Psychological First Aid principles within a community-led arts initiative: lessons from the Blacksmiths' Tree.

Psychological First Aid (PFA) is widely used in the early phases of disaster recovery, despite limited empirical evidence supporting its application. PFA aims to reduce distress and encourage adaptive coping and is grounded in five principles: the promotion of hope, self- and collective efficacy, social connectedness, safety, and calm. Drawing on a constructivist perspective, this study analysed interview transcripts from Forged from Fire: The Making of the Blacksmiths' Tree, a documentary film about a community-led arts project initiated after the 2009 bushfires in Victoria, Australia. Using a reflexive process that employed deductive and inductive coding, the research investigated the presence of PFA principles in participants' experiences of the Blacksmiths' Tree project and whether themes not accounted for by PFA were also salient. The findings supported the PFA principles and generated two additional themes: grassroots and community leadership; and healing through creation and expression. The implications for disaster recovery in community settings are also presented.

Working with clients of higher weight in Australia: Findings from a national survey exploring occupational therapy practice.

INTRODUCTION: Occupational therapists are key members of the multidisciplinary team and regularly work with people of higher weight across age groups and practice settings. There is limited existing research regarding the occupational therapy role with this client group. The aim of this study was to explore occupational therapy practice and barriers to service provision for Australian occupational therapists working with clients of higher weight. METHODS: A cross-sectional study design using a self-administered online survey was distributed to members of the national occupational therapy professional association. The survey was designed to identify common assessments and interventions used with clients of higher weight and explore occupational therapists' perspectives on their knowledge and confidence and the barriers to service delivery. Descriptive statistics were used to summarise rating scales, and open-ended responses were analysed using thematic analysis. RESULTS: Eighty Australian occupational therapists working in a range of settings and with varied experience levels participated in the study. Participants described the most common areas of occupational therapy assessment and intervention when working with clients of higher weight to be self-care, equipment prescription, home modifications and pressure care. Respondents were least confident in interventions related to psychosocial, leisure and employment interventions. Barriers to service delivery included accessibility and cost of equipment, lack of training and weight stigma. CONCLUSION: Occupational therapy practice promotes and enables participation in everyday occupations with people of higher weight. This study highlights not only the occupational therapy skills and unique approach to the person, their environment and occupations but also the challenges faced by occupational therapists when working with people of higher weight. Occupational therapists could consider utilising the weight-inclusive paradigm to broaden their contribution from self-care to other important aspects of participation and well-being.

Virtually Trans: an Australian Facebook group supporting gender diverse adults' health and wellbeing.

Social networking sites are the primary means by which trans and gender diverse people meet, enabling both community contact and information exchange. This study considers the meaning of participation in a secret Facebook group for trans and gender diverse adults in Melbourne (Australia). A peer ethnographic methodology was used to study the Melbourne-based group listed under the pseudonym 'Virtually Trans'. Qualitative semi-structured interviews were conducted with 12 Virtually Trans group members. Interviews were transcribed and thematically analysed. Interview data were supplemented with field notes written throughout online participation over an 8-month period to add richness and provide context to the data. Three major themes were developed from this analysis. First, experiences outside of Virtually Trans, most notably within health care settings, were perceived to be unsafe. Second, practices of care in Virtually Trans conferred a sense of kinship and identity affirmation. Finally, Virtually Trans enabled localized information exchange between peers. Virtually Trans is not a neutral platform of self-performance but a safe(r) environment for expanding the gendered possibilities of who and how people may become. This study highlights the importance of a secret Facebook group in filling care, information and resource gaps experienced by trans and gender diverse people within a major metropolitan setting. The findings have implications for practitioners working with trans and gender diverse adults and peer health navigation.

Community co-produced mental health initiatives in rural Australia: A scoping review.

