Monitoring and evaluation of disaster response efforts undertaken by local health departments: a rapid realist review.

BACKGROUND: Local health departments are often at the forefront of a disaster response, attending to the immediate trauma inflicted by the disaster and also the long term health consequences. As the frequency and severity of disasters are projected to rise, monitoring and evaluation (M&E) efforts are critical to help local health departments consolidate past experiences and improve future response efforts. Local health departments often conduct M&E work post disaster, however, many of these efforts fail to improve response procedures. METHODS: We undertook a rapid realist review (RRR) to examine why M&E efforts undertaken by local health departments do not always result in improved disaster response efforts. We aimed to complement existing frameworks by focusing on the most basic and pragmatic steps of a M&E cycle targeted towards continuous system improvements. For these purposes, we developed a theoretical framework that draws on the quality improvement literature to 'frame' the steps in the M&E cycle. This framework encompassed a M&E cycle involving three stages (i.e., document and assess, disseminate and implement) that must be sequentially completed to learn from past experiences and improve future disaster response efforts. We used this framework to guide our examination of the literature and to identify any context-mechanism-outcome (CMO) configurations which describe how M&E may be constrained or enabled at each stage of the M&E cycle. RESULTS: This RRR found a number of explanatory CMO configurations that provide valuable insights into some of the considerations that should be made when using M&E to improve future disaster response efforts. Firstly, to support the accurate documentation and assessment of a disaster response, local health departments should consider how they can: establish a culture of learning within health departments; use embedded training methods; or facilitate external partnerships. Secondly, to enhance the widespread dissemination of lessons learned and facilitate inter-agency learning, evaluation reports should use standardised formats and terminology. Lastly, to increase commitment to improvement processes, local health department leaders should possess positive leadership attributes and encourage shared decision making. CONCLUSION: This study is among the first to conduct a synthesis of the CMO configurations which facilitate or hinder M&E efforts aimed at improving future disaster responses. It makes a significant contribution to the disaster literature and provides an evidence base that can be used to provide pragmatic guidance for improving M&E efforts of local health departments. TRIAL REGISTRATION: PROSPERO 2015: CRD42015023526 .

Do Non-Clinical Services Help to Improve Functional Outcomes Among Young Adults With Mental Disorders? A Systematic Review.

INTRODUCTION: Mental disorders during young adulthood can significantly impair functioning in daily activities. Non-clinical support services aim to improve functioning by helping people to build social and life skills, participate in education and employment and improve physical health. This study aims to examine and synthesise the evidence for non-clinical services on improving functional outcomes for young adults with mental disorders. METHODS: A systematic search was undertaken to identify quantitative and qualitative studies reporting on a non-clinical service component (vocational support, peer support, youth development, lifestyle interventions, family and network support) and examining functional outcomes (e.g., outcomes focussed on work and education, life skills, relationships and healthy behaviours). RESULTS: Seventeen studies met inclusion criteria. Identified studies focussed on vocational support services (n = 9), lifestyle interventions (n = 6) and family and network support services (n = 2). No studies on peer-support services or youth development services were found. More than half of the vocational support service studies reported increased employment rates among young adults (n = 6). Studies focussing on lifestyle interventions included a combination of physical activity, nutrition education, health coaching and motivation and behaviour change. However, the measures of functioning used across studies were too varied to determine whether lifestyle interventions may be useful in improving functional outcomes for young adults. CONCLUSION: Further research is needed to understand the impact of non-clinical services on functioning. This evidence will provide pragmatic guidance for service planners to invest in supports and interventions that make a meaningful difference to the lives of young adults living with mental disorders.

Using the National Mental Health Service Planning Framework to inform integrated regional planning: a case study in Tasmania, Australia.

BACKGROUND: The aim of this study was to demonstrate the application of a needs-based mental health service planning model in Tasmania, Australia to identify indicative directions for future service development that ensure the equitable provision of mental health services across the State. METHODS: The activity and capacity of Tasmania's 2018-19 mental health services were compared to estimates of required care by: (1) generating estimates of required care using the National Mental Health Service Planning Framework (NMHSPF); (2) collating administrative mental health services data; (3) aligning administrative data to the NMHSPF; and (4) comparing aligned administrative data and NMHSPF estimates to identify priority areas for service development. Findings were contextualised using information about service location, population demographics, and upcoming service development. RESULTS: Bed-based services capacity reached 85% of the NMHSPF estimate. However, access to certain bed types was inequitable across regional areas. Access to jurisdictional clinical ambulatory team-based services was lowest in the South, while overall full-time equivalent staff capacity reached 58% of the NMHSPF estimate. Access to Primary Health Tasmania (PHT) primary care services was highest in the North West; access to Medicare services was highest in the South. Collectively, activity across primary care (PHT, headspace and Medicare) reached 43% of the NMHSPF estimate. Over half of Community Managed Mental Health Support Services were state-wide services. CONCLUSIONS: This study demonstrates the application of a needs-based planning model for mental health services. Findings revealed service priority areas across Tasmania and highlight considerations for needs-based planning.

