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Background: This paper aimed to describe the legal worries of Australian general practitioners (GPs) and nurses regarding end-of-life care provided in the aged care setting. Methods: An analysis of responses to the final, open-ended question of a cross-sectional online survey of GPs and nurses practising in aged care settings in Queensland, New South Wales and Victoria was undertaken. Results: Of the 162 GPs and 61 nurses who gave valid responses to the survey, 92% (151 GPs and 55 nurses) responded to the open-ended question. Participants identified concerns across all relevant areas of end-of-life law. The most common concerns were substitute decision-makers or family member(s) wanting to overrule an Advance Care Directive, requests for futile or non-beneficial treatment and conflict about end-of-life decision-making. Participants often also identified concerns about their lack of legal knowledge and their fear of law or risk related to both end-of-life care generally and providing medication that may hasten death. Conclusions: Australian GPs and nurses working in aged care have broad-ranging legal concerns about providing end-of-life care. Legal concerns and knowledge gaps identified here highlight priority areas for future training of the aged care workforce. The law supports good end-of-life clinical practice by facilitating health care that aligns with the values and goals of patients, including those residing in residential aged care facilities. GPs and nurses here reported broad-ranging legal concerns relevant to providing end-of-life care within aged care, including substitute decision makers/family members wanting to overrule Advance Care Directives, requests for futile or non-beneficial treatment and conflict about decision-making. Participants' concerns can inform end-of-life legal training for aged care GPs and nurses. [ABSTRACT FROM AUTHOR]

A strong First Nations health workforce is necessary to meet community needs, health rights, and health equity. This paper reports the findings from a national survey of Australia's First Nations people employed in health services to identify enablers and barriers to career development, including variations by geographic location and organisation type. A cross-sectional online survey was undertaken across professions, roles, and jurisdictions. The survey was developed collaboratively by Aboriginal and non-Aboriginal academics and Aboriginal leaders. To recruit participants, the survey was promoted by key professional organisations, First Nations peak bodies and affiliates, and national forums. In addition to descriptive statistics, logistic regression was used to identify predictors of satisfaction with career development and whether this varied by geographic location or organisation type. Of the 332 participants currently employed in health services, 50% worked in regional and remote areas and 15% in Aboriginal Community-Controlled Health Organisations (ACCHOs) with the remainder in government and private health services. All enablers identified were associated with satisfaction with career development and did not vary by location or organisation type. "Racism from colleagues" and "lack of cultural awareness," "not feeling supported by their manager," "not having role models or mentors," and "inflexible human resource policies" predicted lower satisfaction with career development only for those employed in government/other services. First Nations people leading career development were strongly supported. The implications for all workplaces are that offering even a few career development opportunities, together with supporting leadership by Aboriginal and Torres Strait Islander staff, can make a major difference to satisfaction and retention. Concurrently, attention should be given to building managerial cultural capabilities and skills in supporting First Nations' staff career development, building cultural safety, providing formal mentors and addressing discriminatory and inflexible human resources policies. [ABSTRACT FROM AUTHOR]

Intergenerational programs that bring the young and old together are known to facilitate social connections. However, benefits of intergenerational programs cannot be achieved by simply bringing the two generations together. We need to understand the factors which enhance intergenerational engagement. This paper specifically explores barriers and enablers for improving engagement of older people in an intergenerational program conducted within four research sites in South East Queensland and New South Wales, Australia. Video ethnography was used to examine the intergenerational environment and observe patterns of engagement between older people and children. Findings reveal the type of activity, group structure and length of activity to increase engagement of older people in an intergenerational program. [ABSTRACT FROM AUTHOR]

Objective: To describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities. Methods: A retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services. Results: The use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services. Conclusions: Less than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access. What is known about the topic? People living in residential aged care facilities report very high rates of mental health conditions, including depression and anxiety. What does this paper add? We demonstrate very low use (<3%) of Government-funded mental health services among people living in residential aged care facilities in Australia, with only small increases in use over time. What are the implications for practitioners? Practitioners should routinely assess the mental health needs of people living in residential aged care and refer for in-reach mental health services where needed, noting that facility staff are usually not trained for this role. [ABSTRACT FROM AUTHOR]

Lesbian, gay, bisexual, transgender, and intersex (LGBTI) police liaison programs were established around Australia from the late 1980s onwards to ameliorate discriminatory relationships between LGBTIQ people and police. With specialized training to better understand LGBTIQ issues, police liaison officers can provide support to LGBTIQ people as victims, offenders, or witnesses. Interestingly, very few LGBTIQ people seek support from these officers, even though many know they exist. This paper reports the results of a survey of a sample of LGBTIQ community members across two Australian states (Queensland and New South Wales) that explored why LGBTIQ people seek support from LGBTI police liaison officers. An online questionnaire asked LGBTIQ people about their perceptions of, and experiences with, police generally, and LGBTI police liaison officers specifically. Similar to past research, our analysis primarily found high levels of awareness of liaison officers, but very few participants accessed them. Further, and concerningly, the participants were generally reluctant to seek them out for support. Key implications of our findings for policy and practice development in police and LGBTIQ community services are discussed. [ABSTRACT FROM AUTHOR]

