Suicide Risk among Older Adults: The Moderating Role of Hope.

OBJECTIVES: The current study investigated whether hope and its two components (agency and pathways) acted as protective factors by weakening the relations between perceived burdensomeness, thwarted belongingness, and acquired capability for suicide and suicide risk among older adults. METHODS: A community sample of 594 older Australians aged from 60 to 95 years (Mage = 68.72, SDage = 6.67) completed the Suicidal Behaviors Questionnaire-Revised, Interpersonal Needs Questionnaire-Revised, Acquired Capability for Suicide Scale-Fearlessness about Death Scale, Adult Hope Scale, and Geriatric Depression Scale-short form. RESULTS: After controlling for depressive symptoms and sociodemographic variables, hope and agency moderated the thwarted belongingness-suicide risk relation, and hope, agency, and pathways moderated the acquired capability for suicide-risk relation. CONCLUSIONS: Hope may play an important role in reducing suicide risk among older adults experiencing thwarted belongingness and who have acquired the capability for suicide. Research is required to identify ways of reducing suicide risk among older adults who experience perceived burdensomeness. CLINICAL IMPLICATIONS: Increasing hope may reduce suicide risk among older adults experiencing thwarted belongingness and who have acquired the capability for suicide.

Guide for community leaders to meet the challenges of personal preparation in the event of a disaster.

OBJECTIVE: In the aftermath of fires which swept through a regional community in 2013, community leaders were thrust, unprepared, into the disaster recovery arena. The objective of this research was to investigate the subsequent lived experience of these community leaders and, based on this information, develop a guide to meet the challenges for their personal preparation in the context of disaster. DESIGN: Ethical approval for the overarching Community Connections project was provided by Charles Sturt University (H2014073). The project design was informed by an interpretivist paradigm and the methodology embraced participatory action research and thus engaged community members and leaders as research partners. This paper reports on the community leader component of the overarching project. SETTING: Blue Mountains, New South Wales, Australia. PARTICIPANTS: There were 7 interview participants in both 2014 and 2018; 5 participated in both years. Participants were either managers of a local non-government organisation, peak body, school, emergency service or large relief organisation with a local presence. MAIN OUTCOME MEASURE: The development of a guide for the personal preparation of community leaders. RESULTS: The stress of community leaders escalated after the disaster, resulting in a debilitating blurring of professional and personal boundaries, heightened demand on personal knowledge, networking relationships and communication strategies. CONCLUSION: The guide is practical and far reaching; the researchers could not locate anything similar to guide community leaders in their personal planning and preparation for work in disaster recovery.

Evaluating a low-intensity cognitive behavioural program for young people in regional Australia.

NewAccess is a low-intensity cognitive behavioural program which was recently trialled for the first time in Australia for clients aged under 18. Given that accessing support earlier tends to result in better outcomes for people with mild-to-moderate mental health issues, having NewAccess available for young people has the potential to reduce the likelihood of mild-to-moderate mental health concerns developing into more serious, or chronic mental illness over time for some clients, while also freeing up resources for those with more severe support needs. This mixed methods approach presents the findings of an independent evaluation of the program delivered out of two regional headspace centres in 2017-2019. From an initial sample of 165 young participants aged between 12 and 25, 109 completed the program. Of those who completed the program 60 were under the age of 18. The standardised assessment and outcome measures indicated a very good response to the program, with the majority showing significant improvements in their depression, anxiety and psychological distress scores. The overall 'reliable improvement' and 'recovery rates' were 64.2% and 72.3% respectively. Overall, the results indicated this program was an acceptable and efficacious intervention for young people in rural settings, when delivered in a 'youth-friendly' service environment.

Assessing the impact of vulnerability on perceptions of social cohesion in the context of community resilience to disaster in the Blue Mountains.

OBJECTIVE: To assess the impact of network communications, community participation and elements of vulnerability on the perception of social cohesiveness in the Blue Mountains local government area (Blue Mountains LGA). DESIGN: A questionnaire was administered to residents of the Blue Mountains LGA. Econometric analysis of the resulting data was undertaken. SETTING: Blue Mountains LGA, Australia. PARTICIPANTS: One thousand one hundred and three residents of the Blue Mountains LGA responded to the questionnaire. MAIN OUTCOME MEASURE(S): The responses enabled the construction of variables measuring individual perceptions of community cohesiveness, their network communications and community participation. Demographic data and data on the vulnerabilities of individuals were also collected. RESULTS: The data were used in an econometric model which identified that network communications and community participation impacted positively on perceptions of social cohesiveness while vulnerability factors had a negative impact. CONCLUSIONS: Remedial action to build community cohesiveness and network communications can be expected to have a positive impact on social cohesiveness. In developing strategies to build community cohesiveness and network communication, particular care needs to be taken to ensure the inclusion of those members of society who are regarded as the most vulnerable.

Service and infrastructure needs to support recovery programmes for Indigenous community mental health consumers.

