Health practitioners play an important role in identifying and responding to domestic violence and abuse (DVA). Despite a large amount of evidence about barriers and facilitators influencing health practitioners' care of survivors of DVA, evidence about their readiness to address DVA has not been synthesised. This article reports a meta-synthesis of qualitative studies exploring the research question: What do health practitioners perceive enhances their readiness to address domestic violence and abuse? Multiple data bases were searched in June 2018. Inclusion criteria included: qualitative design; population of health practitioners in clinical settings; and a focus on intimate partner violence. Two reviewers independently screened articles and findings from included papers were synthesised according to the method of thematic synthesis. Forty-seven articles were included in the final sample, spanning 41 individual studies, four systematic reviews and two theses between the years of 1992 and 2018; mostly from high income countries. Five themes were identified as enhancing readiness of health practitioners to address DVA: Having a commitment; Adopting an advocacy approach; Trusting the relationship; Collaborating with a team; and Being supported by the health system. We then propose a health practitioners' readiness framework called the CATCH Model (Commitment, Advocacy, Trust, Collaboration, Health system support). Applying this model to health practitioners' different readiness for change (using Stage of Change framework) allows us to tailor facilitating strategies in the health setting to enable greater readiness to deal with intimate partner abuse.

OBJECTIVE: To investigate whether domestic violence (DV) impacts on health professionals' clinical care of DV survivor patients. DESIGN, SETTING: Descriptive, cross-sectional study at an Australian tertiary maternity hospital. PARTICIPANTS: 471 participating female health professionals (45.0% response rate). OUTCOME MEASURES: Using logistic and linear regression, we examined whether health professionals' exposure to lifetime DV was associated with their clinical care on specific measures of training, attitudes, identification and intervention. RESULTS: DV survivor health professionals report greater preparedness to intervene with survivor patients in a way that is consistent with ideal clinical care. This indicates that personal DV experience is not a barrier, and may be a facilitator, to clinical care of survivor patients. CONCLUSIONS: Health professionals are at the front line of identifying and responding to patients who have experienced DV. These findings provide evidence that survivor health professionals may be a strength to the healthcare organisations in which they work since among the participants in this study, they appear to be doing more of the work seen as better clinical care of survivor patients. We discuss the need for greater workplace supports aimed at promoting safety and recovery from violence and strengthening clinical practice with patients.

The second of two special issues on kinship care.

The first of two special issues on kinship care.

This is the Editorial to the first of two Special Issues of Developing Practice devoted to kinship care. It describes the 2018 ACWA project Kinship Care: Making it a National Issue and its various elements. It also outlines some things that are known and not known about kinship care, myths about kinship care that have sprung up in place of knowledge, and the depth of unmet support needs of kin children and their carers.

This is the second of two Special Issues on kinship care. Here I explore ways forward to address kin children’s wellbeing from a human rights perspective.

Australia has one of the largest multicultural populations in the world, with cultural and linguistic diversity (CALD) a defining feature. CALD populations have unique identities and experiences of mental health and suicide, with multicultural differences, trauma and experiences of discrimination and stigma pertinent to effective suicide prevention approaches. Very little is known however about suicide and suicidality among this population in Australia. This systematic review explored literature on suicidality and suicide prevention in CALD communities as a means of informing suicide prevention research, policy and practice in the Australian context. Five electronic databases (Medline, PsycINFO, Embase, Emcare, and CINAHL) were searched. Studies were included if they examined factors associated with suicidality or described suicide prevention initiatives in CALD populations, and were conducted in OECD countries. Study quality was assessed using the CASP qualitative checklist for qualitative studies and the Quality Assessment Tool for quantitative studies. Thematic analysis was used to identify key themes in the included studies. Eighteen studies met the criteria for inclusion, including ten qualitative and eight quantitative studies. No Australian studies were identified. Key themes included acculturation difficulties, stigma, the influence of social networks and family, heterogeneity of CALD populations, and suggested prevention strategies. The review found no Australian studies looking at suicidality or suicide prevention in CALD communities. It highlights the need for a greater focus across policy, research and evaluation on suicide prevention in Australian CALD communities.

BACKGROUND: There is much discourse in healthcare about the importance of client-centred rehabilitation, however in the realm of community-based therapy post-stroke there has been little investigation into the efficacy of goal-directed practice that reflects patients' valued activities. In addition, the effect of active involvement of carers in such a rehabilitation process and their subsequent contribution to functional and emotional recovery post-stroke is unclear. In community based rehabilitation, interventions based on patients' perceived needs may be more likely to alter such outcomes. In this paper, we describe the methodology of a randomised controlled trial of an integrated approach to facilitating patient goal achievement in the first year post-stroke. The effectiveness of this intervention in reducing the severity of post-stroke depression, improving participation status and health-related quality of life is examined. The impact on carers is also examined. METHODS/DESIGN: Patients (and their primary carers, if available) are randomly allocated to an intervention or control arm of the study. The intervention is multimodal and aims to screen for adverse stroke sequelae and address ways to enhance participation in patient-valued activities. Intervention methods include: telephone contacts, written information provision, home visitation, and contact with treating health professionals, with further relevant health service referrals as required. The control involves treatment as usual, as determined by inpatient and community rehabilitation treating teams. Formal blinded assessments are conducted at discharge from inpatient rehabilitation, and at six and twelve months post-stroke. The primary outcome is depression. Secondary outcome measures include participation and activity status, health-related quality of life, and self-efficacy. DISCUSSION: The results of this trial will assist with the development of a model for community-based rehabilitation management for stroke patients and their carers, with emphasis on goal-directed practice to enhance home and community participation status. Facilitation of participation in valued activities may be effective in reducing the incidence or severity of post-stroke depression, as well as enhancing the individual's perception of their health-related quality of life. The engagement of carers in the rehabilitation process will enable review of the influence of the broader social context on recovery. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12608000042347.

