Lynda R. Matthews

Australian guidelines for the treatment of adults with acute stress disorder and post-traumatic stress disorder

Over the past 2–3 years, clinical practice guidelines (CPGs) for post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) have been developed in the USA and UK. There remained a need, however, for the development of Australian CPGs for the treatment of ASD and PTSD tailored to the national health-care context. Therefore, the Australian Centre for Posttraumatic Mental Health in collaboration with national trauma experts, has recently developed Australian CPGs for adults with ASD and PTSD, which have been endorsed by the National Health and Medical Research Council (NHMRC). In consultation with a multidisciplinary reference panel (MDP), research questions were determined and a systematic review of the evidence was then conducted to answer these questions (consistent with NHMRC procedures). On the basis of the evidence reviewed and in consultation with the MDP, a series of practice recommendations were developed. The practice recommendations that have been developed address a broad range of clinical questions. Key recommendations indicate the use of trauma-focused psychological therapy (cognitive behavioural therapy or eye movement desensitization and reprocessing in addition to in vivo exposure) as the most effective treatment for ASD and PTSD. Where medication is required for the treatment of PTSD in adults, selective serotonin re-uptake inhibitor antidepressants should be the first choice. Medication should not be used in preference to trauma-focused psychological therapy. In the immediate aftermath of trauma, practitioners should adopt a position of watchful waiting and provide psychological first aid. Structured interventions such as psychological debriefing, with a focus on recounting the traumatic event and ventilation of feelings, should not be offered on a routine basis.

Competencies and frameworks in interprofessional education: a comparative analysis.

Health professionals need preparation and support to work in collaborative practice teams, a requirement brought about by an aging population and increases in chronic and complex diseases. Therefore, health professions education has seen the introduction of interprofessional education (IPE) competency frameworks to provide a common lens through which disciplines can understand, describe, and implement team-based practices. Whilst an admirable aim, often this has resulted in more confusion with the introduction of varying definitions about similar constructs, particularly in relation to what IPE actually means. The authors explore the nature of the terms competency and framework, while critically appraising the concept of competency frameworks and competency-based education. They distinguish between competencies for health professions that are profession specific, those that are generic, and those that may be achieved only through IPE. Four IPE frameworks are compared to consider their similarities and differences, which ultimately influence how IPE is implemented. They are the Interprofessional Capability Framework (United Kingdom), the National Interprofessional Competency Framework (Canada), the Core Competencies for Interprofessional Collaborative Practice (United States), and the Curtin University Interprofessional Capability Framework (Australia). The authors highlight the need for further discussion about establishing a common language, strengthening ways in which academic environments work with practice environments, and improving the assessment of interprofessional competencies and teamwork, including the development of assessment tools for collaborative practice. They also argue that for IPE frameworks to be genuinely useful, they need to augment existing curricula by emphasizing outcomes that might be attained only through interprofessional activity.

Reproductive health and access to healthcare facilities: risk factors for depression and anxiety in women with an earthquake experience

BackgroundThe reproductive and mental health of women contributes significantly to their overall well-being. Three of the eight Millennium Development Goals are directly related to reproductive and sexual health while mental disorders make up three of the ten leading causes of disease burden in low and middle-income countries. Among mental disorders, depression and anxiety are two of the most prevalent. In the context of slower progress in achieving Millennium Development Goals in developing countries and the ever-increasing man-made and natural disasters in these areas, it is important to understand the association between reproductive health and mental health among women with post-disaster experiences.MethodsThis was a cross-sectional study with a sample of 387 women of reproductive age (15-49 years) randomly selected from the October 2005 earthquake affected areas of Pakistan. Data on reproductive health was collected using the Centers for Disease Control reproductive health assessment toolkit. Depression and anxiety were measured using the Hopkins Symptom Checklist-25, while earthquake experiences were captured using the Harvard Trauma Questionnaire. The association of either depression or anxiety with socio-demographic variables, earthquake experiences, reproductive health and access to health facilities was estimated using multivariate logistic regression.ResultsPost-earthquake reproductive health events together with economic deprivation, lower family support and poorer access to health care facilities explained a significant proportion of differences in the experiencing of clinical levels of depression and anxiety. For instance, women losing resources for subsistence, separation from family and experiencing reproductive health events such as having a stillbirth, having had an abortion, having had abnormal vaginal discharge or having had genital ulcers, were at significant risk of depression and anxiety.ConclusionThe relationship between womens post-earthquake mental health and reproductive health, socio-economic status, and health care access is complex and explained largely by the socio-cultural role of women. It is suggested that interventions that consider gender differences and that are culturally appropriate are likely to reduce the incidence.

Building capacity in Australian interprofessional health education: perspectives from key health and higher education stakeholders

OBJECTIVE A substantial literature engaging with the directions and experiences of stakeholders involved in interprofessional health education exists at the international level, yet almost nothing has been published that documents and analyses the Australian experience. Accordingly, this study aimed to scope the experiences of key stakeholders in health and higher education in relation to the development of interprofessional practice capabilities in health graduates in Australia. METHODS Twenty-seven semi-structured interviews and two focus groups of key stakeholders involved in the development and delivery of interprofessional health education in Australian higher education were undertaken. Interview data were coded to identify categories that were organised into key themes, according to principles of thematic analysis. RESULTS Three themes were identified: the need for common ground between health and higher education, constraints and enablers in current practice, and the need for research to establish an evidence base. Five directions for national development were also identified. CONCLUSIONS The study identified a range of interconnected changes that will be required to successfully mainstream interprofessional education within Australia, in particular, the importance of addressing issues of culture change and the need for a nationally coordinated and research informed approach. These findings reiterate those found in the international literature.

