Dr Dominiek Coates is a social scientist and counsellor with expertise in mental health, women's health and safety, maternity care, health services research, translational research and implementation science. She is passionate about improving care for vulnerable populations.
Can supervise: YES
Coates, D, Donnolley, N, Foureur, M & Henry, A 2020, 'Women's experiences of decision-making and attitudes in relation to induction of labour: A survey study', Women and Birth.View/Download from: Publisher's site
© 2020 Background: Rates of induction of labour have been increasing globally to up to one in three pregnancies in many high-income countries. Although guidelines around induction, and strength of the underlying evidence, vary considerably by indication, shared decision-making is increasingly recognised as key. The aim of this study was to identify women's mode of birth preferences and experiences of shared decision-making for induction of labour. Method: An antenatal survey of women booked for an induction at eight Sydney hospitals was conducted. A bespoke questionnaire was created assessing women's demographics, indication for induction, pregnancy model of care, initial birth preferences, and their experience of the decision-making process. Results: Of 189 survey respondents (58% nulliparous), major reported reasons for induction included prolonged pregnancy (38%), diabetes (25%), and suspected fetal growth restriction (8%). Most respondents (72%) had hoped to labour spontaneously. Major findings included 19% of women not feeling like they had a choice about induction of labour, 26% not feeling adequately informed (or uncertain if informed), 17% not being given alternatives, and 30% not receiving any written information on induction of labour. Qualitative responses highlight a desire of women to be more actively involved in decision-making. Conclusion: A substantial minority of women did not feel adequately informed or prepared, and indicated they were not given alternatives to induction. Suggested improvements include for face-to-face discussions to be supplemented with written information, and for shared decision-making interventions, such as the introduction of decision aids and training, to be implemented and evaluated.
Coates, D, Donnolley, N, Foureur, M, Spear, V & Henry, A 2020, 'Exploring unwarranted clinical variation: The attitudes of midwives and obstetric medical staff regarding induction of labour and planned caesarean section', Women and Birth.View/Download from: Publisher's site
© 2020 Australian College of Midwives Background: Unexplained clinical variation is a major issue in planned birth i.e. induction of labour and planned caesarean section. Aim: To map attitudes and knowledge of maternity care professionals regarding indications for planned birth, and assess inter-professional (midwifery versus medical) and intra-professional variation. Methods: A custom-created survey of medical and midwifery staff at eight Sydney hospitals. Staff were asked to rate their level of agreement with 45 "evidence-based" statements regarding caesareans and inductions on a five-point Likert scale. Responses were grouped by profession, and comparisons made of inter- and intra-professional responses. Findings: Total 275 respondents, 78% midwifery and 21% medical. Considerable inter- and intra-professional variation was noted, with midwives generally less likely to consider any of the planned birth indications "valid" compared to medical staff. Indications for induction with most variation in midwifery responses included maternal characteristics (age≥40, obesity, ethnicity) and fetal macrosomia; and for medical personnel in-vitro fertilisation, maternal request, and routine induction at 39 weeks gestation. Indications for caesarean with most variation in midwifery responses included previous lower segment caesarean section, previous shoulder dystocia, and uncomplicated breech; and for medical personnel uncomplicated dichorionic twins. Indications with most inter-professional variation were induction at 41+ weeks versus 42+ weeks and cesarean for previous lower segment caesarean section. Discussion: Both inter- and intra-professional variation in what were considered valid indications reflected inconsistency in underlying evidence and/or guidelines. Conclusion: Greater focus on interdisciplinary education and consensus, as well as on shared decision-making with women, may be helpful in resolving these tensions.
Coates, D, Homer, C, Wilson, A, Deady, L, Mason, E, Foureur, M & Henry, A 2020, 'Indications for, and timing of, planned caesarean section: A systematic analysis of clinical guidelines.', Women and Birth, vol. 33, no. 1, pp. 22-34.View/Download from: Publisher's site
BACKGROUND:There has been a worldwide rise in planned caesarean sections over recent decades, with significant variations in practice between hospitals and countries. Guidelines are known to influence clinical decision-making and, potentially, unwarranted clinical variation. The aim of this study was to review guidelines for recommendations in relation to the timing and indications for planned caesarean section as well as recommendations around the process of decision-making. METHOD:A systematic search of national and international English-language guidelines published between 2008 and 2018 was undertaken. Guidelines were reviewed, assessed in terms of quality and extracted independently by two reviewers. FINDINGS:In total, 49 guidelines of varying quality were included. There was consistency between the guidelines in potential indications for caesarean section, although guidelines vary in terms of the level of detail. There was substantial variation in timing of birth, for example recommended timing of caesarean section for women with uncomplicated placenta praevia is between 36 and 39weeks depending on the guideline. Only 11 guidelines provided detailed guidance on shared decision-making. In general, national-level guidelines from Australia, and overseas, received higher quality ratings than regional guidelines. CONCLUSION:The majority of guidelines, regardless of their quality, provide very limited information to guide shared decision-making or the timing of planned caesarean section, two of the most vital aspects of guidance. National guidelines were generally of better quality than regional ones, suggesting these should be used as a template where possible and emphasis placed on improving national guidelines and minimising intra-country, regional, variability of guidelines.
Coates, D, Homer, C, Wilson, A, Deady, L, Mason, E, Foureur, M & Henry, A 2020, 'Induction of labour indications and timing: A systematic analysis of clinical guidelines.', Women and birth : journal of the Australian College of Midwives, vol. 33, no. 3, pp. 219-230.View/Download from: Publisher's site
BACKGROUND:There is widespread and some unexplained variation in induction of labour rates between hospitals. Some practice variation may stem from variability in clinical guidelines. This review aimed to identify to what extent induction of labour guidelines provide consistent recommendations in relation to reasons for, and timing of, induction of labour and ascertain whether inconsistencies can be explained by variability guideline quality. METHOD:We conducted a systematic search of national and international English-language guidelines published between 2008 and 2018. General induction of labour guidelines and condition-specific guidelines containing induction of labour recommendations were searched. Guidelines were reviewed and extracted independently by two reviewers. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II Instrument. FINDINGS:Forty nine guidelines of varying quality were included. Indications where guidelines had mostly consistent advice included prolonged pregnancy (induction between 41 and 42 weeks), preterm premature rupture of membranes, and term preeclampsia (induction when preeclampsia diagnosed ≥37 weeks). Guidelines were also consistent in agreeing on decreased fetal movements and oligohydramnios as valid indications for induction, although timing recommendations were absent or inconsistent. Common indications where there was little consensus on validity and/or timing of induction included gestational diabetes, fetal macrosomia, elevated maternal body mass index, and twin pregnancy. CONCLUSION:Substantial variation in clinical practice guidelines for indications for induction exists. As guidelines rated of similar quality presented conflicting recommendations, guideline variability was not explained by guideline quality. Guideline variability may partly account for unexplained variation in induction of labour rates.
Coates, D & Clerke, T 2020, 'Training Interventions to Equip Health Care Professionals With Shared Decision-Making Skills: A Systematic Scoping Review', The Journal of continuing education in the health professions, vol. 40, no. 2, pp. 100-119.View/Download from: Publisher's site
INTRODUCTION: To support the development, implementation, and evaluation of shared decision-making (SDM) training programs, this article maps the relevant evidence in terms of training program design and content as well as evaluation outcomes. METHOD: A systematic scoping review methodology was used. To identify studies, the databases PubMed, Medline, and CINAHL were searched from 2009 to 2019, and reference lists of included studies were examined. After removal of duplicates, 1367 articles were screened for inclusion. To be included, studies were to be published in peer-reviewed journals, and should not merely be descriptive but report on evaluation outcomes. Articles were reviewed for inclusion by both authors, and data were extracted using a purposely designed data charting form implemented using REDCap. RESULTS: The review identified 49 studies evaluating 36 unique SDM training programs. There was considerable variation in terms of program design and duration. Most programs included an overview of SDM theories and key competencies, as well as SDM skill development through role plays. Few programs provided training in reflective practice, in identifying and working with patients' individually preferred decision-making style, or in relation to SDM in a context of medical uncertainty or ambiguity. Most programs were evaluated descriptively, mostly using mixed methods, and there were 18 randomized controlled trials, showing that training was feasible, well received, and improved participants' knowledge and skills, but was limited in its impact on patients. DISCUSSION: Although there is limited capacity to comment on which types of training programs are most effective, overall training was feasible, well received, and improved participants' knowledge and skills.
