Sound thinking: Neurologic music therapy for cognitive training in adult mental health rehabilitation

Mr Cameron Haigh1

1Metro South Health, Brisbane, Australia

BACKGROUND: Cognitive impairment is a key factor limiting long term function and quality of life for individuals with mental illness. While a number of Cognitive Remediation Therapy (CRT) approaches have shown to provide benefits, they often exclude more severely impaired consumers. Access to, and engagement with, CRT remains limited. Neurologic Music Therapy (NMT) is an emerging treatment approach drawing on the neuroscience of music perception and music production to inform clinical techniques for cognitive, communication and sensorimotor dysfunctions. The ‘Sound Thinking’ group incorporates NMT techniques to create an engaging program for individuals in mental health rehabilitation.

AIMS: This project examines whether a group NMT program can provide engaging and effective cognitive training for mental disorders, including for individuals who may not participate in existing CRT programs.

METHODS and RESULTS: Participants were asked to rate the helpfulness of the program’s goals, methodology and overall effectiveness, and provide free text comments on their experience of the program. Survey responses showed strong acceptability and engagement from consumers as well as positive self-reported cognitive outcomes. Consumers also highlighted strong affective and social responses. A further controlled research study is commencing in 2019 using psychometric measures to examine changes in participants’ cognition during the program.

DISCUSSION: The utilisation of group musical experiences to teach and train improved cognition holds promise for increased engagement in cognitive rehabilitation.  This project addresses a need for rigorous evaluation of NMT in the psychiatric setting and may lead to improved treatment options for consumers with cognitive deficit.


Biography:

Cameron Haigh is Senior Registered Music Therapist and Music Therapy Clinical Educator in Metro South Health, working in mental health rehabilitation, clinical education and acquired brain injury rehabilitation. Cameron is a Fellow of the Academy of Neurologic Music Therapy and is completing Masters research with the University of Melbourne on the use of music therapy for cognitive rehabilitation.

Innovative Culturally Integrative Models in Psychological Treatments of CALD Population

Mr Dragos Ileana1, Mrs  Annette  Ruzicka1

1World Wellness Group, Stones Corner, Brisbane, Australia

Historically, psychological approaches on treatment and their validity on wider population have been widely disputed since its first years of inception. Whilst most of the psychotherapy approaches have been researched and validated on Western population responding to specific symptoms from the spectrum, the applicability of these theories on CALD population remains a significant challenge for both consumers of services and the Allied Health Practitioners.  When the challenge around language barriers are enhanced by the cultural diversity and their explanatory models plus specific challenges in delivering, adapting and tailoring Western approach treatments to CALD consumers, the effect can be seen on multiple levels – from client’s attendance and response to treatment to further impact on wider systems costs and sustainability.

This paper will present the experience of World Wellness Group in the development of their Multicultural Psychological Therapies Program  based on a 4-Tiered  Model to meet cultural and language needs of CALD consumers via therapeutic approaches in an integrative manner in order to provide culturally responsive psychological services. The 4 tiers consist of ethnic matching, co-therapy with a bicultural worker, therapy via an interpreter and therapy in English.

With half of the Australian population being born overseas or having one or both parents born overseas, the provision of culturally responsive psychological therapies presents unique challenges in the primary mental health setting.

This presentation will be present the Multicultural Psychological Therapies Program model,  a case study and preliminary research results with the aim to outline to inform innovative and evidence based approaches in primary mental health care for an increasingly diverse Australian population.


Biography:

Dragos is a clinical psychologist with expertise in working cross-culturally in the mental health, counselling and psychotherapy areas. He is the Acting Coordinator of the Transcultural Clinical Services at the Qld Transcultural Mental Health Centre, where, since 2010 he has been providing transcultural consultation to public MHS and non government organisations across the state and clinical care to clients from a diverse cultural background and with a wide range of mental health diagnoses.

He is a part of the Brisbane Metro South Trauma Leadership Group which aims to implement, educate and train mainstream mental health practitioners and services in culturally sensitive trauma informed and trauma trained care. He is an AHPRA clinically endorsed psychologist supervisor and has been involved in delivering training in culturally sensitive practice, to clinical psychology Master and PhD students from different Brisbane based universities.