INTRODUCTION: Inaccessibility of mental health services in rural Australia is widely reported. Community co-produced mental health and well-being initiatives could fill gaps and complement other services. OBJECTIVE: This scoping review summarises findings from peer-reviewed articles to identify the key features of co-produced Australian rural mental health initiatives that engage communities in their design, delivery or evaluation processes. DESIGN: Between 2009 and 2019 inclusive, 14 articles met inclusion criteria and were reviewed using Arksey and O'Malley's review methodology. FINDINGS: Communities co-produced initiatives through informing, collaborating and instigating them. Some initiatives operated in specific places, for example an art gallery, while others operated across regions. Only two initiatives involved community members in multiple activities targeting prevention, early intervention, education and service accessibility; other initiatives were more focused, for example designing a new service. Over half of initiatives found were targeted at Aboriginal and Torres Strait Islander Peoples. Most articles discussed evaluation approaches, though methods were diverse. DISCUSSION: Published peer-reviewed evidence about Australian rural community co-produced mental health initiatives appears scant. Evidence found suggests they generate a range of supports that could complement or mitigate for lack of, public health services. The overall lack of evidence, diversity of initiatives and inconsistent evaluation makes it difficult to assess effectiveness and which activities might be scaled-up for wider benefit. CONCLUSION: Rural communities have limited resources, and evidence of what constitutes best practice in co-producing mental health services would help to avoid 'reinventing the wheel.' Greater efforts in evaluating and publishing about initiatives would be helpful.

Collaboration with community connectors to improve primary care access for hardly reached people: a case comparison of rural Ireland and Australia.

BACKGROUND: This study presents a way for health services to improve service access for hardly reached people through an exploration of how staff can find and collaborate with citizens (referred to as connectors) who span socio-cultural boundaries in their community. The study explored the local socio-cultural contexts of connectors' boundary spanning activities and if they are health related; boundary spanning occurring between connectors and health professionals at the interface of health systems and community; and the opportunities and barriers to actively seeking out and collaborating with community connectors to access marginalised and hardly reached people. METHODS: We conducted a qualitative case comparison from rural Ireland and Australia. Following purposive snow-ball sampling techniques to recruit participants, semi-structured interviews were conducted with 34 community informants, 21 healthcare staff and 32 connectors. Transcripts were coded and analysed using an inductive approach to ascertain categories and overall themes. RESULTS: We found a diverse sample of connectors relating to heterogenous, small and locally distinct groups of hardly reached people. Overall 26 connectors were active at the interface between health services and the community, with variation in how this occurred between cases. The majority (21) described one or more health related activities with hardly reached people. All connectors expressed a willingness to develop a relationship with local health services on issues they identified as relevant. Barriers to collaborations between connectors and health services related to bureaucracy, workload, and burnout. CONCLUSIONS: Collaborating with connectors has potential as one strategy to improve access to health services for hardly reached people. To enact this, health staff need to identify local socio-cultural boundaries and associated connectors, facilitate two-way connections at the boundary between health services and community and enable collaboration by attending to activities in the community, at the interface between health services and community, and within the health system.

The impact of undergraduate occupational therapy students' interpersonal skills on their practice education performance: A pilot study.

BACKGROUND/AIM: Interpersonal skills such as active listening, verbal communication and body language are essential competencies for occupational therapists, and students are expected to demonstrate these skills when completing practice placements. To investigate whether interpersonal skills are predictive of occupational therapy students' practice performance. METHODS: A cross-sectional study was conducted involving third and fourth year occupational therapy undergraduate students (n = 70). Students' interpersonal skills were measured using the Interpersonal Communication Competence Scale (ICCS), Listening Styles Profile (LSP-R) and Active-Empathic Listening Scale (AELS). Students' practice performances at the mid-way and final points of their placements were measured using the Student Practice Evaluation Form-Revised (SPEF-R). The relationships between students' interpersonal skills and practice performance were examined using univariate and multi-variate regressions. RESULTS: Higher ICCS Interaction Management subscale scores predicted better SPEF-R Self-Management Skills at the mid-way point through practice placements (ß = 1.93, SE = 0.76), and better Professional Behaviours (ß = 1.28, SE = 0.64) and better Service Evaluation Skills (ß = 2.84, SE = 0.95) at the final SPEF-R completion point. Higher ICCS Empathy subscale scores predicted lower SPEF-R Documentation scores at the mid-way point (ß = -0.81, SE = 0.38), while higher ICCS Supportiveness subscale scores predicted lower mid-way SPEF-R Service Provision scores (ß = -2.84, SE = 1.77). No ICCS subscale scores were predictive of the SPEF-R communication, co-worker communication and information gathering subscale scores. As well, LSP-R and AELS subscale scores were not predictive of the SPEF-R subscale scores. CONCLUSION: While predictive relationships were not found between occupational therapy students' communication, co-worker communication and information gathering skills, this preliminary evidence indicates that students' interpersonal skills (including interaction management and empathetic supportiveness) were predictive of some notable SPEF-R competencies (including Professional Behaviours, Self-Management, Documentation, Service Provision and Service Evaluation). Therefore, students' exposure to professional interpersonal skills should be incorporated into the curriculum of academic education programs with the aim of better preparing them for practice education.

