Michelle L Townsend

The Educational Outcomes of Young People 4–5 Years after Leaving Care: An Australian Perspective

Judy Cashmore, Marina Paxman and Michelle Townsend focus on the educational and employment pathways and outcomes for young people after leaving care in Australia, based on a longitudinal study of young people ‘ageing’ out of care in New South Wales. Consistent with the findings of other research on the educational performance and attainment of children and young people in care, the young people leaving care in this study were less likely to have completed their secondary schooling than others their age in the general population. Four to five years after leaving care, they were much less likely than their peers to be in full-time work and/or education. Many had a history of part-time and casual work in poorly paid and low-skill jobs, and over half the young women had had children. Those who had completed Year 12, however, were more likely to be employed or studying, and to be faring well across a number of areas compared with those who did not complete Year 12. The more stable and secure they had been in care, the more years of schooling they completed, and the better they were faring 4–5 years after leaving care.

Personality disorder: A mental health priority area:

Personality disorders have received limited recognition as a public health priority, despite the publication of treatment guidelines and reviews showing effective treatments are available. Inclusive approaches to understanding and servicing personality disorder are required that integrate different service providers. This viewpoint paper identifies pertinent issues surrounding early intervention, treatment needs, consumer and carer experiences, and the need for accurate and representative data collection in personality disorder as starting points in mental health care reform.

Longitudinal intergenerational birth cohort designs: a systematic review of Australian and New Zealand studies

Background The longitudinal birth cohort design has yielded a substantial contribution to knowledge of child health and development. The last full review in New Zealand and Australia in 2004 identified 13 studies. Since then, birth cohort designs continue to be an important tool in understanding how intrauterine, infant and childhood development affect long-term health and well-being. This updated review in a defined geographical area was conducted to better understand the factors associated with successful quality and productivity, and greater scientific and policy contribution and scope. Methods We adopted the preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach, searching PubMed, Scopus, Cinahl, Medline, Science Direct and ProQuest between 1963 and 2013. Experts were consulted regarding further studies. Five inclusion criteria were used: (1) have longitudinally tracked a birth cohort, (2) have collected data on the child and at least one parent or caregiver (3) be based in Australia or New Zealand, (4) be empirical in design, and (5) have been published in English. Results 10665 records were initially retrieved from which 23 birth cohort studies met the selection criteria. Together these studies recruited 91,196 participants, with 38,600 mothers, 14,206 fathers and 38,390 live births. Seventeen studies were located in Australia and six in New Zealand. Research questions initially focused on the perinatal period, but as studies matured, longer-term effects and outcomes were examined. Conclusions This review demonstrates the significant yield from this effort both in terms of scientific discovery and social policy impact. Further opportunities have been recognised with cross-study collaboration and pooling of data between established and newer studies and international studies to investigate global health determinants.

Biomarker correlates of psychotherapy outcomes in borderline personality disorder: A systematic review

HighlightsNeurobiological factors are implicated in psychotherapy outcomes.Brain activity subserving executive control and emotion regulation changed.Hypoactivation in prefrontal and cingulate regions predicted treatment response.Further work may inform personalised treatment approaches in clinical practice. Abstract Studies of neurobiological mechanisms in borderline personality disorder (BPD) have increased our understanding of the pathophysiology of its development and course. Less is known about how psychotherapy may influence these neurobiological factors, and also whether biomarkers may predict psychotherapy outcomes. We conducted a systematic review using PRISMA guidelines. Fourteen studies providing data from 467 participants diagnosed with BPD met inclusion criteria to: (a) investigate biomarkers predicting response to psychotherapy for BPD; or (b) examine neurobiological factors altered by psychotherapy. Neuroimaging studies (n = 11) used mostly functional magnetic resonance imaging methods to scope brain regions related to emotion regulation and cognitive control. Three studies examined genetic or neuroendocrine markers. The evidence suggests that psychotherapy alters neural activation and connectivity of regions subserving executive control and emotion regulation. Additionally, hypoactivation in prefrontal and cingulate regions predicted treatment response. Further work in this area may inform personalised treatment approaches in clinical practice for BPD through elucidating neural mechanisms of evidence‐based psychotherapy.

Effectiveness of a brief parenting intervention for people with borderline personality disorder: a 12-month follow-up study of clinician implementation in practice

ABSTRACT Objective: Borderline personality disorder exacerbates the everyday challenges of parenting and may lead to adverse consequences for both the individual and their family. This study is the first to evaluate the effectiveness of a brief parenting intervention for people with personality disorder using the perspectives of trained clinicians. Method: The study used detailed retrospective qualitative and quantitative methods to evaluate clinician (n = 12) implementation in real world settings over the first 12-months after being trained in the intervention. Results: Clinicians were all using the intervention, predominantly as a module or sub-set of strategies within a larger treatment plan. Including the parenting intervention was associated with positive client outcomes across multiple areas of psychological functioning. Clinicians reported that the intervention was also effective at increasing their capacity to reflect upon parenting issues with their clients. Qualitative responses revealed three major themes: noticing client parenting improvement; improved clinician efficacy in conducting parenting interventions due to a manualised approach; and systemic improvement in work practices and attitudes to working with parenting aspects of treatment. Discussion: Follow-up evaluation indicated that adding a parenting intervention to standard treatment improved parenting capacity for people with personality disorder, while simultaneously supporting clinicians’ capacity to work with this clinical population. The findings contribute to an understanding of how clinicians’ use interventions in practice and their effectiveness in an area that has the potential to reduce the impact of personality disorder on families.