Data roles: youth mental health outcome measures and the young people who defy them

Evaluating service quality and satisfaction is central to the provision of accessible and developmentally appropriate youth mental health services. However, there are limited suitable measures and a lack of published evidence on the psychometric properties of measures to assess young people's satisfaction with youth mental health services. The headspace Youth (Mental Health) Service Satisfaction Scale (YSSS) was designed and implemented to assess young people's satisfaction with headspace mental health services in Australia. This study examined the reliability and factor structure of the YSSS in a youth mental health service in Ireland. The sample comprised 1449 young people (66.2% female) aged 12-25 years (M = 16.48, SD = 2.97). Participants completed the YSSS after their final brief intervention session through Jigsaw-The National Centre for Youth Mental Health. Confirmatory factor analysis (CFA) was performed on one- and four-factor models to test findings from previous studies. Reliability was also examined. CFA supported a single-factor structure of the YSSS, and all items were suitable for inclusion. The internal consistency of the measure was deemed acceptable (α = 0.89). Findings suggest that the YSSS is a reliable measure for monitoring satisfaction with youth mental health services in an Irish context. The measure demonstrated a unidimensional construct of satisfaction. These findings support the broader application of the YSSS and add to existing knowledge on measuring satisfaction within youth mental health services.

This study aimed to explore current data collection and feedback practice, in the form of monitoring and evaluation, among youth mental health (YMH) services and healthcare commissioners; and to identify barriers and enablers to this practice. Qualitative semi-structured interviews were conducted via Zoom videoconferencing software. Data collection and analysis were informed by the Theoretical Domains Framework (TDF). Data were deductively coded to the 14 domains of the TDF and inductively coded to generate belief statements. Healthcare commissioning organisations and YMH services in Australia. Twenty staff from healthcare commissioning organisations and twenty staff from YMH services. The umbrella behaviour 'monitoring and evaluation' (ME) can be sub-divided into 10 specific sub-behaviours (e.g. planning and preparing, providing technical assistance, reviewing and interpreting data) performed by healthcare commissioners and YMH services. One hundred belief statements relating to individual, social, or environmental barriers and enablers were generated. Both participant groups articulated a desire to improve the use of ME for quality improvement and had particular interest in understanding the experiences of young people and families. Identified enablers included services and commissioners working in partnership, data literacy (including the ability to set appropriate performance indicators), relational skills, and provision of meaningful feedback. Barriers included data that did not adequately depict service performance, problems with data processes and tools, and the significant burden that data collection places on YMH services with the limited resources they have to do it. Importantly, this study illustrated that the use of ME could be improved. YMH services, healthcare commissioners should collaborate on ME plans and meaningfully involve young people and families where possible. Targets, performance indicators, and outcome measures should explicitly link to YMH service quality improvement; and ME plans should include qualitative data. Streamlined data collection processes will reduce unnecessary burden, and YMH services should have the capability to interrogate their own data and generate reports. Healthcare commissioners should also ensure that they provide meaningful feedback to their commissioned services, and local and national organisations collecting youth mental health data should facilitate the sharing of this data. The results of the study should be used to design theory-informed strategies to improve ME use.

ObjectivesThis study aimed to explore current data collection and feedback practice, in the form of monitoring and evaluation, among youth mental health (YMH) services and healthcare commissioners; and to identify barriers and enablers to this practice.DesignQualitative semi-structured interviews were conducted via Zoom videoconferencing software. Data collection and analysis were informed by the Theoretical Domains Framework (TDF). Data were deductively coded to the 14 domains of the TDF and inductively coded to generate belief statements.SettingHealthcare commissioning organisations and YMH services in Australia.ParticipantsTwenty staff from healthcare commissioning organisations and twenty staff from YMH services.ResultsThe umbrella behaviour ‘monitoring and evaluation’ (ME) can be sub-divided into 10 specific sub-behaviours (e.g. planning and preparing, providing technical assistance, reviewing and interpreting data) performed by healthcare commissioners and YMH services. One hundred belief statements relating to individual, social, or environmental barriers and enablers were generated. Both participant groups articulated a desire to improve the use of ME for quality improvement and had particular interest in understanding the experiences of young people and families. Identified enablers included services and commissioners working in partnership, data literacy (including the ability to set appropriate performance indicators), relational skills, and provision of meaningful feedback. Barriers included data that did not adequately depict service performance, problems with data processes and tools, and the significant burden that data collection places on YMH services with the limited resources they have to do it.ConclusionsImportantly, this study illustrated that the use of ME could be improved. YMH services, healthcare commissioners should collaborate on ME plans and meaningfully involve young people and families where possible. Targets, performance indicators, and outcome measures should explicitly link to YMH service quality improvement; and ME plans should include qualitative data. Streamlined data collection processes will reduce unnecessary burden, and YMH services should have the capability to interrogate their own data and generate reports. Healthcare commissioners should also ensure that they provide meaningful feedback to their commissioned services, and local and national organisations collecting youth mental health data should facilitate the sharing of this data. The results of the study should be used to design theory-informed strategies to improve ME use.

