The cost of youth suicide in Australia

© 2018 by the authors. Licensee MDPI, Basel, Switzerland. Suicide is the leading cause of death among Australians between 15 and 24 years of age. This study seeks to estimate the economic cost of youth suicide (15-24 years old) for Australia using 2014 as a reference year. The main outcome measure is monetized burden of youth suicide. Costs, in 2014 AU$, are measured and valued as direct costs, such as coronial inquiry, police, ambulance, and funeral expenses; indirect costs, such as lost economic productivity; and intangible costs, such as bereavement. In 2014, 307 young Australians lost their lives to suicide (82 females and 225 males). The average age at time of death was 20.4 years, representing an average loss of 62 years of life and close to 46 years of productive capacity. The average cost per youth suicide is valued at$2,884,426, including $9721 in direct costs,$2,788,245 as the value of lost productivity, and $86,460 as the cost of bereavement. The total economic loss of youth suicide in Australia is estimated at$22 billion a year (equivalent to US$17 billion), ranging from$20 to $25 billion. These findings can assist decision-makers understand the magnitude of adverse outcomes associated with youth suicide and the potential benefits to be achieved by investing in effective suicide prevention strategies

The complexity of health service integration: A review of reviews

© 2016 Heyeres, McCalman, Tsey and Kinchin. Background: The aim of health service integration is to provide a sustainable and integrated health system that better meets the needs of the end user. Yet, definitions of health service integration, methods for integrating health services, and expected outcomes are varied. This review was commissioned by Queensland Health, the government department responsible for health service delivery in Queensland, Australia, to inform efforts to integrate their mental health services. This review reports on the characteristics, reported outcomes, and design quality of studies included in systematic reviews of health service integration research. Method: The review was developed by systematically searching nine electronic databases to find peer-reviewed Australian and international systematic reviews with a focus on health service integration. Reviews were included if they were in the English language and published between 2000 and 2015. A standardized assessment tool was used to analyze the study design quality of included reviews. Data relating to the integration types, methods, and reported outcomes of integration were synthesized. Results: Seventeen publications met the inclusion criteria. Eleven (65%) reviews were published during the past 5 years, which may indicate a trend for increased awareness of the need for service integration. The majority of reviews were published by researchers in the UK (8/47%), USA (3/18%), and Australia (3/18%). Included reviews focused on a variety of integration types, including integrated care pathways, governance models, integration of interventions, collaborative/integrated care models, and integration of different types of health care. Most (53%) of the reviews reported on the cost-effectiveness of service integration, e.g., positive results, no effect, or inconclusive. Only one of the reviews reported on the importance of consumer involvement. The overall design of 70% of the reviews was high, 18% medium, and 12% low. Conclusion: There is no "one size fits all" approach to health service integration. Instead, this literature review highlighted the complexity of service integration, which in most primary studies involved a range of strategies. Rigorous assessments of cost-effectiveness and reporting on consumer involvement are required in future research

The cost of inadequate sleep among on-call workers in Australia: A workplace perspective

© 2018 by the authors. Licensee MDPI, Basel, Switzerland. On-call or stand-by is becoming an increasingly prevalent form of work scheduling. However, on-call arrangements are typically utilised when workloads are low, for example at night, which can result in inadequate sleep. It is a matter of concern that on-call work is associated with an increased risk of workplace injury. This study sought to determine the economic cost of injury due to inadequate sleep in Australian on-call workers. The prevalence of inadequate sleep among on-call workers was determined using an online survey, and economic costs were estimated using a previously validated costing methodology. Two-thirds of the sample (66%) reported obtaining inadequate sleep on weekdays (work days) and over 80% reported inadequate sleep while on-call. The resulting cost of injury is estimated at $2.25 billion per year ($1.71–2.73 billion). This equates to $1222 per person per incident involving a short-term absence from work;$2.53 million per incident classified as full incapacity, and $1.78 million for each fatality. To the best of our knowledge this is the first study to quantify the economic cost of workplace injury due to inadequate sleep in on-call workers. Well-rested employees are critical to safe and productive workplace operations. Therefore, it is in the interest of both employers and governments to prioritise and invest far more into the management of inadequate sleep in industries which utilise on-call work arrangements