In parallel, since 2012, he has been a part of the World Wellness Group Clinic, providing psychological treatments under Medicare, ATAPS and more recently Multicultural Psychological Therapies Group Program, assisting migrants, refugees, asylum seekers, as well as, other vulnerable CALD consumers who experience mental health issues in their visa processes, settlement and acculturation journey. He is one of the co-creators of MPTG Program and Assoc. Board Director at the World Wellness Group – overseeing the clinical program of the Allied Health Practitioners portfolio within a multidisciplinary integrative health care clinic designated for vulnerable population.

Annette is a member of the Australian Association of Social Work, and is an accredited mental health Social Worker. Annette has over 20 years of professional work in both generalised and clinical social work in mental health. Annette has a number of qualifications including Bachelor of Adult Education and Training, Bachelor of Social Work, Master in Social Work, Certificate in Nursing, and Graduate Diploma in Buddhist Psychotherapy & Counselling and is an accredited Family Dispute Resolution Practitioner.

Annette has management experiences working in Queensland government in particular in the child protection area as a Director for Transitional Placements Unit and Manager for a number of Child Safety Service Centres in South East Queensland. Annette also has significant social work experiences working in hospital Emergency Department &, Community Mental Health. She is the current Manager of the Multicultural Psychological Therapies Group Program and a health practitioner at the World Wellness Group.

Annette speaks three languages (Sinhala, Tamil, and English) and values of social justice approach to respecting culturally appropriate health outcomes for clients and their families with mindful and clinical practices that enhance a sense of purpose, connectedness, with a quest for wholeness filled with hope and harmony. Annette’s aspirations to work in the human services resonates these values and reflects in her approaches to social work practice and theoretical frameworks.

Strategies to enhance Allied Health Professionals in Mental Health Services to practice to full scope: A paradigm shift from case management

Dr Fiona Hall1, Ms Catherine Stephens1

1Allied Heatlh Professions Office of Queensland, Department Of Health, Cairns, Australia

Background: Exploring service models which optimise the expertise and scope of practice of mental health workforces and increase therapeutic, psychosocial and rehabilitative outcomes for individuals has been prioritised as a part of the Connecting care to recovery 2016– 2021 and Mental Health Alcohol and Other Drugs Workforce development framework. Despite these initiatives, the case management model has prevailed as the predominate paradigm for allied health in Mental Health Alcohol and Drug service delivery in Queensland Health.

Method: Focus groups were conducted with senior allied health managers and clinician to identify changes that would increase capacity for allied health to work to their professions scope. The outcome was the development and implementation of the Statwide Allied Health Mental Health Advisory Group Strategies (2017-2019) that emphasise:

  • A paradigm shift from case coordination activities to clinical interventions based on community needs
  • Enhanced clinical governance of allied health
  • Developing and implementing mental health models of care that optimise scope of practice of all allied health
  • Developing of standard intervention key performance indicators to evaluate progress.

Results: Evaluation of the strategies included collection of data relating to allied health professional expanded scope of practice activities. Nineteen Allied Health led, mental health expanded scope models of care have been implemented across eleven Hospital and Health Services. Partnership models with community managed organisations and AH led models for personality disorders, suicide and affective disorders are the most established models.

Discussion: The Strategy implementation has bought expectations about the transformation of services for people with mental health problems, however the strategies are only part of the way through the implementation process and the reform process is measured.  The pledge for culture change has been responsive but strong leadership in Queensland Health along with durable collaboration with community managed organisations is required for the reforms to be fully realised.


Biography:

Upon graduating Fiona worked as a counsellor and psychologist in community, educational and hospital settings in rural, remote and metropolitan locations in Australia.  Following this she worked as a clinical psychologist and researcher providing mental health services for more than a decade and completing post-graduate studies in clinical hypnotherapy, acute care in the community and a Doctorate in Psychology. The last ten years in the workforce have been   committed to progressing the National allied health workforce and mental health reform agendas through the management of Statewide projects and programs. Fiona lives with her family in Cairns, North Queensland and works for the Allied Health Professions Office of Queensland, where she manages statewide strategic workforce planning and policy development activities.

