BACKGROUND: Young people commonly use social media platforms to communicate about suicide. Although research indicates that this communication may be helpful, the potential for harm still exists. To facilitate safe communication about suicide on social media, we developed the #chatsafe guidelines, which we sought to implement via a national social media campaign in Australia. Population-wide suicide prevention campaigns have been shown to improve knowledge, awareness, and attitudes toward suicide. However, suicide prevention campaigns will be ineffective if they do not reach and resonate with their target audience. Co-designing suicide prevention campaigns with young people can increase the engagement and usefulness of these youth interventions. OBJECTIVE: This study aimed to document key elements of the co-design process; to evaluate young people's experiences of the co-design process; and to capture young people's recommendations for the #chatsafe suicide prevention social media campaign. METHODS: In total, 11 co-design workshops were conducted, with a total of 134 young people aged between 17 and 25 years. The workshops employed commonly used co-design strategies; however, modifications were made to create a safe and comfortable environment, given the population and complexity and sensitivity of the subject matter. Young people's experiences of the workshops were evaluated through a short survey at the end of each workshop. Recommendations for the campaign strategy were captured through a thematic analysis of the postworkshop discussions with facilitators. RESULTS: The majority of young people reported that the workshops were both safe (116/131, 88.5%) and enjoyable (126/131, 96.2%). They reported feeling better equipped to communicate safely about suicide on the web and feeling better able to identify and support others who may be at risk of suicide. Key recommendations for the campaign strategy were that young people wanted to see bite-sized sections of the guidelines come to life via shareable content such as short videos, animations, photographs, and images. They wanted to feel visible in campaign materials and wanted all materials to be fully inclusive and linked to resources and support services. CONCLUSIONS: This is the first study internationally to co-design a suicide prevention social media campaign in partnership with young people. The study demonstrates that it is feasible to safely engage young people in co-designing a suicide prevention intervention and that this process produces recommendations, which can usefully inform suicide prevention campaigns aimed at youth. The fact that young people felt better able to safely communicate about suicide on the web as a result of participation in the study augurs well for youth engagement with the national campaign, which was rolled out across Australia. If effective, the campaign has the potential to better prepare many young people to communicate safely about suicide on the web.

Mental health presentations to the emergency department (ED) have increased, and the emergency department has become the initial contact point for people in a mental health crisis. However, there is mounting evidence that the ED is not appropriate nor effective in responding to people in mental health crises. Insufficient attention has been paid to the subjective experience of people seeking support during a mental health crisis. This review aims to describe the qualitative literature involving the subjective experiences of people presenting to the ED during a mental health crisis. The method was guided by Arksey and O'Malley's framework for scoping studies and included keyword searches of PsycINFO, CINAHL, Medline and Embase. A narrative analysis, drawing on the visual tool of journey mapping, was applied to summarise the findings. Twenty-three studies were included. The findings represent the experience of accessing EDs, through to the impact of treatment. The review found points of opportunity that improve people's experiences and characteristics associated with negative experiences. The findings highlight the predominance and impact of negative experiences of the ED and the incongruence between the expectations of people presenting to the ED and the experience of treatment.

AIM: To describe the health needs identified in children attending a comprehensive health assessment at a tertiary hospital, multidisciplinary clinic for children following entry to out-of-home care and timeliness of referral and assessment compared with national recommendations. METHODS: This was a retrospective audit of all the children who attended the Pathway to Good Health clinic at The Royal Children's Hospital, Melbourne from May 2013 until 31 August 2016. RESULTS: A total of 119 children aged 0-12 years attended the clinic during the audit period. Of these children, 17% (including more than 30% of 0-2-year-olds) were not up-to-date with immunisations, and 87% had physical health concerns that were addressed on the day or needed further management. Over 50% had mental health concerns identified (76% of 7-12-year-olds). In children aged 3-6 years, 64% had behavioural problems and 77% had developmental problems identified. Only a third of the children was referred to the Pathway to Good Health clinic within the national standard of 30 days post-entry to care, and 24% of children attended within 3 months of entry to care. CONCLUSION: Children in out-of-home care within Victoria have high rates of physical, mental and developmental health concerns, consistent with previous studies. Timeliness of attendance at the clinic was low compared with national recommendations, even within a programme designed to facilitate timely health checks. This is the second and largest Australian study exploring timeliness of health checks. Further research would establish whether these results are more systemic.

This paper critiques the Safewards model through the lens of lived experiences of psychiatric hospitalization, diagnosis of mental illness, and distress. Special focus is given to the model's tested 10 interventions and to five lesser known interventions, identifying the impact they can have on hospitalized consumers. We highlight the role and prevalence of trauma, as well as the need to prevent harm in hospital settings. We draw upon notions of hospital as a sanctuary for people and the importance of providing a safe ward. 'Sanctuary harm' and 'Sanctuary trauma' are thus defined, with emphasis placed on the Safewards interventions as means by which sanctuary can be achieved. Finally, the consumer-perspective authors propose expansions to the model, critiquing the defining literature and moving towards a consumer experience of safety that is beyond the model's original intention: to reduce seclusion and restraint practices. Throughout the paper, the term 'consumer' is used in this context to mean people who have experienced or are experiencing psychiatric inpatient care.

Abstract This article explores parental experiences over nearly seven years that followed catastrophic Australian bushfires in 2009. Principles of pragmatism and the constructionist tradition guided the use of semi-structured interviews with parents (nineteen mothers and three fathers) and inductive thematic analysis to distil what participants said about the trauma, loss and disruption caused by the fires, and ways in which they responded as parents. Changes described in their parenting role and family life were themed as ‘losing normal’ which encompassed managing additional exposures, losing fun and living at their capacity. Parents then evinced the struggle of settling and seeking to regain a sense of normal. This theme highlighted tensions, pressures and expectations they faced (their own and external) in trying to get back to normal, along with extended recovery timeframes. Participants valued strategies to provide stability, familiarity and manage their own emotions. The analysis highlights the influence of the parental role on an experience of trauma, the range of losses and the extended experience of disaster recovery for parents. Insights for social work practice are discussed, including the potential to inform expectations of recovery timeframes and supporting parents and their families to reconstruct their sense of normal in their new, post-disaster context.

