Veteran families with complex needs: a qualitative study of the veterans’ support system

Background Families with complex needs face significant challenges accessing and navigating health and social services. For veteran families, these challenges are exacerbated by interactions between military and civilian systems of care, and the density of the veterans’ non-profit sector. This qualitative study was designed to gather rich, detailed information on complex needs in veteran families; and explore service providers’ and families’ experiences of accessing and navigating the veterans’ support system. Methods The study comprised participant background questionnaires (n = 34), focus groups with frontline service providers (n = 18), and one-on-one interviews with veteran families (n = 16) in Australia. The semi-structured focus groups and interviews were designed to gather rich, detailed information on four study topics: (i) health and wellbeing needs in veteran families; (ii) service-access barriers and facilitators; (iii) unmet needs and gaps in service provision; and (iv) practical solutions for improving service delivery. The study recruited participants who could best address the focus on veteran families with complex needs. The questionnaire data was used to describe relevant characteristics of the participant sample. The focus groups and interviews were audio-recorded, transcribed, and a reflexive thematic analysis was conducted to identify patterns of shared meaning in the qualitative data. Results Both service providers and families found the veterans’ support system difficult to access and navigate. System fragmentation was perceived to impede care coordination, and delay access to holistic care for veteran families with complex needs. The medico-legal aspects of compensation and rehabilitation processes were perceived to harm veteran identity, and undermine health and wellbeing outcomes. Recovery-oriented practice was viewed as a way to promote veteran independence and self-management. Participants expressed a strong preference for family-centred care that was informed by an understanding of military lifestyle and culture. Conclusion The health and wellbeing needs of veteran families intensify during the transition from full-time military service to civilian environments, and service- or reintegration-related difficulties may emerge (or persist) for a significant period of time thereafter. Veteran families with complex needs are unduly burdened by care coordination demands. There is a pressing need for high-quality implementation studies that evaluate initiatives for integrating fragmented systems of care.

Comparing participation in sports discussion and art therapy groups in ABI

Background: Social connection is often impacted by acquired brain injury (ABI), contributing to isolation and compromised mental health. Group therapy is thought useful in this context. For those experiencing cognitive communication challenges, finding alternative ways to engage is also valuable. Art therapy may offer pro-social support through shared activity, self-expression, organic subject matter and enduring visual prompts. Method: A multiple A-B-A single case experimental design compared participation in sports discussion and art therapy groups on a long-stay secure unit. Nine individuals with ABI and complex combinations of communication, cognitive and mental health needs were studied. It was hypothesised that for some individuals, participation would be greater in art therapy than sports discussion groups. Results: Results from six individuals with at least five measurement points per phase are reported. Tau statistics revealed significant interphase differences for three individuals. Significantly less participation was recorded for two individuals in art than sports discussion, however they still appeared invested in the art groups. The remaining participant, with the most severe communication difficulties, avoided all baseline sports discussion groups, but participated in almost all art groups, with significant increase between initial sports discussion and art phases. Conclusion: Further research is warranted regarding the potential art therapy offers for group engagement, particularly where complex challenges render traditional talking-style groups less appropriate. Furthermore, disparate and complex needs in severe ABI require diverse, well-designed groups offering different opportunities and responding to individual strengths and motivations. More research into such approaches may increase group participation in this challenging cohort.

Telepractice in service delivery: A survey of perspectives and practices of speech and language therapists in Ireland during COVID-19

BACKGROUND: COVID-19 accelerated telepractice implementation in speech and language therapy (SLT) in Ireland. OBJECTIVE: This study documents the service delivery changes that took place in the SLT profession in Ireland during the public health crisis. METHODS: An online survey of speech and language therapists (SLTs) in Ireland was conducted from June-September 2020 to investigate their perceptions of telepractice. Data were analysed using descriptive and inferential statistics and frequency distribution. RESULTS: 173 SLT responses were analysed. Over half of the participants worked in urban locations. Respondents’ years of experience varied from less than four years to over 20 years. Slightly over half the participants reported using telepractice, with 85% starting to use telepractice in the six months prior to the survey. Telepractice uptake was not influenced by participants’ professional experience or geographical location (p > 0.05). Almost all participants who used telepractice were trained informally (92%,). Telepractice was most commonly used with school-aged children with developmental language and speech sound disorders. Respondents perceived that telepractice was not suitable for all individuals who need SLT, including those with complex needs. Clinicians reported that telepractice facilitated access to therapy for clients and opportunities to see clients in their own environments. Technology barriers were the biggest hurdle to telepractice use. CONCLUSIONS: Uptake of telepractice by the SLT profession in Ireland was widespread during COVID-19, highlighting the profession’s flexibility and innovation. Respondents indicated they are likely to continue to use telepractice as a complementary service delivery model post-COVID due to the distinct benefits for clinicians and clients.

