evaluation: livewire in-hospital program · evaluation undertaken in 2013 that found that the...

EVALUATION:

LIVEWIRE IN-HOSPITAL

PROGRAMA review of service delivery in The Royal Children's Hospital

Adolescent Mental Health Unit

Further information

Dr Claire Treadgold, National Manager – Research & Evaluation

Starlight Children’s Foundation

Email: [email protected]

AcknowledgementsThe Starlight Children’s Foundation would like to thank the entire Banksia Unit

team at The Royal Children’s Hospital Melbourne, with special thanks to

Dr Chidambaram Prakash, Emma Barker, Camille Foley and Daniel Darmanin.

We would also like to thank the Livewire team across Australia, the Livewire

facilitators at The Royal Children’s Hospital Melbourne and the young people

in the Banksia Unit who generously donated their time to participate and

provide us with their feedback.

Lastly, the Starlight Children’s Foundation would like to acknowledge the

generous support of nib foundation.

Evaluation – Livewire in Hospital

ISBN: 978-0-9944282-1-9

Suggested citation:

Starlight Children’s Foundation 2016

Evaluation – Livewire in Hospital,

Starlight Children’s Foundation,

Sydney.

Evaluation – Livewire in Hospital

by Starlight Children’s Foundation is

licensed under a Creative Commons

Attribution 4.0 International License.

Copies of this report can be

downloaded from the Starlight

website: https://starlight.org.au/

EVALUATION:

LIVEWIRE IN-HOSPITAL

PROGRAMA review of service delivery in The Royal Children's Hospital

Adolescent Mental Health Unit

Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

What is the Livewire in-hospital program? . . . . . . . . . . . . . . . 4

Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Literature review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Evaluation results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Discussion and Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . 24

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

CONTENTS

EVALUATION: LIVEWIRE IN-HOSPITAL PROGRAM | 1

Adolescence is a time of

change. For young people with

a serious mental health condition,

these normal changes and

development stages can be

delayed or compromised.

Repeated hospitalisation, long

lengths of stay, the restrictive nature

of mental health units and the effects

of the illness can compromise the

young person’s development.

Starlight delivers the Livewire

program to young people being

treated in mental health units at six

paediatric centres across Australia.

The program was launched in 2012,

based on the successful trial of an

adolescent program at Princess

Margaret Hospital in Perth. The

program fosters social connections

and plays a key role in lifting the

mood of young people. Livewire also

plays a role in building self-esteem

and self-efficacy in young people by

providing a program that engages

them and improves their well-being.

This evaluation builds on a formative

evaluation undertaken in 2013 that

found that the program was highly

valued by young people, health

professionals and Livewire facilitators.

Livewire provided opportunities

for young people to: (1) explore

their creativity, (2) develop new skills

(e.g. multimedia, arts and crafts), and

(3) connect with peers, enhancing

(4) psychosocial wellbeing and

(5) autonomy. These are provided

through unit-based activities,

skill-based workshops, and events.

The key aims of this evaluation

were to understand more about

the use of arts based programs in

mental health services, document

the services provided by Livewire

facilitators, measure the satisfaction

of young people, facilitators, and

health professionals and assess

the impact of the program.

A mixed methods approach was

used to evaluate the Livewire

program provided in mental health

units. The evaluation included a

literature review, a collection of

non-identified demographic data,

documentation of workshop content,

in-depth evaluation of sessions

provided at The Royal Children’s

Hospital, Melbourne (RCH), and

surveys with health professionals

located there. The evaluation was

undertaken between October 2015

and January 2016 and was approved

by the Human Research and Ethics

Committee of the RCH.

The literature review suggests

that peer support was generally

associated with increased hope,

empowerment, improved self-

efficacy and an increased sense

of belonging, which in turn

promoted a personalised recovery.

The evaluation involved connections

with 88 young people (31% male,

68% female), documentation of the

content of 14 Livewire Workshops

across six sites (including direct

feedback from 19 young people

who participated in five sessions at

the RCH Banksia Unit) and surveys

completed by 13 health professionals

also based at the RCH.

The key results of the

evaluation were:

1. Livewire is highly valued by

hospital staff and young

people

2. Livewire fosters social

connections

3. Livewire lifts the mood of

young people

4. Livewire builds self-esteem

and self-efficacy

5. Young people look

forward to Livewire

6. Young people on mental

health wards need longer

to engage

7. Livewire fills a service gap

8. Wish for increased hours

by young people, Livewire

facilitators and health

professionals

9. Livewire assists hospital

staff in their role

10. Livewire facilitators are

highly engaged in their

job and feel passionate

about Livewire.

Overall the results of the

evaluation confirm the findings

of the earlier formative

evaluation and support the

continued provision and

possible expansion of the

Livewire Program to

adolescent mental health units

across Australia.

EXECUTIVE SUMMARY

2 | EVALUATION: LIVEWIRE IN-HOSPITAL PROGRAM

Adolescence is a time of change. Young people face physical, psychological, emotional and social changes which can occur at different rates depending on the individual. Young people are developing their identity and are often focused on what their peers think, while also exploring relationships, sexuality and considering possible career paths. They can also challenge authority figures as they seek to find their way in the world.

For young people with a serious mental health condition, these normal

changes and development stages can be delayed or compromised. Repeated

hospitalisation, long lengths of stay, the restricted nature of mental health

wards and the effects of illness may disrupt the young person’s development.

Often the hospital environment is not conducive to important aspects of

adolescent development such as the need to make choices, to have a sense of

control over their own environment, and to have a space to escape to.

Additionally, there are very few age-appropriate recreational and leisure

services programs specifically designed to meet the needs of young people on

mental health wards (AIHW, 2011; McGorry, P., Bates, T., & Birchwood, M.

2013).

The Livewire program delivers a program to young people who are being

treated in mental health units.

INTRODUCTION


Livewire transforms the hospital experience of young people through

the provision of resilience enhancing activities that promote personal

development, recognising the need for targeted and age appropriate programs

to support them. Young people are encouraged to use their creativity and learn

new skills through ward-based activities, skill-based workshops and event

nights. The program is delivered to both adolescent wards and mental health

units by Livewire facilitators. The program was based on the successful trial of

an adolescent program at Princess Margaret Hospital.

Livewire was launched in 2012 and operates at six paediatric centres in

Australia. Livewire provides opportunities for young people to

1. Explore their creativity

2. Develop new skills (e.g. multimedia, arts and crafts)

3. Connect with peers

4. Enhancing psychosocial wellbeing

5. Autonomy

Livewire underwent a formative evaluation one year after the program

commenced (see Appendix A) to assess the reach, delivery and functional

processes. This evaluation reported very high satisfaction by health

professionals who strongly supported the need for such a service in paediatric

hospitals, especially in mental health units. A recommendation of the formative

evaluation was to include direct feedback from young people in any

future evaluations.

WHAT IS THE LIVEWIRE IN-HOSPITAL PROGRAM?


EVALUATION

Following the recommendations of the formative evaluation this evaluation focuses specifically on the

delivery of Livewire Workshops within mental health units and includes direct feedback from young people

who use the program.

The key aims of the evaluation were to:

1. Undertake a literature review focused on the use of arts-based programs for young people in mental health units.

2. Describe the Livewire program that is provided to mental health units.

3. Measure the satisfaction of young people, facilitators, and health professionals with the Livewire program.

4. Assess how well the program meets the needs of young people receiving treatment in mental health units.

The evaluation was approved by the Human Research and Ethics Committee of The Royal Children’s

Hospital Melbourne (REF 35211).


MethodologyA mixed methods approach was

used to meet the aims of the

evaluation. This included a literature

review, collection of non-identified

demographic data and workshop

content, surveys and observation.

The evaluation was undertaken

between October 2015 and January

2016. Collection of field data was

undertaken at The Royal Children’s

Hospital’s Banksia Unit in the week

of November 16–22, 2015.

The stages of the evaluation are

outlined below:

Stage 1: Literature review The literature review sought to

understand more about the impact

of arts based programs on young

people being treated in mental

health units.

Stage 2: Description and documentation of the Livewire in- hospital programThe information collected was

non-identified and is routinely

collected by Livewire facilitators

as part of standard data collection.

The only other data that was

collected was the number of

inpatients that were admitted on

the days the Livewire sessions were

held so that the report could

establish what percentage of young

people attended the sessions.

No personal medical records were

accessed (see Appendix B).

This also included:

Estimating reach: Information

about program reach and participant

demographics were estimated by

obtaining the participation figures

from each Livewire site over one

week. Demographic data collected

by facilitators included: number of

participating young people, ages,

genders and the total number of

young people admitted on the ward

that day (to estimate reach).

Format of Livewire workshops:

Livewire facilitators were asked to

record structured activities, materials,

duration of workshops that they

delivered in the mental health units

over one week. The information

about the activities that were

undertaken in the Livewire sessions

were all collected from November

16–22, 2015.

Stage 3: Evaluating satisfactionKey stakeholders were invited to

complete a paper/online survey to

explore their satisfaction with the

Livewire program.

Locations

The on-site evaluation took place in

Banksia Unit (the Mental Health Unit)

at The Royal Children’s Hospital in

Melbourne.

Participants

Responses were gathered from

young people who had been

admitted to the Banksia Unit and

who had participated in at least one

Livewire activity, health professionals

working on the Banksia Unit, and

Livewire facilitators (from all six sites

around Australia).

