A thesis submitted in partial fulfillment of a PhD in Community Psychology at the University of Zululand, South Africa, 2012. / Ongoing global crises impact negatively on human health. International comparison studies may improve health promotion. A community psychology, appreciative inquiry was conducted into local staff perceptions of selected child and adolescent mental health interventions in the Kent and Zululand regions of the United Kingdom and South Africa respectively. The Kent findings, supported by a quasi-experimental investigation, indicated that intervention was beneficial, the mental health practitioner role had value and additional mental health practitioners should be employed. The Zululand findings, complemented by a single client case study, suggested that intervention provided a valuable people focused programme, and that additional emphasis should be placed on promoting the intervention, its structure and staffing. Evaluative comparisons thus illustrated the differential effectiveness of the respective interventions. The Kent service could learn from the way in which the Zululand intervention was people orientated and the Zululand programme could learn from the way in which the Kent intervention was structured and organized. Findings highlighted the ongoing need to evaluate existing models of community psychology, create new models, and the temporal and contextual nature of any such models.

Ecological interventions hold promise for meeting the needs of post-disaster communities, yet little systematic quantitative evidence is available about such programs. This study evaluated the short-term outcomes of participants in the Strategies for Trauma Awareness and Resilience (STAR) program, a novel and exemplar ecological intervention for helpers working in post-disaster settings. It is a one week training and support program for helpers working in disaster-affected communities. Changes in the psychological distress of 42 STAR participants, across four STAR sessions, were assessed and identified as primary outcome variables. Knowledge, attitude, and intended practice changes were also assessed, along with perceived support, using a pre (T1)/post (T2) design. These indicators were then tested as possible predictors of participants' changes in distress. An integrity check was conducted on a sample of the seminar modules to assess fidelity to the program manual. Qualitative data were also gathered from follow up visits conducted with two participants. These data were used to help interpret quantitative findings, as well as to plan for future studies of how STAR effects might extend out from helpers into their home communities. Results showed that participants exhibited significant changes in knowledge, attitudes, and intended practices from the beginning of the seminar to the end. Results also showed significant decreases in psychological distress over the STAR week. Regression analyses showed that changes in knowledge, attitudes, and practice, as well as perceived social support during the seminar, explained significant amounts of variance in self reported trauma symptoms at T2. Variance in T2 burnout and compassion fatigue explained by these predictors was notable but not statistically significant due to lack of power. Results suggest that STAR can change knowledge and attitudes of helpers from disaster communities and that participants in this program experience decreases in distress during their stay. The lack of a valid comparison group makes causal interpretations of these findings premature. Findings also suggest that changes in distress are not caused by, or even significantly related to, learning that takes place during the STAR week. The mechanism for distress reduction during the STAR week is an unresolved question. Other significant unresolved questions remain regarding the STAR intervention and ways the present findings can be generalized to ecological interventions more broadly. For example, while the current study suggests important changes occur in helpers during the STAR week, it is of central importance to explore how these changes translate into the disaster-affected home communities. Discussion also focuses on the difficulties involved in conducting systematic research with organizations and helpers whose primary goals are practical or clinical, not scientific. Despite the questions that remain, taken together, results point to the promise of STAR to address the mental health needs of helpers and perhaps eventually disaster communities. / Ph. D.

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Aim: To determine if a significant relationship exists between a) nurse-driven interventions to foster collaborative psychiatric and oncology care and b) higher rates of cancer treatment adherence and lower healthcare utilization rates in patients with serious mental illness (SMI) and cancer. Background: It is not uncommon for patients with SMI to suffer from treatment noncompliance and present in the acute care setting, such as the emergency department. Patients with cancer and SMI pose a unique challenge to nurses and providers due to the psychological effect of a cancer diagnosis as well as side effects experienced from psychotropic medications and oncology treatments alike. As a result, these patients are less likely to maintain cancer treatment regimens and present with advances stages of cancer in the acute care setting. Methods: An extensive electronic literature search in the CINAHL Plus and APA PsycINFO databases was completed and included the keywords: cancer, neoplasms, carcinoma, serious mental illness, chronic mental illness, mental disorders, mental disorders, chronic, psychiatric illness, psychiatric disability, cognitive behavioral therap*, intervention*, mindful*, and mental health. Inclusion criteria included: published in the years 2012-2022. The available literature was carefully examined for interventions performed with SMI and cancer for ultimate results to be finalized as a written report. Significance: The results of this research can optimize healthcare and prognosis for the population of mental health patients with cancer and also reduce costs to the healthcare system. Conclusion: The 10 studies reviewed indicated that collaborative psychiatric-oncology care with specific Registered Nurse (RN)-led interventions, such as medication management programs and behavioral counseling, was associated with increased rates of cancer treatment adherence and lower rates of healthcare utilization. Conclusions were based on data collected in cohort studies, randomized control trials, pre- and post-intervention assessments, and clinic data from quality improvement projects. More research is needed to explore the implementation of collaborative care practices.