INTRODUCTION:Improving support for people affected by another's substance use disorder (affected family members [AFM]) is a priority, but implementation is challenging. This mixed-methods evaluation assessed the perceived effectiveness of SMART Family and Friends training and applied the Consolidated Framework for Implementation Research (CFIR) to examine program implementation. METHODS:N = 24 participants with professional or lived experience of supporting AFMs were recruited and trained to deliver groups. Training was evaluated using the Work Practice Questionnaire. Semi-structured interviews (n = 19) captured experiences of training and group delivery. Transcripts were analysed using iterative categorisation, informed by CFIR domains. RESULTS:Participants felt equipped to deliver groups (M = 20.79, SD = 3.09) and found the training useful (M = 28.40, SD = 2.74) and relevant (M = 27.16, SD = 2.85). The approach, applicability and structure of the intervention (intervention characteristics) promoted engagement. Workplace characteristics influenced time and resources available to support implementation, with adequate staffing paramount (inner setting). Participants identified a clear need for the program, but practical and attitudinal barriers complicated engagement (outer setting). Lived experience promoted facilitator engagement and also raised wellbeing and training considerations (individual characteristics). Challenges associated with delivery modality and experiences facilitating groups (implementation process) were identified. DISCUSSION AND CONCLUSIONS:SMART Family and Friends has potential for scaled implementation by peers and providers within voluntary positions and those employed within existing AOD and community service programs, although service limitations and barriers around help-seeking may hinder delivery. Efforts to address training and infrastructure considerations, particularly among those with lived experience, are needed. Improved understanding of the support needs and preferences of AFMs is warranted.

OBJECTIVES:Quality-of-life research in premature ovarian insufficiency is limited by the under-representation of women aged ≤25 and the lack of attention to how age at diagnosis shapes outcomes. This study addresses these gaps by employing recruitment strategies to increase participation of younger women, while exploring age at diagnosis as a key influence on their experiences. STUDY DESIGN:A qualitative design was employed using an online open-ended questionnaire distributed through social media support groups. Data was analysed using thematic analysis. RESULTS:Participants were 191 women aged 20-56 years from three English-speaking countries. Women described debilitating symptoms affecting sleep, cognition, mood, sexual functioning and relationships, alongside treatment-related burdens that disrupted education and employment. Difficulties accessing timely diagnosis and care were reported, citing provider knowledge gaps and limited adolescent-focused diagnostic expertise. A number of women disclosed a history of suicidal ideation, with some attributing it to untreated hormone-related symptoms and others to existential loss related to infertility and disrupted life trajectories. Age at onset shaped identity disruption; adolescence-onset was associated with developmental stalling. Women approaching midlife described a 'care cliff' where they felt abandoned by services. Across groups, interactions with healthcare providers were central to adjustment and long-term health. CONCLUSIONS:Reports of suicidal ideation highlighted the need for both optimised hormonal treatment and psychological support. Participants reported that many clinicians were inadequately prepared to manage the condition. Provider education in premature ovarian insufficiency is essential, particularly to improve timely adolescent diagnosis and prevent irreversible permanent developmental impacts.

Objectives This exploratory study identifies competency subgroups within a Clinical Psychology trainee sample. Subgroups will reflect supervisor-rated clinical competence following first practicum placement. The study also examines demographic and placement factors associated with subgroup membership.Methods Clinical supervisors completed the Clinical Psychology Practicum Competencies Rating Scale for 252 trainee participants. Latent profile analysis was conducted to determine if unobserved subgroups existed within the sample. Differences between subgroups in several demographic and placement factors were assessed using Bayesian t-tests.Results Latent Profile Analysis identified two subgroups: Higher Competency and Competent. The difference between these groups was only significant in the four clinical competency domains used in the analysis (e.g. scientist-practitioner). Secondary analyses revealed that the two groups were differentiated by the number of face-to-face placement hours completed at the time of the assessment.Conclusion The current study showed that unobserved subgroups based on competency are present within the sample of trainees. These groups differed significantly on Diagnosis and Clinical Assessment, Case Conceptualisation, Effective and Skilful Assessment and Intervention and Scientist-Practitioner competencies. This study enhances our understanding of between subgroup variations in competency attainment, extends our conceptualisation of competency profiles among trainees at first placement and helps plan training and supervision.