Mental health is a major concern in Indigenous communities, as Indigenous people experience poorer health outcomes generally, and poorer social and emotional well-being throughout their lives, compared to non-Indigenous populations. Interviews were conducted with 20 mental health workers from a housing assistance programme for Indigenous clients with mental illness. Service and infrastructure needs identified to support clients were classified under the following overarching theme 'supports along the road to recovery'. Subthemes were: (i) It is OK to seek help; (ii) linking in to the local community; (iii) trusting the workers; and (iv) help with goal setting and having activities that support their achievement. This paper highlights the importance of targeted housing and accommodation support programmes for Indigenous people to prevent homelessness, and the essential services and infrastructure required to support Indigenous clients' mental health needs. These insights may inform service review, workforce development, and further research.

Attitudes to lesbian, gay, bisexual and transgender parents seeking health care for their children in two early parenting services in Australia.

AIMS AND OBJECTIVES: To examine the attitudes to and knowledge and beliefs about homosexuality of nurses and allied professionals in two early parenting services in Australia. BACKGROUND: Early parenting services employ nurses and allied professionals. Access and inclusion policies are important in community health and early childhood service settings. However, little is known about the perceptions of professionals who work within early parenting services in relation to lesbian, gay, bisexual and transgender families. DESIGN: This is the final in a series of studies and was undertaken in two early parenting services in two states in Australia using a cross-sectional design with quantitative and qualitative approaches. METHODS: Validated questionnaires were completed by 51 nurses and allied professionals and tested with chi-squared test of independence (or Fisher's exact test), Mann-Whitney U-test, Kruskal-Wallis one-way analysis of variance or Spearman's rank correlation. Thematic analysis examined qualitative data collected in a box for free comments. RESULTS: Of the constructs measured by the questionnaires, no significant relationships were found in knowledge, attitude and gay affirmative practice scores by sociodemographic variables or professional group. However, attitude scores towards lesbians and gay men were significantly negatively affected by conservative political affiliation (p = 0·038), held religious beliefs (p = 0·011) and frequency of praying (p = 0·018). Six overall themes were found as follows: respect, parenting role, implications for the child, management, disclosure, resources and training. CONCLUSIONS: The study provided an in-depth analysis of the attitudes, knowledge and beliefs of professionals in two early parenting services, showing that work is needed to promote acceptance of diversity and the inclusion of lesbian, gay, bisexual and transgender families in planning, developing, evaluating and accessing early parenting services. RELEVANCE TO CLINICAL PRACTICE: Access and inclusion plans for lesbian, gay, bisexual and transgender families are crucial in early parenting services in Australia and should be included in professional development programmes.

The Role of the Mental Health Worker in a Housing and Accommodation Support Initiative for Indigenous Australians.

PURPOSE: To explore the experiences of mental health workers and perceptions of their role and the scope of their work. DESIGN AND METHODS: Qualitative design. Twenty interviews were conducted with mental health workers. Interviews were analyzed using thematic analysis. FINDINGS: Three overarching themes were identified. In this paper the overarching theme of "dimensions of my role" is discussed. Subthemes were (a) information and education, (b) person-centered care, and (c) networking and partnerships. PRACTICE IMPLICATIONS: Professional development, networking, and partnerships underpin the provision of coordinated services and ultimately person-centered care. Enhancing staff capacity building may also enable sustainability of appropriate quality services.

Brokering Community Engagement: Proactive Strategies for Supporting Indigenous Australians with Mental Health Problems.

This qualitative study explored the experiences of mental health employees working with Indigenous clients living with mental illness. Interviews were conducted with 20 mental health workers to identify strategies they adopt to facilitate community engagement with Indigenous clients. Using a thematic analysis approach, 'Brokering community engagement' was the umbrella theme from which two subthemes related to community engagement for the service and clients emerged (1) enabling connections -community and family; and (2) recovery and reconnecting with community. Participant insights enabled a deeper understanding of the role of community in the recovery process for Indigenous clients and highlight the importance of community engagement as a primary, yet multifaceted strategy used by mental health workers in the communities they serve.

Enhancing Connectedness Through Peer Training for Community-Dwelling Older People: A Person Centred Approach.

Social interaction and connectedness is important to the mental health and wellbeing of older people. The aim of this research study was to facilitate and increase opportunities for social connectedness for older people living in regional areas through the use of technology training. Weekly technology training sessions were conducted at a Seniors Citizen's Club with a peer trainer (an experienced, retired computer teacher) and sessions were attended not only by the six study participants, but also by other club members, with up to 15 club members participating in sessions. Data analysis involved all documents generated by the project, including the individual interviews, researcher observations of training sessions, reports from the peer trainer and weekly diaries maintained by participants. Findings demonstrated that computer training at the Senior Citizens Club helped participants build group cohesion and to form tiered connections with partners, family, and friends with whom they no longer live. When the trainer is seen as a peer, and training is person-centred, older people are more receptive to learning, exploring, and experimenting with technology. Although only six people were involved in the in-depth evaluation part of the study, voluntary training with the trainer in the absence of any funding continues even to this present time. The outcome of this research reinforces the potential for technology facilitated tiered connectivity to enhance the quality of life for older people living in regional and rural Australia.