Coates, D & Mickan, S 2020, 'The embedded researcher model in Australian healthcare settings: comparison by degree of "embeddedness".', Translational research : the journal of laboratory and clinical medicine, vol. 218, pp. 29-42.View/Download from: Publisher's site
The embedded researcher model is a health-academic partnership where researchers are core members of a healthcare organization, with an aim to support evidence translation. The purpose of this study was to describe the characteristics and experiences of embedded researchers in Australian healthcare settings, and investigate how the model is experienced differently based on the level of "embeddedness." This exploratory study utilized a purpose-designed online survey. Responses were described using Word and Excel and analyzed using SPSS. To investigate how the model was experienced based on the level of "embeddedness," we tested for differences in responses between respondents with primary academic vs healthcare affiliations. A total of 104 embedded researchers from nursing and midwifery, allied health and medicine completed the survey, with equal numbers reporting a primary academic vs primary healthcare affiliation. Most indicated that research is a strategic objective of the healthcare organization (85.9%) yet almost a third (31%) reported that research outputs were not measured. While 60% agreed that clinical practice informed by research was valued, only 28% reported having adequate resources. Of those with a formal dual affiliation over a quarter reported conflict between expectations of the healthcare and academic organizations. Respondents with a primary academic affiliation were older, more qualified, had more research experience, had been in the role longer, and had more positive perceptions of the research culture of healthcare organizations. This study provides a starting point for healthcare organizations and academic institutions to partner in the further development and implementation of this model.
Coates, D, Coppleson, D & Schmied, V 2020, 'Integrated physical and mental healthcare: an overview of models and their evaluation findings.', International journal of evidence-based healthcare, vol. 18, no. 1, pp. 38-57.View/Download from: Publisher's site
BACKGROUND:Comorbid physical and mental health problems are common across the age spectrum. However, services addressing these health concerns are typically siloed and disconnected. Over the past 2 decades efforts have been made to design integrated services to address the physical and mental health needs of the population but little is known about the characteristics of effective integrated care models. The aim of the review was to map the design of integrated care initiatives/models and to describe how the models were evaluated and their evaluation findings. METHOD:Using a scoping review methodology, quantitative and qualitative evidence was systematically considered. To identify studies, Medline, PubMed, PsychINFO, CINAHL were searched for the period from 2003 to 2018, and reference lists of included studies and review articles were examined. RESULTS:The current review identified 43 studies, describing 37 models of integrated physical and mental healthcare. Although modest in terms of evaluation design, it is evident that models are well received by consumers and providers, increase service access, and improve physical and mental health outcomes. Key characteristics of models include shared information technology, financial integration, a single-entry point, colocated care, multidisciplinary teams, multidisciplinary meetings, care coordination, joint treatment plan, joint treatment, joint assessment/joint assessment document, agreed referral criteria and person-centred care. Although mostly modest in term of research design, models were well received by consumers and providers, increased service access and improved physical and mental health outcomes. There was no clear evidence regarding whether models of integrated care are cost neutral, increase or reduce costs. CONCLUSION:Future research is needed to identify the elements of integrated care that are associated with outcomes, measure cost implications and identify the experiences and priorities of consumers...
Coates, D, Donnolley, N, Thirukumar, P, Lainchbury, A, Spear, V & Henry, A 2020, 'Women's experiences of decision-making and beliefs in relation to planned caesarean section: A survey study', Australian and New Zealand Journal of Obstetrics and Gynaecology.View/Download from: Publisher's site
© 2020 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Background: The caesarean section (CS) rate is over 25% in many high-income countries, with a substantial minority of CSs occurring in women with low-risk pregnancies. CS decision-making is influenced by clinician and patient beliefs and preferences, and clinical guidelines increasingly stipulate the importance of shared decision-making (SDM). To what extent SDM occurs in practice is unclear. Aims: To identify women's birth preferences and SDM experience regarding planned CS. Material and Methods: Survey of women at eight Sydney hospitals booked for planned CS. Demographic data, initial mode of birth preferences, reason for CS, and experiences of SDM were elicited using questions with multiple choice lists, Likert scales, and open-ended responses. Quantitative data were analysed using descriptive statistics and qualitative data using content analysis. Responses of women who perceived their CS as 'requested' vs 'recommended' were compared. Results: Of 151 respondents, repeat CS (48%) and breech presentation (14%) were the most common indications. Only 32% stated that at the beginning of pregnancy they had a definite preference for spontaneous labour and birth. Key reasons for wanting planned CS were to avoid another emergency CS, prior positive CS experience, and logistical planning. Although 15% of women felt pressured (or were unsure) about their CS decision, the majority reported positive experiences, with over 90% indicating they were informed about CS benefits and risks, had adequate information, and understood information provided. Conclusions: The majority (85%) of women appeared satisfied with the decision-making process, regardless of whether they perceived their CS as requested or recommended.
© 2019 Australian College of Midwives Background: There has been a rise in induction of labour over recent decades. There is some tension in the literature in relation to when induction is warranted and when not, with variability between guidelines and practice. Given these tensions, the importance of shared decision-making between clinicians and women is increasingly highlighted as paramount, but it remains unclear to what extent this occurs in routine care. Method: Using a scoping review methodology, quantitative and qualitative evidence were considered to answer the research question "What are the views, preferences and experiences of women and clinicians in relation to induction of labour more broadly, and practices of decision-making specifically?" To identify studies, the databases PubMed, Maternity and Infant Care, CINAHL and EMBASE were searched from 2008 to 2018, and reference lists of included studies were examined. Findings: 20 papers met inclusion criteria, in relation to (a) women's preferences, experiences and satisfaction with IOL; (b) women's experience of shared-decision making in relation to induction; (c) interventions that improve shared decision-making and (d) factors that influence decision-making from the perspective of clinicians. Synthesis of the included studies indicates that decision-making in relation to induction of labour is largely informed by medical considerations. Women are not routinely engaged in the decision making process with expectations and preferences largely unmet. Conclusion: There is a need to develop strategies such as decision aids, the redesign of antenatal classes, and clinician communication training to improve the quality of information available to women and their capacity for informed decision-making.
Coates, D, Makris, A, Catling, C, Henry, A, Scarf, V, Watts, N, Fox, D, Thirukumar, P, Wong, V, Russell, H & Homer, C 2020, 'A systematic scoping review of clinical indications for induction of labour.', PloS one, vol. 15, no. 1.View/Download from: Publisher's site
BACKGROUND:The proportion of women undergoing induction of labour (IOL) has risen in recent decades, with significant variation within countries and between hospitals. The aim of this study was to review research supporting indications for IOL and determine which indications are supported by evidence and where knowledge gaps exist. METHODS:A systematic scoping review of quantitative studies of common indications for IOL. For each indication, we included systematic reviews/meta-analyses, randomised controlled trials (RCTs), cohort studies and case control studies that compared maternal and neonatal outcomes for different modes or timing of birth. Studies were identified via the databases PubMed, Maternity and Infant Care, CINAHL, EMBASE, and ClinicalTrials.gov from between April 2008 and November 2019, and also from reference lists of included studies. We identified 2554 abstracts and reviewed 300 full text articles. The quality of included studies was assessed using the RoB 2.0, the ROBINS-I and the ROBIN tool. RESULTS:68 studies were included which related to post-term pregnancy (15), hypertension/pre-eclampsia (15), diabetes (9), prelabour rupture of membranes (5), twin pregnancy (5), suspected fetal compromise (4), maternal elevated body mass index (BMI) (4), intrahepatic cholestasis of pregnancy (3), suspected macrosomia (3), fetal gastroschisis (2), maternal age (2), and maternal cardiac disease (1). Available evidence supports IOL for women with post-term pregnancy, although the evidence is weak regarding the timing (41 versus 42 weeks), and for women with hypertension/preeclampsia in terms of improved maternal outcomes. For women with preterm premature rupture of membranes (24-37 weeks), high-quality evidence supports expectant management rather than IOL/early birth. Evidence is weakly supportive for IOL in women with term rupture of membranes. For all other indications, there were conflicting findings and/or insufficient power to provide definitive eviden...
Coates, D, Thirukumar, P & Henry, A 2020, 'Making shared decisions in relation to planned caesarean sections: What are we up to?', Patient education and counseling, vol. 103, no. 6, pp. 1176-1190.View/Download from: Publisher's site
OBJECTIVE:To map the literature in relation to shared decision making (SDM) for planned caesarean section (CS), particularly women's experiences in receiving the information they need to make informed decisions, their knowledge of the risks and benefits of CS, the experiences and attitudes of clinicians in relation to SDM, and interventions that support women to make informed decisions. METHODS:Using a scoping review methodology, quantitative and qualitative evidence was systematically considered. To identify studies, PubMed, Maternity and Infant Care, MEDLINE, and Web of Science were searched for the period from 2008 to 2018. RESULTS:34 studies were included, with 9750 women and 3313 clinicians. Overall women reported limited SDM, and many did not have the information required to make informed decisions. Clinicians generally agreed with SDM, while recognising it often does not occur. Decision aids and educational interventions were viewed positively by women. CONCLUSION:Many women were not actively involved in decision-making. Decision aids show promise as a SDM-enhancing tool. Studies that included clinicians suggest uncertainty regarding SDM, although willingness to engage. PRACTICE IMPLICATIONS:Moving from clinician-led decision-making to SDM for CS has potential to improve patient experiences, however this will require considerable clinician training, and implementation of SDM interventions.
