The experiences of young witnesses and caregivers in Aotearoa New Zealand's Sexual Violence Pilot Courts.

New Zealand's Sexual Violence Courts Pilot was established in late 2016, intended in part, to reduce the stress experienced by complainants. Young witnesses who testified in the specialist courts and their caregivers were interviewed about their experiences of court involvement. Interview transcripts were analysed using thematic analysis and the following themes were identified: The period between reporting an alleged offence and the trial is far too long and stressful; moving forward with life is difficult until the trial has concluded; cross-examination is distressing; feeling comfortable and supported when at court is important; safety and distance from the defendant when at court is important; separation of young witnesses from their caregivers at court is difficult; information is lacking throughout the process; and parenting young witnesses through the court process is challenging. Young witnesses typically experienced court involvement as very stressful and distressing, and further innovation within the courts is therefore needed.

Service-user efforts to maintain their wellbeing during and after successful withdrawal from antipsychotic medication.

BACKGROUND: It is well-known that attempting antipsychotic withdrawal can be a fraught process, with a high risk of relapse that often leads people to resume the medication. Nonetheless, there is a group of people who appear to be able to discontinue successfully. Relatively little is known about how people do this. METHODS: A convenience sample of adults who had stopped taking antipsychotic medication for more than a year were recruited to participate in semi-structured interviews through an anonymous online survey that investigated antipsychotic medication experiences in New Zealand. Thematic analysis explored participant descriptions of their efforts to maintain their wellbeing during and after the withdrawal process. RESULTS: Of the seven women who volunteered to participate, six reported bipolar disorder diagnoses and one reported diagnoses of obsessive compulsive disorder and depression. The women reported successfully discontinuing antipsychotics for 1.25-25 years; six followed a gradual withdrawal method and had support to prepare for and manage this. Participants defined wellbeing in terms of their ability to manage the impact of any difficulties faced rather than their ability to prevent them entirely, and saw this as something that evolved over time. They described managing the process and maintaining their wellbeing afterwards by 'understanding myself and my needs', 'finding what works for me' and 'connecting with support'. Sub-themes expand on the way in which they did this. For example, 'finding what works for me' included using a tool-box of strategies to flexibly meet their needs, practicing acceptance, drawing on persistence and curiosity and creating positive life experiences. CONCLUSION: This is a small, qualitative study and results should be interpreted with caution. This sample shows it is possible for people who experience mania and psychosis to successfully discontinue antipsychotics and safely manage the impact of any symptoms that emerge as a result of the withdrawal process or other life stressors that arise afterwards. Findings suggest internal resources and systemic factors play a role in the outcomes observed among people who attempt to stop taking antipsychotics and a preoccupation with avoiding relapse may be counterproductive to these efforts. Professionals can play a valuable role in facilitating change.

Interviews with health professionals about the National Child Protection Alert System.

AIM: The New Zealand National Child Protection Alert System is administered by multidisciplinary teams in every district health board. The aim of this study was to investigate the factors that influence multidisciplinary child protection teams' (MDTs') decisions about whether to place a child protection alert. METHOD: Members of the Child Protection Alert System teams were invited to participate in semi-structured interviews. Interview data were coded and grouped into themes using inductive thematic analysis. RESULTS: Six themes were identified: the system works well; a wide range of factors are considered in multidisciplinary team decision-making; there are some difficulties with multidisciplinary team meetings; there are problems with the administration of the system across district health boards; there is concern about the potential for the Child Protection Alert System to stigmatise families or cause unjustified responses; improvements can be made to the system. CONCLUSION: There is overall support for the National Child Protection Alert System and a consensus that the benefits outweigh any potential risks. There is a need for further improvements to the system, including consistent training, further standardisation and increased accessibility of the information to health professionals, including making information on the system available to primary healthcare.

Health professionals' perception of the New Zealand National Child Protection Alert System: An online survey.

