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Aims: Services for individuals with a first episode of psychosis or at ultra-high risk of psychosis have become a treatment model of choice in mental health care. The longitudinal changes in clinical and functional outcomes as a result of real-world treatment remain under-reported. Methods: We analysed data from first episode of psychosis and ultra-high risk services delivered across Australian primary youth mental health care services known as headspace between 19 June 2017 and 30 September 2019. Outcome measures were completed and entered into a minimum dataset every 90 days a participant was receiving treatment and included psychiatric symptomatology (Brief Psychiatric Rating Scale and psychological distress, K10) and psychosocial functioning (Social and Occupational Functioning Assessment Scale and My Life Tracker). Linear mixed-effects models were used to evaluate changes in outcome over time. Results: Outcome data from a total of 1252 young people were evaluated (643 first episode of psychosis, 609 ultra-high risk). Of those who entered ultra-high risk services, 11.8% transitioned to first episode of psychosis services. Overall, substantial improvement in clinical (Brief Psychiatric Rating Scale, K10) and functional (Social and Occupational Functioning Assessment Scale, My Life Tracker) outcomes were seen across groups and outcomes. Ultra-high risk patients showed a greater reduction in distress symptoms, while first episode of psychosis patients experienced a greater reduction in positive psychosis symptoms. Although clinical outcomes showed a plateau effect after approximately 3 months of care, improvement in functional outcomes (Social and Occupational Functioning Assessment Scale, My Life Tracker) continued later in treatment. Conclusion: These findings support the use of real-time, real-world and low-cost administrative data to rigorously evaluate symptomatic and functional outcomes in early psychosis treatment settings. Findings that functional outcomes improve past the remittance of clinical outcomes also support the functional recovery focus of early psychosis services and remaining high levels of distress suggest the need for ultra-high risk services to extend beyond 6 months of care.

Aims The utility of quality of life (QoL) as an outcome measure in youth-specific primary mental health care settings has yet to be determined. We aimed to determine: (i) whether heterogeneity on individual items of a QoL measure could be used to identify distinct groups of help-seeking young people; and (ii) the validity of these groups based on having clinically meaningful differences in demographic and clinical characteristics. Methods Young people, at their first presentation to one of five primary mental health services, completed a range of questionnaires, including the Assessment of Quality of Life–6 dimensions adolescent version (AQoL-6D). Latent class analysis (LCA) and multivariate multinomial logistic regression were used to define classes based on AQoL-6D and determine demographic and clinical characteristics associated with class membership. Results 1107 young people (12–25 years) participated. Four groups were identified: (i) no-to-mild impairment in QoL; (ii) moderate impairment across dimensions but especially mental health and coping; (iii) moderate impairment across dimensions but especially on the pain dimension; and (iv) poor QoL across all dimensions along with a greater likelihood of complex and severe clinical presentations. Differences between groups were observed with respect to demographic and clinical features. Conclusions Adding multi-attribute utility instruments such as the AQoL-6D to routine data collection in mental health services might generate insights into the care needs of young people beyond reducing psychological distress and promoting symptom recovery. In young people with impairments across all QoL dimensions, the need for a holistic and personalised approach to treatment and recovery is heightened.

Young people (ages 12-25) experience the highest risk of developing mental disorders; however, their uptake of and engagement with treatment is low. The study explored sociodemographic predictors of attendance and discontinuation of mental health services in a large, population-based sample.Data were from the minimum data set collected from young people (ages 12-25) who attended headspace, Australia's National Youth Mental Health Foundation, from 2013 to 2017 (N=80,502). Data on key demographic and clinical variables and practitioner ratings of need for ongoing care were analyzed. Cox regression was used to examine the association between sociodemographic factors and rates of discontinuation based on practitioner-rated need for ongoing treatment.The mean±SD number of sessions attended during the first episode of care was 4.6±4.4 sessions (median=3). Session-by-session discontinuation rates ranged from 14% to 19% across 10 sessions. The proportion discontinuing treatment before session 11 was 71.2%. Analysis of a subgroup (N=40,039) showed that 24% of those who discontinued treatment later returned to the same headspace center for a second episode of care. Those who were most at risk of discontinuation were older (ages 18-25), male, heterosexual, Aboriginal or Torres Strait Islander, and living in a rural location.Sociodemographic factors were found to be associated with treatment discontinuation, and some young people followed a pathway in and out of mental health treatment. Further exploration is needed to determine the appropriate length and type of care for specific sociodemographic groups and how best to tailor treatment accordingly.