Healthy living program: Improving the dietary behaviours of people with severe mental illness

Ms Hannah Olufson1

1Queensland Health

People living with severe mental illness (SMI) consume more energy dense, nutrient poor diets than the general population and have lower levels of nutrition literacy (Dipasquale et al., 2013; Teasdale et al., 2017). To provide comprehensive nutrition care, tailored to this population in a regional Queensland setting, a dietetics service was established in the community mental health service (CMHS). Initially the mode of service delivery was via individual, face-to-face dietitian appointments. Anecdotal evidence gained through these one-on-one sessions revealed that not only did consumers with SMI have limited nutrition knowledge and poor dietary behaviours, but they were often marginalised from society due to the symptoms and stigma of mental illness. As a result, a multifaceted group nutrition education program based on the Healthy Living Group, facilitated at a metropolitan facility, was initiated. The CMHS Healthy Living Program is a 6-week multidisciplinary, practical group education program, co-facilitated by a dietitian and occupational therapist. The program aims to improve participants’ dietary and lifestyle behaviours, and enhance social engagement and connectedness. Prior to implementation, the original program content and materials were adapted for the requirements of a regional setting through the engagement of key stakeholders including CMHS consumers with SMI and case managers. Evaluation data from pre- and post-implementation will be presented. This information will be gathered through a combination of qualitative feedback, as well as measures of dietary behaviours, intuitive eating, quality of life and readiness to change. Learnings and subsequent changes from the implementation of the program will also be highlighted.

Bibliography:

1 Dipasquale, S., et al. (2013). The dietary pattern of patients with schizophrenia: a systematic review. J. Psychiatr. Res., 47(2), 197–207.

2 Teasdale, S.T., et al. (2017). Solving a weighty problem: Systematic review and meta-analysis of nutrition interventions in severe mental illness. Br. J. Psychiatry, 210(2), 110-118.


Biography:

Hannah Olufson is a passionate Accredited Practicing Dietitian with a special interest in mental health. Hannah aspires to improve the nutrition related health outcomes of people with severe mental illness (SMI) through nutrition advocacy, education and research. She currently works as a sole dietitian within a regional community mental health service, through which she has led the development, implementation and evaluation of a new model of nutrition care. As part of this role, Hannah has initiated the Healthy Living Program. This is a multidisciplinary, practical group education program, aimed at improving dietary and lifestyle behaviours of people with SMI.

Groups 4 Health (G4H): Building connectedness to support health in transitioning home from rehabilitation

Ms Julian  Whitmore1, Professor Catherine  Haslam2

1Metro North Hospital and Health Service, Community and Oral Health Directorate, Australia, 2University of Queensland, St Lucia, Australia

Background: Social engagement is key in protecting health, but challenging for those transitioning home after intensive rehabilitation. Targeting this issue is a new social group intervention, Groups 4 Health (G4H), that helps people to reconnect and extend their social group-based relationships in ways that support their health. In this feasibility study, we developed and piloted an adaptation of this program — G4H: Going Home — focusing on older adults transitioning home from rehabilitation.

Method: 30 participants (mean age=74.9; F=19, M=12) were recruited, among whom 12 completed all 5 sessions of the program and all measures. Primary measures at three timepoints (pre-G4H, end-G4H, 1-month follow-up) were depression, loneliness and quality of life (QoL). A smaller sample of participants (n=5) also took part in qualitative interviews aimed at gauging their experience of the program.

Results: Analysis of the full sample revealed clinically significant change in depression scores (of >2 points on the scale) between the pre-G4H and follow-up, and the post-G4H and follow-up periods. For the 12 completers, only the difference between post-G4H and follow-up was clinically significant. There was improvement on the remaining variables in both samples — with a small decline in loneliness and small increase in QoL between pre-G4H and follow up timepoints. Qualitative feedback was largely positive with the experiences of sharing and learning with others and realising the value of social groups emerging as common themes.

