Who uses community mental health centres? A study of one health district

A caseload analysis was undertaken to investigate those clients seen by five community mental health centre teams within one healthcare district. The 985 clients are described in terms of demographic and clinical features and questions relating to service provision are discussed.     

Is community necessary? Quasi-philosophical ruminations

In responding to and examining Mary Anne Raywid's (1989) adoption of community building as an aim for schools, I survey a number of types of communities, including recreational, intentional and language communities. In considering all these communities, I try to show both the power of communities in our personal lives and some idea of why we might be of two minds about promoting community as an ideal in the modern world and in schools in particular.     

TEACHING THE HANDICAPPED TO EAT IN PUBLIC PLACES: ACQUISITION,GENERALIZATION AND MAINTENANCE OF RESTAURANT SKILLS

This study examined classroom-based instruction in restauranting skills for handicapped persons. Three male students were taught each of four skill components in sequential order: locating, ordering, paying, and eating and exiting. Training was implemented in a multiple baseline design across subjects and consisted of modeling and role playing in conjunction with photo slide sequences and a simulated ordering counter. The use of a menu containing general item classes and a finger matching procedure for identifying errors in the delivery of change greatly reduced the reading and math skills necessary to enter and complete the program. Periodic probes were conducted in a McDonald's restaurant prior to, during, and up to one-year following the termination of training. In addition, two probes (overt and covert observation) were conducted in a Burger King restaurant to assess further generalization to a location different from the one depicted throughout training. Results showed that students' performance on restaurant probes improved as a result of training, generalized to novel settings, maintained over an extended period of time, and was comparable to that of a normative sample of nonretarded persons.     

The effects of hand and direction parameter preknowledge on choice reaction times

The two studies undertaken investigated how reaction times are affected by preknowledge concerning hand and direction parameters, and the order in which these data are disclosed. In the first experiment, preknowledge was manipulated by selecting 2-CRT pairs which had either a common hand or direction component. Reaction signal information content (as defined by the number of unknown response parameters) was controlled, but no parameter differences emerged. When parameter order was manipulated by sequential precuing, the ‘hand then direction’ order conferred a significant advantage. Motor preparation and response selection explanations for this effect are considered. Various difficulties with the paradigms used are discussed, including those of distinguishing between response selection and motor programming contributions, controlling and inferring the strategies adopted by subjects, and defining task difficulty. The prospects for independently fostering either response identification or motor preparation by means of an appropriate selection of precues are also discussed.     

From “4Rs and 2Ss” to “Amaka Amasanyufu” (Happy Families): Adapting a U.S.-based Evidence-Based Intervention to the Uganda Context

In Uganda, one in five children presents mental health challenges, including disruptive behavior disorders (DBDs). DBDs can persist through adulthood and result in negative outcomes. Effective interventions for DBDs have been developed and tested in high-poverty communities in developed countries. Yet, most African countries, such as Uganda, lack such interventions. This paper describes the adaptation process of an evidence-based intervention of U.S. origin to optimize fit to context with intervention fidelity, as part of a randomized trial conducted with youth that exhibit behavioral challenges and their caregivers in 30 schools in Uganda. The process involved: initial meetings with headteachers and teachers to introduce the study and the main concepts of the intervention; initial manual review focusing on 4Rs and 2Ss content by the Uganda team; engagement of community stakeholders for additional feedback on content and cultural relevance; final revision of the manual; and collection of children’s drawings for the illustration of the manual. This paper describes both similarities and differences between the original and adapted intervention content and methods of delivery. The findings also highlight the importance of involving community stakeholders in the adaptation process.     

Together Helping Reduce Youth Violence for Equity (ThrYve): Examining the Development of a Comprehensive Multisectoral Approach to Youth Violence Prevention

Comprehensive approaches to youth violence prevention are needed to simultaneously address multiple risk factors across socioecological levels. ThrYve (Together Helping Reduce Youth Violence for Equity) is a collaborative initiative focused on addressing broader factors influencing youth violence, including social determinants of health. Using a participatory approach, the development of ThrYve is examined through an empirical case study. Through a Systems Advisory Board (SAB), ThrYve deploys multiple strategies that support cross-sector collaboration involving over 40 partners across 13 community sectors. Based on the Institute of Medicine’s model for public health action in communities, the SAB identified 87 change levers (i.e., program, policy, practice changes) to support community and systems-level improvements. As a result of the collaborative process, in the first couple of years, ThrYve facilitated 85 community actions and changes across sectors. The changes aligned with identified risk and resilience needs of the youth served in the community. The findings further support prior research, which suggests disparities related to gender may influence risk and resilience factors for youth violence. The study also indicates the importance of continuing to examine academic performance as a factor related to youth resilience.     

Young Indigenous Australians' Sexually Transmitted Infection Prevention Practices: A Community‐based Participatory Research Project

National surveillance data indicate marked differences between Indigenous and other Australians in the prevalence of many sexually transmitted infections (STIs). Young Indigenous people bear a particularly high burden of these infections. A collaboration of university researchers, Indigenous health workers and young Indigenous people conducted 45 field interviews to examine how young Indigenous Australians keep themselves healthy and protected against STIs. Our findings emphasise the complexity of health behaviours, where individuals are rarely always ‘risky’ or always ‘safe’, as well as subtle gender differences in health practices. Preventive strategies employed by the young people were contingent on beliefs and knowledge about sexual partners, the type of relationship, the context of the sexual encounter and access to condoms. Tangible strengths such as young Indigenous people's commitments to condoms and STI screening should be celebrated and bolstered to enhance their ability to protect themselves against adverse health outcomes and enhance their resilience against STIs. Focusing on strengths helps to counter the deficit model of health commonly deployed in Indigenous health research and draws attention to health issues facing young Indigenous people and their communities, without reinforcing negative stereotypes or focusing solely on individual risk behaviour. We provide concrete recommendations for health promotion and education. Copyright © 2011 John Wiley & Sons, Ltd.     

Supporting Implementation: The Role of Community Development Teams to Build Infrastructure

Evidence-based methods for assisting consumers, such as counties, in successfully implementing practices are lacking in the field of implementation science. To fill this gap, the Community Development Teams (CDT) approach was developed to assist counties in developing peer networks focused on problem-solving and resource sharing to enhance their possibility of successful implementation. The CDT is an interactive, solution-focused approach that shares many elements of the Interactive Systems Framework (ISF) for Dissemination and Implementation. An ongoing randomized implementation trial of Multidimensional Treatment Foster Care (MTFC) was designed to test the hypothesis that such interactive implementation methods are more successful at helping counties achieve successful and sustainable MTFC programs than standard individualized implementation methods. Using the Stages of Implementation Completion measure, developed for this study, the potential benefit of these interactive methods is examined at different stages of the implementation process ranging from initial engagement to program competency.