Questionnaires

Young people (Banksia Unit only):

Young people were able to provide

feedback on Livewire in several ways:

they were asked at the end of the

workshop by the Livewire facilitator

what they thought about the group,

and they were then given the

opportunity to complete a brief

survey which they were able to place

in the feedback box (Appendix C).

Health professionals (Banksia Unit

only): The health professionals had

been identified as all members of the

hospital team who work with young

people on the unit: medical, nursing

and allied health. They were emailed

an online questionnaire and were

provided with a paper-based version

(see Appendix D) asking them to

describe their experiences with

Livewire.

Livewire facilitators (from all six

sites): All Livewire facilitators were

emailed an online questionnaire (see

Appendix E) asking them to reflect

on their roles and processes when

working in mental health units to

identify common engagement skills

and techniques.


An initial scoping of the literature

regarding the impact of arts-based

programs on young people being

treated in mental health units,

including the search terms youth

and adolescents did not produce

any relevant studies. However, what

emerged from this initial review was

a body of growing literature focused

on the role of Peer Support Workers.

The search terms were modified and

the review investigated the

effectiveness of peer support workers

(PSWs) employed in mental health

settings, who provide psychosocial

interventions that aim to support and

engage individuals with a mental

illness. As there were limited articles

that spotlighted the effect that PSWs

had on young consumers (12–25

years of age), adult populations were

also included. The primary aim of the

review was to understand more

about the influence that PSWs have

on consumers receiving treatment

and support in both inpatient and

outpatient settings.

Particular attention was focused on

five areas: self-esteem, self-efficacy,

consumers perceived level of support

and sense of social connectedness,

mediated empowerment and

personalised recovery.

A search of published literature

between 2004 to 2015 was

undertaken using the following

databases CINAHL plus, PubMed,

Medline and Proquest Central. Key

words used in the search included

“peer support”, “social support”,

“mental illness” or “mental health”,

“recovery” and “psychosocial”.

The screening process involved the

following inclusion and exclusion

criteria. Articles were included if

they were written in English; included

individuals aged up to 65 years of

age; published after 1 Jan 2004;

included consumers who were

receiving treatment at a mental

health facility; and, were peer

reviewed publications. Articles

were excluded if they were published

before December 31, 2003; not

written in English; reports, working

papers, government documents,

or evaluations (grey literature); and,

included consumers older than

65 years.

Eight articles were identified which

met the inclusion criteria. These

articles have been summarised in the

Literature review summary table

(see Appendix F). The key areas that

emerged from the review are peer

support; self-esteem; self-efficacy;

consumers perceived level of

support; empowerment;

and, recovery.

Defining peer supportOver the course of the last decade

there has been an exponential

expansion in the employment and

use of PSWs in both inpatient and

community settings in the United

States, United Kingdom, Australia

and New Zealand (Castelein, 2008).

The literature in this emerging field

is limited and highlights numerous,

conflicting definitions for PSWs

suggesting that the role is in its

early stages of development.

In its most basic form, peer support

can be defined as a process of giving

and at times receiving help, founded

on the values of mutual respect,

comradery and shared responsibility.

It is not bound by, or defined by

psychiatric diagnostic criteria. It is

about hearing and responding to an

LITERATURE REVIEW


individual’s unique story in an

empathetic and caring way, providing

social support when it is needed.

Davidson et al. (1999) defined three

primary forms of peer support that

have been developed and are used

by mental health consumers. These

three forms include naturally

occurring mutual support groups,

consumer-run services and, the

employment of consumers as

providers within clinical and

rehabilitative settings.

Resnick and Rosenheck (2008)

expanded Davidson et al.’s definition,

asserting that peer services are

founded on core values “such as

empowerment, taking responsibility

for one’s own recovery, the need to

have opportunities for meaningful life

choices, and the valuation of lives of

people with disabilities as equal to

those of people without disabilities”

(pp 1307). This thereby broadens the

definition of PSWs, allowing

individuals from non-clinical

backgrounds (who may or may not

have experienced a mental illness)

to provide peer support as a

component of mental health

treatment. Bracke, Christiaens and

Verhaeghe (2008) argue that the

development of peer-support

networks has enabled people with

mental illness to engage in social

scenarios that enrich their social

network and diminish their reliance

on mental health clinicians. They

highlight that PSWs are

complementary to professionals,

founding their practice on the

principals of equality and mutuality

which in turn challenges traditional

hierarchies between those providing

and those receiving treatment.

Several reviews of the literature

have been completed, focusing on

self-help/mutual support (Pistrang,

Barker, & Humphreys, 2008; Raiff,

1984) and peer-run services

(Davidson et al., 1999; Humphreys,

1997; Repper & Carter, 2011). These

reviews are limited in the context of

this literature review because they

only include articles that review the

practice of PSWs with a lived

experience of mental illness. This

review focuses both on non-clinical

PSWs (individuals employed as PSWs

who may or may not have a lived

experience of mental illness) and

PSWs with a lived and reported

experience of mental illness. This

review may provide supplementary

support for the implementation of

non-clinical PSWs in the mental

health setting.

While there was a sizeable volume of

research articles that reviewed PSWs

with a lived experience of mental

illness, many did not meet the

inclusion criteria specified. There

were limited studies which reviewed

non-clinical PSWs, which is

presumed to be a result of the recent

emergence of this occupational

group in the mental health setting.

Key data from the studies that met

inclusion criteria was extracted and is

presented in Table 1 which references

the author and year, the study design,

sample, setting and measurement

tool(s) used, the intervention, main

findings and the strengths and

limitations of reviewed studies.

Findings were then categorised

into groups of recurring themes

including self-esteem, self-efficacy,

and consumers perceived level of

support, empowerment and

recovery. These are reviewed in

more depth below:

Self-esteem Self-stigma has been shown to have

deleterious effects on the self-esteem

and self-efficacy of individuals with a

mental illness (Corrigon & Watson,

2002). This can be fueled by cultural

stereotypes and expectations (with

the general population deliberately or

inadvertently holding prejudicial and

discriminatory views against those

with a mental illness), further

diminishing the individual’s sense of

self and willingness to engage with

healthcare professionals (Corrigon,

Watson & Barr, 2006).

According to a study completed by

Davidson, Shahar and Stayner (2006),

contact with PSWs improved the

self-esteem of consumers over time,

regardless as to which PSW cohort

they had been allocated to.

When exposed to non-clinical

PSWs self-esteem rates improved for

participants as they attended more

meetings with their allocated PSW.

When engagement levels were

factored in to the cohort allocated

a PSW with a lived experience of

mental illness there was a reported

improvement in self-esteem when

they did not meet with their PSW.

In contrast, Castelein, Bruggeman,

van Busschbach, van der Gaag, Stant,

Knegtering and Wiersma (2002) and

Resnick and Rosenheck (2008) found

that self-efficacy scores improved in

the cohorts that were routinely

engaged by a PSW with a lived

experience of mental illness.

Following exposure, statistically

significant results for self-confidence


were obtained for both studies when

contrasted to the control cohort.

Moreover, both studies suggest that

self-esteem scores progressively

increased through ongoing

engagement with a PSW. Results

obtained were compared and found

to be similar to consumers’ exposure

to Cognitive Behavioural Therapy, a

mainstream treatment for psychosis,

(Valmaggia, van der Gaag, Tarrier,

Pijnenborg & Slooff (2005).

Self-efficacySimilarly, to self-esteem, routine engagement with PSWs appears to bolster consumers’ self-belief and confidence to advocate for themselves and work through feelings of depression and loneliness

(Bracke, Christiaens & Verhaeghe,

2008; Castelein, Bruggeman, van

Busschbach, van der Gaag., Stant,

Knegtering & Wiersma, 2008).

The randomised control trial

completed by Castelein et al. (2008),

reported that reciprocal peer support

(provided through mutual group

support) appears to improve self-

efficacy, with increasing levels of

contribution in group settings being

positively linked to an increase in

self-reported confidence levels. This

enhanced sense of self-efficacy

potentially develops from the

individual reflecting on how they

have positively influenced another

person’s life in the group setting,

acquiring social approval and positive

feedback through engagement.

Providing peer support had stronger effects on male populations, with increasing levels of support appearing to directly improve consumer rated levels of self-efficacy


2008).

Scores on self-efficacy obtained from

the study by Castelein et al. (2008)

were similar to other self-help

programs and outpatient treatment

approaches, providing further

support for the use of peer support

as a therapeutic intervention in the

treatment of mental illness

(Carpinello, Knight, Markowitz &

Pease, 2000). Bracke, Christiaens and

Verhaeghe (2008) theorised that

through the development of peer

support systems, consumers were

able enlarge their support network

thereby diminishing their

dependence on healthcare

professionals. This in turn better

equipped consumers to individualise

their recovery, founding their

treatment on their own unique and

personalised goals.

