Diagnostic colonoscopy completion after abnormal fecal immunochemical testing and quality of tests used at 8 Federally Qualified Health Centers in Southern California: Opportunities for improving screening outcomes.

BACKGROUND: The effectiveness of colorectal cancer screening with fecal immunochemical tests (FITs) of stool blood depends on high rates of colonoscopy follow-up for abnormal FITs and the use of high-quality tests. This study characterized colonoscopy referral and completion among patients with abnormal FITs and the types of FITs implemented in a sample of Southern California Federally Qualified Health Centers (FQHCs). METHODS: FQHCs in San Diego, Imperial, and Los Angeles Counties were invited to define a cohort of ≥150 consecutive patients with abnormal FITs in 2015-2016 and to provide data on sex, insurance status, diagnostic colonoscopy referrals and completion within 6 months of abnormal FITs, and the types (brands) of FITs implemented. The primary outcomes were the proportions with colonoscopy referrals and completion for all patients at each FQHC and in aggregate. RESULTS: Eight FQHCs provided data for 1229 patients with abnormal FITs; 46% were male, and 20% were uninsured. Among patients with abnormal FITs, 89% (1091 of 1229; 95% confidence interval [CI], 0.87-0.91) had a colonoscopy referral, and 44% (539 of 1229; 95% CI, 0.41-0.47) had colonoscopy completion. Across FQHCs, the range for colonoscopy referral was 73% to 96%, and the range for completion was 18% to 57%. Six of the 8 FQHCs (75%) reported FIT brands with limited data to support their effectiveness. CONCLUSIONS: In a sample of Southern California FQHCs, diagnostic colonoscopy completion after abnormal FITs was substantially below the nationally recommended benchmark to achieve 80% completion, and the use of FIT brands with limited data to support their effectiveness was high. These findings suggest a need for policies and multilevel interventions to promote diagnostic colonoscopy among individuals with abnormal FITs and the use of higher quality FITs.

Approaches to the Assessment of Children in the Context of Disasters.

Children exposed to disasters are a vulnerable population, making the assessment of children post-disaster an important issue. Utilizing a Multiple Gating Stepped Care framework, we highlight recent literature related to post-disaster assessment and intervention for children. In particular, we focus on screening, clinical evaluation, and feedback-informed service delivery. Screening allows large populations of children to be assessed at a relatively low cost. Children identified by screening as being at risk may then be assessed through more in-depth clinical evaluations, in order to assess clinical symptoms, strengths, and stressors, and to make determinations about appropriate interventions. Continued assessment during therapy provides important feedback for the delivery of appropriate care. New formats for assessment, as well as issues related to identifying sources for assessment, are discussed. Recommendations for future directions are provided.

Improving the Impact and Implementation of Disaster Education: Programs for Children Through Theory-Based Evaluation.

A main weakness in the evaluation of disaster education programs for children is evaluators' propensity to judge program effectiveness based on changes in children's knowledge. Few studies have articulated an explicit program theory of how children's education would achieve desired outcomes and impacts related to disaster risk reduction in households and communities. This article describes the advantages of constructing program theory models for the purpose of evaluating disaster education programs for children. Following a review of some potential frameworks for program theory development, including the logic model, the program theory matrix, and the stage step model, the article provides working examples of these frameworks. The first example is the development of a program theory matrix used in an evaluation of ShakeOut, an earthquake drill practiced in two Washington State school districts. The model illustrates a theory of action; specifically, the effectiveness of school earthquake drills in preventing injuries and deaths during disasters. The second example is the development of a stage step model used for a process evaluation of What's the Plan Stan?, a voluntary teaching resource distributed to all New Zealand primary schools for curricular integration of disaster education. The model illustrates a theory of use; specifically, expanding the reach of disaster education for children through increased promotion of the resource. The process of developing the program theory models for the purpose of evaluation planning is discussed, as well as the advantages and shortcomings of the theory-based approaches.

Disaster preparedness for children and families: a critical review.