Discussion: The program had its greatest impact on mental health alongside raising awareness of the importance of others as a resource to support health in a challenging period of transitioning home. These data support investment in testing G4H further, with appropriate controls, to address alternative explanations for improvement and address generalisability. Alongside these data we discuss the program’s wider feasibility and challenges of delivering G4H within an active rehabilitation program.


Biography: 

Juliann Whitmore is an experienced Social Worker (Bachelor of Social Work, 1st class honours) with over 20 years’ clinical experience.  Juliann has worked in various roles in her field including child protection, with children with severe behavioural issues and their families, as a parenting specialist in child health and indigenous child health, with patients undergoing rehabilitation and in residential transition care working with clients transitioning home or into Residential Aged Care. Further Juliann has been a supervisor, a team leader and manager of Social Workers and other allied health staff.  She has experience in the design, implementation and review of new or revised organisational policies and procedures and models of practice. Juliann has undertaken a project on Domestic and Family Violence and was part of the roll out of the Domestic and Family Violence training in Community and Oral Health, Queensland Health. Juliann is passionate about clinical leadership and the growth of the team members meeting their own goals, those of their clients and the organisation.

 

In 2018 working for Community and Oral Health, Queensland Health, Juliann was the principal co-investigator in a collaborative research project with the University of Queensland and Ballycara Residential Aged Care Home and Wellness program.  This funded research study was to evaluate the effects of Groups 4 Health: Going Home program.     This social group intervention focused on helping people to reconnect and build their social connections within their community on transitioning home after a period in hospital believing that social engagement is key in protecting a person’s overall health.

Sensory modulation implementation in mental health services: The North Queensland experience

Mrs Luciana Theodoro De Freitas1, Mrs Andrea Catt1, Mrs Nikeea Cross1, Mrs Wendy Freedman1, Mrs Sally Rathbone1, Mrs Erin Aumann1, Mrs Xanthia Venz1

1Queensland Health, Townsville, Australia

Background: The use of Sensory Modulation (SM) interventions have increased in Mental Health (MH) settings in the last few years. These interventions assist consumers to self-regulate their emotional and physiological arousal states increasing their occupational engagement, self-awareness and dignity. Occupational Therapists (OTs) have taken a lead role in the implementation of these practices with a view to improving outcomes for consumers and service delivery. This project summarises the steps taken to incorporate and consolidate sensory approaches in a regional Hospital and Health Service in North Queensland.

Method: A SM working party was convened by OTs under the supervision of their professional senior. A literature review was conducted to identify the safe and efficient implementation of sensory approaches. Staff members participated in formal SM training to ensure consistency in knowledge and application across settings. SM resources such as weighted blankets, massage chairs, fidget items and other sensory tools were purchased. Procedures, local instruction documents, a Personal Sensory Plan and Weighted Modality Plan documentation tools were developed, trialled and implemented within the inpatient units. A Clinical Competency Assessment and training for the use of weighted modalities were also developed increasing confidence and knowledge of staff in implementing sensory plans.

Results: Preliminary findings have shown increased use of sensory assessments and interventions by OTs. Consumers have been regularly requesting SM resources as part of their coping strategies in inpatient settings. Community OTs have shown interest in participating in the SM working group with initial discussion and implementation of this approach being rolled out into community services.

Conclusion: SM appears to be well received by OTs and consumers both in inpatient and community mental health services. Sustainable funding, and developing multidisciplinary capacity in competently using SM will be an ongoing challenge for OTs in delivering sensory approaches.


Biography:

Luciana is a passionate Occupational Therapist currently employed as a Clinical Research Coordinator in Queensland Health.  She has a strong commitment for evidence based approaches and values research through clinical experiences. She is highly interested in research within aged care and adult mental health population.