OBJECTIVE: Online psychological therapies provide a way to connect adolescent and young adult (AYA) cancer survivors to evidence-based support. We aimed to establish the feasibility, acceptability, and safety of Recapture life, a six-session group-based online cognitive-behavioural intervention, led by a facilitator, for AYAs in the early post-treatment period. METHODS: A randomised-controlled trial compared Recapture Life to an online peer-support group control and a waitlist control. Participants could nominate a support person. Acceptability was assessed using study opt-in and retention rates, participant-reported benefits/burdens of participation, and group facilitator burden. We also assessed the feasibility (eg, frequency/impact of technological difficulties) and psychological safety (ie, occurrence of clinically concerning distress) of the program. RESULTS: Sixty-one participants took part (45 AYAs, 51.1% female; 19 support people). The opt-in rate was 30%, the enrolment rate was 87%, and 75% of participants took part in ≥5/6 sessions. AYAs reported high benefit and low burden of participation. Overall, 95 online group sessions were conducted; few required rescheduling by group facilitators (3%), but many took place outside of office hours (~90 hours). It took 40 days on average to create online groups, but established weekly sessions commenced quickly (M = 4.0 minutes). Technological difficulties were common but had a low impact on intervention delivery. Although 54% of AYAs returned a clinically concerning distress screen at some point, none reflected acute mental health risks. CONCLUSIONS: The data largely indicate that Recapture Life is an acceptable, feasible, and safe model of evidence-based psychological support for AYAs during early survivorship, which nevertheless experienced common challenges in online/AYA intervention delivery.

OBJECTIVES: This research explored residential aged care (RAC) workplace design features that influence how RAC staff feel valued, productive, safe, like they belong and connected. A secondary aim was to validate emerging themes about RAC design features with stakeholders. METHODS: A multistage qualitative study was conducted in one RAC facility with 100 residents in outer metropolitan Melbourne: (i) photo-elicitation - photographs were used to prompt discussions with RAC staff; (ii) individual interviews with RAC directors; and (iii) validity testing with the advisory committee occurred. RESULTS: Key workplace design features that influenced how RAC staff feel valued, productive, safe, like they belong and connected included the following: (i) home-like environment; (ii) access to outdoor spaces; (iii) quality indoor environment; and (iv) access to safe, open and comfortable workplaces. CONCLUSIONS: Key workplace design features that matter to RAC staff in a 'shared workspace' exist. Increasing demands upon RAC requires evidence-based workplace design policy and evaluation approaches that support RAC staff to work in RAC shared workspaces.

OBJECTIVE: To examine the relationship between the cancer care experiences of adolescents and young adults (AYAs) and their quality of life. METHODS: Two hundred and nine AYAs completed a cross-sectional, self-report survey distributed through the population-based cancer registries in 2 Australian states (New South Wales and Victoria). Eligible AYAs were 15 to 24 years old when diagnosed with any cancer (excluding early-stage melanoma) and were 3 to 24 months post-diagnosis. Questions examined whether particular care experiences occurred for the patient at different points in the cancer care pathway, including diagnosis, treatment, inpatient care, and at the end of treatment. Quality of life was assessed using the Functional Assessment of Cancer Therapy-General scale. RESULTS: Positive experiences of care at diagnosis, during treatment, during inpatient stays, and when finishing treatment were associated with higher functional, emotional, and social well-being. However, these associations generally became nonsignificant when communication and support experiences were included in the model. Inpatient experiences positively influenced emotional well-being over and above the effect of communication and support experiences. CONCLUSIONS: The results suggest that, for most AYAs' quality of life outcomes, positive experiences of age-appropriate communication and emotional support may underpin the effect of positive experiences of care throughout the cancer care pathway. The results support the need for communication and support tailored to an AYA audience, as recognised by recent Australian and international guidelines on the care of AYAs with cancer.

INTRODUCTION AND AIMS: The workplace holds substantial potential as an alcohol harm reduction and prevention setting. Few studies have rigorously examined strategies to reduce workplace alcohol-related harm. Hence, an in-situ 3 year trial of a comprehensive alcohol harm reduction intervention in Australian manufacturing workplaces was undertaken. DESIGN AND METHODS: Informed by a gap analysis, a multi-site trial was undertaken. Three manufacturing industry companies, located at four separate worksites, with a minimum of 100 employees were recruited through a local industry network. Based on worksite location, two worksites were allocated to the intervention group and two to the comparison group. The pre-specified primary outcome measure, risky drinking (Alcohol Use Disorders Identification Test, AUDIT-C) and other self-report measures were collected pre-intervention (T1), 12 months (T2) and 24 months post-intervention (T3). RESULTS: No significant intervention effect was observed for the primary outcome measure, risky drinking. Significant intervention effects were observed for increased awareness of alcohol policy and employee assistance. At T3, the odds of intervention group participants being aware of the workplace policy and aware of employee assistance were 48.9% (95% confidence interval 29.3-88.9%) and 79.7% (11.5%, 91.8%), respectively, greater than comparison group participants. DISCUSSION AND CONCLUSIONS: Comprehensive tailored workplace interventions can be effective in improving workplace alcohol policy awareness. This is one of few workplace alcohol trials undertaken to-date and the findings make an important contribution to the limited evidence base for workplace alcohol harm prevention initiatives.

