Exploration of counsellors' perceptions of the redesigned service pathways: a qualitative study of a UK university student counselling service

To address the mental health needs of students, UK universities offer bespoke student counselling services. Economic pressures have led services to find innovative ways of redesigning their service pathway. Few studies have investigated staff perceptions of these changes. The aim of this study was to investigate perceptions of staff employed as counsellors at a student counselling service at a UK university that underwent service delivery changes. Face-to-face interviews were conducted with counsellors (n = 5). Framework analysis was used to identify themes and meta-themes. Five meta-themes were identified: the overarching service ethos and service working style; change in the university context; impact of change on working practice; recording and perceived impact on confidentiality; acceptability and effectiveness. Changes to the service resulted in a more efficient service that is perceived to be more acceptable to students. Staff perceptions differed regarding how changes have affected their counselling practice. Despite these differences, the increase in workload was consistently expressed. Tensions remain as staff strive to maintain high standards of service in this changing context. Future research should investigate the process of developing and implementing change as student counselling services strive to evolve sustainable ways of working.     

Child witnesses to violence between parents: Critical issues in Behavioral and social adjustment

This study examined the impact of exposure to family violence on children's adjustment. Two groups of residents of shelters for battered women (current and former residents) were compared to a nonviolent control group. All three groups of mothers completed interviews and selfreport questionnaires related to both their own and their children's adjustment. Children recently witnessing violence tended to have the lowest levels of social competence ratings, and their mothers reported the most health and emotional difficulties. Former residents of shelters experienced the highest level of family/social disadvantage. The results are discussed in the context of previous research findings, and implications for intervention programs are outlined.This research was supported by a grant from the Ontario Ministry of Community and Social Service and the Ontario Mental Health Foundation. The authors wish to thank the staff of transition houses in Cambridge, Catham, Guelph, Kitchener, Sarnia, and Woodstock for their generous support of this project.     

School peer counselling for bullying services as a source of social support: a study with secondary school pupils

Individual interviews to solicit secondary school pupils' (N=99) views of the peer counselling for bullying service in their own school, with a focus on the issue of social support for bullying-related problems, were conducted. Three themes were addressed: (1) willingness to use the service relative to other potential sources of support, (2) preferred gender and age of peer counsellor, and (3) disclosure of using the service to friends. Most participants reported a willingness to use the service, but only around one in 20 would 'definitely not' do so. Relative to their willingness to use the service, participants were more willing to solicit help from friends, but less willing to solicit help from their form teacher and siblings. Around a third of participants expressed a preference for seeing a counsellor of a particular gender, and around two thirds expressed a preference for seeing one of a specific relative age. Several significant differences were obtained between girls and boys, and between users and non-users of the service. The results are discussed in terms of the implications for providers of peer counselling for bullying services.     

Selecting outcomes for intimate partner violence intervention trials: Overview and recommendations

Intimate partner violence (IPV) is endemic in societies around the world and detrimental to women's wellbeing. Abused women are frequent users of health services. Despite the recent World Health Organization guidelines on IPV and sexual violence, we need more evidence on effective responses to women in health care settings. Developing robust evidence with potential to inform policy and clinical practice requires greater clarity and consistency across studies in the selection and use of outcomes to evaluate interventions. Drawing on systematic reviews and individual trials aimed at reducing abuse and improving women's health, we discuss critical issues in respect of outcomes. We discuss primary, secondary, intermediate and proxy outcomes and measures used to evaluate interventions for women who experience IPV. We offer recommendations about which outcomes to assess and approaches to doing so within the context of trials in health care settings.     

