informal social connectedness and civic engagement were the strongest predictors of mental health over and above more traditional substance use outcomes such as cravings.Originality/value This is one of the first studies to describe the relationships between community participation, substance use and mental health in participants seeking treatment for substance misuse. Despite having a drug or alcohol addiction requiring treatment, those participants with flourishing mental health have higher levels of community participation than community norms. Furthermore, community participation predicts mental health. This offers promise for interventions that increase community participation but further research using longitudinal designs is needed to replicate and clarify the direction of these relationships. [ABSTRACT FROM AUTHOR]

Objective Supervisor assessments of trainee competence are integral to ensuring that clinical psychology trainees reach competency benchmarks. The commonly used Clinical Psychology Practicum Competencies Rating Scale (CΨ PRS) has been shown to elicit inflated ratings of competency. Hence, the aim of this study is to examine whether brief supervisor training reduces ratings by providing objective criteria with which supervisors can assess trainee competency. Method The ratings included were of 124 psychology trainees from nine Australian university clinical programmes. Of 170 supervisors, 32 completed the online training immediately prior to commencing the CΨ PRS. Training required supervisors to rate the competency level described in five standardised vignettes (Beginner through to Competent). Vignette ratings, as determined by a panel of expert supervisors, were provided as feedback. A sixth calibration vignette was also rated (no feedback provided). Firstly, CΨ PRS ratings from the trained and untrained supervisors were compared. Secondly, the difference between supervisor and expert ratings of the calibration vignettes were compared across trained and untrained groups. Results Trained supervisors provided lower CΨ PRS ratings than untrained supervisors. In addition, trained supervisors (vs untrained supervisors) provided ratings of the calibration vignette that more accurately matched the ratings provided by the expert panel. Conclusions Brief online training using standardised vignettes was associated with lower CΨ PRS ratings. The standardised vignettes helped calibrate supervisors' ratings and likely attuned supervisors to the skills and competency levels that are expected at particular developmental stages. As a consequence, training appeared to reduce ratings, arguably resulting in more accurate assessments of trainee performance. [ABSTRACT FROM AUTHOR]

Objectives: Smoking continues to be a major health concern for people with a history of alcohol or other substance use problems. The current research is aimed to (1) describe the prevalence of smoking in residential addictions treatment services and (2) compare characteristics of people who had or had not quit smoking.Methods: Participants were attending residential substance abuse treatment provided by the Australian Salvation Army. These programs are up to 10 months in length and offer a range of low-intensity smoking cessation supports. Measures of smoking, substance use, and clinical characteristics were collected from 2008 to 2015 at baseline and three months post-discharge from treatment (N= 702).Results: At baseline, 86% of people were smokers (n =606). At follow-up, only 48 participants who were smokers at baseline (7%) had quit smoking. Participants who had quit smoking at follow-up also reported higher rates of abstinence from alcohol or other substances at follow-up (72%) than people who had not quit smoking (46%;OR= 2.95, 95% CI [1.52, 5.74]).Conclusions: There is potential for smoking cessation to be better addressed as part of routine care in substance abuse treatment settings. Future research should evaluate the provision of more systematic smoking cessation interventions within these settings. [ABSTRACT FROM PUBLISHER]

Purpose Recovery in mental health emphasises the empowerment of clients to discover and develop hope and a more satisfying life often in the presence of ongoing symptoms of mental illness. Work values that are incompatible with values that underpin the recovery philosophy may be contributing to the challenges in implementing recovery values in practice. The purpose of this paper is to explore the types of work values espoused by Australian mental health workers and their degree of congruence with recovery values.Design/methodology/approach In total, 65 Australian mental health workers completed an open-ended work values question. Leximancer content analysis was used to generate a thematic work values profile followed by a theory-led thematic analysis of the responses to assess congruence with recovery values.Findings This sample valued client-centred practice that supports recovery, making a difference in others’ lives, work competence, being caring and empathic, and meaningful work. Overall, there was substantial congruence between work and recovery values, with less evidence of endorsement of values relating to strengths-based approaches, personal responsibility, and positive self-identity. These values should be targeted in future training initiatives.Originality/value The current study is the first study to identify the types of work values espoused by Australian mental health workers and to examine the degree to which they are recovery-consistent. This is an important research agenda given the high national and international priority to adopt a recovery orientation, and the need to identify and modify potential barriers to the implementation of recovery-oriented services. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Despite clinical recommendations that further treatment is critical for successful recovery following drug and alcohol detoxification, a large proportion of clients fail to attend treatment after detoxification. In this study, individual factors and constructs based on motivational and volitional models of health behaviour were examined as predictors of post-detoxification treatment attendance.Design and Methods: The sample consisted of 220 substance-dependent individuals participating in short-term detoxification programs provided by The Australian Salvation Army. The Theory of Planned Behaviour and Implementation Intentions were used to predict attendance at subsequent treatment.Results: Follow-up data were collected for 177 participants (81%), with 104 (80%) of those participants reporting that they had either attended further formal treatment (e.g. residential rehabilitation programs, outpatient counselling) or mutual support groups in the 2 weeks after leaving the detoxification program. Logistic regression examined the predictors of further treatment attendance. The full model accounted for 21% of the variance in treatment attendance, with attitude and Implementation Intentions contributing significantly to the prediction.Discussion and Conclusions: Findings from the present study would suggest that assisting clients to develop a specific treatment plan, as well as helping clients to build positive perceptions about subsequent treatment, will promote greater attendance at further treatment following detoxification. [Kelly PJ, Leung J, Deane FP, Lyons GCB. Predicting client attendance at further treatment following drug and alcohol detoxification: Theory of Planned Behaviour and Implementation Intentions. Drug Alcohol Rev 2016;35:678-685]. [ABSTRACT FROM AUTHOR]

Background: The implementation and use of evidence-based practices is a key priority for recovery-oriented mental health service provision. Training and development programmes for employees continue to be a key method of knowledge and skill development, despite acknowledged difficulties with uptake and maintenance of behaviour change. Self-determination theory suggests that autonomy, or a sense that behaviour is self-generated, is a key motivator to sustained behaviour change, in this case practices in mental health services. This study examined the utility of values-focused staff intervention as a specific, reproducible method of autonomy support.Methods: Mental health workers (n = 146) were assigned via cluster randomisation to either a values clarification condition or an active problem-solving control condition.Results: Results demonstrated that a structured values clarification exercise was useful in promoting integrated motivation for the changed practice and resulted in increased implementation planning.Conclusions: Structured values clarification intervention demonstrates utility as a reproducible means of autonomy support within the workplace. We discuss future directions for the study of autonomous motivation in the field of implementation science.Trial Registration: ACTRN12613000353796. [ABSTRACT FROM AUTHOR]