Background: The University of New England (UNE), Australia decided to develop innovative placemen... more Background: The University of New England (UNE), Australia decided to develop innovative placement opportunities for its increasing numbers of nursing students. Extensive community and stakeholder consultation determined that a community centre in rural New South Wales was the welcomed site of the student-led clinic because it fit the goals of the project-to increase access to health care services in an underserved area while providing service learning for students. Methods: Supported by a grant from Health Workforce Australia and in partnership with several community organisations, UNE established a student-led clinic in a disadvantaged community using an engaged scholarship approach which joins academic service learning with community based action research. The clinic was managed and run by the students, who were supervised by university staff and worked in collaboration with residents and local health and community services. Results: Local families, many of whom were Indigenous Australians, received increased access to culturally appropriate health services. In the first year, the clinic increased from a one day per week to a three day per week service and offered over 1000 occasions of care and involved 1500 additional community members in health promotion activities. This has led to improved health outcomes for the community and cost savings to the health service estimated to be $430,000. The students learned from members of the community and community members learned from the students, in a collaborative process. Community members benefited from access to drop in help that was self-determined. Conclusions: The model of developing student-led community health and wellbeing clinics in underserved communities not only fulfils the local, State Government, Federal Government and international health reform agenda but it also represents good value for money. It offers free health services in a disadvantaged community, thereby improving overall health and wellbeing. The student-led clinic is an invaluable and sustainable link between students, health care professionals, community based organisations, the university, and the community. The community benefits from the clinic by learning to self-manage health and wellbeing issues. The benefits for students are that they gain practical experience in an interdisciplinary setting and through exposure to a community with unique and severe needs.
2 This work is copyright. It may be reproduced and the Centre for Population Studies in Epidemiol... more 2 This work is copyright. It may be reproduced and the Centre for Population Studies in Epidemiology (CPSE) welcomes requests for permission to reproduce in the whole or in part for work, study or training purposes subject to the inclusion of an acknowledgment of the source and not commercial use or sale. CPSE will only accept responsibility for data analysis conducted by CPSE staff or under CPSE supervision.
There is a need to establish reliability and the various forms of validity in all measures in ord... more There is a need to establish reliability and the various forms of validity in all measures in order to feel confident in the use of such tools across a wide diversity of settings. The aim of this study is to describe the reliability and validity of the Victorian Gambling Screen (VGS) and in particular one of the sub-scales (Harm to Self—HS) in a specialist problem gambling treatment service in Adelaide, Australia. Sixty-seven consecutive gamblers were assessed using a previously validated clinical interview and the VGS (Ben-Tovim et al., The Victorian Gambling Screen: project report. Victorian Research Panel, Melbourne, 2001). The internal consistency of the combined VGS scales had a Cronbach’s alpha of .85 with the HS scale .89. There was satisfactory evidence of convergent validity which included moderate correlations with another measure of gambling—the South Oaks Gambling Screen. There were also moderate correlations with other measures of psychopathology. Finally, how the VGS may best be used in clinical settings is discussed.
Cognitive-Behaviour Therapy (CBT) is considered the number one nonpharmacological treatment for a... more Cognitive-Behaviour Therapy (CBT) is considered the number one nonpharmacological treatment for a number of mental and psychological disorders ). While CBT with problem gamblers has shown promise, the quality of the research in this area is lacking. One area of concern is that across the many trials and reports using CBT with gamblers no single unified approach has been used and so comparison across studies is limited. Similarly, translation of the CBT research into clinical practice is almost entirely absent . This article will explore the concepts of CBT with problem gamblers and identify common elements across all reported approaches. A unified model of CBT with problem gamblers will be suggested and the direct clinical application of this model described from a state-wide gambling service in Australia (Flinders Approach) with 205 problem gamblers. The results indicate that the Flinders Approach is successful in treating gamblers considered to be at the severest end of the experience, with a 69% completion rate. Implications for future research in which this model may be tested against other therapies and pharmacological treatments will be discussed.
