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Unpacking the black box of respite: A realist evaluation of a non-clinical crisis intervention
No full textThe prevalence of psychological distress and suicidality are issues of international concern. This concern includes discussion in both academic literature and the public sphere about the failure of existing services to adequately meet the needs of people experiencing acute distress and suicidal thoughts. Reflecting the medicalisation of distress and suicidality, discussion of these issues is heavily focussed on the need for an expansion and improvement of clinical services. Meanwhile, the role of non-clinical, community-based organisations in providing comprehensive support to people experiencing acute distress remains widely overlooked. Such services are scarce, and research into these services is even more so.
This thesis undertakes a realist evaluation of the Taranaki Retreat – a charitable organisation, staffed by non-clinical volunteers, which provides free respite for people who are experiencing distress and suicidal thoughts. Broadly, this thesis asks: How does respite function to support people experiencing a state of crisis? As a realist evaluation, it specifically asks: What are the key outcomes for service users of the Taranaki Retreat? What are the underlying mechanisms that generate these outcomes? And finally, What are the key contextual factors in which these mechanisms operate? By answering these research questions and developing theory at a middle-range of abstraction, this thesis aims to provide an explanation of how respite, as a non-clinical form of crisis intervention, functions to support people who are suicidal and/or acutely distressed. The purpose of developing such an explanation is to support the improvement of crisis intervention services.
Realist evaluation, which serves as the methodological framework of this thesis, is a form of theory-driven evaluation. Developing, testing, and refining a programme theory in this study involved a retroductive process over two phases of data collection and analysis. In phase one, an initial programme theory was abductively inferred following a review of related literature, interviews with the programme designers, and analysis of key policy and procedure documents. In phase two, that initial theory was deductively tested and inductively refined using data gathered from four qualitative methods: participant observation, a focus group with staff and volunteers, interviews with former guests, and a review of the case notes of those same guests. These different methods of data collection provided the diverse evidence needed for this approach and enabled triangulation of data.
The refined programme theory that emerged from the two phases of data collection and analysis identifies key outcomes of this intervention, and furthermore identifies five key mechanisms that, operating in different contexts, explain how these outcomes are generated. Three of the mechanisms relate to the fulfilment of previously unmet needs and can be collectively abstracted as ‘warmth’. The other two mechanisms relate to the removal of service users from agitating or unhelpful circumstances and can be abstracted as ‘quiet’. All five mechanisms primarily attend to secondary stressors, which are stressors arising from or exacerbated by the state of crisis itself. By removing the secondary stressors and, to a lesser extent, reducing the impact of initial stressors, these mechanisms generate five key outcomes for service users: reduced emotional distress, restored clarity of thought, reduced suicidality, restored sleep, and restored functioning. Collectively, these five outcomes constitute the resolution of a state of crisis (which can also be understood as the restoration of a state of affective and cognitive equilibrium). While the findings of this thesis indicate the ability of respite to facilitate a restored state of equilibrium, they also indicate that respite does not directly help service users develop additional coping skills or new interpretations of stressor events.
By developing a generative explanation of how respite functions to support people experiencing a state of crisis, this thesis contributes to the crisis intervention literature and also carries practical implications. First, the theory developed in this thesis demonstrates a ‘non-interventionist’ approach to crisis resolution, thereby challenging an implicit assumption in the literature that crisis resolution must be facilitated by an active interventionist (typically a health professional). Second, the prominence of the theme ‘genuine care’ within the refined theory highlights the importance of considering how people in crisis interpret the motivations of those around them. Third, this thesis illustrates that the ‘warmth’ mechanisms are enhanced by both the structure of charitable organisations as well as the use of non-professional volunteers. This serves as an argument against a trend in the literature towards promoting the formalisation of crisis resolution services along with the professionalisation of staff. Charitable organisations and non-professional volunteers should be viewed as not merely useful additions, but as bringing unique advantages that distinctly contribute to positive outcomes. Finally, the findings of this thesis suggest that the potential of respite to strengthen the spectrum of crisis responses should receive greater attention from policymakers. These findings furthermore point to the advantages of establishing crisis resolution services independently of mental health services
A preliminary investigation of the archaeology of whaling stations on the Southern Coast
No full textShore whaling represents the earliest period of European settlement in the lower South Island. While the history of whaling has been well documented, little systematic work has been carried out on the archaeology of whaling. A site survey was undertaken in order to establish a basis for any further investigation of shore whaling in the area. This initial brief was extended to include analysing an 1844 survey that included the Otakou station and an excavation of the Wellers Rock try-works at Otakou.