Preparedness for disasters is universally low; children and families are particularly vulnerable groups. Against this backdrop, research on disaster preparedness for children and families is reviewed, with a focus on disaster preparedness and prevention education programs. Following definitions and theory/rationale, research is critically analyzed. While findings indicate a large growth in research in the past 15 years and largely positive findings, significant challenges remain. These challenges include issues related to methodological rigor, long-term effectiveness, and implementation. Recent research reflecting these important challenges is reviewed. At the same time, other recent research documents real potential for these programs, including findings which suggest that increased attention to incorporating theory- and evidence-supported components can enhance outcomes. Thus, despite some important limitations and challenges, research done to date signals promise for these programs in reducing risk and increasing resilience to disasters for children, families, and the households and communities in which they live.

Interactive hazards education program for youth in a low SES community: a quasi-experimental pilot study.

A pilot study of an interactive hazards education program was carried out in Canberra (Australia), with direct input from youth participants. Effects were evaluated in relation to youths' interest in disasters, motivation to prepare, risk awareness, knowledge indicators, perceived preparedness levels, planning and practice for emergencies, and fear and anxiety indicators. Parents also provided ratings, including of actual home-based preparedness activities. Using a single group pretest-posttest with benchmarking design, a sample of 20 youths and their parents from a low SES community participated. Findings indicated beneficial changes on a number of indicators. Preparedness indicators increased significantly from pre- to posttest on both youth (p < 0.01) and parent ratings (p < 0.01). Parent ratings reflected an increase of just under six home-based preparedness activities. Youth knowledge about disaster mitigation also was seen to increase significantly (p < 0.001), increasing 39% from pretest levels. While personalized risk perceptions significantly increased (p < 0.01), anxiety and worry levels were seen either not to change (generalized anxiety, p > 0.05) or to reduce between pre- and posttest (hazards-specific fears, worry, and distress, ps ranged from p < 0.05 to < 0.001). In terms of predictors of preparedness, a number of variables were found to predict posttest preparedness levels, including information searching done by participants between education sessions. These pilot findings are the first to reflect quasi-experimental outcomes for a youth hazards education program carried out in a setting other than a school that focused on a sample of youth from a low SES community.

Combinations of social participation and trust, and association with health status-an Australian perspective.

A limited number of studies have examined the 'miniaturization of community' model which is based on belief that 'new' individualistic, and narrower forms of social participation, do not promote generalized trust in others. Little is known about miniaturization of community and self-reported health, physical health and psychological health in Australia. Data from a 2009 computer-assisted-telephone-interview survey was used to investigate generalized trust, social participation and health-related quality of life in a regional Australian population (n = 1273; mean age 51.2 years). Logistic regression analyses were performed to investigate the associations between generalized trust, social participation and poor self-reported health (global self-rated, psychological and physical), and included four social participation/trust categories. A majority (67%) reported high generalized trust of others, 54% were categorized as high social participators. Miniaturization of community was a risk factor for poor self-rated psychological health across genders, and a risk factor for poor self-rated health for males. For women, low social participation (irrespective of trust level) was associated with poor self-reported health. Given current and previous findings, there is a need for further research in a range of contexts which explores the underlying concept of miniaturization of community, that is, the changes in social participation and social networks which may negatively impact community health.

Associations between occupational indicators and total, work-based and leisure-time sitting: a cross-sectional study.

BACKGROUND: A better understanding of how occupational indicators (e.g. job type, doing shift-work, hours worked, physical demand) influence sitting time will aid in the design of more effective health behaviour interventions. The aim of the study was to examine the associations between several occupational indicators and total, occupational and leisure-time sitting. METHODS: Cross-sectional self-report data was collected in November 2011 from 1194 participants through a telephone interview in regional Queensland, Australia (response rate was 51.9%). The Workforce Sitting Questionnaire was used to measure sitting time. Multiple logistic regression was applied to examine associations between sitting time and occupational indicators. RESULTS: Of all participants 77.9% were employed full-time, 72.7% had white-collar jobs, 35.7% were engaged in shift-work, 39.5% had physically demanding jobs, and 53.2% had high total sitting time (>8 hours a day). Those in physically demanding and blue-collar occupations were less likely to report high total (physically demanding: OR = 0.41,95% CI = 0.29-0.58; blue-collar: OR = 0.55,95% CI = 0.37-0.82) and occupational (physically demanding: OR = 0.26,95% CI = 0.14-0.24; blue-collar: OR = 0.32,95% CI = 0.21-0.49) sitting time compared to those in physically undemanding and white-collar occupations respectively. Working more than 8 hours per day was inversely associated with high leisure-time sitting (OR = 0.44,95% CI = 0.29-0.68). No evidence for 'compensation' effects, where lower occupational sitting is compensated with higher leisure-time sitting, was found. CONCLUSIONS: Behaviour change interventions are needed to reduce sitting time as a means to prevent chronic disease. Workplace initiatives to reduce sitting time may be particularly important among individuals employed in white-collar and physical undemanding occupations, although other intervention strategies targeting leisure-time sitting are also required.