Background . Suicidal ideation is common in young people. Assessment and monitoring can help to understand its dynamic nature and inform treatment planning. Aims . The aims were to evaluate psychometric properties of a brief screening tool - the Youth Suicide Ideation Screen-3 item (YSIS-3) and determine its correlation with the Suicidal Ideation Question-Junior (SIQ-JR) and measures of depressive and anxiety symptoms a. Method . Cronbach's alpha (α) was used to evaluate internal consistency of the YSIS-3 in 1107 young people. Convergent validity was evaluated using network analysis based on individual item polychoric correlations. Structural equation modelling was used to understand latent constructs; pearson product moment correlations to validate the integrity of the underlying construct. and two-way mixed Intraclass Correlation Coefficient to examine longitudinal stability and Cohen's d to assess sensitivity to change. Results . The YSIS-3 was found to have internal consistency, convergent validity and criteria validity almost identical to the 15-item SIQ-JR. There was a high correlation (0.91) between the latent factor underpinning YSIS-3 and SIQ-JR. The YSIS-3 was more sensitive to change among those presenting with suicidal ideation at baseline. Conclusions . The YSIS-3 is a valid measure for the assessment and monitoring of suicidal ideation, and is sensitive to change. This brief measure can contribute to regular monitoring of the presence and nature of suicidal ideation, which when included in comprehensive assessment, will inform the clinical management of those at risk of suicide.

Young men experiencing mental ill health report the lowest rates of professional help-seeking of any demographic group across the lifespan. This phase of life (i.e. adolescence and emerging adulthood) also corresponds to a period of disconnection from healthcare services for young men.The present exploratory qualitative study aimed to identify barriers and facilitators to mental health care, as identified by a sample of young help-seeking men and staff involved in mental health service provision.Interviews and focus groups were undertaken with 25 young males (mean = 18.80 years, SD = 3.56) and four service providers. Participants were recruited from headspace enhanced primary care early intervention centres in Australia.Thematic analysis indicated four overarching barriers and facilitators. The identified barriers were male role expectations, talk therapy as unknown territory, difficulties navigating the system and intake processes. The identified facilitators were positive initial contact, effective cross-sector partnerships, availability of male practitioners and use of targeted messaging.Given the ongoing low rates of help-seeking, high rates of suicide and other adverse outcomes for young men, priority research and clinical attention is needed for this group. Recommendations are offered for future research, including suggestions for implementation of targeted strategies addressing gender-based health needs.

OBJECTIVES: To describe the services provided to young people aged 12-25 years who attend headspace centres across Australia, and how these services are being delivered. DESIGN: A census of headspace clients commencing an episode of care between 1 April 2013 and 31 March 2014. PARTICIPANTS: All young people first attending one of the 55 fully established headspace centres during the data collection period (33 038 young people). MAIN OUTCOME MEASURES: Main reason for presentation, wait time, service type, service provider type, funding stream. RESULTS: Most young people presented for mental health problems and situational problems (such as bullying or relationship problems); most of those who presented for other problems also received mental health care services as needed. Wait time for the first appointment was 2 weeks or less for 80.1% of clients; only 5.3% waited for more than 4 weeks. The main services provided were a mixture of intake and assessment and mental health care, provided mainly by psychologists, intake workers and allied mental health workers. These were generally funded by the headspace grant and the Medicare Benefits Schedule. CONCLUSIONS: headspace centres are providing direct and indirect access to mental health care for young people. Language: en

