Well-being Plan Research Articles

Community Connector Pilot – Review Of A Non-Clinical Programme Within An Integrated Care Programme For Older Persons Team

Abstract Background A Community Connector is a specialist Social Prescriber for older individuals who often present with complex medical needs and are referred directly by an Integrated Care team. The programme is a collaborative model between this team and a respective community host organisation. Integrated Care, as part of the Sláintecare Programme, places a stronger emphasis on social supports and person-centredness as key elements in healthcare (Goodwin, 2013). Methods Referrals are received approximately two to three weeks prior to discharge from the Integrated Care team which allows for relevant feedback from the Community Connector to this team. A coaching approach is utilised as a way of exploring each participant’s individual priorities and their expressed interests and goals in order to enhance their awareness of resources and supports in their own community and their subsequent readiness to engage. This process involves co-creating a personalised wellbeing plan with each individual which can act as the basis for a joint learning journey together. Results On referrals received to the programme, ongoing data is recorded regarding the number of individuals participating, the activities undertaken and the outcomes affecting the wellbeing of participants. Social isolation is a key reason for referral among this cohort in addition to cognitive stimulation, reengagement in social outlets and carer stress. Programme participants continue to be referred to a range of community activities, programmes and supports. Preliminary findings show an increase in community connectedness in regard to individuals’ increased knowledge and subsequent participation in local activities. Conclusion Key qualitative and quantitative data are the basis for initial and ongoing evaluation of the programme. These include recording any reflections and challenges which then act as key learning tools in delivering a unique person-centred programme for older individuals.

Guiding Clients Towards Self-Kindness and Acceptance: Wrestling With the Inner Critic

Research and methodology on the treatment of self-criticism in counselling is limited in the recent literature. This article describes how harsh automatic self-criticism became viewed within several theoretical frameworks as a sub-personality with a purpose rather than a simple psychological mechanism. The article reviews a number of approaches to therapeutic work with clients experiencing habitual self-criticism. It outlines eight therapeutic steps to gaining freedom from the inner critic, including getting to know self-critical “voices”, understanding their origins, recognising what activates escalation of self-criticism, and making efforts that create distance from the corrosive effect of self-criticism. Ways to become grounded and self-compassionate, and to develop an individualised wellbeing plan are discussed as components of gaining freedom from self-critical dominance.

Telehealth-delivered recovery-orientated well-being plan group program for bipolar disorder: a pilot randomised feasibility and acceptability study.

Psychological interventions may assist in the management of bipolar disorder, but few studies have assessed the use of group therapy programs using telehealth. The present study aimed to assess the feasibility and acceptability of a well-being group program for people living with bipolar disorder designed to be delivered via telehealth (Zoom platform) using a randomised controlled pilot design. Participants were randomly assigned to either the 8-week well-being plan treatment condition or the wait-list control condition. They were administered a structured diagnostic instrument to confirm bipolar disorder diagnosis followed by a set of self-report questionnaires relating to mood, quality of life, personal recovery, and stigma. A total of 32 participants (16 treatment; 16 control) were randomised with 12 participants completing the intervention, and 13 the control condition. The program appeared acceptable and feasible (75% retention rate) with a mean attendance being reported of 7.25 sessions attended out of a possible 8 sessions. Participants reported high levels of satisfaction overall with the intervention, with a mean score of 9.18 out of 10. Preliminary evidence suggests that delivery of the group program online is feasible and acceptable for participants living with bipolar disorder. As the program was designed to prevent relapse over time, further research is needed to determine if the program may be helpful in improving symptom outcomes over a longer follow-up period.

Call to put schools at the heart of mental health and wellbeing plan

Report by think-tank says next government should expand the reach and remit of mental health support teams so they provide advice and guidance to all pupils to prevent emerging problems from escalating

The role of an equine nutritionist in equine health, performance and wellbeing: Ideas stemming from an equine science society symposium workshop

