Review: Improving access to mental health interventions for children from birth to five years: A Scoping Review.

BACKGROUND: In spite of infants and children aged 0-5 years experiencing mental health difficulties being estimated to be in the range of 6%-18% globally, the mental health care needs for this age group are often overlooked in the design of specialist mental health services. Although there is increasing recognition of the importance of infant mental health services and treatments for younger children, access remains a barrier. Mental health services specifically designed for children 0-5 years are vital; however, little is known about how these services ensure access for infants at risk of mental health difficulties and their families. This scoping review seeks to address this knowledge gap. METHODS: A scoping review methodology framework was used to search for relevant articles published between January 2000 and July 2021, identified using five databases: MEDLINE, CINAHL, PsycINFO, SocIndex and Web of Science. The selection of studies was based on empirical research about access to infant mental health services and models of care. A total of 28 relevant articles met the eligibility criteria for inclusion in this review. RESULTS: Findings can be summarised under five broad themes: (1) accessibility for at-risk populations (2) the importance of early detection of infants in need of mental health services and interventions; (3) the promotion of culturally responsive services and interventions; (4) ensuring the sustainability of IMH services and programs and (5) the integration of innovative interventions to improve existing practice models. CONCLUSIONS: The findings from this scoping review highlight barriers to access and provision of infant mental health services. Future infant mental health service design, informed by research, is needed to improve access for infants and young children with mental health difficulties and their families.

The concept of holism applied in recent palliative care practice: A scoping review.

BACKGROUND: Whilst there is a sense of holism existing within palliative care practice, what is not clear is the extent to which holism, as applied in recent palliative care practice, has been adequately researched. Currently, no reviews on this topic were identified through systematic and scoping review registries. AIM: To identify and describe the available published evidence on the key features of holism and the core domains underpinning the application of holism in relation to recent palliative care practice. DESIGN: Scoping review using the Johanna Briggs Institute design. DATA SOURCES: MEDLINE, EMCARE, and CINAHL (Ovid), PsycINFO, SocINDEX, SCOPUS and Web of Science. (International, peer-reviewed, published papers in the English language from January 2010to December 2020). RESULTS: Five studies met inclusion criteria. Two studies used qualitative methods, one used mixed-methods, and two were randomised controlled trials. The research investigated (1) frameworks for holistic care and (2) assessment tools applied in palliative care settings. CONCLUSIONS: The results from the review led to identifying key features of palliative care that were presented as interconnected aspects of holistic care domains in both assessments and interventions. The literature revealed a focus on curative and biomedical approaches to disease management with holistic aspects acknowledged, but not in the forefront of core service delivery. Holism was generally conceptualised as an overarching theoretical framework to palliative care service provision and positioned as an adjunct to palliative models of care. These findings point to a gap in research that links the concept of holism to applied palliative care practices.

The dynamic course of psychological outcomes following the Victorian Black Saturday bushfires.

OBJECTIVES: To profile the long-term mental health outcomes of those affected by the 2009 Black Saturday bushfires and to document the course of mental health since the disaster. METHOD: The longitudinal Beyond Bushfires study included 1017 respondents (Wave 1; 3-4 years after the fires), 736 (76.1%) at Wave 2 (5 years after the fires) and 525 (51.6%) at Wave 3 (10 years after the fires). The survey indexed fire-related and subsequent stressful events, probable posttraumatic stress disorder, major depressive disorder, alcohol use, severe distress and receipt of health services for mental health problems. RESULTS: Relative to their status 3-4 years after the fires, there were reduced rates of fire-related posttraumatic stress disorder (6.2% vs 12.2%), general posttraumatic stress disorder (14.9% vs 18.7%) and severe distress (4.4% vs 7.5%) at 10 years. There were comparable rates between Wave 1 and Wave 3 for depression (10.9% vs 8.3%) and alcohol abuse (21.8% vs 18.5%). Of people in high-affected regions, 22.1% had posttraumatic stress disorder, depression or severe distress at Wave 3. One-third to one-half of participants who reported probable posttraumatic stress disorder or depression at any assessment did not display the disorder at the next assessment. Worsening of mental health at Wave 3 was associated with the extent of property loss, exposure to recent traumatic events or recent stressful life events. Only 24.6% of those with a probable disorder had sought professional help for this in the previous 6 months. CONCLUSION: Approximately one-fifth of people from high-affected areas have a probable psychological disorder a decade after the fires. Mental health appears to fluctuate for those who are not consistently resilient, apparently as a result of ongoing stressors. The observation that most people with probable disorder are not receiving care highlights the need for further planning about managing long-term mental health needs of disaster-affected communities.