The experience of uncertainty is inherent to the practice of medicine. It influences healthcare professionals' perceptions of risk and decision-making. Our objective was to provide empirical insights into how healthcare professionals manage uncertainty and navigate risk related to antibiotics in residential aged-care facilities. Interview data from aged-care nurses was coded deductively, drawing on a taxonomy of uncertainty tolerance in medical decision-making developed by Han and colleagues (2021). Additional themes that did not map onto existing codes were inductively coded. Views from the 16 nurses in the study revealed use of a wide range of strategies that often co-occurred when managing their uncertainty. Consulting with colleagues and deferring to others were the most commonly used strategies to reduce uncertainty. 'Avoidance' and 'reflection' were response-focused strategies that had not been previously described in the taxonomy. Managing uncertainty is an active and ongoing process that requires clinicians to engage multiple strategies, often with conflicting aims. These findings have implications for deepening our understanding of how uncertainty affects healthcare professionals engaged in risk work. They also highlight the need to expand educational interventions to include cognitive strategies focused on managing uncertainty. Additionally, the findings point to the importance of involving multiple stakeholders in sharing the burdens associated with uncertainty in clinical decision-making.

ObjectiveThe impostor phenomenon theoretically emerges early in psychology training, with implications for personal and professional well-being, including development of reflective-practitioner and other competencies, professional identity formation and career longevity. The present study is one of few studies directly examining the impostorism construct among trainee psychologists, and the first to examine the relationship between impostorism and mindfulness.MethodThe Leary Impostorism Scale and Five Facet Mindfulness Questionnaire - Short Form were used to assess impostorism and mindfulness among 231 trainee psychologists enrolled in a Master of School, Professional or Clinical Psychology at an Australian university.ResultsResults indicated trainee psychologists experience impostorism. Increased mindfulness was associated with decreased impostorism, but only three of five mindfulness facets uniquely predicted impostorism.ConclusionUnderstanding the relationship between key mindfulness mechanisms and impostorism is necessary for training institutions, clinical supervisors and trainee psychologists themselves to inform early intervention within and beyond pedagogical approaches in clinical training.

OBJECTIVE:Mindfulness training (MT) in healthcare training has been associated with improvement in mental wellbeing and clinical skills such as empathy. Despite this, it is often challenging for professional psychology programs to include MT in the curriculum due to competing coursework demands and staffing requirements. The current study aimed to determine whether changes in mindfulness, self-compassion and tolerance of uncertainty were equivalent for those completing MT face-to-face on campus or online. METHOD:Ninety-eight professional psychology trainees completed pre-post measures of Mindfulness, Self-compassion, and Tolerance of Uncertainty. Fifty-eight participants completed it on campus and 40 participants completed it online. RESULTS:A series of one-way ANOVAs found no significant differences in change between the two delivery mode groups on seven of the eight variables. There was a very small significant difference for self-compassion with those in the campus group showing slightly higher increases compared to the online group. CONCLUSION:Changes in mindfulness and related variables appear to be similar whether MT occurs face-to-face or via online delivery. Thus, providing online MT may address difficulties related to staffing and timetabling that previously prohibited its inclusion in coursework.

