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A high prevalence of maltreatment, abuse, neglect and the onset of subsequent trauma has been well-documented among both young people with disability and young people residing in foster and kinship care. However, no uniform policies or guidelines currently exist for the delivery of trauma-informed models of care to build the capacity of foster and kinship carers in responding to and supporting the complex needs of children and young people in their care with disability who may have been exposed to trauma. While no evidence of the application of trauma-informed models of care for this cohort exists, some evidence of trauma-informed models of care to support people with disability beyond the scope of out-of-home care has recently emerged. The authors discuss this emerging work and recognise an opportunity to leverage this evidence to guide the practices of foster and kinship carers. Clearly, there is an opportunity to work towards improving the development and well-being of children and young people with disability in foster and kinship care through the development, implementation, and evaluation of a tailored trauma-informed model of care that is co-designed and grounded in the underlying theoretical principles of disability and trauma.

Objective: Serious mental illness (SMI) remains a leading cause of disability worldwide. However, there is limited Australian evidence of community-based programs to enhance the psychosocial wellbeing of adults experiencing SMI. Foundations is a long-term community-based psychosocial outreach support program delivered in Tasmania, Australia. A longitudinal non-randomised controlled trial was conducted to examine the effectiveness of the Foundations program on adults' psychosocial functioning, clinical symptomology, and hospital readmissions, in comparison to standard care only. Method: Participants were adults aged 18-64 years experiencing SMI. Control participants received standard clinical care only. Intervention participants were engaged in the Foundations program in addition to standard care. Data were collected at program commencement, midpoint, closure, and six-months post-closure. Linear mixed modelling was used to examine differences between groups. Results: Intervention participants achieved better psychosocial functioning in comparison to the control group by program closure and at six-month follow-up. No significant differences were observed for clinical mental health symptomology or hospital readmission rates. Length of readmission stay was significantly shorter for intervention participants. Conclusions: The findings highlight the additional value of community-based, recovery-oriented, psychosocial outreach support alongside clinical mental health care to enhance the psychosocial wellbeing of adults experiencing SMI. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic had a significant impact on community mental health globally and widened pre-existing health and social inequities. Tasmania, Australia has one of the highest rates of mental ill health and socioeconomic disadvantage in the country. Whilst Tasmania experienced a delayed and reduced physical presence of COVID-19 compared to other states and territories, mental health impacts remain. It is necessary to understand such impacts to inform policy, practice, and recommendations to enhance the mental health service sector and prevent future mental health burden. This qualitative study aimed to explore expert mental health stakeholders' perspectives of the impact of COVID-19 on: (1) the mental health of people living in Tasmania, and (2) mental health services. Method: Semi-structured interviews with 12 expert mental health stakeholders across Tasmania were conducted. This sample was well-positioned to comment on the impact of COVID-19 on community mental health and provide recommendations to enhance the sector. Interviews were thematically analysed. Results: Three subthemes exploring the COVID-19 impact on mental health were included: (1) anxiety, distress, and isolation; (2) varying presentations across age groups; and (3) increased complexity. Four key themes capturing the COVID-19 impact on mental health services were identified: (1) transition to telehealth; (2) increased service demand; (3) spotlight on service gaps; and (4) local workforce shortages. Conclusions: The pandemic has highlighted existing gaps across the community mental health service sector, and exacerbated existing psychosocial/structural stressors resulting in increased presentations and complexity of mental illness among the community, particularly for youth. Existing treatment gaps and inequities in service access, engagement, and mental health outcomes will persist if not addressed. Recommendations have been provided to inform community mental health service planning, policy, design, access, and provision, and improve wellbeing. The COVID-19 pandemic has widened pre-existing health and social inequities and adversely impacted community mental health. In Tasmania, Australia, COVID-19 has exacerbated existing psychosocial and contextual stressors that underpin or perpetuate mental ill health, and highlighted existing gaps in Tasmania's underdeveloped community mental health service sector, including limited service availability, accessibility, and capacity. These findings will inform the (re)design, resourcing, development, and implementation of community mental health services to address such inequities, reduce mental health burden, and enhance wellbeing. [ABSTRACT FROM AUTHOR]