Anger Dimensions and Mental Health Following a Disaster: Distribution and Implications After a Major Bushfire.

Anger is an important dimension of affect and a prominent feature of posttraumatic mental health, but it is commonly overlooked in postdisaster settings. We aimed to examine the distribution and implications of significant anger problems in the aftermath of a natural disaster, via analyses of Beyond Bushfires survey data from 736 residents of rural communities 5 years after the 2009 Black Saturday bushfires in Victoria, Australia. Assessments included the five-item Dimensions of Anger Reaction (DAR-5) scale along with measures of PTSD, depression, and significant mental illness, and indicators of life satisfaction, suicidality, hostile aggressive behavior, and violence exposure. The results indicated that approximately 10% of respondents from areas highly affected by the bushfires scored above the provisional cutoff criteria for significant anger problems on the DAR-5, which was a more than 3-fold increase, OR = 3.26, relative to respondents from areas of low-to-moderate bushfire impact. The rates were higher among women, younger participants, and those who were unemployed, and co-occurred commonly, although not exclusively, with other postdisaster mental health problems. Anger problems were also associated with lower life satisfaction, ß = -.31, an 8-fold increase in suicidal ideation, OR = 8.68, and a nearly 13-fold increase in hostile aggressive behavior, OR = 12.98. There were associations with anger problems and violence exposure, which were reduced when controlling for covariates, including probable PTSD. The findings provide evidence indicating that anger is a significant issue for postdisaster mental health and should be considered routinely alongside other posttraumatic mental health issues.

Being a Parent: Findings from a Grounded Theory of Memory-Making in Neonatal End-of-Life Care.

PURPOSE: Neonatal palliative care guidelines increasingly recommend that parents be encouraged to provide care for their dying baby and to spend time with the before and after death. However, little is currently known about how parents perceive such memory-making interventions. This study explored the significance of memory-making for bereaved parents and the impact of memory-making on parents' experience of neonatal end-of-life care. DESIGN AND METHODS: We conducted extended interviews with 18 parents who had experienced neonatal loss. Corbin and Strauss' grounded theory method was used throughout sampling, data collection and data analysis. A constant comparative approach was utilised throughout each stage of the data collection/data analysis process, resulting in the development of a grounded theory titled "Affirmed Parenthood". RESULTS: The core category of "Affirmed parenthood" was underpinned by three primary categories: 'Creating Evidence', 'Needing Guidance' and 'Being a parent'. Opportunities to parent the baby by having contact with them, engaging with them, and providing care were central to parent's experiences of memory-making in the context of neonatal bereavement. CONCLUSIONS: 'Being a Parent' provided important affirmation of the baby's identity and importance, and affirmed the role of the parents. 'Being a Parent' was a critical element of memory-making and had a significant impact on parents' experience of loss. PRACTICE IMPLICATIONS: Parents should be supported to have unrestricted contact with their baby, to engage with them, and to provide care throughout the baby's brief life and after their baby's death.

Creating Evidence: Findings from a Grounded Theory of Memory-Making in Neonatal Bereavement Care in Australia.