Salient beliefs about earthquake hazards and household preparedness.

Prior research has found little or no direct link between beliefs about earthquake risk and household preparedness. Furthermore, only limited work has been conducted on how people's beliefs influence the nature and number of preparedness measures adopted. To address this gap, 48 qualitative interviews were undertaken with residents in three urban locations in New Zealand subject to seismic risk. The study aimed to identify the diverse hazard and preparedness-related beliefs people hold and to articulate how these are influenced by public education to encourage preparedness. The study also explored how beliefs and competencies at personal, social, and environmental levels interact to influence people's risk management choices. Three main categories of beliefs were found: hazard beliefs; preparedness beliefs; and personal beliefs. Several salient beliefs found previously to influence the preparedness process were confirmed by this study, including beliefs related to earthquakes being an inevitable and imminent threat, self-efficacy, outcome expectancy, personal responsibility, responsibility for others, and beliefs related to denial, fatalism, normalization bias, and optimistic bias. New salient beliefs were also identified (e.g., preparedness being a "way of life"), as well as insight into how some of these beliefs interact within the wider informational and societal context.

Dissemination and effectiveness of multisystemic treatment in New Zealand: a benchmarking study.

The transportability of Multisystemic Therapy (MST) for the treatment of juvenile offenders in a community-based context was examined in the current study. Results of this New Zealand study showed that significant pre- to posttreatment improvements occurred on most indicators of ultimate (i.e., offending behavior) and instrumental (i.e., youth compliance, family relations) treatment outcomes. Reductions in offending frequency and severity continued to improve across the 6- and 12-month follow-up intervals. In comparison to benchmarked studies, the current study demonstrated a more successful treatment completion rate. Additionally, overall treatment effect sizes were found to be clinically equivalent with the results of previous MST outcome studies with juvenile offenders and significantly greater than the effect sizes found in the control conditions. The findings of this evaluation add to the growing body of evidence that supports MST as an effective treatment for antisocial youth.

Public health and natural hazards: new policies and preparedness initiatives developed from an Australian bushfire case study.

OBJECTIVE: Public preparedness for natural hazard events is low. With worsening severe weather events due to climate change, public health policy and practices must evolve to more effectively engage communities. This study's findings identify and suggest new strategic public health policies to shift the practice of all-hazards preparedness into routine, everyday life. METHODS: Semi-structured interviews, focus groups and Thematic Analysis were used to investigate the interactions between participant groups: emergency responders and animal owners. RESULTS: Three policies designed to improve human safety and well-being are proposed and discussed. These are (i) a new system of workplace leave, (ii) an innovative regime of financial incentives for fire-ready properties, and (iii) review of the use of firebreaks on farms and rural blocks. CONCLUSION: Policies proposed in this research aim to proactively narrow the awareness-preparedness gap and build adaptive capacity to minimise risk to human health in all-hazards contexts. Further research could evaluate the efficacy of trialled public policy. Implications for public health: These new policies seek to contribute to establishing and maintaining a culture of preparedness as a routine aspect of everyday life, and thus promote and protect public health in the short, medium and long terms.

Children in the 2015 South Indian floods: community members' views.

Little is known about children's experiences and involvement in disaster preparation and recovery, in particular in low- and middle-income countries. Eliciting community members' perspectives on the 2015 floods in Tamil Nadu, India, may generate useful insights for improving services in low-resource settings. This qualitative study aimed to understand how children in Chennai experienced the floods, as reported by the adults in their community, and to explore children's involvement in disaster preparedness, response and recovery efforts as reported from the adults' perspective. We conducted in-depth, semi-structured interviews (N = 48) with family members (n = 36), and with staff of non-governmental organizations (NGOs) (n = 12) who actively participated in relief and recovery efforts. We also conducted two focus group discussions (n = 14) with NGO staff about a year after the 2015 South Indian floods in Chennai, India. Six broad themes regarding children's experiences and behaviours during and after the floods emerged: (1) unexpectedness of the floods; (2) children's safety - barriers and facilitators; (3) parents' reactions - helplessness, fear and pride; (4) children's reactions - helping hands, fun and fear; (5) barriers to a return to 'normal'; and (6) a determination to be prepared for next time. Children and families were deeply impacted by the floods, in part owing to a lack of preparation, as perceived by the study participants. It was also clear from the data analysis that caste and socioeconomic status played an important role in the families' ability to evacuate safely. Helplessness on the part of the parents was apparent, as was children's concern over recurrence of the flood. Similarly, gender appeared to affect child safety, recovery and other outcomes such as continued education. Priorities for future efforts involve the development and evaluation of child-centred education about flood awareness, child participation and safety.

