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Background: Less than optimal outcomes and escalating costs for chronic conditions including mental illness have prompted calls for innovative approaches to chronic illness management. Aims: This study aimed to test the feasibility and utility of combining a generic, clinician administered and peer-led self-management group approach for people with serious mental illness. Method: General practitioners and mental health case managers used a patientcentred care model (the Flinders model) to assist 38 patients with serious mental illness to identify their self-management needs, and match these with interventions including Stanford peer-led, self-management groups and one-to-one peer support. Self-management and quality of life outcomes were measured and qualitative evaluation elicited feedback from all participants. Results: Collaborative care planning, combined with a problems and goals focused approach, resulted in improved self-management and mental functioning at 3 to 6 months follow-up. The Stanford self-management course was applicable and acceptable to patients with serious mental illnesses. Qualitative feedback was highly supportive of this approach. Conclusions: Generic, structured assessment and care planning approaches, resulting in self-management education targeted to the individual, improved self-management and quality of life. Patients and service providers reported considerable gains despite the challenges associated with introducing a generic model within the mental health and general practice sector.

Abstract: Currently, it is unknown whether treatment outcomes derived from randomized controlled trials (RCTs) of cognitive–behavioural therapy (CBT) for problem gamblers still hold when applied to patients seen in routine practice. Thus, data from an RCT of cognitive therapy versus exposure therapy for problem gambling versus patients of a gambling help service were compared. Assessments of problem gambling severity, psychosocial impairment, and alcohol use were undertaken at baseline and post‐treatment and evaluated within a counterfactual framework. Findings showed that the contrast between routine CBT for pokies and horse betting had a significant effect, indicative of a 62% lower gambling urge score if routine CBT recipients had all been horse/track betters opposed to gambling with “pokies.” However, the majority of contrasts indicated therapeutic outcomes achieved in routine CBT treatments were of equivalent robustness relative to RCT conditions. The present findings infer routine practice treatment outcomes are as efficacious as those generated in RCT contexts. [ABSTRACT FROM AUTHOR]

The aim of this study was to establish reliability and validity of the Gambling Urge Scale (GUS) in a clinical population of problem gamblers. This cohort study was conducted in South Australia between March 2008 and March 2009. Participants were problem gamblers aged ≥18 years ( n = 158) who were seeking treatment from a range of gambling help services. Measures included gambling urge, problem gambling screening, gambling behaviour and problems caused by gambling, such as personal health and relationships. The psychometric properties investigated were internal reliability, criterion-related validity, concurrent validity and construct validity. Results showed high internal consistency for GUS ( α = 0.93) and significant item-rest correlations ranging from 0.72 to 0.86. For criterion-related validity, a GUS cut score of three correctly classified 81.13% of participants as problem gambling with sensitivity 84.75% and specificity 76.6%. Concurrent validity was significant with a number of gambling-related symptoms and problems including psychological disturbance, work and social functioning and gambling-related cognitions ( p < 0.001). An insignificant correlation was found between gambling urge and sensation seeking traits ( p = 0.663). When controlling for gender and age the instrument was shown to have significant predictive properties for different levels of gambling severity ( p < 0.001). A principal component analysis for the one component showed an overall explained variance of 75.54%. These findings indicate that GUS is a valid and reliable instrument for problem gambling screening, to measure treatment outcomes and may predict relapse in problem gambling. [ABSTRACT FROM AUTHOR]

A pilot program for Aboriginal people with diabetes on Eyre Peninsula, South Australia, aimed to test the acceptability and impact of using the Flinders model of self-management care planing to improve patient self-management. A community development approach was used to conduct a twelve-month demonstration project. Aboriginal health workers (AHWs) conducted patient-centred, self-management assessment and care planning. Impacts were measured by patient-completed diabetes self-management assessment tool, goal achievement, quality of life and clinical measures at baseline and 12 months. Impact and acceptability were also assessed by semi-structured interviews and focus groups of AHWs. Sixty Aboriginal people with type 2 diabetes stated their main problems as family and social dysfunction, access to services, nutrition and exercise. Problems improved by 12% and goals by 2 6%, while quality of life scores showed no significant change. Self-management scores improved in five of six domains. Mean HbA1c reduced from 8.74-8.09 and mean blood pressure was unchanged. AHWs found the process acceptable and appropriate for them and their patients. It was concluded that a diabetes self-management program provided by AHWs is acceptable, improves self-management and is seen to be useful by Aboriginal communities. Barriers include lack of preventative health services, social problems and time pressure on staff. Enablers include community concern regarding the prevalence and mortality associated with diabetes. [ABSTRACT FROM AUTHOR]

This case describes the use of innovative person-centred motivational behaviour change tools to enhance chronic condition self-management with a person with chronic paranoid schizophrenia, significant drug abuse and multiple psychosocial issues. In standard care, the complexity of this patient's presentation, their cognitive impairment level and history of violence would likely exclude them from many therapies and treatment programs as unsuitable or in the "too hard" basket. In fact, using a motivational and highly person-centred approach proved to be extremely necessary and rewarding for the person and their mental health worker. This approach provided a clear structure, actual tools and a clear rationale for what many would argue, yet is often ill-defined, was "just good clinical practice". However, it also facilitated the development of "something special" in the relationship between the person and their worker that is central to person-centred care. Through a semistructured, motivational, sequential process that encouraged gradual disclosure and greater self-awareness by the client and active listening by the worker, greater collaboration and shared responsibility was enhanced.