Melbourne School of Government - Research Publications
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Avatar Therapy for people with schizophrenia or related disorders
BACKGROUND: Many people with schizophrenia do not achieve satisfactory improvements in their mental state, particularly the symptom of hearing voices (hallucinations), with medical treatment. OBJECTIVES: To examine the effects of Avatar Therapy for people with schizophrenia or related disorders. SEARCH METHODS: In December 2016, November 2018 and April 2019, the Cochrane Schizophrenia Group's Study-Based Register of Trials (including registries of clinical trials) was searched, review authors checked references of all identified relevant reports to identify more studies and contacted authors of trials for additional information. SELECTION CRITERIA: All randomised clinical trials focusing on Avatar Therapy for people with schizophrenia or related disorders. DATA COLLECTION AND ANALYSIS: We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and 95% confidence intervals (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and 95% CIs. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. Our main outcomes of interest were clinically important change in; mental state, insight, global state, quality of life and functioning as well as adverse effects and leaving the study early. MAIN RESULTS: We found 14 potentially relevant references for three studies (participants = 195) comparing Avatar Therapy with two other interventions; treatment as usual or supportive counselling. Both Avatar Therapy and supportive counselling were given in addition (add-on) to the participants' normal care. All of the studies had high risk of bias across one or more domains for methodology and, for other risks of bias, authors from one of the studies were involved in the development of the avatar systems on trial and in another trial, authors had patents on the avatar system pending. 1. Avatar Therapy compared with treatment as usual When Avatar Therapy was compared with treatment as usual average endpoint Positive and Negative Syndrome Scale - Positive (PANSS-P) scores were not different between treatment groups (MD -1.93, 95% CI -5.10 to 1.24; studies = 1, participants = 19; very low-certainty evidence). A measure of insight (Revised Beliefs about Voices Questionnaire; BAVQ-R) showed an effect in favour of Avatar Therapy (MD -5.97, 95% CI -10.98 to -0.96; studies = 1, participants = 19; very low-certainty evidence). No one was rehospitalised in either group in the short term (risk difference (RD) 0.00, 95% CI -0.20 to 0.20; studies = 1, participants = 19; low-certainty evidence). Numbers leaving the study early from each group were not clearly different - although more did leave from the Avatar Therapy group (6/14 versus 0/12; RR 11.27, 95% CI 0.70 to 181.41; studies = 1, participants = 26; low-certainty evidence). There was no clear difference in anxiety between treatment groups (RR 5.54, 95% CI 0.34 to 89.80; studies = 1, participants = 19; low-certainty evidence). For quality of life, average Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (QLESQ-SF) scores favoured Avatar Therapy (MD 9.99, 95% CI 3.89 to 16.09; studies = 1, participants = 19; very low-certainty evidence). No study reported data for functioning. 2. Avatar Therapy compared with supportive counselling When Avatar Therapy was compared with supportive counselling (all short-term), general mental state (Psychotic Symptom Rating Scale (PSYRATS)) scores favoured the Avatar Therapy group (MD -4.74, 95% CI -8.01 to -1.47; studies = 1, participants = 124; low-certainty evidence). For insight (BAVQ-R), there was a small effect in favour of Avatar Therapy (MD -8.39, 95% CI -14.31 to -2.47; studies = 1, participants = 124; low-certainty evidence). Around 20% of each group left the study early (risk ratio (RR) 1.06, 95% CI 0.59 to 1.89; studies = 1, participants = 150; moderate-certainty evidence). Analysis of quality of life scores (Manchester Short Assessment of Quality of Life (MANSA)) showed no clear difference between groups (MD 2.69, 95% CI -1.48 to 6.86; studies = 1, participants = 120; low-certainty evidence). No data were available for rehospitalisation rates, adverse events or functioning. AUTHORS' CONCLUSIONS: Our analyses of available data shows few, if any, consistent effects of Avatar Therapy for people living with schizophrenia who experience auditory hallucinations. Where there are effects, or suggestions of effects, we are uncertain because of their risk of bias and their unclear clinical meaning. The theory behind Avatar Therapy is compelling but the practice needs testing in large, long, well-designed, well-reported randomised trials undertaken with help from - but not under the direction of - Avatar Therapy pioneers.