Summary: Health outcomes for young people living in residential out-of-home care are poor. There has been increased emphasis on the need to prioritize preventative support and upskill residential care workers to better meet young people's health needs. The aim of this study was to examine the food quality and physical activity environment in residential care houses in Victoria, Australia prior to staff undertaking Healthy Eating, Active Living Matters (HEAL) training; 102 residential care houses participated. House representatives completed an online survey exploring: (1) physical activity equipment and engagement and (2) weekly food budget and expenditure. Findings: The average weekly food expenditure per household was $318.98 (SD = $106.51), with variation between different sized households. The majority (61%) of houses' weekly food expenditure was spent on ultra-processed food products that are ready to eat with no/little preparation, in comparison to 36% spent on unprocessed foods (fresh fruit and vegetables). The majority of houses reported having two types of equipment. Young people were not often engaged in physical and/or recreational activities in their community. Application: Residential care houses in Victoria require additional supports to ensure that young people are supported to eat well and be active at home and in the community. HEALing Matters aims to provide this, by offering professional development for residential carers to better facilitate engagement in physical activity and healthy eating among the young people in their care. If successful, HEALing Matters may provide an effective pathway to improved health and wellbeing outcomes for young people in residential care. [ABSTRACT FROM AUTHOR]

Objective: No synthesis of the Australian evidence regarding targeted prevention and early intervention for mental health concerns among young children exists. This review aimed to (1) describe the types of targeted community-based mental health programmes evaluated in Australia to support children aged 1–9 years exhibiting internalising and/or externalising symptoms and (2) examine their impact on children's internalising and externalising symptoms and disorder diagnosis. Method: A systematic review and meta-analysis was conducted (PROSPERO: CRD42021255257). Four databases (PsycINFO, PsycArticles, MEDLINE and CINAHL) were searched for Australian studies published in the past 10 years that quantitatively evaluated the impact of a targeted programme on children's mental health. The National Institute of Health Quality Assessment Tools were used to evaluate the study quality. Results: Forty-two studies were included; the majority (67%) were medium quality. The mean sample size was 142 (SD = 170), children's average age was 5.78 years (SD = 2.44) and 58% were male. Aboriginal and Torres Strait Islander children were underrepresented. Studies evaluated 16 programmes that targeted (1) externalising symptoms (n = 20 studies, n = 6 programmes), (2) internalising symptoms (n = 14 studies, n = 7 programmes) or (3) both, termed transdiagnostic programmes (n = 8 studies, n = 3 programmes). Externalising programmes achieved a significant moderate mean reduction in externalising behaviours (standardised mean differences = −0.56), internalising programmes yielded a small mean improvement in anxiety symptoms (standardised mean differences = −0.25) and 57% reduced odds of anxiety disorder diagnosis. Evidence supporting transdiagnostic programmes was inconclusive. Conclusion: Parenting-focused programmes targeting young children's internalising or externalising behaviours have the largest local evidence base supporting their effectiveness. Limitations include a lack of engagement with fathers, triangulation of outcomes, homogeneity and implementation reporting. Greater implementation and evaluation of community-driven integrated and systemic approaches that identify, engage and support Australia's most disadvantaged cohorts of young children and their families are needed. [ABSTRACT FROM AUTHOR]

Australia has undergone significant youth mental health reform over the past 10 years, leading to numerous studies examining the effects of community-based mental health care programs for Australian youth. However, no synthesis of this literature currently exists. Therefore, this systematic review aimed to: (1) describe the types of community-based mental health programs that have been delivered to Australian youth in the past 10 years; and (2) examine their impact in improving young people's mental health symptomology and psychosocial functioning. A systematic search of the peer-reviewed literature was conducted. Studies were included if they evaluated the extent to which such programs improved mental health symptomology (e.g., depression, anxiety, substance use) and/or psychosocial outcomes (e.g., social functioning, school engagement, employment) for Australian youth aged 10–25 years. Thirty-seven studies were included. Four types of community-based youth mental health care programs were identified: therapy (n = 16), case management (n = 9), integrated 'one-stop-shop' (n = 6) and lifestyle (n = 6) programs. The majority of therapeutic programs were effective in reducing mental health symptomology. Case management and integrated approaches consistently yielded significant improvements in both symptomology and psychosocial outcomes. Lifestyle programs were effective in alleviating depressive symptoms, but inconclusive for other outcomes. This review provides support for youth-friendly, systemic, multidisciplinary and integrated assertive outreach models of community mental health care to improve outcomes for young Australians experiencing mental health concerns. Several recommendations for future research are provided to strengthen the local evidence-base supporting community mental health programs to ultimately enhance young people's life trajectory. [ABSTRACT FROM AUTHOR]