General Practitioners (GPs) are well placed to identify problem gamblers and provide early interv... more General Practitioners (GPs) are well placed to identify problem gamblers and provide early intervention. To date there is no evidence to suggest that GP's are routinely screening patients for potential gambling problems. This paper discusses the prevalence of problem gambling, the links with other health problems and ways that GPs can assist. Results from a pilot project that provided educational resources to GPS are also discussed. Suitable screening tools are available that could easily be used by GPs to assess the possibility of gambling problems in patients who may be at increased risk but do not seek help. Early identification and intervention may help prevent a gambling habit escalating to a serious problem. More work needs to be done to increase awareness with GPs of the extent of problem gambling in our community and to alert patients to the fact that gambling can affect their health and that GPs can help.
Australian and New Zealand Journal of Psychiatry, 2000
ABSTRACT The Somatisation Project (SP) was one of eight sub-projects of the South Australian Heal... more ABSTRACT The Somatisation Project (SP) was one of eight sub-projects of the South Australian HealthPlus Coordinated Care Trial. This trial involved the enrolment of an original cohort of 4,600 subjects. Of these, 124 subjects (89 intervention and 35 controls) suffering from GP diagnosed somatisation disorder (SD) constituted the SP cohort. One of the tasks required by the trial was to develop evidence-based, clinical protocols for systematic use at the GP level. The aims of the trial were to coordinate the care of patients suffering from chronic and complex disorders using systematic, behavioural care planning; the use of clinical care protocols and the provision of a designated care coordinator (GP), supported by a service coordinator. Objectives: This paper aims to:describe the development of the somatisation projectpresent the findings and implication from the audit of 5826 case recordsdescribe the development of the “containment” protocol for use in GPpresent some preliminary outcome data. Results:A Clinical Audit: A total of 5,826 casenotes were audited by the research team. Of these 1,105 or (19%) of selected patients were considered to be likely to be suffering from a psychiatric disorder which was presenting with unexplained, or poorly explained physical symptoms. Whilst a significant proportion of these patients suffered anxiety or depressive disorders the majority had a clear somatisation disorder.A containment approach to management: The reference group evaluated the approaches advocated for somatisation in a review and recommended a theoretical model to be used in the trial. This model was then developed as a clinical algorithm and constituted the initial guidelines for management for the patients enrolled in the project. Over the next 10 months it was subjected to further review by a reference group of experienced GPs, who translated the guidelines into an algorithm.Assessment, involvement and preliminary outcomes: Subjects were enrolled on the basis of GP diagnosis of SD. They were then assessed by means of the computerised version of the CIDI and psychometric evaluation, after which they were randomised to intervention or control groups. The intervention group received coordinated care and the controls best standard care. Outcomes were assessed by monitoring all service use and psychometric evaluation at 12 months and at the completion of the trial. Discussion: The audit throws into question the current diagnostic criteria used for the definition of somatisation disorder and adds to the weight of the arguments presented by Escobar (1987) for a revision of these criteria. It is also apparent that unexplained physical symptoms are potent source of health anxiety. The relationship between SD and anxiety disorders requires further study as the avoidant behaviour of these patients is very similar to that by patients suffering anxiety disorders. The process used to develop the “containment” algorithm and its associated GP education program was an interesting example of the role for consultation–liaison psychiatry at the primary health care level. GPs found the model useful from conceptual, educational and practical perspectives. The improvement in intervention subjects occurred whilst protocols were being developed and GPs were being educated in their use. It is likely that systematic intervention by well-trained GPs could do better. There are important implications in this project for clinical services in general hospitals and general practice.
International Journal of Mental Health Nursing, 2002
The training and outcomes for a mental health nurse, who completed a 6-month nurse behavioural ps... more The training and outcomes for a mental health nurse, who completed a 6-month nurse behavioural psychotherapy course at Flinders Medical Centre (Bedford Park, South Australia) is described. Completion of this course enabled the nurse to work mainly with pathological gamblers as a trainee nurse behaviour therapist. Her experience demonstrates that with appropriate training and supervision, mental health nurses are able to increase their knowledge base in specialist areas and gain skills in therapies that will allow them to work autonomously with clients. A brief description of the training, outcome of patient case management and skills acquisition achieved through training is presented.
