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Background: It seems to be a truth universally acknowledged that pathways to care for people with eating disorders are inconsistent and difficult to navigate. This may, in part, be a result of the complex nature of the illness comprising both mental and medical ill-health across a broad range of severity. Care therefore is distributed across all parts of the health system resulting in many doors into the system, distributed care responsibility, without well developed or integrated pathways from one part of the system to another. Efforts in many parts of the world to redesign health service delivery for this illness group are underway, each dependent upon the local system structures, geographies served, funding sources and workforce availability. Methods: In NSW—the largest populational jurisdiction in Australia, and over three times the size of the UK—the government embarked six years ago on a program of whole-of-health system reform to embed identification and treatment of people with eating disorders across the lifespan and across the health system, which is largely publicly funded. Prior to this, eating disorders had not been considered a 'core' part of service delivery within the health system, meaning many patients received no treatment or bounced in and out of 'doorways'. The program received initial funding of $17.6 million ($12.5 million USD) increasing to $29.5 million in phase 2 and the large-scale service and workforce development program has been implemented across 15 geographical districts spanning almost one million square kilometres servicing 7.75 million people. Conclusions: In the first five years of implementation there has been positive effects of the policy change and reform on all three service targets—emergency departments presentations, hospital admissions and community occasions of service as well as client hours. This paper describes the strategic process of policy and practice change, utilising well documented service design and change strategies and principles with relevance for strategic change within health systems in general. Plain English summary: This review outlines a $30 million health system reform to eating disorder treatment implemented by the NSW State Government six years ago which has seen large-scale service and workforce development across 15 geographical districts. This spans almost one million square kilometres and services 7.75 million people in Australia. The reform is very large in scale and is now in its second phase of implementation. Here outlined is the strategic process of policy and practice change of the entire reform and initial findings from an external review of phase one, which demonstrates positive effects on all three service targets—emergency departments presentations, hospital admissions and community occasions of service—including increased rates of treatment provision, improved perception of eating disorders amongst health professionals, improved pathway options and better communication within multidisciplinary teams. This type of whole-of-health system government led reform has relevance and learnings for health systems internationally. [ABSTRACT FROM AUTHOR]

To identify strengths and challenges faced by alcohol and other drug (AOD) non-government (NGO) workers in New South Wales (NSW), Australia to inform future workforce planning initiatives. An online survey assessed workers' demographics, organizational characteristics, health and wellbeing. Respondents (N = 294) were mainly female (66.7%), 15.3% identified as lesbian, gay, homosexual, or queer, 8.4% identified as Aboriginal and/or Torres Strait Islander and 42.5% reported AOD lived experience. A third (34.4%) were ≥50 years, 40.3% had <5 years AOD-related experience, 42.0% had clinical supervision access, and half (55.1%) reported that their organization provided professional development support practices. Satisfaction working in the AOD NGO sector (66.0%) and work/life balance (58.5%) was high, as was turnover intention (31.4%), job insecurity (30.3%), and dissatisfaction with remuneration (67.8%). Most (76%) full-time workers earned below the national average wage. Large proportions of older workers and young/inexperienced workers necessitate specific workforce planning and development action. Professional development and supervision access are priority areas for remediation. High turnover intention rates, potentially reflecting job insecurity or remuneration dissatisfaction, require strategies to increase workforce attraction, and retention in this sector. [ABSTRACT FROM AUTHOR]

Background: Workers with lived experience of problematic alcohol and other drug (AOD) use are increasingly recognized as integral to the AOD field. However, little is known about the prevalence or characteristics of AOD workers with lived experience across the general AOD workforce, in Australia or internationally. This study aimed to (1) investigate the prevalence of lived experience in AOD workers, (2) build an initial profile of workers with lived experience, (3) identify areas where appropriate support mechanisms may be warranted, and (4) generate recommendations for future work. Method: Nongovernment organization AOD workers from New South Wales, Australia, were invited to participate in a purpose-designed, online survey. Measures included demographic and workforce characteristics, work-related psychosocial factors, and health, quality of life, and AOD use. Descriptive analyses compared responses from workers with and without lived experience on key variables. Results: Two hundred and sixty-eight workers responded. Workers with lived experience comprised 43% of the sample; were more likely to be older; male; identify as lesbian, gay, homosexual, or queer; have lower salary; report discrimination in the workplace; abstain from alcohol; report opioid use; and experience less support outside work. Conclusion: This is the first Australian study to examine the profile of AOD workers with lived experience. Workers with lived experience constituted a substantial proportion of the AOD workforce. Analogous to other countries, comprehensive, appropriately tailored workforce development and support policies are required. Future research should build on these findings by extending to a broader population base, including government workers. [ABSTRACT FROM AUTHOR]

