BackgroundOut-of-home care (OoHC) refers to young people removed from their families by the state because of abuse, neglect or other adversities. Many of the young people experience poor mental health and social function before, during and after leaving care. Rigorously evaluated interventions are urgently required.This publication describes the protocol for the Ripple project and notes early findings from a controlled trial demonstrating the feasibility of the work. The Ripple project is implementing and evaluating a complex mental health intervention that aims to strengthen the therapeutic capacities of carers and case managers of young people (12-17 years) in OoHC.MethodsThe study is conducted in partnership with mental health, substance abuse and social services in Melbourne, with young people as participants. It has three parts:1. Needs assessment and implementation of a complex mental health intervention; 2. A 3-year controlled trial of the mental health, social and economic outcomes; and 3. Nested process evaluation of the intervention.ResultsEarly findings characterising the young people, their carers and case managers and implementing the intervention are available. The trial Wave 1 includes interviews with 176 young people, 52% of those eligible in the study population, 104 carers and 79 case managers.ConclusionsImplementing and researching an affordable service system intervention appears feasible and likely to be applicable in other places and countries. Success of the intervention will potentially contribute to reducing mental ill-health among these young people, including suicide attempts, self-harm and substance abuse, as well as reducing homelessness, social isolation and contact with the criminal justice system.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12615000501549. Retrospectively registered 19 May 2015.
Objective: To compare the quality of care offered by a community hospital hostel and three hospital rehabilitation facilities (two traditional rehabilitation wards and an innovative normalisation unit) for people with longterm mental illnesses.Method: Quality of care is assessed here on three different levels: those of Input using Programme Analysis of Service Systems; Assessment of Care Environments; Process using Ward Management Practices Questionnaire; Attitudes to Treatment Questionnaire; Outcome using Rehabilitation Evaluation Hall and Baker and the Life Experiences Checklist and resident and staff questionnaires. These measures cover a range of perspectives from staff to residents, and include both standardised assessments as well as specific schedules developed for the study.Results: On Input measures, the community hospital hostel had the best scores on the Programme Analysis of Service Systems schedule, which measures the degree to which services meet predetermined normalisation criteria. On the Assessment of Care Environments it also scored favourably against other community facilities. Process measures showed no differences between units in terms of their management practices, all scoring well, but suggested some differences in staff attitudes. Staff in the community hospital hostel had the most medical approach to care, however this was accounted for by the scores of untrained staff. Qualified nurses had a more psychological approach to care. Finally on Output measures, residents in the community hospital hostel were found to be the most disabled on the REHAB scale. Despite this, they had a significantly better quality of life as assessed by the Life Experiences Checklist. Staff in the community hospital hostel had the clearest perceptions of their roles, though there were differences again in how qualified and unqualified staff perceived their work. Residents were generally satisfied with services, though residents in the community hospital hostel and in the hospital normalisation unit had the highest satisfaction levels.Conclusion: The results of this comparative evaluation show that a high standard of care, equal to or surpassing some of the best hospital provision, can be provided in the community. This is despite the fact that the residents in the community hospital hostel were more disabled. Community patients' quality of life is better in a number of domains than their hospital counterparts and even patients initially reticent about the move into the community report higher levels of satisfaction, especially regarding their home environment. There-were interesting differences between trained and unqualified staff in the community hospital hostel. Trained staff had a more psychological view of patient care and felt more supported and appreciated by the team than their untrained colleagues. The implications of these findings for community residential care are discussed.
Elite competitive sport is linked with a unique collection of stressors distinct from the general population. While there have been advancements in understanding the role that stressors play within the elite sporting environment, uncertainty still exists around a clear process for measuring stressors, and their specific relationship to injury. A number of models have been proposed as useful frameworks for investigating and describing the role of stress and its interaction with the psychological response to athletic injury. While these models provide evolving points of view drawing on different theoretical backgrounds regarding their interpretation of athletic stress and injury, they offer little application to the applied elite sporting environment, and no detail of how they these models support athletes, and high performance staff in the applied setting. This narrative review will present two popular theoretical psychological models of sports injury rehabilitation. We argue that these models could be better applied in the current sporting environment if they utilized biological markers such as cortisol measures of personality. Extending from the Biopsychosocial model of injury, we present an updated model of injury quantifying the psychophysiological response for athletes [1]. This model is aligned with the current applied sporting landscape, incorporating the implementation of measurement practice guidelines, and offering high-performance staff an example that can be applied to their unique setting by assessing individuals' distinct measures of cortisol and personality in response to stress and injury.
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