The impact of community mental health programs for Australian youth : a systematic review

Australia has undergone significant youth mental health reform over the past 10 years, leading to numerous studies examining the effects of community-based mental health care programs for Australian youth. However, no synthesis of this literature currently exists. Therefore, this systematic review aimed to: (1) describe the types of community-based mental health programs that have been delivered to Australian youth in the past 10 years; and (2) examine their impact in improving young people’s mental health symptomology and psychosocial functioning. A systematic search of the peer-reviewed literature was conducted. Studies were included if they evaluated the extent to which such programs improved mental health symptomology (e.g., depression, anxiety, substance use) and/or psychosocial outcomes (e.g., social functioning, school engagement, employment) for Australian youth aged 10–25 years. Thirty-seven studies were included. Four types of community-based youth mental health care programs were identified: therapy (n = 16), case management (n = 9), integrated ‘one-stop-shop’ (n = 6) and lifestyle (n = 6) programs. The majority of therapeutic programs were effective in reducing mental health symptomology. Case management and integrated approaches consistently yielded significant improvements in both symptomology and psychosocial outcomes. Lifestyle programs were effective in alleviating depressive symptoms, but inconclusive for other outcomes. This review provides support for youth-friendly, systemic, multidisciplinary and integrated assertive outreach models of community mental health care to improve outcomes for young Australians experiencing mental health concerns. Several recommendations for future research are provided to strengthen the local evidence-base supporting community mental health programs to ultimately enhance young people’s life trajectory

The impact of transition interventions for young people leaving care : a review of the Australian evidence

Whilst advancing outcomes for young people transitioning from out-of-home care is a national priority, no synthesis of Australian interventions that support their transition from care and into independence currently exists. The aim of this systematic scoping review was to examine the characteristics of such interventions delivered in Australia and to evaluate their impact. Papers were included if they assessed the extent to which transitional support interventions, delivered in Australia, improved housing, employment, education, financial, health, or social functioning outcomes. Eleven studies were included. Interventions primarily adopted a case management approach to support care-leavers' transition. Interventions facilitated improvements in care-leavers' independent living outcomes (e.g., housing, education, and financial stability), but less so in health outcomes. This synthesis provides guidance for how research organizations in partnership with community service organizations and statutory services should develop and deliver interventions to support young Australians transitioning from care

Implementing a healthy lifestyle program in residential out‐of‐home care : what matters, what works and what translates?

The Healthy Eating, Active Living Matters (HEALing Matters) program is being scaled up across residential out-of-home care (OOHC) in Victoria, Australia and is providing young people with the knowledge, skills and resources to promote better health through healthy eating and activity. HEALing Matters was piloted as the HEAL program, a dual-intervention program that aimed to provide young people living in residential care with education and opportunities to improve their eating and physical activity habits, while simultaneously building the capacity of their carers to promote, encourage and role model healthy lifestyle behaviours. Qualitative findings indicated that HEAL resulted in increased participation in community sport, increased availability of sports equipment, healthy meal preparation and healthy food availability and improvements in perceived young person self-esteem and independent living skills. Findings also revealed some limitations of the program. Following the pilot, a participatory methodological approach was used to better understand how to align the HEAL program with individual and community needs. This approach engaged diverse stakeholders to better understand the barriers and enablers, address limitations, identify key intervention points and build trust and a shared vision to co-design the HEALing Matters program. HEALing Matters is now delivered within a framework that is informed by attachment, trauma and resilience theories. This paper outlines the HEALing Matters journey from what matters, to what works, to what translates in relation to a healthy eating and active living intervention in OOHC

The interconnectedness of disability and trauma in foster and kinship care : the importance of trauma-informed care

A high prevalence of maltreatment, abuse, neglect and the onset of subsequent trauma has been well-documented among both young people with disability and young people residing in foster and kinship care. However, no uniform policies or guidelines currently exist for the delivery of trauma-informed models of care to build the capacity of foster and kinship carers in responding to and supporting the complex needs of children and young people in their care with disability who may have been exposed to trauma. While no evidence of the application of trauma-informed models of care for this cohort exists, some evidence of trauma-informed models of care to support people with disability beyond the scope of out-of-home care has recently emerged. The authors discuss this emerging work and recognise an opportunity to leverage this evidence to guide the practices of foster and kinship carers. Clearly, there is an opportunity to work towards improving the development and wellbeing of children and young people with disability in foster and kinship care through the development, implementation, and evaluation of a tailored trauma-informed model of care that is co-designed and grounded in the underlying theoretical principles of disability and trauma

The extent to which non-conditional housing programs improve housing and well-being outcomes : a systematic review

