Art and Safe Communities: the role of Big hART in the regeneration of an inner city housing estate.

ISSUE ADDRESSED: This paper describes how a notorious central housing estate nicknamed '' became the first public housing estate to achieve the World Health Organization criteria for designation as a Safe Community. METHODS: A case study was the method of choice to report on the way Government and non-government agencies worked with tenants in a community development approach. RESULTS: The Neighbourhood Advisory Board formed at Northcott worked collaboratively with tenants, Big hART, Government and non-government organisations to make Northcott a safer place to live. This resulted in improved social cohesion, improved environments and a decrease in violent crime. Most importantly, tenants reported feeling more valued, much safer and more comfortable since the project started. CONCLUSIONS: Although the arts are not often considered part of the community development process, the use of the art of story telling was the catalyst for the regeneration of this notorious housing estate. In addition, the criteria required for Safe Community accreditation provided an infrastructure within the Northcott Housing Estate for Government and non-government agencies to work with the Northcott community to establish the inter-connectiveness necessary to turn this community into somewhere that the residents felt safe and were proud to be part of.

Using local injury surveillance for community-based injury prevention: an analysis of scandinavian WHO safe community and canadian safe community foundation programmes.

Injury surveillance is widely recognized as a critical prerequisite for effective injury prevention, yet few studies have investigated its use by community-based injury prevention programmes. This study examined the extent to which local injury data were collected, documented, analysed, linked to injury prevention action and used for evaluation among WHO Safe Communities in Scandinavia (25 programmes) and the Canadian Safe Community Foundation (SCF) network (16 programmes). For each programme, a key informant with relevant local knowledge was selected to respond to an emailed questionnaire. The study demonstrates that community-based injury prevention programmes experience difficulties accessing and effectively utilizing local injury surveillance data. The findings suggest that the responding SCF programmes approach injury prevention more scientifically than the Scandinavian WHO-designated Safe Community programmes, by making greater use of injury surveillance for assessment, integration into prevention strategies and measures, and evaluation. Despite study limitations, such as the low response rate among Canadian programmes and a large number of non-responses to two questions, the results highlight the importance of, and need for, greater use of local injury surveillance.

Effective strategies for suicide prevention in New Zealand: a review of the evidence.

A national suicide prevention strategy for New Zealand was developed in 2006. There is relatively little strong evidence for the efficacy of many existing suicide prevention initiatives, and this area has frequently been captured by strong claims about the effectiveness of programmes that have not been adequately evaluated. This paper provides a conceptual framework for classifying suicide prevention initiatives, reviews evidence for their effectiveness, and makes recommendations for initiatives to be undertaken as part of suicide prevention activities in New Zealand. The available evidence thus far suggests that the most promising interventions likely to be effective in reducing suicidal behaviours are medical practitioner and gatekeeper education, and restriction of access to lethal means of suicide. This evidence also suggests a clear agenda for research, which includes evaluating interventions and prevention programmes, developing model and demonstration projects, identifying meaningful outcome measures, and refining and identifying the critical elements of effective programmes.

Mental health services and sexual abuse: the need for staff training.

Identification of child abuse by mental health services is important for formulation of the causes of presenting problems and for development of comprehensive treatment plans. A small but growing number of studies suggest, however, that the majority of child sexual abuse cases are not identified by mental health services. A similarly small literature also suggests that abuse survivors are extremely reluctant to spontaneously tell anyone about the abuse, indicating that professionals have a responsibility to ask rather than wait for spontaneous disclosures. The purpose of this study, therefore, was to add to these two bodies of literature with a New Zealand sample. A postal questionnaire was completed by 191 women who had received counselling for childhood sexual abuse. The average amount of time taken to tell anyone about the abuse was 16 years. Only 22% of those who had been in contact with public mental health services had ever been asked about abuse by those services. It was concluded that New Zealand women are reluctant to disclose abuse and that mental health services are, as is the case elsewhere, failing to assist them with this process. The need for staff training is discussed, and an example described.

Injury associated with methamphetamine use: a review of the literature.

This paper reviews the literature exploring issues around methamphetamine and injury. There was a paucity of peer reviewed quantitative research and a lack of large scale epidemiological studies. Further sources described cases and others described injury risk as part of an overall review of methamphetamine misuse. Thus, a number of limitations and potential biases exist within the literature. The main areas where associations were noted or extrapolated with methamphetamine use and injury were around driving and violence. Other associations with injury related to methamphetamine manufacture. There was also circumstantial evidence for third party injury (that is injury to those not specifically involved in drug use or drug manufacture); however, the available data are inadequate to confirm these associations/risks.