Consumers’ perceived level of support Studies reviewing consumers’ sense

of social connectedness reported

improved outcomes through long

term exposure to PSWs (Bracke,

Christiaens & Verhaeghe, 2008;

Castelein, Bruggeman, van

Busschbach, van der Gaag, Stant,

Knegtering & Wiersma; Davidson,

Shahar & Stayner, 2004). Castelein et

al. (2004) found that consumers had

a significant increase in contact with

peers outside of sessions and higher

levels of self-esteem following

exposure to non-clinical PSWs over a

period of 8 months. Consumers

appeared to improve in the cohort

exposed to PSWs with a lived

experience of mental illness, however

when attendance levels were

factored in consumers tended to

self-report a better capacity for social

functioning following non-adherence

to meetings with their PSW. In

conflict, Davidson, Shahar and

Stayner (2004) found that peer

support improved social support and

functioning when provided by

individuals with a lived experience of

mental illness. The cohort allocated

more peer support sessions also

reported significantly higher levels of

social support when contrasted to

the control group.

The results may reflect the wider

views of consumers that PSWs are

unlike healthcare professionals,

founding their clinical practice on

mutuality and equality. For individuals

diagnosed with a mental illness peer

support may also offer an

opportunity for consumers to extend

their social support network, gaining

assistance, guidance and positive

reinforcement in their recovery

journey. This can in turn improve an

individual’s social worth, perceived

competence and social usefulness


2008).

EmpowermentHistorically, mental health care and

treatment at times was provided in a

paternalistic manner which promoted

dependence on healthcare

professionals (Brown et al., 2008).

Inadequacies in the mental health


system has driven consumer

advocates to question this model of

care, endorsing ideologies such as

autonomy and self-management

which assumes that all consumers

have the capacity to problem solve

and make their own decisions (Brown

et al., 2008). Additionally, recent

evidence highlights the importance

of consumers having appropriate

support persons who empower them

to take charge of their individual

recovery journey (Brown et al., 2008).

The literature highlights that peer

support programs provide a

behavioural setting that fosters

personal empowerment which has

been linked to improved mental

health, reduced re-admission rates

and greater success in community

engagement (Bracke, Christiaens

& Verhaeghe 2008; Brown et al.,

2008; Gillard, Gibson, Holley &

Lucock, 2014).

Gillard, Gibson, Holley and Lucock

(2014) conducted a qualitative study

involving 71 participants (peer

workers, service users, staff and

managers) which explored their

experience of peer support.

Participants described peer support

in a positive regard, stating that peer

support provided consumers with a

sense of acceptance, understanding

and hope which in turn empowered

them to envisage an alternate view of

themselves and life beyond the

constraints of hospitalisation (Gillard,

Gibson, Holley & Lucock, 2014).

Similarly, Rogers et al. (2007)

conducted a multi-site trial that

investigated the difference in

measures of empowerment between

participants exposed to consumer

operated peer support programs and

the control (treatment as usual). On

completion of the study it became

apparent that participants exposed to

the intervention experienced higher

levels of personal empowerment

(Rogers et al., 2007).

Resnick and Rosenheck (2008) also

investigated the effect a peer support

intervention had on participants

compared to the control and found

that those who were exposed to peer

support scored significantly higher

on empowerment measures.

Additionally, those exposed to the

peer support intervention spent less

money on substances and had

significantly higher follow-up rates at

both three and nine months which

can be associated with increased

general empowerment (Resnick &

Rosenheck, 2008). Both Rogers et al.

(2007) and Resnick and Rosenheck

(2008) reported that success of the

peer support intervention in their

studies was largely influenced by

attendance rates and levels of

engagement.

Recovery According to the Victorian

Department of Health (2011), there

are two main types of recovery in

mental health which can be defined

as clinical and personal recovery.

Clinical recovery is often defined by

mental health professionals and

relates to the reduction or cessation

in psychiatric symptomatology, while

personal recovery is self-defined by

the consumer. Personal recovery is

viewed as a unique and personalised

experience which works towards

ongoing, holistic growth of the

individual.

The literature suggests that loneliness

and social isolation are two of the

most challenging factors experienced

by persons living with mental illness

(Davidson, Shahar & Stayner, 2004).

Davidson, Shahar & Stayner (2004)

noted that the support offered by

peers and professionals during this

time provided consumers with a

sense of social connectedness and

belonging. Upon consumers being

reintegrated to the community

minimal social structures and

supports exist that mimic the

therapeutic milieu individuals may

have been exposed to during their

hospitalisation (Davidson, Shahar &

Stayner, 2004). Additionally, as a

result of stigma, a loss of social

role(s), lack of alternate social

structures and some of the

symptoms of the disorders, many

individuals living with mental illness

report spending the majority of their

time in a solitary manner (Davidson,

Shahar & Stayner, 2004). Despite this,

there is a large evidence base that

suggests that engagement in peer

support programs in the community

can assist in improving psychosocial

functioning which supports recovery

(Brown et al., 2008; Castelein et al.,

2008; Davidson, Shahar & Stayner,

2004; Resnick and Rosenheck, 2008;

Gillard, Gibson, Holley & Lucock,

2014).

Resnick and Rosenheck (2008)

conducted a quasi-experimental

study that researched the

effectiveness of a peer support

program compared to standard care

(control condition) on measures of

recovery. On completion of the trial it

became evident that the peer

support cohort demonstrated

significant improvements in both

recovery-oriented and traditional

clinical measures (Resnick &

Rosenheck, 2008). Castelein et al.

(2008) also reviewed recovery


orientated parameters, having piloted

a randomised controlled trial which

examined the efficacy of participation

in a minimally guided peer support

group compared to a control group.

Findings of the trial suggest that high

attenders of the peer support group

had fewer negative symptoms,

reported less distress and an

improved quality of life.

Brown et al. (2008) conducted a

cross-sectional study (encompassing

a cohort of 250 participants) that

investigated the effect that consumer

led peer support groups have on

recovery outcomes. Results of the

study revealed that participants who

assumed leadership roles and

experienced supportive social

involvement experienced greater

progress towards their recovery as

defined by the 15 item recovery scale

and the modified version of the

organizationally medicated

empowerment scale (Brown et al.,

2008). Gillard, Gibson, Holley and

Lucock (2014) suggested that

consumer led peer support provides

consumers with an opportunity to

experience a connection based on a

shared lived experience which in turn

provides hope for future recovery.

Participants involved in the qualitative

study designed by Gillard, Gibson,

Holley & Lucock (2014) reported

increased resilience, engagement

levels, empowerment and control

over their lives which are pertinent

factors that aid in personal recovery.

SummaryThis review has examined existing

literature that investigated the role of

peer support for consumers receiving

care and treatment in inpatient and

community based mental health

settings. The efficacy of peer support

focused on five outcomes: self-

esteem, self-efficacy, consumers

perceived level of support and sense

of social connectedness,

empowerment and recovery.

Although peer support is an

emerging field within mental health,

the eight articles reviewed suggest

that peer support was generally

associated with increased hope,

empowerment, improved self-

efficacy and an increased sense of

belonging, which in turn promoted a

personalised recovery.

The majority of reviewed studies

suggest that contact with PSWs

improve the self-esteem of

consumers over time, with

engagement with non-clinical PSWs

bolstering self-reported levels of

self-esteem. The literature is

conflicted when reviewing the effect

of PSWs with a lived experience of

mental illness on self-esteem scores

with Davidson, Shahar and Stayner

(2006) suggesting that consumers

were more inclined to self-report an

improvement in their self-esteem

when they did not meet with their

PSW. In paradox, Castelein,

Bruggeman, van Busschbach, van der

Gaag, Stant, Knegtering & Wiersma

(2002) and Resnick & Rosenheck

(2008) demonstrated statistically

significant improvements in the

cohort exposed to PSWs with a lived

experience of mental illness. Because

there is a conflict in the literature,

further research is warranted on the

true effect of PSWs with a lived

experience on self-esteem before a

conclusion can be made.

Exposure to PSWs appeared to

bolster consumers’ self-belief and

confidence which was evidenced by

increasing levels of contribution in

group settings and higher scores on

self-reported confidence measures.

Particularly in male populations,

social approval and positive feedback

appeared to positively impact on

consumer rated levels of self-efficacy.

The literature also suggests that

long-term exposure to peer support

appears to enhance a consumer’s

sense of social connectedness.

Castelein et al. (2004) found that

when exposed to reciprocal peer

support, consumers were inclined to

meet outside of sessions with

significantly higher levels of self-

esteem being reported.

Reviewed literature also suggested

that exposure to PSWs empowered

consumers to be autonomous and

self-directed in meeting their

recovery goals. Compared to

treatment as usual, Resnick and

Rosenheck (2008) found that

consumers exposed to peer support

reported significantly higher

empowerment measures.


They were also less likely to spend

money on substances (e.g. alcohol

and or other drugs) and had

significantly higher follow up rates,

suggesting that consumers were

actively involved in treatment

planning. Both articles that reviewed

empowerment found that higher

attendance rates improved

empowerment measures, further

supporting peer support as a

therapeutic intervention (Rogers

et al., 2007; Resnick & Rosenheck,

2008).

The majority of reviewed articles that

assessed the effect of PSWs on

recovery found that peer support led

to significant improvements in

recovery-orientated measures

(Resnick & Rosenheck, 2008), led to

decreased negative symptoms of

schizophrenia, less distress and a

self-reported improvement to the

individual’s quality of life (Castelein et

al., 2008). Moreover, participants also

reported increased levels of

resilience, engagement and

empowerment, with consumers

reporting that they felt more in

control of their lives following

exposure to PSWs. Participants

reported that by being engaged

with a respected, valued and

non-professional member of the

healthcare team they felt empowered

to be actively involved in their care

and treatment.