Antecedentes: Se conoce poco acerca de las experiencias de los niños y su participación en la preparación y recuperación de desastres, en particular en países de bajos y medios ingresos. La obtención de las perspectivas de los miembros de la comunidad sobre las inundaciones de 2015 en Tamil Nadu, India, puede generar reflexiones útiles para mejorar los servicios en entornos de bajos recursos. Objetivo: Este estudio cualitativo apuntó a comprender a) Cómo experimentaron las inundaciones los niños en Chennai, según el reporte de los adultos en su comunidad, y b) explorar la participación de los niños en la preparación para el desastre, la respuesta y las labores de reconstrucción, según el reporte desde la perspectiva de los adultos. Método: Realizamos entrevistas semi estructuradas en profundidad (N=48) con miembros de la familia (n=36), y con miembros de organizaciones no gubernamentales (n=12) que participaron activamente en las labores de ayuda y reconstrucción. También realizamos dos grupos de discusión (n=14) con miembros de ONG, aproximadamente un año después de las inundaciones del sur de la India en 2015 en Chennai, India. Resultados: Surgieron seis amplios temas respecto a las experiencias de los niños y las conductas durante y después de las inundaciones: a) Lo inesperado de las inundaciones; b) Las barreras y facilitadores para la seguridad de los niños; c) La reacciones de los padres - impotencia, miedo y orgullo; d) Las reacciones de los niños ­ ayuda, diversión y miedo; e) Las barreras para el retorno a lo 'normal', y f) Una determinación para estar preparados para una próxima vez. Conclusión: Los niños y las familias estuvieron profundamente impactados por las inundaciones, en parte debido a una falta de preparación, según la percepción de los participantes del estudio. También fue claro desde el análisis de los datos que el status socioeconómico y de castas jugó un rol importante en la capacidad de las familias para evacuar en forma segura. La impotencia de parte de los padres fue evidente, así como también la preocupación de los niños por la recurrencia de la inundación. Así también, el género pareció afectar la seguridad, recuperación y otros resultados de los niños, como la continuidad en la educación, etc. Las prioridades para los esfuerzos futuros incluyen el desarrollo y evaluación de la educación centrada en los niños acerca de la concientización de las inundaciones, participación de los niños, y seguridad.

The application of a feedback-informed approach in psychological service with youth: Systematic review and meta-analysis.

Research with adults has consistently demonstrated that the use of regular client feedback in psychological services can improve outcomes. However, there appear to be fewer studies with youth. The purpose of the current review was to explore/assess (1) current developments in research on the use of feedback-informed approaches in mental health interventions or services for youth 10-19years of age; (2) the efficacy of client feedback in youth treatment settings; and (3) consider future directions for research. A total of 12 studies were included in this review, comprising a meta-analysis (n=9) and a qualitative review (n=3). Most studies assessed the benefits of a feedback framework in terms of symptom severity, functioning levels and/or goal attainments in therapy (i.e., ratings on the feedback-informed tools). The Hedges's g indexes of 0.20 (for independent-groups trials), 0.32 (single-group trials) and 0.28 (for all trials) suggest that the collection and application of continuous feedback from youth clients throughout the course of the interventions/services can boost and produce beneficial outcomes for the youth, while noting the feedback effect to be in the small range. Based on these initial findings, implications for future research and clinical practice are discussed, including considering fruitful research directions.

Expanding protection motivation theory: investigating an application to animal owners and emergency responders in bushfire emergencies.