Historically, the Australian health system has failed to meet the needs of young people with mental health problems and mental illness. In 2006, New South Wales (NSW) Health allocated considerable funds to the reform agenda of mental health services in NSW to address this inadequacy. Children and Young People's Mental Health (CYPMH), a service that provides mental health care for young people aged 12-24 years, with moderate to severe mental health problems, was chosen to establish a prototype Youth Mental Health (YMH) Service Model for NSW. This paper describes nine key principles developed by CYPMH to guide the development of YMH Service Models in NSW. A literature review, numerous stakeholder consultations and consideration of clinical best practice were utilized to inform the development of the key principles. Subsequent to their development, the nine key principles were formally endorsed by the Mental Health Program Council to ensure consistency and monitor the progress of YMH services across NSW. As a result, between 2008 and 2012 YMH Services across NSW regularly reported on their activities against each of the nine key principles demonstrating how each principle was addressed within their service. The nine key principles provide mental health services a framework for how to reorient services to accommodate YMH and provide a high-quality model of care. [Corrections added on 29 November 2013, after first online publication: The last two sentences of the Results section have been replaced with "As a result, between 2008 and 2012 YMH Services across NSW regularly reported on their activities against each of the nine key principles demonstrating how each principle was addressed within their service."].

Youth mental health (YMH) services have been established internationally to provide timely, age-appropriate, mental health treatment and improve long-term outcomes. However, YMH services face challenges including long waiting times, limited continuity of care, and time-bound support. To bridge this gap, MOST was developed as a scalable, blended, multi-modal digital platform integrating real-time and asynchronous clinician-delivered counselling; interactive psychotherapeutic content; vocational support; peer support, and a youth-focused online community. The implementation of MOST within Australian YMH services has been publicly funded. The primary aim of this study was to evaluate the real-world engagement, outcomes, and experience of MOST during the first 32 months of implementation. Young people from participating YMH services were referred into MOST. Engagement metrics were derived from platform usage. Symptom and satisfaction measures were collected at baseline, 6, and 12 (primary endpoint) weeks. Effect sizes were calculated for the primary outcomes of depression and anxiety and secondary outcomes of psychological distress and wellbeing. Five thousand seven hundred and two young people from 262 clinics signed up and used MOST at least once. Young people had an average of 19 login sessions totalling 129 min over the first 12 weeks of use, with 71.7% using MOST for at least 14 days, 40.1% for 12 weeks, and 18.8% for 24 weeks. There was a statistically significant, moderate improvement in depression and anxiety at 12 weeks as measured by the PHQ4 across all users irrespective of treatment stage (d = 0.41, 95% CI 0.35-0.46). Satisfaction levels were high, with 93% recommending MOST to a friend. One thousand one hundred and eighteen young people provided written feedback, of which 68% was positive and 31% suggested improvement. MOST is a highly promising blended digital intervention with potential to address the limitations and enhance the impact of YMH services.

Globally, mental illness and substance use disorders are the leading cause of disability and disease burden for young people. Orygen is an Australian youth mental health organisation with a mission to reduce the impact of mental ill health on young people, families and society, through research, clinical services, advocacy, and the design and delivery of youth mental health workforce and service development initiatives. Orygen is one of only a few known research and clinical centres with a dedicated knowledge translation division, which concentrates on growing the capacity of the systems, services, and professionals who support young people experiencing mental ill health. This paper provides a case study of the workforce development team within the Orygen knowledge translation, outlining how implementation science informs their work and how the division has adapted its model in the face of COVID-19. Since 2017, the team has delivered training to more than 4000 youth mental health workers across Australia, on the topics of trauma, psychosis, mood and anxiety disorders, brief interventions, cognition and other areas of youth mental health. The COVID-19 pandemic generated abrupt and dramatic changes to the delivery of workforce and service development initiatives in Australia due to significant restrictions to travel and in-person events. It also placed major delivery demands on youth mental health services. This paper outlines how the team at Orygen adapted their approach to youth mental health workforce development in response to COVID-19, offering reflections and future directions for implementation science that can support flexible models of support in a changing system.