PURPOSE: Perinatal and neonatal palliative care guidelines recommend the provision of photographs and other mementos as an element of care for parents bereaved by neonatal loss. However, little is known about parents' perceptions of such bereavement interventions. This study explored the significance of memory-making for bereaved parents and the impact of memory-making on parents' experience of loss following neonatal loss. DESIGN AND METHODS: We conducted semi-structured interviews with 18 bereaved parents. A grounded theory approach informed by Corbin and Strauss was used to underpin data sampling, data collection and data analysis. A constant comparative approach was used to engage in open, axial and selective coding to distil parents' stories into categories supporting a core concept. RESULTS: "Creating evidence" emerged as a key theme in the grounded theory of memory-making in bereavement care for parents following neonatal loss. Creating evidence involved taking photographs, creating mementos, as well as involving friends and family during the baby's time in the Neonatal Unit. CONCLUSIONS: Creating evidence affirmed the life of the baby and the role of the parents. Creating evidence was a significant element of memory-making that had a positive impact on parents' experience of bereavement. PRACTICE IMPLICATIONS: Parents should be supported to create evidence of their baby's life, through taking photos, creating mementos, and involving others in their baby's care. Such interventions provide affirmation of the baby's life and of the individual's role as a parent.

Prenatal yoga for young women a mixed methods study of acceptability and benefits.

BACKGROUND: High rates of psychological-distress, trauma and social complexity are reported among young pregnant women. At the Royal Women's Hospital, Australia, young pregnant women acknowledge wanting tools to improve maternal wellbeing yet remain challenging to engage in antenatal education and support. While yoga is a widely accepted and participated activity in pregnancy, with demonstrated benefits for adult pregnant women, adolescent women are often excluded from both these yoga interventions and related pregnancy studies. METHODS: This mixed methods study examined the acceptability and benefits of yoga for young women. We recruited 30 participants aged under 24 years, who were offered twice a week, one-hour voluntary prenatal yoga sessions throughout their pregnancy. A medical file audit gathered baseline demographics, pre and post yoga session surveys were administered and brief individual interview were conducted with study participants. RESULTS: While 26 study participants were positive about the availability of a yoga program, only 15 could attend yoga sessions (mean = 8 sessions, range 1-27). No differences were found in the demographic or psychosocial factors between those who did and did not attend the yoga sessions. The medical file audit found that 60% of all the study participants had a documented history of psychological distress. Barriers to participation were pragmatic, not attitudinal, based on the timing of the group sessions, transport availability and their own health. All study participants identified perceived benefits, and the yoga participants identified these as improved relaxation and reduction of psychological distress; labour preparation; bonding with their baby in utero; and social connectedness with the yoga group peers. CONCLUSIONS: This study demonstrated yoga was acceptable to young pregnant women. For those who did participate in the sessions, yoga was found to decrease self-reported distress and increase perceived skills to assist with their labour and the birth of their baby. The provision of accessible yoga programs for pregnant young women is recommended.

Longitudinal study of changing psychological outcomes following the Victorian Black Saturday bushfires.

OBJECTIVES: To map the changing prevalence and predictors of psychological outcomes in affected communities 5 years following the Black Saturday bushfires in Victoria. METHOD: Follow-up assessment of longitudinal cohort study in high, medium and non-affected communities in Victoria, Australia. Participants included 1017 respondents (Wave 1) interviewed via telephone and web-based survey between December 2011 and January 2013, and 735 (76.1%) eligible participants were retested between July and November 2014 (Wave 2). The survey included measures of fire-related and subsequent stressful events, probable posttraumatic stress disorder, major depressive episode, alcohol use and severe distress. RESULTS: There were reduced rates of fire-related posttraumatic stress disorder (8.7% vs 12.1%), general posttraumatic stress disorder (14.7% vs 18.2%), major depressive episode (9.0% vs 10.9%) and serious mental illness (5.4% vs 7.8%). Rates of resilience increased over time (81.8% vs 77.1%), and problem alcohol use remained high across Wave 1 (22.1%) and Wave 2 (21.4%). The most robust predictor of later development of fire-related posttraumatic stress disorder (odds ratio: 2.11; 95% confidence interval: [1.22, 3.65]), general posttraumatic stress disorder (odds ratio: 3.15; 95% confidence interval: [1.98, 5.02]), major depressive episode (odds ratio: 2.86; 95% confidence interval: [1.74, 4.70]), serious mental illness (odds ratio: 2.67; 95% confidence interval: [0.57, 1.72]) or diminished resilience (odds ratio: 2.01; 95% confidence interval: [1.32, 3.05]) was extent of recent life stressors. CONCLUSION: Although rates of mental health problems diminished over time, they remained higher than national levels. Findings suggest that policy-makers need to recognize that the mental health consequences of disasters can persist for many years after the event and need to allocate resources towards those who are most at risk as a result of substantive losses and ongoing life stressors.