BACKGROUND: Protection Motivation Theory (PMT) was developed by Rogers in 1975, to describe how individuals are motivated to react in a self-protective way towards a perceived health threat. Rogers expected the use of PMT to diversify over time, which has proved true over four decades. The purpose of this paper is to explore how PMT can be used and expanded to inform and improve public safety strategies in natural hazards. As global climate change impacts on the Australian environment, natural hazards seem to be increasing in scale and frequency, and Emergency Services' public education campaigns have necessarily escalated to keep pace with perceived public threat. Of concern, is that the awareness-preparedness gap in residents' survival plans is narrowing disproportionately slowly compared to the magnitude of resources applied to rectify this trend. Practical applications of adaptable social theory could be used to help resolve this dilemma. DISCUSSION: PMT has been used to describe human behaviour in individuals, families, and the parent-child unit. It has been applied to floods in Europe and wildfire and earthquake in the United States. This paper seeks to determine if an application of PMT can be useful for achieving other-directed human protection across a novel demographic spectrum in natural hazards, specifically, animal owners and emergency responders in bushfire emergencies. These groups could benefit from such an approach: owners to build and fortify their response- and self-efficacy, and to help translate knowledge into safer behaviour, and responders to gain a better understanding of a diverse demographic with animal ownership as its common denominator, and with whom they will be likely to engage in contemporary natural hazard management. Mutual collaboration between these groups could lead to a synergy of reciprocated response efficacy, and safer, less traumatic outcomes. Emergency services' community education programs have made significant progress over the last decade, but public safety remains suboptimal while the magnitude of the awareness-preparedness gap persists. This paper examines an expanded, other-directed application of PMT to expand and enhance safer mitigation and response behaviour strategies for communities threatened by bushfire, which may ultimately help save human life.

"Don't Just Do Something Stand There!" Emergency Responders' Peri-Incident Perceptions of Animal Owners in Bushfire.

INTRODUCTION: Narrowing the awareness-preparedness gap in bushfires (wildfires) means that new strategies and tactics will be needed to improve human safety and survival in this increasingly frequent and severe globally significant natural hazard. One way to do this is to explore the peri-event experiences of novel demographic groups living and working in at-risk areas to determine how best to strengthen a collaborative, mutually beneficial interface with emergency responders. Thus, this study included participants from one novel demographic, animal owners, in combination with emergency responders. Animal owners themselves are a large, diverse group whose preparedness and response behavior has not been assessed with respect to their potential contribution to contemporary natural hazard management. METHOD: Data were collected using semi-structured interviews and focus group discussions from four emergency responder classifications who were asked about their perceptions of animal owners in bushfire. Thematic analysis was used for data analysis because of its flexibility and suitability to this pragmatic qualitative study. Results from the first of 10 themes, chosen for its "overview" properties, are discussed in this paper, and indicate that exploring the animal owner-emergency responder interface has the potential to generate useful additions to public policy and expansion of social theory. CONCLUSION: Analysis of these data in this paper supports the potential for positive outcomes gained by reciprocal collaboration between animal owners and emergency responders. Some simple practical solutions are evident and two major outcome streams are identified. These are (1) policy development and implementation and (2) etiology of decision-making. Considerations and recommendations for research examining the efficacy of these streams and solutions are provided.

The effects of sports participation on young adolescents' emotional well-being.

This study examined the relationship between children's sports participation and emotional well-being including self-reported emotional and behavioral problems and multidimensional aspects of self-concept. Data were collected from 203 young adolescents using a multitrait-multimethod assessment methodology. Information was obtained using a sports questionnaire concerning participation in and perceptions of sporting activities. Emotional well-being was assessed by the Youth Self-Report (Achenbach, 1991) and the Self-Perception Profile for Children (Harter, 1985). The study found that increased levels of sports participation had a positive relationship with aspects of emotional and behavioral well-being, particularly self-concepts. Results also showed that children with increased perceptions of sport-related competencies reported significantly fewer emotional and behavioral problems than did children who were, by external standards (e.g., teacher rating, number of sporting achievements), actually competent at sport. The study also found particular areas of sports participation to be positively associated with self-concept. Evidence suggests a similar beneficial association with some aspects of behavior problems. Practical implications of the findings are discussed along with recommendations for future research.

Impact of client feedback on clinical outcomes for young people using public mental health services: A pilot study.

