Operationalizing the Consolidated Framework for Implementation Research to build and support the lived experience workforce in direct health service provision.

BACKGROUND: The involvement of people with lived experience (LEX) workers in the development, design, and delivery of integrated health services seeks to improve service user engagement and health outcomes and reduce healthcare gaps. Yet, LEX workers report feeling undervalued and having limited influence on service delivery. There is a need for systematic improvements in how LEX workforces are engaged and supported to ensure the LEX workforce can fully contribute to integrated systems of care. OBJECTIVE: This study aimed to operationalize the Consolidated Framework for Implementation Research (CFIR) using a rigorous scoping review methodology and co-creation process, so it could be used by health services seeking to build and strengthen their LEX workforce. SEARCH STRATEGY: A systematic literature search of four databases was undertaken to identify peer-reviewed studies published between 2016 and 2022 providing evidence of the inclusion of LEX workers in direct health service provision. DATA EXTRACTION AND SYNTHESIS: A descriptive-analytical method was used to map current evidence of LEX workers onto the CFIR. Then, co-creation sessions with LEX workers (n = 4) and their counterparts-nonpeer workers (n = 2)-further clarified the structural policies and strategies that allow people with LEX to actively participate in the provision and enhancement of integrated health service delivery. MAIN RESULTS: Essential components underpinning the successful integration of LEX roles included: the capacity to engage in a co-creation process with individuals with LEX before the implementation of the role or intervention; and enhanced representation of LEX across organizational structures. DISCUSSION AND CONCLUSION: The adapted CFIR for LEX workers (CFIR-LEX) that was developed as a result of this work clarifies contextual components that support the successful integration of LEX roles into the development, design, and delivery of integrated health services. Further work must be done to operationalize the framework in a local context and to better understand the ongoing application of the framework in a health setting. PATIENT OR PUBLIC CONTRIBUTION: People with LEX were involved in the operationalization of the CFIR, including contributing their expertise to the domain adaptations that were relevant to the LEX workforce.

The ripple effect, silence and powerlessness: hidden barriers to discussing suicide in Australian Aboriginal communities.

BACKGROUND: Suicide is one of the leading causes of death for Aboriginal Australians. There is an urgent need to actively engage with Aboriginal communities to better understand these issues and to develop solutions together to prevent deaths by suicide in Aboriginal communities. METHODS: Utilising a qualitative, thematic, cross-sectional design, we conducted focus groups in three communities in the Hunter New England area in New South Wales (Australia) to explore the perceptions and views of Aboriginal participants in relation to discussing suicide. RESULTS: The key themes found to influence discussions about suicide in Aboriginal communities included the sense that suicide is a whole of community issue, the ripple effect of suicide deaths, silence about suicide and the impact of this silence, and being powerless to act. Participants described a reluctance to have discussions about suicide; feeling they had limited skills and confidence to have these sorts of discussions; and multiple and interrelated barriers to discussing suicide, including shame, fear and negative experiences of mental health care. Participants also described how their experiences maintained these barriers and prevented Aboriginal Australians from seeking help in suicidal crises. CONCLUSION: Future initiatives should address the interrelated barriers by supporting Aboriginal people to build skills and confidence in discussing suicide and mental health and by improving access to, and the experience of, mental health care and psychosocial and community-based supports for Aboriginal Australians. We suggest trying to address any one of these factors in isolation may increase rather than decrease suicide risk in Aboriginal communities.

Federal and state cooperation necessary but not sufficient for effective regional mental health systems: insights from systems modelling and simulation.

For more than a decade, suicide rates in Australia have shown no improvement despite significant investment in reforms to support regionally driven initiatives. Further recommended reforms by the Productivity Commission call for Federal and State and Territory Government funding for mental health to be pooled and new Regional Commissioning Authorities established to take responsibility for efficient and effective allocation of 'taxpayer money.' This study explores the sufficiency of this recommendation in preventing ongoing policy resistance. A system dynamics model of pathways between psychological distress, the mental health care system, suicidal behaviour and their drivers was developed, tested, and validated for a large, geographically diverse region of New South Wales; the Hunter New England and Central Coast Primary Health Network (PHN). Multi-objective optimisation was used to explore potential discordance in the best-performing programs and initiatives (simulated from 2021 to 2031) across mental health outcomes between the two state-governed Local Health Districts (LHDs) and the federally governed PHN. Impacts on suicide deaths, mental health-related emergency department presentations, and service disengagement were explored. A combination of family psychoeducation, post-attempt aftercare, and safety planning, and social connectedness programs minimises the number of suicides across the PHN and in the Hunter New England LHD (13.5% reduction; 95% interval, 12.3-14.9%), and performs well in the Central Coast LHD (14.8% reduction, 13.5-16.3%), suggesting that aligned strategic decision making between the PHN and LHDs would deliver substantial impacts on suicide. Results also highlighted a marked trade-off between minimising suicide deaths versus minimising service disengagement. This is explained in part by the additional demand placed on services of intensive suicide prevention programs leading to increases in service disengagement as wait times for specialist community based mental health services and dissatisfaction with quality of care increases. Competing priorities between the PHN and LHDs (each seeking to optimise the different outcomes they are responsible for) can undermine the optimal impact of investments for suicide prevention. Systems modelling provides essential regional decision analysis infrastructure to facilitate coordinated federal and state investments for optimal impacts.