Evaluating Genetic Counseling: Client Expectations,Psychological Adjustment and Satisfaction with Service

Periodic evaluations of genetic counseling services are useful for determining the effectiveness of counseling in meetings its psycho-educational aims, as well as identifying where improvements to the service may be made. This study aimed to evaluate the genetic counseling services provided by Genetic Services of Western Australia (GSWA) to determine the impact of counseling on client expectations, satisfaction with the service, and psychological adjustment, defined as wellbeing and perceived personal control (PPC). A total of 122 clients participated in a self-administered survey conducted pre- and post-counseling. Client expectations of the service as a means of providing information were met, and opportunities for counselors to meet client’s expectations of psychological support were identified. Furthermore, counseling was found to maintain and enhance psychological wellbeing of clients. The role of counseling in facilitating the development of PPC was a key contributor to a high sense of satisfaction in clients.     

Therapist, Parent, and Youth Perspectives of Treatment Barriers to Family-Focused Community Outpatient Mental Health Services

This exploratory qualitative study describes treatment barriers to receiving family-focused child mental health services for youths with disruptive behavior problems from multiple perspectives. Data were collected during a series of focus groups and interviews, including: 4 therapist focus groups (n = 26), 3 parent focus groups (n = 14), and 10 youth (10–13 years) semi-structured interviews. Data analysis followed inductive, iterative processes typical of qualitative research using an editing style and thematic content analysis approach. Therapist, parent, and youth stakeholder participants discussed perceived barriers to effective treatment, the problems with current child outpatient therapy, and desired changes (i.e., policy, intervention, etc.) to improve mental health services. Results indicate similar themes around treatment barriers and dissatisfaction with services within and across multiple stakeholder groups, including inadequate service system support, lack of family involvement and feeling overwhelmed with the complexities of families’ needs; however, parents and therapists, in particular, identified different contributing factors to these barriers. Therapists highly endorse using family-focused therapy and desire parent participation; however, parents feel unsupported by their child’s therapist. Parents’ report feeling blamed and not heard by service providers which negatively impacts their attitude about service delivery, causing discomfort and resistance to participation in their youth’s treatment. Youth also discussed dissatisfaction with mental health services, specifically related to their direct experiences in therapy, and desired more active, directive family-focused approaches. Overall, stakeholders reported much frustration and dissatisfaction with current community-based outpatient child therapy services. Study findings can inform service provision, intervention development, and future research.     

Using Patient-Reported Outcome Measures for Quality Improvement in Clinical Genetics: an Exploratory Study

International advocacy of patient-centred healthcare delivery has led to emphasis on the (re)design and evaluation of healthcare processes and outcomes from a patient perspective. Patient-reported outcome measures (PROMs) have significant potential to inform such attempts. However there is limited understanding of the processes by which this can be achieved. This exploratory study followed attempts to utilise two different PROMs measures to support service quality improvement in clinical genetics. PROMs used were the Genetic Counseling Outcome Scale (GCOS-24), a well-validated clinical genetics-specific PROM and Euroqol (EQ-5D), a generic PROM favoured by the UK National Institute for Health and Excellence (NICE). Both of these PROMs enable pre/post intervention comparison. A service audit tool was also used, premised on a patient-reported experience measure. In addition, the study draws on interviews with clinical staff to identify challenges associated with the use of PROMs (response rate, data collection, analysis). Benefits are also explored and include the provision of insight into patients’ needs; complementing clinical judgement; identification of needs being met, evidencing the benefit of services provided; prompting consideration of areas requiring attention; and encouraging professional development.     

Bioinspired decision-making for a socially interactive robot

Nowadays, robots and humans coexist in real settings where robots need to interact autonomously making their own decisions. Many applications require that robots adapt their behavior to different users and remember each user’s preferences to engage them in the interaction. To this end, we propose a decision making system for social robots that drives their actions taking into account the user and the robot’s state. This system is based on bio-inspired concepts, such as motivations, drives and wellbeing, that facilitate the rise of natural behaviors to ease the acceptance of the robot by the users. The system has been designed to promote the human-robot interaction by using drives and motivations related with social aspects, such as the users’ satisfaction or the need of social interaction. Furthermore, the changes of state produced by the users’ exogenous actions have been modeled as transitional states that are considered when the next robot’s action has to be selected. Our system has been evaluated considering two different user profiles. In the proposed system, user’s preferences are considered and alter the homeostatic process that controls the decision making system. As a result, using reinforcement learning algorithms and considering the robot’s wellbeing as the reward function, the social robot Mini has learned from scratch two different policies of action, one for each user, that fit the users’ preferences. The robot learned behaviors that maximize its wellbeing as well as keep the users engaged in the interactions.     