There is a need for effective and youth-friendly approaches to suicide prevention, and social media presents a unique opportunity to reach young people. Although there is some evidence to support the delivery of population-wide suicide prevention campaigns, little is known about their capacity to change behaviour, particularly among young people and in the context of social media. Even less is known about the safety and feasibility of using social media for the purpose of suicide prevention. Based on the #chatsafe guidelines, this study examines the acceptability, safety and feasibility of a co-designed social media campaign. It also examines its impact on young people's willingness to intervene against suicide and their perceived self-efficacy, confidence and safety when communicating on social media platforms about suicide. A sample of 189 young people aged 16-25 years completed three questionnaires across a 20-week period (4 weeks pre-intervention, immediately post-intervention, and at 4-week follow up). The intervention took the form of a 12-week social media campaign delivered to participants via direct message. Participants reported finding the intervention acceptable and they also reported improvements in their willingness to intervene against suicide, and their perceived self-efficacy, confidence and safety when communicating on social media about suicide. Findings from this study present a promising picture for the acceptability and potential impact of a universal suicide prevention campaign delivered through social media, and suggest that it can be safe to utilize social media for the purpose of suicide prevention.

BACKGROUND: Children living in out-of-home care (OOHC) have significant unmet health care needs and use more tertiary and specialist health care services compared with children from similar social and economic backgrounds. Allied health professionals and nurses have a central role in health care; however, very little is known about the engagement of children in OOHC with nursing and allied health professionals. This scoping review addresses this knowledge gap. METHODS: A scoping review methodology framework was used to search for relevant articles published between January 1970 and November 2019, identified using three databases: MEDLINE, CINAHL and ProQuest. Selection of studies was based on empirical research about the health of children in OOHC and their engagement with nursing or allied health services. A total of 37 relevant articles met the eligibility criteria for inclusion in this review. RESULTS: Findings could be summarized under five broad themes: (1) nursing and allied health professionals engaging with children in OOHC to support their health and development, (2) opportunities and challenges for nursing and allied health professionals to engage children in OOHC in healthcare, (3) identification and complexity of healthcare needs, (4) access to healthcare services and (5) coordination of healthcare. CONCLUSIONS: Children in OOHC have multiple healthcare needs that require monitoring and treatment by allied health professionals and the health and development of these children is best supported through comprehensive health screening on entry into OOHC, and community-based, multidisciplinary healthcare while children are living in OOHC. While nurses in hospitals and community settings were found to play a role in health assessment and care coordination targeted at children in OOHC, the literature was silent on the role of allied health professionals in this healthcare approach.

BACKGROUND: Healthcare practitioners (HCPs) play a crucial role in recognising, responding to, and supporting female patients experiencing intimate partner abuse (IPA). However, research consistently identifies barriers they perceive prevent them from doing this work effectively. These barriers can be system-based (e.g. lack of time or training) or personal/individual. This review of qualitative evidence aims to synthesise the personal barriers that impact HCPs' responses to IPA. METHODS: Five databases were searched in March 2020. Studies needed to utilise qualitative methods for both data collection and analysis and be published between 2010 and 2020 in order to qualify for inclusion; however, we considered any type of healthcare setting in any country. Article screening, data extraction and methodological appraisal using a modified version of the Critical Appraisal Skills Program checklist for qualitative studies were undertaken by at least two independent reviewers. Data analysis drew on Thomas and Harden's thematic synthesis approach. RESULTS: Twenty-nine studies conducted in 20 countries informed the final review. A variety of HCPs and settings were represented. Three themes were developed that describe the personal barriers experienced by HCPs: I can't interfere (which describes the belief that IPA is a "private matter" and HCPs' fears of causing harm by intervening); I don't have control (highlighting HCPs' frustration when women do not follow their advice); and I won't take responsibility (which illuminates beliefs that addressing IPA should be someone else's job). CONCLUSION: This review highlights the need for training to address personal issues in addition to structural or organisational barriers. Education and training for HCPs needs to: encourage reflection on their own values to reinforce their commitment to addressing IPA; teach HCPs to relinquish the need to control outcomes so that they can adopt an advocacy approach; and support HCPs' trust in the critical role they can play in responding. Future research should explore effective ways to do this within the context of complex healthcare organisations.

OBJECTIVE: To assess the demographic, social, and clinical characteristics of young Australians who die by suicide. DESIGN: Retrospective analysis of National Coronial Information System (NCIS) data. SETTING, PARTICIPANTS: People aged 10-24 years who died by suicide in Australia during 2006-2015. MAIN OUTCOME MEASURES: Demographic, social, and clinical characteristics of young people who died by suicide; circumstances of death recorded in the NCIS. RESULTS: 3365 young people died of suicide during 2006-2015 (including 2473 boys and men, 73.5%); 1292 people (38.4%) lived in areas of greater socio-economic disadvantage. Free text reports were included in the NCIS for 3027 people (90%), of whom 1237 (40.9%) had diagnosed mental health disorders and 475 (15.7%) had possible mental health disorders. Alcohol consumption near the time of death was detected in 1015 of 3027 cases (33.5%); histories of self-harm were recorded in 940 cases (31.1%) and of illicit substance misuse in 852 (28.1%). Adverse life events included history of abuse or neglect (223, 7.4%), suicide of relatives, friends, or acquaintances (202, 6.7%), and financial difficulties (174, 5.8%). CONCLUSIONS: Three-quarters of the young people who died by suicide were boys or young men, and 57% had diagnosed or possible mental health disorders, suggesting that the mental health and wellbeing of young Australians should be a key target for youth suicide prevention. To reduce the number of youth suicides, it is imperative that prevention strategies target the mental health and psychosocial stressors that lead to suicidal crises in young people.