BACKGROUND:With around one third of woman having a cesarean birth, better understanding of women's experiences of having a cesarean is vital to improve women's experiences of care. The aim of this review was to gain insight into women's experiences of and satisfaction with cesarean and to identify factors that contribute to women's poor experiences of care. METHODS:Using an integrative methodology, evidence was systematically considered in relation to women's experiences of cesarean birth and whether they were satisfied with their experience of care. To identify studies, PubMed, Maternity and Infant Care, MEDLINE, and Web of Science were searched for the period from 2008 to 2018, and reference lists of included studies were examined. RESULTS:Twenty-six studies were included. Although the majority of women were satisfied with their cesarean, a large minority of women were dissatisfied and reported a negative experience. In particular, women who had an emergency cesarean were less satisfied than women who had a vaginal birth. Nonmedical factors or experiences that appear associated with dissatisfaction include (a) feeling ignored and disempowered; (b) experiencing a loss of control; (c) not being informed; and (d) birth values that favor vaginal birth. CONCLUSIONS:Women's experiences of cesarean birth appear influenced by the circumstances (emergency vs planned), the extent to which they felt involved in decision-making and in control of their experience, and their birth values and beliefs. Increasing antenatal, intrapartum, and postpartum communication and shared decision-making may help engage women as an active participant in their own birth.
Coates, D, Thirukumar, P, Spear, V, Brown, G & Henry, A 2020, 'What are women's mode of birth preferences and why? A systematic scoping review.', Women and Birth, vol. 33, no. 4, pp. 323-333.View/Download from: Publisher's site
BACKGROUND:The optimal caesarean section rate is estimated to be between 10-15%; however, it is much higher in high and many middle-income countries and continues to be lower in some middle and low-income countries. While a range of factors influence caesarean section rates, women's mode of birth preferences also play a role. The aim of this study was to map the literature in relation to women's mode of birth preferences, and identify underlying reasons for, and factors associated with, these preferences. METHOD:Using a scoping review methodology, quantitative and qualitative evidence was systematically considered. To identify studies, PubMed, Maternity and Infant Care, MEDLINE, and Web of Science were searched for the period from 2008 to 2018, and reference lists of included studies were examined. FINDINGS:A total of 65 studies were included. While the majority of women prefer a vaginal birth, between 5-20% in high-income countries and 1.4 to 50% in low-middle-income countries prefer a caesarean section. The six main reasons or factors associated with a mode of birth preference were: (1) perceptions of safety; (2) fear of pain; (3) previous birth experience; (4) encouragement and dissuasion from health professionals; (5) social and cultural influences; and (6) access to information and educational levels. CONCLUSION:To help ensure women receive the required care that is aligned with their preferences, processes of shared decision-making should be implemented. Shared decision-making has the potential to reduce the rate of unnecessary interventions, and also improve the willingness of women to accept a medically-indicated caesarean section in low-income countries.
Rogers, HJ, Hogan, L, Coates, D, Homer, CSE & Henry, A 2020, 'Responding to the health needs of women from migrant and refugee backgrounds-Models of maternity and postpartum care in high-income countries: A systematic scoping review.', Health & social care in the community, vol. 28, no. 5, pp. 1343-1365.View/Download from: Publisher's site
Pregnant women from migrant and refugee backgrounds living in high-income countries (HIC) are at increased risk of adverse perinatal outcomes compared with women born in the host country. Women from migrant and refugee background have perinatal healthcare needs that are recognised internationally as a public health priority. The aim of this study was to identify, appraise and synthesise available evidence on the effectiveness of models of care in pregnancy or first 12 months postpartum for women from migrant and refugee backgrounds living in HIC. Care models were mapped in terms of (a) effectiveness at improving service access, (b) effectiveness at improving maternal and infant health outcomes, (c) acceptability and appropriateness from the perspective of women and (d) acceptability and appropriateness from the perspective of service providers. Using systematic scoping review methodology, qualitative, quantitative, and mixed methods research published in English 2008-2019 were included. The databases MEDLINE, Embase, Emcare, PubMed, Scopus, CINAHL, PsycINFO, Web of Science, Google Scholar, Cochrane Database of Systematic Reviews and Joanna Briggs Institute were searched between 27 February 2019 and updated 27 December 2019. Qualitative and quantitative data were analysed narratively. Seventeen studies, involving 1,499 women and 203 service providers, were included. A diverse range of interventions were identified, including bilingual/bicultural workers, group antenatal care and specialised clinics. All identified interventions were acceptable to women, and improved access, however, few provided evidence of improved perinatal outcomes. Gaps identified for future research include the use of qualitative and quantitative approaches to ascertain the experiences of women, their families, service providers and impact on perinatal outcomes. Synthesis of the included studies indicates the key elements of acceptable and accessible models, which were as follows: culturally ...
Simmons, MB, Grace, D, Fava, NJ, Coates, D, Dimopoulos-Bick, T, Batchelor, S, Howe, D & Montague, AE 2020, 'The Experiences of Youth Mental Health Peer Workers over Time: A Qualitative Study with Longitudinal Analysis.', Community mental health journal, vol. 56, no. 5, pp. 906-914.View/Download from: Publisher's site
Peer work is a rapidly growing part of the mental health workforce, yet few studies explore the implementation of peer work in youth mental health. Qualitative focus groups were conducted with eight youth peer workers at the commencement of their employment, then at 3-months and 6-months after this time. Data were transcribed verbatim and analysed using thematic and trajectory analysis. The three main findings included: (1) there was a trajectory from fear to hope; (2) there was an improved understanding of benefits and role definition over time; and (3) there was an evolving concept of understanding shared experiences as a primary asset. Known barriers to implementing peer work are likely to occur in youth mental health settings as well. Ensuring that adequate training, change management and tailored support strategies are important to maximise the chances of successful youth peer work programs.
Thirukumar, P, Coates, D & Henry, A 2020, 'Women's experiences of intrapartum care and recovery in relation to planned caesarean sections: An interview study', Women and Birth.View/Download from: Publisher's site
© 2020 Australian College of Midwives Problem and background: Approximately one third of women in high-income countries give birth by caesarean section (CS). Better understanding of women's CS experiences is vital in identifying opportunities to improve women's experience of care. Aim: To identify opportunities for service improvement by investigating Australian women's experiences of care and recovery when undergoing a planned CS. Methods: Qualitative telephone interview study with 33 women who had a planned CS at one of eight Australian hospitals. Semi-structured interviews were conducted to elicit women's perspectives, experiences and beliefs surrounding their planned CS. Interviews were transcribed verbatim and analysed inductively using NVivo-12. Results: Women's experiences of CS care were mixed. Regarding intrapartum care, many women stated their planned CS was a positive experience compared to a previous emergency CS, but was scarier and more medicalised compared to vaginal birth. CS recovery was viewed more negatively, with women feeling unprepared. They reported disliking how CS recovery restricted their role as a mother, wanting more time in hospital, and greater support and continuity of care. Discussion: Women reported largely positive intrapartum experiences of planned CS but relatively negative experiences of CS recovery. They wished for time in hospital and support from staff during recovery, and continuity of care. Conclusion: By incorporating shared decision-making antenatally, clinicians can discuss women's birth expectations with them and better prepare them for their planned CS and recovery.
Coates, D & Foureur, M 2019, 'The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review.', Health & social care in the community, vol. 27, no. 4, pp. e389-e405.View/Download from: Publisher's site
Perinatal mental health problems are linked to poor outcomes for mothers, babies and families. Despite a recognition of the significance of this issue, women often do not receive the care they need and fall between the gap of maternity and mental health services. To address this, there is a call for reform in the way in which perinatal mental healthcare is delivered. This paper responds to this by exploring the role and competence of midwives in delivering mental healthcare. Using a scoping review methodology, quantitative and qualitative evidence were considered to answer the research question 'what is the nature of the evidence relevant to the provision of mental health interventions by midwives?' To identify studies, the databases PubMed, Maternity and Infant Care, Science Citation Index, Social Sciences Citation Index, Medline, Science Direct and CINAHL were searched from 2011 to 2018, and reference lists of included studies were examined. Studies relevant to the role of midwives in the management and treatment of perinatal mental health issues were included; studies focussed on screening and referral were excluded. Thirty papers met inclusion criteria, including studies about the knowledge, skills, and attitudes of midwives and student midwives; the effectiveness of educational interventions in improving knowledge and skills; the delivery of counselling or psychosocial interventions by midwives; and barriers and enablers to embedding midwife-led mental healthcare in practice. Synthesis of the included studies indicates that midwives are interested in providing mental health support, but lack the confidence, knowledge and training to do so. This deficit can be addressed with appropriate training and organisational support, and there is some evidence that midwife-led counselling interventions are effective. Further research is needed to test midwife-led interventions for women with perinatal mental health problems , and to develop and evaluate models of integr...