International Journal of Mental Health and Addiction, 2006
This study aimed to describe the 12-month period prevalence and risk factors for suicidal ideatio... more This study aimed to describe the 12-month period prevalence and risk factors for suicidal ideation and behaviour in a cohort of patients with pathological gambling attending a treatment service. Seventy-nine people with a diagnosis of pathological gambling received a mail out survey that included questions on postulated risk factors for suicidal ideation and behaviour, the modified Suicide Ideation Scale (SIS), the South Oaks Gambling Screen (SOGS), the Beck Depression Inventory (BDI) and the CAGE. A total of 54.4% of the surveys were returned completed. There were 81.4% who showed some suicidal ideation and 30.2% reported one or more suicide attempts in the preceding 12 months. Suicidal ideation and behaviours were positively correlated with the gambling severity (SOGS scores), the presence of debt attributed to gambling, alcohol dependence and depression (BDI). Suicidal ideation/behaviour was not significantly associated with gender and living arrangements, nor a history of receiving treatment for depression during the preceding 12 months. People with pathological gambling attending a treatment service had higher levels of suicidal ideation and behaviour than previous studies. Pathological gambling should be seen as a chronic condition with a similar risk for suicidal ideation and behaviour as other mental illnesses. Counselling services, general practitioners and mental health services should screen for gambling problems when assessing risk after suicide Int attempts and for suicide risk in patients presenting with gambling problems and co-morbid depression, alcohol abuse and a previous suicide attempt.
The South Oaks Gambling Screen (SOGS) is a psychometric instrument widely used internationally to... more The South Oaks Gambling Screen (SOGS) is a psychometric instrument widely used internationally to assess the presence of pathological gambling. Developed by Lesieur and Blume (1987) in the United States of America (USA) as a self-rated screening instrument, it is based on DSM-III and DSM-III-R criteria. This paper describes the origins and psychometric development of the SOGS and comments critically in relation to its construct validity and cutoff scores. Reference is made to the use of the SOGS in the Australian setting, where historically gambling has been a widely accepted part of the culture, corresponding to one of the highest rates of legalised gambling and gambling expenditure in the world. An alternative approach to the development of an instrument to detect people who have problems in relation to gambling is proposed.
Journal of Psychiatric and Mental Health Nursing, 2000
Nurses have been employed as behavioural psychotherapists for over 25 years. The first training i... more Nurses have been employed as behavioural psychotherapists for over 25 years. The first training in this field was established at The Maudsley Hospital ( Marks et al. 1977 ). Since then there have been a number of courses producing many specialist nurse behavioural psychotherapists (NBTs) ( Duggan et al. 1993 ). Nurse behavioural therapy is taken to mean nurses working as behavioural psychotherapists. This title does not mean they are practising a separate form of therapy from other professionals such as psychologists. In Australia there is no such training, with nurse behavioural psychotherapists working here having trained first in UK. Initially NBTs were trained to treat people with anxiety disorders. Over the past 25 years this emphasis has remained, but many NBTs have gone on to provide help to people with other problems. This paper will demonstrate the practical application of behavioural psychotherapy with problem gamblers, and how specialist trained nurses can provide such treatment. The paper will look briefly at nurse behavioural psychotherapy from its initial inception to its current status in Australia. The outcomes of the treatment programme carried out at Flinders Medical Centre for Problem Gamblers will be discussed with a view to nurses carrying out therapy. Finally, the future of nurse behavioural psychotherapy in Australia and how nurses can apply such skills across a wide range of problems, including gambling, will be reviewed.Aspects of this paper were first presented to the 7th NAGS conference, Adelaide 1996.
Journal of Psychiatric and Mental Health Nursing, 1995
Treatment of Gilles de la Tourette syndrome using behavioural psychotherapy: a single case exampl... more Treatment of Gilles de la Tourette syndrome using behavioural psychotherapy: a single case example.This paper describes the clinical condition of Gilles de la Tourette syndrome (TS) and outlines some of the causes for the condition and its possible treatments. It describes a single case demonstrating the effectiveness of one type of treatment, namely habit reversal. Finally the implications of the condition's classification as a psychiatric disorder are discussed as is the possibility that other health care professionals may be able to help in the treatment of such cases.