This paper reports on research conducted in public health settings with young people who have serious mental health issues. An easy to use feedback system for clinicians providing psychotherapy was assessed against treatment as usual. Data were collected on four widely used outcome measures. There has been little previous research in this area. We found evidence for treatment effects. There was some evidence supportive of the feedback system but further study is needed.

How do different occupational factors influence total, occupational, and leisure-time physical activity?

BACKGROUND: A better understanding of how occupational indicators influence physical activity levels will aid the design of workplace interventions. METHODS: Cross-sectional data were collected from 1194 participants through a telephone interview in Queensland, Australia. The IPAQ-long was used to measure physical activity. Multiple logistic regression was applied to examine associations. RESULTS: Of participants, 77.9% were employed full-time, 32.3% had professional jobs, 35.7% were engaged in shift work, 39.5% had physically-demanding jobs, and 66.1% had high physical activity levels. Participants with a physically-demanding job were less likely to have low total (OR = 0.25, 95% CI = 0.17 to 0.38) and occupational (OR = 0.17, 95% CI = 0.12 to 0.25) physical activity. Technical and trade workers were less likely to report low total physical activity (OR = 0.44, 95% CI = 0.20 to 0.97) compared with white-collar workers. Part-time (OR = 1.74, 95% CI = 1.15 to 2.64) and shift workers (OR = 1.86, 95% CI = 1.21 to 2.88) were more likely to report low leisure-time activity. CONCLUSIONS: Overall, the impact of different occupational indicators on physical activity was not strong. As expected, the greatest proportion of total physical activity was derived from occupational physical activity. No evidence was found for compensation effects whereby physically-demanding occupations lead to less leisure-time physical activity or vice versa. This study demonstrates that workplaces are important settings to intervene, and that there is scope to increase leisure-time physical activity irrespective of occupational background.

Multisystemic treatment: a meta-analysis of outcome studies.

Multisystemic treatment (MST) is a family- and home-based therapeutic approach that has been found to be effective in treating antisocial youths and that has recently been applied to youths with serious emotional disturbances. In light of the increasing dissemination of MST, this review examines the effectiveness of MST by quantifying and summarizing the magnitude of effects (treatment outcomes) across all eligible MST outcome studies. Included in a meta-analysis were 7 primary outcome studies and 4 secondary studies involving a total of 708 participants. Results indicated that across different presenting problems and samples, the average effect of MST was d = .55; following treatment, youths and their families treated with MST were functioning better than 70% of youths and families treated alternatively. Results also showed that the average effect of MST was larger in studies involving graduate student therapists (i.e., efficacy studies; d = .81) than in studies with therapists from the community (i.e., effectiveness studies; d = .26). In addition, MST demonstrated larger effects on measures of family relations than on measures of individual adjustment or peer relations.

Perioperative angioedema: background, diagnosis, and management.

Angioedema is a potentially life-threatening condition that may present at any point in the perioperative care of patients. It requires prompt recognition and diagnosis; the primary concern during acute attacks is airway management. The pathophysiology, various causes of angioedema, and treatment strategies according to underlying etiology are presented.

Increased prevalence of chronic physical health disorders in Australians with diagnosed mental illness.

OBJECTIVE: To compare chronic physical health disorder prevalence amongst Australian adults with and without mental illness. METHOD: Total n=1,716 participants (58% female) with a mean age of 52 ± 13 years (range: 18 to 89 years) completed an online survey of Australian adults in 2010. Outcome measures including prevalence of chronic physical conditions and self-reported body mass index (BMI) in n=387 (23%) with a self-reported mental illness diagnosis were compared to respondents without mental illness. RESULTS: A significantly higher proportion of participants with mental illness were obese (BMI ≥ 30; 31 vs 24%, p=0.005). Adjusted odds ratios (OR) for coronary heart disease, diabetes, chronic bronchitis or emphysema, asthma, irritable bowel syndrome, and food allergies or intolerances (OR range: 1.54-3.19) demonstrated that chronic physical disorders were significantly more common in participants with a mental illness. CONCLUSION: Australian adults with a diagnosis for mental illness have a significantly increased likelihood of demonstrating chronic physical health disorders compared to persons without mental illness. IMPLICATIONS: Health professionals must be alert to the increased likelihood of comorbid chronic physical disorders in persons with a mental illness and should consider the adoption of holistic approaches when treating those with either a mental or physical illness.