Peer support appears to be an

effective adjunct to care and

treatment for consumers with a

range of mental health disorders,

however further research is

warranted to clearly delineate

potential effects following exposure.

Emerging evidence suggests that

non-clinical PSWs may improve the

self-esteem and self-efficacy of

consumers, however due to the small

number of research articles reviewing

non-clinical PSWs in mental health

settings it proved difficult to evaluate

the validity of their effect. Because

much of the literature focused on

PSWs with a lived experience of

mental illness, further research needs

to be conducted on the effectiveness

of non-clinical PSWs before a clear



The results are divided into two

sections. Section one focuses on the

results of the overall delivery of the

Livewire program to mental health

units across Australia from November

16–22, 2015. Section 2 focuses on

the results related to the delivery of

the program on the Banksia Unit at

the RCH.

SECTION 1: RESULTS LIVEWIRE IN MENTAL HEALTH UNITS

In 2015, 25,826 connections were made by Livewire facilitators with young

people in hospital and over 1,400 workshops were held.

Hospital

No. of

Livewire

workshops

held in

2015

No. of connections

made with young

people in 2015

(adolescent ward

and mental

health ward

The Royal Children’s Hospital 229 4,808

Princess Margaret Hospital 214 8,620

Lady Cilento Children’s Hospital 231 2,672

Children’s Hospital at Westmead 313 4,211

Sydney Children’s Hospital 291 3,638

John Hunter Children’s Hospital 177 1,877

Total 1,455 25,826

Figure 1: 2015 Livewire figures

As part of this evaluation, a total of 88 connections were made with young

people in mental health units across Australia in the week November 16–22,

2015. The number of participants varied between 1 and 17 per session with an

average of six young people per session. One third of all participants were boys

(31%) and two-thirds were girls (69%). The age of participants was estimated by

the Livewire facilitators and was only recorded for 48% of participants (n=43).

The average age of participants was 14.4 years.

0

2

4

6

8

10

12

12 years 13 14 15 16 17 18 years

National RCH

Figure 2: Number and age of Livewire participants (nationally vs. RCH)

EVALUATION RESULTS


In the week of November 16–22, 2015 fourteen Livewire workshops

were provided across the six sites as illustrated in Table 1 below.

Hospital

Number of Livewire Mental

Health workshops

documented

The Royal Children’s Hospital 4

Princess Margaret Hospital 2

Lady Cilento Children’s Hospital 3

Children’s Hospital at Westmead 1

Sydney Children’s Hospital 1

John Hunter Children’s Hospital 3

Total 14

Table 1: Number of Livewire workshops documented during the evaluation

Length and activities — Livewire workshops Livewire sessions lasted between 20 minutes and 1.5 hours. The majority of

sessions (72%) ran for one hour. Lady Cilento Children’s Hospital was the

exception to this and ran eight twenty-minute sessions.

A range of activities were offered during the Livewire sessions,

these included:

• Art and craft (e.g. Japanese manga drawing, friendship bracelets)

• Card games and board games (e.g. Trivia, Scattergories)

• Music

• Electronic games (e.g. Nintendo)

• Talking with young people about topics of interest.

Participation rate A comparison of the number

of young people admitted on

the ward during the time of

the Livewire session and the

number of young people who

participated in the session

showed that 68% of young

people who were admitted on

the ward participated in the

Livewire session.

Livewire facilitators stated that

young people on mental health

wards seem to especially look

forward to Livewire sessions.

I actually sense the Livewire program feels somewhat more important (hard to explain but feel like in MH young people comment more frequently about waiting for us to come or wondering when we are going to come back) than those on general wards. - Livewire facilitator


Facilitators expressed that due to this they often felt like their work was

particularly valuable on the mental health wards.

It feels like we are more needed in the mental health unit – usually, there are several young people waiting at the door as we enter, wanting to know what we are going to do. – Livewire facilitator

0

1

2

3

4

5

6

7

8

1. com

plet

ely fa

lse 2 3 4 5 6 7 8 9

10. c

ompl

etely

true

Figure 3: Health professionals rated on scale from 1-10 whether it is hard to motivate young people to engage with Livewire (1 = completely false, it is not difficult to motivate young people to engage with Livewire; 10 = completely true, it is hard to motivate young people to engage with Livewire)

Young people on mental health wards need longer to engageWhile Livewire facilitators

emphasised that the young

people they work with in the

mental health wards are very

similar in their needs adolescents

without mental illness, they also

frequently observed that young

people with mental illnesses

often take longer to engage and

to settle than in other wards

(see Figure 3).

However, once engaged, these

young people engage longer in

groups and appear to work more

intensively.

They can be a lot harder to engage, however, if you are able to connect with them they can get a lot more out of the experience. Often I have noticed mental health patients are open to exploring ‘deeper’, ‘stronger’ ideas. When it comes to art they often put more time, effort and thought into what they are doing. Whereas general patients often rush and look at the activity on a surface level.

– Livewire facilitator


SECTION 2: RESULTS — LIVEWIRE BANKSIA UNIT, RCH

Young People 19 connections were made with

young people over five Livewire

sessions at the RCH Banksia Unit.

Young people were given

the opportunity to participate in a

feedback session at the end of each

Livewire workshop. 13 young people

provided verbal feedback at the end

of the Livewire session and six young

people completed a paper-based

survey. On average 5 people

participated per session. 42% of

participants were boys and 58% were

girls. The average age of participants

at the RCH was 15.4 years.

A comparison of the number of

young people admitted on the ward

during the time of the Livewire

session and the number of young

people who participated in the

session showed 50% of young

people who were admitted on the

ward participated in the Livewire

session. Two instances were

recorded where a young person

left the Livewire session for a short

period and then returned.

The reasons for young people not

participating or leaving during a

session included:

• Young people being on

weekend leave;

• Not being on the ward due to

medical appointments; and

• Poor mental health, including

need for intensive care or the

young person was exhibiting

risky or inappropriate behaviour

If they are psychotic and misinterpreting what is being said or what is done as an activity – Nurse, RCH

Safety, i.e. young person is aggressive or requires very low stimulus. – Nurse, RCH

Satisfaction 83% of young people rated the Livewire workshop they had participated in as 10 out of 10 (excellent). The average rating was 9.6 out of 10.

100% of young people rated the level of responsiveness of the Livewire facilitators to their requests or interests as a 9 or 10 out of 10.


One hundred percent (100%) of young people stated they would come back for another Livewire workshop.

When asked what they would tell a new person on the

Banksia Unit, young people responded:

They’re just really cool people who come and hang out with you for a bit. – Young person, RCH

It’s the best part of being here, so do it, your day will be better. – Young person, RCH

Definitely try Livewire, there’s lot of fun activities. – Young person, RCH

I like to chill with LW. I look forward to the LW guys coming every day. – Young person, RCH

Figure 4: Words young people used to describe Livewire to another

young person

Livewire fills a service gap Feedback from young people

highlighted the small number of

recreational and leisure services

available while they are in the mental

health ward. Some of the young

people acknowledged that other

services are available, such as Clown

Doctors, school or music therapy, and

Starlight’s Captain Starlight program.

One young person commented that

the Captain Starlight program is

targeted at younger children and it

does not meet the needs of an older,

adolescent group. Half of young

people (50%) stated “nothing” was

available to them or that they didn’t

know of any other services.

Wish for increased hours

A strong theme among the young

people was the wish for an increase

in Livewire hours.

When asked what they enjoy least

about today’s session young people

stated “that it only goes for an hour”

and “that [the Livewire facilitators]

had to leave”.

Livewire facilitators are highly engaged in their job and feel passionate about Livewire

Descriptions by health professionals

highlighted the high commitment and

passion Livewire facilitators bring to

their work.


Livewire facilitators described how

they try to motivate young people

by offering fun activities which are

built around their interests. They

also emphasised the importance of

respecting young people’s autonomy,

while at the same time letting them

know that they are always welcome

to join the session.

Find a common ground that you can chat about: most often, this is music, and sometimes sport. They are two things that transcend cultures and ages, genders and religions. You don’t meet many people not into one or the other. If not, then find that common thing that you can get them talking about: whatever they’re into. –Livewire facilitator

Let them know they can join the workshop in their own time or just sit and watch so they don’t feel pressured, and also feel like they have a choice and that I respect their space. – Livewire facilitator

Facilitators also described how they

often adapt activities for young

people with physical or cognitive

impairment, provide extra assistance

and provide a variety of options in

order to ensure that everyone has the

opportunity to participate.

One of the patients we were working with loved engaging in our workshops but had difficulty concentrating on detailed tasks, and also had a tendency to get violent and throw things. We were conducting an art workshop with stencils, which was a little challenging for this patient so we simplified it and just allowed her to paint whatever she liked. We also limited her to one paintbrush and ask for a nurse to assist in the likelihood that she felt the need to throw it. - Livewire facilitator

Figure 5: Facilitators describing what type of quality they would see in a

friend that they would recommend to work for Livewire


Health professionals 13 health professionals from the Banksia Mental Health Unit responded to the online survey.

Respondents included nurses, teachers and administrative support staff as illustrated in Figure 6 below:

9

2

1

Nurse Teacher Admin Support N/A

Figure 6: Role of Banksia Unit staff members who participated in the survey

More than half (69.2%) of survey respondents had observed 20 or more

Livewire sessions on the Banksia Unit.