Background: The University of New England (UNE), Australia decided to develop innovative placemen... more Background: The University of New England (UNE), Australia decided to develop innovative placement opportunities for its increasing numbers of nursing students. Extensive community and stakeholder consultation determined that a community centre in rural New South Wales was the welcomed site of the student-led clinic because it fit the goals of the project-to increase access to health care services in an underserved area while providing service learning for students. Methods: Supported by a grant from Health Workforce Australia and in partnership with several community organisations, UNE established a student-led clinic in a disadvantaged community using an engaged scholarship approach which joins academic service learning with community based action research. The clinic was managed and run by the students, who were supervised by university staff and worked in collaboration with residents and local health and community services. Results: Local families, many of whom were Indigenous Australians, received increased access to culturally appropriate health services. In the first year, the clinic increased from a one day per week to a three day per week service and offered over 1000 occasions of care and involved 1500 additional community members in health promotion activities. This has led to improved health outcomes for the community and cost savings to the health service estimated to be $430,000. The students learned from members of the community and community members learned from the students, in a collaborative process. Community members benefited from access to drop in help that was self-determined. Conclusions: The model of developing student-led community health and wellbeing clinics in underserved communities not only fulfils the local, State Government, Federal Government and international health reform agenda but it also represents good value for money. It offers free health services in a disadvantaged community, thereby improving overall health and wellbeing. The student-led clinic is an invaluable and sustainable link between students, health care professionals, community based organisations, the university, and the community. The community benefits from the clinic by learning to self-manage health and wellbeing issues. The benefits for students are that they gain practical experience in an interdisciplinary setting and through exposure to a community with unique and severe needs.
2 This work is copyright. It may be reproduced and the Centre for Population Studies in Epidemiol... more 2 This work is copyright. It may be reproduced and the Centre for Population Studies in Epidemiology (CPSE) welcomes requests for permission to reproduce in the whole or in part for work, study or training purposes subject to the inclusion of an acknowledgment of the source and not commercial use or sale. CPSE will only accept responsibility for data analysis conducted by CPSE staff or under CPSE supervision.
There is a need to establish reliability and the various forms of validity in all measures in ord... more There is a need to establish reliability and the various forms of validity in all measures in order to feel confident in the use of such tools across a wide diversity of settings. The aim of this study is to describe the reliability and validity of the Victorian Gambling Screen (VGS) and in particular one of the sub-scales (Harm to Self—HS) in a specialist problem gambling treatment service in Adelaide, Australia. Sixty-seven consecutive gamblers were assessed using a previously validated clinical interview and the VGS (Ben-Tovim et al., The Victorian Gambling Screen: project report. Victorian Research Panel, Melbourne, 2001). The internal consistency of the combined VGS scales had a Cronbach’s alpha of .85 with the HS scale .89. There was satisfactory evidence of convergent validity which included moderate correlations with another measure of gambling—the South Oaks Gambling Screen. There were also moderate correlations with other measures of psychopathology. Finally, how the VGS may best be used in clinical settings is discussed.
Cognitive-Behaviour Therapy (CBT) is considered the number one nonpharmacological treatment for a... more Cognitive-Behaviour Therapy (CBT) is considered the number one nonpharmacological treatment for a number of mental and psychological disorders ). While CBT with problem gamblers has shown promise, the quality of the research in this area is lacking. One area of concern is that across the many trials and reports using CBT with gamblers no single unified approach has been used and so comparison across studies is limited. Similarly, translation of the CBT research into clinical practice is almost entirely absent . This article will explore the concepts of CBT with problem gamblers and identify common elements across all reported approaches. A unified model of CBT with problem gamblers will be suggested and the direct clinical application of this model described from a state-wide gambling service in Australia (Flinders Approach) with 205 problem gamblers. The results indicate that the Flinders Approach is successful in treating gamblers considered to be at the severest end of the experience, with a 69% completion rate. Implications for future research in which this model may be tested against other therapies and pharmacological treatments will be discussed.
