Measuring clinical competencies in facilitating group-based rehabilitation interventions: development of a new competency checklist.

OBJECTIVE: Group-based intervention formats are common in rehabilitation, but no tool for objectively measuring clinical competencies in group facilitation currently exists. We aimed to develop a psychometrically sound group facilitation competency checklist for use in clinical, training, and research settings. METHOD: The Delphi method of expert consensus was used to establish checklist items that clearly describe competencies considered important for effective group facilitation. Inter-rater reliability was determined with two experienced psychologists who used the checklist to rate the competencies of psychology trainees facilitating a memory skills group. RESULTS: After two Delphi rounds, consensus was reached on 17 items, defined as at least 80% agreement among the panel of 15 experts. The four checklist item categories were (a) Facilitating focused group discussion, (b) Communication skills, (c) Interpersonal style, and (d) Session structure. One item was removed after piloting. Inter-rater reliability was excellent (88% agreement) using a simple coding method (competent/incompetent). When using a detailed coding method that discriminated between 'done adequately' and 'done well', inter-rater reliability was weaker (κ = 0.481, 55% agreement); however, it improved to almost perfect after the raters calibrated their standards. CONCLUSION: The new group facilitation competency checklist is fit for purpose for measuring clinical competencies in delivering group-based rehabilitation interventions and can be used in the training of effective group facilitators.

Are Motor Control and Regulation Problems Part of the ASD Motor Profile? A Handwriting Study.

The primary aim of this study was to kinematically assess how children with autism spectrum disorder (ASD) plan and control their handwriting actions. Forty-three boys aged between 8 to 12 years were included in the present analysis; 23 with ASD and 20 typically developing (TD) controls. Sophisticated objective and quantifiable assessment of movement metrics and dynamics was applied across a series of basic cursive handwriting sequences. Children with ASD demonstrated atypical control of handwriting metrics and dynamics, as well as significantly greater neuromotor noise relative to age-matched peers. They also engaged in less regular monitoring and regulation of their movement during the handwriting task. This study provides new insights into the way children with ASD plan and sequence their handwriting movements. Overall, results revealed that even at a basic level, children with ASD appear to have a breakdown in their ability to control and regulate their handwriting movements. This has important implications for the school-aged child who constantly engages in handwriting tasks within the classroom environment and provides insight into possible directions for future intervention.

Do Handwriting Difficulties Correlate with Core Symptomology, Motor Proficiency and Attentional Behaviours?

Handwriting is commonly identified as an area of weakness in children with autism spectrum disorder (ASD), but precise deficits have not been fully characterised. Boys with ASD (n = 23) and matched controls (n = 20) aged 8-12 years completed a simple, digitised task to objectively assess handwriting performance using advanced descriptive measures. Moderate to large associations were identified between handwriting performance and attention, ASD symptoms and motor proficiency. The ASD group demonstrated significantly less smooth movements and significantly greater sizing variability and peak velocity relative to controls. These findings provide a clearer indication of the specific nature of handwriting impairments in children with ASD, and suggest a relationship with core clinical symptom severity, attention and motor behaviours.

An open label trial of clustered maintenance rTMS for patients with refractory depression.

Whilst the antidepressant properties of repetitive transcranial magnetic stimulation treatment (rTMS) have been repeatedly demonstrated, minimal research has investigated the use of rTMS to prevent relapse in patients who have responded to treatment. To address this issue, a large open label trial of a new form of clustered maintenance rTMS was conducted. Thirty-five patients with treatment resistant depression were included. All patients had responded to two courses of rTMS treatment for depression. Following their second course of rTMS, they received clustered maintenance rTMS which involved monthly maintenance sessions of five rTMS treatments over a two day period. The time to relapse and clinical characteristics are described. Twenty-five patients experienced a relapse within the study period, with a mean treatment duration of 10.5 ± 10.3 months. This was substantially longer than their period of wellness following their initial acute treatment without maintenance (<3 months). Ten additional patients continued maintenance until withdrawal from the study without having experienced relapse (4 at a mean of 6.2 ± 4.3 months) or until study end (6 patients with mean duration of 12.0 ± 9.7 months). Although preliminary, this study suggests that clustered maintenance rTMS has the potential to substantially delay the occurrence of relapse following a successful course of rTMS treatment.

Partner or perish? Exploring inter-organisational partnerships in the multicultural community aged care sector.

Given an Australian national and state policy agenda that continues to promote collaborative work, many community organisations are attempting to engage in partnerships with mixed results. This paper reports on a qualitative study conducted to explore the experiences of existing partnerships between organisations and small community groups who deliver community based support services to older people from culturally diverse backgrounds. In particular, this study sought to identify the key factors that facilitate and hinder the formation, maintenance and effectiveness of partnerships within the ethnic and multicultural community aged care (EMCAC) sector. Fourteen participants representing nine community and health service organisations located in the Melbourne metropolitan area took part in semi-structured interviews. Participants reported that partnerships between organisations are necessary and beneficial within the EMCAC sector. Organisational capacity, access to information and guidelines, and the inequality experienced by smaller organisations were key issues identified by participants. Increasing organisational capacity and reducing the inequalities experienced in partnerships may be addressed via training and education about the nature of partnerships, as well as by advocating for increased resources to smaller ethno-specific organisations. Further investigation is required to examine whether not engaging in partnerships will deem an organisation unsustainable in the longer term.