In the United States, there is little clarity on the qualifications and availability of equine nutritionists. Currently, no regulatory body exists for formal credentialing outside of veterinary medicine. Most equine nutritionists are not veterinarians but do have advanced scientific degrees (Master of Science and/or Doctor of Philosophy) in the field of Animal Science. However, not all reporting to be equine nutritionists have formal education in the field of equine nutrition. To discuss this, a workshop was held at the 2023 Equine Science Society (ESS) meeting. The purpose of this discussion was to share ideas among equine nutrition professionals about how best to provide support for the inclusion of the specialty as part of a horse's health team, alongside the veterinarian, farrier and other equine health specialists. In human, small animal and livestock practices, the importance of nutrition as part of an overall health, production (livestock) and well-being plan has been documented. However, surveys of veterinarians, the top source of information for horse owners, reveal a lack of confidence in the area of nutrition after graduating from veterinary school and a lack of available continuing education opportunities to learn more. Further, it appears that many horse owners may unknowingly be obtaining nutrition information from unverified sources (such as the internet). The discussion included formal and informal education of equine nutritionists, as well as avenues to open lines of communication with the veterinary community to provide nutrition resources for horse owners, managers and veterinarians.

Implementation of a Systematic, Digital Oncology Workflow for Patient Distress Screening in a National, Multi-Site Radiotherapy Outpatient Setting.

Distress screening is recommended as standard of care in oncology to improve the quality of personalized care for patients, however previously reported barriers have led to poor uptake and reporting of clinician follow up and interventions. Our purpose was to improve the quality of personalized care for patients with high patient participation rate (>50%), clinical and nurse workflow compliance rate (>70%) and create structured data for practice improvement. To achieve this purpose, an in-house systematic digital screen and templated well-being plan (WBP) workflow was implemented across 33 outpatient Radiation Oncology sites in a multi-institutional center. An in-house digital version of the NCCN Distress Thermometer and Problem Checklist (DT) was built in the integrated web-based portal for patients to complete at home or in a clinic setting. A digital workflow was co-designed with clinicians with automatic integration of the DT PDF document into the Electronic Medical Record (EMR), assigned for doctor review. Nurses subsequently recorded screening actions in the WBP. An extensive engagement, education and support program was completed nationally with phased implementation after an initial pilot at 3 sites. Staff and patient feedback were documented and presented with the collated data for review. The program was successfully implemented at 33 centers across Australia in the multi-site organization between March and October 2022. A total of 7788 distress screening forms were submitted with an uptake rate of 78% at baseline and 53% at end of treatment (EOT). DT document approval rates by doctors varied (41%-98%), and WBP was completed for 48-100% of patients, with variations of rates and use noted between states and individuals for both. Referrals were recorded in the WBP for 3% of patients, however, as up to 52% of documentation was not in a WBP (for some states), true referral numbers require further manual analysis. Pairwise analysis of screening scores between time points saw 42% of scores reduced, 34% increased and 24% with no change. Analysis of a subset of patients with increased or no change in score showed 57% had some change in categories of distress, 22% had complete change and 10% had no change. With an increasing global focus on improving patient centered care, implementation of a systematic digital workflow for distress screening and supportive care was achieved resulting in patient identified stressors being addressed as standard of care. Key barriers reported, include confidence discussing screening results with patients and manual workflows at EOT. The provision of a rich data set can also highlight opportunities for clinical practice improvement, cohort-based focus, clinical quality indicators, benchmarking and reporting.

Gender Issues Behind Bars: Insights for a Sustainable Wellbeing Plan

Philippines is one of the countries, where understanding and awareness of gender and development issues and concerns have evolved from a conventional perspective to a more openly discussed topic. This study explored the gender issues and gaps in terms of legal protection, medical care, and religious freedom faced by Persons Deprived of Liberty (PDLs) of the Bureau of Jail Management and Penology (BJMP) Kalibo, Aklan for a sustainable well-being plan. A descriptive-qualitative approach leaning on intrinsic case study design was utilized. A researcher-made interview guide was employed in data gathering. The informants were the twelve (12) PDLs at the BJMP, who have been detained for at least six (6) months through purposive sampling technique. The data gathering was approximately 30 days. The researcher interviewed the informant face-to-face following strict appointment from the authorities of BJMP Kalibo, and health and safety protocols relative to COVID-19. A Thematic Analysis Approach was used. The gender issues found were slow process during trials, delayed service of service, lack of medical facilities inside the jail. Among the gaps were the delay in justice system, bullying, discrimination, other crimes and abuses in BJMP, and unmet needs in terms of medical and health care facilities and services. A Sustainable Wellbeing Plan that would benefit the PDLs of BJMP Kalibo contains comprehensive and inclusive actions to take to at least alleviate the conditions of the PDLs.