Evaluation of the Ngati Porou Community Injury Prevention Project.

OBJECTIVE: To evaluate the Ngati Porou Community Injury Prevention Project based in a rural district in the North Island of New Zealand with an extensive indigenous population (Maori). METHOD: The evaluation design was quasi-experimental and included process, impact and outcome measures. RESULTS: Process evaluation found that the Ngati Porou Community Injury Prevention Project was based on sound principles related to injury prevention, as well as addressing Maori aspirations. The main activities undertaken were: road safety campaigns; alcohol and drug programmes; family violence initiatives; and the development of a playground safety audit. A significant increase in awareness of injury prevention was found among Ngati Porou whanau (families) (pre 17% and post 25%, p < 0.05). Injury morbidity statistics for the period 1996-99 showed a significant decrease in injury rates for all age groups, compared with the comparison community (p < 0.05). CONCLUSION: The Ngati Porou Community Injury Prevention Project successfully applied the principles of role modelling, life span focus, accessibility, acceptability and active participation. This is a promising model that could be repeated in other indigenous communities.

TRAVELLERS: a school-based early intervention programme helping young people manage and process change, loss and transition. Pilot phase findings.

OBJECTIVE: This paper outlines the conceptual background and findings from the pilot phase of TRAVELLERS--an early intervention programme designed to enhance protective factors for young people experiencing change, loss and transition events and early signs of emotional distress. The pilot study aimed to determine whether TRAVELLERS was a feasible, acceptable and promising intervention for young people within secondary schools in Aotearoa/New Zealand. METHOD: The conceptual origins of the TRAVELLERS programme are described in terms of: adolescent mental health concerns; emerging mental health promotion theory and practice; and prevention and early intervention models. The key elements of the TRAVELLERS programme are described. The programme was piloted in two secondary schools, one rural and one urban with 34 participants (females n = 24, males n = 10). Evaluation methods included: review of programme materials; identification of potential selection tools appropriate to Year 9 students; analysis of selection questionnaire; and conduct of feedback from participants, facilitators and parents/caregivers. RESULTS: The TRAVELLERS programme provides a means of identifying and selecting young people who may benefit from participating in an early intervention programme. The programme has achieved a statistically significant reduction in participants' distress (p < 0.01). Young people were overwhelmingly enthusiastic about most aspects of TRAVELLERS. School personnel reported that TRAVELLERS was an appropriate and acceptable programme to the school. CONCLUSIONS: Targeted interventions provided within a supportive school environment can contribute to enhancing protective factors such as personal and interpersonal coping strategies, increased help-seeking behaviour, and young people feeling more positive about themselves and their lives. The pilot programme has been amended and prepared for a two year trial phase in 10 secondary schools during 2002-2003.

Problematising depression: young people, mental health and suicidal behaviours.

The published literature provides strong evidence for connections between mental health issues, such as depression, and suicidal behaviours. However, in spite of this, no investigations to date have explored young people's perceptions of the interconnections between depression, and suicidal behaviours. This article presents discussive analyses of discussions of the contributions of depression to their suicidal behaviours of young people in New Zealand. Two dominant discourses of depression emerged: a medicalised discourse, and a moral discourse. The medicalised discourse was accessible to the majority of participants, and constructed depression as a disease. This discourse prioritised the voices of health professionals and suggested that depression was difficult to resist. The moral discourse was an alternative to the medicalised discourse, and constructed young people who experienced depression and suicidal behaviours as failures. Both discourses were informed by a mechanistic cause-and-effect relationship between depression and suicidal behaviours: attempting suicide was seen as an inevitable outcome of experiencing depression, and suicidal behaviours were inevitably undertaken by young people who were depressed. Resistance to either of these dominant discourses was problematic, and was best articulated during discussions of the stigma associated with mental ill-health and depression.

Evaluation of a New Zealand indigenous community injury prevention project.