Chivaurah, BM, Lienert, D & Coates, D 2019, 'Amphetamine-type-substance-related presentations to the Emergency Department Mental Health Team of a local health district in Australia.', Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists, vol. 27, no. 4, pp. 369-373.View/Download from: Publisher's site
OBJECTIVES:To identify the prevalence and profile of amphetamine-type-substance-related presentations to the Emergency Department Mental Health Team of a local health district in Australia. METHODS:Data was collected from medical records of all amphetamine-type-substance presentations to the Emergency Department Mental Health Team over a 1-year period, between 1 January 2015 and 31 December 2015. RESULTS:Of all presentations referred to the Emergency Department Mental Health Team, 0.15% ( N = 189) were amphetamine-type-substance related. Of these, the majority were male, the average age was 32, 19.0% engaged in intravenous drug use, some were aggressive and 15.9% required tranquilisation. The most common presenting issues were psychosis and suicidal threats, intent and behaviour (including intentional overdose). Multiple comorbid conditions were identified. On discharge, 34.4% were admitted into a psychiatric hospital and 32.8% were referred to Community Mental health teams. CONCLUSIONS:Amphetamine-type-substance users suffer from multiple comorbidities and pose a significant burden on emergency services.
Coates, D, David, M, Roberts, B & Duerden, D 2019, 'An examination of the profile and journey of patients with mental illness in the emergency department', International Emergency Nursing, vol. 43, pp. 15-22.View/Download from: Publisher's site
© 2018 Objective: To examine the profile and journey of patients with mental illness in the emergency departments (ED) of a Local Health District in Australia. There is limited evidence around the patient profile and journey of people in who present to EDs with mental illness, and the aim of this study was to inform the development of a psychiatric emergency service model. Methods: The study design was a retrospective descriptive analysis of routinely collected data of two hospital EDs. Retrospective health care data of patients who presented to the EDs between July 2016 and June 2017 was analysed using descriptive and inferential statistics. Results: Mental health presentations (N = 4506) consisted of 3.44% of all presentations to the Emergency Department, mostly for anxiety and stress, comorbid alcohol and drug issues, and suicidality. Females were more likely to present, and significantly more likely to present multiple times (specifically for age groups 12–17 and over 65). Presenting issues were associated with age and gender for most diagnostic groups, but not with number of presentations, except for personality disorder. 24.83% were admitted to a mental health inpatient unit, 54.34% were referred to a mental health community team, 4.63% medically, and the remaining referred to alcohol and drug services, GPs, or NGOs. Length of stay was associated with gender (female), age (>65) and diagnosis (drug related and eating disorder). Conclusion: There is limited evidence around the patient profile and journey of people who present to EDs for mental health reasons, and this study contributes to this literature.
Coates, D, Saleeba, C & Howe, D 2019, 'Mental Health Attitudes and Beliefs in a Community Sample on the Central Coast in Australia: Barriers to Help Seeking.', Community mental health journal, vol. 55, no. 3, pp. 476-486.View/Download from: Publisher's site
There continues to be call for greater community awareness actions and strategies to reduce stigma and enhance mental health literacy nationally and internationally. To identify local barriers to help-seeking and perceptions around stigma, we developed a 'mental health attitudes and beliefs' survey which was administered at a range of community events on the Central Coast in New South Wales, Australia. The aim was for the results of this survey to inform the development of strategies that enhance local help-seeking behaviours that are sensitive to the role of age, gender and Indigenous status. People who approached our Mental Health Information stall were invited to complete the survey and 282 individuals completed the survey. The data was analysed descriptively with a focus on comparing subgroups based on age, gender, Indigenous status, and previous service access or experience of mental illness. Cost, stigma and mental health literacy were found to be prominent barriers to help-seeking for the overall cohort; however, the ways in which or extent to which these barriers impact on help seeking varied between subgroups. A discussion of these differences and their implications for practice is the focus of this paper.
Coates, D, Wright, L, Moore, T, Pinnell, S, Merillo, C & Howe, D 2019, 'The psychiatric, psychosocial and physical health profile of young people with early psychosis: Data from an early psychosis intervention service', Child and Youth Services, vol. 40, no. 1, pp. 93-115.View/Download from: Publisher's site
© 2019, © 2019 Crown Copyright in the Commonwealth of Australia [Central Coast Local Health District]. This article outlines client and service data from an early psychosis service in New South Wales (NSW), Australia, and presents a client and service profile, with a focus on the psychiatric, psychosocial, and physical health profile of young people with early psychosis. Implications for practice are discussed. Client and service data were captured through a range of processes and comprise a number of different datasets, specifically client demographical information and service data as routinely collected (N = 601), psychosocial data collected through a file audit (N = 33), and client physical health data maintained by the physical health nurse (N = 39). The service researcher extracted all data from each of the databases and analyzed the data descriptively for client and service profile information. The client profile data indicate early psychosis clients present with a range of psychiatric, psychosocial, and physical health vulnerabilities. The data presented support the need for mental health care to be provided in conjunction with primary health care, vocational and employment support, exercise and dietary interventions, and support with substance use. Furthermore, this article highlights the importance of family inclusive practice and trauma-informed care in early psychosis services. The findings support calls for services to be integrated and young people to be responded to holistically through the integration of psychological, psychosocial, and physical health care.
Coates, D 2018, 'Service Models for Urgent and Emergency Psychiatric Care: An Overview', Journal of Psychosocial Nursing and Mental Health Services, vol. 56, no. 8, pp. 23-30.View/Download from: Publisher's site
There is variation in the way mental health services respond to urgent and emergency presentations, with few evidence-based models reported in the literature, and no agreed on best practice models. To inform the development of urgent and emergency psychiatric care models, a literature review was performed. The review sought to identify strengths and critiques of varying models, evidence gaps, and areas for future research. After review, significant variation was found in the design and scope of urgent and emergency care models. Most models are either community or hospital based, with few integrated models that span community and hospital care. The development of integrated models has the potential to reduce service duplication and support a shift toward provision of least restrictive care. The overall evidence base of urgent and emergency care models is limited, with few studies in the area, and there is a need for further research
Coates, D, Livermore, P & Green, R 2018, 'The development and implementation of a peer support model for a specialist mental health service for older people: lessons learned', Mental Health Review Journal, vol. 23, no. 2, pp. 73-85.View/Download from: Publisher's site
There has been a significant growth in the employment of peer workers over the past decade in youth and adult mental health settings. Peer work in mental health services for older people is less developed, and there are no existing peer work models for specialist mental health services for older people in Australia. The authors developed and implemented a peer work model for older consumers and carers of a specialist mental health service. The purpose of this paper is to describe the model, outline the implementation barriers experienced and lesson learned and comment on the acceptability of the model from the perspective of stakeholders.
To ensure the development of the peer work model met the needs of key stakeholders, the authors adopted an evaluation process that occurred alongside the development of the model, informed by action research principles. To identify stakeholder preferences, implementation barriers and potential solutions, and gain insight into the acceptability and perceived effectiveness of the model, a range of methods were used, including focus groups with the peer workers, clinicians and steering committee, consumer and carer surveys, field notes and examination of project documentation.
While the model was overall well received by stakeholders, the authors experienced a range of challenges and implementation barriers, in particular around governance, integrating the model into existing systems, and initial resistance to peer work from clinical staff.
Older peer workers provide a valuable contribution to the mental health sector through the unique combination of lived experience and ageing. The authors recommend that models of care are developed prior to implementation so that there is clarity around governance, management, reporting lines and management of confidentiality issues.