Informant discrepancies in assessments of psychosocial functioning in school-based services and research: Review and directions for future research

Psychosocial functioning plays a key role in students' wellbeing and performance inside and outside of school. As such, techniques designed to measure and improve psychosocial functioning factor prominently in school-based service delivery and research. Given that the different contexts (e.g., school, home, community) in which students exist vary in the degree to which they influence psychosocial functioning, educators and researchers often rely on multiple informants to characterize intervention targets, monitor intervention progress, and inform the selection of evidence-based services. These informants include teachers, students, and parents. Across research teams, domains, and measurement methodologies, researchers commonly observe discrepancies among informants' reports. We review theory and research—occurring largely outside of school-based service delivery and research—that demonstrates how patterns of informant discrepancies represent meaningful differences that can inform our understanding of psychosocial functioning. In turn, we advance a research agenda to improve use and interpretation of informant discrepancies in school-based services and research.     

Non-Driving Related tasks and journey types for future autonomous vehicle owners

Highly automated vehicles (AVs) have the potential to improve the journey experience for all users by allowing them to partake in Non-Driving Related Tasks (NDRTs). Using a 42-question online survey of drivers (n = 1378, 59% males, 40% females), and in-depth interviews (n = 18, 56% males, 44% females), this study investigated NDRTs and the motivations for private ownership of highly automated vehicles (AVs). 42% of participants were identified to be more likely to own an AV and, believed that they were safer, would reduce congestion and the risk of accidents. There was also a genuine desire to actively fill the non-driving time being productive or using a device rather than passive tasks such as listening to music or watching their surroundings. Commuting was reported to be the most likely journey type amongst those more likely to own an AV. The commuting journey also showed the most diverse range of NDRTs including social (e.g., conversation, playing games), wellbeing (e.g., eating a meal, sleep), leisure (e.g., watching a video), and being productive (e.g., working on a laptop). This study provides insights into NDRTs to inform future interior vehicle design and motivations for owning highly automated vehicles.     

Prolonged Separation and Reunification among Chinese Immigrant Children and Families: An Exploratory Study

The present study explored the lived experiences of Chinese immigrant parents in New York City who went through prolonged separation and faced challenges after reunification in the United States. The study assessed their attitudes, perceptions, and reactions to the separation and reunification process to gain better understanding of the ways prolonged separation and reunification impact on child development and family wellbeing. A phenomenological research approach was used to study qualitatively the narrative data from in-depth interviews. The analytical process was based on data immersion, coding, sorting codes into themes, and comparing the themes across interviews. The sample included 18 Chinese immigrant families who had sent their American-born children to China for rearing and reunited with their children within the past 5 years. Data analyses revealed specific themes that included reasons for separation, parenting methods, child’s initial adjustment, behavior, and family relationship, child’s social, emotional, and academic challenges, parental stress and challenges, and recommendations for services. This study contributed to our knowledge of prolonged separation, a common practice among a vulnerable, hard-to-reach immigrant population. It shed light on specific needs of Chinese immigrant families by examining closely the unique circumstances pertaining to prolonged separation, parenting practice, and related family challenges. An understanding of the approaches these families adopt to cope with life challenges may help inform practitioners in formulating service strategies for these families. Specific assessments in child-care, education, and health care settings are essential to prompt immediate follow-up and intervention when needed.     