0

3

1

0

9

0

1

2

3

4

5

6

7

8

9

10

0 times 1–5 times 5–10 times 10–20 times 20+ times

Figure 7: Number of times staff members have been on the unit when a Livewire session has taken place

84% of health professionals rated the activities provided as being well matched

for young people (see Figure 8).

[Livewire facilitators are] well prepared with activities that are age appropriate. – Nurse, RCH

Health professionals reported that fun and well matched activities are the main

ways in which the Livewire facilitators succeed in engaging young people.

1 2 2

7

12

1

0

2

4

6

8

10

12

14

1. com

plet

ely fa

lse 2 3 4 5 6 7 8 9

10. c

ompl

etely

true

Tota

l

Skip

ped

Figure 8: Health professionals rating the appropriateness of Livewire activities for young people


Analysis of the surveys and sessions that were documented on the Banksia Unit identified what young people, health

professionals and Livewire facilitators (across all sites) valued the Livewire program. These overall views are summarised

in the table below.

Young people Health professionals Facilitators

Livewire has a wide range of positive impacts on young people

Young people value the program Health professionals value the program

Young people look forward to LivewireYoung people look forward to Livewire

Livewire fosters social connections (during the session and improves dynamics on the ward afterwards)

Livewire fosters social connections (during the session)

Livewire lifts mood of young people

Livewire builds self-esteem and self-efficacy

Young people on mental health wards need longer to engage

Livewire fills a service gap

Wish for increased Livewire hours Wish for increased Livewire hours

Livewire assists hospital staff in their role

Livewire facilitators are highly engaged in their job and feel passionate about Livewire

Positive Impacts

Health professionals stated that the Livewire program has a wide range of positive impacts on young people

0

1

2

3

4

5

6

7

8

Youn

g pe

ople

in goo

d m

ood

Enga

gem

ent

Socia

l con

nect

ions

Inclu

sive of

eve

ryon

e

Incr

ease

in se

lf-es

teem

Impr

ovem

ents in

men

tal h

ealth

Youn

g pe

ople

learn

t new

skills

Enou

gh LW te

am m

embe

rs p

rese

nt

Fun

activ

ities

Frien

dly c

hatti

ng

Nurse

s can

ass

ist

Youn

g pe

ople

are re

laxe

d

Figure 9: Positive impacts of Livewire session on young people as observed by health professionals


Health professionals value the

program

Livewire was also highly valued

by the 13 health professionals

that participated in the survey and

comments included clear support

for the program:

Engagement, acceptance and respect of the young person by the Livewire team builds self-esteem and self-efficacy. The young people feel validated as legitimate patients within RCH.– Teacher, RCH

It provides a structured, fun and engaging program that allows patients to do something creative and interesting. This can then facilitate time/space for myself to engage with a patient who is not involved in the group. – Mental health nurse, RCH

Livewire shows the young people that there are good people in the world. – Admin support, RCH

Young people look forward to

Livewire

77% of health professionals rated that

young people look forward to

Livewire days as a 9 or 10 out of 10.

Hospital staff members identified the

main strengths of Livewire facilitators

was their ability to:

• Tailor activities to meet the

interests of the young people;

• Treat all young people as unique

individuals, making an effort to

connect with each individual

attending the session; and

• Be recognised by the young

people as independent of the

treating medical team.

I like how they learn all young people’s names. Ask individuals what they like to do.– Teacher, RCH

Livewire fosters social connections

Both Livewire facilitators and RCH

hospital staff noted that Livewire

sessions create opportunities for

young people to engage positively

with each other on the ward.

It was noted by both Livewire

facilitators and hospital staff that

sometimes the mood on the ward

can be tense with members of a

group being excluded or talked

about behind their back.

Negative group dynamics can be hard to break, especially when members of a group are excluding or talking about another member, present or not. – Livewire facilitator

When conducting a workshop there was quite a bit of tension in the ward between the patients and some of them began to verbally lash out at each. – Livewire facilitator

However, following a Livewire session

the atmosphere on the ward was

described as friendlier, more

relaxed and more inclusive.

[After a Livewire session] the young people are better at connecting with each other, they have something fun from

the previous day to talk about, they are excited for the next visit. – Mental Health Nurse, RCH

The ward generally seems more settled, young people are in good spirits and continue to interact with each other. – Teacher, RCH

They are up-beat and happier. They may have developed confidence to engage with other young people on the ward. Sometimes they stop isolating themselves to participate in the program. – Nurse, RCH

Additionally, health professionals

valued that young people have

access to adults other than the

medical staff. One nurse stated that

Livewire facilitators serve as role

models to the young people.

Livewire lifts the mood of

young people

Hospital staff reported that Livewire

sessions alleviated boredom,

enhanced mood, reduced stress

and anxiety, and left young people

feeling more relaxed.

[After a Livewire session] some of the changes I notice are improved mood, decreased anxiety, distracted from problematic thoughts, more inclusive group, happier, less bored and frustrated. – Nurse, RCH

They are upbeat and happier. – Nurse, RCH


92% of staff reported that Livewire helps to reduce anxiety and stress as eight

out of 10 or higher. 53% rated the statement as 10 out of 10 (completely true,

Livewire helps to reduce anxiety and stress) – see below Figure 10.

0

1

2

3

4

5

6

7

8

1. com

plet

ely fa

lse 2 3 4 5 6 7 8 9

10. c

ompl

etely

true

Figure 10: Hospital staff rating whether Livewire helps to reduce anxiety and stress

100% of hospital staff reported that Livewire promotes improved mood.

50% rated the statement as completely true – see Figure 11 below.

0

1

2

3

4

5

6

7

1, com

plet

ely fa

lse 2 3 4 5 6 7 8 9

10, c

ompl

etely

true

Figure 11: Hospital staff rating whether Livewire promotes improved mood

Additionally, respondents highlighted that Livewire takes the focus off the

young person’s illness and allows young people to be young people.

It is not clinically driven [and] it is presented in a fun way allowing the young people to be adolescents. – Nurse, RCH

The young people forget that they are in hospital because they are having a fun session where they can interact with peers and adults in an enjoyable way.– Nurse, RCH

Livewire builds self-esteem and

self-efficacy

Several health professionals

stated that due to the inclusive

nature of the Livewire sessions

and the way in which Livewire

facilitators interact with young

people the young people feel

valued, heard and special.

Hospital staff especially

mentioned the respectful and

non-judgmental way in which

facilitators engage with the

young people and how this can

enhance the young person’s

self-esteem.

Acceptance and respect of the young person by the livewire team builds self-esteem and self-efficacy. – Nurse, RCH


In Figure 12 below the majority of respondents rated highly the efforts Livewire

facilitators made to engage young people in the program.

0

1

2

3

4

5

6

7

8

1. com

plet

ely fa

lse 2 3 4 5 6 7 8 9

10. c

ompl

etely

true

Figure 12: Hospital staff rating whether Livewire facilitators make efforts to include all participating young people

Wish for increased hours

A strong theme among the staff on the Banksia Unit was the wish for an

increase in Livewire hours. 80% of staff mentioned in an open question that

they wanted more sessions throughout the week.

Have them on the ward more often – Nurse, RCH

More Livewire !!! – Nurse, RCH

Additionally, one staff member raised the need to make sessions longer in

order to be able to undertake more activities that are safe for young people

with a mental health issue and to give young people who take longer to warm

up an opportunity to participate.

Livewire assists hospital staff in their role

Staff members also noted that the presence of the Livewire team on the ward

makes their work with the young people easier, both during and after

completion of the Livewire workshop.

It allows a period of structure and containment on the ward that does not rely

on the regular staff to fully organise, contain and run. This gives us time to

work with other young people individually that may have otherwise missed

out. It allows us a little more time to develop their treatment plans further with

other members of their treating team.- Nurse, RCH

One staff member highlighted that Livewire allows her to undertake

therapeutic work with socially anxious young people. Staff also mentioned

they value being part of the sessions themselves as it improves their own

relationship with the young people and supports engagement between

patients and medical staff.


Livewire is highly valued by young

people, health professionals and

Livewire facilitators. This evaluation

was undertaken to understand the

impact of the Livewire program in

mental health units across six

paediatric centres, including a

more in-depth evaluation of the

program offered at the Banksia

Unit at the RCH.

An initial literature review was

problematic as very little had been

reported on the impact of arts

programs in mental health units

where young people are treated.

As a result, a decision was made to

focus the review on the impact of

peer support in mental health units.

Peer support appears to be an

effective adjunct to care and

treatment for consumers with a

range of mental health disorders,

however further research is

warranted to clearly delineate

potential effects following exposure.

Emerging evidence suggests that

non-clinical PSWs may improve the

self-esteem and self-efficacy of

consumers, however due to the small

number of research articles reviewing

non-clinical PSWs in mental health

settings it proved difficult to evaluate

the validity of their effect. Because

much of the literature focused on

PSWs with a lived experience of

mental illness, further research needs

to be conducted on the effectiveness

of non-clinical PSWs before a clear


The literature review and the

results of the evaluation suggest

that further investigation is required

to determine where the Livewire

facilitator role fits in the delivery

of mental health services.