Coates, D, Livermore, P & Green, R 2018, 'The unique contribution of older people with a lived experience of mental illness to the peer workforce: observations from older peer workers', European Journal for Person Centered Healthcare, vol. 6, no. 1, pp. 78-87.View/Download from: Publisher's site
Coates, D, Saleeba, C & Howe, D 2018, 'Profile of consumers and their partners of a perinatal and infant mental health (PIMH) service in Australia.', Health & social care in the community, vol. 26, no. 1, pp. e154-e163.View/Download from: Publisher's site
The perinatal period is a time of great vulnerability for many women, in particular those with a range of psychosocial vulnerabilities and mental health risk factors. This paper outlines the psychosocial and mental health profile of consumers and their partners of a perinatal and infant mental health (PIMH) service in Australia. To establish the consumer profile, we analysed client vulnerabilities and demographical information maintained over a 6-year period for 406 consumers. Consumer information, including mental health problems, psychosocial vulnerabilities and demographical information, was entered into a standalone database by the allocated clinicians upon service allocation and throughout treatment. The women accepted by PIMH presented with an average of nine different vulnerabilities. Frequently endorsed risk factors included depression (72.66%), anxiety (71.43%), comorbid depression and anxiety (58.13%), self-harm (past, 7.88%, present, 16.26%), a history of family mental health issues (39.66%), childhood trauma (57.88%), limited support (68.84%), relationship conflict with partners (38.92%) and financial stress (47.29%). The women's partners also presented with a range of vulnerabilities, in particular childhood trauma (34.11%) and mental health issues (30.81%). This study contributes to our understanding of the profile of vulnerable women in the perinatal period, and in particular contributes to the literature by highlighting that in addition to depression, anxiety, self-harm and trauma are also significant in PIMH service delivery.
Coates, D, Woodford, P, Higgins, O & Grover, D 2018, 'Evaluation of a general practitioner-led cardiometabolic clinic: Physical health profile and treatment outcomes for clients on clozapine.', International journal of mental health nursing, vol. 27, no. 1, pp. 303-310.View/Download from: Publisher's site
The present study is a review of a cardiometabolic clinic for consumers taking clozapine. This clinic was recently established and co-located with the clozapine clinic at a regional hospital in New South Wales, Australia, to enhance engagement and improve the physical health outcomes of consumers taking antipsychotic medication. A descriptive analysis of clients' (n = 73) information collected during routine care for the first 6 months of the clinic's operation, from January 2016 to July 2016, was conducted. First-visit data were analysed to establish a client profile, consisting of weight, height, blood pressure, pulse, a range of blood measurements, smoking status, alcohol consumption, and eating and exercise habits. Data collected for clients who had three or more visits with the general practitioner (n = 40) were analysed separately for outcomes. Two case studies are used to depict the service received and client profile. At the first appointment, the majority of clients had metabolic syndrome that was mostly left untreated; many of these clients were commenced on metformin. The outcomes are positive, and show that the majority of clients lost weight (82.5%) and had a reduction in body mass index (84.6%); nearly half (44.4%) had a reduction in waist circumference. The majority of clients self-reported increased physical activity (72.5%, n = 29) and positive dietary changes (77.5%, n = 31) since their first appointment. The model trialled by the cardiometabolic clinic integrated a specialist mental health and primary care service, and demonstrates success in engaging clients with severe mental illness in physical health care. Co-location is conceptualized as critical for positive patient outcomes and high levels of engagement.
Dharni, A & Coates, D 2018, 'Psychotropic medication profile in a community youth mental health service in Australia', Children and Youth Services Review, vol. 90, pp. 8-14.View/Download from: Publisher's site
There has been a rise in the use of psychotropic medication in young people, despite limited risk-benefit profile of psychotropic medication for this population. Given their side effect profile, the use of psychotropic medications should occur with caution. This study investigated psychotropic prescribing pattern in a public youth community mental health service and gives an estimate of general level of psychotropic medication use in this setting.
A retrospective file review was undertaken of all young people aged 12–17 who received care from the service in 2016 (N = 189) for a range of mental health problems, excluding psychosis. Files were reviewed for demographical information (age, gender), diagnosis/presenting issues, prescribed medications, indications of medications, and prescriber type (e.g. psychiatrist, general practitioners (GPs), paediatrician). The data was analysed descriptively.
Over 60% (60.8%, n = 115) of young people were prescribed psychotropic medications. Over half of the entire sample were on antidepressants (51.32%, n = 97), nearly a quarter (n = 46, 24%) on antipsychotics, 6% on ADHD medications (6.35%, n = 12), and a fifth (19.58%, n = 37) on polypharmacy. Antidepressants and antipsychotics were mostly used off-label, prescribed by public psychiatric staff. Quetiapine was the most prescribed antipsychotic predominantly for insomnia. Fluoxetine and fluvoxamine were the most prescribed antidepressants predominantly for anxiety disorders. Girls are more likely to be prescribed psychotropic medications than boys, specifically antipsychotic medication.
A high proportion of young people were prescribed psychotropic medication, including antipsychotic medication, mostly for the treatment of anxiety and depressive disorders. There is little evidence around how psychotropic medication is used in youth mental health settings, and this study contributes to this gap.
Simmons, MB, Coates, D, Batchelor, S, Dimopoulos-Bick, T & Howe, D 2018, 'The CHOICE pilot project: Challenges of implementing a combined peer work and shared decision-making programme in an early intervention service.', Early Intervention in Psychiatry, vol. 12, no. 5, pp. 964-971.View/Download from: Publisher's site
Youth participation is central to early intervention policy and quality frameworks. There is good evidence for peer support (individuals with lived experience helping other consumers) and shared decision making (involving consumers in making decisions about their own care) in adult settings. However, youth programs are rarely tested or described in detail. This report aims to fill this gap by describing a consumer focused intervention in an early intervention service.This paper describes the development process, intervention content and implementation challenges of the Choices about Healthcare Options Informed by Client Experiences and Expectations (CHOICE) Pilot Project. This highly novel and innovative project combined both youth peer work and youth shared decision making.Eight peer workers were employed to deliver an online shared decision-making tool at a youth mental health service in New South Wales, Australia. The intervention development involved best practice principles, including international standards and elements of co-design. The implementation of the peer workforce in the service involved a number of targeted strategies designed to support this new service model. However, several implementation challenges were experienced which resulted in critical learning about how best to deliver these types of interventions.Delivering peer work and shared decision making within an early intervention service is feasible, but not without challenges. Providing adequate detail about interventions and implementation strategies fills a critical gap in the literature. Understanding optimal youth involvement strategies assists others to deliver acceptable and effective services to young people who experience mental ill health.
Coates, D 2017, 'Working with families with parental mental health and/or drug and alcohol issues where there are child protection concerns: inter-agency collaboration', Child and Family Social Work, vol. 22, no. S4, pp. 1-10.View/Download from: Publisher's site
© 2015 Commonwealth of Australia. Child and Family Social Work © 2015 John Wiley & Sons Ltd Child abuse commonly occurs within the context of multiple risk factors, in particular parental mental health and/or drug and alcohol problems. As no one agency can address all these factors, inter-agency collaboration is paramount to the protection of vulnerable children, especially in families with a complex array of problems. This paper outlines a range of recommendations to improve collaboration between child protection workers and mental health/drug & alcohol (MH/D & A) clinicians from the perspective of Keep Them Safe-Whole Family Team (KTS-WFT) clinicians. Taking referrals from child protection, the KTS-WFT offers interventions to families with parental MH/D & A problems where there are child protection concerns. As part of a larger evaluation of a KTS-WFT site, 10 KTS-WFT clinicians participated in in-depth interviews. Analysis of the interviews identified collaboration with child protection as a primary theme. Participants reported a number of barriers to effective collaboration; in particular, participants reported challenges with information sharing and confidentiality, inconsistency in terms of the level and style of collaboration, tensions between the different theoretical paradigms that underpin practice for MH/D & A clinicians vs. child protection workers, and insufficient clarity around processes and expectations. Consistent with the identified barriers, primary recommendations to improve collaboration were to improve information sharing, overcome silo ways of thinking, manage risk together more consistently, and develop consistent processes and expectations.
Coates, D & Howe, D 2017, 'Improving throughput in a youth mental health service.', International Journal of Health Care Quality Assurance, vol. 30, no. 3, pp. 224-234.View/Download from: Publisher's site
Purpose The discrepancy between increasing demand and limited resources in public mental health is putting pressure on services to continuously review their practices and develop innovative models of care that redress this discrepancy. To ensure the service models continue to meet the needs of all stakeholders, children and young people's mental health (CYPMH) conducts regular reviews of its service models. Accordingly, the youth mental health (YMH) model at CYPMH has evolved significantly over time in response to the needs of young people and service demand. The purpose of this paper is to outline the findings of a recent review of the YMH service, and the subsequent changes to the service model. Design/methodology/approach Informed by a participatory action philosophy, feedback was sought from staff on the service model through a range of methods including a questionnaire, staff consultations through a working party and interviews. This feedback was used to redesign the model, which was then evaluated again. Findings Staff identified a number of challenges with the service model and a range of service improvement solutions. The key issues included exceedingly high caseloads, workplace tensions, and fragmentation of the client journey. This paper outlines the primary solution to these key concerns, namely, the introduction of brief intervention (BI) as the entry point to the service. Originality/value BI approaches provide a solution to overly high caseloads as the direct and focussed approach of BI generally reduces the number of sessions people need. BI is an important addition to other treatment options and should be seen as a valid component of the continuum of mental healthcare.