AIM: To describe the multi-disciplinary child protection teams which administer the National Child Protection Alert System in District Health Boards in New Zealand and the understanding and perceptions of that system held by team members. METHODS: This is a mixed-method observational study. In December 2016 and January 2017, all child protection alert system multi-disciplinary team members were invited to participate in an online survey. Quantitative data were expressed with simple descriptive statistics. Qualitative findings were analysed using thematic analysis. RESULTS: Ninety-one (56.9%) of 160 team members nationwide completed the survey. All 20 District Health Boards and multiple disciplines were represented. Most respondents agreed that they received good information to make decisions (74/90, 82.2%), that it was usually easy to reach consensus (82/91, 90.1%), that the system helped to keep children safe (72/91, 79.1%) and that it did not stigmatise families (49/91, 53.9%). Qualitative analysis identified considerable variation in understanding of the system and a need for more training to support more consistent implementation of the system. CONCLUSIONS: Overall, health professionals responsible for the child protection alert system regard it positively but express a need for more training for team members and front-line staff to maximise the system's potential and minimise any risk of stigmatisation.

Attempting to discontinue antipsychotic medication: Withdrawal methods, relapse and success.

Few studies explore subjective experiences of attempting to discontinue antipsychotic medication, the withdrawal methods people use, or how their efforts affect their outcomes. People who take antipsychotics for off-label purposes are poorly represented in the literature. This study investigates experiences of attempting to discontinue antipsychotics in a cross-sectional sample and explores potential associations between withdrawal methods, relapse, and success. An anonymous online survey was completed by 105 adults who had taken antipsychotics for any reason and had attempted discontinuation at least once. A mixed methods approach was used to interpret the responses. Just over half (55.2%) described successfully stopping for varying lengths of time. Half (50.5%) reported no current use. People across diagnostic groups reported unwanted withdrawal effects, but these were not universal. Withdrawing gradually across more than one month was positively associated, and relapse was negatively associated with both self-defined successful discontinuation and no current use. Gradual withdrawal was negatively associated with relapse during withdrawal. We conclude it is possible to successfully discontinue antipsychotic medication, relapse during withdrawal presents a major obstacle to successfully stopping AMs, and people who withdraw gradually across more than one month may be more likely to stop and to avoid relapse during withdrawal.

Attempting to stop antipsychotic medication: success, supports, and efforts to cope.

PURPOSE: To explore supports and coping strategies used during attempts to discontinue antipsychotic medication and test for associations with success. METHOD: 144 people who were taking or had taken antipsychotics completed The Experiences of Antipsychotic Medication Survey. Among them, 105 people had made at least one discontinuation attempt and answered a series of questions about their most recent attempt to stop. Content analysis and Chi-square tests of independence were used to categorise the data and explore associations. Success was defined as stopping all AM use irrespective of the duration of the medication-free period or whether relapse occurred, which were explored separately. RESULTS: Among the 105 people who had attempted discontinuation, 61.9% described unwanted withdrawal effects and 27.6% of the group described psychotic or manic relapse during the withdrawal period. Within this group 55% described successfully stopping all AM for varying lengths of time, half reported no current use, and half described having some form of professional, family, friend, and/or service user or peer support for their attempt. Having support was positively associated with success and negatively associated with both current use, and relapse during withdrawal. A range of coping efforts were described, but having coping strategies failed to show significant associations with any of the dependent variables explored. Among those who described successfully stopping, some described returning to AM for short periods when needed, while others reported managing well with alternative methods alone. CONCLUSIONS: Findings cannot be readily generalised due to sampling constraints, but results suggest a wide range of supports and coping strategies may be used when attempting to discontinue antipsychotics. Many people may attempt to discontinue antipsychotics without any support. Those who have support for their attempts may be significantly less likely to relapse during withdrawal and more likely to succeed in their attempt. There is a pressing need for further research in this area.

The Experiences of Young Complainant Witnesses in Criminal Court Trials for Sexual Offences.

For effective provision of justice it is important that young witnesses are involved in criminal trials, yet participation may be detrimental to their well-being and presents challenges for gaining full and accurate evidence from them. Innovations in court processes intended to support the well-being of young witnesses should, amongst other considerations, be informed by the perspectives and experiences of those whom they are intended to assist. The participants in the current study consisted of young complainant witnesses who were involved in criminal court trials for sexual offences, along with their parents or caregivers. Semi-structured interviews with individual participants were conducted. Audio recordings of interviews were then transcribed and analysed using thematic analysis. Nine themes were identified in the data: (1) pre-trial delay makes everything worse, (2) uncertainty is difficult and being prepared is important, (3) cross-examination is stressful, (4) having a voice is a positive aspect of the trial, (5) the possibility of seeing the defendant is stressful, (6) for parents, putting on a brave face and being a supporter is challenging, (7) young witnesses feel exposed by the court process and family members feel exposed to details of the offending, (8) support is critical, and (9) families place importance on the verdict and sentencing. The findings are considered within the New Zealand context as well as other jurisdictions, and recommendations are made.