‘I almost felt like I can be a little bit more honest’: experiences of a telehealth group for bipolar disorder

Abstract Despite the increasing use of telehealth platforms to deliver cognitive behavioural group therapy programs, few studies have been conducted that explore the experience of using telehealth platforms for those living with bipolar disorder. The present study aimed to explore the impact of the telehealth platform on the delivery of a recovery-orientated well-being plan group program for participants living with bipolar disorder. A total of 19 participants completed the qualitative interviews (3 male, 16 female). Using content analysis, data were deductively coded in line with pre-existing codes and matrix categories with unexpected data that discussed the telehealth experience being coded using an inductive content analysis framework. Two themes were identified: (1) Social inclusion, which included the subthemes of (a) connection to others via telehealth and (b) feeling safe using telehealth; and (2) Barriers and engagement, which included the subthemes of (a) removing barriers by using telehealth and (b) symptom impacts to engagement using the telehealth platform. Participants reported increased connection with others using telehealth and feeling greater safety overall when using the telehealth platform; however, some noted that dominant personalities could contribute to feeling unsafe within the group at times. Overall, the platform reduced barriers and was easy to use with this being a convenient way to attend, even if in some instances the platform highlighted differences between the members. Key learning aims (1) Telehealth platforms provide a unique opportunity for connection for those living with bipolar disorder. (2) Telehealth platforms may increase feelings of personal safety but may also increase feelings of difference between group members. (3) Symptoms may impact on engagement with anxiety and mood symptoms playing a role; however, telehealth may also decrease barriers to engagement.

Planning for community well-being: Prioritizing and identifying local neighbourhood attributes of belonging.

ObjectivesLocal neighbourhoods have great potential to foster community belonging which can improve health and well-being. In partnership with the City of Toronto, we prioritize and assess the importance of physical and social environmental attributes to community belonging. Using new data linkages, we contribute to Toronto’s community safety and well-being plan, SafeTO.
 ApproachWe leverage an individual-level record linkage of respondents from multiple cycles of the Canadian Community Health Survey (CCHS, 2000 to 2017), the Canadian Vital Statistics Death Database (CVSD), and the Discharge Abstract Database (DAD) from the Centre for Population Health Data at Statistics Canada. Environmental data sources include the Census, administrative data, and open-source data. Using postal code information from the CCHS, we connected each respondent with their neighbourhood’s attributes, which include but are not limited to proximity to amenities (such as childcare, libraries and public transit), the Canadian Active Living Environment measure, green space, and air quality.
 ResultsOf the 74,000 CCHS respondents from the Toronto census metropolitan area (representing a population of 4 to 5 million annually), an overall rate of 86% agreed to link and share their data, which renders an estimated linked sample of approximately 63,600 respondents. Across the entire linkage, 54% of respondents are linked to a record in the DAD between 1999/00 and 2017/18, and 10% are linked to a death record in the CVSD between 2000 and 2017. In consultation with municipal agencies and community stakeholders, we will prioritize the environmental attributes that are most relevant to community belonging and well-being, and comprehensively model the relationship between these attributes, community belonging and downstream health outcomes using multivariable regression and time-to-event models.
 ConclusionThis on-going work contributes to the development of innovative approaches for using multi-sector data to inform decision making, as per the goals of SafeTO. Results from the analyses will be used to identify environmental attributes potentially important for community belonging and will support municipal city planning and resource allocation.

Cultivating Community Resilience With Agency and Sociality in Gardens for Health and Healing

Communities must develop ever greater resilience as they face the climate emergency and concomitant health and food system challenges. Sustainable food systems research tends to adopt broad and often theoretical social-ecological systems perspectives on resilience. Models theorize that community self-organization for mobilizing change and agency in taking planned action are key processes for community resilience. Empirically, however, how individuals come together to engage in collective action for community resilience remains little explored. In this research, we examine strategies for resilience employed by 19 participants with multiple chronic health conditions in Gardens for Health and Healing, a community-based participatory research project conducted in southeast Wyoming. Through random assignment, participants either received a home garden or designed their own 16-week wellbeing program from a menu of community health and food systems services (e.g., cooking classes, farmers' market gift certificates, home garden). Using a pre-post wellbeing survey, interviews, and 14 months of ethnographic research, we explored the role of choice—or agency—for participants' wellbeing. Survey results suggest that receiving a garden more greatly benefitted participants' physical health while designing and implementing a wellbeing plan more greatly benefitted mental health. Qualitative results find that participants in both the garden and menu conditions identified their intervention as empowering them to take action to improve their own health and wellbeing. Participants attributed their wellbeing less to what condition they were in (garden or menu), and more to the relational processes they engaged in through the project. These processes included bringing the family together; associating with friends, neighbors, and colleagues; caring for garden environments; and engaging with the community-based organization that supported both the gardens and the wellbeing plans. We find that this sociality can help promote and explain a move from individual wellbeing and agency to the collective forms of agency and self-organization necessary to cultivate community resilience for sustainable food systems.