Issues: The transgenerational impacts of colonisation—inclusive of dispossession, intergenerational trauma, racism, social and economic exclusion and marginalisation—places First Nations peoples in Australia at significant risk of alcohol and other drug (AOD) use and its associated harms. However, knowledge and evidence supporting community‐based AOD treatment for First Nations adults is limited. Therefore, this review aimed to examine the impact and acceptability of community‐based models of AOD support for First Nations adults in Australia. Approach: A systematic search of the empirical literature from the past 20 years was conducted. Key Findings: Seventeen studies were included. Nine studies evaluated the program's impact on substance use and 10 studies assessed program acceptability (two studies evaluated both). Only three out of nine studies yielded a statistically significant reduction in substance use. Acceptable components included cultural safety, First Nations AOD workers, inclusion of family and kin, outreach and group support. Areas for improvement included greater focus on holistic wrap‐around psychosocial support, increased local community participation and engagement, funding and breaking down silos. Implications: Culturally safe, holistic and integrated AOD outreach support led by First Nations peoples and organisations that involves local community members may support First Nations peoples experiencing AOD concerns. These findings may inform the (re)design and (re)development of community‐based AOD services for First Nations peoples. Conclusion: There is a limited evidence‐base for community‐based AOD programs for First Nations peoples. First Nations‐led research that is controlled by and co‐produced with First Nations peoples is necessary to extend our understanding of community‐based programs within First Nations communities. [ABSTRACT FROM AUTHOR]

Care‐experienced young people demonstrate significantly poor physical, social and mental health outcomes during and beyond their time in care, yet they have rarely been consulted or included in research examining their health needs to date. This qualitative paper explores care‐experienced young people's perceptions of health in care, including accessing healthcare and interacting with health professionals. The research methodology was informed by a co‐design approach through consultation with care‐experienced young people. Semi‐structured interviews were conducted with 10 young people. The findings revealed that: (1) the care system does not nurture young people's health; (2) young people in care experience difficulty accessing and navigating a complex health system; and (3) young people are not given a voice when it comes to their health. The findings provide key recommendations for practice, including the empowerment of young people through positive, responsive and trusting relationships to prioritise the health of young people in care. [ABSTRACT FROM AUTHOR]

The transition out of inpatient mental health is a crucial time for adults experiencing concurrent mental illness and homelessness, yet evidence regarding effective support options is mixed. Choices is an intensive 3-month psychosocial outreach and crisis accommodation support programme for adults experiencing mental illness and homelessness, delivered by Baptcare in Tasmania, Australia. This study examined the effect of Choices on adults’ psychosocial functioning, clinical symptomology and psychiatric readmissions in comparison to standard care only.Participants were adults aged 18–64 years experiencing mental illness and homelessness, recruited upon discharge from a psychiatric admission. Intervention participants (n = 124) received the Choices programme. Control participants (n = 122) received standard care, clinical assessment and treatment from hospital-based Mental Health Services. Outcomes were psychosocial functioning (primary), clinical symptomology, hospital readmission rate and readmission length of stay. Outcomes were assessed at programme commencement and closure (3 months) and 3 months post-closure (intervention group only). Analysis of covariance was used to analyse differences between groups at closure, while controlling for baseline differences.Intervention participants had significantly improved social functioning (encompassing living conditions, social relationships, self-esteem/confidence), overall psychosocial functioning, symptoms of depression and anxiety and shorter hospital readmission length of stay in comparison to the control group. Intervention participants experienced further improvements in social and overall psychosocial functioning 3 months post-closure.The Choices programme is effective in enhancing the psychosocial functioning of adults experiencing concurrent mental illness and homelessness. These findings support the ongoing delivery of this combined accommodation and wrap-around psychosocial model of intensive support. [ABSTRACT FROM AUTHOR]

