An implementation science approach to early mental health programs for young people in Australian schools

School-based mental health prevention programs have been found to improve social, health and educational outcomes across the life course. The PAX Good Behaviour Game (PAX GBG) is one of the most established, effective programs for improving students’ emotional and behavioural problems in the US, Canada, and Europe. To date, there is little evidence regarding how to support implementation of programs like PAX GBG at-scale. To advance knowledge translation in the field of youth mental health, this research aimed to co-design and trial a novel multicomponent implementation strategy to accelerate the uptake and adoption of the PAX GBG program in New South Wales (NSW) primary schools. The findings from this research are presented as four original studies, across four chapters. Chapter 2 presents a systematic review of strategies with evidence of supporting school-based program implementation. Chapter 3 reports the iterative process in which researchers, educators and Department of Education leaders used qualitative methods to co-design the multicomponent implementation strategy. Chapter 4 presents results from the effectiveness-implementation study of the multicomponent strategy, examining what components of the strategy supported program adoption for which staff, under what conditions, and why. Chapter 5 reports a case study that identified program adaptations that teachers perceived to increase program engagement among students with neurodivergence. Chapter 6 synthesises the key findings from the overall research. The multicomponent strategy increased the acceptability and appropriateness of the program and facilitated adoption among teachers who had positive attitudes towards evidence-based practices. Collectively, the strategies increased the program’s appeal by offering positive reinforcement, enhancing learning, and reducing the cognitive load of teachers. There was also evidence the program could be adapted to be more inclusive of students with diverse learning, social and cultural needs. This research advances what is known about the factors, strategies and processes that support mental health program implementation in Australian schools. It supports knowledge translation by providing an evidence-based, educator informed multicomponent strategy that can be used and adapted to enhance implementation. The research also provides evidence that acceptability and appropriateness need to be targeted in early efforts to facilitate program adoption

How frontline domestic and family violence workforce in Australia kept connected to their clients and each other through the pandemic. Practitioner report

Australia, like most countries, introduced strict infection control measures to curb the spread of COVID-19 after it was declared a pandemic on the 11th of March, 2020. People's movement was restricted through physical distancing, border closures and mandatory lockdowns. Many businesses and schools also closed down. There have been international concerns that these restrictions have put people at increased risk of experiencing domestic and family violence (DFV) whilst also reducing their capacity to seek help. Services have had to adapt and innovate to find ways to continue to connect to at risk clients whilst staying COVID-19 safe. There are concerns that adjusting to challenging work conditions has and will continue to take a toll on practitioners' wellbeing. This report presents the findings of a nation-wide study of the experiences of frontline DFV practitioners in Australia during the early months of COVID-19, funded under UNSW's Rapid Research Initiative. The study explores the perceived impacts of COVID-19 on clients, service adaptations and innovations, and the challenges faced by frontline staff. We draw on insights gained from interviews with 50 practitioners from DFV services between July and October 2020. Our interviews revealed that clients' experience of DFV changed during COVID-19. The demand for DFV services mostly increased, with the exception of shelters where demand initially decreased. The study highlights that DFV has become more complex and escalated in intensity during COVID-19. Practitioners spoke about how COVID-19 has been used as a tactic for DFV, and that monitoring and technology abuse appear to have worsened during lockdown. Practitioners felt that services did well to adapt and innovate to stay connected with clients under these circumstances. The four most common service adaptations were 1) shifting to outreach models of care 2) implementing infection control 3) telehealth and digitally enabled service delivery and 4) remote legal support and advocacy. Where possible, frontline practitioners worked remotely in the early months of the pandemic. Practitioners acknowledged that it has been challenging for them to adjust to COVID-19 conditions. They felt the added stress of being an essential worker in a pandemic on top of already being on the frontlines of the DFV epidemic. Practitioners also found it challenging to adjust to remote working because of the collision of work and home life, vicarious trauma, fatigue, and professional isolation. On the other hand, practitioners highlighted that some COVID-19 adaptations/innovations have been valuable and that they would like to see these carried forward into the 'new normal'. These are listed below as recommendations to inform future service responses

“The real pandemic’s been there forever”: qualitative perspectives of domestic and family violence workforce in Australia during COVID-19