Background: The current study aimed to further our understanding of second opinions among medical oncology patients by examining the proportion of patients who sought a second opinion about their cancer treatment, and why. Methods: The study was conducted between 2013 and 2015 in three medical oncology clinics located in public hospitals in Australia: in metropolitan New South Wales, metropolitan Queensland, and in Tasmania. Those patients who provide written informed consent were asked to complete a brief paper and pencil survey in the clinic containing questions on sociodemographic, disease and treatment characteristics. Approximately 1 month later, participants were mailed a second paper and pencil survey which contained questions about whether they had sought a second opinion and their motivation for doing so. Non-responders were followed up by letter at 3 and 6 weeks. Results: Of 823 patients screened for eligibility, 698 eligible patients, 612 provided consent. Of those who consented, 355 completed both the initial survey and the second survey and were included in the analyses. Of the 57 patients who sought a second opinion, the most frequent reasons given for doing so were the need for reassurance (49.1%) and the need to consider the range of treatment options (41.8%). Of the 297 (83.6%) participants who did not seek a second opinion, the main reason was confidence in the first doctor (88.7%). Only 3.1% patients did not know that they could ask for a second opinion. Occasionally the doctor will initiate the referral for a second opinion. Conclusions: Our study suggests that a minority of cancer patients seek a second opinion at some phase during their care. Most did so for reassurance or to ensure that they had covered all of the treatment options and not because of discomfort or distrust of their treating doctor. Few patients reported a lack of awareness of second opinions. This suggests that second opinions form part of a patient-centred approach to information provision about care options. Whether the second opinion improves the quality of care or indeed outcomes has been difficult to demonstrate. [ABSTRACT FROM AUTHOR]

Mobility as a Service (MaaS) is seen as a transition from mobility being satisfied by a dominant car ownership model to a service model where mobility needs are met by a multimodal suite of services. The research environment of MaaS is heavily driven by the younger generation's travel behaviour which appears to be less dominated by car ownership (following the peak car literature) and by their interest in all things technological, particularly their smart phones. However, this paper is looking at a different but very specific segment of the population in Australia that have their accessibility provided by Community Transport (CT), focusing specifically on New South Wales (NSW) and Queensland (QLD). Arguably, this population segment is the complete antithesis of the younger generation in terms of chasing technological change but in other ways, for example, a lack of access to private cars, shows some similarities. This paper is motivated by likely changes in funding for CT providers. Currently CT providers receive a supply side subsidy but there are plans to introduce funding to be placed directly with clients, in the form of person centred funding (PCF). Clients will then have a single budget to purchase mobility along with other services they require. The paper investigates the mobility services which comprise bundles that CT clients would be willing to pay in the new era of PCF. Five participating CT providers from a cross section of operating areas recruited clients to take part in a stated choice experiment, processed by a computer assisted personal interview (CAPI). Advanced choice models are used to develop models using the behavioural data collected by the CAPI and estimates of a CT client's willingness to pay (WTP) for the MaaS bundle are presented. WTP provides a ceiling for pricing the elements within a MaaS bundle which is an important part of the CT providers' future strategy. The WTP estimates were much smaller than the CT providers' unit costs of providing the service. This poses a challenge for CT providers in the creation of mobiltiy bundles which cover costs, suggesting that the possible transition to PCF using MaaS bundles will not be an easy process and will require significant education as to the cost of provision. The paper concludes with some suggestions as to how CT providers could make the transition to PCF building on the evidence of this research. [ABSTRACT FROM AUTHOR]

Abstract Young people with complex support needs who live outside metropolitan areas face unique challenges. Issues such as poor educational and employment opportunities, homelessness, racism, problematic substance use, challenging behaviour, disability and mental illness can be magnified and lead to judgment and marginalisation in small communities such as those in rural and regional areas. As a result of poor resourcing of services in these areas, young people may be forced to transition from place to place, service to service as a way of coping with life challenges. This paper presents findings from interviews and focus groups with service providers who support such young people in regional and rural Queensland, New South Wales and Victoria in Australia. Service providers reported similar challenges to professionals working in urban areas, such as navigating inter-agency and inter-professional work and dealing with funding shortages. However, these issues were amplified by the need to work across broad geographical areas, to recruit and retain skilled workers and to respond to the many structural and resource inadequacies in smaller communities. While services aimed to be responsive to young people, the challenges of providing support in a non-metropolitan context could create a context in which young people either disengaged from services or poor response resulted in systemic escalation to crisis. The implications for policy and practice are explored. Highlights • Supports to young people with complex support needs in non-metropolitan areas in Australia are poorly resourced. • Non-metropolitan services work best when they are based on relationship-based practice and local community needs. • Interagency collaboration is essential when working across broad geographical areas. [ABSTRACT FROM AUTHOR]