In recent years, youth mentoring programmes (YMPs) have received significant attention as an intervention tool delivered to young people with the aim of fostering positive psychosocial development. The aim of the current study was to conduct a needs assessment that examined the current trends in YMPs across Australia to inform their implementation. Utilizing the COM-B model, a mixed-method design that consisted of an exploratory survey administered to young people and semi-structured interviews conducted with key YMP stakeholders was adopted. The findings of this study provided several compelling insights regarding the need for YMPs and the barriers and enablers to their implementation, while also highlighting several positive outcomes that are commonly experienced by young people who engage in mentoring. Based on these promising findings, several recommendations for the implementation of YMPs are provided herein in order to maximize their effectiveness in fostering positive psychological and behavioural outcomes among young people. [ABSTRACT FROM AUTHOR]

Although numerous studies have examined the effects of community-based mental health care programs in Australia, no synthesis of this literature exists. This systematic review of peer-reviewed and grey literature described the types of community-based mental health care programs delivered and evaluated in Australia in the past 20 years, and evaluated their impact in improving outcomes for those with a serious mental illness (SMI). Articles were included if they evaluated the extent to which the programs delivered in Australia improved individual outcomes, including hospitalisations, psychiatric symptoms, substance misuse or psychosocial outcomes, for individuals with an SMI. Forty studies were included. Community-based mental health care programs were categorised into three types: case management (n = 23), therapeutic (n = 11) and lifestyle (n = 6). Therapeutic programs were most effective in reducing psychiatric symptoms. Case management approaches yielded significant improvements in psychosocial outcomes. Lifestyle programs were inconclusive in improving individual outcomes. This review provides support for the implementation of community-based mental health care programs that are informed by both therapeutic and case management principles. A multidisciplinary team that can facilitate the provision of therapeutic and psychosocial support may be most beneficial for those with an SMI within the Australian community. No synthesis of the Australian literature regarding the effect of community-based mental health care programs currently exists. This review evaluated the impact of Australian community mental health programs for adults diagnosed with a serious mental illness. This evidence base provides a useful framework within which health professionals and policy makers can be guided. We foresee readers being able to adopt these learnings into their own work, across mental health care and the community healthcare setting more broadly. [ABSTRACT FROM AUTHOR]

Whilst advancing outcomes for young people transitioning from out-of-home care is a national priority, no synthesis of Australian interventions that support their transition from care and into independence currently exists. The aim of this systematic scoping review was to examine the characteristics of such interventions delivered in Australia and to evaluate their impact. Papers were included if they assessed the extent to which transitional support interventions, delivered in Australia, improved housing, employment, education, financial, health, or social functioning outcomes. Eleven studies were included. Interventions primarily adopted a case management approach to support care-leavers' transition. Interventions facilitated improvements in care-leavers' independent living outcomes (e.g., housing, education, and financial stability), but less so in health outcomes. This synthesis provides guidance for how research organizations in partnership with community service organizations and statutory services should develop and deliver interventions to support young Australians transitioning from care. [ABSTRACT FROM AUTHOR]

Fifty percent of Australian women enter pregnancy overweight or obese. Unfortunately, few women receive weight management advice from health professionals during pregnancy. The aim of this study was to investigate current midwifery curricula from Australian universities to identify strengths and deficits in the teaching of preconception and antenatal weight management. Midwifery courses from 20 universities were identified. Of the 568 units taught at these universities, 252 course outlines were obtained. Data were coded using the qualitative analysis technique of Framework Analysis for the following main themes: 1) the effect of weight, diet and physical activity on health outcomes for women who are pregnant or planning a pregnancy; 2) weight management advice in any population; and 3) health behaviour change techniques in any context. Analysis revealed a variety of teaching methods and skills training that emphasised the importance of clinical judgement and autonomous clinical practice, in conjunction with critical enquiry and sourcing reputable evidence. There was little evidence, however, that weight management advice was taught explicitly to midwifery students in the curricula. A greater emphasis on skilling midwifery students to address weight gain during pregnancy, and behavioural techniques to achieve this, is required. • More than 50% of women enter pregnancy at over recommended weight. • Few women receive advice on managing weight during pregnancy from health professionals. • Health professionals have considered their current levels of training for gestational weight management to be inadequate. • This study found that explicit teaching about advising women on weight management during pregnancy was minimal. • Midwifery courses should explicitly teach midwifery students about how to address weight gain during pregnancy. [ABSTRACT FROM AUTHOR]