Caregiver Needs Following Disclosure of Child Sexual Abuse.

Caregiver support is vital in improving outcomes for child sexual abuse victims; however, the disclosure can significantly affect caregivers, thus impacting their ability to meet their children's needs. To maximize the support from caregivers, their own needs following disclosure need to be met. This study investigated the impact of child sexual abuse disclosure and associated needs as identified by caregivers. Sixty needs assessment forms were collected from families who accessed a parenting support pilot program run in New Zealand. These forms were completed by nonoffending caregivers during an assessment session with their counselor and consisted of both open-ended and Likert scale questions focusing on both the needs of the child and the family. Caregivers identified a range of impacts of the disclosure on their children, themselves, and other families members and the related support that may be needed. In particular, caregivers identified that they needed support with child behavior management and with their own coping. The findings suggest that interventions with caregivers following disclosure of child sexual abuse may be a valuable adjunct to therapy provided directly to the child.

Offending behaviours of child and adolescent firesetters over a 10-year follow-up.

BACKGROUND: To assess the postintervention arson recidivism and other offending rates of a group of 182 firesetting children and adolescents referred to the New Zealand Fire Awareness and Intervention Program (FAIP) over a follow-up period of 10 years. To investigate predictors of offending behaviour as well as variables associated with previous involvement in firesetting behaviour and offending severity. METHOD: Data collected at the time of the FAIP intervention was provided by the New Zealand Fire Service and the offence histories of the sample were accessed from the New Zealand Police database (NIA). Data were analyzed using both descriptive and inferential statistics. RESULTS: Although the arson recidivism rate was low (2%), rates of general offending were high, with 59% of the sample having committed an offence during the follow-up period. Fifteen percent of the sample was classified as severe offenders, 40% as moderate and 4% as minor. Of offenders, 12.6% had been imprisoned during the follow-up period. Offending was predicted by experience of abuse and a previous firesetting behaviour at the time of the FAIP intervention. Living with both parents at the time of intervention decreased the probability of an individual engaging in future offending behaviour. The presence of family stress and a diagnosis of Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder (ADD/ADHD) were associated with previous firesetting behaviour. In addition, involvement with family violence (as a perpetrator, complainant or victim) was associated with more severe offending behaviour. CONCLUSIONS: In light of existing research, the findings of this study indicate that many firesetters are at risk for future offending and that identification of high-risk individuals is therefore an important consideration for any organization involved with firesetters. To minimize this risk, there is a need for a collaborative, multiagency approach to firesetting behaviour involving comprehensive risk assessment and appropriate referral for at-risk individuals.

Interventions for caregivers of children who disclose sexual abuse: a review.

The importance of interventions for non-offending caregivers following the disclosure of child sexual abuse (CSA) is increasingly recognised in the literature. These interventions are particularly important given what is currently known about the impact of CSA disclosure on non-offending caregivers and the value of caregiver support in assisting their children's recovery. This review provides summary background information on the prevalence and short-term impact of CSA on children, with a particular focus on variables that mediate outcomes including caregiver support. The impact of a child's disclosure on the non-offending caregiver is discussed considering both the emotional effects and changes in their support networks. Furthermore, we examine the associated needs of non-offending caregivers including information, emotional support, support around their own victimisation if relevant, and parenting assistance. Finally, we provide a detailed review of the specific interventions available for caregivers after such a disclosure is made. These interventions include those that just provide information, support groups, psycho-educational groups, support incorporated into the child's intervention, and individual caregiver support. We conclude that interventions for non-offending caregivers are vital in the recovery of the child and their caregiver following CSA and discuss future research considerations.

Community reintegration of sex offenders of children in new zealand.

Reintegration of offenders following incarceration is most successful if matched to the needs of offenders, victims, and the community. This study explored child sex offenders' expectations for and experiences of reintegration into the community. A longitudinal design was used in which semistructured interviews covered issues identified in the literature as being related to reintegration. Nine offenders were interviewed within 1 week prior to release, 3 months post release, and 6 months post release. Interviews were analysed using thematic analyses producing six key themes. The interviews revealed that most of the participants feared their release from prison into the community and once released struggled to live in society. Overall, reintegration planning was simplistic and aimed primarily to manage risk factors rather than promote reintegration. Those participants who reported most satisfaction with their adjustment following release had more comprehensive reintegration plans, which enabled them to visualise what life would be like after release.