BACKGROUND: Broad community access to high quality evidence-based primary mental health care is an ongoing challenge around the world. In Australia one approach has been to broaden access to care by funding psychologists and other allied health care professionals to deliver brief psychological treatments to general practitioners' patients. To date, there has been a scarcity of studies assessing the efficacy of social worker delivered psychological strategies. This study aims to build the evidence base by evaluating the impact of a brief educational intervention on social workers' competence in delivering cognitive behavioural strategies (strategies derived from cognitive behavioural therapy). METHODS: A randomised controlled trial design was undertaken with baseline and one-week follow-up measurement of both objective and self-perceived competence. Simulated consultations with standardised depressed patients were recorded on videotape and objective competence was assessed by blinded reviewers using the Cognitive Therapy Scale. Questionnaires completed by participants were used to measure self-perceived competence. The training intervention was a 15 hour face-to-face course involving presentations, video example consultations, written materials and rehearsal of skills in pairs. RESULTS: 40 Melbourne-based (Australia) social workers enrolled and were randomised and 9 of these withdrew from the study before the pre training simulated consultation. 30 of the remaining 31 social workers (97%) completed all phases of the intervention and evaluation protocol (16 from intervention and 14 from control group). The intervention group showed significantly greater improvements than the control group in objective competence (mean improvement of 14.2 (7.38-21.02) on the 66 point Cognitive Therapy Scale) and in subjective confidence (mean improvement of 1.28 (0.84-1.72) on a 5 point Likert scale). On average, the intervention group improved from below to above the base competency threshold on the Cognitive Therapy Scale whilst the control group remained below. CONCLUSIONS: Social workers can attain significant improvements in competency in delivering cognitive behavioural strategies from undertaking brief face to face training. This is relevant in the context of health reforms that involve social worker delivery of evidence based psychological care. Further research is required to assess how these improvements in competence translate into performance in practice and clinical outcomes for patients.

Becoming a parent and mother is ‘the irreversible crossing of the boundary from being someone's (daughter) to becoming someone's mother’ (Schmidt Neven 1996) and what we know of this transition for adopted women is still primarily anecdotal. Many women adopted during and after the 1970s in Victoria are still in the parenting life stage, and this paper describes the experiences of three of them. The women participated in qualitative, in-depth interviews that were part of a Master of Social Work research study. This article primarily takes a life course approach in eliciting themes of normative family experiences, delay of identity consolidation until the time of childbearing, the impact of search, reunion and divided loyalties, and the negotiation of multiple family systems (adoptive, in-law and birth). The management of these complex phenomena have demanded a high level of skill and effort by these women as they cope with their own emotional reactions, continue to be responsive mothers and assist their children and partners to negotiate new, extended, family relationships. The study draws attention to and provides insight for practitioners in this hidden area of welfare and indicates the need for further research.

Twenty-one women adopted as infants within the Australian state of Victoria discussed their lived experience as mothers and the impacts of their adoption at this life stage. Sixteen participants took part in semi-structured interviews and the emerging categories were evaluated by a focus group of five additional adopted women. While each of their accounts is unique, reflecting their own individual life histories, partnerships and social networks, shared threads of meaning run through the combined narratives. The women’s descriptions of the values and models of care they bring to motherhood, their view of their children and the hopes they have for their family of procreation are each discussed in the light of their adoption status and experiences. Particular emphasis is given to issues of their adjustments to identity and extended family relationships and experiences of loss. This breaks new ground for a population that remains largely hidden within Australian society and points a way to future research endeavours in this area.

BACKGROUND: Disasters pose a documented risk to mental health, with a range of peri- and post-disaster factors (both pre-existing and disaster-precipitated) linked to adverse outcomes. Among these, increasing empirical attention is being paid to the relation between disasters and violence. AIMS: This study examined self-reported experiences of assault or violence victimisation among communities affected by high, medium, and low disaster severity following the 2009 bushfires in Victoria, Australia. The association between violence, mental health outcomes and alcohol misuse was also investigated. METHOD: Participants were 1016 adults from high-, medium- and low-affected communities, 3-4 years after an Australian bushfire disaster. Rates of reported violence were compared by areas of bushfire-affectedness. Logistic regression models were applied separately to men and women to assess the experience of violence in predicting general and fire-related post-traumatic stress disorder, depression and alcohol misuse. RESULTS: Reports of experiencing violence were significantly higher among high bushfire-affected compared with low bushfire-affected regions. Analyses indicated the significant relationship between disaster-affectedness and violence was observed for women only, with rates of 1.0, 0 and 7.4% in low, medium and high bushfire-affected areas, respectively. Among women living in high bushfire-affected areas, negative change to income was associated with an increased likelihood of experiencing violence (odds ratio, 4.68). For women, post-disaster violence was associated with more severe post-traumatic stress disorder and depression symptoms. CONCLUSIONS: Women residing within high bushfire-affected communities experienced the highest levels of violence. These post-disaster experiences of violence are associated with post-disaster changes to income and with post-traumatic stress disorder and depression symptoms among women. These findings have critical implications for the assessment of, and interventions for, women experiencing or at risk of violence post-disaster.