Coates, D, Davis, E & Campbell, L 2017, 'The experiences of women who have accessed a perinatal and infant mental health service: a qualitative investigation', Advances in Mental Health, vol. 15, no. 1, pp. 88-100.View/Download from: Publisher's site
Coates, D, Phelan, R, Heap, J & Howe, D 2017, '"Being in a group with others who have mental illness makes all the difference": The views and experiences of parents who attended a mental health parenting program', Children and Youth Services Review, vol. 78, pp. 104-111.View/Download from: Publisher's site
© 2017 Background The relationship between parental mental illness and poor outcomes in children is well established. While parents with mental illness could benefit from accessing parenting programs, this population tends to be reluctant to do so. To address this need, we developed an adaptation of the Triple P program specific to people with mental illness, and this paper presents the views and experiences of parents who attended this program. The program is a ten week intervention consisting of a six week group parenting program, followed by four weekly home visits. Methodology This client satisfaction evaluation consists of 18 telephone interviews with program participants as well as feedback from the Triple P Client Satisfaction Questionnaire (CSQ) (N = 116). While this evaluation sought to gain participant feedback on the entire program, the focus was on gaining insight into the usefulness of a modified program specifically for this population, and how the unique components of this modified Triple P program are perceived by the participants. Results Both the qualitative and quantitative findings indicate high satisfaction with the program, and highlight the value of a parenting program designed specifically for parents with mental illness. In particular, participants stressed that the design of the program was essential to their satisfaction and engagement with the program. Analysis of the interview data identified a number of reasons why participants engaged with this particular parenting program and found it very useful, in particular: being in a group with others with mental illness; focus on child development and parenting with a mental illness; and the home visits. Conclusion This study adds to the limited evidence base specific to parent programs for parents who experience mental illness, and highlights the importance participants attach to sharing the group experience with other parents who also experience mental illness, and the significance of this...
Howe, D, Batchelor, S & Coates, DD 2017, 'Young Australians with moderate to severe mental health problems: client data and outcomes at Children and Young People's Mental Health.', Early Intervention in Psychiatry, vol. 11, no. 4, pp. 334-341.View/Download from: Publisher's site
Almost a quarter of young Australians experience a mental health issue that may become chronic if left untreated. Children and Young People's Mental Health (CYPMH) is a specialist tertiary service for young people with moderate to severe mental health problems on the Central Coast in Australia. This paper presents an overview of client data and service use collected over a 1 year period specific to the Youth Mental Health (YMH) component of the service.Client data, including demographic characteristics, service usage, presenting issues and standardized outcome measures, were analysed using SPSS. Clinicians routinely collect MH-OAT (Mental Health Outcomes and Assessment Tools) measures at different points in a client's episode of care, and each of these measures was analysed separately. Wilcoxon Z and a series of McNemar's tests were used to report on the difference between admission and discharge scores.During a designated 1 year period, 830 referrals to YMH were received. The most prevalent presenting issue was suicidal ideation followed by deliberate self-harm and depression. A comparison of admission and discharge outcome scores shows significant improvement by discharge on a range of measures. Specifically, analysis identified significant differences between admission and discharge HoNOSCA (Health of the Nation Outcomes Scales for Children and Adolescents) and CGAS (Children's Global Assessment Scale) scores for young people aged 12-17 and HONOS (Health of the Nation Outcomes Scale) scores for young people aged 18-24.The clinical outcomes for young people are positive with improvements seen on a range of measures.
Coates, D 2016, 'Client and parent feedback on a Youth Mental Health Service: The importance of family inclusive practice and working with client preferences.', International journal of mental health nursing, vol. 25, no. 6, pp. 526-535.View/Download from: Publisher's site
In mental health settings, feedback from clients and carers is central to service evaluation, development and delivery. Increasingly, client and carer feedback is considered an integral part of service planning, and recognized as a critical element of the provision of recovery oriented service. This paper outlines the findings of a qualitative evaluation of a Youth Mental Health (YMH) service from the perspective of discharged clients and their parents. The service researcher conducted telephone interviews with 39 parents of discharged clients, and 17 young people themselves. Participants reported positive or mixed experiences with the service. In addition to more generic positive statements about the service, analysis identified two key themes: the importance of 'family inclusive practice' and the importance of 'working with client preferences'. Young people and their parents want to be actively engaged in treatment and have their treatment preferences considered in treatment planning. Participants expressed the importance of "a good fit" between the client and the worker in terms of the clinician's gender, personality and treatment style/modality. While for some participants these themes were raised in the context of service strengths, others identified them as limitations or opportunities for service improvement. The extent to which clients and their parents felt engaged and heard by their allocated clinician is critical to their satisfaction or dissatisfaction with the service, depending on their unique experience. As an outcome of this evaluation, a range of service improvement strategies have been recommended.
Coates, D & Howe, D 2016, 'An evaluation of a service to keep children safe in families with mental health and/or substance abuse issues.', Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists, vol. 24, no. 5, pp. 483-488.View/Download from: Publisher's site
The objective of this study was to evaluate a specialised service designed to improve parenting capacity, child safety and family functioning in the context of parental mental health, drug and alcohol and child protection concerns.Client data was collected over a period of 3 years and 3 months, including demographic characteristics, service usage, presenting issues and pre and post revised North Carolina Family Assessment Scale (NCFAS-G) scores.A significant improvement between intake and discharge occurred on the majority of the 58 NCFAS-G subscale items (32/58). In particular, most significant change occurred in the domains 'family safety' (p < 0.001) and 'family interactions' (p < 0.001).Specialised programs can assist families with child safety concerns suffering from mental health and/or drug and alcohol problems.
Coates, D & Howe, D 2016, 'Integrating a youth participation model in a youth mental health service: Challenges and lessons learned', Child and Youth Services, vol. 37, no. 3, pp. 287-300.View/Download from: Publisher's site
© 2016 Crown copyright. Youth participation in mental health settings is fundamental to service design and delivery, and is beneficial for the young people involved as well as the organisation. This paper presents the findings of an evaluation of a youth participation model where tiered participation was attempted in a clinical youth mental health setting. To inform the ongoing development and improvement of a youth participation model, an evaluation was conducted consisting of three focus groups with the youth consultants, consultations with management about the implementation of the tiered participation model, and a review of records. The purpose of this evaluation was to identify possible barriers to implementation early on so these could be addressed and a youth participation model that meets the needs of all key stakeholders could be developed. The findings of this evaluation and the way in which these findings informed the model's development are discussed.
Coates, DD 2016, 'Life inside a deviant "religious" group: Conformity and commitment as ensured through 'brainwashing' or as the result of normal processes of socialisation', International Journal of Law, Crime and Justice, vol. 44, pp. 103-121.View/Download from: Publisher's site
© 2015 Elsevier Ltd. The 'dependency inducing practices', sometimes called 'brainwashing', that are commonly alleged to occur in deviant "religious" groups such as a cult movements or new religious movements are not well understood and have promoted considerable debate. There is a general agreement that many of these groups are controlled environments in which conformity to behavioural, emotive, cognitive and social expectations as determined by leadership is expected and enforced; however, whether conformity is the result of normal processes of socialisation or deviant practices such as brainwashing that cause harm continues to be disputed. To gain an increased understanding of the conformity and commitment inducing practices that occur in 'cult movements', the accounts of group life of 23 former members of 11 different groups were analysed. A conceptualisation of 'brainwashing' as on a continuum of social influence is proposed, and some legal implications are discussed.
Coates, D & Howe, D 2015, 'Combatting staff burnout in mental health: key managerial and leadership tasks that are fundamental to staff wellbeing and retention', Asia Pacific Journal of Health Management, vol. 10, pp. 24-32.