General Practitioners (GPs) are well placed to identify problem gamblers and provide early interv... more General Practitioners (GPs) are well placed to identify problem gamblers and provide early intervention. To date there is no evidence to suggest that GP's are routinely screening patients for potential gambling problems. This paper discusses the prevalence of problem gambling, the links with other health problems and ways that GPs can assist. Results from a pilot project that provided educational resources to GPS are also discussed. Suitable screening tools are available that could easily be used by GPs to assess the possibility of gambling problems in patients who may be at increased risk but do not seek help. Early identification and intervention may help prevent a gambling habit escalating to a serious problem. More work needs to be done to increase awareness with GPs of the extent of problem gambling in our community and to alert patients to the fact that gambling can affect their health and that GPs can help.
Australian and New Zealand Journal of Psychiatry, 2000
ABSTRACT The Somatisation Project (SP) was one of eight sub-projects of the South Australian Heal... more ABSTRACT The Somatisation Project (SP) was one of eight sub-projects of the South Australian HealthPlus Coordinated Care Trial. This trial involved the enrolment of an original cohort of 4,600 subjects. Of these, 124 subjects (89 intervention and 35 controls) suffering from GP diagnosed somatisation disorder (SD) constituted the SP cohort. One of the tasks required by the trial was to develop evidence-based, clinical protocols for systematic use at the GP level. The aims of the trial were to coordinate the care of patients suffering from chronic and complex disorders using systematic, behavioural care planning; the use of clinical care protocols and the provision of a designated care coordinator (GP), supported by a service coordinator. Objectives: This paper aims to:describe the development of the somatisation projectpresent the findings and implication from the audit of 5826 case recordsdescribe the development of the “containment” protocol for use in GPpresent some preliminary outcome data. Results:A Clinical Audit: A total of 5,826 casenotes were audited by the research team. Of these 1,105 or (19%) of selected patients were considered to be likely to be suffering from a psychiatric disorder which was presenting with unexplained, or poorly explained physical symptoms. Whilst a significant proportion of these patients suffered anxiety or depressive disorders the majority had a clear somatisation disorder.A containment approach to management: The reference group evaluated the approaches advocated for somatisation in a review and recommended a theoretical model to be used in the trial. This model was then developed as a clinical algorithm and constituted the initial guidelines for management for the patients enrolled in the project. Over the next 10 months it was subjected to further review by a reference group of experienced GPs, who translated the guidelines into an algorithm.Assessment, involvement and preliminary outcomes: Subjects were enrolled on the basis of GP diagnosis of SD. They were then assessed by means of the computerised version of the CIDI and psychometric evaluation, after which they were randomised to intervention or control groups. The intervention group received coordinated care and the controls best standard care. Outcomes were assessed by monitoring all service use and psychometric evaluation at 12 months and at the completion of the trial. Discussion: The audit throws into question the current diagnostic criteria used for the definition of somatisation disorder and adds to the weight of the arguments presented by Escobar (1987) for a revision of these criteria. It is also apparent that unexplained physical symptoms are potent source of health anxiety. The relationship between SD and anxiety disorders requires further study as the avoidant behaviour of these patients is very similar to that by patients suffering anxiety disorders. The process used to develop the “containment” algorithm and its associated GP education program was an interesting example of the role for consultation–liaison psychiatry at the primary health care level. GPs found the model useful from conceptual, educational and practical perspectives. The improvement in intervention subjects occurred whilst protocols were being developed and GPs were being educated in their use. It is likely that systematic intervention by well-trained GPs could do better. There are important implications in this project for clinical services in general hospitals and general practice.
International Journal of Mental Health Nursing, 2002
The training and outcomes for a mental health nurse, who completed a 6-month nurse behavioural ps... more The training and outcomes for a mental health nurse, who completed a 6-month nurse behavioural psychotherapy course at Flinders Medical Centre (Bedford Park, South Australia) is described. Completion of this course enabled the nurse to work mainly with pathological gamblers as a trainee nurse behaviour therapist. Her experience demonstrates that with appropriate training and supervision, mental health nurses are able to increase their knowledge base in specialist areas and gain skills in therapies that will allow them to work autonomously with clients. A brief description of the training, outcome of patient case management and skills acquisition achieved through training is presented.