Mental Health Following Separation in a Disaster: The Role of Attachment.

Short-term separation from close family members during a disaster is a highly salient event for those involved. Yet, its subsequent impact on mental health has received little empirical attention. One relevant factor may be attachment style, which influences patterns of support-seeking under threatening conditions. Individuals (N = 914) affected by the 2009 Victorian bushfires in southeastern Australia were assessed for disaster experiences, depression, posttraumatic stress disorder (PTSD) symptoms, and attachment style 3-4 years after the fires. Using multigroup structural equation modelling, individuals who reported separation from close family members during the bushfires (n = 471) were compared to those who reported no separation (n = 443). Cross-sectional results indicated that separated individuals had higher levels of PTSD symptoms. Furthermore, attachment anxiety was more strongly positively associated with depression among separated (b = 0.62) versus not separated individuals (b = 0.32). Unexpectedly, among separated individuals, attachment avoidance had a statistically weaker association with depression (b = 0.17 vs. b = 0.35) and with PTSD symptoms (b = 0.06 vs. b = 0.22). These results suggest that attachment anxiety amplifies a negative reaction to separation; meanwhile, for avoidant individuals, separation in times of danger may facilitate defensive cognitive processes.

The role of anger and ongoing stressors in mental health following a natural disaster.

OBJECTIVE: Research has established the mental health sequelae following disaster, with studies now focused on understanding factors that mediate these outcomes. This study focused on anger, alcohol, subsequent life stressors and traumatic events as mediators in the development of mental health disorders following the 2009 Black Saturday Bushfires, Australia's worst natural disaster in over 100 years. METHOD: This study examined data from 1017 (M = 404, F = 613) adult residents across 25 communities differentially affected by the fires and participating in the Beyond Bushfires research study. Data included measures of fire exposure, posttraumatic stress disorder, depression, alcohol abuse, anger and subsequent major life stressors and traumatic events. Structural equation modeling assessed the influence of factors mediating the effects of fire exposure on mental health outcomes. RESULTS: Three mediation models were tested. The final model recorded excellent fit and observed a direct relationship between disaster exposure and mental health outcomes (b = .192, p < .001) and mediating relationships via Anger (b = .102, p < .001) and Major Life Stressors (b = .128, p < .001). Each gender was compared with multiple group analyses and while the mediation relationships were still significant for both genders, the direct relationship between exposure and outcome was no longer significant for men (p = .069), but remained significant (b = .234, p < .001) for women. CONCLUSIONS: Importantly, anger and major life stressors mediate the relationship between disaster exposure and development of mental health problems. The findings have significant implications for the assessment of anger post disaster, the provision of targeted anger-focused interventions and delivery of government and community assistance and support in addressing ongoing stressors in the post-disaster context to minimize subsequent mental health consequences.

Psychological outcomes following the Victorian Black Saturday bushfires.