Measuring outcome in child and adolescent mental health services: consumers' views of measures.

BACKGROUND: Outcome measurement in child and adolescent mental health services in New Zealand became mandatory in 2005 and little is known about how this is perceived by service users. AIMS: This study aimed to ascertain what service users think about routine outcome measurement in child and adolescent mental health services. METHOD: Nine semi-structured focus groups of child and adolescent service users (n=34) and family members (n=21) were held in different sites in New Zealand to determine their views on outcome measures. RESULTS: Consumers supported outcome assessment with some provisos that have important implications for clinical services: the method of collecting information is critical to acceptance; assessment should be done in the context of an established relationship with the clinician; care is needed over the timing and context of assessment, access to information and feedback of results; and measures should be brief and holistic and their limitations recognised. CONCLUSION: Service users support outcome measures but their implementation requires care and consultation.

Young people and caregivers' perceptions of an intervention program for children who deliberately light fires.

A significant number of children and adolescents engage in deliberate fire setting, beyond the scope of curiosity and experimentation. Interventions developed to respond to the needs of such fire setters generally involve educational and/or psychosocial approaches. Research evaluating the effectiveness of these interventions is dominated by outcome studies which rely on recidivism rates determined by either official records or parent reports. There has however, been no process evaluation studies published. This study presents a process analysis which aimed to identify the strengths and weaknesses of a Fire Awareness and Intervention Program in New Zealand, from the perspectives of program consumers. Qualitative research methods were employed, with data being derived from in-depth interviews with young people and their parents/caregivers. The analysis indicated that (a) the FAIP was generally regarded as a positive experience, (b) practitioners' qualities of empathy and understanding are important for developing rapport with the young people and their parents, (c) education-based intervention tailored to the young person's age and developmental level is important, (d) educational resources need to be updated and used flexibly to respond appropriately to the age and developmental level of the young person, and (e) inter-agency and intra-agency relationships need to be developed and maintained, with formal arrangements for reciprocal referral systems developed in order to respond to the needs of the clients. The resulting implications for service providers, along with future research are discussed.

A parent-focused early intervention program for autism: who gets access?

BACKGROUND: The EarlyBird program is a psycho-educational early intervention program for parents of children with autistic spectrum disorder (ASD). It aims to provide parents with skills to increase their child's communication and manage challenging behaviour using behavioural techniques. METHOD: Two interlinked studies examined access to the EarlyBird program and barriers which may affect uptake. Study 1 investigated who accessed the EarlyBird program, and what factors influenced this choice. Study 2 was a qualitative investigation which focused on barriers to uptake for ethnic minority groups in New Zealand. RESULTS: Findings indicated that approximately 85% of families eligible for the program do not participate. Non-membership of Autism New Zealand (the agency responsible for administering the program), ethnicity, and length of wait time were significant factors in non-participation. CONCLUSIONS: A model of factors which may influence uptake of interventions targeting the families of children with a disability is proposed.

Resiliency in the victim-offender cycle in male sexual abuse.

The prevalence of childhood sexual abuse in child molesters is considerably higher than that in the general population. This finding had led to the "victim-offender cycle" being popularized as an explanation for sexual offending. However, not all child molesters were victimized as children, so it is of interest to examine the factors that contribute to the victim-offender cycle or, conversely, resiliency. This study examined the "moderating factors" that may prevent a male victim of sexual abuse from entering the victim-offender cycle. Two groups were interviewed as part of the study: a "resilient group" (n = 47) and a victim-offender group (n = 41). After correction for age and education level, the resilient group were less likely to have fantasized and masturbated about the abuse, less likely to report deriving pleasure from the abuse, more likely to have had frequent social contact with adolescent peers and to have had more family and nonfamily support during childhood. The findings support the need for multifactorial models of resiliency, the victim-offender cycle, and sexual offending. Recommendations about the prevention of the victim-offender cycle are made, including the need for a thorough systemic assessment of all male victims of sexual abuse and the involvement of their family system in counseling.