title: Just part of the job: The experiences of parent caregivers caring for adolescents with mild traumatic brain injury

authors: Giles, Kathryn Jane

subjects: Caregiving

abstract: Mild traumatic brain injury (mTBI) is one of the most frequently occurring injuries during adolescence.  Typically care following such injuries is provided informally, by parents and close family members.  The requirement for such caregiving is likely to increase as national health policies attempt to balance the growing costs of health-care provision with requirements for culturally responsive care. 
While studies have shown that caregivers may experience considerable burden, it is increasingly evident that caregiving also has a positive impacts for carers.  To date, few studies have evaluated the positive experiences of caregiving.  Even less is known about the positive experiences of parents who care for their adolescent children following acute injury events such as mTBI.  It is important to understand caregiver experiences more completely as caregiver coping and burden contribute to recovery and adaption to injury.
The aim of this study was to describe and understand the experience of caregivers of adolescents aged 10 – 18 years with mTBI.  Using a mixed methods approach, existing quantitative data gathered as part of the Brain Injury Outcomes New Zealand in the Community (BIONIC) and Consequences of Brain Injury in Childhood (COBIC) studies of TBI in New Zealand were analysed (mTBI group = 54 caregiver-adolescent dyads, control group = 54 dyads). Semi-structured interviews were then completed with a sample of caregivers of adolescents with mTBI now aged 13 – 16 years recruited from the same source studies (n=10).  Interview transcripts were qualitatively assessed using thematic analysis.  
Quantitative analysis confirmed previous research findings that for the majority, the impacts of mTBI are minimal and typically resolve within the first year with generally positive outcomes. While carers in both groups described caring for adolescents as a predominantly positive experience, caregivers of injured adolescents reported a greater number of positive caregiving experiences.  In addition, caregivers of injured adolescents reported significantly greater quality of life related to their physical health two years after injury compared with caregivers of adolescents without mTBI. 
Thematic analysis of interviews uncovered five core themes underpinning caregiver experiences: initiation; impacts and attributions; accommodation and adjustment; a valued experience; and, just part of the job.  These themes revealed the importance of timely and relevant communication from schools and health providers to caregiver’s feelings of competency and to their ongoing relationship with these organisations.  Reflecting on their experiences, caregivers valued the opportunities a mTBI created for emotional closeness with adolescents at a challenging time in human development.  They also described intrinsic benefits of being able to share wisdom and experiences with others and the practical benefit of developing transferrable skills.  Carers viewed their experiences as providing a unique opportunity for personal development through the recognition of carers’ capability and resilience as individuals.  For all caregivers, the provision of care following mTBI was seen as an expected part of parenting – just part of the job.
In contrast to family caregiving involving other caregiver – care recipient dyads (such as adult children caring for their elderly parents, or parents caring for their children as a result of chronic illness or disability), parent caregivers in the current study viewed caregiving as a positive experience.  Rather than a burdensome additional responsibility, carers viewed caring for their adolescent children following mTBI as – just part of the job - an expected and indistinguishable aspect of their existing roles as parents.

text: Just part of the job: The experiences of parent caregivers caring for adolescents with mild traumatic brain injury Mild traumatic brain injury (mTBI) is one of the most frequently occurring injuries during adolescence.  Typically care following such injuries is provided informally, by parents and close family members.  The requirement for such caregiving is likely to increase as national health policies attempt to balance the growing costs of health-care provision with requirements for culturally responsive care. 
While studies have shown that caregivers may experience considerable burden, it is increasingly evident that caregiving also has a positive impacts for carers.  To date, few studies have evaluated the positive experiences of caregiving.  Even less is known about the positive experiences of parents who care for their adolescent children following acute injury events such as mTBI.  It is important to understand caregiver experiences more completely as caregiver coping and burden contribute to recovery and adaption to injury.
The aim of this study was to describe and understand the experience of caregivers of adolescents aged 10 – 18 years with mTBI.  Using a mixed methods approach, existing quantitative data gathered as part of the Brain Injury Outcomes New Zealand in the Community (BIONIC) and Consequences of Brain Injury in Childhood (COBIC) studies of TBI in New Zealand were analysed (mTBI group = 54 caregiver-adolescent dyads, control group = 54 dyads). Semi-structured interviews were then completed with a sample of caregivers of adolescents with mTBI now aged 13 – 16 years recruited from the same source studies (n=10).  Interview transcripts were qualitatively assessed using thematic analysis.  
Quantitative analysis confirmed previous research findings that for the majority, the impacts of mTBI are minimal and typically resolve within the first year with generally positive outcomes. While carers in both groups described caring for adolescents as a predominantly positive experience, caregivers of injured adolescents reported a greater number of positive caregiving experiences.  In addition, caregivers of injured adolescents reported significantly greater quality of life related to their physical health two years after injury compared with caregivers of adolescents without mTBI. 
Thematic analysis of interviews uncovered five core themes underpinning caregiver experiences: initiation; impacts and attributions; accommodation and adjustment; a valued experience; and, just part of the job.  These themes revealed the importance of timely and relevant communication from schools and health providers to caregiver’s feelings of competency and to their ongoing relationship with these organisations.  Reflecting on their experiences, caregivers valued the opportunities a mTBI created for emotional closeness with adolescents at a challenging time in human development.  They also described intrinsic benefits of being able to share wisdom and experiences with others and the practical benefit of developing transferrable skills.  Carers viewed their experiences as providing a unique opportunity for personal development through the recognition of carers’ capability and resilience as individuals.  For all caregivers, the provision of care following mTBI was seen as an expected part of parenting – just part of the job.
In contrast to family caregiving involving other caregiver – care recipient dyads (such as adult children caring for their elderly parents, or parents caring for their children as a result of chronic illness or disability), parent caregivers in the current study viewed caregiving as a positive experience.  Rather than a burdensome additional responsibility, carers viewed caring for their adolescent children following mTBI as – just part of the job - an expected and indistinguishable aspect of their existing roles as parents.