International Journal of Mental Health and Addiction, 2006
This study aimed to describe the 12-month period prevalence and risk factors for suicidal ideatio... more This study aimed to describe the 12-month period prevalence and risk factors for suicidal ideation and behaviour in a cohort of patients with pathological gambling attending a treatment service. Seventy-nine people with a diagnosis of pathological gambling received a mail out survey that included questions on postulated risk factors for suicidal ideation and behaviour, the modified Suicide Ideation Scale (SIS), the South Oaks Gambling Screen (SOGS), the Beck Depression Inventory (BDI) and the CAGE. A total of 54.4% of the surveys were returned completed. There were 81.4% who showed some suicidal ideation and 30.2% reported one or more suicide attempts in the preceding 12 months. Suicidal ideation and behaviours were positively correlated with the gambling severity (SOGS scores), the presence of debt attributed to gambling, alcohol dependence and depression (BDI). Suicidal ideation/behaviour was not significantly associated with gender and living arrangements, nor a history of receiving treatment for depression during the preceding 12 months. People with pathological gambling attending a treatment service had higher levels of suicidal ideation and behaviour than previous studies. Pathological gambling should be seen as a chronic condition with a similar risk for suicidal ideation and behaviour as other mental illnesses. Counselling services, general practitioners and mental health services should screen for gambling problems when assessing risk after suicide Int attempts and for suicide risk in patients presenting with gambling problems and co-morbid depression, alcohol abuse and a previous suicide attempt.
The South Oaks Gambling Screen (SOGS) is a psychometric instrument widely used internationally to... more The South Oaks Gambling Screen (SOGS) is a psychometric instrument widely used internationally to assess the presence of pathological gambling. Developed by Lesieur and Blume (1987) in the United States of America (USA) as a self-rated screening instrument, it is based on DSM-III and DSM-III-R criteria. This paper describes the origins and psychometric development of the SOGS and comments critically in relation to its construct validity and cutoff scores. Reference is made to the use of the SOGS in the Australian setting, where historically gambling has been a widely accepted part of the culture, corresponding to one of the highest rates of legalised gambling and gambling expenditure in the world. An alternative approach to the development of an instrument to detect people who have problems in relation to gambling is proposed.
Journal of Psychiatric and Mental Health Nursing, 2000
Nurses have been employed as behavioural psychotherapists for over 25 years. The first training i... more Nurses have been employed as behavioural psychotherapists for over 25 years. The first training in this field was established at The Maudsley Hospital ( Marks et al. 1977 ). Since then there have been a number of courses producing many specialist nurse behavioural psychotherapists (NBTs) ( Duggan et al. 1993 ). Nurse behavioural therapy is taken to mean nurses working as behavioural psychotherapists. This title does not mean they are practising a separate form of therapy from other professionals such as psychologists. In Australia there is no such training, with nurse behavioural psychotherapists working here having trained first in UK. Initially NBTs were trained to treat people with anxiety disorders. Over the past 25 years this emphasis has remained, but many NBTs have gone on to provide help to people with other problems. This paper will demonstrate the practical application of behavioural psychotherapy with problem gamblers, and how specialist trained nurses can provide such treatment. The paper will look briefly at nurse behavioural psychotherapy from its initial inception to its current status in Australia. The outcomes of the treatment programme carried out at Flinders Medical Centre for Problem Gamblers will be discussed with a view to nurses carrying out therapy. Finally, the future of nurse behavioural psychotherapy in Australia and how nurses can apply such skills across a wide range of problems, including gambling, will be reviewed.Aspects of this paper were first presented to the 7th NAGS conference, Adelaide 1996.
Journal of Psychiatric and Mental Health Nursing, 1995
Treatment of Gilles de la Tourette syndrome using behavioural psychotherapy: a single case exampl... more Treatment of Gilles de la Tourette syndrome using behavioural psychotherapy: a single case example.This paper describes the clinical condition of Gilles de la Tourette syndrome (TS) and outlines some of the causes for the condition and its possible treatments. It describes a single case demonstrating the effectiveness of one type of treatment, namely habit reversal. Finally the implications of the condition's classification as a psychiatric disorder are discussed as is the possibility that other health care professionals may be able to help in the treatment of such cases.
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