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Introduction With rapid ageing of the population, falls have become a significant public health issue in China. Although falls prevention activities have been mandated in the National Essential Public Health Service Package since 2009, recommendations remain only as general advice and are not evidence-based. This thesis aims to generate an evidence base to support the integration of falls prevention programs for older people into the National Essential Public Health Service Package within the Chinese primary health care system. Methods This thesis contains five interrelated studies: an epidemiological study to understand the burden of falls among older people at the national and subnational level in mainland China from 1990 to 2019 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019; a scoping review to characterise existing evidence for fall-prevention interventions in community-dwelling older people in mainland China from 1990 to 2022; a policy review to document national healthy ageing-related policies from a health system perspective in mainland China from 2016 to 2020; a qualitative study to identify the perceptions of facilitators and barriers to implementation of falls prevention programs in primary health care settings in China; and a participatory design study to develop an implementation framework to support the integration of evidence-based falls prevention programs for older people into the National Essential Public Health Service Package. Results In mainland China, the incidence rate of falls in older adults increased substantially over the last three decades. Very few high-quality studies were identified to provide evidence on the effectiveness of existing interventions in China. The national policies on healthy ageing, including falls prevention, were fragmented and inadequate. At the primary health care level, major barriers, including the lack of confidence in delivering interventions, fragmentation in service delivery and limited multi-sectoral collaboration, posed challenges to the implementation of falls prevention in the National Essential Public Health Service Package. An implementation framework consisting of data, workforce, organisation, service and policy themes was jointly developed to support the integration of falls prevention into the National Essential Public Health Service Package. Conclusions In mainland China, falls remain as an ongoing health burden for older people. The challenges to preventing falls for older people primarily arise from low-quality evidence for intervention effectiveness, fragmented policy support and multiple barriers to implementation at the primary health care level. Establishing data-driven surveillance, generating high-quality evidence for the effectiveness of interventions, and creating a supportive environment are three key strategies to address these challenges and have the potential to integrate falls prevention into the National Essential Public Health Service Package within the Chinese primary health care system.

“Microservices” is a new term in software architecture that was defined in 2014 [1]. It is a method to build a software application with a set of small services. Each service has its process to serve a single purpose and communicates with other services through lightweight mechanisms. Because of a great deal of independently distributed services, it is a challenge to integrate the loose services fully. Too many trivial relationships can be messed up easily during deployment. Also, it is hard to modify the relationships if the services are updated as the source codes need to be re-edited and tested. The microservices architecture is attracting much attention recently. More and more software-developers are producing continuous applications and microservices deliveries [2]. There is a need to develop a mechanism to better integrate the scattered services during the application delivery process. The thesis proposes three general design patterns to integrate services in microservices architecture. These patterns are classified by the inter-service communication mechanisms and described with specific problems, contexts, solutions, example implementations and consequences. Besides, the informative guidelines are provided to make these patterns apply in different applications quickly. The service integration design patterns help compose services and facilitate the process of building applications in microservices. All the patterns are helpful tools to address the service integration issues in microservices. Each approach is simple and flexible to apply generally. The structures can be easily modified through these approaches.

Social service, criminal justice and healthcare systems are poorly placed to respond effectively to people facing multiple co-occurring needs. This group falls simultaneously within and outside of the remit of a number of responding agencies, generating complexities at the intersection of agency jurisdictions. As such, responses to complex social needs can themselves heighten complexity. To date, conceptualisations of complex needs have drawn heavily on policy and scholarly discussions of distinct social issues that tend to co-occur with other areas of need, such as homelessness, mental illness or criminal offending. Complex needs has largely been conceptualised as a peripheral problem on the margins of other policy agendas, with a comparatively meagre literature investigating complex needs as a policy problem in itself. This thesis takes the phenomenon of complex needs itself as the topic of central inquiry and considers its co-creation through interactions between multiply disadvantaged individuals and frontline workers. Ten case studies are presented, compiled from a multidimensional linked administrative dataset, in order to explore and interrogate the complexities that arise as multiply disadvantaged individuals interact with a range of frontline agencies. The cases present a compilation of administrative records for the individuals, with data drawn from a number of agencies in a single Australian jurisdiction including police, hospitals, courts and prisons. A series of bounded vignettes drawn from these case studies are discussed, highlighting the patterns of action and interaction between individuals and institutions. Applying a complex realist theoretical and conceptual framework, analysis focuses on the emergent consequences of small-scale interactions between multiply disadvantaged individuals and frontline workers enacting agency policy. A relational conceptualisation of complex needs is developed, highlighting the ways in which needs and behaviours are identified as problems requiring a response, the moderating impact of small-scale factors at the moment of presentation, and the consequences of differential priorities placed on different types of need. This approach offers novel scholarly insights regarding the consequences of policy interventions.

Starting Early Starting Smart (SESS) is an innovative service integration approach for adding behavioral health services (i.e. mental health, substance abuse prevention/treatment, parenting/family services) for families to primary health care and early childhood settings. The goal of SESS is to improve child socio-emotional and cognitive functioning by addressing the mental health and substance use needs of families. At Southwest Counseling and Development Services (SWCDS), SESS has been integrated into three programs: New Steps, a substance abuse treatment program, Even Start, a family literacy program, and CHASS a primary health care clinic. The purpose of the current study is to assess how well the SESS program has been implemented at each of these sites and whether SESS services have resulted in increased use of health and behavioral resources by families. The key research questions were: (1) to what extent did SWCDS successfully implement the SESS program model; (2) how were behavioral health and other services integrated into the three host programs; (3) how has SWCDS structured and delivered services adhering to the SESS philosophy of family-centered, strengths-based, culturally competent services; (4) are care coordination services delivered with fidelity to the SESS model; (5) do clients report increased access to, use and satisfaction with behavioral health and other needed services. Data were collected from staff interviews, chart reviews, questionnaires and informal meetings with staff and field notes. Overall, SWCDS was successful at implementing the SESS program. Staff integrated assessment and treatment services, care coordination and behavioral health services into the three host programs. The degree of integration achieved varied by the host agency. SWCDS implemented intake and treatment procedures that were family-centered and strengths-based. Family members were included in treatment session and received referrals for other services. The chart review indicated that most clients had frequent contact with the SESS clinician and received facilitated referrals for other services. Clients reported that their child(ren)'s medical and mental health needs were being met; however several mothers did not feel that they had received the medical and behavioral health services they needed. Results indicate that community-based agencies can effectively implement the SESS service integration model and change their service delivery systems. When service integration is successfully implemented, families have increased access to behavioral health and other needed social services.