With origins in video gaming, 3D virtual worlds (VWs) are digital environments where people engage and interact synchronously using digital characters called avatars. VWs may have future potential for delivering youth mental health (YMH) services. Despite progress in developing VW-based YMH interventions, limited consultation with young people may be contributing to mixed uptake and engagement. This study aimed to understand how young people with experiences accessing YMH services view the potential (i.e., hypothetical) use of VWs for YMH service delivery to understand qualitative factors influencing uptake. Eleven 18–25-year-old consumers (M = 22.91 years; five women, five men, and one non-binary person) took part in one-on-one, semi-structured interviews via videoconferencing. Interviews explored anticipated ease of use, helpfulness, and perceived intention to use VW-based YMH interventions if they were made available. Interviews were analysed using reflexive thematic analysis. Four themes were produced: (1) VWs as unique therapeutic spaces; (2) creative engagement for therapy; (3) VW communication promoting both connection and distance; (4) flexible access. All participants expressed a level of openness towards the potential use of VWs for YMH interventions. Features such as creative world-building and avatar customisation, increased anonymity, and remote accessibility were seen as ways to improve access to convenient, personalised, and engaging mental healthcare. Concerns included technology misuse, privacy risks, and reduced physical and emotional presence. Future research and service development should test real-world outcomes to ensure clinical benefit and employ codesign approaches that leverage servicer-users’ expectations to ensure accessible and acceptable delivery.

Introduction : The commitment to partnering with consumers and carers remains a stable priority for mental health services. This is evidenced by an emerging lived experience workforce. Research demonstrates that when people share their lived experience they can have a positive impact on the recovery journeys of others. Less clear is the role of young people in peer support roles, especially within child and youth mental health settings. There is no known dedicated child and youth mental health peer workforce operating within Queensland public mental health services. This paper will challenge the status quo and pose the question “why not”. Furthermore, this paper will examine how a large child and youth mental health service has developed and sustained a model of meaningful consumer and carer participation for more than ten years. It will analyse the key success factors such as organisation readiness, mutuality and co-design practice. This paper will explore the trajectory of consumer and carer participation to the current work occurring to implement a dedicated youth mental health peer workforce. Practice Change Implemented : The experiences of consumers, carers, clinicians and managers over the past decade have driven many practice changes, including defining and refining meaningful consumer and carer particiaption and engagement, governance mechanisms, as well as policies and procedures. The paper will share the lived experience of a young person (co-author) who has transitioned from service user to valued mental health worker and will explore the key ingredients that have led to the organisational readiness to co-design, develop, implement and evaluate an innovative youth peer support worker model, using a participatory action research approach. Aims : The paper aims to showcase integrated practice and present the voice of lived experience, to shift perceptions about the value of consumers and carers working in partnership with health professionals and improve integrated mental health services for young people and families. Highlights : The paper will showcase lessons learned and common threads gleaned from young people, parents and carers as well as from clinicians and managers including: Value your experiences Listen to young people and what they want Do not reinvent the wheel - learn from others Perseverance is the key ingredient to change, closely followed by commitment and action Co-designing services for young people with young people is hugely rewarding and improves service delivery and consumer outcomes and experiences Furthermore, it will identify the success factors and limitations and barriers to working alongside young people and present the collaborative partnership between Children’s Health Queensland Hospital and Health Service and Health Consumers Queensland as we embark on co-designing the youth peer support workforce with young people. Discussion and conclusions : Creating a valued youth peer workforce is more than merely transplanting a model into an organisation, you need to nurture and build the machinery that supports meaningful integration of the lived experience. It is believed that CYMHS has created this foundation and the establishment of a youth peer workforce is a much-desired outcome of years of preparatory work.