Using the Intervention Mapping Approach to Develop a Mental Health Intervention: A Case Study on Improving the Reporting Standards for Developing Psychological Interventions.

Replicating or distilling information from psychological interventions reported in the scientific literature is hindered by inadequate reporting, despite the existence of various methodologies to guide study reporting and intervention development. This article provides an in-depth explanation of the scientific development process for a mental health intervention, and by doing so illustrates how intervention development methodologies can be used to improve development reporting standards of interventions. Intervention development was guided by the Intervention Mapping approach and the Theoretical Domains Framework. It relied on an extensive literature review, input from a multi-disciplinary group of stakeholders and the learnings from projects on similar psychological interventions. The developed programme, called the “Be Well Plan”, focuses on self-exploration to determine key motivators, resources and challenges to improve mental health outcomes. The programme contains an online assessment to build awareness about one’s mental health status. In combination with the exploration of different evidence-based mental health activities from various therapeutic backgrounds, the programme teaches individuals to create a personalised mental health and wellbeing plan. The use of best-practice intervention development frameworks and evidence-based behavioural change techniques aims to ensure optimal intervention impact, while reporting on the development process provides researchers and other stakeholders with an ability to scientifically interrogate and replicate similar psychological interventions.

Pregnancy audit in the PATH (Psychosis Prevention, Assessment and Treatment in Hertfordshire) early intervention in psychosis service

AimsTo identify whether staff from the PATH Early Intervention in Psychosis (EIP) Service routinely ask female service users of child bearing age about their plans for pregnancy, whether risks of medication in pregnancy are routinely discussed and whether contraception is routinely discussed.MethodIn May 2019, a report was run capturing all female PATH service users of child bearing age (16-50 years) who were on the pathway at this time. This totalled 177 service users, all of whom were included in the sample. We used the search terms “pregnant”, “pregnancy”, “having children”, “contraception”, “conceive”, “baby”, “conception”, “miscarriage”, “abortion”, “IVF”, “still born” to interrogate the patient records . Auditors searched case notes, clinic letters, recent physical health assessment and recent wellbeing plan for evidence as to whether staff had asked about pregnancy plans, contraception, offered a referral to the Community Perinatal Team, and discussed risks about medication in pregnancy.ResultOf the 177 service users, 34 were asked whether they had plans for pregnancy (19%). Of the 177 service users, 28 were given advice regarding contraception (16%). Of the 34 service users who were asked about pregnancy plans, 27 did have plans for pregnancy. Of these 27 service users, 15 were offered a referral to the Community Perinatal Team (56%). Of the 27 service users who did have plans for pregnancy, 12 received advice and or information about risks of antipsychotic medication in pregnancy (44%).ConclusionIt is clear that PATH staff are not routinely having discussions with female service users of child bearing age about their plans for pregnancy or contraception; this audit has identified that this occurs in less than 20% of cases. Of service users that did have plans for pregnancy, only 56% were offered a referral to the Community Perinatal Team; we should strive for this to be 100% so service users can access specialist support and advice. Work is underway to include information on pregnancy in the PATH service information leaflet to ensure women referred to PATH expect staff to ask them about their plans for pregnancy and contraception. Questions about pregnancy planning and contraception are to be embedded in the Trust's Physical Health Assessment care document to act as a prompt for staff. Finally, the topics of pregnancy and contraception in women with psychosis have been incorporated into the PATH physical health training programme which will be delivered with support from the Community Perinatal Team.