Anger is an important dimension of affect and a prominent feature of posttraumatic mental health, but it is commonly overlooked in postdisaster settings. We aimed to examine the distribution and implications of significant anger problems in the aftermath of a natural disaster, via analyses of Beyond Bushfires survey data from 736 residents of rural communities 5 years after the 2009 Black Saturday bushfires in Victoria, Australia. Assessments included the five-item Dimensions of Anger Reaction (DAR-5) scale along with measures of PTSD, depression, and significant mental illness, and indicators of life satisfaction, suicidality, hostile aggressive behavior, and violence exposure. The results indicated that approximately 10% of respondents from areas highly affected by the bushfires scored above the provisional cutoff criteria for significant anger problems on the DAR-5, which was a more than 3-fold increase, OR = 3.26, relative to respondents from areas of low-to-moderate bushfire impact. The rates were higher among women, younger participants, and those who were unemployed, and co-occurred commonly, although not exclusively, with other postdisaster mental health problems. Anger problems were also associated with lower life satisfaction, β = -.31, an 8-fold increase in suicidal ideation, OR = 8.68, and a nearly 13-fold increase in hostile aggressive behavior, OR = 12.98. There were associations with anger problems and violence exposure, which were reduced when controlling for covariates, including probable PTSD. The findings provide evidence indicating that anger is a significant issue for postdisaster mental health and should be considered routinely alongside other posttraumatic mental health issues.

There is growing recognition of the links between knowledge translation, policy and practice, particularly in the domestic violence research area. A literature review applying a systematic approach with a realist lens was the preferred methodology. The review answered the following question: What are the mechanisms of change in research networks which 'work' to support knowledge translation? A search of eight electronic databases for articles published between 1960 and 2018 was completed, with 2,999 records retrieved, 2,869 records excluded and 130 full-text articles screened for final inclusion in the review. The inclusion criteria were purposefully broad, including any study design or data source (including grey literature) with a focus on domestic violence knowledge translation. The analysis of included studies using a realist lens identified the mechanisms of change to support knowledge translation. A disaggregation of the included studies identified five theories focused on the following outcomes: (1) develop key messages, (2) flexible evidence use, (3) strengthen partnerships, (4) capacity building and (5) research utilisation. This review adds to our understanding of knowledge translation of domestic violence research. The mechanisms of change identified may support knowledge translation of research networks. Further research will focus on exploring the potential application of these program theories with a research network.

PROBLEM: Critical illness in children is a significant and stressful life event for families. Within pediatric emergency department (ED) settings it is acknowledged that these crises are challenging for both the families of these children, and for the clinical staff treating the child. Literature recommends routine care should include an offer to the family to be present with their critically ill child, however there is a lack of clarity regarding specific family care models or evidence-based interventions to guide clinical practice. ELIGIBILITY CRITERIA: Peer reviewed articles written in English, published between 2006 and 2016, proposing or testing psychosocial care models in pediatric (or mixed) emergency settings. SAMPLE: Nine articles met inclusion criteria. RESULTS: Search results showed limited evidence available in the literature at this time. Thematic analysis of article content and proposed model showed strong support for the benefit of family presence, including shifting the family role from passive to active, needing to be inclusive of the psychological impact of critical health events, importance of multidisciplinary education, and the need for additional exploratory and empirical research to evaluate and refine proposed care models. CONCLUSIONS: Pediatric emergency health events are challenging for both families and staff, and care models provide staff with a consistent, evidence-informed approach to caring for families in challenging situations. IMPLICATIONS: There is a need to find common ground from specific discipline guidelines into a multidisciplinary team approach for the care of families within emergency care.

Purpose: This paper examines the empirical research on police reassurance following a collective trauma event (CTE). Design/methodology/approach: Using a scoping review methodology, this paper sought to establish the extent, range and nature of published literature on policing responses to collective traumatic events, and to identify key features of this form of direct practice. Included papers needed to focus on police responses oeassurance with the public related to events (pre-or post) that could be regarded as collective trauma events by nature or scale. Searches were conducted using the Web of Science, SCOPUS and PsychINFO databases for literature published between January 2000 and December 2019. Findings: Fourteen articles met the inclusion criteria. The key themes identified: (1) measuring the impact of reassurance and community policing; (2) community attitudes to policing and social disorder/critical events; (3) police workforce responses to traumatic events; and (4) interventions to support police to respond to their community. Research limitations/implications: Future research needs to examine the elements that create a robust organisational infrastructure that can withstand the demands of policing in ordinary and extraordinary times. Fundamental to the studies in this review is the relationship between the police agencies and the community. The nature of this relationship and how it can be strengthened to ameliorate the negative impact of CTEs in communities needs further exploration. Originality/value: This paper provides important findings that can inform future reassurance policing practice and research.

In India, cardiovascular disease (CVD), with hypertension as its foremost risk factor, has the highest prevalence rate of non-communicable diseases (NCDs) and a rising mortality. Previous research has found a clustering of behavioural and social risks pertaining to NCDs, though the latter are infrequently addressed in public health interventions in India. This paper reaches toward the development of a social intervention to address social determinants of NCD relating to hypertension and diabetes. We used Theory of Change (ToC) as a theoretical approach to programme design. Mixed methods were used, including qualitative interviews with community members (n = 20), Accredited Social Health Activists (n = 6) and health professionals (n = 8), and a stakeholder workshop (n = 5 participants). The recruitment of participants from one local area in Kerala enabled us to map service provision and gain a holistic understanding of how to utilise the existing workforce to target social risk factors. The findings suggest that social interventions need to focus on ensuring health behaviour information reaches all parts of the community, and that those with more social risk factors are identified and supported to engage with treatment. Further research is required to test the resulting intervention model.

