Description and qualitative evaluation of Jigsaw, an integrated young persons' mental health program

A mixed methods evaluation of an integrated adult mental health service model

Background

The Floresco integrated service model was designed to address the fragmentation of community mental health treatment and support services. Floresco was established in Queensland, Australia, by a consortium of non-government organisations that sought to partner with general practitioners (GPs), private mental health providers and public mental health services to operate a ‘one-stop’ mental health service hub.

Methods

We conducted an independent mixed-methods evaluation of client outcomes following engagement with Floresco (outcome evaluation) and factors influencing service integration (process evaluation). The main data sources were: (1) routinely-collected Recovery Assessment Scale — Domains and Stages (RAS–DS) scores at intake and review (n = 108); (2) RAS–DS scores, mental health inpatient admissions and emergency department (ED) presentations among clients prospectively assessed at intake and six-month follow-up (n = 37); (3) semi-structured interviews with staff from Floresco, consortium partners, private practitioners and the local public mental health service (n = 20); and (4) program documentation.

Results

Interviews identified staff commitment, co-location of services, flexibility in problem-solving, and anecdotal evidence of positive client outcomes as important enablers of service integration. Barriers to integration included different organisational practices, difficulties in information-sharing and in attracting and retaining GPs and private practitioners, and systemic constraints on integration with public mental health services. Of 1129 client records, 108 (9.6%) included two RAS–DS measurements, averaging 5 months apart. RAS–DS ‘total recovery’ scores improved significantly (M = 63.3%, SD = 15.6 vs. M = 69.2%, SD = 16.1; p < 0.001), as did scores on three of the four RAS–DS domains (‘Looking forward’, p < 0.001; ‘Mastering my illness’, p < 0.001; and ‘Connecting and belonging’, p = 0.001). Corresponding improvements, except in ‘Connecting and belonging’, were seen in the 37 follow-up study participants. Decreases in inpatient admissions (20.9% vs. 7.0%), median length of inpatient stay (8 vs. 3 days), ED presentations (34.8% vs. 6.3%) and median duration of ED visits (187 vs. 147 min) were not statistically significant.

Conclusions

Despite the lack of a control group and small follow-up sample size, Floresco’s integrated service model showed potential to improve client outcomes and reduce burden on the public mental health system. Horizontal integration of non-government and private services was achieved, and meaningful progress made towards integration with public mental health services.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4501-7) contains supplementary material, which is available to authorized users.

Key attributes of integrated community-based youth service hubs for mental health: a scoping review

BACKGROUND

Community-based, integrated youth service hubs have the potential to address some of the longstanding issues with mental health services for youth, including problems with access and system fragmentation. Better understanding of these approaches, particularly efforts to create a single point of entry to comprehensive, evidence-based services through youth service hubs, is needed to help guide future implementation and evaluation. This scoping review identifies the key principles and characteristics of these models of care, as well as the state of the literature, particularly with regard to implementation and replicability.

METHOD

Electronic databases and grey literature sources were searched for material from 2001 to 2019, with diverse search terms capturing the concept of "integrated" or "one-stop shop" youth mental health services. Title/abstract and full text review were conducted, as well as additional focused searching. After screening 4891 texts at the title/abstract level and 496 at the full-text level, 110 documents were included for data extraction.

RESULTS

Several integrated care hub models for youth mental health services and related frameworks were identified internationally, largely in high-income countries. Common principles included an emphasis on rapid access to care and early intervention, youth and family engagement, youth-friendly settings and services, evidence-informed approaches, and partnerships and collaboration. Program characteristics also revealed similarities (e.g., providing evidence-informed or evidence-based services in youth-friendly spaces), with some differences (e.g., care coordination methods, types of service providers), potentially attributable to lack of available information about key ingredients. Outcome research was limited, with few rigorous evaluations of youth outcomes. Moreover, sufficient information for replication, community evaluation of feasibility or actual implementation was rarely provided.

CONCLUSION

Internationally, integrated youth service hubs were found to share common key principles, while providing comprehensive services to youth with mental health difficulties. There is a great need for common language and measurement framework to facilitate replication, rigorous evaluation of outcomes, knowledge exchange, and dissemination of findings.

Broadening the early intervention paradigm: a one stop shop for youth

AIM

Despite recognition of the early onset and disease burden of mental and substance use disorders in young people, poor access to services persists. A new youth outreach clinic, with principles consistent with the early intervention paradigm and intake criteria not linked to presumptive diagnostic status, was set up within an existing youth hub. The service development and early service delivery are described.

METHODS

The particulars of the clinic, including location, service recipients and service delivery structure, were conceptualized and implemented. A service model based on secondary and primary consultations and up to six sessions of treatment was adopted to maximize the number of referrers and clients the clinic could service.

RESULTS

Twenty referrals were received by the clinic in the first 2 months. The clients' ages ranged from 14 to 21 with just less than half under 18 years of age. Clients had complex mixes of symptomatology that fulfilled multiple diagnoses.

CONCLUSIONS

The described model of service delivery can help improve accessibility, fulfil gaps in current youth mental health delivery, and build the capacity of non-tertiary level services. This is consistent with the early intervention paradigm.

Are we reaching them yet? Service access patterns among attendees at the headspace youth mental health initiative

BACKGROUND

Australian young people have a high prevalence of mental health problems but low rates of service use. This article examines whether the Australian National Youth Mental Health Foundation, headspace, has helped redress this through providing youth-specific services.

METHOD

The article compares headspace service use demographics with population data from the Australian Survey of Mental Health and Wellbeing from 2007.

RESULTS

Headspace has improved access relative to the population, particularly among males and socially and economically excluded young people.

CONCLUSIONS

Despite overall successes, certain ethnic and age groups appear under-represented and in need of more careful targeting by youth mental health services.

Forming and sustaining partnerships to provide integrated services for young people: an overview based on the headspace Geelong experience

AIM

To discuss critical considerations in the formation and maintenance of agency partnerships designed to provide integrated care for young people.

METHODS

Two years after its establishment, an evaluation of the headspace Barwon collaboration and a review of the health-care and management literature on agency collaboration were conducted. The principal findings together with the authors' experience working at establishing and maintaining the partnership are used to discuss critical issues in forming and maintaining inter-agency partnerships.

RESULTS

Structural and process considerations are necessary but not sufficient for the successful formation and maintenance of inter-agency partnerships and integrated care provision. Specifically, organizational culture change and staff engagement is a significant challenge and planning for this is essential and often neglected.

CONCLUSIONS

Although agreeing on common goals and objectives is an essential first step in forming partnerships designed to provide integrated care, goodwill is not enough, and the literature consistently shows that most collaborations fail to meet their objectives. Principles and lessons of organizational behaviour and management practices in the business sector can contribute a great deal to partnership planning.