Australia's innovation in youth mental health care: The headspace centre model.

AIM: headspace is Australia's innovation in youth mental healthcare and comprises the largest national network of enhanced primary care, youth mental health centres world-wide. headspace centres aim to intervene early in the development of mental ill-health for young people aged 12 to 25 years by breaking down the barriers to service access experienced by adolescents and emerging adults and providing holistic healthcare. Centres have been progressively implemented over the past 12 years and are expected to apply a consistent model of integrated youth healthcare. Internationally, several countries are implementing related approaches, but the specific elements of such models have not been well described in the literature. METHOD: This paper addresses this gap by providing a detailed overview of the 16 core components of the headspace centre model. RESULTS: The needs of young people and their families are the main drivers of the headspace model, which has 10 service components (youth participation, family and friends participation, community awareness, enhanced access, early intervention, appropriate care, evidence-informed practice, four core streams, service integration, supported transitions) and six enabling components (national network, Lead Agency governance, Consortia, multidisciplinary workforce, blended funding, monitoring and evaluation). CONCLUSION: Through implementation of these core components headspace aims to provide easy access to one-stop, youth-friendly mental health, physical and sexual health, alcohol and other drug, and vocational services for young people across Australia.

Evaluation of the acceptability of standardised clinical handover tools at four Victorian health services.

OBJECTIVE: To evaluate the appropriateness and acceptability of five standardised tools for shift-to-shift clinical handover (CH). SETTING AND PARTICIPANTS: In July 2007, a pilot project was conducted in four Victorian public health services. Five standardised tools developed by the Victorian Quality Council were trialled at night medical handover: an organisational readiness checklist, a suggested organisational policy, a recommended organisational protocol, a CH template containing a minimum dataset to be collected, and a set of key performance indicators. Baseline and post-trial data and observational data were collected, and participating medical staff completed questionnaires before and after project implementation to gauge their opinions on the usefulness of the tools. RESULTS: The tools considered most useful were the organisational readiness checklist, the suggested organisational policy, the protocol for CH, and the CH template. Using the number of medical emergency team calls and incident reports as key performance indicators was not considered appropriate. CONCLUSIONS: The project highlighted that organisational support and commitment and stakeholder engagement and involvement are essential for implementing and sustaining changes in CH.

Significant reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture-change program and subsequent successful statewide roll-out.

OBJECTIVE: To assess the efficacy of a multimodal, centrally coordinated, multisite hand hygiene culture-change program (HHCCP) for reducing rates of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia and disease in Victorian hospitals. DESIGN, PARTICIPANTS AND SETTING: A pilot HHCCP was conducted over a 24-month period (October 2004 to September 2006) in six Victorian health care institutions (4 urban, 2 rural; total beds, 2379). Subsequently, we assessed the efficacy of an identical program implemented throughout Victorian public hospitals over a 12-month period (beginning between March 2006 and July 2006). MAIN OUTCOME MEASURES: Rates of hand hygiene (HH) compliance; rates of MRSA disease (patients with bacteraemia and number of clinical isolates per 100 patient discharges [PD]). RESULTS: Mean HH compliance improved significantly at all pilot program sites, from 21% (95% CI, 20%-22%) at baseline to 48% (95% CI, 47%-49%) at 12 months and 47% (95% CI, 46%-48%; range, 31%-75%) at 24 months. Mean baseline rates for the number of patients with MRSA bacteraemia and the number of clinical MRSA isolates were 0.05/100 PD per month (range, 0.00-0.13) and 1.39/100 PD per month (range, 0.16-2.39), respectively. These were significantly reduced after 24 months to 0.02/100 PD per month for bacteraemia (P = 0.035 for trend; 65 fewer patients with bacteraemia) and 0.73/100 PD per month for MRSA isolates (P = 0.003; 716 fewer isolates). Similar findings were noted 12 months after the statewide roll-out, with an increase in mean HH compliance (from 20% to 53%; P < 0.001) and reductions in the rates of MRSA isolates (P = 0.043) and bacteraemias (P = 0.09). CONCLUSIONS: Pilot and subsequent statewide implementation of a multimodal HHCCP was effective in significantly improving HH compliance and reducing rates of MRSA infection.