supervision consultants in their first year the transfer to consultancy management skill i want...
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SupervisionConsultants in their first yearThe transfer to consultancyManagement SkillI want them to be able to supervise
othersI want them to stay in the serviceIdentification of gapsNot paid; no time allocationMentoring
Supervision
Professional HierarchicalCross professional for special
purposes or on special requestPeer group (cross team)Personal Appraisal (Service based)
On Prevention
Primary Prevention Evidence
Durlak & Wells in 1997 reviewed 1200 primary prevention programs of which 77 met a stringent 54 standards for meta-analysis.
Average effect size was between 0.2 and 0.9 Better than most of the work on heart disease Better than results from antidepressant studies At least as good as composite results for MST
Universal Work
EVIDENCE
INFANCYImproved maternal diet and reduced
smoking during pregnancy led to fewer pre-term deliveries, higher birth weight babies and less child abuse
Olds et al 1988
1958 British Cohort health at age 33
Significant Latent Factors (Early life 0-7 yrs)
Birth weight and height age 7 (as ratio of adult height)
Whether read to.Social & emotional status age 7
(assessed by school teachers, how well they adjusted to school)
Source: Clyde HertzmanSource: Clyde Hertzman
‘Sensitive periods’ in early brain development
Binocular vision
0 1 2 3 7654
High
Low
Years
Habitual ways of respondingLanguageEmotional
controlSymbolPeer social
skillsRelative quantity
Central auditory system
Breakfast and Annual Changes in Test Scores
-1.0-0.2
0.61.4
2.2
0.71.1
1.51.9
2.4
0.51.0
1.52.0
2.5
Reading Language Mathematics
Percent who ate breakfast
-10
-5
0
5
10
Cha
nge
in S
AT
-9 (
NP
R)
48 55 62 69 76 48 55 62 69 76 48 55 62 69 76
Source: California Healthy Kids Survey & STAR data files.
EVIDENCE
SCHOOL AGE CHILDRENIncreased resilience and connectedness to
the school led to 50 point reduction in suicidal thinking
Resnick, Blum et al, 1997
Because of the trajectory from thinking through planning to attempts, we can assume this reduction will have long term benefit
Selective Work
COPMI Qualitative Studies
“Family-centered, strengths-based approaches were identified across program directors as critical to intervention success.”
Hinden, Nicholson et al, Uni Massachusetts, 2006
Hinden et al., 2002(Child Outcomes)
Child outcomes included achieving developmental milestones, enhanced school readiness, improved child behavior and emotional adjustment, and improved school attendance.
For those programs engaged in political advocacy and social marketing, increased public awareness, decreased stigma, and increased funding opportunities reflected positive outcomes.
PATS Evaluation, 2005
Structured questionnaire follow-up study over 3 years
PATS participants reported significant reductions in depressive symptoms (60% pre-intervention, 38% 12 months later), risk of homelessness (44% pre-intervention, 17% 12 months later) and stigma (30% pre-intervention, 15% 12 months later) after their involvement in the program.
http://www.rch.org.au/emplibrary/pats/PATS_FinalEvaluationReport_Dec2005.pdf
Indicated Work
MST: Meta-Analysis of Programs
8 programs met criteria At follow up:
fewer arrests less time in institutions lower self reported delinquency No differences for behaviour, parental
mental health, family functioning and relationships, risk of incarceration, and peer relationships.
Bruce, J., 2002. Evidence Based Mental Health. 5:4.
MST
Costs may be up to $30,000 per family RESULTS
A number of randomised controlled trials with chronic juvenile offenders
Reduces re-arrest by 25 - 70% Reduces out-of-home placement by 47 -
64% in long-term follow-upJuvenile Forensic Evaluation Resource Centre,
2000
Can Trajectories be Averted?Longitudinal study of 909 students up to 17 years
of age: More types of trajectories than expected < 6% followed trajectory of chronic antisocial
behaviour Disruptive preschool children are at higher risk of
following trajectories of frequent antisocial behaviour
Intensive intervention between 7- 9 yrs of (parent training, social skills training), changed long term developmental trajectories of physical aggression, vandalism, and theft for disruptive kindergarten boys in low socio-economic areas.
Lacourse et al., 2002
Thinking through to the Future
So what should we be thinking about?
It is likely that Australia will have to confront the economic realities, and this may make social exclusion worse
Despite the percentage reduction overall in young people over the next 20 years, more of them may react to stress with mental health problems
We need to consider every scrap of evidence that allows us to put in place preventive strategies along the trajectory of young life
We need to ‘proof’ our children against stress
We do need to grab as much as we can of the available new monies for mental health services.
However, the increased demands are at this time likely to drown services capacity
We must collaborate to present to Bureaucracies what is most likely to work in prevention
A major part of this may be to revisit the first 3 years of a child’s life and promote the primary relationships - perhaps through such simple things as reading.
So what should we be thinking about?
A Couple of Elegant Tiered Partnerships
Bayside Ei ProgramUniversal Program20 weeks (2 terms) of in school, class teacher
managed, AUSSIE OPTIMISMProgram based on an Australianisation of the work of Seligman (Optimistic
Child), and his team - Jaycox, Gillham et al.
Selective ProgramIF a young person scores over 30 on the CES-D
(>2SD greater than mean) and the SDQ also scores over 20, THEN
We discuss with school personnel and further assessment occurs with the MINI Kid and either set up a program in the school or refer direct to CYMHS
CadetLiFeAustralian Defence Force Cadets
(n=22,000)UNIVERSAL CD based program using
elements adapted from LiFe, the national MHPPEi documents, Aussie Optimism, Mind Matters, and available research
A ‘Pathways to Care’ program acknowledging national resources (eg Kid’s Helpline, Reach Out) and possible local service access.
Access to Reach Out On Line (ROC!)
USAF Suicides by year
A Changed WorldA Changed World
Youth Suicides 1968-2005
Australian Suicide Rates15-24 yrs, per 100,000 (ABS)
0
5
10
15
20
25
30
35
1968 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 2000 2002 2004
Mobile Phone Ownership (Australian Bureau of Statistics,
2006)
0102030405060708090
100
1990 1995 1999 2005
Mobile Phone Ownership in Young People (Roy Morgan Research 2006)
0
20
40
60
80
100
Seven Nine Eleven Thirteen
Boys
Girls
Battling the forces of Darkness
Consumerism creates Public health challenges for us QuickTime™ and a
TIFF (Uncompressed) decompressorare needed to see this picture.
The Centre for MHPPEi
Steering Committee
MHPPEi Working Group
Infant Psychiatry Hub Innovative technologies Suicide Prevention
Centre for MHPPEi Advisory Board
Director Centre for MHPPEi
Mental Health Statewide Network
Director of Mental Health Mental Health Interdepartmental Committee
Minister of Health
Possibilities for the Centre
Placement at a Major Health Centre (eg RBH) (adv. Infrastructure)
Placement in the Community (eg Nundah) (adv. Links with NGOs and Community)
Placement across Institutions (ie Uni plus Health Service) (adv. ?Kudos plus academic input)