OBJECTIVE: We aimed to map the prevalence and predictors of psychological outcomes in affected communities 3-4 years after the Black Saturday bushfires in the state of Victoria, Australia. METHODS: Baseline assessment of a longitudinal cohort study in high-, medium-, and low-affected communities in Victoria. Participants included 1017 residents of high-, medium-, and low-affected fire communities. Participants were surveyed by means of a telephone and web-based interview between December 2011 and January 2013. The survey included measures of fire-related post-traumatic stress disorder (PTSD) and general PTSD from other traumatic events, major depressive episode, alcohol use, and general psychological distress. RESULTS: The majority of respondents in the high- (77.3%), medium- (81.3%), and low-affected (84.9%) communities reported no psychological distress on the K6 screening scale. More participants in the high-affected communities (15.6%) reported probable PTSD linked to the bushfires than medium- (7.2%) and low-affected (1.0%) communities (odds ratio (OR): 4.57, 95% confidence interval (CI): 2.61-8.00, p = 0.000). Similar patterns were observed for depression (12.9%, 8.8%, 6.3%, respectively) (OR: 1.83, 95% CI: 1.17-2.85, p = 0.008) and severe psychological distress (9.8%, 5.0%, 4.9%, respectively) (OR: 2.08, 95% CI: 1.23-3.55, p = 0.007). All communities reported elevated rates of heavy drinking (24.7%, 18.7%, 19.6%, respectively); however, these were higher in the high-affected communities (OR: 1.39, 95% CI: 1.01-1.89, p = 0.04). Severe psychological distress was predicted by fear for one's life in the bushfires, death of someone close to them in the bushfires, and subsequent stressors. One-third of those with severe psychological distress did not receive mental health assistance in the previous month. CONCLUSIONS: Several years following the Black Saturday bushfires the majority of affected people demonstrated resilience without indications of psychological distress. A significant minority of people in the high-affected communities reported persistent PTSD, depression, and psychological distress, indicating the need for promotion of the use of health and complementary services, community-based initiatives, and family and other informal supports, to target these persistent problems.

Rural palliative care transitions from home to hospital: carers' experiences.

OBJECTIVE: To document carer perceptions of patients' transitions from community to hospital-based palliative care in a rural setting. DESIGN: A qualitative study using an interview method at two time points. SETTING: Rural palliative care providers: Kyneton District Health Service and the Macedon Ranges Palliative Care Service, Victoria. PARTICIPANTS: Six adult caregivers of six palliative care patients who had cancer were interviewed, three of whom were male and three female. MAIN OUTCOME MEASURES: Semistructured interviews were conducted exploring the caregivers' decisions to transition to hospital-based care and their perceptions of the transition to hospital and the hospital-based care these patients received. RESULTS: Thematic analysis revealed that carers made the decision for the patient in their care to transfer from home to hospital care. Carers experienced the transition to hospital care positively, particularly in relation to the communication of the patient's care needs. While communication issues arose while in hospital, they were not related to the transitional aspects of the palliative care service. CONCLUSIONS: The findings from this small, exploratory study suggest that these carers benefited from the new model of rural palliative care service provision. A large-scale, mixed-method study would enable more generalisable findings to be established.

Individual and community experiences of posttraumatic growth after disaster: 10 years after the Australian Black Saturday bushfires.

OBJECTIVE: To understand longer-term posttraumatic growth (PTG) and how this is associated with individual and community bushfire experiences. METHOD: Survey data (n = 391) from the Beyond Bushfires and the 10-year Beyond Bushfires studies were analyzed. Multilevel modeling examined relationships between basic individual demographics, bushfire exposure, and community-level variables at 3-4 years after the fires, and PTG at 10 years using the short form of the PTG Inventory. RESULTS: Ten years after these Australian bushfires, being female, experiencing higher degrees of property loss, and stronger individual sense of community were the factors associated with PTG. Approximately 12% of the variance observed in PTG scores was attributable to differences in PTG across communities. Individuals from medium and high bushfire-affected communities reported significantly higher PTG relative to those in low bushfire-affected communities. While there was evidence of community differences in PTG, and individuals' own sense of community was positively and significantly associated with increased PTG, community-level cohesion scores were not found to be significantly related to PTG (although the trend was in the expected direction). CONCLUSIONS: PTG is evident in longer-term disaster recovery. While PTG appears to vary across communities, the findings suggest that it is an individual's own sense of community (rather than community-level cohesion) that is most closely related to this longer-term growth following a bushfire event. While PTG is currently understood as an outcome of individual-level perceptions, community-level experiences shape the potential for positive transformations to occur after disasters and warrant further investigation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Trajectory of adjustment difficulties following disaster: 10-year longitudinal cohort study.