Facilitated transitions: coaching to improve the medical school to residency continuum

ABSTRACT Background: Current efforts incompletely address the educational, social, and developmental aspects of a learner’s transition from medical school to residency. Objective: To determine the feasibility and acceptability of a transition to residency (TTR) coaching program. Designs: In March 2019, we designed, implemented, and evaluated a TTR coaching program for students who matched into residency programs at our institution. Goals were to stimulate reflection on successes and challenges encountered during medical school, develop strategies to problem-solve barriers and address concerns, identify professional and personal resources, improve confidence, and make an action plan. Results: Of eligible learners, 42% (10/24) enrolled in TTR coaching. Learners were most interested in coaching in the following areas: wellbeing (70%, 7/10), interpersonal/communication skills (60%, 6/10), and learning plan development (50%, 5/10). The majority (90%; 9/10) expressed satisfaction with the program and would recommend participation. One month after starting internship, 90% (9/10) of learners stated the program helped facilitate their transition. Learners who did not enroll in TTR cited concerns around the coach selection process (72%, 8/11), upcoming travel (45%, 5/11), insufficient time/competing demands (27%, 3/11), and lack of perceived benefit (18%, 2/11). Conclusion: This pilot study demonstrated preliminary feasibility and acceptability for TTR coaching.

Acting on climate change and health in Victoria.

Acting on climate change and health in Victoria.

Involving End Users in Adapting a Spanish Version of a Web-Based Mental Health Clinic for Young People in Colombia: Exploratory Study Using Participatory Design Methodologies.

BackgroundHealth information technologies (HITs) hold enormous promise for improving access to and providing better quality of mental health care. However, despite the spread of such technologies in high-income countries, these technologies have not yet been commonly adopted in low- and middle-income countries. People living in these parts of the world are at risk of experiencing physical, technological, and social health inequalities. A possible solution is to utilize the currently available HITs developed in other counties.ObjectiveUsing participatory design methodologies with Colombian end users (young people, their supportive others, and health professionals), this study aimed to conduct co-design workshops to culturally adapt a Web-based Mental Health eClinic (MHeC) for young people, perform one-on-one user-testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC and adapt it to the Colombian context, and inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C).MethodsThis study involved the utilization of a research and development (R&D) cycle including 4 iterative phases: co-design workshops; knowledge translation; tailoring to language, culture, and place (or context); and one-on-one user-testing sessions.ResultsA total of 2 co-design workshops were held with 18 users—young people (n=7) and health professionals (n=11). Moreover, 10 users participated in one-on-one user-testing sessions—young people (n=5), supportive others (n=2), and health professionals (n=3). A total of 204 source documents were collected and 605 annotations were coded. A thematic analysis resulted in 6 themes (ie, opinions about the MHeC-C, Colombian context, functionality, content, user interface, and technology platforms). Participants liked the idea of having an MHeC designed and adapted for Colombian young people, and its 5 key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video-visit system, and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop additional functionality (eg, phone network backup; chat; geolocation; and integration with electronic medical records, apps, or electronic tools) as well as an adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context.ConclusionsThe application of an R&D cycle that also included processes for adaptation to Colombia (language, culture, and context) resulted in the development of an evidence-based, language-appropriate, culturally sensitive, and context-adapted HIT that is relevant, applicable, engaging, and usable in both the short and long term. The resultant R&D cycle allowed for the adaptation of an already available HIT (ie, MHeC) to the MHeC-C—a low-cost and scalable technology solution for low- and middle-income countries like Colombia, which has the potential to provide young people with accessible, available, affordable, and integrated mental health care at the right time.

Our Healthy Clarence: A Community-Driven Wellbeing Initiative.

In 2015–2016, the Clarence Valley in Northern New South Wales, Australia, experienced an unexpectedly high number of deaths by suicide, and the resulting distress was exacerbated by unhelpful press coverage. The local response was to adopt a community-wide positive mental health and wellbeing initiative. This paper describes the process and achievements of the initiative called ‘Our Healthy Clarence’. Key stakeholders were interviewed at year two and relevant documents reviewed. Data were analysed using document and thematic analysis. Our Healthy Clarence was established following community consultation, including forums, interviews, surveys and workshops. It adopted a strengths-based approach to suicide prevention, encompassing positive health promotion, primary and secondary prevention activities, advocacy, and cross-sectoral collaboration. A stakeholder group formed to develop and enact a community mental health and wellbeing plan. Factors contributing to its successful implementation included a collective commitment to mental health and wellbeing, clarity of purpose, leadership support from key local partners, a paid independent coordinator, and inclusive and transparent governance. Stakeholders reported increased community agency, collaboration, optimism and willingness to discuss mental health, suicide and help-seeking. Our Healthy Clarence draws ideas from mental health care, community development and public health. This initiative could serve as a model for other communities to address suicide, self-harm and improve wellbeing on a whole-of-community scale.