Development of an online intervention for bipolar disorder. www.moodswings.net.au.

We describe the development process and completed structure, of a self-help online intervention for bipolar disorder, known as MoodSwings ( www.moodswings.net.au) . The MoodSwings program was adapted as an Internet intervention from an efficacious and validated face-to-face, group-based psychosocial intervention. The adaptation was created by a psychologist, who had previously been involved with the validation of the face-to-face program, in collaboration with website designers. The project was conducted under the supervision of a team of clinician researchers. The website is available at no cost to registered participants. Self-help modules are accessed sequentially. Other features include a mood diary and a moderated discussion board. There has been an average of 1,475,135 hits on the site annually (2008 and 2009), with some 7400 unique visitors each year. A randomised controlled trial based on this program has been completed. Many people with bipolar disorder are accepting of the Internet as a source of treatment and, once engaged, show acceptable retention rates. The Internet appears to be a viable means of delivering psychosocial self-help strategies.

An investigation into the role and meaning of occupation for people living with on-going health conditions.

BACKGROUND/AIM: In Australia and internationally, more people are developing on-going health conditions (chronic illnesses) in which their daily occupations are implicated in both the onset and management of the condition. This article investigates the role and meaning of occupation from a client-centred perspective. It presents one aspect of a broader study that aimed to inform occupation-based practice for people living with on-going health conditions. METHODS: This study used an emergent, mixed methods design. A total of 16 adult participants, with one or more on-going health conditions that impacted on their participation in occupations, were interviewed using two semi-structured interviews. Narrative data were analysed using grounded theory methods which included coding, memo-writing and constant comparison. A theoretical understanding, consisting of four categories and a core concept, was constructed through the data analysis. RESULTS: Occupation fulfils four distinct, but interrelated, roles for people living with on-going health conditions. Engaging in occupation can reveal, explain, manage and overcome on-going health conditions. The core concept, 'occupation empowers', integrates the different roles of occupation and reflects the meaning of occupation for people with on-going health conditions. CONCLUSIONS: This study contributes a theoretical understanding of the roles and meaning of occupation that is grounded in the experiences of people living with on-going health conditions. These findings extend our understanding of human occupation, and highlight the importance of narrative techniques to support occupation-based practice and empower people living with on-going illness.

Controlled clinical trial of a self-management program for people with mental illness in an adult mental health service - the Optimal Health Program (OHP).

OBJECTIVE: The objective of this study was to evaluate the effect and cost-effectiveness of a self-management intervention, delivered as part of routine care in an adult mental health service. METHOD: In a community mental health setting, routine care was compared with routine care plus a nine-session intervention (the Optimal Health Program) using a non-randomised controlled design. Adult (18-65 years) consumers of mental health services in the Australian Capital Territory were eligible for participation. RESULTS: The Optimal Health Program was associated with significant improvements in health and social functioning as measured by the Health of the Nation Outcome Scale (average change relative to control: -3.17; 95% CI -4.49 to -1.84; P<0.001). In addition, there was a reduction in hospital admissions in the treatment group (percentage of time in hospital reduced from 3.20 to 0.82; P=0.07). This translated into a net cost saving of over AU$6000 per participant per year (uncertainty range AU$744 to AU$12656). CONCLUSIONS: This study shows promising results for incorporating a self-management program into routine care to improve the health and social functioning of mental health consumers in a cost-effective manner.

Group-based psychosocial intervention for bipolar disorder: randomised controlled trial.

BACKGROUND: Psychosocial interventions have the potential to enhance relapse prevention in bipolar disorder. AIMS: To evaluate a manualised group-based intervention for people with bipolar disorder in a naturalistic setting. METHOD: Eighty-four participants were randomised to receive the group-based intervention (a 12-week programme plus three booster sessions) or treatment as usual, and followed up with monthly telephone interviews (for 9 months post-intervention) and face-to-face interviews (at baseline, 3 months and 12 months). RESULTS: Participants who received the group-based intervention were significantly less likely to have a relapse of any type and spent less time unwell. There was a reduced rate of relapse in the treatment group for pooled relapses of any type (hazard ratio 0.43, 95% CI 0.20-0.95; t(343) = -2.09, P = 0.04). CONCLUSIONS: This study suggests that the group-based intervention reduces relapse risk in bipolar disorder.

Trans, gender diverse and non-binary adult experiences of social support: A systematic quantitative literature review.