• Cradle to Kinder supports families experiencing multiple risk factors/stressors. • There were improvements in family functioning, parenting, and child development. • Family preservation was maintained for 89% of families. • Greater support for fathers, cultural awareness and worker consistency is required. Cradle to Kinder is an Australian intensive, long-term, home visitation program that supports young families experiencing multiple stressors, including poverty, family violence, mental illness, substance use, childhood trauma, intellectual disability, child projection involvement, teenage pregnancy, or social isolation, which places them at high risk of child removal. The program adopts a multidisciplinary, whole-of-family and trauma-informed approach to provide families with long-term case management, practical support and evidence-based therapeutic parenting interventions from pregnancy for up to four years to address these underlying risk factors. The aim of this study was to evaluate: (1) the extent to which families experienced improvements in family, caregiver and infant wellbeing outcomes after 24 months engagement; and (2) caregivers' experiences of the program. A mixed-method evaluation was employed, which included two components: (1) uncontrolled pre-post quantitative assessment for 57 families using the North Carolina Family Assessment Scale and Brigance Early Child Development Assessment, completed every six months; and (2) qualitative interviews with 14 caregivers engaged in the program. The quantitative findings showed significant improvements in key domains of family functioning, parenting capabilities, infant development, and family preservation. The qualitative results validated these findings as caregivers reported favourable outcomes via participation in the program, including improved parenting skills and confidence, personal wellbeing, and child development. Suggestions for program development included greater support for fathers, increased cultural awareness, and consistency in workers. This mixed-methods study provides support for Cradle to Kinder as a promising model of family support that can improve family functioning, caregiver and child wellbeing, and prevent child removal among families experiencing significant disadvantage. These findings support the ongoing delivery of Cradle to Kinder in Australia to ensure families at greatest risk receive the support they urgently need. [ABSTRACT FROM AUTHOR]

• Home-based carers face numerous barriers to facilitating healthy lifestyle behaviours. • Upskilling carers is crucial to improving long-term health outcomes for the child/ren in their care. • Training must be accessible, practical, and unique to both foster and kinship carers. Foster and kinship carers face unique and complex challenges in caring for Australia's most vulnerable children. It is therefore necessary to ensure that home-based carers are adequately upskilled and supported to promote the health of children in their care. The aim of this paper was to better understand the barriers to developing healthy lifestyle behaviours (relevant to nutrition and physical activity) among children in home-based care, from the perspective of foster and kinship carers. Focus group sessions were conducted with 21 carers: eight foster carers and 13 kinship carers. Four key themes were identified: (1) Childhood experience and children's healthy lifestyle behaviours; (2) There are personal costs of being a carer; (3) Carers require support to develop healthy lifestyle behaviours in children; and (4) Broader systemic factors impact healthy lifestyle development. Carers in the current study described their experience of key emotional, financial, and systemic barriers to facilitating healthy lifestyle behaviours among the children in their care. To address such challenges, carers recommended the development of trauma-informed support, education, and resources to prioritise and facilitate healthy lifestyle development among children in home-based care. [ABSTRACT FROM AUTHOR]

• Understanding what drives outcomes in family preservation programs is important. • Realist methods applied to focus group data found important demi-regularities. • Practitioners easily share their knowledge of what works for programs and families. • Practitioners clearly articulate what leads to intended and unintended outcomes. Programs for families where children are at risk aim to develop the conditions for safety and care that is rewarding, loving, stable and secure. Understanding what leads to outcomes is less clear, and realist research methods are a useful in unpacking this. The Social Care Theorising Model informed the collection of focus group data from practitioners and team leaders in a family preservation and reunification program being scale up across the state of Victoria in Australia. Demi-regularities (patterns of a program's function that are reasonably stable) were generated to provide a rapid understanding of practice knowledge to inform data-driven decision making. This study combined the methodology from two studies to balance the need for realist informed findings without time and resource intensive processes of program theory development. Twelve demi-regularities were found which were grouped into three socio-ecological themes of family, organisation and system. At the family level, practitioners described what enabled engagement, readiness, the development of a therapeutic relationship and the need for supported closure. The organisational level suggested the preconditions to engagement, the caseload needed to work intensively, management of staff stress and work needed to operationalise goals. The systems level largely described the essential role of the Child Protection Navigator and how they enable service delivery. This study provides an understanding of what works, for whom, when and why in an innovative family preservation and reunification program. [ABSTRACT FROM AUTHOR]

