Barriers and facilitators affecting the sustainability of dialectical behaviour therapy programmes: A qualitative study of clinician perspectives

Dialectical behaviour therapy (DBT) is a psychological treatment developed for individuals experiencing chronic suicidality and high‐risk behaviours. Despite the substantial evidence supporting the effectiveness of DBT, many programmes have problems with its sustainability. The goals of the current qualitative study were to identify factors that impact the sustainability of DBT programmes within a publicly funded mental health system and identify factors that are particularly relevant for youth DBT programmes. Interviews with trained adult and youth DBT clinicians (N = 31) were conducted to explore their experiences providing DBT. Three major themes that emerged as barriers to the sustainability of DBT programmes included the following: systemic challenges, conflicts within the consultation teams and clinician burnout. Factors influencing the success of DBT programmes included the following: systemic support, clinician commitment and “buy in”, and team cohesion. Factors specific to providing DBT with youth (i.e. level of commitment, simplifying the language, and parental investment) and recommendations for sustainability for adults and youth programmes were also identified. Findings of this study provide valuable information on factors impacting DBT programmes within the unique context of a Canadian mental health service system, where community‐based services are publicly funded. These findings have clear clinical utility and can be used to generate solutions to clinicians' perceived barriers and to foster perceived facilitators within similar contexts.     

Parent Perspectives on Family Involvement in Therapeutic Foster Care

There has been an increasing focus on family involvement in the treatment of children with serious emotional disorders, but it has received only limited attention in relation to out-of-home placements. I present the findings from a qualitative study of family involvement from the perspectives of parents whose children were placed in therapeutic foster care (TFC). Parents' perspectives on their involvement in placement decisions, relationships with professionals and TFC providers, practices related to family involvement, barriers to involvement, and strategies to enhance family involvement are described. Parents of children in TFC wanted to have contact with their children and to participate in decision making. They described relationships and practices that contributed to their involvement.     

Person and environmental factors associated with well-being in medical students

Medical students are exposed to demanding academic workloads and are often under considerable psychological strain. This study examined important person and environmental variables that might predict their psychological well-being. Participants were 755 students in years 2-6 from 11 Australian medical schools. A web-based survey assessed well-being, personality, professional expectations, lifestyle expectations, barriers, academic stress, and debt. A hierarchical regression analysis demonstrated that extraversion, conscientiousness, professional expectations, and lifestyle expectations were positively associated with well-being, while academic stress, which was the strongest predictor, neuroticism, and concern about debt were negatively associated. Medical students who displayed a disposition that was outgoing, conscientious, and stable, who were less stressed about their academic workload and their level of debt, and who held higher expectations for their future professional career, and expectations of a balanced lifestyle, had better well-being. Medical educators should be aware of these factors and provide support and strategies that promote well-being to students during medical training.     

An internet survey of emotional health,treatment seeking and barriers to accessing mental health treatment among Chinese-speaking international students in Australia

The present internet survey examined the demographic characteristics of Chinese-speaking international students in Australia, psychological distress levels as measured by the Kessler-10 (K-10) Item scale, help-seeking history and preferences, as well as treatment barriers. Of the 144 respondents, 54% reported high psychological distress (mean K-10 score?=?23.96; SD?=?9.03). However, only 9% of those who were highly distressed reported they had sought mental health services in the past year. While the majority preferred help from informal social networks, they tended to favour mental health services over traditional culture-specific forms of help. Common barriers to accessing mental health services reported by respondents with high psychological distress included costs or transportation concerns, limited knowledge of available services, time constraints, the perception that symptoms were not severe enough to warrant treatment, language difficulties and lack of knowledge of symptoms of psychological distress. Although the majority preferred face-to-face treatments over internet treatments, a considerable percentage of respondents were willing to try either treatment modality. Chinese-speaking international students are a high risk group for developing psychological distress, yet they tend to underuse mental health services. Education about the effectiveness of face-to-face and online treatments may increase treatment seeking by this population.     

Women with Physical Disabilities Who Want to Leave Their Partners

Abstract

Four domains of barriers for women with physical disabilities who are considering leaving a partner are outlined. These obstacles include (a) physical needs; (b) financial needs; (c) custody concerns; and (d) relationship issues. Disability policies can have direct bearing on the lives of women with disabilities, and hence on their freedom to choose to remain with or to leave a partner.     

The lived experiences of people diagnosed with multiple sclerosis in relation to exercise

The purpose of this study was to examine the lived experiences of people diagnosed with Multiple Sclerosis (MS). Seven active exercisers with MS participated in semi-structured interviews regarding their exercise experiences since diagnosis. Data were analysed using Interpretative Phenomenological Analysis (IPA; Smith?&?Osborn, 2003 Smith, JA and Osborn, M. 2003. “Interpretive phenomenological analysis”. In Qualitative psychology: A practical guide to research methods, Edited by: Smith, JA. 51–80. London: Sage.  [Google Scholar]). Interpretive Phenomenological Analysis. The results and interpretations of narratives revealed a number of functional limitations due to the severity of MS symptoms, which were found to have a major effect on the ability of the participants to exercise. Furthermore, psychological problems and the heightened behavioural adjustments to the progressive disability led to re-appraisal of ability to exercise. Previous, relevant exercise experience made participants more determined to continue to be able to exercise after diagnosis. The wider exercise experience narratives were related to concerns about safety, dependability on others to overcome the challenges, and potential environmental hazards. The loss of spontaneous opportunities to exercise because of these actual and perceived barriers was key to this population. This research highlighted the need to rethink the health and social service arrangements in relation to exercise provision for individuals with MS.     

Acquired physical disability: Personal meanings in a rural South African setting

This study explored personal meanings attached to acquired physical disabilities in a rural South African community. Informants were seven adults with disability (females?=?4; age range?=?18 to 55 years). They responded to semi-structured face-to-face interviews on the meanings they attached to their physical disabilities acquired during adulthood. Four themes emerged from the thematic analysis: new life style, activity limitations, participation restrictions, and cultural marginalisation. The meanings and accompanying lifestyle changes have implications for personal functioning and social well-being.     

Combining Ericksonian and Sandplay Approaches to Therapy with Children who Manifest Depression as a Developmental Barrier

This study reports on the use of the Ericksonian approach combined with sandplay therapy to assist children who present with depression, a troublesome developmental barrier. Participants were six children and/or adolescents with depression (two males and four females; age range 7 to 18; ethnicity: five white and one black). The intervention occurred once a week over a two-month period (eight 60-minute sessions in total). Outcome data were collected using qualitative interview and thematically analyzed. The Ericksonian approach to sandplay therapy had an overall positive effect on children who experienced depression as a developmental barrier.