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Objective: Cognitive remediation is an intervention to overcome cognitive deficits through drills and use of strategies. Previous studies have reported positive effects for cognitive remediation on neurocognition, but researchers' allegiance effects are not always adequately controlled. Furthermore, its efficacy amongst the Asian population has not been established. Hence, this study aimed to determine if cognitive remediation would have positive effects on neurocognition and functioning within an English-speaking Asian population, when compared against the effects of a credible and balanced control provided by therapists blinded to the study hypothesis., Method: A total of 70 participants with schizophrenia who attended vocational training or day rehabilitation programmes were randomised to receive a 60-hour programme of either cognitive remediation or physical exercise. Neurocognition and functional outcomes were measured at baseline, upon completion of treatment, 6 months after treatment and 1 year after treatment., Results: Participants who received cognitive remediation had significantly greater improvement in all neurocognitive domains. Furthermore, the cognitive remediation group achieved greater attainment of vocational or independent living skills and better functional outcomes at post-intervention and at the end of the 1-year follow-up., Conclusions: When compared against a credible intervention such as physical exercise, cognitive remediation was able to show significant positive effects on both neurocognition and functional outcomes among the Asian population of schizophrenia patients.

Objective: The present study was designed to investigate the clinical and social outcomes for a group of individuals (n = 181) discharged into supported accommodation from three long-stay facilities in Queensland., Method: Data were collected prospectively using a battery of standardized measures and individual interviews at 6 weeks pre-discharge and again at 6, 18, 36, and 84 months post-discharge., Results: While there was little functional gain at follow up, the clients, as a group, did not deteriorate. Sixty per cent of the clients were engaged in some form of structured community activity and the need for hospitalization decreased significantly in the follow-up period. The ongoing costs of the programme, while remaining high, were significantly less than inpatient alternatives., Conclusion: The provision of community accommodation with adequate clinical and non-clinical support is a suitable option for a large proportion of individuals with serious mental illness.

Objective: In Australia and comparable countries, case management has become the dominant process by which public mental health services provide outpatient clinical services to people with severe mental illness. There is recognition that caseload size impacts on service provision and that management of caseloads is an important dimension of overall service management. There has been little empirical investigation, however, of caseload and its management. The present study was undertaken in the context of an industrial agreement in Victoria, Australia that required services to introduce standardized approaches to caseload management. The aims of the present study were therefore to (i) investigate caseload size and approaches to caseload management in Victoria's mental health services; and (ii) determine whether caseload size and/or approach to caseload management is associated with work-related stress or case manager self-efficacy among community mental health professionals employed in Victoria's mental health services., Method: A total of 188 case managers responded to an online cross-sectional survey with both purpose-developed items investigating methods of case allocation and caseload monitoring, and standard measures of work-related stress and case manager personal efficacy., Results: The mean caseload size was 20 per full-time case manager. Both work-related stress scores and case manager personal efficacy scores were broadly comparable with those reported in previous studies. Higher caseloads were associated with higher levels of work-related stress and lower levels of case manager personal efficacy. Active monitoring of caseload was associated with lower scores for work-related stress and higher scores for case manager personal efficacy, regardless of size of caseload. Although caseloads were most frequently monitored by the case manager, there was evidence that monitoring by a supervisor was more beneficial than self-monitoring., Conclusion: Routine monitoring of caseload, especially by a workplace supervisor, may be effective in reducing work-related stress and enhancing case manager personal efficacy.

Objectives: Comparatively few people with severe mental illness are employed despite evidence that many people within this group wish to obtain, can obtain and sustain employment, and that employment can contribute to recovery. This investigation aimed to: (i) describe the current policy and service environment within which people with severe mental illness receive employment services; (ii) identify evidence-based practices that improve employment outcomes for people with severe mental illness; (iii) determine the extent to which the current Australian policy environment is consistent with the implementation of evidence-based employment services for people with severe mental illness; and (iv) identify methods and priorities for enhancing employment services for Australians with severe mental illness through implementation of evidence-based practices., Method: Current Australian practices were identified, having reference to policy and legal documents, funding body requirements and anecdotal reports. Evidence-based employment services for people with severe mental illness were identified through examination of published reviews and the results of recent controlled trials., Results: Current policy settings support the provision of employment services for people with severe mental illness separate from clinical services. Recent studies have identified integration of clinical and employment services as a major factor in the effectiveness of employment services. This is usually achieved through co-location of employment and mental health services., Conclusions: Optimal evidence-based employment services are needed by Australians with severe mental illness. Providing optimal services is a challenge in the current policy environment. Service integration may be achieved through enhanced intersectoral links between employment and mental health service providers as well as by co-locating employment specialists within a mental health care setting.

