R McGuire-Snieckus

A new scale to assess the therapeutic relationship in community mental health care: STAR

BACKGROUND No instrument has been developed specifically for assessing the clinician-patient therapeutic relationship (TR) in community psychiatry. This study aimed to develop a measure of the TR with clinician and patient versions using psychometric principles for test construction. METHOD A four-stage prospective study was undertaken, comprising qualitative semi-structured interviews about TRs with clinicians and patients and their assessment of nine established scales for their applicability to community care, administering an amalgamated scale of more than 100 items, followed by Principal Components Analysis (PCA) of these ratings for preliminary scale construction, test-retest reliability of the scale and administering the scale in a new sample to confirm its factorial structure. The sample consisted of patients with severe mental illness and a designated key worker in the care of 17 community mental health teams in England and Sweden. RESULTS New items not covered by established scales were identified, including clinician helpfulness in accessing services, patient aggression and family interference. The new patient (STAR-P) and clinician scales (STAR-C) each have 12 items comprising three subscales: positive collaboration and positive clinician input in both versions, non-supportive clinician input in the patient version, and emotional difficulties in the clinician version. Test-retest reliability was r=0.76 for STAR-P and r=0.68 for STAR-C. The factorial structure of the new scale was confirmed with a good fit. CONCLUSIONS STAR is a specifically developed, brief scale to assess TRs in community psychiatry with good psychometric properties and is suitable for use in research and routine care.

Hope, optimism and delusion

Optimism is generally accepted by psychiatrists, psychologists and other caring professionals as a feature of mental health. Interventions typically rely on cognitive-behavioural tools to encourage individuals to ‘stop negative thought cycles’ and to ‘challenge unhelpful thoughts’. However, evidence suggests that most individuals have persistent biases of optimism and that excessive optimism is not conducive to mental health. How helpful is it to facilitate optimism in individuals who are likely to exhibit biases of optimism already? By locating the cause of distress at the individual level and ‘unhelpful’ cognitions, does this minimise wider systemic social and economic influences on mental health?

Attachment Aware Schools: working with families to enhance parental engagement and home-school relationships

Background:- Application of attachment theory in school contexts lacks empirical evidence. The Attachment Aware Schools pilot project was commissioned by two Local Authorities in England to improve the educational outcomes of Looked After Children, and to build an evidence base. Informed by attachment research, Attachment Aware Schools programs provide a coherent and integrated theoretical framework, discourse, and practice for all practitioners working with children and young people. Objective:- The primary focus was to provide whole school and targeted attachment-based strategies to support children’s well-being, behaviour, and academic attainment. This paper; however, documents a secondary objective, which was to facilitate collaborative partnerships with families. Method:- As part of the mixed methods approach to the Attachment Aware Schools project, a series of case studies were collected and thematically coded. The case studies were generated by practitioners using an outcomes-based framework. Results:- Although the case study sample size is small (N=10), the case studies presented here illustrate how Attachment Aware Schools programs can promote increased home-school engagement and shared practice between home and school. Outcomes include improved home-school relationships, reductions in behavioral incidents, and improved family dynamics. Conclusion:- Attachment Aware Schools can be a vehicle for facilitating supportive home-school collaborative partnerships with positive outcomes for vulnerable children and young people.