BACKGROUND: Although much is known about psychopathology such as post-traumatic stress disorder (PTSD) and depression following bushfire (also known as wildfire), little is known about prevalence, trajectory and impacts for those experiencing general adjustment difficulties following exposure to these now-common events. AIMS: This was an exploratory analysis of a large cohort study that examined the prevalence, trajectory and risk factors of probable adjustment disorder over a 10-year period following bushfire exposure. METHOD: The Beyond Bushfires study assessed individuals exposed to a large and deadly bushfire across three time points spanning 10 years. Self-report survey data from participants from areas with moderate and high levels of fire-affectedness were analysed: n = 802 participants at Wave 1 (3-4 years post-fires), n = 596 at Wave 2 (5 years post-fires) and n = 436 at Wave 3 (10 years post-fires). Surveys indexed fire-related experiences and post-fire stressors, and comprised the six-item Kessler Psychological Distress Scale (probable adjustment disorder index), four-item Posttraumatic Stress Disorder Checklist (probable fire-related PTSD) and nine-item Patient Health Questionnaire (probable major depressive episode). RESULTS: Prevalence of probable adjustment disorder was 16% (Wave 1), 15% (Wave 2) and 19% (Wave 3). Probable adjustment disorder at 3-4 years post-fires predicted a five-fold increase in risk for escalating to severe psychiatric disorder (i.e. probable fire-related PTSD/major depressive episode) at 10 years post-fires, and was associated with post-fire income and relationship stressors. CONCLUSIONS: Adjustment difficulties are prevalent post-disaster, many of which are maintained and exacerbated over time, resulting in increased risk for later disorder and adaptation difficulties. Psychosocial interventions supporting survivors with adjustment difficulties may prevent progression to more severe disorder.

Beyond Bushfires: Community, Resilience and Recovery - a longitudinal mixed method study of the medium to long term impacts of bushfires on mental health and social connectedness.

BACKGROUND: Natural disasters represent an increasing threat both in terms of incidence and severity as a result of climate change. Although much is known about individual responses to disasters, much less is known about the social and contextual response and how this interacts with individual trajectories in terms of mental health, wellbeing and social connectedness. The 2009 bushfires in Victoria, Australia caused much loss of life, property destruction, and community disturbance. In order to progress future preparedness, response and recovery, it is crucial to measure and understand the impact of disasters at both individual and community levels. METHODS/DESIGN: This study aims to profile the range of mental health, wellbeing and social impacts of the Victorian 2009 bushfires over time using multiple methodologies and involving multiple community partners. A diversity of communities including bushfire affected and unaffected will be involved in the study and will include current and former residents (at the time of the Feb 2009 fires). Participants will be surveyed in 2012, 2014 and, funding permitting, in 2016 to map the predictors and outcomes of mental health, wellbeing and social functioning. Ongoing community visits, as well as interviews and focus group discussions in 2013 and 2014, will provide both contextual information and evidence of changing individual and community experiences in the medium to long term post disaster. The study will include adults, adolescents and children over the age of 5. DISCUSSION: Conducting the study over five years and focussing on the role of social networks will provide new insights into the interplay between individual and community factors and their influence on recovery from natural disaster over time. The study findings will thereby expand understanding of long term disaster recovery needs for individuals and communities.

The subjective effect of antipsychotic medication on trauma-related thoughts, emotions, and physical symptoms: A qualitative study with people who have experienced childhood trauma and psychosis.