BACKGROUND: This study investigated the knowledge of depression and preference for professional help, medications and treatment methods among Australians of Chinese-speaking background, and the perceptions of this population of the causes of mental illness. METHODS: Adopting a cluster convenience sampling method, the study recruited 200 Chinese-speaking subjects from four major areas in metropolitan Melbourne where many Chinese live. The respondents were presented with a vignette describing an individual with depression and then asked questions to assess their understanding of depression and preference for professional help, medications and treatment methods. A comparative approach was used to compare the findings with those of a previous study of the mental health literacy of Australian and Japanese adults. RESULTS: Compared to the Australian and Japanese samples, a much lower percentage of Chinese-speaking Australians (14%) could correctly identify major depression described in the vignette, and a higher percentage believed that counseling professionals could be helpful. Higher percentages of those who believed that close family members could be helpful were found in the Chinese-speaking Australian and Japanese samples, and these two groups also expressed more uncertainty about the usefulness or harmfulness of certain medications compared to the Australian sample. Higher percentages of respondents in both the Chinese-speaking Australian and the Australian sample considered "lifestyle changes" to be helpful compared to the Japanese sample. In the Chinese-speaking sample, 30%, 17.4%, 33% and 27% of the respondents rated "traditional Chinese medicine doctors," "Chinese herbal medications," "taking Chinese nutritional foods/supplements" and "qiqong" as helpful. Many perceived "changing fungshui" and "traditional Chinese worship" to be harmful. Regarding the perception of causes of mental illness, items related to psychosocial perspectives including "life stress" and "interpersonal conflict" were rated highly by the respondents, whereas traditional beliefs including "punishment for misdeeds conducted by ancestors" and "demon possession" had the lowest ratings. CONCLUSIONS: Campaigns to increase the mental health literacy of Chinese-speaking Australians are needed. The above-mentioned socially and culturally driven beliefs need to be taken into consideration in the development of culturally relevant education programs.

Objective: Suicide is major public health problem in India. The objective of the analyses presented in this paper is to examine depressive and anxiety symptoms and socio-demographic indicators as correlates of suicidal ideation and attempts among people who inject drugs (PWID), a high-risk group for suicide. Method: We analysed data collected in April–May of 2012 from a community-based sample of 420 PWID in Delhi using time location sampling. Self-report symptom scales were used to measure the severity of symptoms of depression (PHQ-9) and anxiety (GAD-2) within the preceding 2 weeks. We assessed the presence of suicidal thoughts within the past 12 months. Results: Depressive and anxiety symptoms were associated with suicidal ideation, as were a range of social stressors including poor physical health, length of injecting drug use, housing insecurity, and experiences of violence and sexual abuse. However, depressive and anxiety symptoms were not associated with suicide attempts. Factors associated with suicide attempts among ideators were housing insecurity and relational dynamics including a poor relationship with family and, interestingly, being married. Conclusion: Suicide prevention interventions among this population should address not only individual mental health and addiction support needs but also the overwhelmingly poor psychosocial circumstances of this group.

This Practice Framework isdesigned as a brief guide for practitioners and program designers to the principles and intervention style deemed essential for working with this population. It is best read in the context of a program curriculum such as the Positive Shift Curriculum or the University of Melbourne research reports on this topic. The framework is based on a research program about women who use force in a family context, which has included academic researchers from the University of Melbourne and Curtin University and service providers and users (Baptcare and Berry Street).

This is the final report (3 volumes) of a research program that has developed the Australian knowledge base about women who use force in a family context, and appropriate service responses. The research was funded by the Department of Social Services. Volume 1 contains a practice framework for intervening with this population, a description and evaluation of +SHIFT (a group work and case management program for women who use force) and the executive summary.

This book makes an important contribution to the international understanding of domestic violence and shares the latest knowledge of what causes and sustains domestic violence between intimate partners, as well as the effectiveness of ...

This article explores how employees with mental illness perceive HRM and its impact, drawing on consumer-centred perspectives. Using the case of consumer-workers employed for their lived experience of mental illness in mental health care services, we investigate the degree to which they feel included or marginalised by HR systems, processes and practices. Through a mixed method study designed along co-production principles, we found consumer-workers faced different but interrelated problems stemming from their status: a general lack of understanding of the role and its purpose; inequity in pay rates, workplace conditions, and training and development; as well as employment precarity and difficulties around disclosure, stigmatisation and discrimination. Overall, organisational support for these unique roles seemed to be lacking despite the clear business need for these positions. We make several contributions: firstly, we show how employees in a unique role that requires experience of mental illness are impacted by the interaction between HR systems, processes and practices; secondly, we illustrate why HR scholars need to engage with varied paradigms of knowledge about mental illness beyond the dominant medical/psychiatric one; and thirdly, we demonstrate a methodology that not only explores employee perspectives, but includes employees in the research design and process.

Given the rapidly ageing population, interest is growing in robots to enable older people to remain living at home. We conducted a systematic review and critical evaluation of the scientific literature, from 1990 to the present, on the use of robots in aged care. The key research questions were as follows: (1) what is the range of robotic devices available to enable older people to remain mobile, independent, and safe? and, (2) what is the evidence demonstrating that robotic devices are effective in enabling independent living in community dwelling older people? Following database searches for relevant literature an initial yield of 161 articles was obtained. Titles and abstracts of articles were then reviewed by 2 independent people to determine suitability for inclusion. Forty-two articles met the criteria for question 1. Of these, 4 articles met the criteria for question 2. Results showed that robotics is currently available to assist older healthy people and people with disabilities to remain independent and to monitor their safety and social connectedness. Most studies were conducted in laboratories and hospital clinics. Currently limited evidence demonstrates that robots can be used to enable people to remain living at home, although this is an emerging smart technology that is rapidly evolving.