Objectives Following the outbreak of COVID-19, social distancing restrictions limited access to face-to-face mental health services in Western Australia (WA), necessitating a rapid transition to non-face-to-face alternatives, including telehealth. The current study investigated barriers and facilitators to telehealth access and engagement, and preferences for child and youth mental health service delivery during and beyond COVID-19. Methods Three participant groups were recruited via social media and partner organisations, and completed a tailored online survey: i) young people (14–25 years) who had ever accessed or attempted to access mental health support or services (n = 84), ii) parents of young people with a child aged 0–25 years who had ever accessed or attempted to access mental health support or services with or on behalf of their child (n = 68), and iii) professionals working in the child or youth mental health sector (n = 167). Results Regarding barriers to engagement, young people were primarily concerned with the privacy implications of telehealth and its efficacy relative to face-to-face alternatives. Parents and clinicians were more concerned with the technological pitfalls of telehealth (e.g., internet-connectivity, picture/sound issues). Telehealth’s accessibility was highlighted as a facilitator for all groups. Although certain participant groups were considered to be more suited to telehealth than others, most participants endorsed a blended approach to the future provision of mental health services. Conclusions To facilitate a blended approach to the delivery of child and youth mental health services, participants recommended more reliable and affordable internet access, implementing funding models that support telehealth delivery, and training for clinical staff. KEY POINTS What is already known about this topic: At the time of writing, Western Australia has been fortunate enough to resist a large-scale outbreak of COVID-19, making the state relatively unique in its experience of the pandemic. Despite this, the state has experienced periods of social distancingrequirements and associated impact on mental health service provision. Young people have been especially susceptible to mental health decline during the pandemic. Social distancing requirements have necessitated the rapid transition of mental health service provision from face-to-face to non-face-to-face alternatives. What this topic adds: Findings from this study provide localised insights into barriers and facilitators to engagement with non-face-to-face service delivery from the perspective of children and young people, carers and mental health professionals. Despite concerns about the relative efficacy of telehealth compared to traditional face-to-face services and challenges with technology, the majority of young people, parents, and mental health professionals in the study felt that moving forwards, child and youth mental health services should be provided using a flexible, blended approach where both face-to-face and non-face-to-face options are available.

IntroductionMainstream Australian mental health services are failing Aboriginal young people. Despite investing resources, improvements in well-being have not materialised. Culturally and age appropriate ways of working are needed to improve service access and responsiveness. This Aboriginal-led study brings Aboriginal Elders, young people and youth mental health service staff together to build relationships to co-design service models and evaluation tools. Currently, three Western Australian youth mental health services in the Perth metropolitan area and two regional services are working with local Elders and young people to improve their capacity for culturally and age appropriate services. Further Western Australian sites will be engaged as part of research translation.Methods and analysisRelationships ground the study, which utilises Indigenous methodologies and participatory action research. This involves Elders, young people and service staff as co-researchers and the application of a decolonising, strengths-based framework to create the conditions for engagement. It foregrounds experiential learning and Aboriginal ways of working to establish relationships and deepen non-Aboriginal co-researchers’ knowledge and understanding of local, place-based cultural practices. Once relationships are developed, co-design workshops occur at each site directed by local Elders and young people. Co-designed evaluation tools will assess any changes to community perceptions of youth mental health services and the enablers and barriers to service engagement.Ethics and disseminationThe study has approval from the Kimberley Aboriginal Health Planning Forum Kimberley Research Subcommittee, the Western Australian Aboriginal Health Ethics Committee, and the Curtin University Human Research Ethics Committee. Transferability of the outcomes across the youth mental health sector will be directed by the co-researchers and is supported through Aboriginal and non-Aboriginal organisations including youth mental health services, peak mental health bodies and consumer groups. Community reports and events, peer-reviewed journal articles, conference presentations and social and mainstream media will aid dissemination.

BackgroundMental illnesses are the leading cause of disability in young people, and lifestyle interventions in young people at risk of mental illness remain a priority. Opportunities to improve nutrition and physical activity among young people through youth mental health services remain unclear. This study aimed to determine the knowledge and behaviors towards nutrition and physical activity, the barriers and enablers to improving behaviors, and the preferred providers and sources of information for nutrition and physical activity among a sample of young people attending a youth mental health service.MethodsA mixed-method study was conducted in regional Tasmania, Australia in a sample of young people (15–25 years) attending a youth mental health service (headspace). A quantitative survey (n = 48) determined young people’s nutrition and physical activity knowledge, behaviors, barriers and enablers to achieving recommendations, and their preferred providers and sources of information. Structured interviews and a focus group further explored these concepts (n = 8), including the role of the mental health service as a provider of this support.ResultsThe majority of participants did not meet national recommendations for nutrition and physical activity, despite possessing a high level of knowledge regarding their importance for mental health. Improving mental health was a common enabling factor for participants choosing to alter diet and physical activity habits, but also the leading barrier for participating in physical activity. Young people wanted to receive information from reputable health providers, ideally through social media sources. headspace was seen as an important potential provider of this information.ConclusionsOur results indicate that there is a clear need to improve diet and physical activity habits to enhance mental and physical health outcomes in this at-risk group, and youth mental health services could provide further interventions to support their clients. Specialized staff (e.g. dietitians and exercise physiologists) may provide additional benefits alongside existing mental health care support.