An empowerment intervention for Indigenous communities: An outcome assessment

© 2015 Kinchin et al. Background: Empowerment programs have been shown to contribute to increased empowerment of individuals and build capacity within the community or workplace. To-date, the impact of empowerment programs has yet to be quantified in the published literature in this field. This study assessed the Indigenous-developed Family Wellbeing (FWB) program as an empowerment intervention for a child safety workforce in remote Indigenous communities by measuring effect sizes. The study also assessed the value of measurement tools for future impact evaluations. Methods: A three-day FWB workshop designed to promote empowerment and workplace engagement among child protection staffwas held across five remote north Queensland Indigenous communities. The FWB assessment tool comprised a set of validated surveys including the Growth and Empowerment Measure (GEM), Australian Unity Wellbeing Index, Kessler psychological distress scale (K10) and Workforce engagement survey. The assessment was conducted pre-intervention and three months post-intervention. Results: The analysis of pre-and post-surveys revealed that the GEM appeared to be the most tangible measure for detecting positive changes in communication, conflict resolution, decision making and life skill development. The GEM indicated a 17 % positive change compared to 9 % for the Australian Unity Wellbeing Index, 5 % for the workforce engagement survey and less than 1 % for K10. Conclusions: This study extended qualitative research and identified the best measurement tool for detecting the outcomes of empowerment programs. The GEM was found the most sensitive and the most tangible measure that captures improvements in communication, conflict resolution, decision making and life skill development. The GEM and Australian Unity Wellbeing Index could be recommended as routine measures for empowerment programs assessment among similar remote area workforce

Economic and epidemiological impact of youth suicide in countries with the highest human development index

This research estimates the economic and epidemiological impact of youth suicide in countries with the highest human development index. The study relied on secondary analysis of suicide mortality data for youth aged between 15-24 years in countries with the highest human development index-Norway, Australia, Switzerland, Germany, Denmark, Singapore, Netherlands, Ireland, Canada and the United States. The impact of youth suicide is measured using years of life lost, years of productive life lost and present economic value of lost productivity. Costs are expressed in 2014 International dollars. Future earning potential is estimated using adjusted gross domestic product per capita, employment potential and historical trends in productivity and real interest rates. In 2014, an estimated 6,912 young people living in the most developed countries in the world lost their lives to suicide. These preventable deaths resulted in a loss of 406,730 years of life at a cost of $5.53 billion in lost economic income with the average cost of suicide estimated at$802,939. The United States stands out as a country with the most significant youth suicide problem accounting for 77% of total costs. Reducing youth suicide requires a multifaceted approach and significant investment by governments

Incomplete equilibrium in long-range interacting systems

We use a Hamiltonian dynamics to discuss the statistical mechanics of long-lasting quasi-stationary states particularly relevant for long-range interacting systems. Despite the presence of an anomalous single-particle velocity distribution, we find that the Central Limit Theorem implies the Boltzmann expression in Gibbs' $\Gamma$-space. We identify the nonequilibrium sub-manifold of $\Gamma$-space characterizing the anomalous behavior and show that by restricting the Boltzmann-Gibbs approach to this sub-manifold we obtain the statistical mechanics of the quasi-stationary states.Comment: Title changed, throughout revision of the tex

Evaluating the Implementation of a Mental Health Referral Service "Connect to Wellbeing": A Quality Improvement Approach.

There is increasing demand for mental health services to be accessible to diverse populations in flexible, yet, cost-effective ways. This article presents the findings from a study that evaluated the process of implementing Connect to Wellbeing (CTW), a new mental health intake, assessment and referral service in regional Australia, to determine how well it improved access to services, and to identify potential measures that could be used to evaluate value for money. The study used a hybrid study design to conduct a process evaluation to better understand: the process of implementing CTW; and the barriers and factors enabling implementation of CTW. In addition, to better understand how to measure the cost-effectiveness of such services, the hybrid study design included an assessment of potential outcome measures suitable for ascertaining both the effectiveness of CTW in client health outcomes, and conducting a value for money analysis. The process evaluation found evidence that by improving processes, and removing waitlists CTW had created an opportunity to broadened the scope and type of psychological services offered which improved accessibility. The assessment of potential outcome measures provided insight into suitable measures for future evaluation into service effectiveness, client health outcomes and value for money

Efficacy and cost-effectiveness of a community-based model of care for older patients with complex needs: A study protocol for a multicentre randomised controlled trial using a stepped wedge cluster design