Background Online youth mental health services are an expanding approach to meeting service need and can be used as the first step in a stepped-care approach. However, limited evidence exists regarding satisfaction with online services, and there is no standardized service satisfaction measure. Objective This study implemented an online youth mental health service satisfaction questionnaire within eheadspace, an online youth mental health service. The aims were to test the questionnaire’s psychometric properties and identify current levels of satisfaction among service users, as well as to identify client and service contact characteristics that affect satisfaction. Methods Data were collected from 2280 eheadspace clients via an online questionnaire advertised and accessed through the eheadspace service platform between September 2016 and February 2018. Client and service contact characteristics, potential outcomes, and session and service feedback data were collected. Results The service satisfaction questionnaire demonstrated high internal consistency for the overall satisfaction scale (alpha=.95) and its three subscales: session satisfaction, potential outcomes, and service satisfaction. A three-factor model was the best fit to the data, although including a higher order unidimensional construct of overall satisfaction was also a reasonable fit. Overall, young people were very satisfied with eheadspace (mean 3.60, SD 0.83). Service characteristics, but not client characteristics, were significantly associated with satisfaction. Young people were more satisfied with eheadspace when they had greater engagement as evident through receiving esupport rather than briefer service provision, having a longer session and greater interaction with the clinician, and not previously attending a face-to-face headspace center. Conclusions The online youth mental health service satisfaction questionnaire developed for and implemented in eheadspace showed good psychometric properties. The measure is brief, has good internal consistency, and has a clear factor structure. The measure could be adapted for use in other online youth mental health services. The young people using eheadspace and completing the feedback survey were highly satisfied. Greater engagement with the online service was shown to be associated with greater satisfaction. No specific client demographic groups were shown to be more or less satisfied.

Background The adolescent and early adult years are periods of peak prevalence and incidence for most mental disorders. Despite the rapid expansion of Web-based mental health care, and increasing evidence of its effectiveness, there is little research investigating the characteristics of young people who access Web-based mental health care. headspace, Australia’s national youth mental health foundation, is ideally placed to explore differences between young people who seek Web-based mental health care and in-person mental health care as it offers both service modes for young people, and collects corresponding data from each service type. Objective The objective of this study was to provide a comprehensive profile of young people seeking Web-based mental health care through eheadspace (the headspace Web-based counseling platform), and to compare this with the profile of those accessing help in-person through a headspace center. Methods Demographic and clinical presentation data were collected from all eheadspace clients aged 12 to 25 years (the headspace target age range) who received their first counseling session between November 1, 2014 and April 30, 2015 via online chat or email (n=3414). These Web-based clients were compared with all headspace clients aged 12 to 25 who received their first center-based counseling service between October 1, 2014 and March 31, 2015 (n=20,015). Results More eheadspace than headspace center clients were female (78.1% compared with 59.1%), and they tended to be older. A higher percentage of eheadspace clients presented with high or very high levels of psychological distress (86.6% compared with 73.2%), but they were at an earlier stage of illness on other indicators of clinical presentation compared with center clients. Conclusions The findings of this study suggest that eheadspace is reaching a unique client group who may not otherwise seek help or who might wait longer before seeking help if in-person mental health support was their only option. Web-based support can lead young people to seek help at an earlier stage of illness and appears to be an important component in a stepped continuum of mental health care.

The primary aim of this pilot study was to determine the psychometric properties of the 18-item headspace Family and Friends Satisfaction Scale (hFAFSS).During August 2015, staff from 22 headspace centres approached family members and friends of young people attending headspace to complete the hFAFSS. Principal components analysis with oblique Promin rotation and polychoric correlations were used to assess the factor structure of the hFAFSS.There were 277 usable responses. Satisfaction was high, resulting in little variance. Parallel analyses suggested that the scale items tapped a single factor (68% of variance).This study is one of the first attempts to measure the satisfaction of family and friends with primary care-based youth mental health services. Satisfaction of family members and friends was shown to be high, but limited variance restricts the usability of the hFAFSS as an evaluation measure, and revision and further testing is needed.