In mental health settings, feedback from clients and carers is central to service evaluation, development and delivery. Increasingly, client and carer feedback is considered an integral part of service planning, and recognized as a critical element of the provision of recovery oriented service. This paper outlines the findings of a qualitative evaluation of a Youth Mental Health (YMH) service from the perspective of discharged clients and their parents. The service researcher conducted telephone interviews with 39 parents of discharged clients, and 17 young people themselves. Participants reported positive or mixed experiences with the service. In addition to more generic positive statements about the service, analysis identified two key themes: the importance of 'family inclusive practice' and the importance of 'working with client preferences'. Young people and their parents want to be actively engaged in treatment and have their treatment preferences considered in treatment planning. Participants expressed the importance of "a good fit" between the client and the worker in terms of the clinician's gender, personality and treatment style/modality. While for some participants these themes were raised in the context of service strengths, others identified them as limitations or opportunities for service improvement. The extent to which clients and their parents felt engaged and heard by their allocated clinician is critical to their satisfaction or dissatisfaction with the service, depending on their unique experience. As an outcome of this evaluation, a range of service improvement strategies have been recommended.

What Is Causing the Ongoing Youth MH Crisis?

BackgroundAs the demand for youth mental health care continues to rise, managing wait times and reducing treatment delays are key challenges to delivering timely and quality care. Clinical staging is a heuristic model for youth mental health that can stratify care allocation according to individuals’ risk of illness progression. The application of staging has been traditionally limited to trained clinicians yet leveraging digital technologies to apply clinical staging could increase the scalability and usability of this model in services.ObjectiveThe aim of this study was to validate a digital algorithm to accurately differentiate young people at lower and higher risk of developing mental disorders.MethodsWe conducted a study with a cohort comprising 131 young people, aged between 16 and 25 years, who presented to youth mental health services in Australia between November 2018 and March 2021. Expert psychiatrists independently assigned clinical stages (either stage 1a or stage 1b+), which were then compared to the digital algorithm’s allocation based on a multidimensional self-report questionnaire.ResultsOf the 131 participants, the mean age was 20.3 (SD 2.4) years, and 72% (94/131) of them were female. Ninety-one percent of clinical stage ratings were concordant between the digital algorithm and the experts’ ratings, with a substantial interrater agreement (κ=0.67; P<.001). The algorithm demonstrated an accuracy of 91% (95% CI 86%-95%; P=.03), a sensitivity of 80%, a specificity of 93%, and an F1-score of 73%. Of the concordant ratings, 16 young people were allocated to stage 1a, while 103 were assigned to stage 1b+. Among the 12 discordant cases, the digital algorithm allocated a lower stage (stage 1a) to 8 participants compared to the experts. These individuals had significantly milder symptoms of depression (P<.001) and anxiety (P<.001) compared to those with concordant stage 1b+ ratings.ConclusionsThis novel digital algorithm is sufficiently robust to be used as an adjunctive decision support tool to stratify care and assist with demand management in youth mental health services. This work could transform care pathways and expedite care allocation for those in the early stages of common anxiety and depressive disorders. Between 11% and 27% of young people seeking care may benefit from low-intensity, self-directed, or brief interventions. Findings from this study suggest the possibility of redirecting clinical capacity to focus on individuals in stage 1b+ for further assessment and intervention.

Background: Today, young people face a variety of social, environmental and psychological challenges, making them more vulnerable to developing mental health issues. Worldwide 15% of adolescents experience poor mental health, with the majority not seeking help or receiving care. Therefore, it is critical that youth mental health services become more youth-friendly to encourage help-seeking. This study examines a new pilot volunteer model of care introduced into a youth mental health service in Melbourne, Australia. The aim of the study is to explore staff perspectives of the volunteer model. Methods: A qualitative research design was undertaken using semi-structured one-on-one interviews. Eight staff participated. Data was thematically analysed using an inductive approach. Results: Two main themes, 'promoting service use' and 'implementation to practice', were generated, along with sub-themes. The themes highlight benefits to staff such as reductions in workload and benefits to volunteers through the gaining of experience and knowledge. However, there was a need to support volunteers through greater training and supervision. Conclusions: Volunteers in youth mental health services can create a welcoming environment which enhances access and engagement for young people seeking help. Volunteers in a youth mental health setting can enhance accessibility, reducing staff workload and fostering meaningful engagement.