BACKGROUND: Intimate partner violence (IPV) can result in significant harm to women and families and is especially prevalent when women are pregnant or recent mothers. Maternal and child health nurses (MCHN) in Victoria, Australia are community-based nurse/midwives who see over 95% of all mothers with newborns. MCHN are in an ideal position to identify and support women experiencing IPV, or refer them to specialist family violence services. Evidence for IPV screening in primary health care is inconclusive to date. The Victorian government recently required nurses to screen all mothers when babies are four weeks old, offering an opportunity to examine the effectiveness of MCHN IPV screening practices. This protocol describes the development and design of MOVE, a study to examine IPV screening effectiveness and the sustainability of screening practice. METHODS/DESIGN: MOVE is a cluster randomised trial of a good practice model of MCHN IPV screening involving eight maternal and child health nurse teams in Melbourne, Victoria. Normalisation Process Theory (NPT) was incorporated into the design, implementation and evaluation of the MOVE trial to enhance and evaluate sustainability. Using NPT, the development stage combined participatory action research with intervention nurse teams and a systematic review of nurse IPV studies to develop an intervention model incorporating consensus guidelines, clinical pathway and strategies for individual nurses, their teams and family violence services. Following twelve months' implementation, primary outcomes assessed include IPV inquiry, IPV disclosure by women and referral using data from MCHN routine data collection and a survey to all women giving birth in the previous eight months. IPV will be measured using the Composite Abuse Scale. Process and impact evaluation data (online surveys and key stakeholders interviews) will highlight NPT concepts to enhance sustainability of IPV identification and referral. Data will be collected again in two years. DISCUSSION: MOVE will be the first randomised trial to determine IPV screening effectiveness in a community based nurse setting and the first to examine sustainability of an IPV screening intervention. It will further inform the debate about the effectiveness of IPV screening and describe IPV prevalence in a community based post-partum and early infant population. TRIAL REGISTRATION: ACTRN12609000424202.

Introduction. We aimed to describe perceptions of Australian emergency clinicians of differences in management of mental health patients in rural and remote Australia compared with metropolitan hospitals, and what could be improved. Methods. Descriptive exploratory study using semi-structured telephone interviews of doctors and nurses in Australian emergency departments (EDs), stratified to represent states and territories and rural or metropolitan location. Content analysis of responses developed themes and sub-themes. Results. Of 39 doctors and 32 nurses responding to email invitation, 20 doctors and 16 nurses were interviewed. Major themes were resources/environment, staff and patient issues. Clinicians noted lack of access in rural areas to psychiatric support services, especially alcohol and drug services, limited referral options, and a lack of knowledge, understanding and acceptance of mental health issues. The clinicians suggested resource, education and guideline improvements, wanting better access to mental health experts in rural areas, better support networks and visiting specialist coverage, and educational courses tailored to the needs of rural clinicians. Conclusion. Clinicians managing mental health patients in rural and remote Australian EDs lack resources, support services and referral capacity, and access to appropriate education and training. Improvements would better enable access to support and referral services, and educational opportunities.

BACKGROUND: Natural disasters represent an increasing threat both in terms of incidence and severity as a result of climate change. Although much is known about individual responses to disasters, much less is known about the social and contextual response and how this interacts with individual trajectories in terms of mental health, wellbeing and social connectedness. The 2009 bushfires in Victoria, Australia caused much loss of life, property destruction, and community disturbance. In order to progress future preparedness, response and recovery, it is crucial to measure and understand the impact of disasters at both individual and community levels. METHODS/DESIGN: This study aims to profile the range of mental health, wellbeing and social impacts of the Victorian 2009 bushfires over time using multiple methodologies and involving multiple community partners. A diversity of communities including bushfire affected and unaffected will be involved in the study and will include current and former residents (at the time of the Feb 2009 fires). Participants will be surveyed in 2012, 2014 and, funding permitting, in 2016 to map the predictors and outcomes of mental health, wellbeing and social functioning. Ongoing community visits, as well as interviews and focus group discussions in 2013 and 2014, will provide both contextual information and evidence of changing individual and community experiences in the medium to long term post disaster. The study will include adults, adolescents and children over the age of 5. DISCUSSION: Conducting the study over five years and focussing on the role of social networks will provide new insights into the interplay between individual and community factors and their influence on recovery from natural disaster over time. The study findings will thereby expand understanding of long term disaster recovery needs for individuals and communities.

OBJECTIVES: To profile the long-term mental health outcomes of those affected by the 2009 Black Saturday bushfires and to document the course of mental health since the disaster. METHOD: The longitudinal Beyond Bushfires study included 1017 respondents (Wave 1; 3-4 years after the fires), 736 (76.1%) at Wave 2 (5 years after the fires) and 525 (51.6%) at Wave 3 (10 years after the fires). The survey indexed fire-related and subsequent stressful events, probable posttraumatic stress disorder, major depressive disorder, alcohol use, severe distress and receipt of health services for mental health problems. RESULTS: Relative to their status 3-4 years after the fires, there were reduced rates of fire-related posttraumatic stress disorder (6.2% vs 12.2%), general posttraumatic stress disorder (14.9% vs 18.7%) and severe distress (4.4% vs 7.5%) at 10 years. There were comparable rates between Wave 1 and Wave 3 for depression (10.9% vs 8.3%) and alcohol abuse (21.8% vs 18.5%). Of people in high-affected regions, 22.1% had posttraumatic stress disorder, depression or severe distress at Wave 3. One-third to one-half of participants who reported probable posttraumatic stress disorder or depression at any assessment did not display the disorder at the next assessment. Worsening of mental health at Wave 3 was associated with the extent of property loss, exposure to recent traumatic events or recent stressful life events. Only 24.6% of those with a probable disorder had sought professional help for this in the previous 6 months. CONCLUSION: Approximately one-fifth of people from high-affected areas have a probable psychological disorder a decade after the fires. Mental health appears to fluctuate for those who are not consistently resilient, apparently as a result of ongoing stressors. The observation that most people with probable disorder are not receiving care highlights the need for further planning about managing long-term mental health needs of disaster-affected communities.