Crimes and sentences in individuals with intellectual disability in a forensic psychiatric context: a register-based study

Aims To study associations between intellectual disability (ID) and sexual and violent offending among individuals subject to pre-trial forensic psychiatric assessment. To investigate sentences following pre-trial forensic psychiatric assessment in offenders with and without ID. Methods A population-based observational study using data from pre-trial forensic psychiatric assessments in Sweden (1997–2013), the Swedish National Crime Register and several other Swedish national registers. The study population consisted of 7450 offenders (87% men, 13% women) who were subject to forensic psychiatric assessment in 1997–2013, of whom 481 (6.5%) were clinically assessed as having ID. Results ID offenders were more likely than non-ID offenders to have a sexual crime as an index crime [26.2 v. 11.5%, adjusted odds ratio (OR) 2.7, 95% confidence interval (CI) 2.02–3.58] as well as previous convictions regarding sexual offending (10.4 v. 5.6%, adj OR 2.3, 95% CI 1.70–3.12). These associations were restricted to male offenders; sexual offending was uncommon among women. Comorbid attention-deficit hyperactivity disorder reduced the association between ID and sexual offending (adj OR 2.7 v. 3.1, p = 0.017), while comorbid autism spectrum disorder had no significant influence on the association (adj OR 2.7 v. 3.0, p = 0.059). Violent crime was equally common among ID and non-ID offenders. Offenders with ID were more likely than non-ID offenders to be sentenced to forensic psychiatric care or community sanctions and measures (such as probation, conditional sentences or fines) than to prison; however, 15% of individuals who received an ID diagnosis during the forensic psychiatric assessment were sentenced to prison. Previous criminal convictions, concurrent antisocial personality disorders and substance use disorders were associated with a higher probability of a prison sentence among offenders with ID. Conclusions Sexual crime is overrepresented among offenders with ID compared to offenders with other mental disorders than ID in forensic psychiatric contexts. ID offenders become subject to forensic psychiatric care and forensic psychiatric services need evidence-based treatment programmes for offenders with ID. In addition, there is a need for early intervention strategies suitable for disability services and special education schools, in order to address the complex needs of individuals with ID and prevent sexual and violent offending.

Support Needs and Interventions for Family Caregivers of Patients with Amyotrophic Lateral Sclerosis (ALS): A Narrative Review with Report of Telemedicine Experiences at the Time of COVID-19 Pandemic

Family caregivers of people with amyotrophic lateral sclerosis (ALS), a severely disabling neurodegenerative disease due to the degeneration of both upper and lower motor neurons, have a very demanding role in managing their relatives, thereby often experiencing heavy care burden. Previous literature has widely highlighted that this situation reduces caregivers’ quality of life and increases their psychological distress and risk of health problems, but there are relatively few studies that focus on psychological interventions for these situations. Family support is more—not less—important during crisis. However, during the COVID-19 pandemic, maintaining public safety has required restricting the physical presence of families for hospitalized patients. Caregivers of ALS patients felt increased sense of loneliness and experienced greater difficulties in the access to both hospital and home assistance. In response, health systems rapidly adapted family-centric procedures and tools to circumvent restrictions on physical presence. In this regard, internet-based and telehealth solutions have been adopted to facilitate the routine, predictable, and structured communication, crucial to family-centered care. This narrative review aims at addressing more current matters on support needs and interventions for improving wellbeing of caregivers of ALS patients. In particular, we aimed at highlighting several gaps related to the complex needs of caregivers of ALS patients, to the interventions carried out in order to respond to these needs, and to the changes that COVID-19 pandemic caused from 2020 to nowadays in clinical managing of ALS patients. Finally, we report ongoing experiences of psychological support for family caregivers of ALS patients through telehealth solutions, which have been reinforced in case of needing of physical distancing during the COVID-19 pandemic.