Road trauma, PTSD and occupational functioning: implications for policy development, intervention and rehabilitation.

Objective: With survivors of road trauma at risk of experiencing posttraumatic stress disorder (PTSD) and more routinely seeking psychosocial and vocational rehabilitation services, published research findings on the impact of PTSD on occupational functioning following road trauma are of increasing interest. This report investigates the literature in this area to highlight findings that may guide the development of public policy and interventions to improve occupational functioning post‐accident.

Implementing curriculum evaluation: case study of a generic undergraduate degree in health sciences

This case study presents a longitudinal, evidence‐based approach to health science curriculum reform and evaluation. Curriculum in higher education must meet the needs of diverse stakeholders and must respond to dynamic local, national and international contexts, and this creates challenges for evaluation. The long lead time prior to the introduction of new or revised university curriculum (at least two years), the length of degree programmes (three to five years) and the lag time in the availability of objective indicators of degree outcomes (at least one year post‐graduation) mean that findings may be obsolete before an evaluation can be completed. Few would argue that evaluation is important and methods and approaches for conducting curriculum evaluation are proposed in the literature, although few published reports of the outcomes of comprehensive evaluations are evident. This paper discusses potential for evaluation to establish responsive communication between students, teaching staff and programme administrators, ensuring a match between the intended, implemented and attained curriculum.

Prediction of work functioning following accidental injury: The contribution of PTSD symptom severity and other established risk factors

Responses to a mail survey were used to investigate the contribution of PTSD symptom severity to work functioning in 69 previously employed adult survivors of accidental injury approximately 8 months post‐hospitalization. Associations of PTSD symptom severity with other established risk factors for poor work functioning were also examined. Participants were initially divided into three groups based on PTSD symptom severity and analysis of variance undertaken to determine the differences in work functioning between survivors with PTSD, subclinical PTSD, and no PTSD. As anticipated, survivors with PTSD reported significantly poorer work functioning than those with subclinical PTSD and no PTSD. Those with subclinical PTSD, however, reported significantly lower levels of work functioning than survivors with no PTSD, suggesting that this population may also be at risk of poor outcomes and in need of vocational interventions post‐accident. To determine the influence of PTSD symptom severity on work functioning ...

Perspectives on barriers to employment for job seekers with mental illness and additional substance-use problems

This paper examines the barriers to employment faced by job seekers (JS) with mental illness and additional substance-use issues. Semi-structured interviews concerning barriers to employment for JS with mental illness and substance-use problems and strategies to improve employment outcomes were conducted with stakeholders associated with an employment service provider specialising in mental illness (n = 17). Stakeholders were JS, family members who provide significant support to JS [support persons (SP)] and staff [employment staff (ES)]. Data were collected between May and August 2009 at the premises of the employment service provider in metropolitan Sydney. Thematic analysis of transcribed interview data was conducted to develop a meaningful data framework. The expectations of JS and SP regarding employment outcomes were higher than those of ES. Length of time unemployed was perceived as the most important barrier to future employment associated with mental illness, and substance-use problems were associated with lower, more variable motivation, restrictions on the environments where JS could work and more negative community and employer perceptions. The findings are consistent with studies from non-vocational settings and provide direction for meeting the needs of clients with mental illness and additional substance-use problems. Ensuring alignment between JS and ES concerning service goals and expected timeframes may improve JS motivation, satisfaction with service delivery and ultimately, employment outcomes.

Trauma-related appraisals and coping styles of injured adults with and without symptoms of PTSD and their relationship to work potential

Purpose. This study aimed to document the self-reported trauma-related appraisals and coping strategies of injured workers with and without symptoms of posttraumatic stress disorder (PTSD) and to explore relationships between these cognitive variables and work potential. Method. Sixty-nine (55% males) respondents previously admitted to a teaching hospital following accidental injury completed a self-report survey which included measures for PTSD, trauma-related appraisals, coping strategies and work potential approximately 8 months post-accident. Results. Nineteen percent of the sample reported symptoms consistent with a PTSD diagnosis, and these participants reported more negative appraisals about the self and the world, greater use of avoidant coping and poorer work outcomes than those without clinically significant PTSD symptoms. After partialing out the influence of PTSD symptom severity, active cognitive coping was associated with increased work potential and negative appraisals of the world was associated with reduced work potential. Conclusions. Trauma-related appraisals and coping strategies are associated with work potential following accidental injury. Although the role of negative appraisals in the maintenance of PTSD is well documented, this study identified negative appraisals of the world as being associated with work potential after controlling for PTSD symptoms. Reducing negative appraisals of the world and increasing active coping may influence work potential, however, longitudinal studies that substantiate the direction of the associations are required.

A Comparative Study of the Job Tasks, Functions, and Knowledge Domains of Rehabilitation Professionals Providing Vocational Rehabilitation Services in Australia and Germany

Vocational rehabilitation services have been implemented in a number of countries to facilitate the return to work of sick and injured workers, yet little research has been undertaken to document competencies required to provide services globally. This study compared the job tasks, functions, and knowledge domains deemed important by Australian and German rehabilitation professionals working in vocational rehabilitation settings to identify common practice domains. An online survey comprising items from the Rehabilitation Skills Inventory–Amended and the International Survey of Disability Management was completed by 149 Australian and 217 German rehabilitation professionals. Items from each measure were submitted to factor analysis, using principal axis factoring as the extraction technique. Three common domains were identified: (a) vocational counseling, (b) workplace disability case management, and (c) workplace intervention and program management. Differences in skill and knowledge domains centered on the levels of specialization in vocational rehabilitation practices in each country. Ongoing transnational research is required to ensure that a “global curriculum” covers core competencies, while at the same time allowing for specialization at a local level.