Background This study provides the first comprehensive empirical evidence of developmental changes in the social influences on seeking mental health care, both in-person and online, during the critical lifestages for mental health of adolescence and young adulthood. Methods Main source of help-seeking influence was determined via self-report for all young people accessing youth-targeted mental health services in Australia for a first episode of care over a 12 month period during 2013. This comprised 30,839 young people who accessed in-person services and 7,155 clients of the online service. Results Results show a major developmental shift in help-seeking influence across the age range, which varied for males and females, and a striking difference between the online and in-person service modalities. The dominant influence online, regardless of age, was the young person themself. In contrast, for in-person services, the dominant influence during adolescence was family, but this changed markedly in late adolescence to favour self-influence, with a lessor, but still substantial effect of family. The influence of friends was surprisingly low. Conclusions To support young people with mental health problems to access mental health care, the personal connection of parents and family needs to be engaged to encourage in-person service use through better mental health literacy, particularly for adolescents. In the online environment, ways to ensure that young people themselves are guided to appropriate services are required.

Aims This study aimed to determine the psychometric properties of the headspace youth (mental health) service satisfaction scale (YSSS), a 14-item purpose-designed scale for use with adolescents and young adults attending headspace centres, and to examine the level of satisfaction with headspace centre services and the client characteristics that predict this. Methods There were 21 354 eligible headspace clients who had received more than one service over the 12-month data collection period during 2013–2014, and 12 436 (58%) completed a satisfaction scale. headspace clients could optionally self-complete the satisfaction scale at the beginning of visits 2, 5, 10 and 15. Clients' demographic and clinical characteristics were also recorded. Results Factor analysis identified a four-factor solution for the scale and internal consistency of the subscales was acceptable to excellent. Satisfaction with headspace was high and increased over time for those who completed the scale multiple times. Several demographic and clinical characteristics predicted the likelihood of completion and level of satisfaction, with younger age shown to be a persistent predictor of lower satisfaction. Conclusions Client satisfaction with headspace is high and increases with ongoing engagement. Development of the headspace YSSS contributes a new client satisfaction scale with tested psychometric properties for adolescents and young adults engaged in mental health services, providing an essential tool for youth mental health services to routinely evaluate the experiences of young people accessing their services.

OBJECTIVES: To examine changes in psychological distress and psychosocial functioning in young people presenting to headspace centres across Australia for mental health problems. DESIGN: Analysis of routine data collected from headspace clients who had commenced an episode of care between 1 April 2013 and 31 March 2014, and at 90-day follow-up. PARTICIPANTS: A total of 24 034 people aged 12-25 years who had first presented to one of the 55 fully established headspace centres for mental health problems during the data collection period. MAIN OUTCOME MEASURES: Main reason for presentation, types of therapeutic services provided, Kessler Psychological Distress Scale (K10) scores, and Social and Occupational Functioning Assessment Scale (SOFAS) scores. RESULTS: Most headspace mental health clients presented with symptoms of depression and anxiety and were likely to receive cognitive behaviour therapy (CBT). Younger males were more likely than other age- and sex-defined groups to present for anger and behavioural problems, while younger females were more likely to present for deliberate self-harm. From presentation to last assessment, over one-third of clients had significant improvements in psychological distress (K10) and a similar proportion in psychosocial functioning (SOFAS). Sixty per cent of clients showed significant improvement on one or both measures. CONCLUSIONS: Data regarding outcomes for young people using mental health care services similar to headspace centres are scarce, but the current results compare favourably with those reported overseas, and show positive outcomes for young people using headspace centres. Language: en

headspace centres comprise a significant innovation in community-based youth mental health service delivery in Australia. This paper examines the service activity of the first headspace centres to determine common and unique practice characteristics across headspace centres in this new approach to mental health service delivery.Data come from quarterly progress reports provided by the first 30 headspace centres during the 2010-2011 financial year. The information from 120 reports was analysed qualitatively using thematic analysis techniques to determine the types of activities reported by centres against key performance indicators.The main finding was the large number and wide range of centre activity. This heterogeneity may be explained in part by the diversity of communities across Australia and the importance that headspace places on addressing the specific needs of the local community as well as drawing upon the existing capacity that is available within a community. The most common activities were community engagement, building local partnerships and providing a youth friendly environment. There was a particularly strong focus by the majority of centres on establishing and supporting a Youth Reference Group to guide centre development and implementation.The progressive upscaling of headspace centres across Australia provides a unique opportunity to observe how a significant reorientation in health service delivery is implemented in practice to meet the needs of diverse communities. Further investigation of the headspace experience will provide critical lessons for other countries investing in new approaches to youth mental health.