Avoiding critical consequences of dysphagia: A collaboration between speech pathology and nursing staff in mental health

Ms Alison Battin1, Ms Bronwen  Craig1, Ms Katrina  Moore1, Ms  Hardie Grace1, Ms Laura Foley1, Ms Clare Lorenzen2

1Westmead Hospital, Western Sydney Local Health District , Westmead, Australia, 2Cumberland Hospital, Western Sydney Local Health District, Westmead, Australia

Background: Critical incidents related to swallowing problems (dysphagia) such as choking, were identified in our local mental health facility. While many mental health facilities employ speech pathologists, our local facility does not. Current research into dysphagia in this population indicates an incidence of 35% compared to 16% of the general population. Limited staff knowledge of dysphagia in mental health facilities can lead to an increased risk of critical events. The project aimed to increase knowledge and awareness of dysphagia, to increase appropriate referrals to the outpatient speech pathology service.

Method: A multi-faceted approach was implemented. A flowchart of signs, symptoms and strategies for dysphagia was developed for nursing staff by speech pathology and mental health management. A referral pathway for speech pathology was developed, followed by education to staff within the facility. The model of handover for patients returning to the facility post speech pathology intervention was changed to incorporate patient-specific feeding plans. Project outcomes were measured using referral numbers.

Results: Seven in-services were provided to 81 staff, resulting in 31 outpatient referrals to speech pathology during 2017-2018. This was a significant increase from nil referrals the previous year. Referrals were all deemed clinically appropriate for dysphagia intervention. Since implementation, nil critical incidents have been reported to speech pathology.

Discussion: Project implementation has caused systemic change demonstrated by the increase in appropriate referrals, indicating an improvement in staff knowledge and overall patient physical care. This collaborative approach to patient care enabled mental health facility staff to identify dysphagia, implement strategies and work in partnership with speech pathologists to facilitate comprehensive assessment. Absence of further critical incidents highlights the benefits of this approach and need for ongoing collaboration. Proportionally, referrals remain low compared with reported incidence of dysphagia, indicating further work is required.


Biography:

Alison Battin is the Head of Department Speech Pathology for Westmead and Auburn Hospitals in Sydney. She holds a Bachelor of Applied Science Speech Pathology (University of Sydney) and has a Diploma of Leadership and Management through NSW Health. Since graduating Alison has worked in the adult acute care setting and has specialised in the area of head and neck oncology. She is passionate about providing quality speech pathology services to the population of Western Sydney and has interests in workforce development and using innovative models of service delivery to overcome obstacles to patient care.

A new self-catering model of food service delivery for the University of Canberra (UCH) Adult Mental Health Rehabilitation Unit (AMHRU)

Janna Lutze1, Lorna Munro2, Dorothy Aawulenaa2, Jacinta Bryce1, Susan Davis1, Kannan Sakthivel1, Deanna Skitt1, Nanette Taylor1, Susan Jacques1, Andrew Slattery1

1Canberra Health Services, , Australia, 2University of Canberra, , Australia

Background:  A self-catering food service model was implemented within the new UCH AMHRU.  This unique model allows consumers to prepare and cook their own meals within a pod kitchen, facilitated by occupational therapists and allied health assistants.  Each pod group select a main course meal from two options daily, and are provided with fresh ingredients and recipes from the kitchen with the aim of enhancing independent living skills.

Methods:  A preliminary assessment of the adequacy of this food service model was undertaken.  Two student dietitians investigated; (i) menu and recipe compliance with the ACI Standards for Consumers of Inpatient Mental Health Services(1), (ii) quantitative dietary intakes and food patterns of consumers’, and (iii) key stakeholder feedback on the self-catering model implementation via qualitative semi-structured interviews.

Results:  The food service model achieved 78% compliance with the ACI Standards(1), with small areas for improvement identified, such as improved variety of meals (hot) at lunch.  Food intake data from a sample of four consumers was highly variable.  Some consumers met, and exceeded, key nutrient recommendations (e.g. in total energy, protein, saturated at, sodium and vitamin C).  Others did not appear to achieve adequate intakes for important nutrients (e.g. fibre and magnesium).  Lunch was found to be generally consumed outside of the unit (e.g. purchased from local cafe), and breakfast was frequently skipped.  Most consumers were highly engaged and satisfied with the evening meal and self-catering model.