Background: Trans, gender diverse and non-binary (TGDNB) adults experience significant health disparities relative to their cisgender peers. While social support is a known health-protective factor within the general population, no systematic reviews of TGDNB experiences of social support exist. Aim: To systematically review prior research of social support for TGDNB adults. We sought to assess the defining characteristics of the research, the participants and the research findings, mapping emerging trends across disciplines. Methods: Six electronic databases (PubMed, MEDLINE, CINAHL, Web of Science, LGBT Life and PsycNet) were searched for literature pertaining to TGDNB adults, social support, and health or well-being published in the past decade. Results: The findings illustrate a predominance of USA-based quantitative research that measures social support of friends, family and a singular intimate partner. The majority of participants were white, binary-identified transgender women and TGDNB people living in metropolitan settings. Social support was commonly reported as a protective factor, with TGDNB peer support the most frequently reported correlate of health and well-being for TGDNB adults. Discussion: The results suggest standardized inventories do not capture the emic nature of social support for TGDNB adults. A key opportunity lies in an inductive, hypothesis-forming approach to the study of what is socially supportive for TGDNB adults. In turn, this knowledge will enable the appropriate measurement, implementation and interpretation of social support studies.

'I know what I am doing': A grounded theory investigation into the activities and occupations of adults living with chronic conditions.

Background: A growing number of adults experience chronic conditions and related disability. However, a limited understanding of the activities and occupations of this population reduces the capacity of occupational therapists to deliver person-centred, occupation-based care.Aims: To investigate the activities and occupations of adults living with chronic conditions.Methods: Sixteen adults with multiple chronic conditions participated in two semi-structured interviews at their home or health center. Grounded theory methods were used to analyze data and construct a conceptual understanding of human occupation.Findings: Human occupation was conceptualized as doing activities and actions with meaning, in the context of one's life, health condition(s), and world. Three, two-dimensional categories of meaning were developed from the data: (i) connecting/reconnecting and disconnecting; (ii) caring and harming; and (iii) contributing and detracting.Conclusions: The findings present a complex, dynamic and multifaceted understanding of the activities and occupations of adults living with chronic conditions.Significance: This study demonstrates the value of exploring the experiences of actual or potential occupational therapy clients to refine the concept of human occupation. An in-depth knowledge of what people do is an essential foundation for person-centred, occupation-based practice.

Living a Healthy Life in Australia: Exploring Influences on Health for Refugees from Myanmar.

BACKGROUND: Humanitarian migrants from Myanmar represent a significant refugee group in Australia; however, knowledge of their health needs and priorities is limited. This study aims to explore the meaning and influencers of health from the perspectives of refugees from Myanmar. METHOD: Using a community-based participatory research (CBPR) design, a partnership was formed between the researchers, Myanmar community leaders and other service providers to inform study design. A total of 27 participants were recruited from a government-funded English language program. Data were collected using a short demographic survey and four focus groups, and were analysed using descriptive statistics and thematic analysis methods. RESULTS: Key themes identified included: (1) health according to the perspectives of Australian settled refugees from Myanmar, (2) social connections and what it means to be part of community, (3) work as a key influence on health, and (4) education and its links with work and health. CONCLUSIONS: This study outlined the inter-relationships between health, social connections, work and education from the perspectives of refugees from Myanmar. It also outlined how people from Myanmar who are of a refugee background possess strengths that can be used to manage the various health challenges they face in their new environment.

Multimorbidity and the process of living with ongoing illness.

OBJECTIVES: Living with two or more health conditions, or multimorbidity, is associated with higher rates of disability and lower quality of life. To overcome the challenges associated with multimorbidity, person-centred health care is essential. However, to provide person-centred health care, health professionals first need to understand how people with multiple health conditions experience their illness. METHODS: Sixteen adult participants, with one or more health conditions, were recruited from hospital outpatient and community health services and interviewed twice. Qualitative data from interview transcripts and field notes were inductively analysed using constructivist grounded theory and life chart methods. FINDINGS: 'Living with ongoing illness' describes a process involving four interrelated experiences. Participants described, 'recognising something is not right,' 'working out what is wrong,' 'getting things under control' and 'getting on with life.' A case example is used to illustrate and compare the process across a participant's first and subsequent health conditions. DISCUSSION: Participants with different health conditions shared similar illness experiences. Yet, the process of living with ongoing illness was unique and differed according to participants' health conditions and life context. By understanding the experiences, needs, and priorities of people with multimorbidity, health professionals can provide timely and relevant health care.