People accessing alcohol and other drug (AOD) treatment experience high rates of loneliness, which is a strong driver of substance use. Groups for Belonging is a 6-session group-based intervention that combines elements of the social identity informed intervention Groups for Health with psychoeducation and strategies to help participants manage loneliness and overcome cognitive barriers to social connection. The project will examine the effectiveness and cost-effectiveness of delivering Groups for Belonging within routine care offered by AOD treatment providers in Australia. Participants will be adults attending residential or community-based AOD treatment provided by either public sector or non-government treatment providers across New South Wales (NSW), Victoria (VIC), Queensland (QLD) and the Australian Capital Territory (ACT) in Australia. The study will be conducted as a parallel cluster randomized controlled trial (RCT), involving 26 clusters (13 treatment, 13 control, N = 520), with randomization occurring at the service level. Depending on randomization, participants will either complete treatment as usual (i.e., AOD treatment provided by participating services) or Groups for Belonging and treatment as usual. This study aims to determine the effectiveness of a loneliness intervention, Groups for Belonging, for people accessing residential and community-based treatment for AOD use. If the intervention is effective and cost-effective, implementation efforts will focus on embedding the intervention into routine care in AOD treatment services across metropolitan and regional areas in Australia. This has significant potential to decrease loneliness and its associated effects on health and wellbeing for people accessing AOD treatment. Australia and New Zealand Clinical Trials Registry, CTRN12625000132448 ( https://www.anzctr.org.au/ACTRN12625000132448.aspx ). Registered on 6 February 2025.

BACKGROUND:Previous research suggests telephone-delivered continuing care interventions are effective in reducing rates of substance use. This study assessed the effectiveness of telephone-delivered continuing care for people who had stayed in a residential alcohol and other drug (AOD) treatment facility for at least 4-weeks. METHODS:Participants were 277 (20 - 71 years; M = 38 years, SD = 10.4; 58 % male) individuals attending residential AOD treatment. Following discharge participants were randomised to: i) 12 weekly telephone sessions; ii) 4 weekly telephone sessions; or iii) no telephone sessions (control group). A multi-centre prospective, randomised, open, blinded endpoint (PROBE) design compared three study arms with follow up at 3- and 6-months. Primary outcome was the odds of complete abstinence and the days of AOD use for those not completely abstinent at 6-months. RESULTS:At 6-months follow-up, the odds of being completely abstinent in the past month was not significantly different between the three study arms (p > 0.6) and the number of days abstinent was not significantly different (p > 0.4). Participants across all arms were more likely (p <  0.001) to be completely abstinent compared to baseline [12-session OR = 12.86 (5.4, 30.9); 4-session OR = 9.52 (4.0, 22.4); Control OR = 7.02, (3.4, 14.7)]. CONCLUSIONS:The results suggest that the residential programs are associated with positive long-term impacts among participants who complete at least 4 weeks of treatment. Further continuing care research should include those who do not remain in treatment for at least 4 weeks, as they may be likely to benefit the most.

Continuum conceptualizations of mental illness are prevalent in adolescent mental health promotion despite a lack of research into how they relate to mental health stigma and help-seeking and help-providing intentions. Moreover, adolescent males are one of the least likely populations to seek help for a mental illness. The present study examined the relationship between continuum beliefs about mental illness in general, stigma, help-seeking intentions, and help-providing intentions, in a sample of 591 adolescent males aged between 12 and 18 years. Results revealed that stronger continuum beliefs predicted lower social distance toward people with mental illness. Continuum beliefs also weakly predicted greater intentions to seek help from formal and informal sources via an indirect path with social distance as a mediating variable. Similarly, the relationship between continuum beliefs and intentions to provide help was mediated by social distance. There was a direct relationship between higher continuum beliefs and lower intentions to not seek help. These findings suggest that promoting continuum beliefs may be beneficial in reducing social distance among adolescent males, which may in turn promote help-seeking and help-providing intentions. Future research using experimental manipulations of adolescents' continuum beliefs could help to clarify these potentially causal relationships.