International evidence supports the effect of intensive family preservation and reunification services in preventing children's placement in out-of-home care (OOHC). Evidence within Australia is scarce. This protocol paper describes a hybrid effectiveness-implementation evaluation of the Victorian Family Preservation and Reunification (FPR) Response implemented by MacKillop Family Services. Participants include families engaged in the program and staff involved in program delivery. A pre-post study design will be used to assess the effectiveness of the FPR in improving family outcomes from intake to closure, including: (i) parenting knowledge, skills, and capability; (ii) family safety and home environment; (iii) child development, adolescent behaviour, education attendance and attachment; (iv) connection to services; and (v) prevention of children from entering or re-entering OOHC. Interviews and focus groups will be conducted with staff to evaluate the program's fidelity, reach, feasibility, acceptability, and enablers and barriers to implementation. Quantitative data will be analysed using descriptive statistics and a series of paired-samples t-tests and F tests to examine changes in outcomes over time; thematic analysis will be used for qualitative data. If the FPR can yield significant improvements in families' outcomes, this would provide strong support for its scale-up across Australia, to better support vulnerable families.

Although numerous studies have examined the effects of community-based mental health care programs in Australia, no synthesis of this literature exists. This systematic review of peer-reviewed and grey literature described the types of community-based mental health care programs delivered and evaluated in Australia in the past 20 years, and evaluated their impact in improving outcomes for those with a serious mental illness (SMI). Articles were included if they evaluated the extent to which the programs delivered in Australia improved individual outcomes, including hospitalisations, psychiatric symptoms, substance misuse or psychosocial outcomes, for individuals with an SMI. Forty studies were included. Community-based mental health care programs were categorised into three types: case management (n=23), therapeutic (n=11) and lifestyle (n=6). Therapeutic programs were most effective in reducing psychiatric symptoms. Case management approaches yielded significant improvements in psychosocial outcomes. Lifestyle programs were inconclusive in improving individual outcomes. This review provides support for the implementation of community-based mental health care programs that are informed by both therapeutic and case management principles. A multidisciplinary team that can facilitate the provision of therapeutic and psychosocial support may be most beneficial for those with an SMI within the Australian community.

Introduction: People with serious mental illness (SMI) often fail to receive adequate treatment. To provide a higher level of support, mental health systems have been reformed substantially to integrate mental healthcare into the community. MyCare is one such community-based mental health model of care. This paper describes the study protocol of a controlled trial examining the effect of MyCare on psychosocial and clinical outcomes and hospital admission and duration rates for adults with SMI., Methods and Analysis: This is a multisite non-randomised controlled trial with a 3, 6 and 12-month follow-up period. The study participants will be adults (18-64 years of age) with SMI recruited from Hobart, Launceston and the North-West of Tasmania. The treatment group will include adults who receive both the MyCare intervention and standard mental health support; the control group will include adults who receive only standard mental health support. The primary outcome includes psychosocial and clinical functioning and the secondary outcome will examine hospital admission rates and duration of stay. Mixed-effects models will be used to examine outcome improvements between intake and follow-up. This trial will generate the evidence needed to evaluate the effect of a community mental health support programme delivered in Tasmania, Australia. If MyCare results in sustained positive outcomes for adults with SMI, it could potentially be scaled up more broadly across Australia, addressing the inequity and lack of comprehensive treatment that many individuals with SMI experience., Ethics and Dissemination: This study has been approved by the Tasmanian Health and Medical Human Research Ethics Committee. The findings will be disseminated to participants and staff who delivered the intervention, submitted for publication in a peer-reviewed journal and shared at academic conferences., Trial Registration Number: ACTRN12620000673943., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)