OBJECTIVES: Among people with psychosis, those with a history of childhood trauma are likely to experience trauma-related symptoms, such as trauma memory intrusions. Irrespective of whether these individuals continue to remember and re-experience trauma, their treatment very often includes alleviating psychotic symptoms through the use of antipsychotic medication. Antipsychotics, while primarily used to treat psychotic symptoms, can influence non-psychotic symptoms and alter how people think and feel. We thus aimed to explore how people with childhood trauma and psychosis experience the effects that antipsychotics have on their (1) thoughts, images, and memories, (2) emotions, and (3) physical responses, related to their childhood trauma. DESIGN: A qualitative phenomenological research design using semi-structured interviews was implemented. METHODS: Data were analysed using interpretative phenomenological analysis. RESULTS: Nineteen participants were interviewed. Two super-ordinate themes were conceptualized. Many participants spoke about the impact of antipsychotics on trauma-related experiences (Theme 1). Some indicated that antipsychotics alleviated the intensity and frequency of trauma-related thoughts, emotions, and physical symptoms. A few others reported that their trauma-related flashbacks, thoughts, and physical symptoms intensified while taking antipsychotics. Participants spoke about the role of antipsychotics in confronting and processing trauma (Theme 2). A few participants reported that by suppressing trauma-related thoughts and emotions antipsychotics prevented them from confronting their trauma. CONCLUSIONS: The effects of antipsychotics can be subjectively experienced as beneficial or detrimental depending on how they influence trauma-related thoughts, emotions, and physical responses. Intervention studies are needed to determine how people with childhood trauma and psychosis respond to antipsychotic drugs. PRACTITIONER POINTS: Antipsychotics may alter the way in which people with childhood trauma and psychosis remember and re-experience trauma. These alterations can be beneficial or detrimental, and thus play a role in whether people consider their medication helpful. By suppressing trauma-related thoughts and emotions, antipsychotics can prevent people from confronting their trauma. This may be considered beneficial to some, but other people may need or want to confront their trauma to heal. The effectiveness of trauma-focused psychological therapies may be influenced by the emotional, cognitive, and physiological effects of antipsychotic medications. The ability of antipsychotics to suppress people's trauma memories may contribute to post-traumatic avoidance. People with post-traumatic stress symptoms and psychosis should be provided with psycho-education about post-traumatic avoidance and its role in the maintenance of post-traumatic stress disorder.

Family-centred care for children with traumatic brain injury and/or spinal cord injury: a qualitative study of service provider perspectives during the COVID-19 pandemic.

OBJECTIVES: COVID-19 has led to rapid changes in rehabilitation service provision for young people living with traumatic brain and/or spinal cord injury. The aim of this project was to understand the experiences of rehabilitation service providers during the acute response stage of the COVID-19 pandemic. Specifically, we aimed to identify innovative approaches to meeting the ongoing needs of young people with traumatic brain and/or spinal cord injury during this time. SETTING: This study was conducted at a research institute and involved remote interviews with key informants around Australia and internationally. PARTICIPANTS: Key informants from 11 services supporting children and/or adolescents with traumatic brain injury and/or spinal cord injury were interviewed using a semistructured interview guide. Interviews were transcribed and analysed using inductive thematic analysis. RESULTS: Three key themes emerged: (1) recognising and responding to the experiences of families during the pandemic, (2) the impact of greater use of telehealth on care delivery, and (3) realising opportunities to enhance family-centred care. CONCLUSIONS: These themes capture shifting perspectives and process changes relevant to longer term practice. Research findings suggest opportunities for future service development, enabling service delivery that is more family centred, flexible and efficient in meeting the needs of families. Understanding these experiences and the changed nature of service delivery provides important insights with implications for future service improvement.

Hierarchies of affectedness after disasters.