Aim. Diagnostic uncertainty, risk perceptions, time constraints, and pressure from resident/family members and nurses have been identified as potential barriers to reducing antibiotic prescribing in residential aged-care facilities. The current study investigated the relationship between nurses’ anxiety, clinical tolerance of uncertainty, and behaviors that favor antimicrobial initiation. Methods. A cross-sectional online survey was used to present a clinical vignette with measures of situational anxiety, clinical tolerance to uncertainty using the Physicians Reactions to Uncertainty Scale (adapted for nurses), and self-reported behavior on the Immediate Assessment and Antibiotics scale. The vignette described a hypothetical resident with a potential upper respiratory tract infection. Incremental information was provided with varying levels of symptoms, input from aged-care staff, and the availability of test results. Results. A total of 157 registered and enrolled nurses completed the survey from August 2021 to August 2022. Nurses’ anxiety fully mediated on the relationship between clinical tolerance of uncertainty and perceived need for antibiotics and immediate assessment ( P = 0.004), with 6% of variation explained by the model. Significant effects of clinical tolerance of uncertainty on anxiety ( P < 0.001) and anxiety on antibiotic initiation ( P = 0.002) were found, but there was no significant direct effect between clinical tolerance of uncertainty and antibiotic initiation ( P = 0.34). Conclusions. This is the first study that links perceived need for antibiotics and assessment to nurses’ anxiety and clinical tolerance of uncertainty. Thus, it may be that providing strategies for the management of anxiety related to uncertainty could nullify some processes contributing to inappropriate prescribing in aged-care settings Highlights The impact of non-clinical factors (e.g., resident and family preferences) on prescribing is well-established. There is a gap in the literature regarding the mechanisms through which these preferences are experienced as pressure by prescribers within the unique context of residential aged-care facilities (RACFs). A significant relationship was found between nurses’ anxiety, clinical tolerance of uncertainty, and the perceived need for antibiotics and assessment. As such, there is a need to expand stewardship beyond education alone to include interventions that help nurses manage uncertainty and anxiety and include other stakeholders (e.g., family members) when making clinical decisions in the RACF setting.

Introduction Improving support options for people who use methamphetamine is of critical national and global importance. The role of mutual-help groups within the treatment-seeking journey of people who use methamphetamine is unclear. Self-Management and Recovery Training (‘SMART Recovery’) mutual-help groups are led by a trained facilitator and support participants to work on individual goals, including, but not limited to abstinence. This study examined how people who use methamphetamine came to be involved in SMART Recovery mutual-help groups and factors associated with engagement. Methods A sample of Australian SMART Recovery participants who self-reported using methamphetamine in the preceding 12-months (n = 18) discussed their history of substance use and experience of service provision in a semi-structured telephone interview. Interviews were audio-recorded, transcribed, and analysed using iterative categorization. Results Participant initiation of SMART Recovery groups was described across two themes: i) delayed attendance and ii) use as an adjunct to other services. Factors associated with engagement were discussed in terms of: i) the ‘fit’ of SMART Recovery mutual-help groups; ii) coping and tolerance of discomfort; iii) the power of shared lived experience; iv) choice and autonomy; and v) short-term goal setting supports self-efficacy and the possibility of change. Discussion and conclusions SMART Recovery mutual-help groups show promise for engaging people who use methamphetamine. There is a clear need to improve awareness of mutual-help group options amongst service users, providers and the general community. Offering choice over mutual-help groups may help to engage people earlier and support improved linkage between services.

AimThe purpose of the current study was to develop and assess the psychometric properties of a measure that captures nursing behaviours that have the potential to influence the initiation of antibiotics in residential aged-care facilities.DesignCross-sectional online survey.MethodOne hundred and fifty-seven nurses completed an online survey. The survey consisted of two clinical vignettes and measures of tolerance of uncertainty and anxiety. The vignettes consisted of the most common presentations (urinary tract infections and upper respiratory tract infections) of two hypothetical residents in aged-care facilities. The vignettes provided participants with incremental information with varying levels of symptoms, input from other people and availability of test results. Both vignettes were subjected to exploratory factor analysis.ResultsThe results focus on the 16 items in the second vignette which resulted in the extraction of three factors. The derived factors were labelled as follows: (i) Noting and Calling GP, (ii) Consult a Colleague and (iii) Immediate Assessment and Antibiotics. Reliability analysis revealed excellent to satisfactory reliability. All three scales were significantly correlated with measures of clinical tolerance of uncertainty, and the 'noting and calling GP' scale was also negatively correlated with measures of anxiety and general tolerance of uncertainty. The measure showed satisfactory reliability and validity for capturing nursing behaviours that have the potential to influence decisions regarding antibiotics. As such, the current study provides a first step towards addressing the lack of ecologically valid measures that capture the complex and nuanced context of nurses' behaviours in RACF that have the potential to inform future stewardship interventions.