The Impact of a Participatory Care Model on Work Satisfaction of Care Workers and the Functionality, Connectedness, and Mental Health of Community-Dwelling Older People.

This study describes and evaluates an innovative program designed to reduce functional decline among seniors, using a participatory care approach and integrated health teams. The evaluation provides older people and community support workers (CSWs) with the opportunity to share their experiences of being involved with an innovative program to reduce functional decline (mobility, skin integrity, nutrition, mental health, continence) of older, community dwelling adults implemented by a Nursing Service in a major capital city in Australia. As part of the program, CSWs were trained to provide care that aimed to reduce functional decline, and improve the quality of life for the care recipients. Data were collected through in-depth interviews with older people receiving care and a focus group (FG) was conducted with CSWs. Seven themes emerged during data analysis: 1) functionality/independence; 2) prevention; 3) confidence; 4) connection; 5) the approach; 6) care plans; and 7) the role of the CSWs. The relationship built between care giver and receiver and the mutual respect facilitated through adopting a participatory care approach was crucial. This relationship-focused care contributed to improved functionality and consequently quality of life for the older person, and for the CSW professional it contributed to their development, improved satisfaction with their role, and increased pride in the difference they make in the lives of their clients. Opportunities for improvement of the program included ensuring that participants understood the rationale for all aspects of the program, including regular reminders, as well as the use of regular reviews of individual outcomes.

Information and communication technology solutions for outdoor navigation in dementia.

INTRODUCTION: Information and communication technology (ICT) is potentially mature enough to empower outdoor and social activities in dementia. However, actual ICT-based devices have limited functionality and impact, mainly limited to safety. What is an ideal operational framework to enhance this field to support outdoor and social activities? METHODS: Review of literature and cross-disciplinary expert discussion. RESULTS: A situation-aware ICT requires a flexible fine-tuning by stakeholders of system usability and complexity of function, and of user safety and autonomy. It should operate by artificial intelligence/machine learning and should reflect harmonized stakeholder values, social context, and user residual cognitive functions. ICT services should be proposed at the prodromal stage of dementia and should be carefully validated within the life space of users in terms of quality of life, social activities, and costs. DISCUSSION: The operational framework has the potential to produce ICT and services with high clinical impact but requires substantial investment.

Diffractively coupled Fabry-Perot resonator with power-recycling.

We demonstrate the optical coupling of two cavities without light transmission through a substrate. As the all-reflective coupling component, we use a dielectric low-efficiency 3-port diffraction grating. In contrast to a conventional transmissive coupling component, such an all-reflective coupler avoids all thermal effects that are associated with light absorption in the substrate. An all-reflective scheme for cavity coupling is of interest in the field of gravitational wave detection. In such detectors light that is resonantly enhanced inside the so-called power-recycling cavity is coupled to (kilometre-scale) Fabry-Perot resonators representing the arms of a Michelson interferometer. We realized such an all-reflective coupling in a table-top experiment. Our findings are in qualitative agreement with the theoretical model incorporating the characteristics of the 3-port grating used, and therefore encourage the application of all-reflective cavity couplers in future gravitational wave detectors.

Pound-Drever-Hall error signals for the length control of three-port grating coupled cavities.

Gratings enable light coupling into an optical cavity without transmission through any substrate. This concept reduces light absorption and substrate heating and was suggested for light coupling into the arm cavities of future gravitational wave detectors. One particularly interesting approach is based on all-reflective gratings with low diffraction efficiencies and three diffraction orders (three ports). However, it was discovered that, generally, three-port grating coupled cavities show an asymmetric resonance profile that results in asymmetric and low quality Pound-Drever-Hall error signals for cavity length control. We experimentally demonstrate that this problem is solved by the detection of light at both reflection ports of the cavity and the postprocessing of the two demodulated electronic signals.

All-reflective coupling of two optical cavities with 3-port diffraction gratings.

The shot-noise limited sensitivity of Michelson-type laser interferometers with Fabry-Perot arm cavities can be increased by the so-called power-recycling technique. In such a scheme the power-recycling cavity is optically coupled with the interferometer's arm cavities. A problem arises because the central coupling mirror transmits a rather high laser power and may show thermal lensing, thermo-refractive noise and photo-thermo-refractive noise. Cryogenic cooling of this mirror is also challenging, and thus thermal noise becomes a general problem. Here, we theoretically investigate an all-reflective coupling scheme of two optical cavities based on a 3-port diffraction grating.We show that power-recycling of a high-finesse arm cavity is possible without transmitting any laser power through a substrate material. The power splitting ratio of the three output ports of the grating is, surprisingly, noncritical.