Opportunities:  Six key opportunities to enhance the food service model were proposed;

  • greater staffing assistance to consumers at breakfast and lunch to improve engagement,
  • enhanced labelling of delivered food items and more user-friendly recipes,
  • modifying evening recipes to suit special diet needs (e.g. vegetarian),
  • improved protein profile of the lunch meal,
  • further nutritional assessment of the mid-meal snack service, and
  • advocacy for an ongoing dietitian role within the AMHRU.
  1. Agency for Clinical Innovation. Nutrition standards for consumers of inpatient mental health services in NSW. Sydney: NSW Agency for Clinical Innovation; 2013.

Biography: To be confirmed

Australian Occupational Therapists responses to an online survey about restraint and seclusion in Adult Acute Mental Health Inpatient Units

Mrs Luciana Theodoro De Freitas1, Adjunct Professor Tilley Pain1

1Queensland Health, Townsville,, Australia

Background: Restraint and Seclusion (R&S) are still widely used amongst psychiatric services around the world including Australia despite efforts to reduce them. Emerging evidence suggests Sensory Modulation (SM) improves self-regulation for the mentally ill person and is a safe and an effective intervention which decreases the use of R&S in inpatient settings. Although Occupational Therapists (OTs) have taken the lead internationally in the implementation of these interventions, there is limited evidence that Australian OTs are trained, or are using SM.  This project explored OT’ practices in supporting the multidisciplinary team in Adult Acute Mental Health Inpatient Units (AAMHIU) to reduce R&S.

Methods: A questionnaire was created specifically for this study. Occupational Therapy Australia Association disseminated the online survey and snowball sampling was used to increase number of participants. IBM SPSS statistics package Version 24 was used to analyse categorical data. Free text responses were analysed using qualitative content analysis.

Results: Thirty-Three OTs responded to the survey. Findings showed most respondents were senior females working in a full-time position in the public sector, and had participated in formal SM training. These participants had four years or less of experience in their position at the AAMHIU. Respondents used sensory assessments and interventions in their clinical workload to support the multidisciplinary team to minimise R&S incidents. The court yard was the environment most frequently used to mitigate R&S incidents. Analysis of the open-ended questions indicate barriers to sustainable SM implementation include education, funding, environment modifications and workplace culture.

Conclusion: OTs in Australia have a significant role in supporting the multidisciplinary team to reduce or eliminate R&S in AAMHIU. Individual or group SM interventions are used by OTs to minimise R&S incidents. However, further research is recommended to identify which sensory intervention or tool is most appropriate for this setting.


Biography:

Luciana is a passionate Occupational Therapist currently employed as a Clinical Research Coordinator in Queensland Health.  She has a strong commitment for evidence based approaches and values research through clinical experiences. She is highly interested in research within aged care and adult mental health population.

Seeing the baby and family in the home to hold health and mental health in mind: Mental health and maternal health collaborations to support vulnerable infants and their families through primary consultation

Amity Mcswan1

1Eastern Health Child Youth Mental Health Service, Specialist Child Team, Box Hill, Australia

In June 2018, after much planning, Eastern Health CYMHS (Child and Youth Mental Health Service) and the Maroondah Enhanced Maternal Child Health Service began a pilot program to provide Infant mental health services to families accessing maternal child health services.

This is an exciting partnership where the mental health clinician and enhanced maternal child health nurse can identify families that could benefit from a mental health consultation. We then with these families together in the home environment to think about infant and maternal health, current concerns and what supports may be of help in this early vulnerable stage.  Often after the primary consult appropriate families then consent to a referral for the infant and their family to CYMHS for assessment and treatment.

The project is proving to be successful in identifying families for CYMHS, increasing the understanding in the service environment regarding what is infant mental health, as well using a primary consult model to increase access for difficult to engage families. This presentation will use case studies to demonstrate how CYMHS and EMCH have been able to form this partnership, define the roles of participating professionals, the criteria for referrals,  how we have been able to increase accessibility for families and our learnings from the program.


Biography: To be confirmed

12

NAHC Conferences

2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

Conference Managers

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