Using Participatory Design Methodologies to Co-Design and Culturally Adapt the Spanish Version of the Mental Health eClinic: Qualitative Study.

BackgroundThe Mental Health eClinic (MHeC) aims to deliver best-practice clinical services to young people experiencing mental health problems by making clinical care accessible, affordable, and available to young people whenever and wherever they need it most. The original MHeC consists of home page with a visible triage system for those requiring urgent help; a online physical and mental health self-report assessment; a results dashboard; a booking and videoconferencing system; and the generation of a personalized well-being plan. Populations who do not speak English and reside in English-speaking countries are less likely to receive mental health care. In Australia, international students have been identified as disadvantaged compared with their peers; have weaker social support networks; and have higher rates of psychological distress. This scenario is acquiring significant relevance as Spanish-speaking migration is rapidly growing in Australia, and the mental health services for culturally and linguistically diverse populations are limited. Having a Spanish version (MHeC-S) of the Mental Health eClinic would greatly benefit these students.ObjectiveWe used participatory design methodologies with users (young people aged 16-30 years, supportive others, and health professionals) to (1) conduct workshops with users to co-design and culturally adapt the MHeC; (2) inform the development of the MHeC-S alpha prototype; (3) test the usability of the MHeC-S alpha prototype; (4) translate, culturally adapt, and face-validate the MHeC-S self-report assessment; and (5) collect information to inform its beta prototype.MethodsA research and development cycle included several participatory design phases: co-design workshops; knowledge translation; language translation and cultural adaptation; and rapid prototyping and user testing of the MHeC-S alpha prototype.ResultsWe held 2 co-design workshops with 17 users (10 young people, 7 health professionals). A total of 15 participated in the one-on-one user testing sessions (7 young people, 5 health professionals, 3 supportive others). We collected 225 source documents, and thematic analysis resulted in 5 main themes (help-seeking barriers, technology platform, functionality, content, and user interface). A random sample of 106 source documents analyzed by 2 independent raters revealed almost perfect agreement for functionality (kappa=.86; P<.001) and content (kappa=.92; P<.001) and substantial agreement for the user interface (kappa=.785; P<.001). In this random sample, no annotations were coded for help-seeking barriers or the technology platform. Language was identified as the main barrier to getting medical or psychological services, and smartphones were the most-used device to access the internet. Acceptability was adequate for the prototype’s 5 main elements: home page and triage system, self-report assessment, dashboard of results, booking and video visit system, and personalized well-being plan. The data also revealed gaps in the alpha prototype, such as the need for tailored assessment tools and a greater integration with Spanish-speaking services and communities. Spanish-language apps and e-tools, as well as online mental health information, were lacking.ConclusionsThrough a research and development process, we co-designed and culturally adapted, developed and user tested, and evaluated the MHeC-S. By translating and culturally adapting the MHeC to Spanish, we aimed to increase accessibility and availability of e-mental health care in the developing world, and assist vulnerable populations that have migrated to English-speaking countries.

Integrating Health and Social Care SIG - Part 2: The Healthy Homes and Neighbourhoods Integated Care Initiative

Background: Sydney Local Health District, Australia, undertook a collaborative planning process for vulnerable families in 2013, and an interagency child health and wellbeing plan in 2014. In late 2014 the District successfully tendered for an integrated care initiative for vulnerable families – Healthy Homes and Neighbourhoods, which was implemented in July 2015. The initiative involved significant system redesign and commitment from health, education, social care, local government, and primary-care and non-Government partners. The initial model included: shared intake, care-coordination, family group conferencing, wrap-around delivery models, place-based service hubs, general practice engagement and support, and family and population-based health improvement initiatiave. A significant feature of the design is the collaborative engagement with welfare, disability, education, child protection, civil law, housing, local government and criminal justice sectors. At the level of clinical engagement and support for families all salient matters are considered in scope for the care-coordinators. Collaboration with the non-health sector is challenging for reasons that include: Differing operational policy frameworks, including: district boundaries, training, clinical tools, and performance indicators Increased commissioning and outsourcing to multiple private sector providers Privacy legislation, case-law and related sector policies and protocols Different digital technology across non-health sectors and providers. Progress toward addressing the challenges has been partially achieved at a place-based clinical level where multi-disciplinary team processes enable shared-care approaches to develop. Lessons learnt in the place-based demonstration sites are expected to be transferable. Aims and Objectives: 1- Provide an overview of the design of the Healthy Homes and Neighbourhoods Integrated Care Initative 2- Provide an update of previously presented studies 3- Describe new studies Format: Timing 90 minutes. Large group presentation format. Target Audience: Health, education and social care practitioners and researchers who are interested in the design, implementation and evaluation of integrated health and social care inititiaves for vulnerable families. Learnings and Takeaway: The participants will learn of one approach to providing integrated health and social care services for vulnerable populations Those familiar with the HHAN initiative will be brought up to date with new aspects of the initiative including school projects.