OBJECTIVE: To evaluate the Turanganui-a-kiwa Community Injury Prevention Project, based in a provincial town on the North Island of New Zealand with an extensive indigenous population (Maori). METHOD: The evaluation design was quasi-experimental and included process, impact and outcome measures. RESULTS: Process evaluation findings indicated that adopting an holistic lifespan approach to injury prevention was successful in this Maori community. The three main areas of activities were: child road safety; safer alcohol use in the road, sporting and home environments for young people and adults; and fire safety for older people. Significant increases in awareness of injury prevention initiatives were found among Turanganui-a-kiwa whanau (families) (p < 0.001). A large increase in the take-up of car restraints among Maori young children was demonstrated (pre 10%, post 74%). The safe alcohol dual message approach also resulted in significant increases in the number of respondents wearing protective equipment for sports (p < 0.05). The results of the fire safety initiative was that 120 kaumatua homes now have correctly installed smoke alarms and there is now a commitment from the Fire Service to maintain these alarms. Outcome evaluation findings showed that there was a significant decrease in hospitalization injury rates across the lifespan in Turanganui-a-kiwa (p < 0.05). CONCLUSION: Despite the challenges associated with conducting community injury prevention projects the conduct of this evaluation provides previously unknown information on an indigenous (Maori) injury prevention programme. The success of the programme would appear to be that the project was perceived as an intervention for Maori operating within a Maori framework which addressed Maori aspirations. IMPLICATIONS: As so little is known about injury prevention initiatives in indigenous populations, the findings presented in this article will provide important information for the future development of other indigenous injury prevention programmes.

Self-reported injury rates in New Zealand.

AIM: The study aimed to obtain baseline information on the incidence and nature of self-reported injuries in New Zealand. METHODS: A cross-sectional survey was conducted of approximately 400 randomly-selected households from each of 13 Territorial Local Authorities across New Zealand, giving a total sample size of 5282. Respondents were asked if anyone in their household had been treated by a medical doctor in the previous twelve months for any injuries and, if so, details of the injury event were recorded. RESULTS: Forty one per cent of households reported that someone in the household had sustained an injury. The most common types of injuries were falls (33%), sports-related injuries (28%) and injuries caused by lifting an object (16%). Only eight per cent of the injuries required overnight hospitalisation. CONCLUSION: The findings from this study indicate that the total burden of injury in New Zealand is much larger than estimated by routinely-collected injury hospitalisation data.

Risk factors associated with the transition from acute to chronic occupational back pain.

STUDY DESIGN: A prospective cohort study was conducted on workers claiming earnings-related compensation for low back pain. Information obtained at the time of the initial claim was linked to compensation status (still claiming or not claiming) 3 months later. OBJECTIVE: To identify individual, psychosocial, and workplace risk factors associated with the transition from acute to chronic occupational back pain. SUMMARY OF BACKGROUND DATA: Despite the magnitude of the economic and social costs associated with chronic occupational back pain, few prospective studies have investigated risk factors identifiable in the acute stage. METHODS: At the time of the initial compensation claim, a self-administered questionnaire was used to gather information on a wide range of risk factors. Then 3 months later, chronicity was determined from claimants' computerized records. RESULTS: The findings showed that 3 months after the initial assessment, 204 of the recruited 854 claimants (23.9%) still were receiving compensation payments. A combined multiple regression model of individual, psychosocial, and workplace risk factors demonstrated that severe leg pain (odds ratio [OR], 1.9), obesity (OR, 1.7), all three Oswestry Disability Index categories above minimal disability (OR, 3.1-4), a General Health Questionnaire score of at least 6 (OR, 1.9), unavailability of light duties on return to work (OR, 1.7), and a job requirement of lifting for three fourths of the day or more all were significant, independent determinants of chronicity (P < 0.05). CONCLUSIONS: Simple self-report measures of individual, psychosocial, and workplace factors administered when earnings-related compensation for back pain is claimed initially can identify individuals with increased odds for development of chronic occupational disability.

Presentations by youth to Auckland emergency departments following a suicide attempt.

The objective of this study was to describe the population of European youth (15-24 years) presenting to emergency departments (EDs) at one of the three Auckland public hospitals following attempted suicide; and to identify factors associated with presentations to EDs by these youth. A 1-year medical record review was undertaken. A total of 212 presentations (196 individuals) occurred during the surveillance; alcohol was present for 29%. Attempts involving alcohol were more likely to occur at weekends (P < 0.01); involve cutting and piercing (P < 0.05); be undertaken by employed people (P < 0.05), and be undertaken by those not residing with family (P < 0.01). Two groups of particular concern were identified: those who involved alcohol in their attempt; and those who represented during the study period following multiple suicide attempts. These findings have implications for immediate care within an ED setting, and long-term follow-up healthcare options for distressed young people.