Background: Law purports to regulate end-of-life care but its role in decision-making by doctors is not clear. This paper, which is part of a three-year study into the role of law in medical practice at the end of life, investigates whether law affects doctors' decision-making. In particular, it considers whether the fact that the law differs across Australia's three largest states - New South Wales (NSW), Victoria and Queensland - leads to doctors making different decisions about withholding and withdrawing life-sustaining treatment from adults who lack capacity. Methods: A cross-sectional postal survey of the seven specialties most likely to be involved in end-of-life care in the acute setting was conducted between 18 July 2012 and 31 January 2013. The sample comprised all medical specialists in emergency medicine, geriatric medicine, intensive care, medical oncology, palliative medicine, renal medicine and respiratory medicine on the AMPCo Direct database in those three Australian states. The survey measured medical specialists' level of legal compliance, and reasons for their decisions, concerning the withholding or withdrawal of lifesustaining treatment. Multivariable logistic regression was used to examine predictors of legal compliance. Linear regression was used to examine associations between the decision about life-sustaining treatment and the relevance of factors involved in making these decisions, as well as state differences in these associations. Results: Response rate was 32% (867/2702). A majority of respondents in each state said that they would provide treatment in a hypothetical scenario, despite an advance directive refusing it: 72% in NSW and Queensland; 63% in Victoria. After applying differences in state law, 72% of Queensland doctors answered in accordance with local law, compared with 37% in Victoria and 28% in NSW (p < 0.001). Doctors reported broadly the same decision-making approach despite differences in local law. Conclusions: Law appears to play a limited role in medical decision-making at the end of life with doctors prioritising patient-related clinical and ethical considerations. Different legal frameworks in the three states examined did not lead to different decisions about providing treatment. More education is needed about law and its role in this area, particularly where law is inconsistent with traditional practice. [ABSTRACT FROM AUTHOR]

Within the planning literature, the distinction between regulatory planning and strategic spatial planning has exposed a recurring dichotomy that exists between the idea of ‘conforming’ (regulative certainty) and ‘performing’ (strategic flexibility) plans and planning systems. This paper critically examines the divergent trajectories of land-use policy and regulation in two Australian states, Queensland and New South Wales. This paper concludes by arguing that the flexibility/certainty dilemma is something of an artifice—a land-use planning shibboleth—that serves to distract professional and scholarly attention away from substantive issues such as how planning might better engender more sustainable urban settlements. [ABSTRACT FROM AUTHOR]

This paper offers an ethnographic exploration of the assertion of a 'Barkindji style' art: why this matters and to whom it matters. Focusing particularly on the Darling River area of Wilcannia and on the period from the 1980s to the present, the increasing interest in art-making by local Aboriginal people is considered. Through a dialogue with artists, artworks, and others, the work examines the changing form, design and content of art and the rote of art in defining ideas of Barkindji Aboriginal culture and tradition. Invocations by key cultural brokers to produce work that is seen to 'belong to us' is explored in terms of the cultural, political, and personal work that this involves; particularly as this intersects with ideas of artistic freedoms versus artistic direction by cultural brokers. The paper discusses the personal considerations and tensions that come to bear in the processes connected with production of art and its making. In so doing, this paper engages with, and extends, the work of Tacon et al. (2003), Cooper (1994), Kleinert (1994) and Morphy (2001) as this pertains to art 'styles' and material culture from what is widely referred to as south-eastern Australia. [ABSTRACT FROM AUTHOR]

This paper examines the differences in school (NAPLAN) outcomes between New South Wales and Queensland. It shows that there are pronounced differences in Year 3 NAPLAN results between these states, though these dissipate when later class years are considered. The reasons for these state effects in school outcomes are explored using an empirical framework grounded in the regression discontinuity literature. There is no systematic evidence of school-specific unobservables that are linearly related to the distance of schools from the New South Wales–Queensland border that account for this state effect. In other words, the lower outcomes of schools in Queensland relative to schools in New South Wales appear to be a pure institutional phenomenon. This conclusion carries over to the various sensitivity tests undertaken based on the partition of the sample by school sector and by distance from the border. Accordingly, the border effects are expected to be eroded by the recent reforms to the school starting age in Queensland and by the national curriculum currently proposed for implementation in Australia. [ABSTRACT FROM PUBLISHER]

Education is state-run in Australia, and within each of the eight states and territories there are both government and independent schooling systems. This paper details the position of gay, lesbian, bisexual, transgender, intersex and queer (GLBTIQ) students within Australian education policy documents nationally, focusing on the three largest states and educational sectors in Australia. Survey data are used to report on the schooling experiences of over 3000 Australian GLBTIQ young people aged 14–21 years. Data from interviews with key policy informants identify both the obstacles to implementing policies, and how such obstacles have been overcome. Much official policy sees sexuality education as promoting inclusive, protective and affirming messages around GLBTIQ students. There exist significant correlations between policy and a variety of well-being and psycho-social outcomes for GLBTIQ students, including lowered incidence of homophobic abuse and suicide, and the creation of supportive school environments. Ideal policy visions are outlined, along with practical recommendations of relevance to a variety of stakeholders. [ABSTRACT FROM PUBLISHER]