© 2018 The Author(s). Background: Community-dwelling older persons with complex care needs may deteriorate rapidly and require hospitalisation if they receive inadequate support for their conditions in the community. Intervention: A comprehensive, multidimensional geriatric assessment with care coordination was performed in a community setting - Older Persons ENablement And Rehabilitation for Complex Health conditions (OPEN ARCH). Objectives: This study will assess the acceptability and determine the impact of the OPEN ARCH intervention on the health and quality of life outcomes, health and social services utilisation of older people with multiple chronic conditions and emerging complex care needs. An economic evaluation will determine whether OPEN ARCH is cost-effective when compared to the standard care. Methods/design: This multicentre randomised controlled trial uses a stepped wedge cluster design with repeated cross-sectional samples. General practitioners (GPs; n ≥ 10) will be randomised as 'clusters' at baseline using simple randomisation. Each GP cluster will recruit 10-12 participants. Data will be collected on each participant at 3-month intervals (- 3, 0, 3, 6 and 9 months). The primary outcome is health and social service utilisation as measured by Emergency Department presentations, hospital admissions, in-patient bed days, allied health and community support services. Secondary outcomes include functional status, quality of life and participants' satisfaction. Cost-effectiveness of the intervention will be assessed as the change to cost outcomes, including the cost of implementing the intervention and subsequent use of services, and the change to health benefits represented by quality adjusted life years. Discussion: The results will have direct implications for the design and wider implementation of this new model of care for community-dwelling older persons with complex care needs. Additionally, it will contribute to the evidence base on acceptability, efficacy and cost-effectiveness of the intervention for this high-risk group of older people. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12617000198325p. Registered on 6 February 2017

Evaluating research impact: The development of a research for impact tool

© 2016 Tsey, Lawson, Kinchin, Bainbridge, McCalman, Watkin, Cadet-James and Rossetto. Introduction: This paper examines the process of developing a Research for Impact Tool in the contexts of general fiscal constraint, increased competition for funding, perennial concerns about the over-researching of Aboriginal and Torres Strait Islander issues without demonstrable benefits as well as conceptual and methodological difficulties of evaluating research impact. The aim is to highlight the challenges and opportunities involved in evaluating research impact to serve as resource for potential users of the research for impact tool and others interested in assessing the impact of research. Materials and methods: A combination of literature reviews, workshops with researchers, and reflections by project team members and partners using participatory snowball techniques. Results: Assessing research impact is perceived to be difficult, akin to the so-called "wicked problem," but not impossible. Heuristic and collaborative approach to research that takes the expectations of research users, research participants and the funders of research offers a pragmatic solution to evaluating research impact. The logic of the proposed Research for Impact Tool is based on the understanding that the value of research is to create evidence and/or products to support smarter decisions so as to improve the human condition. Research is, therefore, of limited value unless the evidence created is used to make smarter decisions for the betterment of society. A practical way of approaching research impact is, therefore, to start with the decisions confronting decision makers whether they are government policymakers, industry, professional practitioners, or households and the extent to which the research supports them to make smarter policy and practice decisions and the knock-on consequences of doing so. Embedded at each step in the impact planning and tracking process is the need for appropriate mix of expertise, capacity enhancement, and collaborative participatory learning-by-doing approaches. Discussion: The tool was developed in the context of Aboriginal and Torres Strait Islander research but the basic idea that the way to assess research impact is to start upfront with the information needs of decisions makers is equally applicable to research in other settings, both applied (horizontal) and basic (vertical) research. The tool will be further tested and evaluated with researchers over the next 2 years (2016/17). The decision by the Australian Government to include 'industry engagement' and 'impact' as additions to the Excellence in Research for Australia (ERA) quality measures from 2018 makes the Research for Impact Tool a timely development. The wider challenge is to engage with major Australian research funding agencies to ensure consistent alignment and approaches across research users, communities, and funders in evaluating impact

Charting the elements of pedagogic frailty

Background: The concept of pedagogic frailty has been proposed as a unifying concept that may help to integrate institutional efforts to enhance teaching improvement within universities by helping to maintain a simultaneous focus on four key areas that are thought to impede development. Purpose: The variation in internal structure of the four dimensions of pedagogic frailty and the links that have been proposed to connect them are explored here through the analysis of interviews with academics working in a variety of disciplinary areas. Methods: The application of concept map-mediated interviews allows us to view the variable connections within and between these dimensions and the personal ways they are conceptualised by academics working across the heterogeneous university context. Results: The data show that academics conceptualise the discourse of teaching in various ways that have implications for the links that may be developed to integrate the elements within the model. Conclusions: Whilst the form and content of the maps representing dimensions of the pedagogic frailty model exhibit considerable variation, it is suggested that factors such as academic resilience and the explicit use of integrative concepts within disciplines may help to overcome some of the vulnerabilities that accompany pedagogic frailty. The data also raises questions about the links between factors that tend to be under individual control and those that tend towards institutional control