Enfoques educativos, culturales, éticos y en valores de la Educación Inicial

Analizar los nuevos enfoques educativos, culturales, éticos y en valores de la Educación Inicial fue el objetivo general de este estudio de investigación formativa. Promover la importancia que tiene el inspirar valores a los niños desde temprana edad es, como futuros docentes de educación infantil, un reto en una sociedad multicultural e intercultural, desarrollando seres humanos respetuosos con una sociedad democrática. La metodología de este proyecto de investigación es cuantitativa y cualitativa, de carácter exploratorio y descriptivo. El instrumento utilizado es la entrevista. La población universo del Centro de Educación Inicial fue siete docentes. Todos ellos trabajan con niños de cero a tres años de edad. El instrumento contiene quince reactivos acerca de la temática en cuestión, es decir, la interculturalidad y lo que implica la implementación de la misma en la institución permitiendo verificar los conocimientos de los docentes acerca del tema y su aplicación, rigiéndose al Plan del Buen Vivir (2013-2017).Las conclusiones extraídas son las diferencias entendidas sobre la interculturalidad, multiculturalidad y pluriculturalidad por parte de los docentes y sus características comprendiendo su importancia dentro del marco del Buen Vivir. Se resalta que la interacción de los docentes con los alumnos es constante y buscan implementar en los niños diversos valores, la aceptación de diversas culturas y tradiciones a través de temas o clases especificas; sin embargo, también se pudo comprobar que como institución no cuentan con un programa explícito donde trabajen sobre los temas antes mencionados siendo un Centro Infantil donde coexisten niños de diversas provincias y nacionalidades.

Developing a Mental Health eClinic to Improve Access to and Quality of Mental Health Care for Young People: Using Participatory Design as Research Methodologies.

BackgroundEach year, many young Australians aged between 16 and 25 years experience a mental health disorder, yet only a small proportion access services and even fewer receive timely and evidence-based treatments. Today, with ever-increasing access to the Internet and use of technology, the potential to provide all young people with access (24 hours a day, 7 days a week) to the support they require to improve their mental health and well-being is promising.ObjectiveThe aim of this study was to use participatory design (PD) as research methodologies with end users (young people aged between 16 and 25 years and youth health professionals) and our research team to develop the Mental Health eClinic (a Web-based mental health clinic) to improve timely access to, and better quality, mental health care for young people across Australia.MethodsA research and development (R&D) cycle for the codesign and build of the Mental Health eClinic included several iterative PD phases: PD workshops; translation of knowledge and ideas generated during workshops to produce mockups of webpages either as hand-drawn sketches or as wireframes (simple layout of a webpage before visual design and content is added); rapid prototyping; and one-on-one consultations with end users to assess the usability of the alpha build of the Mental Health eClinic.ResultsFour PD workshops were held with 28 end users (young people n=18, youth health professionals n=10) and our research team (n=8). Each PD workshop was followed by a knowledge translation session. At the conclusion of this cycle, the alpha prototype was built, and one round of one-on-one end user consultation sessions was conducted (n=6; all new participants, young people n=4, youth health professionals n=2). The R&D cycle revealed the importance of five key components for the Mental Health eClinic: a home page with a visible triage system for those requiring urgent help; a comprehensive online physical and mental health assessment; a detailed dashboard of results; a booking and videoconferencing system to enable video visits; and the generation of a personalized well-being plan that includes links to evidence-based, and health professional–recommended, apps and etools.ConclusionsThe Mental Health eClinic provides health promotion, triage protocols, screening, assessment, a video visit system, the development of personalized well-being plans, and self-directed mental health support for young people. It presents a technologically advanced and clinically efficient system that can be adapted to suit a variety of settings in which there is an opportunity to connect with young people. This will enable all young people, and especially those currently not able or willing to connect with face-to-face services, to receive best practice clinical services by breaking down traditional barriers to care and making health care more personalized, accessible, affordable, and available.