Clinical training can represent a time of great uncertainty for trainee psychologists. Existing research has identified a relationship between low tolerance of uncertainty and a range of negative physiological and psychological reactions, as well as an increased potential for burnout. We developed a mindfulness program to support trainees in their clinical training and proposed that increased mindfulness and self-compassion would support an increase in the tolerance of uncertainty experienced by trainees. Postgraduate psychology students who completed the 6-week mindfulness program as part of the curriculum were invited to participate in the study. Pre- and postintervention measures regarding mindfulness, self-compassion, and tolerance of uncertainty were completed (n = 98). Significant increases in the mindfulness facets of nonjudging, nonreacting, and observing as well as self-compassion were found, while a significant decrease in Uncertainty Reluctance to Disclose and Uncertainty Stress was also noted. Regression models revealed that the change in mindfulness facets nonjudging and nonreacting represented the largest effect on Uncertainty Reluctance to Disclose, while the change in self-compassion represented a smaller, significant effect. Nonjudging and self-compassion were found to have a marginal but not significant effect on Uncertainty Stress. Supporting trainee psychologists to tolerate the uncertainty inherent to clinical work is an important aspect of university training programs. Mindfulness programs can support student learning and potentially reduce burnout through the promotion of a nonjudging, nonreactive, and self-compassionate stance that may encourage trainees to disclose their uncertainty and seek support.

Objective Gatekeeper training programs are widely used with promising results for suicide prevention. However, studies have found that when delivered to Indigenous communities, outcomes can be variable or ineffective. This study is a feasibility trial of a gatekeeper program based on the standardised ‘Question, Persuade and Refer’ (QPR) approach, which was adapted to the cultural needs of local Aboriginal communities in the Shoalhaven region of New South Wales, Australia. The study aims to identify whether 1) knowledge of suicide and intentions to help increase over the course of completing the gatekeeper program; 2) participants of different educational backgrounds have similar outcomes in suicide literacy and intentions to help; and 3) Aboriginal people and non-Aboriginal people have similar outcomes. Methods One hundred individuals participated in the research, of which 50% identified as an Aboriginal person. Pre- and post-training questionnaires assessed whether participants experienced an increase in suicide literacy and intentions to support others at risk of suicide. Results Although pre-test scores for suicide literacy and intentions to help were high, these increased significantly from pre- to post-test. Those with no prior gatekeeper training showed larger changes in both suicide literacy and intentions to ask about suicide compared to those with prior training. Conclusion Overall, this study highlights that delivery of culturally adapted gatekeeper training is associated with improved suicide literacy and intentions to ask about suicide amongst trainees.