The aim of this study was to understand the extent, range and nature of social work research activity after natural disasters and to identify the implications for future research and practice. A Scoping review methodology framework was used search of three databases: Web of Science, ProQuest and Informit was conducted to identify relevant studies between 2000 and 2018. Selection of studies was based on empirical research about social work and natural disasters and/or authored by social workers. Study selection found a total of 38 relevant articles. Charting the data was conducted and the following areas of focus were summarised: (1) interventions relating to psychosocial care, aid work and community work; (2) the effects of disasters on people and mediators of these effects; (3) social work education and challenges in disaster relief; and (4) measuring mental health outcomes of people who have experienced a disaster event. This scoping review has established that there is a range of social work literature focused on natural disasters that primarily examines social work interventions, the effects of disasters and social work education. Future social work research and practice needs to focus on the types and timing of interventions that promote positive recovery following natural disasters.

This article describes a dataset containing information on children exiting to kinship guardianship in California between 2003 and 2010 (N = 18,831). Children and young people in the sample were followed for up to fourteen years. The data presented here show summary statistics of the sample included in the analysis. Furthermore, the data consist of life tables showing counts of children at risk of reentry, counts of children who reentered the foster care system as well as nonparametric estimates of the survival function and the cumulative hazard function for the period 2003-2017.

Children who live in households where domestic violence is occurring have been variously described in the literature over time as silent witnesses, witnesses, a cohort who is “exposed” to the violence, and more recently, as individual victim survivors and active agents in their own right, each with their own lived experience of violence. Research methodologies in this arena have shifted from adult-focused measurements of the impacts of domestic violence on children to more qualitative attempts to understand the experience from the child’s perspective. In doing so, there have been notions of giving “voice to the voiceless” and doing no further harm through a desire to protect children from exposure. However, the relational framing of children’s voices and recognition and enabling of children’s agency is less evolved in research and professional interventions. A study undertaken in Australia researched with a primary care population of 23 children and 18 mothers, children’s experiences of safety and resiliency in the context of domestic violence. The findings of the research were realized using qualitative research methods with children and the analytical framing of hermeneutical phenomenology, ethics of care and in particular dialogical ethics, to draw practical understanding and application in health care settings. This article aims to demonstrate how the analytical methodology chosen was applied in the research process and reveals the elements required for children to experience agency in navigating their relationships in an unsafe world, while learning about themselves. It draws upon understandings of the child’s relational context and introduces a model of children’s agency, which may have applicability for domestic violence policy and practice settings.

There has been growing enthusiasm amongst those who undertake research with children, for the development of participatory and visual research methods. The greater availability and affordability of digital technology (such as digital cameras, tablets and smart phones) has meant that there has been greater scope for digital technology to support participatory research methods, or augment more traditional qualitative research methods. While digital technology provides new opportunities for qualitative researchers, they also come with a series of challenges – some of which have been grappled with by those using more traditional research methods but also some which are new. Our study was undertaken in Victoria, Australia, and used a combination of interviews, focus groups and digital storytelling to bring together two strands of work which have historically occurred separately: work with children experiencing domestic violence and programs for men who use domestic violence. While digital storytelling proved to be an effective method of engaging children and young people in the research, a range of challenging ethical issues emerged. Some of these issues were considered as part of the formal ‘procedural ethics’ process, but additional and more challenging issues relating to anonymity and the complex safety considerations of using of the children’s digital stories within programs for men who use violence and dissemination emerged in practice. It is hoped that sharing our experiences and decision-making will contribute to the knowledge base for others considering engaging in sensitive research using digital technology.

A critical interpretive synthesis (CIS) methodology was used with the aim of informing practice with children and families when domestic and family violence (DFV) and parental issues relating to alcohol and other drugs (AOD) and mental health (MH) are also present. A CIS is grounded in the literature, but includes questioning of the literature in order to problematise gaps, contradictions and constructions of issues. A review of the literature from 2010 to 2018 was conducted with the structured search strategy identifying 40 relevant research articles. Synthesis and critique of these articles revealed three mutually informative themes through which to understand the literature and how it can inform practice. They were as follows: differences in theoretical approaches and client focus; complexity of system's collaboration; and practices converging on mothers. Taken together, these themes facilitated the development of the synthesising construct: strengthening intersection between DFV, AOD and MH sectors. Attention to practice at multiple levels that responds to the dynamics of gender and the differing impacts of violence was often lacking, particularly in the context of heightened child protection concerns where collaboration between sectors is needed. Both promising and problematic practices relating to gender dynamics and accountability converged on mothers. While there were exceptions, generally, there was an absence of engagement with, and recognition of, the impacts of fathers' patterns of using violence and control on adult and child survivors. Promising practice related to the strengthening of the mother-child relationship and attention to MH and its intersection with domestic violence. Strengthening the intersections between DFV, AOD and MH practices with attention to keeping the perpetrator of violence in view is critical to overcoming the poor practice that can occur when sectors are siloed from each other.

The disproportionate rate of entry into out-of-home care (OOHC) is well documented for Aboriginal and Torres Strait Islander children and youth throughout Australia (Australian Institute of Health and Welfare (AIHW) 2020a; Lewis et al 2019). However, less is known about children and youth who exit out-of-home care by returning to the care of their parents or former carers. This special report reviews the literature, and the publicly available data for 2018-19, about reunification for Aboriginal and Torres Strait Islander children and non-Indigenous children in out-of-home care systems. It was found that in 2018-19, Aboriginal and Torres Strait Islander children were less likely to have case plans that included reunification as a possibility compared to non-Indigenous children, and Aboriginal and Torres Strait Islander children were also less likely to be reunified with family compared to non-Indigenous children. Reunification rates for Aboriginal and Torres Strait Islander children were highest in Victoria, however, entry to care rates were also highest in Victoria compared to other states and territories. Except for the Australian Capital Territory and South Australia, once reunified, there was no marked difference between rates of re-entry to care for Aboriginal and Torres Strait Islander children compared to non-Indigenous children. Examination of differences in reunification patterns across states and territories were also limited by the low numbers of children reunified in some states and territories (such as the Northern Territory), as well as absent data from New South Wales and Queensland. Ultimately, questions concerning reunification casework practices across the nation remain, while reunification data from 2018-19 has generated more questions than answers.