Abstract: Background: The world''s populations are ageing and the need for nurses and health care workers from all disciplines to manage this phenomenon is increasing. Yet the literature and previous research undertaken by the author reveal consistently that working with older people is ranked poorly as a perceived career destination of student of nursing. Objective: The main research objectives in this study were to (1) develop a profile of nursing career preferences and the rationale underpinning those choices and (2) compare these results with other literature to indicate if this profile is changing. Design: This study uses a repeated measures design, with a non-probability sample of undergraduate Bachelor of Nursing students in the State of NSW, Australia between 2007 and 2009. Results: The results show that 8% of the students began their course wanting to work with older people. Overall the ranking of ‘working with older people’ for commencing students was 7 out of ten. This ranking decreased throughout their course to ultimately become the least desired career choice of graduating nurses with only 3 of the 150 participants stating a desire to work with older people. Career choices, over all, divide along the lines of ‘high-tech’ and ‘low-tech’ which support the findings commonly found in the literature. It would appear that socialising factors within the education process, negative clinical experiences and the ageist bias within the broader community play an important role in these student''s career choices. [Copyright &y& Elsevier]

Issue addressed: Evidence-based practice (EBP) is essential for effective health promotion practice, but not all health promotion staff have the required skills. In New South Wales this issue was addressed by implementing an EBP train-the-trainer (TTT) program to build workforce capacity. Methods: The success of the program was assessed through surveys completed by EBP-TTT participants and AHS participants of the disseminated EBP training activities. Results: Ten formal EBP training activities were delivered in five of the eight NSW Areas, reaching a total of 133 practitioners. Participants reported significant improvements in their EBP knowledge and skills, and that these had been incorporated into their practice. A range of informal activities were also conducted. Barriers to delivery of training activities in the three remaining areas included resource restrictions, staff movement and organisational change, and insufficient confidence. Conclusions: The EBP-TTT program was an effective means of disseminating EBP knowledge and skills when the local 'training-team' felt sufficiently prepared and the Area Health Service was able to support local training activities. [ABSTRACT FROM AUTHOR]

Background: The alcohol and other drugs (AOD) workforce faces multiple challenges including stigma, limited resources, ideological conflicts and complex demands. An engaged, supported and stable workforce is essential for optimal service provision, quality care, effective harm reduction implementation and cost efficiency. However little research has examined factors that impact worker engagement in the AOD sector. To inform policy and practice on cost efficient service provision and effective workforce development, this study examined a range of potential predictors of work engagement among Australian AOD non-government workers.Methods: An online, cross-sectional survey of 294 non-government AOD workers measuring demographic, work-related psychosocial, and health and wellbeing variables was conducted in New South Wales, Australia. Multiple hierarchical linear regressions were conducted to identify significant predictors of worker engagement.Results: Most AOD workers demonstrated high work engagement levels. Significant predictors of engagement included role clarity, leadership quality, growth opportunities, resilience and social support, and older age. These workers were likely to be more energised, enthusiastic and dedicated in their jobs.Conclusions: This study is an important initial step in understanding work engagement among AOD workers. It offers valuable insights into ways to foster engagement, which in turn may ensure a more sustainable workforce that can deliver high quality care. Workers with high levels of engagement are more likely remain in their AOD roles over longer periods of time, acquire more skills and experience, and be better equipped to address complex demands. Workforce policies and programs specifically designed to enhance leadership skills and role clarity, while enhancing professional growth, resilience, and social supports, particularly for younger workers, are highlighted as essential strategies to promote engagement among AOD workers. [ABSTRACT FROM AUTHOR]