Coates, D & Howe, D 2015, 'Working with Families Who Experience Parental Mental Health and/or Drug and Alcohol Problems in the Context of Child Protection Concerns: Recommendations for Service Improvement', Australian and New Zealand Journal of Family Therapy, vol. 36, no. 3, pp. 325-341.View/Download from: Publisher's site
© 2015 Australian Association of Family Therapy. Child abuse and neglect often occur within the context of multiple risk factors, in particular parental mental health (MH) and/or drug and alcohol (D&A) problems. Interventions aimed at improving parental MH and D&A issues can have a positive impact on children now, as well as in the future. However, implementing sustainable service models that facilitate positive change for families with multiple risk factors is challenging. The purpose of the present study was to gain feedback from key stakeholders on a service model targeted at families where there are parental D&A, MH and child protection concerns to identify possible strengths and limitations of the model. This identified possible strategies for service improvement from the perspective of discharged clients and clinical staff. Gaining feedback from key stakeholders on service models is increasingly recognised as central to service evaluation and development. Ten interviews were conducted with clinical staff and twenty interviews with discharged clients of a pilot service that works with families where the child or children are at risk of significant harm in the context of parental MH and/or D&A issues. The interviews with clinicians highlighted difficulties working with this complex client group and its impact on staff burnout. Clinicians suggested how the model could be changed to better support clinical staff from burnout. Interviews with discharged clients highlighted the importance of the relationship with the worker in establishing client engagement and facilitating change. The way in which these recommendations informed the design of the service model is discussed.
Coates, DD & Howe, D 2015, 'The Design and Development of Staff Wellbeing Initiatives: Staff Stressors, Burnout and Emotional Exhaustion at Children and Young People's Mental Health in Australia.', Administration and policy in mental health, vol. 42, no. 6, pp. 655-663.View/Download from: Publisher's site
Mental health work presents problems for staff over and above those encountered in other organisations, including other areas of healthcare. Healthcare workers, in particular mental health workers, have poorer job satisfaction and higher job burnout and turnover compared with established norms for other occupational groups. To make sense of why healthcare workers experience high levels of burnout, a strong body of literature points to the emotionally demanding nature of people-work. The negative effects of mental health work on employee health can be mitigated by the provision of appropriate job resources and wellbeing initiatives. As to develop initiatives that appropriately target staff sources of stress and needs, it is important to engage staff in this process. As such, Children and Young People's Mental Health (CYPMH) and headspace Gosford, in Australia, New South Wales (NSW), developed a survey to identify how staff experience and manage the emotional demands of mental health work, what they identify as key stressors and which initiatives they would like to see implemented. Fifty-five staff (response rate of 73 %) completed the survey, and the results suggest that while staff find the work emotionally demanding, they do not appear to be emotionally exhausted and report administrative rather than client issues as their primary concerns. While a strong body of literature identifies the management of emotions in the workplace as a significant cause of stress, organisational stressors such as working in a bureaucratic environment are also important to understanding staff wellbeing.
Coates, D & Howe, D 2014, 'The importance and benefits of youth participation in mental health settings from the perspective of the headspace Gosford Youth Alliance in Australia', Children and Youth Services Review, vol. 46, pp. 294-299.View/Download from: Publisher's site
© 2014 Published by Elsevier Ltd. Objectives: Young people's participation in decision making that affects them is increasingly recognised and valued as a right. Youth participation in mental health settings is fundamental to service design and delivery, and is beneficial for the young people as well as the organisation. Headspace recognises the many benefits of youth participation with its national and local youth participation initiatives. In 2013, headspace Gosford in Australia established its current youth participation model, called the Youth Alliance (YA), consisting of 12 young people. These young people contribute ideas and opinions around service design and delivery, and participate in a range of activities. Method: This paper presents the findings of a focus group conducted with the YA immediately following recruitment. All 12 young people participated in a two hour focus group which sought to identify the key reasons these young people joined the YA, and what they hope to achieve in their capacity of YA consultants. Results: The two main reasons participants joined the YA are to help 'overcome barriers to help seeking and ensure young people get the support they need' and 'to build confidence, social skills and make new friends'. The barriers to help seeking identified by the participants are consistent with those outlined in the literature. Conclusion: Youth participation in youth mental health settings is beneficial to young people as well as organisations and the community, and it is crucial that strategies are put in place to increase youth participation. The ways in which these young people perceive their participation as beneficial to themselves as well as the organisation and the community is the focus of this paper.
Coates, DD 2014, 'New religious movement membership and the importance of stable 'others' for the making of selves.', Journal of religion and health, vol. 53, no. 5, pp. 1300-1316.View/Download from: Publisher's site
Challenging the view that people join New Religious Movements because they have fallen victim to powerful brainwashing techniques, the analysis of in-depth life history interviews of 23 former members from 11 different Australian 'cults' suggests that membership was personally negotiated and motivated by a desire for stronger social connections, albeit for different reasons. While for some participants, a desire for social connectedness was related to a strong need for guidance and direction from 'stable' others, for others it reflected a desire for self-change or self-enhancement. To make sense of the participant narratives, symbolic interactionist understandings of the self are applied.
Howe, D, Batchelor, S, Coates, D & Cashman, E 2014, 'Nine key principles to guide youth mental health: development of service models in New South Wales.', Early intervention in psychiatry, vol. 8, no. 2, pp. 190-197.View/Download from: Publisher's site
AIMS: Historically, the Australian health system has failed to meet the needs of young people with mental health problems and mental illness. In 2006, New South Wales (NSW) Health allocated considerable funds to the reform agenda of mental health services in NSW to address this inadequacy. Children and Young People's Mental Health (CYPMH), a service that provides mental health care for young people aged 12-24 years, with moderate to severe mental health problems, was chosen to establish a prototype Youth Mental Health (YMH) Service Model for NSW. This paper describes nine key principles developed by CYPMH to guide the development of YMH Service Models in NSW. METHODS: A literature review, numerous stakeholder consultations and consideration of clinical best practice were utilized to inform the development of the key principles. RESULTS: Subsequent to their development, the nine key principles were formally endorsed by the Mental Health Program Council to ensure consistency and monitor the progress of YMH services across NSW. As a result, between 2008 and 2012 YMH Services across NSW regularly reported on their activities against each of the nine key principles demonstrating how each principle was addressed within their service. CONCLUSIONS: The nine key principles provide mental health services a framework for how to reorient services to accommodate YMH and provide a high-quality model of care. [Corrections added on 29 November 2013, after first online publication: The last two sentences of the Results section have been replaced with "As a result, between 2008 and 2012 YMH Services across NSW regularly reported on their activities against each of the nine key principles demonstrating how each principle was addressed within their service."].
Howe, D, Coates, D & Batchelor, S 2014, 'Headspace Gosford data: The local application of a National model.', Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists, vol. 22, no. 4, pp. 374-377.View/Download from: Publisher's site
Despite the high prevalence of mental health problems for young Australians, many do not have ready access to treatment or are reluctant to seek help. Until recently there was a tendency for young Australians to fall between the gap of Child and Adolescent Mental Health Services and Adult Mental Health Services, and this has contributed to low rates of service use for young people. In 2006, the Australian Government sought to redress this gap in service delivery with its establishment of the Australian National Youth Mental Health Foundation, headspace. This paper presents demographic data collected at headspace Gosford over a 5.5-year period.The data presented indicates that headspace Gosford has been successful in improving early access to mental health treatment for young people on the Central Coast, in particular for young people aged 14-18. Headspace Gosford has attracted young people of both sexes, with a higher proportion of females. The majority of young people access headspace for mental health problems, predominantly depression and anxiety; however, a significant proportion report physical health or alcohol and drug-related reasons. The likelihood of these referral reasons is informed by gender and age.
Coates, D 2013, 'Balancing Personal Autonomy and Social Connectedness: the Role of New Religious Movements or 'Cult' Membership from the Perspective of Former Members', Psychotherapy in Australia, vol. 19, no. 4.
Coates, D 2013, 'Tensions between self and "others" in the making of the self: The role of childhood experiences in the development of reflexivity', Current Perspectives in Social Theory, vol. 31, pp. 277-295.View/Download from: Publisher's site
Purpose - While a number of scholars have observed that the contemporary self has to negotiate a "push and pull" between autonomy and a desire for community (Austin & Gagne, 2008; Bauman, 2001a, p. 60; Coles, 2008; Giddens, 2003, p. 46, the struggle between the "self" and "others" that is at the heart of symbolic interactionist (SI) understandings of the self is often missing from sociological discussion on the "making of the self" (Coles, 2008, p. 21; Holstein & Gubrium, 2000), and the current chapter contributes to this literature. Design/methodology/approach - To gain insight into "the making of the self," in-depth life history interviews were conducted with 23 former members of new religious movements (NRMs) specific to their construction of self. Interview data was analyzed for variations in the ways in which individuals describe their construction of self. To make sense of these variations, SI understandings of the self are applied. Findings - Analysis indicates that the extent to which individuals are informed by the social versus the personal in their self-construction is a continuum. From an SI perspective the self is conceptualized as to varying degrees informed by both the personal and the social. These two "domains" of the self are interrelated or connected through an ongoing process of reflexivity that links internal experiences and external feedback. From this perspective, "healthy" selves reflexively balance a sense of personal uniqueness against a sense of belonging and social connectedness. While a reflexive balance between the "self" and "others" is optimal, not everyone negotiates this balance successfully, and the extent to which individuals are informed by the social versus the personal in their self-construction varies and can be conceptualized as on a continuum between autonomy and social connectedness. The current findings suggest that where individuals are positioned on this continuum is dependent on the availability of cultural and perso...