Background: In 2020, Australia, like most countries, introduced restrictions related to the global pandemic of coronavirus disease 2019 (COVID-19). Frontline services in the domestic and family violence (DFV) sector had to adapt and innovate to continue supporting clients who were experiencing and/or at risk of DFV. There is a need to understand from the perspective of those on the frontline how DFV service responses in different contexts impacted their working conditions and subsequent wellbeing, and what they want to see continued in ‘the new normal’ to inform future effective practices. We address this by reporting on findings from in-depth interviews conducted with practitioners and managers from the DFV sector in Australia. Methods: Between July and September 2020 semi-structured interviews were conducted with 51 DFV practitioners and managers from a range of services and specialisations across legal, housing, health and social care services. The data was analysed using iterative thematic analysis. Results: The most common service adaptations reported were shifting to outreach models of care, introducing infection control procedures and adopting telehealth/digital service delivery. Adjacent to these changes, participants described how these adaptations created implementation challenges including increased workload, maintaining quality and safety, and rising costs. Impacts on practitioners were largely attributed to the shift towards remote working with a collision in their work and home life and increased risk of vicarious trauma. Despite these challenges, most expressed a sense of achievement in how their service was responding to COVID-19, with several adaptations that practitioners and managers wanted to see continued in ‘the new normal’, including flexible working and wellbeing initiatives. Conclusions: The pandemic has amplified existing challenges for those experiencing DFV as well as those working on the frontline of DFV. Our findings point to the diversity in workforce experiences and has elucidated valuable lessons to shape future service delivery. Given the continuing impacts of the pandemic on DFV, this study provides timely insight and impetus to strengthen the implementation of remote working and telehealth/digital support across the DFV sector and to inform better supports for DFV workforce wellbeing in Australia and other contexts. Trial registration: Not a clinical intervention

Assessing violence and injury prevention plans, strategies and indicators in eighteen Pacific Islands countries: an environmental scanResearch in context

Summary: Background: Similar to many other resource poor settings, due to competing priorities, injury is often neglected in the Pacific Islands despite being a prevalent cause of death and disability. This study identifies, and synthesises existing plans and strategies, and assesses progress against indicators for the prevention of violence and injury in 18 Pacific Islands nations to identify gaps and highlight opportunities. Methods: An environmental scan of known government repositories and Google Advanced was conducted to identify publicly available documents describing/evaluating national-level injury prevention strategies and plans in the Pacific Islands. Data were extracted on the strategy/plan, country, government department responsible, indicators and related progress. Findings: We identified 44 relevant documents. Most were published in more resourced countries (e.g., Fiji, Cook Islands) and described strategies/plans relating to traffic injury, injury from natural disaster and/or intimate partner violence. No strategies/plans to prevent injury mechanisms of drowning, falls, suffocation, burns, or electrocution were identified. Progress against only one indicator was reported for road traffic injury in the Commonwealth of the Northern Mariana Islands. Interpretation: This study suggests that there would be benefit in Pacific Islands nations to develop more robust data systems to assess progress against indicators of existing strategies and plans for traffic-injury, natural disaster and intimate partner violence. Development of strategies and implementation plans to address neglected injury areas such as drowning and falls which account for a significant burden of injury in the Pacific Islands is also recommended. Funding: This work was funded by the World Health Organization Regional Office for the Western Pacific (RG 221962)

Self-harm in 5-to-24 year olds : retrospective examination of hospital presentations to emergency departments in New South Wales, Australia, 2012 to 2020

There is some evidence that self-harm presentations in children and young people have increased over the past decade, yet there are few up-to-date studies examining these trends. This study aims to describe trends in the rates and severity of emergency department self-harm presentations for youth aged 5–24 years in New South Wales, Australia between 1 January 2012 and 31 December 2020. We analysed self-harm hospital presentations using join point analysis to compare quarterly growth in rates and urgency of presentation since 2012 by age group and sex. Binomial logistic modelling was used to identify risks for re-presentation for self-harm, including age group, sex, country of birth, mode of arrival, inpatient status, triage category, rurality, and socio-economic disadvantage. In total, 83,111 self-harm presentations for 51,181 persons were analysed. Overall rates of self-harm among those aged 5–24 years increased by 2.4% (p < .001) per quarter in females and 1.6% (p < .001) per quarter in males, with statistically significant average quarterly increases observed across all age groups. Overall and age-specific self-harm triage urgency rates increased statistically significantly for potentially serious, and potentially- and immediately life-threatening categories. A higher likelihood of re-presentation to any emergency department for self-harm was associated with younger age, female, residing in a regional area, arriving by ambulance, admitted as an in-patient, and a more severe index self-harm presentation. Hospital self-harm presentations have been growing steadily over the past decade, with the greatest growth in the youngest people. Understanding the reasons for these sustained upward trends is a priority for suicide prevention