Ethics and Law in Research on Algorithmic and Data-Driven Technology in Mental Health Care: Scoping Review
(JMIR PUBLICATIONS, INC, 2021-06-10)
BACKGROUND: Uncertainty surrounds the ethical and legal implications of algorithmic and data-driven technologies in the mental health context, including technologies characterized as artificial intelligence, machine learning, deep learning, and other forms of automation. OBJECTIVE: This study aims to survey empirical scholarly literature on the application of algorithmic and data-driven technologies in mental health initiatives to identify the legal and ethical issues that have been raised. METHODS: We searched for peer-reviewed empirical studies on the application of algorithmic technologies in mental health care in the Scopus, Embase, and Association for Computing Machinery databases. A total of 1078 relevant peer-reviewed applied studies were identified, which were narrowed to 132 empirical research papers for review based on selection criteria. Conventional content analysis was undertaken to address our aims, and this was supplemented by a keyword-in-context analysis. RESULTS: We grouped the findings into the following five categories of technology: social media (53/132, 40.1%), smartphones (37/132, 28%), sensing technology (20/132, 15.1%), chatbots (5/132, 3.8%), and miscellaneous (17/132, 12.9%). Most initiatives were directed toward detection and diagnosis. Most papers discussed privacy, mainly in terms of respecting the privacy of research participants. There was relatively little discussion of privacy in this context. A small number of studies discussed ethics directly (10/132, 7.6%) and indirectly (10/132, 7.6%). Legal issues were not substantively discussed in any studies, although some legal issues were discussed in passing (7/132, 5.3%), such as the rights of user subjects and privacy law compliance. CONCLUSIONS: Ethical and legal issues tend to not be explicitly addressed in empirical studies on algorithmic and data-driven technologies in mental health initiatives. Scholars may have considered ethical or legal matters at the ethics committee or institutional review board stage. If so, this consideration seldom appears in published materials in applied research in any detail. The form itself of peer-reviewed papers that detail applied research in this field may well preclude a substantial focus on ethics and law. Regardless, we identified several concerns, including the near-complete lack of involvement of mental health service users, the scant consideration of algorithmic accountability, and the potential for overmedicalization and techno-solutionism. Most papers were published in the computer science field at the pilot or exploratory stages. Thus, these technologies could be appropriated into practice in rarely acknowledged ways, with serious legal and ethical implications.
Knowledge co-creation in participatory policy and practice: Building community through data-driven direct democracy
(SAGE Publications, 2021-01-01)
Engaging citizens with digital technology to co-create data, information and knowledge has widely become an important strategy for informing the policy response to COVID-19 and the ‘infodemic’ of misinformation in cyberspace. This move towards digital citizen participation aligns well with the United Nations’ agenda to encourage the use of digital tools to enable data-driven, direct democracy. From data capture to information generation, and knowledge co-creation, every stage of the data lifecycle bears important considerations to inform policy and practice. Drawing on evidence of participatory policy and practice during COVID-19, we outline a framework for citizen ‘e-participation’ in knowledge co-creation across every stage of the policy cycle. We explore how coupling the generation of information with that of social capital can provide opportunities to collectively build trust in institutions, accelerate recovery and facilitate the ‘e-society’. We outline the key aspects of realising this vision of data-driven direct democracy by discussing several examples. Sustaining participatory knowledge co-creation beyond COVID-19 requires that local organisations and institutions (e.g. academia, health and welfare, government, business) incorporate adaptive learning mechanisms into their operational and governance structures, their integrated service models, as well as employing emerging social innovations.
Rising to Ostrom's Challenge: An invitation to walk on the bright side of politics, governance and public service
As a group of fifteen scholars from different sub-fields, countries, and generations, we argue that public administration would benefit from launching a self-conscious and cohesive strand of ‘positive’ scholarship, akin to social science subfields like positive psychology (Seligman & Csikshikszentmihalyi, 2000), positive organisational studies (Cameron & Dutton, 2003, p 4), and positive evaluation (Nielsen, Turksema & van der Knaap, 2015). We call for a program of research devoted to uncovering the factors and mechanisms that enable high performing public problem-solving and public service delivery; procedurally and distributively fair processes of tackling societal conflicts; and robust and resilient ways of coping with threats and risks. The core question driving positive public administration scholarship should be: Why is it that in a universe of like cases, specific public policies, programs, organizations, networks, or partnerships manage do much better than others to produce widely valued societal outcomes?
New Zealand: Whānau Ora Agile Government Case
(Agile Government Center, National Academy of Public Administration, 2020)
Aotearoa-New Zealand walks between two cultural worlds - Māori and Western/Anglo traditions - which were embedded following British colonisation, what happens when social policy is designed to reflect these worlds? Māori have perpetually demanded their perspectives be listened to and acted on in public policy since colonisation, but in the past 30 years this call has been gaining broader support. In 2010, Whānau Ora health and social initiative was legislated into action. This came after years of former Minister for the Community and Voluntary Sector Hon. Dame Tariana Turia agitating for change to how Māori health and social services were delivered. For Māori, whānau sits at the centre of culture and community. Whānau Ora, “family wellbeing” in Māori, aims to improve outcomes across areas such as health, education, housing, and employment, with a focus on the hauora of the whānau, as opposed to the traditional focus on individual crisis intervention. “Hauora” is a Māori philosophy of wellbeing entailing four mutually supportive dimensions: taha tinana (physical wellbeing); taha hinengaro (mental and emotional wellbeing); taha whanau (social wellbeing); and taha wairua (spiritual wellbeing) (Durie 1994). As background, it is important to recognize that a central goal of this endeavor is to recognize in Whānau Ora the principle that whānau are best placed to develop their own plans to meet their needs and achieve their aspirations. This contrasts with past practice where services are thrust upon them in times of crisis and with little consideration for their strengths.. Thus, this radical shift towards whānau self-determination required different approaches to developing and implementing Whānau Ora. While not drawing directly from Agile methodology, Whānau Ora shares many of the principles of it, but through a particular Māori and pasifika lens. This case shows us that application of the principles of agile government can be seen in delivering services in a manner that resonates in many communities and has roots in a wide variety of practices.