Fourteen Livewire workshops were

provided and documented across six

sites. These workshops made contact

with 88 young people. The average

number of participants per session

was six, one third were boys and two

thirds were girls with an estimated

average age of 14.4 years. Livewire

sessions lasted on average for one

hour. A range of activities were

offered during the Livewire sessions

including: art and craft; card and

board games; music; electronic

games; and, talking about topics of

interest. The workshops are well

attended with an average of 68% of

young people who were admitted to

the mental health units participating

in Livewire sessions.

The more in-depth evaluation

undertaken at the Banksia Unit at the

RCH reached 19 young people and

13 health professionals through a

mixture of surveys and direct

feedback from young people. More

than half of the health professionals

had observed more than 20 Livewire

sessions. The health professionals

reported that the provision of fun and

well-matched activities was the key

way the Livewire facilitators engaged

young people.

DISCUSSION AND CONCLUSION


The key findings of the evaluation were:

• Livewire is highly valued by hospital staff and young people

• Livewire fosters social connections

• Livewire lifts the mood of young people

• Livewire builds self-esteem and self-efficacy

• Young people on mental health wards need longer to engage

• Livewire fills a service gap

• Wish for increased hours

• Livewire assists hospital staff in their role

• Livewire facilitators are highly engaged in their job and feel passionate about Livewire.

Livewire fosters social connections and plays a key role in lifting the mood of young people. Livewire also plays a role in building self-esteem and self-efficacy in young people providing a program that engages them and improves their well-being.

The program is highly valued by

young people, health professionals

and Livewire facilitators. Both hospital

staff and young people requested

increased hours of operation.

The results of the evaluation support

the continued provision and possible

expansion of the Livewire program

to adolescent mental health units

across Australia.

The Livewire evaluation on the

mental health ward at the RCH

highlighted found that Livewire is

highly valued by hospital staff and

young people and both hospital staff

and young people wish for extended

Livewire hours, Livewire fosters social

connections and lifts the mood of

young people. It was also shown that

Livewire builds self-esteem and

self-efficacy in young people and

provides them with a service that

engages them in a respectful way,

giving them autonomy and providing

them with an environment in which

contributes to their overall well-being.


REFERENCES

Australian Institute of Health and Welfare 2011.

Young Australians: their health and wellbeing 2011.

Cat. no. PHE 140 Canberra: AIHW.

Bracke P., Christiaens W. & Verhaeghe M. (2008). Self-esteem,

self-efficacy, and the balance of peer support among persons

with chronic mental health problems. Journal of Applied

Social Psychology, 38(2), 436–459.

Brown L., Shepherd M., Merkle E., Wituk S. & Meissen G.

(2008). Understanding how participation in a consumer-run

organization related to recovery. American Journal of

Psychology, 42, 167-178.

Carpinello S., Knight E., Markowitz F., Pease E. (2000).

The development of the mental health confidence scale:

tJournal, 23, 236–243.

Castelein S., Bruggeman R., van Busschbach J. T., van der

Gaag M., Stant A. D., Knegtering H. & Wiersma D. (2008).

The effectiveness of peer support groups in psychosis: a

randomized controlled trial. Acta Psychiatrica Scnadanavica,

118(1), 64-72.

Corrigan P., & Watson A. (2002). The paradox of self–stigma

and mental illness. Clinical Psychology: Science and Practice,

9(1), 35–53.

Corrigan P., Watson A. & Barr L. (2006). The self-stigma of

mental illness: Implications for self-esteem and self-efficacy.

Centre for Psychiatric Rehabilitation at Evanstown

Northwestern Healthcare, 25(9), 875-884.

Davidson, L., Chinman, M., Kloos, B., Weingarten, R., Stayner,

D., & Tebes, J.K. (1999). Peer support among individuals with

severe mental illness: A review of the evidence. Clinical

Psychology Science and Practice, 6, 165–187.

Davidson L., Chinman M., Sells D. & Rowe M. (2006). Peer

support among adults with serious mental illness: A report

from the field. Schizophrenia Bulletin, 32(3), 443-450.

Davidson L., Shahar G. & Stayner D. (2004). Supported

socialization for people with psychiatric disabilities: Lessons

from a Randomized Control Trial. Journal of Community

Psychology, 32(4), 453-477.

Department of Health (2011). Framework for

Recovery-Orientated Practice. Retrieved from

http://docs.health.vic.gov.au/docs

doc/0D4B06DF135B90E0CA2578E900256566/$FILE/

framework-recovery-oriented-practice.pdf

Gaag M., Stant D., Knegtering R. & Wiersma D. (2008).

The effectiveness of peer support groups in psychosis:

A randomised controlled trial. Acta Psyhchiatrica

Scandinavica, 118, 64-72.

Gillard S., Gibson S., Holley J. & Lucock M. (2014).

Developing a change model for peer worker interventions

in mental health services: A qualitative research study.

Epidimiology and Psychiatric Sciences, 24(5), 435-445.

Humphreys, K. (1997). Individual and social benefits of mutual

aid and self-help groups. Social Policy, 27, 12–19.

McGorry, P., Bates, T., & Birchwood, M. (2013). Designing

youth mental health services for the 21st century: examples

from Australia, Ireland and the UK. The British Journal of

Psychiatry, 202(s54), s30-s35.

Pistrang, N., Barker, C., & Humphreys, K. (2008). Mutual help

groups for mental health problems: A review of effectiveness

studies. American Journal of Community Psychology, 42,

110–121.

Raiff, N. R. (1984). Some health related outcomes of self-help

participation. In Gartner, A., & Riessman, F., (Eds.), The

self-help revolution (pp. 183–193). New York: Human

Sciences Press.

Repper, J., & Perkins, R. (2003). Social inclusion and recovery:

A model for mental health practice. London: Bailliere Tindall.

Resnick S. & Rosenheck R. (2008). Integrating Peer-Provided

Services: A quasi-experimental study of recovery orientation,

confidence, and empowerment. Psychiatric Services, 59(11),

1307-1314.

Rogers S., Teague G., Lichenstein C., Campbell J., Lyass A.,

Chen R. & Banks S. (2007). Effects of participation in

consumer-operated service programs on both personal and

organizationally medicated empowerment: Results of

multisite study. Journal of Rehabilitation Research and

Development, 44(6), 785-800.

Valmaggia L., van der Gaag M., Tarrier N., Pijnenborg M.,

Slooff C. (2005). Cognitive-behavioural therapy for refractory

psychotic symptoms of schizophrenia resistant to atypical

antipsychotic medication – randomised controlled trial.

British Journal of Psychiatry, 186, 324–330.

Warren J., Stein J., Grella C. (2007). Role of social support and

self-efficacy in treatment outcomes among clients with

co-occurring disorders. Drug Alcohol Dependancy, 89(2-3),

267-274.


A FORMATIVE EVALUATIONBACKGROUNDYoung people are central to the work of the Starlight Children’s Foundation. In 2006 following a needs analysis, Starlight identified a gap in the availability of hospital‑based and online peer support programs that addressed the psychosocial and emotional wellbeing of adolescents with a serious/chronic illness or disability.

Livewire In-Hospital transforms the hospital experience of young people through the provision of meaningful activities that enhance personal development, recognising their need for targeted and age‑appropriate programs to support them. Young people are encouraged to use their creativity and learn new skills through ward‑based activities, skill‑based workshops and event nights that are age, gender and culturally appropriate.

Even if a young person is in hospital for just a short stay they can join livewire.org.au and gain access to written content, music and blogs. In‑Hospital Facilitators can sign up young people to livewire.org.au.

Starlight’s Livewire program provides opportunities for young people to explore their creativity, to develop new skills and to connect with peers, enhancing psychosocial well‑being and autonomy.

Livewire Facilitators deliver a range of meaningful and enjoyable arts, recreational and social activities designed to meet the needs of hospitalised adolescents.

starlight.org.au

LIVEWIREIn-Hospital Program: Reflections on the first six months

RESEARCH & EVALUATION SNAPSHOT

Supported by

APPENDIX A


starlight.org.au

AIMS OF THE EVALUATIONA formative evaluation was undertaken after the Livewire program had been operating for six months.

Formative evaluations typically occur in the early developmental stages of a program. They aim to strengthen or improve programs by reviewing the delivery of a program, the quality of its implementation and the assessment of the organisation’s context, personnel, procedures and resources to highlight any potential barriers and make recommendations to support successful program delivery (McNamara, 2014).

This evaluation used both quantitative and qualitative methods:

– Review of program documents and relevant literature;

– Interviews with the National Livewire Manager, Livewire In-Hospital Program Manager (NSW, Qld, Vic) and Livewire In-Hospital Program Coordinator;

– Focus groups with Livewire Facilitators;

– Interviews with health professionals; and

– Case studies illustrating program impact.

Experience of hospitalised adolescentsResearch exploring adolescents’ experience of hospitalisation has shown that they are generally satisfied with the care provided, though there is a greater need for hospitals to consider their psychosocial well-being. The three most common hospital stressors are:

1. feeling restricted (e.g. feeling confined, controlled);

2. feeling disconnected (e.g. from everyday life, family, friends and peers); and

3. negotiating new relationships (e.g. new and complex relationships with staff and peers).

Young people in hospital need age appropriate support and interventions including recreation and leisure activities, greater control over activities, autonomy, privacy and peer support. Staff trained in the specialist needs of hospitalised adolescents is a key factor influencing adolescents’ experiences. Staff who were easy to talk to, good listeners, non-judgemental, reliable and who patients felt genuinely liked, respected, and accepted them were identified as people adolescents trusted with their care and were more likely to respond positively to them.