Impacts of organisational role and environmental factors on moral injury and trauma amongst police investigators in Internet Child Abuse Teams

Little is known about how the effects of moral injury and trauma manifest amongst police Internet Child Abuse Teams. This article reports on the impacts of organisational role and environmental factors on moral injury and trauma amongst this population. Six participants were recruited from two police constabularies in the United Kingdom. Data were analysed using interpretative phenomenological analysis. Findings indicated that the participants’ moral injury and trauma were predominantly attributable to excessive workloads and stigma in relation to mental health within policing. Generic psychological interventions were insufficiently responsive to the complex needs of the police investigators.

Bodies and Documents: The Material Impact of Collaborative Information- Sharing Within the Seasonal Agricultural Worker Program

This study examines information-sharing practices within the Seasonal Agricultural Worker Program (SAWP), focusing on the program as it is administered within Ontario. I analyze 61 documents for their content, codification of stakeholder relationships, and discourse regarding the program. Documents were selected based on their creation, use, or circulation within Ontario, and based on the likelihood that at least one stakeholder group would look to the document for (what they perceive to be) reliable information. Documents include, for example, SAWP contracts, webpages describing program requirements, and e-pamphlets on workplace safety and accessing services. Document analysis was supplemented by interviews with industry and service provider experts, which guided interpretation of documents’ significance. I argue that documents function as material actors, alongside (and sometimes beyond) human actors, and make physical impact on SAWP bodies and realities. Documents construct and uphold neoliberal structures surrounding the program by contributing to the creation and sustaining of incomplete, labour-centric individuals. Through consistent sharing of narrow, “work” information, and the rare inclusion of more well-rounded, “non-work” knowledge, documents subtly discipline the boundaries of acceptable and unacceptable communication. In doing so, material actors (alongside other SAWP actors) perpetuate a foreign worker program which does not consider the varied, complex needs of whole persons but, instead, treats them as disposable labouring bodies.

Out-of-Hospital Emergencies in Children Under Palliative Home Care

Introduction: Specialized palliative home care (SPHC) enables children and adolescents with life-limiting illnesses and complex needs to receive care at home. In addition to controlling symptoms and stabilizing the psychosocial situation, crisis anticipation is a component of SPHC. Since the establishment of the reporting SPHC team, parents have called for additional help from emergency medical services (EMS) in emergency situations with unexpected frequency. Children with life limiting diseases could undergo invasive procedures and unhelpful treatments with uncertain consequences. The questions arose as to which factors led to the involvement of the EMS in a palliative situation, what therapy was performed and what outcome could be reached.Methods: Records of the pediatric SPHC patients and EMS call-outs in these children of the reporting SPHC-team in the central region of Hesse, Germany (population: 1.1 million) were retrospectively analyzed from 01.11.2014 to 01.05.2021. The causes of the call-outs, the existence of an emergency agreement, the National Advisory Committee for Aeronautics (NACA) score, EMS therapy and outcome were examined. Patient data included age, palliative-justifying diagnosis, duration and intensity of care, place of death and median overall survival (MOS) and palliative SHPC treatment.Results: In total, 172 patients were analyzed during the study period. There were 27 EMS calls for a total of 20 patients/families (= EMS group). Palliative illness or a complication was the most frequent cause of call-outs. The patients in the EMS group were significantly less likely to have a DNR order, required more home visits and telephone calls and were under SPHC care for longer. There was a significantly higher proportion of crisis interventions at home visits. The children in the EMS group died less often from the underlying disease. Of the remaining 152 patients (= non-EMS group), a significantly higher proportion had a European home country.Conclusions: Despite the introduction of the SPHC, parents still call the EMS. Good cooperation and joint training should be sought to prepare all those involved for future call-outs.