Throughout this work both the data collected and the methods used to collect it have been analysed and assessed
"We need to discuss surgery": A multimodal conversation analytic study of intersubjectivity during surgeons' information provision to patients
No full textProviding patients with information, such that they are able to understand the consequences of treatment decisions, is an ethical and legal requirement in New Zealand and many other jurisdictions. While research from the disciplines of bioethics, law, and medicine has shown that patients’ recall and understanding of what they have been told is often limited, such research has focused on the “what” rather than the “how” of informing. While some health communication and health literacy research has addressed the how of informing, such research has relied on observation and coding strategies. By contrast, this thesis project addresses the how of informing via situated interactional analysis.
Information provision creates many challenges for both patients and surgeons. One of the greatest challenges is epistemic asymmetry, which is exacerbated by low health literacy and numeracy. To provide context for my findings in the analytic chapters, I describe the conflicting institutional, social, and psychological demands that surgeons face when providing information to patients. In addition to epistemic asymmetry, these include adherence to legal precepts, upholding bioethical principles, establishing and maintaining social relations, dealing with uncertainty, countering the “curse of expertise”, and forming a mutually acceptable plan for next steps within the circumscribed time frame of a surgical consultation.
In this thesis, I use multimodal conversation analysis to investigate participants’ management of intersubjectivity during surgeons’ extended tellings. Drawing on prior conversation analytic research on intersubjectivity and repair, the structure of storytellings, epistemics, and turn taking, I show that surgeons’ information provision takes the form of extended tellings during which patients say little. Although the content of these tellings varies widely, the content categories, namely Problem, Process, Alternatives, and Risks, which are familiar to me as a former clinician, are similar across most of these tellings. Furthermore, the ordering of these content categories appears designed to scaffold patient understanding.
On the one hand, while structural aspects of extended tellings generally inhibit floor-taking turns by patients, my research reveals that some surgeons use recycling of previous talk to create “unit ends”. Some patients orient to these unit ends by providing full turns-at-talk that initiate repair or display their stance. Furthermore, their full turns (can) provide demonstrations of their understanding. In the event that they reveal misunderstandings, such demonstrations allow surgeons to tailor their repairs.
Notwithstanding the sequential implicativeness of repeats as unit ends, patients’ floor-taking turns are rare in the mid-telling environment. However, patients can claim they are following surgeons’ talk via head nods and minimal vocal responses in the vicinity of TCU completions. In keeping with prior research, my findings show that, providing there is mutual gaze, surgeons in my data usually treat the absence of such on-time acknowledgements as interactional trouble. This orientation is evidenced by progressivity disruptions in the form of post-positioned expansions, reformulations, understanding checks, increments, response pursuits, or reassurances.
While demonstrations of understanding are rare during these extended tellings, patients can upgrade their claims of epistemic access via complex multimodal gestalts, either to claim new understanding or to claim epistemic antecedence. In this regard, analysis shows that the timing of patients’ modal moves (such as nods), in relation both to other modal moves (such as gaze continuation or withdrawal) and to surgeons’ TCU completions, is key to the epistemic affordances created.
Prior research has shown that gaze is central to intersubjectivity management because of its roles in mutual monitoring and in interactional engagement/disengagement. In keeping with this research, my findings emphasise the role of gaze in creating the accountability of patients’ acknowledgements at surgeons’ TCU completions. Furthermore, in keeping with prior research, surgeons in my data use gaze both for response pursuit and recipient selection. Finally, my analysis shows that the epistemic affordances of patients’ complex multimodal gestalts depend on gaze withdrawal or continuation.