(Crnkovi, Divci, Rotim, and Cori, 2009; Ryan-Wenger & Gardner, 2012; van Staa, Jedeloo, and van der Stege, 2011).


Livewire In-Hospital (Livewire) was launched in 2012 and operates at the Royal Children’s Hospital (Melbourne), The Children’s Hospital (Westmead), Sydney Children’s Hospital (Randwick), John Hunter Children’s Hospital (Newcastle), Perth Children’s Hospital (Perth) and the Lady Cilento Children’s Hospital (Brisbane). The program was based on the successful trial of the Club Ado program at Princess Margaret Hospital (Perth).

In Australia, close to one in three admissions to paediatric hospitals are adolescents, and with survival rates improving for the most serious childhood medical conditions, there has been an increase in the number of young people being treated in specialist paediatric hospitals. As a result there is a growing need for specialist adolescent psychosocial services.


251

18

Members of the Livewire team reported that the:

– Impact of the program was overwhelmingly positive;

– Flexibility of the program was highly valued;

– Program facilitates peer support and friendship;

– Health professionals have welcomed the program;

– Facilitators enjoy their work;

– National Team (HQ) provided positive leadership and support for the program; and

– Hospitals have requested increased hours for the program.

Health professionals reported that Livewire is:

– Perceived as a positive and natural extension of the programs provided by Starlight for younger children;

– Highly valued by young people;

– Unique because it focuses on the needs of young people;

– Youth focused and the ‘face to face contact’ is essential to the success of the program;

– Available in the evenings and on weekends;

– Operated by experienced, professional, approachable and respectful Facilitators; and

– Provides services to both mental health and adolescent health units.

TOTAL Sep 12-Mar 13

Expected reach at

six months

Actual reach compared

to projected reach (%)

Royal Children’s Hospital, Melbourne

863 875 99

The Children’s Hospital at Westmead

1,194 875 136

Sydney Children’s Hospital 1,421 875 162

John Hunter Children’s Hospital

478 583 82

Total 3,956 3,208 123

RESULTS

Health professionals and Livewire Facilitators who participated in the evaluation were enthusiastic about the program and its positive impact on young people, and both recommended expansion of the program in the future.

FUTURE DIRECTIONSThis formative evaluation has demonstrated that the Livewire program has been a welcome addition to the services provided to young people in hospital. As a new program, its success has illuminated for health professionals that there was a gap in the services available to young people in hospital, particularly those in Mental Health Units.

Further development of the model underpinning the Livewire program will be undertaken as a result of this formative evaluation. Consultations with our hospital partners and the young people who use the program will be central when we undertake the planned outcome evaluation.

There is strong support for the program, best illustrated by health professionals who told us:

“We want them to be here more often.”

We want Starlight!”

“They’re great!

Program ReachFrom September 2012 to March 2013, the reach of the program exceeded the original target that was set at the commencement of the program. It was estimated that there would be 3,208 connections made with young people across the four hospitals in the first 6 months of operation.


RESEARCH AND EVALUATION AT STARLIGHTStarlight is committed to research and evaluation so that we can ensure our programs are making a significant difference to the lives of seriously ill children, young people and their families. If you would like to learn more about our work please email us at [email protected]

starlight.org.au

Identified Outcomes and Impacts of the Livewire In-Hospital Program

Short Term Medium Long Term

– Supports normalised experiences

– Enhanced relaxation, reduced stress

– Enhanced positive mood

– Increase in confidence and motivation

– Improved interpersonal/ social skills

– Enhanced sense of feeling respected and valued

– Enhanced knowledge, experiences and skills

– Satisfaction, sense of ownership and pride over work produced

– Reduction in pain and symptoms of illness

– Improved self-esteem, self-efficacy and resilience

– Reduction in depressive symptoms

– Improved social inclusion/enhanced team building skills

– Exploration of social identity

– Improved or increased knowledge of life and arts based skills

– Increased self-expression and creativity (ignition of/ discovered passion)

– Shortened hospitalisation and recovery times

– Increased independence, identity and self-determination

– Increased resilience

– Friendships and networks developed

– Enhanced life skills

– Talents discovered and skills identified continue to be used

– Aspirations for the future enhanced


CASE STUDY: CASSANDRA*

Staying busy, staying strong Cassandra has spent the past two months in isolation.

Complications following a transplant have meant that she will

need to remain in isolation until the risk of infection is reduced.

Cassandra spends a part of each day using her crafting skills

to personalise her room and learning new multimedia skills on

her MacBook – gifted by Starlight’s Wishgranting program.

Nurses were concerned that Cassandra’s limited social

interactions were having a negative impact on her mood and

well-being. Zach, a Livewire Facilitator recalls – “We were

referred to Cassandra by a health professional and so

we began to spend some time with her and she seemed

to really enjoy it... Our visits are now scheduled into her care

right after she has seen the physiotherapist. I think it really

shows how we have been integrated into the hospital system

– the fact they have scheduled us in says a lot.”

Livewire has provided a unique point of connection for

Cassandra with people who share her interests, support the

development of new skills and provide social interaction so

that she can stay focused, strong and motivated.

* pseudonym

REFERENCES: Crnkovi, M., Divci, B., Rotim, Z., & Cori, J. (2009). Emotions and experiences of hospitalized school age patients. Acta Clinica Croatica, 48(2), 125-135.McNamara, C. (2014). Basic Guide to Program Evaluation. Retrieved from http://managementhelp.org/evaluation/program-evaluation-guide.htmRyan-Wenger, N., & Gardner, W. (2012). Hospitalized Children’s Perspectives on the Quality and Equity of Their Nursing Care. Journal Of Nursing Care Quality, 27(1), 35-42.van Staa, A., Jedeloo, S., & van der Stege, H. (2011). “What we want”: chronically ill adolescents’ preferences and priorities for improving health care. Patient Preference And Adherence, 5, 291–305.


Description and documentation of LivewireDemographics collected by Livewire facilitators:

1. Total number of young people who participated.

2. Ages.

3. Gender breakdown.

4. Total number of young people admitted to the ward (to estimate inclusion).

Information collected from facilitators:

5. Activities offered.

6. Activities actually delivered.

7. Length of session.

8. Did any participants leave session? Reasons?

APPENDIX B


Young people questionnaireStarlight and the Banksia Unit are keen to find out what you think about the

Livewire sessions that are provided on the Unit. So today we are inviting you to

provide us with some feedback about the session you have just participated in.

Your participation is completely voluntarily and you do not have to participate.

Your feedback can be provided in response to some questions I am going to

ask you about the session, and we will also provide you with a paper survey

that you can complete and put into this feedback box later.

Your responses will be treated as confidential and you do not have to provide

any personal details. This research is being undertaken so that we can find

out what works well in the Livewire sessions and what we might be able

to improve.

General group questions (asked by Livewire facilitator):

1. What did you enjoy most about today’s session?

2. What did you enjoy least about today’s session?

3. What other services are there for you whilst you are staying in hospital?

4. What types of things do you like to do whilst you are staying in hospital?

5. What would you tell a new person staying in Banskia about Livewire,

if they had never been to a workshop before?

6. What three words would you use to describe Livewire to another

young person?

Paper-based questions (given to young people by Livewire facilitator):

7. Thinking about today’s workshop on a scale of 1 – 10 (10 being excellent

and 1 being very poor) how would you rate the session?

8. How responsive have the Livewire facilitators been to your requests

or interests?

9. Would you come back to another Livewire workshop? Yes. No. If no, why?

The following statements are included in Banksia Unit patient

satisfaction survey:

1. Livewire gave me opportunities to be creative.

2. Livewire gave me opportunities to socialise.

3. Livewire taught me something new, please specify.

APPENDIX C


Health professional questionnaireStarlight and the Banksia Mental Health Unit are inviting you to complete

this survey which is seeking your views on the Livewire program that is provided

in the Banksia Inpatient Mental Health Unit. We are seeking your views on the

Livewire sessions that are provided for inpatients. Your participation in the survey

is voluntary and you will not be identified by name. If you have any questions

about the survey please contact Ms Emma Barker by emailing [email protected].

au or Dr Ralph Hampson by emailing [email protected]

Demographics

1. Role.

2. Approximately how many times have you been on the unit when a Livewire

session has taken place (we’re still interested if this is zero)?

Please rate the following statements:

(1 = completely false; 10 = absolutely true)

3. Young people seem to look forward to Livewire days.

4. The activities offered by Livewire are well matched for teenagers.

5. Livewire facilitators make efforts to include all participating young people.

6. Young people interact warmly with each other during Livewire activities.

7. It is hard to motivate young people to engage with Livewire.

8. Livewire supports compliance with medical treatment.

9. Livewire promotes improved mood.

10. Livewire helps to reduce anxiety and stress.

11. Livewire helps to reduce complaints of pain or other physical symptoms.

Short answer response:

12. What factors would lead to a young person being excluded from participating

in a Livewire session?

13. What do you think happens in a Livewire session that benefits a young person?

14. What have you seen Livewire facilitators do to engage young person?

15. What would you want to change about the Livewire program?

16. What changes do you notice in the young people after a Livewire session?

17. If any, in what ways does Livewire support you caring for young people?

Open invitation to have a phone interview if they want to provide additional feedback.