“It kind of fosters a culture of interdependence”: A participatory appraisal study exploring participants' experiences of the democratic processes of a peer‐led organisation

Peer‐led mental health organisations operate through participatory democracy, enabling participants to take an active role in decision making about the running of these organisations. U.K. national policy recommends increased involvement of people accessing statutory mental health services in service development, for example, through co‐production. This study employed a participatory research method to explore participants' perspectives of the democratic processes of a U.K.‐based peer‐led mental health organisation, The Bridge Collective, and the influence of these processes on participant wellbeing. A range of data collection methods were used to gather the perspectives of 16 participants. Participatory thematic analysis identified how the organisations' democratic processes both nurtured and challenged participants' wellbeing. Three main themes captured the influences of the democratic processes on participant wellbeing: (a) negotiating relationships, (b) feeling the responsibility of involvement, and (c) sharing power. The findings identify the value of democratic processes in enabling meaningful social support and empowerment, and also identify the challenges of inclusion and workload management in participatory democracy. These insights may inform the development of co‐production methods and enable The Bridge Collective and other peer‐led organisations to further develop their processes.     

Duty of Care,Safety, Normalisation and the Mental Capacity Act: A Discourse Analysis of Staff Arguments about Facilitating Choices for People with Learning Disabilities in UK Services

The benefits of having choice and control for people with learning disabilities 1 are well documented, and front‐line carers often make efforts ensuring that these are facilitated. However, despite this, government policy reports that disempowerment within learning disability services in the UK is a persistent problem. Using critical discursive psychology, 15 interviews with support workers about empowering people with learning disabilities were analysed. Interpretative repertoires about ‘duty of care’, ‘safety’ and ‘normalisation’ and discursive strategies involving ‘comparative evaluations’ were found, which opened speaker positions of granting or withholding choice, assuming responsibility for those in care and constructing service users as lacking capacity. These resources also allowed speakers to regulate the choices of service users and to normalise limited choice in ways that undermined taking up more empowering practices. The findings may explain the persistence of disempowerment within services by indicating how such discourses are deeply entrenched in service talk and are invoked to justify disempowering practices. This is discussed in view of the implications for empowerment and also current legislative frameworks such as the Mental Capacity Act. Copyright © 2014 John Wiley & Sons, Ltd.     

Spiritual advisors and old age psychiatry in the United Kingdom

This survey investigates the role and views of NHS spiritual advisors across the United Kingdom on the provision of pastoral care for elderly people with mental health needs. The College of Health Care Chaplains provided a database, and questionnaires were sent to 405 registered NHS chaplains/spiritual advisors. The response rate was 59%. Quantitative and qualitative analyses were carried out. Spiritual advisors describe their working patterns and understanding of their roles within the modern NHS, and their observations of the level of NHS staff awareness of the importance of spiritual issues in the mental health care of older adults. They provide insights into possible negative and positive perceptions of their roles at a service level, and contribute suggestions of topics relevant to shared education between pastoral care and clinical services. This survey further highlights ethical and operational dimensions at the point of integration of the work of spiritual advisors and multidisciplinary teams.     

A geography of contaminated sites,mental health and wellbeing: The body,home, environment and state at Australian PFAS sites

Health geographers have long been interested in the connection between place and mental health, proposing that settings influence mental health and vice versa. Research on environmental contamination has tended to focus on the former part of this relationship, examining how the mental health and wellbeing of residents living nearby are affected by the contamination. There has been little investigation of the latter component: how mental health and wellbeing may shape place. This article seeks to explore how the mental health and wellbeing of residents living on or near environmental contamination may be both affected by and reproduced in place. It considers this in a case study of per- and poly-fluoroalkyl substances (PFAS) contamination in New South Wales, Australia, by drawing on interviews with residents. Focus is placed on examining how residents report psychological distress associated with the contamination and how this distress may permeate beyond the contaminated site to become enmeshed in other places at different scales, such as the body, home, local environment, and state. Ultimately, it is proposed that these places reproduce distress on their own and require just as much attention in addressing adverse psychological effects as the physical contamination itself.     

