Co-creating safe spaces: Study protocol for translational research on innovative alternatives to the emergency department for people experiencing emotional distress and/or suicidal crisis.

INTRODUCTION: Safe spaces are an alternative to emergency departments, which are often unable to provide optimum care for people experiencing emotional distress and/or suicidal crisis. At present, there are several different safe space models being trialled in Australia. However, research examining the effectiveness of safe space models, especially in community settings, is rare. In this paper, we present a protocol for a study in which we will investigate the implementation, effectiveness, and sustainability of safe space models as genuine alternatives for people who might usually present to the emergency department or choose not to access help due to past negative experiences. MATERIAL AND METHODS: We will use a mixed methods, co-designed study design, conducted according to the principles of community-based participatory research to obtain deep insights into the benefits of different safe space models, potential challenges, and facilitators of effective practice. We developed the study plan and evaluation framework using the RE-AIM framework, and this will be used to assess key outcomes related to reach, effectiveness, adoption, implementation, and maintenance. Data collection will comprise quantitative measures on access, use, satisfaction, (cost) effectiveness, distress, and suicidal ideation; and qualitative assessments of service implementation, experience, feasibility, acceptability, community awareness, and the fidelity of the models to service co-design. Data will be collected and analysed concurrently throughout the trial period of the initiatives. DISCUSSION: This study will enable an extensive investigation of safe spaces that will inform local delivery and provide a broader understanding of the key features of safe spaces as acceptable and effective alternatives to hospital-based care for people experiencing emotional distress and/or suicidal crisis. This study will also contribute to a growing body of research on the role and benefits of peer support and provide critical new knowledge on the successes and challenges of service co-design to inform future practice.

Time limits? Reflecting and responding to time barriers for healthy, active living in Australia.

Lack of time is the main reason people say they do not exercise or use public transport, so addressing time barriers is essential to achieving health promotion goals. Our aim was to investigate how time barriers are viewed by the people who develop programs to increase physical activity or use active transport. We studied five interventions and explored the interplay between views and strategies. Some views emphasized personal choice and attitudes, and strategies to address time barriers were focused on changing personal priorities or perceptions. Other views emphasized social-structural sources of time pressures, and provided pragmatic ideas to free up time. The most nuanced strategies to address time barriers were employed by programs that researched and solicited the views of potential participants. Two initiatives re-shaped their campaigns to incorporate ways to save time, and framed exercise or active transport as a means to achieve other, pressing, priorities. Time shortages also posed problems for one intervention that relied on the unpaid time of volunteers. Time-sensitive health and active transport interventions are needed, and the methods and approaches we describe could serve as useful, preliminary models.