In addition to the above theoretical contributions, my multimodal transcription method makes a methodological contribution by facilitating reader access to the simultaneous unfolding of modal moves and gaze direction. Moreover, this thesis has the potential to contribute to training of surgeons and other experts involved in information provision to laypersons.
The essence of my thesis argument, which is based on a combination of empirical multimodal conversation analytic research and the ethnographic insights of a former clinician, is that the central issue with informing for informed decision making is the ever-present tension between interactional intersubjectivity and progressivity. However, despite surgeons doing nearly all the talking during extended tellings for information provision, these tellings are co-operatively constructed by the interactional participants
Structural violence in Éire: The bone histology of victims from the Great Famine (Kilkenny, Ireland 1845-1852)
No full textThis project uses bone histological analysis to explore how disease, diet, and social circumstances affected the bone remodeling of a group of people who died during the Great Famine in Ireland between 1845 and 1852. The human remains discovered on the grounds of the nineteenth century Kilkenny Union Workhouse in Kilkenny City, Ireland represent a well contextualized, homogenous group of people who died due to stress induced by the Great Famine sometime between 1847-1851. These factors make this an ideal population to study the biological effects of structural violence and for investigating the meaning of skeletal lesions, often referred to as the “osteological paradox”.
In 1845, a potato blight wiped out the primary means of subsistence for the poor in Ireland, causing the country to lose a quarter of its population to death and migration. This event had a massive cultural, demographic, and biological impact on the world and has been the source of international scholarly interest in the recent past. Historical research has suggested the poor in Ireland suffered and died from comorbidities of infectious and metabolic disease due to food insecurity, the cause of which is debated but is often attributed to conflicts with England. Bioarchaeologists have recently examined the effects of diet and disease on the macroscopic surface of the skeletons but none have looked at the effects of the Great Famine on their bone microstructure.
The skeleton reacts to physiological effects of stress on the micro level before presenting as lesions on bone, and since many diseases are not reflected in the bioarchaeological record, histological analyses of bone may be informative of the lived experience of those with and without lesions. This study compares bone remodeling patterns in the ribs of 99 adults and 87 subadults between four disease categories: metabolic disease, infectious disease, comorbidities of infectious and metabolic disease, and no lesions, to determine if variation in bone microstructure exists between disease types. This was conducted using bone histological variables that reflect the maturity of remodeling and extent of porosity, which can be indicative of overall health. Additionally, carbon (δ13C) and nitrogen (δ15N) stable isotope values obtained from the ribs of the same individuals were compared to bone histological variables to determine if changes in diet due to the loss of the potato and the introduction of maize as a relief food influenced bone remodeling.
The results show that rib bone porosity is highest in adults without lesions and lowest in adults with evidence of infectious disease. Similar results were obtained in the subadult cohort. Additionally, those with evidence of scurvy generally show less porosity throughout the rib cortex for both age cohorts. Comparisons of histomorphometry with stable isotope values showed a positive correlation between osteon size and δ15N values in adults as well as a positive correlation between Haversian canal size and δ13C values in the subadults, possibly indicating slower remodeling in those with more evidence for starvation and less mature remodeling in those with maize in their diet, respectively. This study showed that bone histology is impacted by both disease and diet and may be useful for interpreting the meaning of lesions and understanding the impact of social status on population health
A firm grip on nature: The economic case for environmental personhood.