We examined the relationship between pre-existing beliefs regarding the functions of self-harm and helping/discriminatory responses in an undergraduate sample ( N = 237). Helping and discriminatory responses to self-harm were compared with an existing psychophysical measure that generated thresholds for helping intentions based on the frequency of self-harm behaviors (scratches) presented (Turner et al. in Journal of Psychopathology and Behavioral Assessment , 2021). Participants viewed one of three vignettes depicting self-harm as either hidden or displayed with a third control condition where no information about the self-harm was provided (control). The vignettes aimed to infer either an interpersonal (displayed) or intrapersonal (hidden) motivation (vs the control). Participants completed questionnaires assessing responses towards the vignette, help-seeking attitudes, beliefs about the functions of self-harm, and a computer-based task assessing helping-intentions for self-harm. Results indicated that stronger endorsement of self-harm having interpersonal functions were related to more discriminatory responses. Conversely, endorsement of intrapersonal functions were related to less discriminatory responses. Participants’ responses to self-harm were consistent with the attribution model of stigma (Corrigan et al. in Journal of Health and Social Behavior, 44 (2), 162–179, 2003), and components of a parallel ‘danger-appraisal’ hypothesis wherein discriminatory responses related to perceptions of dangerousness are mediated by fear, rather than personal responsibility beliefs. Differences in thresholds and helping/discriminatory responses between vignette conditions were not significant. Participants’ thresholds were not significantly correlated with other measures of help-seeking attitudes or helping/discriminatory responses. These results suggest that beliefs regarding the functions of self-harm account for significant variance in helping and discriminatory responses to self-harm. Implications for future research are discussed.

Aim . Timely help-seeking and pathways to care (PtC) have been linked to positive outcomes in suicidal adolescents. While the importance of formal contacts is recognised, caregivers also play a significant role in these pathways. Caregiver’s familiarity with mental health issues may influence an adolescent’s PtC. This study explores the relationship between a caregiver’s prior suicidality and mental health treatment on their children’s pathways to entering a specialist suicide prevention treatment program. Method. Caregivers ( n = 118, 35 males and 83 females) of young individuals (12-25 years) who were admitted into an outpatient suicide prevention service, completed a self-report questionnaire describing their child’s onset of symptoms, help-seeking, PtC and the caregiver’s prior suicidality and mental health treatment. Results. Parents were the source most likely to recognise the onset of suicidality, with general practitioners and psychologists the most common first contacts. Significant delays were identified for onset duration averaging 48.0 weeks, and it was observed that shorter delays in treatment were related to fewer number of contacts. Caregiver prior suicidality was associated with longer delays in treatment but had no relationship with onset duration. Conclusion. Caregivers and professional contacts are vital agents in improving the PtC of suicidal adolescents. Results highlight the significant delays in treatment and the added complexity of a caregiver’s prior experience of suicidality to these pathways. These complexities warrant further exploration to minimise obstacles that hinder help-seeking and lengthen PtC, as this may improve interventions and outcomes for suicidal adolescents and their caregivers. Keywords. Pathways to care; delay in treatment; caregiver familiarity; suicide; adolescent.

Prior research suggests mindfulness-based interventions effectively reduce stress in trainee psychologists, enhance wellbeing and cultivate clinical skills and competencies. This study explored how trainee school psychologists perceived the effects of a mindfulness-based intervention on their development as psychologists. Forty trainee school psychologists participated in a 6-week online mindfulness-based intervention. They completed weekly written reflective journals throughout the programme which were later analysed using thematic analysis. Four core themes were identified: (1) changes in awareness and attention; (2) enhanced wellbeing; (3) commitment to ongoing personal practice and (4) cultivation and enhancement of professional development. Participants ( n = 24) who completed the mindfulness workshop during the COVID-19 pandemic indicated that mindfulness practice was particularly useful for managing uncertainty and other related stressors. It was concluded that practicing mindfulness supported trainee school psychologists’ personal and professional development, particularly related to compassion, resilience and therapeutic presence.

Psychology training programs emphasize competencies like professional behavior, interpersonal skills, and emotional intelligence. Some students, known as students with problems of professional competence (SPPC), struggle in these areas. This study explored SPPC characteristics and educator experiences in managing them through semi-structured interviews with twelve Australian psychology educators. Thematic analysis revealed that SPPC often struggle with professional attitudes, feedback integration, reflective skills, and mental health, placing demands on resources and contributing to educator stress. The role of educators as gatekeepers, assessors, and evaluators also raises concerns about maintaining ethical standards. Findings highlight the need for better understanding, support, and strategies for managing SPPC to uphold ethical standards.