APPENDIX D


Livewire facilitator questionnaireStarlight is inviting you to complete an online survey about the Livewire

Workshops you have delivered to the Mental Health Units in the week

November 16-22, 2015. This data is being collected to understand more about

the services we provide and how they are experienced by you and by the

young people who attended the sessions. Your participation is voluntary and

you will not be identified by name.

If you have any questions about the survey please contact Dr Ralph Hampson

on 0425 172 983 or by email: [email protected]

Please rate the following statements:

(1 = completely false; 10 = absolutely true)

1. Young people interact warmly with each other during Livewire activities.

2. It is hard to motivate young people to engage with Livewire.

3. I feel adequately trained to work with young people in mental health units.

Short answer response:

4. What are some of the first things you notice when you meet a

young person?

5. What is something that you know you can do to connect with a resistant

young person?

6. Tell us about a time when you have adapted an activity because of a

specific young person’s age, gender, ability, or culture.

7. Tell us about a time when you have felt really challenged working with a

young person.

8. Tell us about a time that you felt out of your depth.

9. What are the differences between the way young people on the mental

health unit and those on general wards engage with Livewire activities?

10. Imagine you have just left a mental health unit after a successful Livewire

session, what made it successful in your own words.

11. What type of quality would you see in a friend that you would recommend

this job to?

Open invitation to have a phone interview if they want to provide

additional feedback.

APPENDIX E


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ou

ts f

rom

th

e t

rial

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Lim

itat

ion

s

Par

ticip

ants

re

ceiv

ed

mo

neta

ry c

om

pe

nsa

tion

to

com

ple

te t

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rial

wh

ich

may

hav

e in

tro

du

ced

pe

rfo

rman

ce b

ias.

De

scri

ptio

n o

f th

e r

and

om

isat

ion

pro

cess

lack

ed

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il

Gaa

g, S

tan

t,

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eg

teri

ng

&

Wie

rsm

a

20

08

.

Ran

do

mis

ed

Co

ntr

olle

d T

rial

106

ad

ult

par

ticip

ants

with

a

psy

cho

tic d

iso

rde

r e

nro

lled

in

eith

er

the in

terv

en

tion

(50

) or

con

tro

l co

nd

itio

n (5

6).

Mea

sure

men

t to

ols

Co

mm

un

ity

Ass

ess

me

nt

of

Psy

chic

Exp

eri

en

ces

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PE

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Th

e M

en

tal H

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th C

on

fide

nce

Scal

e (M

HC

S)

Ro

sen

be

rg s

cal

e (s

elf-

est

ee

m)

WH

O Q

ual

ity

of

Life

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ale

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rve

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Pe

er

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rt

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Co

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TA

U

Pe

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ps

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ved

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en

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rve

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p h

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n

imp

rove

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oci

al n

etw

ork

an

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gre

ate

r su

pp

ort

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mp

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o

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l.

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lve

me

nt

in t

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ee

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sup

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rt g

rou

p a

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imp

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cac

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ual

ity

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life.

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ng

ths

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e p

rofe

ssio

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spo

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ble

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llec

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om

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ticip

ants

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de

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on

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on

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itat

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s

Ab

sen

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f at

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s

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eff

ec

t.

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ticip

ants

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ud

ed

we

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ll co

nsi

de

red

clin

ical

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le w

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h m

ay li

mit

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en

era

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lts

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ical

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ing

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e m

eas

ure

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nt

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ls a

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ll se

lf-re

po

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tho

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y D

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gn

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ple

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tin

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sure

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ain

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ng

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itat

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Dav

idso

n,

Shah

ar &

Stay

ne

r

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04

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Ran

do

mis

ed

Co

ntr

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d T

rial

260

ad

ults

with

a m

en

tal

illn

ess

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o w

ere

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cial

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iso

late

d. S

tud

y w

as u

nd

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in 1

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and

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of

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sure

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Th

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tre fo

r E

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bal

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nb

erg

Self-

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oci

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Rat

ing

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ale,

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bal

Ass

ess

me

nt

of

Fun

ctio

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Mo

difi

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,

Stru

ctu

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Clin

ical

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rvie

w

for

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d a

sat

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ure

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lop

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fo

r th

e

tria

l.

Co

ho

rt A

: V

olu

nte

ers

pro

vid

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pp

ort

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par

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rs w

ho

hav

e b

ee

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dia

gn

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sim

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psy

chia

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dis

abili

ty

Co

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rt B

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on

sum

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che

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co

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ity

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er

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pre

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usl

y d

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sum

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up

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we

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ing

pro

vid

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r e

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ter.

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ticip

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dar

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liab

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eas

ure

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nt

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ls w

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r th

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tud

y.

Th

ere

was

a lo

w r

ate o

f d

rop

ou

ts f

rom

th

e t

rial

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Lim

itat

ion

s

Par

ticip

ants

re

ceiv

ed

mo

neta

ry c

om

pe

nsa

tion

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ple

te t

he t

rial

wh

ich

may

hav

e in

tro

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ced

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rman

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ias.

De

scri

ptio

n o

f th

e r

and

om

isat

ion

pro

cess

lack

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il

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g, S

tan

t,

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eg

teri

ng

&

Wie

rsm

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20

08

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Ran

do

mis

ed

Co

ntr

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d T

rial

106

ad

ult

par

ticip

ants

with

a

psy

cho

tic d

iso

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r e

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lled

in

eith

er

the in

terv

en

tion

(50

) or

con

tro

l co

nd

itio

n (5

6).

Mea

sure

men

t to

ols

Co

mm

un

ity

Ass

ess

me

nt

of

Psy

chic

Exp

eri

en

ces

(CA

PE

)

Th

e M

en

tal H

eal

th C

on

fide

nce

Scal

e (M

HC

S)

Ro

sen

be

rg s

cal

e (s

elf-

est

ee

m)

WH

O Q

ual

ity

of

Life

Sc

ale

Inte

rve

ntio

n -

Pe

er

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po

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Co

ntr

ol -

TA

U

Pe

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sup

po

rt g

rou

ps

pro

ved

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en

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pe

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pto

ms

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rom

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mu

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e

inte

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rou

p h

ad a

n

imp

rove

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oci

al n

etw

ork

an

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gre

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pp

ort

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mp

are

d t

o

the w

aitli

st c

on

tro

l.

Invo

lve

me

nt

in t

he p

ee

r

sup

po

rt g

rou

p a

lso

imp

rove

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effi

cac

y an

d q

ual

ity

of

life.

Stre

ng

ths

Th

e p

rofe

ssio

nal

re

spo

nsi

ble

fo

r co

llec

ting

dat

a fr

om

par

ticip

ants

was

blin

de

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he c

on

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on

Lim

itat

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s

Ab

sen

ce o

f at

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e b

ee

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eff

ec

t.

Par

ticip

ants

incl

ud

ed

we

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ll co

nsi

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le w

hic

h m

ay li

mit

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lts

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clin

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ing

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e m

eas

ure

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nt

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ls a

re a

ll se

lf-re

po

rtin

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Gill

ard

,

Gib

son

,

Ho

lley

&

Luco

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Cas

e S

tud

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par

ticip

ants

wh

ich

we

re

pe

er

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erv

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n-p

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lin

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nta

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ross

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gla

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ure

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serv

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sers

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ff a

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ere

ask

ed

wh

at t

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pe

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ork

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tru

stin

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le

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gag

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th s

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mu

nity

sup

po

rts.

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ligh

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th

e

sig

nifi

can

ce o

f th

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sup

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hal

len

gin

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inte

rnal

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tigm

a.

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ng

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clu

de

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ran

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en

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ross

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gla

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mak

ing

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re g

en

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itat

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s

Smal

l sam

ple

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me

mb

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st a

n in

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e p

osi

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ed

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e r

esu

lts.

Re

snic

k &

Ro

sen

he

ck

20

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Qu

asi-

exp

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l stu

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ts (

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d 2

18 in

co

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) wh

o

we

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red

om

inan

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(95%

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e a

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gn

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s m

en

tal i

llne

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nd

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y o

f w

ho

m a

re a

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me

less

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e t

rial

to

ok

pla

ce

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mm

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ity

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abili

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sure

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cove

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nt

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atio

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gra

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ivid

ual

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ith a

live

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exp

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en

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up

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at u

sin

g

est

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eco

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ed

lite

ratu

re.

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p in

terv

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ere

con

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e a

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st in

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ort

sco

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nifi

can

tly h

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mp

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en

t.

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nt

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ay im

pro

ve

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eas

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th r

eco

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-ori

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re c

ust

om

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tilis

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.

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ng

ths

Larg

e s

amp

le s

ize

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itat

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s

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ticip

ants

we

re m

ost

ly m

ale li

miti

ng

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e

ge

ne

ralis

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lts

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tho

r/Ye

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gn

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ple

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sure

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ge

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t al

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20

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do

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ed

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ical

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al

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lti-s

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s o

f a

seri

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en

tal

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ess

ac

tive

ly in

volv

ed

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a

trad

itio

nal

me

nta

l heal

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ata

was

co

llec

ted

fro

m 7

diff

ere

nt

me

nta

l heal

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serv

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s in

var

iou

s st

ate

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f

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eri

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sure

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ess

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nt

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he M

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mp

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cal

e

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ts w

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rvic

e p

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com

bin

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s


160

49

1 N

ov

20

16

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