No full textNature is declining at unprecedented rates. We posit that the external effects of ecosystem degradation can be understood as a lack of property rights of stakeholders advocating on behalf of future generations and the intrinsic value of natural systems. The attempt to capture such property rights represents a transaction cost that is borne by environmental, indigenous and climate change movements. A number of environments worldwide have now been accorded Environmental Personhood (EP). We link the evolution of EP as nature’s equivalent of the firm to the history of corporations as legal entities. An economic case can be made for EPs to allow for 1) the objective of capturing total economic value subject to protecting the environment’s intrinsic value which is represented by the capability of the natural system to maintain its ecosystem functions; 2) a property rights structure opening for ecosystem trade-offs among stakeholders, including those advocating on behalf of the environment and future generations; and 3) interactions among stakeholders that mediate transaction costs
Bats, Bioacoustics, & Bat Lures in Brunei Darussalam
No full textBats are the most diverse mammalian order, second to rodents, with 1400+ species found globally across almost every continent. In the tropics, where it is possible to find more than 60 bat species at a single site, they are heavily impacted by fire, deforestation, and land use change. The island of Borneo is a biodiversity hotspot, yet it is undergoing severe deforestation, driven by plantation palm oil and logging. Despite this, the small sultanate of Brunei Darussalam still has approximately 54% coverage of unlogged forest. Monitoring bats is challenging due to their small size, ability to y, cryptic nature and nocturnal activity. More recently, bioacoustic techniques are being incorporated into bat research methods. Either through the use of acoustic bat lures, or by utilising passive acoustic monitoring (PAM) techniques. Acoustic bat lures have been developed on the premise that broadcasting an acoustic stimuli can increase the number of bat captures in mist nets or harp traps. However, this is still a relatively new, niche method, with just 9 published studies on their use. A questionnaire of 27 questions, circulated widely by numerous NGO's and available online for two months, was used to gather information from lure users globally. Results indicated there are ethical and practical concerns surrounding their use, with a myriad of methods, broadcast calls, target species, and projects incorporating lures. Despite general success with acoustic bat lures in the literature, the effect of lures, which will likely always be species-specific, is yet to be fully understood. This raises questions regarding the appropriate use of these lure devices, particularly with a lack of international guidelines.
Field tests comparing different lure devices and broadcast calls in Brunei Darussalam over two consecutive years, totalling 55 `trapping nights', showed increased captures in traps with a lure. Particularly for Kerivoula spp. and Murina spp., whilst Rhinolophus spp. were deterred from traps. Statistically, there was no difference in capture rates between the two lure devices (Sussex Autobat and Apodemus Batlure), or the broadcast calls used. These results highlight the species-specific effects of lures. Diversity estimators Chao 1 & ACE indicate that short-term community surveys are insufficient to assess the full diversity of this region. However, including a variety of trapping sites/traps, and potentially incorporating a lure (being aware of species-specific responses), will likely assist future efforts. Furthermore, PAM is becoming widely used
to study bat populations, although it is still in its infancy in the tropics, and requires a baseline call library. Reference calls were recorded on an Anabat Walkabout bat detector upon release of 40 individual bats across 14 species and 6 genera. Principal Component Analysis of 339 pulses showed considerable overlap in call structure of frequency modulated (FM) bat calls, although constant frequency (CF) bat calls are distinguishable to species level. Kerivoula papiliosa, Kerivoula lenis, and Myotis spp., which are often difficult to distinguish morphologically, could potentially be identified using bioacoustic methods. This reference call library and preliminary analysis is an initial step towards developing an acoustic classifier for the bats of Brunei, and call recordings are being incorporated into a broad acoustic classifier for the bats of Borneo
New Zealand Deprivation Index 2018 - TA66: Waimate District
No full textFor further information about data sources, interpretation of the graphs, and cautions, please see the separate Introduction Chapter
All data relating to the 2018 census is provided by Stats NZ, https://www.stats.govt.nz/
New Zealand Deprivation Index 2018 - TA70: Queenstown-Lakes District
No full textFor further information about data sources, interpretation of the graphs, and cautions, please see the separate Introduction Chapter
All data relating to the 2018 census is provided by Stats NZ, https://www.stats.govt.nz/
New Zealand Deprivation Index 2018 - TA71: Dunedin City
No full textFor further information about data sources, interpretation of the graphs, and cautions, please see the separate Introduction Chapter
All data relating to the 2018 census is provided by Stats NZ, https://www.stats.govt.nz/
New Zealand Deprivation Index 2018 - TA49: Carterton District
No full textFor further information about data sources, interpretation of the graphs, and cautions, please see the separate Introduction Chapter
All data relating to the 2018 census is provided by Stats NZ, https://www.stats.govt.nz/