Key service components for age-appropriate mental health service planning for young adults.

AIM: To identify and describe key service components that should be incorporated into age-appropriate integrated mental health care for young adults aged 18-24 years. METHODS: Key service components were identified through a mixed-methods approach including targeted examinations of the literature and structured discussions with experts in youth mental health. RESULTS: Seven key components were identified as important for providing age-appropriate mental health care to young adults. Two were classified as clinical service components (structured psychological therapies; care coordination and liaison), three were classified as non-clinical service components (vocational support; youth development; peer support) and two as integrated non-clinical and clinical service components (lifestyle interventions and family and network support). Example service models for each of these key service components were identified and described. CONCLUSIONS: This is the first study to identify and describe key service components for age-appropriate mental health care for young adults. The findings provide mental health service planners with a framework of services that should be considered when planning and resourcing services for this age range.

Modelling mental health service needs of Aboriginal and Torres Strait Islander peoples: a review of existing evidence and expert consensus.

OBJECTIVE: To identify key mental health service components required for Aboriginal and Torres Strait Islander peoples and develop proposed modelling to modify the National Mental Health Service Planning Framework to account for the unique needs of these populations. METHODS: Service areas and corresponding modelling rules were informed by a review and analysis of literature and data (on existing service models and policy directions) and expert group discussions on the important aspects of mental health care for Aboriginal and Torres Strait Islander peoples. RESULTS: Eight key service areas were identified and translated into proposed modelling rules for service planning: culturally appropriate assessment; increased care coordination; more family and carer involvement and support; specified workforce; holistic primary care teams; enhanced staffing for inpatient care; integrating culture; and earlier support for behavioural and psychological symptoms of dementia. CONCLUSIONS: This study provides a consolidated framework and implementation guidance to support more effective mental health service planning for Aboriginal and Torres Strait Islander peoples. IMPLICATIONS FOR PUBLIC HEALTH: Better supporting planners to make informed decisions regarding mental health service provision for Aboriginal and Torres Strait Islander peoples will assist in a nationally coordinated approach to closing the mental health gap between Indigenous and non-Indigenous peoples.

Using the National Mental Health Service Planning Framework to support an integrated approach to regional mental health planning in Queensland, Australia.

Regional integrated service planning has been identified as a key priority for improving the mental health system in Australia. The National Mental Health Service Planning Framework (NMHSPF) is an integrated planning tool that estimates the resources required to deliver the optimal mix of mental health services to a population. In 2016, Queensland Health commissioned a trial application of the NMHSPF for joint mental health planning between a Primary Health Network (PHN) and the corresponding state Hospital and Health Services (HHSs) in a regional area. The aim of this work was to collaborate with stakeholders from each organisation to collect available data on the delivery and resources of existing mental health services in the region and compare these to NMHSPF estimates to identify potential priority areas for planning. This paper provides mental health planners with an exemplar model for using the NMHSPF to support integrated planning at the regional level and describes the barriers, facilitators and key outcomes of this work.

Review of services to inform clinical frameworks for adolescents and young adults with severe, persistent and complex mental illness.

OBJECTIVE: Severe, persistent and complex mental illness (SPCMI) affects a small proportion of young people but is associated with severe disability and a large burden on families and health services. This article identifies and describes service models for adolescents and young adults with SPCMI. METHODS: A systematic search was conducted for services for young people aged 12-25 years with SPCMI. The review sought service models providing extended care and/or multidisciplinary services to meet the complex and long-term needs of this population. RESULTS: A total of 43 sources were identified. Evidence of effectiveness was found for both community- and bed-based services. Specific components suggested as important in service delivery included care provided by multidisciplinary teams, consumer and family involvement in care planning, intensive case management and service integration through the continuum of care. CONCLUSION: Clinical frameworks for this population must incorporate effective community care integrated with inpatient treatment of short duration. Frameworks require consumer and family-centred care with flexibility to support progression through developmental stages and tasks while addressing issues related to risk management, fluctuation in illness severity and stages of recovery. A continuum of care is necessary to meet the needs that arise from SPCMI in adolescents and young adults.