Objective: This paper describes the first phase of a larger project that utilizes participatory action research to examine complex mental health needs across an extensive group of stakeholders in the community., Method: Within an objective qualitative analysis of focus group discussions the social ecological model is utilized to explore how integrative activities can be informed, planned and implemented across multiple elements and levels of a system. Seventy-one primary care workers, managers, policy-makers, consumers and carers from across the southern metropolitan and Gippsland regions of Victoria, Australia took part in seven focus groups. All groups responded to an identical set of focusing questions., Results: Participants produced an explanatory model describing the service system, as it relates to people with complex needs, across the levels of social ecological analysis. Qualitative themes analysis identified four priority areas to be addressed in order to improve the system's capacity for working with complexity. These included: (i) system fragmentation; (ii) integrative case management practices; (iii) community attitudes; and (iv) money and resources., Conclusions: The emergent themes provide clues as to how complexity is constructed and interpreted across the system of involved agencies and interest groups. The implications these findings have for the development and evaluation of this community capacity-building project were examined from the perspective of constructing interventions that address both top-down and bottom-up processes.

Objective: To develop a self-report scale of subjective experiences of illness perceived to impact on employment functioning, as an alternative to a diagnostic perspective, for anticipating the vocational assistance needs of people with schizophrenia or schizoaffective disorders., Method: A repeated measures pilot study (n(1) = 26, n(2) = 21) of community residents with schizophrenia identified a set of work-related subjective experiences perceived to impact on employment functioning. Items with the best psychometric properties were applied in a 12 month longitudinal survey of urban residents with schizophrenia or schizoaffective disorder (n(1) = 104; n(2) = 94; n(3) = 94)., Results: Construct validity, factor structure, responsiveness, internal consistency, stability, and criterion validity investigations produced favourable results. Work-related subjective experiences provide information about the intersection of the person, the disorder, and expectations of employment functioning, which suggest new opportunities for vocational professionals to explore and discuss individual assistance needs., Conclusion: Further psychometric investigations of test-retest reliability, discriminant and predictive validity, and research applications in supported employment and vocational rehabilitation, are recommended. Subject to adequate psychometric properties, the new measure promises to facilitate exploring: individuals' specific subjective experiences; how each is perceived to contribute to employment restrictions; and the corresponding implications for specialized treatment, vocational interventions and workplace accommodations.

Objective: The purpose of this study was to explore methods of determining an appropriate caseload for mental health case managers., Method: Seven factors that may impinge on case manager performance and impact on caseload were identified, having reference to published literature and service practice in Victoria and Queensland. The advantages and disadvantages of including these factors in a caseload index were evaluated., Results: Three caseload index methodologies are presented. Each method makes use of different data and has advantages and disadvantages. There is a trade-off between simplicity and ease of application and the comprehensive use of relevant information. Methods vary in their implications for service efficiency and equity in workload distribution., Conclusions: Caseload is a key issue in service planning and staff management. Factors that have the potential to contribute to caseload can be readily identified. However, there is likely to be disagreement as to the weight assigned to any factor and the approach taken may depend on the purpose and context of the caseload calculation. A great deal more research is required to provide an empirical basis for algorithms used in caseload calculation.

Objective: There has been limited research in Australia examining the extent of generic and specialist work activities carried out by occupational therapists and social workers since the introduction of mental health reform. The aim of the project was to: (i) identify specific clinical work activities of occupational therapists and social workers; and (ii) identify whether they are performing a greater proportion of generic than specialist clinical or discipline specific core skills., Method: A cross-sectional survey of 304 (response rate 76.6%) occupational therapists and social workers working in mental health was conducted. For the purposes of the study a new instrument was developed to cover broad categories of clinical work activities., Results: The majority of the respondents were female, under the age of 30 years, who had worked in their current position less than 5 years. Generic work activities were the primary activities of the two professional groups, with nine of the 10 activities undertaken most frequently being generic in nature. Social work respondents performed more work activities while occupational therapists undertook more specialist clinical activities., Conclusions: Occupational therapists and social workers are required to have common competencies in addition to discipline-specific competencies in order to undertake broad-spectrum mental health service activities. This has implications for the skill mix, education and training and recruitment of staff.