year: 2015

title: Offenders who use child sexual exploitation material: Development of an integrated model for their classification, assessment, and treatment

authors: Merdian, Hannah Lena

subjects: child sexual exploitation material

abstract: Since the advent of the internet, convictions for the possession, display, trading and distribution of child sexual exploitation material (CSEM) have risen steadily. Professionals working in sex offender assessment and treatment have seen an influx in individuals who engage in this type of child sexual abuse without any direct contact with the victim. Despite an increase in recent research activities, there is still a lack of knowledge regarding this “new type” of sex offenders, in terms of appropriate assessment, treatment and management strategies.
 
A comprehensive review was undertaken, establishing the knowledge basis regarding CSEM offending and the offenders who engage in it. The identified differences between CSEM offenders (CSEMOs) and contact sex offenders (CSOs) and the nature of their offending led to the development of a theoretical model of CSEM offending, suggesting a classification of CSEM users on three dimensions: CSEM offending with or without direct sexual contact to a minor (fantasy-driven versus contact-driven offending), the individual’s motivation to offend, and the level of networking with other offenders. The question of risk of reoffending in CSEMOs, especially concerning cross-over to contact sex offending with a minor, was examined in terms of actual reoffending data and in the context of behavioural consequences resulting from general pornography consumption. The findings further confirmed the value of the two-fold distinction of CSEMOs, with contact-driven offenders presenting higher risk of direct sex offending based on a greater inclination for sexual violence. A review of existing risk assessment tools and established risk factors for sexual reoffending pointed to the value of structured professional guidelines when assessing CSEM offenders. 
Sixty-eight offenders were assessed via an anonymous computer survey including a variety of clinical and risk-related variables; the sample included 22 CSEMOs, 29 CSOs, and 17 offenders with both offence types (mixed offenders, MOs). The findings confirmed differing profiles between CSEM users and CSOs, most notably in the high emotional, time-related and financial cost involved in CSEMOs’ internet behaviour and MOs’ apparent disregard for their emotional ties to others. As a heterogeneous nature of CSEM users became apparent, numerical and graphical methods were employed to identify subgroups of CSEM users: Contact-driven Users (n = 15), Fantasy-driven Users (n = 12), and three smaller subgroups (each n = 2): Users with a preference for material with extreme content (Extreme Material Users), users who enacted high caution in their CSEM offending (Cautious Users), and users with high social connectedness (Social Users). While the focus of Contact-driven Users was pointed to direct sexual contact with minors, Fantasy-driven Users showed higher involvement in their CSEM usage, for example regarding their social or emotional investment online. The spatial representation of participants identified three dimensions as crucial in the classification of these subgroups: direct sexual contact with a minor, possession of fantasy-generating material, and social contact with other users with a sexual interest in minors. Exploring the subgroups’ profile on these variables and on conventional predictors of sex offending led to the development of an empirical model of CSEM users, differentiating a contact-driven pathway (Cautious Users, Contact-driven Users) from a fantasy-driven pathway (Extreme Material Users, Fantasy-driven Users, and Social Users), with offenders on the contact-driven pathway appearing more similar to CSOs. 
The theoretical and empirical models were then combined into an Integrated Model for the Classification, Assessment, and Treatment of CSEM Users (IMCAT-CU), leading to the development of structured professional guidelines for their assessment and risk evaluation according to the five prototypes of CSEM offending.

text: Offenders who use child sexual exploitation material: Development of an integrated model for their classification, assessment, and treatment Since the advent of the internet, convictions for the possession, display, trading and distribution of child sexual exploitation material (CSEM) have risen steadily. Professionals working in sex offender assessment and treatment have seen an influx in individuals who engage in this type of child sexual abuse without any direct contact with the victim. Despite an increase in recent research activities, there is still a lack of knowledge regarding this “new type” of sex offenders, in terms of appropriate assessment, treatment and management strategies.
 