Australia Post Case Study
(Agile Government Center, National Academy of Public Administration, 2020)
Australia Post faced both disruption and opportunity as the digital era began to shift consumer demands towards ecommerce. The government business enterprise needed to adjust to these headwinds, so in 2012, it embarked on a reinvention of how its Digital Division operated. On a quest to improve customer experience, the Division grew from 15 to 270 open and collaborative people in a couple of years. The Digital Division consciously adopted the Agile methodology in setting out on its transformation.
Confronting the big challenges of our time: making a difference during and after COVID-19
(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2020-09-21)
This article explores key challenges emanating from COVID-19 and how public management and administration research can contribute to addressing them. To do this I discuss the ‘big questions’ debate and then sketch two big thematic challenges. In articulating these, I point to interconnections across various levels of analysis and argue we need to work across a range of boundaries and get more comfortable with complexity. My key argument being that both during and in the aftermath of a catastrophic global pandemic, it is at the intersections, not in silos, that we are likely to move forward intellectually and practically.
Collaborating After Crisis: How Public Administration Scholars and Practitioners Can Work Together
(Melbourne School of Government, 2020)
Key Points This Policy Brief makes the following key points: (a) COVID-19 has laid bare the capacity challenges faced by governments and exacerbated entrenched disadvantage and inequality. The pandemic has acted as an accelerant of many problems that confront governments, shining light on how decades of reform have eroded government capacity and bought to the fore deep divisions in society. (b) Practitioners and scholars can work together on big challenges that confront us during the crisis and in the aftermath. We need a pivot from ‘big questions’ towards ‘big challenges’, so that public administration and management scholars can work closely with practitioners to address these challenges in real time. (c) To make a difference we need new ways of working collaboratively. If we are keen to collaborate in this crisis and beyond it makes more sense to look to successful collaborations rather than dwell on supposed tensions between scholars and practitioners.
"B in IT" - a community-based model for the management of hepatitis B patients in primary care clinics using a novel web-based clinical tool.
(Springer Science and Business Media LLC, 2018)
Background: The current model of care for the treatment of chronic hepatitis B (CHB) in Australia is through specialist Hepatology or Infectious Diseases clinics, and limited accredited primary care practices. Capacity is limited, and less than 5% of Australians living with CHB currently access therapy. Increasing treatment uptake is an urgent area of clinical need. Nucleos(t)ide analogue therapy is safe and effective treatment for CHB that is suitable for community prescribing. We have evaluated the success of a community-based model for the management of CHB in primary care clinics using a novel web-based clinical tool. Methods: Using guidelines set out by the Gastroenterological Society of Australia, we developed an interactive online clinical management tool for the shared care of patients with CHB in primary care clinics, with remote oversight from tertiary hospital-based hepatologists and a project officer. We call this model of care the "B in IT" program. Suitable patients were referred from the specialist liver clinic back to primary care for ongoing management. Compliance with recommended appointments, pathology tests and ultrasounds of patients enrolled in "B in IT" was assessed and compared to that of the same patients prior to community discharge, as well as a matched control group of CHB outpatients continuing to attend a specialist clinic. Results: Thirty patients with CHB were enrolled in the "B in IT" program. Compliance with attending scheduled appointments within 1 month of the suggested date was 87% across all 115 visits scheduled. Compliance with completing recommended pathology within 1 month of the suggested date was 94% and compliance with completing recommended liver ultrasounds for cancer screening within 1 month of the suggested date was 89%. The compliance rates for visit attendance and ultrasound completion were significantly higher than the control patient group (p < 0.0001) and the "B in IT" patients prior to community discharge (p = 0.002 and p = 0.039, respectively). Conclusions: The "B in IT" program's novel web-based clinical tool supports primary care physicians to treat and monitor patients with CHB. This program promotes community-based care and increases system capacity for the clinical care of people living with CHB.
Emerging Business Models and the Evolving Regulatory Response: Perspectives from Australia and Beyond
(LexisNexis Australia, 2019)
This Special Issue contains a selection of articles presented at a workshop, ‘Emerging Business Models and the Evolving Regulatory Response: Perspectives from Australia and Beyond’. This workshop brought together a group of scholars, policymakers and graduate students actively working on, or otherwise interested in, the broad themes of labour and employment regulation and enforcement. The workshop was held in July 2018, with the generous support of the Centre for Employment and Labour Relations Law at the University of Melbourne.