Factors affecting self-referral to counselling services in the workplace: a qualitative study

The benefits of psychological support in the workplace (also known as workplace counselling) are well documented. Most large organisations in the UK have staff counselling schemes. However, it is unclear what, if any, factors affect employee decisions to use such schemes. This study has used a qualitative methodology to explore the reasons that make employees use workplace counselling. Eleven employees of a university in the north of England who had used the staff counselling service of their employer took part in the study. The employer had two schemes available: an internal staff counselling service and an external Employee Assistance Programme (EAP). A semi-structured interview was used with each participant and grounded theory techniques were used to analyse the interviews. The analysis resulted in the construction of a model of psychological help-seeking in the workplace. The main findings indicate that most participants were motivated to use their employer's counselling service by their prior positive experiences of similar or other type of mental health services. Other encouraging factors were: recommendation of service by others, a supportive environment and trust in the confidential ethos of the service. Conversely, negative preconceptions of psychological help-seeking and a perception of the employing environment as unsafe were shown to have been discouraging factors. The study concludes with suggestions for practice and for further research.     

Parental Needs among Children with Birth Defects: Defining a Parent-to-Parent Support Network

The objective of this study was to explore how a parent-to-parent support network could impact parents of a child with a structural birth defect by specifically looking at parents’ continued needs, aspects influencing their participation in support networks, and their recommendations. Structural birth defects occur in approximately 3?% of all infants, representing a significant public health issue. For many reasons, parents are uniquely qualified to provide support to each other. Data were collected retrospectively through a qualitative approach of focus groups or one-on-one interviews. Thirty one parents of infants registered in the Utah Birth Defect Network participated in the study. Three themes emerged, “current sources and inconsistencies in parent-to-parent-support,” “aspects that influence participation in parent-to-parent network,” and “recommendations for a parent-to-parent program.” Health care providers need to be aware of the services and inform parents about these options. A statewide parent-to-parent network integrated into all hospitals would be a valuable resource to facilitate sharing of issues related to caring for an infant or child with a birth defect.     

Emotional support and counselling for people with visual impairment: Quantitative findings from a mixed methods pilot study

Aims: This paper reports on mainly quantitative findings from a mixed methods evaluation of a new model of emotional support and counselling for people with moderate visual impairment. Method: The CORE Outcome Measure was completed with service users at baseline and post‐intervention to assess the impact of the new service on psychological wellbeing and social functioning. Their perceived needs and expectations of the service were also explored. Results: Of the 35 individuals providing data at each assessment time, mean item scores on the CORE fell significantly (p<.001), taking the sample from within a clinical population before therapy, to a mean score below this following therapy. A more positive outlook accompanied this improvement in functioning. Discussion: Findings from the study augment the growing evidence that emotional support and counselling services can play an important role alongside and within related vision services. Implications for practice: The study indicates that therapeutic input for the visually impaired client group may need to target both wellbeing (feelings about oneself and the future) and problems (depression, anxiety, physical health, and trauma). Conclusions: Our findings suggest that a dual model of emotional support and counselling offers considerable benefit for people with visual impairment.     

“You Have to Sit and Explain it All,and Explain Yourself.” Mothers’ Experiences of Support Services for Their Offspring with a Rare Genetic Intellectual Disability Syndrome

The experiences of mothers of adult offspring with Angelman, Cornelia de Lange, or Cri du Chat syndrome have not been previously explored in research. The current study focuses on experiences with social and medical services and the impact the rareness of an adult offspring’s syndrome has on the experiences of mothers. Eight mothers of adults with Angelman, Cornelia de Lange, or Cri du Chat syndrome were interviewed. Thematic Content Analysis was used to interpret the interviews. Four themes emerged from the analysis: (i) The rarity of their offspring’s syndrome, (ii) Uneven medical and social care service provision, (iii) The inertia of social care services, and (iv) Mothers as advocates. Mothers felt that the rareness of their offspring’s syndrome did not affect experiences with social care services, but did affect access to medical services and some aspects of day-to-day living. Accessing appropriate social care services was reported to be a lengthy and complex process. These data may help inform care service providers about how best to support adults with rare genetic syndromes and their families.