Coates, D 2013, 'The effect of new religious movement affiliation and disaffiliation on reflexivity and sense of self', Journal for the Scientific Study of Religion, vol. 52, no. 4, pp. 793-809.View/Download from: Publisher's site
Challenging the contemporary belief that emotional damage invariably results from new religious movement (NRM) participation, this study shows that membership in and exit from a world-rejecting NRM may initiate the development of increased reflexivity and a personal sense of self for some former members. Out of a sample of 23 former members, 12 participants were identified who report prior histories of "other-directedness" and for whom exit from an NRM instigated a shift toward increased independence and individuality. Employing symbolic interactionist theories of self, this article conceptualizes the process through which these participants may be understood to have gained in reflexivity and personal autonomy. Four case studies demonstrate how the identity loss and uncertainty suffered following exit can "shock" former members into self-awareness and reflexivity, instigating a period of active learning about personal emotions, thoughts, and beliefs that leads to the active construction of a stronger personal self. © 2013 The Society for the Scientific Study of Religion.
Coates, DD 2013, 'A symbolic interactionist understanding of the selves of former members of New Religious Movements', Mental Health, Religion and Culture, vol. 16, no. 10, pp. 1066-1079.View/Download from: Publisher's site
The current study investigates the construction of self in New Religious Movement (NRM) membership and argues that there is significant variation in the way in which members construct their sense of self. While the majority of the literature suggests that differences in the way in which former members describe and experience NRM membership can be attributed to gender and the nature of the group, analysis of the life histories of 23 former members identified variations in the way in which these participants construct their sense of self as significant to understanding NRM membership. While some participants describe selves that are high in conformity or social connectedness, and depict NRM membership as motivated by a need for guidance and direction, others describe selves that appear high in individuality and personal autonomy and depict membership as motivated by a desire to overcome isolation and develop social connectedness. Even though these two narratives are conceptualised as distinct, they are not viewed as dichotomous but understood as on a continuum. To make sense of the selves of the participants in this study symbolic interactionist understandings of the self as to varying degrees informed by both "self" and "others" are applied. © 2013 Taylor & Francis.
Challenging the popular belief that people who join new religious movements (NRMs) become "entrapped," this study describes the way in which 23 former members of 11 different "cults" personally negotiated disaffiliation. The current findings support previous studies that posit exit as a resolution to unresolved doubts and dissonances, and contribute to this literature by suggesting that the nature of these dissonances, and the way in which exit constitutes a "solution" to these dissonances may vary. It is suggested that for approximately half of the participants in this study, the dissonances that precipitated exit, were relatively minor, primarily caused by organizational changes and inconsistencies in the teachings. While generally doubts were resolved privately and commitment sustained, exit occurred when alternate discourses or other identity resources became available through which doubts could become resolved. The remaining participants describe the conflicts that precipitated disaffiliation as pertaining to tensions between the groups' expectation of conformity and their sense of autonomy. These participants describe exit as a solution to the stress and emotional exhaustion of membership. To make sense of these different disaffiliation narratives, symbolic interactionist notions of the self as constructed in both the realm of "Self" and "Others" are applied. © 2013 Society for the Study of Symbolic Interaction. All rights reserved.
Coates, DD 2013, 'New religious movements as avenues for self-change and the development of increased emotional connectedness', Studies in Symbolic Interaction, vol. 40, pp. 271-305.View/Download from: Publisher's site
© 2013 by Emerald Group Publishing Limited. The current chapter outlines the process through which New Religious Movement (NRM) membership is conceptualized as facilitating the development of increased reflexivity, in particular the development of an increased ability to connect to others. Based on the narratives of a subsample of 11 former members of NRMs for whom membership signified a desire for an increased ability to emotionally connect to others, a number of factors that are understood as having facilitated or inhibited this type of change were identified and are discussed. The findings extend previous theorizing of NRM as facilitating changes in the behaviors and beliefs of their members, and conceptualizes NRMs as possible avenues through which self-change at an emotional level can occur. Copright
Coates, DD 2012, '"Cult Commitment" from the Perspective of Former Members: Direct Rewards of Membership versus Dependency Inducing Practices', DEVIANT BEHAVIOR, vol. 33, no. 3, pp. 168-184.View/Download from: Publisher's site
Coates, DD 2012, '"I'm Now Far Healthier and Better Able to Manage the Challenges of Life": The Mediating Role of New Religious Movement Membership and Exit', Journal of Spirituality in Mental Health, vol. 14, no. 3, pp. 181-208.View/Download from: Publisher's site
Challenging contemporary discourses of emotional damage from involvement in a new religious movement, or cult, the current study suggests that for many of the participants the experience of membership and exit helped to ameliorate previous vulnerabilities. The analysis of in-depth life history interviews of 23 former members from 11 different groups identified membership as an overall positive experience that has helped to resolve previous difficulties in negotiating the demands of mainstream society, in particular pertaining to managing tensions between community and belonging and individuality and autonomy. While some negative consequences were reported these appeared temporary in nature and are understood as pertaining to the loss of an important social group rather than long-lasting pathology associated with "having been brainwashed.". © 2012 Copyright Taylor and Francis Group, LLC.
Coates, DD 2011, 'Counselling former members of charismatic groups: Considering pre-involvement variables, reasons for joining the group and corresponding values', Mental Health, Religion and Culture, vol. 14, no. 3, pp. 191-207.View/Download from: Publisher's site
A majority of counsellors and other health professionals who work with former members of charismatic groups appear to give little consideration to pre-involvement variables such as reasons for initially joining the group and corresponding values. This study explores reasons for joining a charismatic group from the perspective of former members through the use of qualitative methods. Seven participants from four different groups were recruited via purposive sampling and modified snowball sampling. In-depth interviews were used to explore the participants' accounts of why they joined a charismatic group. The findings of this study suggest that participants of this study joined charismatic groups because of the ability of such groups to provide 'certainty' and meet needs of friendship, meaning, and belonging. The need for health professionals to consider pre-involvement variables when working with former members is discussed. © 2011 Taylor & Francis.
Coates, D 2010, 'Best Practice' Guidelines for working with Adult Survivors of Childhood Abuse', Counselling Australia.
Coates, D 2010, 'Impact of Childhood Abuse: Biopsychosocial Pathways Through Which Adult Mental Health is Compromised', AUSTRALIAN SOCIAL WORK, vol. 63, no. 4, pp. 391-403.View/Download from: Publisher's site
Coates, D 2010, 'Working with Adult Survivors of Childhood Abuse: a Review of Existing Treatment Models', Psychotherapy in Australia, vol. 17, pp. 12-21.
Coates, D 2009, 'Former members of charismatic groups: Modalities of adjustment', Psychotherapy in Australia, vol. 16, pp. 24-31.
Kennedy, DJ & Coates, D 2008, 'Retirement village resident satisfaction in Australia: A qualitative enquiry', Journal of Housing for the Elderly, vol. 22, no. 4, pp. 311-334.View/Download from: Publisher's site
There has been limited research into the types of customer satisfaction experienced by residents in leisure-oriented retirement communities, particularly in Australia and the United Kingdom. Focus groups were conducted at a series of retirement communities. Results have lead to the development of a typology of retirement community resident satisfaction containing five different domains, including the Built Environment, the Financial Environment, the Service Delivery Environment, the Social Environment, and the Spiritual Environment. Furthermore, these five satisfaction domains encompass up to 24 distinct types or facets of customer satisfaction experienced by residents. This proposed typology of leisure-oriented retirement communities' resident satisfaction is the most comprehensive investigation of retirement village customer satisfaction to date. Implications for both researchers and practitioners are discussed, including recommendations for the measuring, managing, and marketing of customer satisfaction with retirement community living. © 2008 by The Haworth Press. All rights reserved.
Coates, D, 'The Significance and Purpose of the "Anti-Cult Movement" in Facilitating Disaffiliation From a New Religious Movement: Resources for Self-construction or a Justificatory Account', International Journal for the Study of New Religions, vol. 3, no. 2, pp. 213-244.View/Download from: Publisher's site