"Family Matters": A Systematic Review of the Evidence For Family Psychoeducation For Major Depressive Disorder.

The first aim of this systematic review was to evaluate the evidence for family psychoeducation (FPE) interventions for major depressive disorder (MDD). A second aim was to compare the efficacy of different modes of delivering face-to-face FPE interventions. Ten studies (based on nine distinct samples) were identified comprising four single-family studies, four multifamily studies, one single versus multifamily comparative study, and one peer-led, mixed-diagnosis study. Seven studies measured patient functioning and six reported positive outcomes. Six studies measured carer's well-being and four reported positive outcomes. Results provide preliminary evidence that FPE leads to improved outcomes for patient functioning and family-carer's well-being for persons with depression. The implications for future development and delivery of FPE interventions for MDD are discussed.

The Child Illness and Resilience Program (CHiRP): a study protocol of a stepped care intervention to improve the resilience and wellbeing of families living with childhood chronic illness.

BACKGROUND: Families of children living with chronic illness are more vulnerable to mental health problems, however this can be ameliorated by a family's resilience. The Child Illness and Resilience Program (CHiRP) will develop and evaluate a parent-focussed family intervention designed to increase the resilience and wellbeing of families living with childhood chronic illness. METHODS/DESIGN: The study will be conducted in an Australian regional paediatric hospital and will use a stepped care intervention that increases in intensity according to parental distress. All parents of children discharged from the hospital will receive a family resilience and wellbeing factsheet (Step 1). Parents of children attending selected outpatient clinics will receive a family resilience and wellbeing activity booklet (Step 2). Parents who receive the booklet and report psychological distress at three-month follow-up will be randomised to participate in a family resilience information support group or waitlist control (Step 3). The Step 3 control group will provide data to compare the relative effectiveness of the booklet intervention alone versus the booklet combined with the group intervention for distressed parents. These participants will then receive the information support group intervention. All parents in Step 2 and 3 will complete baseline, post-intervention and six month follow up assessments. The primary outcomes of the study will be changes in scores between baseline and follow-up assessments on measures of constructs of family resilience, including parental wellbeing, family functioning, family beliefs and perceived social support. Qualitative feedback regarding the utility and acceptability of the different intervention components will also be collected. DISCUSSION: It is hypothesised that participation in the CHiRP intervention will be associated with positive changes in the key outcome measures. If effective, CHiRP will provide an opportunity for the health sector to deliver a standardised stepped care mental health promotion intervention to families living with childhood chronic illness. TRIAL REGISTRATION: Australian clinical Trials Registry ACTRN 12613000844741 Universal Trial Number (UTN): 1111-1142-8829.

Group therapy for repeated deliberate self-harm in adolescents: failure of replication of a randomized trial.

OBJECTIVE: To replicate a study, which found group therapy superior to routine care in preventing the recurrence of self-harming behavior in adolescents who had deliberately harmed themselves on at least two occasions. METHOD: Single blind study with parallel randomized groups undertaken in three sites in Australia. The primary outcome measure was repetition of self-harm, assessed on average after 6 and 12 months. Secondary outcome measures included suicidal ideation, psychiatric disorder, and service use. RESULTS: Seventy-two adolescents aged 12 to 16 years (91% female subjects) were randomized to group therapy or routine care. Primary outcome data were available for 68 of the 72 randomized participants. More adolescents randomized to group therapy than those randomized to routine care had self-harmed by 6 months (30/34 versus 23/34, chi = 4.19, p =.04), and there was a statistically nonsignificant trend for this pattern to be repeated in the interval of 6 to 12 months (30/34 versus 24/34, chi = 3.24, p =.07). There were few differences between the treatment groups on secondary outcome measures, other than a trend for greater improvement over time on global symptom ratings among the experimental group compared with the control group. CONCLUSIONS: Our findings contradict those of the original study. Some differences in participant characteristics between the studies, along with less experience at the Australian sites in delivering the intervention, may have accounted for the different outcome. The benefit of group therapy for deliberate self-harm is unproven outside the environment in which it was originally developed.

Auditory sensory memory and the aging brain: A mismatch negativity study.

The mismatch negativity (MMN) component of the auditory event-related potential has been used in the past to study between group differences in the accuracy and retention of information in auditory sensory memory (ASM). The MMN is elicited by infrequent 'deviant' tones that differ from a repeating 'standard' tone. In the present study, the type of deviant and the time interval between tones (stimulus-onset asynchrony: SOA) were manipulated in a study of normal aging. MMN responses of an elderly (mean age = 69) and a young group (mean age = 21) to both a duration and a frequency deviant tone were measured at a short (450 ms) and long (3 s) SOA. A smaller and later MMN (recorded at Fz) was observed in the elderly relative to the young group across SOA and Deviant conditions. The results are consistent with an age-related deficit in the encoding of sound properties in ASM. However, analysis of the MMN reversal at the mastoids provides some support for the proposal that the elderly have an additional deficit related to the retention of information in ASM.