Purpose To reduce rates of homelessness, recent efforts have been directed toward developing non-conditional supported housing programs that prioritize the delivery of housing support and individual services, without tenancy conditions (i.e. maintaining sobriety and adhering to mental health treatment). As promising as these programs are, findings generally show that while housing stability is improved, other individual outcomes remain largely unchanged. No review to date has synthesized the collective evidence base of non-conditional housing programs, rather the focus has been on specific programs of delivery (e.g. Housing First) or on specific population groups (e.g. those with mental illness). The purpose of this paper is to evaluate the extent to which non-conditional housing interventions improve housing and well-being outcomes for all persons. Design/methodology/approach A systematic search of the literature was conducted for randomized controlled studies that evaluated the effectiveness of a non-conditional housing intervention in improving housing and health outcomes among any participant group. Findings A total of 31 studies were included in this review. Non-conditional supported housing programs were found to be most effective in improving housing stability as compared to health and well-being outcomes. Policymakers should consider this when developing non-conditional supported housing programs and ensure that housing and other health-related outcomes are also mutually supported. Originality/value This is the first review, to the authors’ knowledge, to synthesize the collective impact of all non-conditional supported housing programs. The current findings may inform the (re)design and implementation of supported housing models to prioritize the health and well-being of residents

Predictors of clinician use of Australia’s national Health Information Exchange in the emergency department : an analysis of log data

Objective This study explores patient and context related factors associated with use of Australia’s national personally controlled Health Information Exchange (HIE), My Health Record, by emergency department (ED) clinicians. Materials and methods A retrospective analysis explored secondary routinely-collected data including all patients who presented (between August 2019–2021) to the ED at a not-for-profit hospital in Melbourne. Presentation data were linked to the HIE access log-data, and human resources data. The primary outcome indicated HIE access by an ED pharmacist, doctor or nurse, within 3 days of the patient presenting to the ED, or not. Nine variables were explored with logistic regression, representing patient (gender, age, diagnosis) and other factors (presentation time, arrival method, referral, acuity/triage, length of stay, admitted into hospital). Results HIE is accessed in 17.43% of patient presentations to the ED, led by pharmacists (15.60%). Overall, as demonstrated in the multivariable analysis, increased HIE access was associated with increasing age, with the biggest effect for 75–84-year old’s (odd’s ratio 26.15; 95% confidence interval 15.37–44.50), when compared to < 4 years of age. HIE access was also significantly and positively associated with patients who were later admitted into hospital from the ED (4.96; 4.61–5.34). Conclusion The results suggest users of HIE in the ED employ the system to meet their needs, but not for all patients. To maximise value derived from HIE use, clinicians should target system access for patients where the benefit of accessing the record outweighs the cost - this research suggests that is for patients who are older in age and are likely to be admitted, potentially linked to greater condition complexity. If the use of a HIE is to improve the provision of care in the ED, the key stakeholders governing patient information within the HIE need to focus on improving clinician recording behaviours for older people and those suffering from complex medical conditions. Doctors and nurses lag behind with respect to the use of the HIE by pharmacists. Therefore, a focus on encouraging HIE engagement across these clinician groups is drastically required

A rapid umbrella review of the literature surrounding the provision of patient-centred end-of-life care

Background: Patients have reported a broad range of unmet needs in their receipt of clinical care at the end of life. Therefore, enhancing the quality of end-of-life care through patient-centred healthcare interactions is warranted. Aim: The aim of this rapid umbrella review was to synthesise previous literature reviews that have examined: (1) patient preferences for patient-centred end-of-life care; (2) barriers and enablers to patient-centred end-of-life care; (3) interventions designed to enhance patient-centred end-of-life care; and (4) patient-centred models of end-of-life care. Design: A rapid umbrella review was conducted and informed by the Joanna Briggs Institute’s methodological guidance for conducting umbrella reviews. Data sources: Three academic databases were searched for relevant literature in May 2022: MEDLINE, PsycINFO and CINAHL Plus. Inclusion criteria encompassed literature reviews that examined the topic of patient-centred care for any adult patients in end-of-life care. Results: A total of 92 literature reviews were identified. Findings suggest that there is often a discrepancy between patient preferences and the provision of care. These discrepancies have been associated with a range of barriers at the patient, staff and system levels. Common interventions included education and training for staff which were often met with improved patient outcomes. Patient-centred models of care were underrepresented across the literature. Conclusions: This review highlighted a need for healthcare systems to support staff in providing a patient-centred end of life experience through the development of a co-designed patient-centred model of care, supplemented by professional development and a systematic approach to identifying and documenting patient preferences

Clinical practice guidelines for the prevention of childhood obesity : a systematic review of quality and content

Summary: Obesity in childhood is a significant global issue, and prevention is key to reducing prevalence. Healthcare providers can play an important role in the prevention of obesity. The aim of this systematic review was to identify and evaluate clinical practice guidelines (CPGs) for preventing childhood obesity with a focus on the role of medical doctors. Peer‐reviewed literature and gray literature sources were searched for CPGs published from 2010 to 2021. Eleven CPGs were identified. Quality was evaluated using the Appraisal of Guidelines for Research and Evaluation Collaboration (AGREE II) instrument; seven CPGs were higher quality and four lower quality. Recommendations within the CPGs covered three main areas: growth monitoring, maintaining a healthy weight, and managing overweight. The importance of involving the whole family and healthy lifestyle behaviors was emphasized. The majority of the CPGs rated poorly in guideline applicability highlighting the need for practical implementation tools. Although our review identified a number of CPGs relevant to the prevention of obesity for doctors working with children and their families, more research is needed to produce high‐quality meaningful and applicable CPGs to maximize uptake, implementation, and ultimately, benefit to children and their families