Understanding the dual role of clinician-scientists in cancer clinical trials: a scoping review protocol

ABSTRACT Objectives: This scoping review explores healthcare professionals’ experiences delivering cancer-related clinical trials, including how ‘research’ and ‘clinical practice’ activities interact and/or interfere with trial delivery and patient care. Introduction: Clinical trial research is essential for advancing the quality of care delivered to cancer patients. Healthcare professionals are the main point of contact for patients participating in a trial and play a critical role in trial conception/design, recruitment, informed consent, intervention delivery, and/or monitoring patient outcomes, whilst concurrently providing good clinical practice. Barriers to undertaking trial research are well documented at patient- and systems-levels, yet little is known about how clinical trial research impacts healthcare professionals. Inclusion criteria: This review will consider articles that meet the following criteria: (1) includes any healthcare professional involved in the delivery of a cancer-related clinical trial, (2) concepts of interest include experiences, attitudes or perceptions reported by healthcare professionals pertaining to trial delivery, and (3) context is within or in relation to the hospital setting. Study sources must be published in a peer-reviewed journal from 2000-present and be English-based or translated. Methods: The search will be conducted in Embase (OVID) and PubMED (MEDLINE) databases. The lead reviewer will screen all articles, while a second reviewer will screen a selection (~20%) of titles/abstracts, and full texts. Study characteristics will be extracted using a data extraction table, and qualitative data will be thematically analysed (via NVivo 14) using a mixed inductive/deductive process informed by implementation science frameworks. Keywords: Clinical trials, oncology, implementation science, clinician-researcher, health-care deliver

sj-docx-1-dhj-10.1177_20552076241230072 - Supplemental material for Digital therapeutics in the hospital for suicide crisis – content and design recommendations from young people and hospital staff

Supplemental material, sj-docx-1-dhj-10.1177_20552076241230072 for Digital therapeutics in the hospital for suicide crisis – content and design recommendations from young people and hospital staff by Demee Rheinberger, Rachel Baffsky, Lauren McGillivray, Daniel Z Q Gan, Mark Larsen and Michelle Torok in DIGITAL HEALTH</p

Self-harm in adolescence and risk of crash: A 13-year cohort study of novice drivers in New South Wales, Australia

Introduction: Self-harm and suicide are leading causes of morbidity and death for young people, worldwide. Previous research has identified self-harm is a risk factor for vehicle crashes, however, there is a lack of long-term crash data post licensing that investigates this relationship. We aimed to determine whether adolescent self-harm persists as crash risk factor in adulthood. Methods: We followed 20 806 newly licensed adolescent and young adult drivers in the DRIVE prospective cohort for 13 years to examine whether self-harm was a risk factor for vehicle crashes. The association between self-harm and crash was analysed using cumulative incidence curves investigating time to first crash and quantified using negative binominal regression models adjusted for driver demographics and conventional crash risk factors. Results: Adolescents who reported self-harm at baseline were at increased risk of crashes 13 years later than those reporting no self-harm (relative risk (RR) 1.29: 95% CI 1.14 to 1.47). This risk remained after controlling for driver experience, demographic characteristics and known risk factors for crashes, including alcohol use and risk taking behaviour (RR 1.23: 95% CI 1.08 to 1.39). Sensation seeking had an additive effect on the association between self-harm and single-vehicle crashes (relative excess risk due to interaction 0.87: 95% CI 0.07 to 1.67), but not for other types of crashes. Discussion: Our findings add to the growing body of evidence that self-harm during adolescence predicts a range of poorer health outcomes, including motor vehicle crash risks that warrant further investigation and consideration in road safety interventions. Complex interventions addressing self-harm in adolescence, as well as road safety and substance use, are critical for preventing health harming behaviours across the life course