OBJECTIVES: To report the baseline results of a longitudinal psychosocial study that forms part of the IMPACT study, a multi-national investigation of targeted prostate cancer (PCa) screening among men with a known pathogenic germline mutation in the BRCA1 or BRCA2 genes. PARTICPANTS AND METHODS: Men enrolled in the IMPACT study were invited to complete a questionnaire at collaborating sites prior to each annual screening visit. The questionnaire included sociodemographic characteristics and the following measures: the Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES), 36-item short-form health survey (SF-36), Memorial Anxiety Scale for Prostate Cancer, Cancer Worry Scale-Revised, risk perception and knowledge. The results of the baseline questionnaire are presented. RESULTS: A total of 432 men completed questionnaires: 98 and 160 had mutations in BRCA1 and BRCA2 genes, respectively, and 174 were controls (familial mutation negative). Participants' perception of PCa risk was influenced by genetic status. Knowledge levels were high and unrelated to genetic status. Mean scores for the HADS and SF-36 were within reported general population norms and mean IES scores were within normal range. IES mean intrusion and avoidance scores were significantly higher in BRCA1/BRCA2 carriers than in controls and were higher in men with increased PCa risk perception. At the multivariate level, risk perception contributed more significantly to variance in IES scores than genetic status. CONCLUSION: This is the first study to report the psychosocial profile of men with BRCA1/BRCA2 mutations undergoing PCa screening. No clinically concerning levels of general or cancer-specific distress or poor quality of life were detected in the cohort as a whole. A small subset of participants reported higher levels of distress, suggesting the need for healthcare professionals offering PCa screening to identify these risk factors and offer additional information and support to men seeking PCa screening.

Introduction: Children entering out-of-home care have high rates of health needs across all domains of health. To identify these needs early and optimise long-term outcomes, routine health assessment on entry to care is recommended by child health experts and included in policy in many jurisdictions. If effective, this ought to lead to high rates of health service use as needs are addressed. Victoria (Australia) has no state-wide approach to deliver routine health assessments and no data to describe the timing and use of health service visits for children in out-of-home care. This retrospective cohort data linkage study aims to describe the extent and timeliness of health service use by Victorian children (aged 0-12 years) who entered out-of-home care for the first time between 1 April 2010 and 31 December 2015, in the first 12 months of care. Methods and analysis: The sample will be identified in the Victorian Child Protection database. Child and placement variables will be extracted. Linked health databases will provide additional data: six state databases that collate data about hospital admissions, emergency department presentations and attendances at dental, mental and community health services and public hospital outpatients. The federal Medicare Benefits Schedule claims dataset will provide information on visits to general practitioners, specialist physicians (including paediatricians), optometrists, audiologists and dentists. The number, type and timing of visits to different health services will be determined and benchmarked to national standards. Multivariable logistic regression will examine the effects of child and system variables on the odds of timely health visits, and proportional-hazards regression will explore the effects on time to first health visits. Ethics and dissemination: Ethical and data custodian approval has been obtained for this study. Dissemination will include presentation of findings to policy and service stakeholders in addition to scientific papers.

Implementation is a crucial component for the success of interventions in health service systems, as failure to implement well can have detrimental impacts on the effectiveness of evidence-based practices. Therefore, evaluations conducted in real-world contexts should consider how interventions are implemented and sustained. However, the complexity of healthcare environments poses considerable challenges to the evaluation of interventions and the impact of implementation efforts on the effectiveness of evidence-based practices. In consequence, implementation and intervention effectiveness are often assessed separately in health services research, which prevents the direct investigation of the relationships of implementation components and effectiveness of the intervention. This article describes multilevel decision juncture models based on advances in implementation research and causal inference to study implementation in health service systems. The multilevel decision juncture model is a theory-driven systems approach that integrates structural causal models with frameworks for implementation. This integration enables investigation of interventions and their implementation within a single model that considers the causal links between levels of the system. Using a hypothetical youth mental health intervention inspired by published studies from the health service research and implementation literature, we demonstrate that such theory-based systems models enable investigations of the causal pathways between the implementation outcomes as well as their links to patient outcomes. Results from Monte Carlo simulations also highlight the benefits of structural causal models for covariate selection as consistent estimation requires only the inclusion of a minimal set of covariates. Such models are applicable to real-world context using different study designs, including longitudinal analyses which facilitates the investigation of sustainment of interventions.

Although many Indigenous peoples demonstrate resilience and strength despite the ongoing impact colonization has on their peoples, evidence suggests poor experiences and expectations of health care professionals and access to health care. Health care professionals play an essential role in responding to family violence (FV), yet there is a paucity of evidence detailing Indigenous people's experiences and expectations of health care professionals in the context of FV. Using a meta-synthesis of qualitative studies, this article aims to address the following research question: What are Indigenous people's experiences and expectations of health care professionals when experiencing FV? The inclusion criteria comprised a qualitative study design, Indigenous voices, and a focus on expectations and experiences of health care professionals when FV is experienced. Reviewers independently screened article abstracts, and the findings from included papers were subject to a thematic analysis. Six studies were included in the final meta-synthesis representing studies from Australia, the Americas, and New Zealand. Three themes were identified. Health care professionals need to center the Indigenous person in the care they provide and demonstrate cultural awareness of how history and culture influence an individual's care requirements. Health care professionals also need to ensure they are connecting for trust with the Indigenous person, by slowly developing a rapport, yarning, and investing in the relationship. Finally, Indigenous peoples want their health care professional to work on strengthening safety from culturally inappropriate care, institutional control, and potential lack of confidentiality associated with tight-knit communities.