Are codesigned programmes more difficult to implement? A qualitative study of staff perceptions on the implementation of a new youth mental health programme.

BACKGROUND: Codesigned interventions are becoming more common in health services and, in particular, in the design and development of mental health programmes and interventions. However, previous research has established that the transition from codesign to implementation can experience several challenges and that this transition process has received little research attention. OBJECTIVE: The aim of this study was to explore the experience of staff members charged with the implementation of a codesigned intervention for young people and adolescents at risk of suicide. SETTING AND PARTICIPANTS: Five staff members involved in the implementation of the new codesigned programme took part in semi-structured interviews. METHOD: The study involved qualitative evaluation of staff experiences during the implementation of a new child and youth suicide intervention. Interviews were analysed using reflexive thematic analysis. RESULTS: The analysis identified four themes of 'disconnect', 'operational challenges, 'service user' and 'being authentic'. 'Disconnect' captures the difficulties of implementing a codesigned programme which leads to 'operational challenges' in meeting broader expectations while ensuring the feasibility of the programme. The third theme, 'service user', captures the realisation that the young people accessing the new service were different to those involved in the codesign process. The final theme, 'being authentic', highlights how staff needed to be responsive and flexible while remaining true to the principles proposed in the codesign. DISCUSSION: This study yielded some valuable insights into the challenges around the implementation of a codesigned intervention, an under-researched area. The findings suggest that adaption of the design may be necessary, if it is not informed by implementation constraints, making it necessary for the implementation team to be well-briefed on the initial design and given plenty of time to make the necessary adjustments in a coproduction process. Limitations for the generalisation of the results include a small sample of staff and particular challenges that may be unique to this study. CONCLUSION: The present study highlights that for health services undertaking codesign approaches, appropriate time and resources need to be considered for the implementation phase of an initiative, to ensure that there is effective translation from design to implementation and that new codesigned services can be effective within operational constraints. PATIENT AND PUBLIC CONTRIBUTION: The authors would like to thank and acknowledge the young people with a lived-experience and their carers who participated in the codesign process and research evaluation component of this study. We also wish to thank the clinical staff, peer workers and family peer workers who participated in the evaluation.

A qualitative evaluation of a co-design process involving young people at risk of suicide.

BACKGROUND: Co-design is becoming common practice in the development of mental health services, however, little is known about the experience of such practices, particularly when young people are involved. OBJECTIVE: The aim of this study was to conduct a process evaluation of the co-design which was undertaken for the development of an intervention for youth and adolescents at risk of suicide. This paper briefly outlines the co-design process undertaken during a COVID-19 lockdown and then focuses on a qualitative evaluation of the experience of taking part in a co-design process. SETTING AND PARTICIPANTS: The evaluation involved young consumers of a public youth mental health service, their carers/parents and service delivery staff who had taken part in the co-design process. METHOD: This study used follow-up semistructured interviews with the co-design participants to explore their experience of the co-design process. Inductive thematic analysis was used to draw out common themes from the qualitative data. RESULTS: It was found that despite the practical efforts of the project team to minimise known issues in co-design, challenges centred around perceptions regarding power imbalance, the need for extensive consultation and time constraints still arose. DISCUSSION: Despite these challenges, the study found that the co-design provided a human-centred, accessible and rewarding process for young people, parents and staff members, leaving them with the feeling that they had made a worthwhile contribution to the design of the new service, as well as contributing to changing practice in service design. CONCLUSION: With sensitivity and adaptation to usual practice, it is possible to include young people with suicidal ideation, their parents/carers and professional staff in a safe and effective co-design process. PATIENT AND PUBLIC CONTRIBUTION: The authors would like to thank and acknowledge the young people with a lived experience and their carers who participated in the co-design process and research evaluation component of this study. We also wish to thank the clinical staff, peer workers and family peer workers who participated in this research.

Consumer Views and Experiences of Secondary-Care Services Following REFOCUS-PULSAR Staff Recovery-Oriented Practices Training.

BACKGROUND: The use of recovery-oriented practice (ROP) can be challenging to implement in mental health services. This qualitative sub-study of the Principles Unite Local Services Assisting Recovery (PULSAR) project explored how consumers perceive their recovery following community mental health staff undertaking specific ROP training. METHODS: Using a qualitative participatory methodology, 21 consumers (aged 18-63 years) participated in one-on-one interviews. A thematic analysis was applied. RESULTS: Four main themes were extracted: (1) connection, (2) supportive relationships, (3) a better life, and (4) barriers. Connections to community and professional staff were important to support consumers in their recovery journey. Many consumers were seeking and striving towards a better life that was personal and individual to each of them, and how they made meaning around the idea of a better life. Barriers to recovery primarily focused on a lack of choice. A minor theme of 'uncertainty' suggested that consumers struggled to identify what their recovered future might entail. CONCLUSION: Despite staff undertaking the ROP training, all participants struggled to identify language and aspects of recovery in their interaction with the service, suggesting a need for staff to promote open, collaborative conversations around recovery. A specifically targeted recovery resource might facilitate such conversation.

Provision of a Multidisciplinary Post-Suicidal, Community-Based Aftercare Program: A Longitudinal Study.

Suicide is a global concern with rates in Australia continuing to increase. Effective post-suicidal care is critical for reducing persistent suicidal behaviour. One model of care is that adopted by Alfred Health, delivering a multidisciplinary, hybrid clinical and non-clinical (psycho-social support), assertive outreach approach. This study measured improvements in resilience and wellbeing, changes to distress and suicidal ideation at least 6-months post-discharge from care. Thirty-one consumers participated including a one-on-one interview to gather qualitative feedback. There was a significant change on all outcome measures with large effect sizes. Participants had significantly reduced suicidal ideation and distress and increased coping self-efficacy, hope and well-being. The qualitative findings indicated that a key component to recovery was the staff. Limitations included a low sample size, and broad time range of follow-up data collection. Providing assertive, multidisciplinary, collaborative and outreach-focused post-suicidal care can increase and sustain protective psychological factors and reduced suicidal ideation in most individuals.

General Practitioners' management of young people with mental health conditions in Australia.

AIM: Detecting and diagnosing youth mental health issues can be challenging for General Practitioners (GPs) who are often the first to encounter them. One aim of this study was to understand the challenges GPs faced in identifying, treating and referring young people with mental health issues in Melbourne, Australia. A second aim was to identify gaps in GP knowledge and service provision in order to design a service and training program for GPs that addresses those gaps. METHOD: A representative sampling method was used to invite GPs in south-east Melbourne to complete the study survey. Seventy-seven GPs completed the questionnaire consisting of 10 questions in 3 sections. RESULTS: The results showed that GPs who consulted with young people more often had greater levels of confidence in identifying and treating their mental health issues but not referring. Forty-four percent identified the need for training in regards to youth mental health. GPs considered that the most effective care was provided in youth-friendly spaces but tended to primarily refer young people to private providers. CONCLUSION: GPs need access to ongoing professional development and education programs on youth mental health, in particular more severe issues such as psychosis. Specialist youth mental health services such as CYMHS/CAMHS and headspace can offer GPs support in managing mental health issues in young people. However, there is a need to strengthen the link between GPs and specialist youth mental health service. Stronger links between services will ensure young people have timely and increased access to treatment.