A comprehensive review was undertaken, establishing the knowledge basis regarding CSEM offending and the offenders who engage in it. The identified differences between CSEM offenders (CSEMOs) and contact sex offenders (CSOs) and the nature of their offending led to the development of a theoretical model of CSEM offending, suggesting a classification of CSEM users on three dimensions: CSEM offending with or without direct sexual contact to a minor (fantasy-driven versus contact-driven offending), the individual’s motivation to offend, and the level of networking with other offenders. The question of risk of reoffending in CSEMOs, especially concerning cross-over to contact sex offending with a minor, was examined in terms of actual reoffending data and in the context of behavioural consequences resulting from general pornography consumption. The findings further confirmed the value of the two-fold distinction of CSEMOs, with contact-driven offenders presenting higher risk of direct sex offending based on a greater inclination for sexual violence. A review of existing risk assessment tools and established risk factors for sexual reoffending pointed to the value of structured professional guidelines when assessing CSEM offenders. 
Sixty-eight offenders were assessed via an anonymous computer survey including a variety of clinical and risk-related variables; the sample included 22 CSEMOs, 29 CSOs, and 17 offenders with both offence types (mixed offenders, MOs). The findings confirmed differing profiles between CSEM users and CSOs, most notably in the high emotional, time-related and financial cost involved in CSEMOs’ internet behaviour and MOs’ apparent disregard for their emotional ties to others. As a heterogeneous nature of CSEM users became apparent, numerical and graphical methods were employed to identify subgroups of CSEM users: Contact-driven Users (n = 15), Fantasy-driven Users (n = 12), and three smaller subgroups (each n = 2): Users with a preference for material with extreme content (Extreme Material Users), users who enacted high caution in their CSEM offending (Cautious Users), and users with high social connectedness (Social Users). While the focus of Contact-driven Users was pointed to direct sexual contact with minors, Fantasy-driven Users showed higher involvement in their CSEM usage, for example regarding their social or emotional investment online. The spatial representation of participants identified three dimensions as crucial in the classification of these subgroups: direct sexual contact with a minor, possession of fantasy-generating material, and social contact with other users with a sexual interest in minors. Exploring the subgroups’ profile on these variables and on conventional predictors of sex offending led to the development of an empirical model of CSEM users, differentiating a contact-driven pathway (Cautious Users, Contact-driven Users) from a fantasy-driven pathway (Extreme Material Users, Fantasy-driven Users, and Social Users), with offenders on the contact-driven pathway appearing more similar to CSOs. 
The theoretical and empirical models were then combined into an Integrated Model for the Classification, Assessment, and Treatment of CSEM Users (IMCAT-CU), leading to the development of structured professional guidelines for their assessment and risk evaluation according to the five prototypes of CSEM offending.

year: 2012

title: Cultural vehicles and the Māori print media: What cultural concepts are used to communicate health messages to Māori?

authors: Groot, Shiloh Ann Maree

subjects: health

abstract: Existing research indicates that vaccination programmes to prevent Meningococcal disease have low response rates from Māori which contributes to a belief that Māori are apathetic and irresponsible. Our research question was: How do the Māori and community print media facilitate the promotion of Māori cultural concepts as generators of new meaning, particularly with regard to positive Māori health? This study focuses on the recent health
concern of Meningococcal disease. Twenty-four months of Māori and community print media was scanned to identify how Māori cultural concepts are being applied, modified, and operationalised in order to convey and promote positive health in Māori communities. Contrary to what was expected, the Western medical model with integrated Māori concepts was the main cultural frame employed.

text: Cultural vehicles and the Māori print media: What cultural concepts are used to communicate health messages to Māori? Existing research indicates that vaccination programmes to prevent Meningococcal disease have low response rates from Māori which contributes to a belief that Māori are apathetic and irresponsible. Our research question was: How do the Māori and community print media facilitate the promotion of Māori cultural concepts as generators of new meaning, particularly with regard to positive Māori health? This study focuses on the recent health
concern of Meningococcal disease. Twenty-four months of Māori and community print media was scanned to identify how Māori cultural concepts are being applied, modified, and operationalised in order to convey and promote positive health in Māori communities. Contrary to what was expected, the Western medical model with integrated Māori concepts was the main cultural frame employed.

year: 2006