Disasters result in a range of impacts that significantly disrupt the health and wellbeing of those affected. After disasters, a hierarchy of affectedness may be explicitly or implicitly developed, where those affected are compared to each other, and to people affected by disasters in other locations. When an individual's sense of place is so significantly disrupted, these hierarchies are critical to improving the understanding of recovery trajectories, including mental health and well-being outcomes. These hierarchies have practical implications that influence the health outcomes of those affected, including eligibility for disaster aid, support services, and the way that people affected by disasters relate to others in their community. This paper expands the 'hierarchy of affectedness' concept coined by Andersen (2013) using findings from a qualitative study in Australia and New Zealand. Using a letter writing research method, twenty people who had been impacted by a range of disasters in different locations described what they considered helpful and unhelpful in the recovery. One emergent finding in this study was that hierarchies of affectedness are negotiated between impacted individuals, others affected in the same community, and outsiders. These hierarchies served as a helpful sense-making tool for some people impacted by disasters, while causing considerable secondary stress for others. Based on these findings, we offer an expansion to Andersen's existing model of hierarchies of affectedness in post-disaster settings.

The psychosocial complexities of acute burn patients in an Australian trauma hospital.

INTRODUCTION: Psychosocial risk and protective factors specific to acute burn patients have been shown to impact on longer-term health outcomes. Yet the nature and impact of such factors throughout the acute hospital admission phase have not been extensively examined to date. This study analysed the psychosocial pre-admission, hospitalisation and discharge factors for a sample of burn patients at an Australian specialist acute burns unit (The Alfred) and the relationship with their admission length. METHODS: A retrospective audit was undertaken of psychosocial factors documented in patient medical records, Victorian Adult Burns Service registry data, and social work files (January-December 2014). RESULTS: Two hundred and forty-nine patients were identified, with a mean age of 42.83 years and a preponderance of men (73.9%). The majority (71%) had a low burn severity (<10%), and an average of eight psychosocial factors. Independent of the severity of the burn, two psychosocial domains were strongly predictive of length of stay - coping with treatment and discharge planning - along with pre-existing psychosocial factors and family support. CONCLUSION: A diversity of psychosocial factors was identified, highlighting the clinical complexity of this patient group. Given three domains of admission-related psychosocial factors were predictive of the length of patient stay, more targeted psychosocial interventions in these areas may ensure patients and their families are supported more effectively throughout an admission, and length of stay costs may also be reduced.

Scoping Review of Memory Making in Bereavement Care for Parents After the Death of a Newborn.

OBJECTIVE: To summarize and synthesize extant literature on memory making in bereavement care for parents who experience the death of a newborn and to identify opportunities for future research. DATA SOURCES: We conducted a systematic search of four health-related databases (MEDLINE Complete, CINAHL Complete, Embase, and PsychINFO) for original research in January 2019. We then conducted a manual search of the reference lists of all included articles and a citation search via Scopus. STUDY SELECTION: Selection criteria initially included all original research articles available in English that related to parents' perceptions of perinatal or neonatal palliative care or bereavement care for parents after the death of a newborn. These criteria were refined as we developed familiarity with the available literature. Our initial screening of article titles and abstracts yielded 287 articles for full-text review. After full-text analysis, we included all 25 qualitative or mixed method research articles that met selection criteria. DATA EXTRACTION: We used a spreadsheet modeled on the Joanna Briggs Institute Review Guidelines (2015) for data extraction. DATA SYNTHESIS: Available research was focused primarily on parents' perceptions of care during and after the death of their newborns. Memory making interventions emerged as significant elements of the experiences of bereaved parent. Several researchers examined parents' perceptions of specific memory making interventions, such as bereavement photography. Contact with the newborn, opportunities for caregiving, bereavement photography, and the collection or creation of mementos emerged as important elements of memory making. Parents also identified a need for guidance about each of these key strategies for memory making. CONCLUSION: We identified few studies focused entirely on memory making as an intervention in the context of bereavement care for parents. However, memory making emerged as a recurring theme throughout qualitative and mixed method studies on parents' perceptions of perinatal or neonatal end-of-life care. Further research is required to provide evidence to guide memory making interventions for bereaved parents who experience the death of a newborn.