Innovations to improve access and outcomes for children, families and communities

Dr Bronwyn Dunnachie, Senior Advisor - Werry Workforce Whāraurau, and Sue Dashfield, Director - Werry Workforce Whāraurau, attended the International Initiative for Mental Health Leadership (IIMHL) Child and Youth match in New Haven, Connecticut, USA as part of the 2019 IIMHL Leadership Exchange. Here they reflect and share their experiences from the match.

The match, hosted by Dr Nathalie Szilagyi and colleagues at Yale University’s Yale Child Study Center, gave an introduction to a broad range of clinical and community focused child, youth and family mental health and well-being programmes, with many examples of service/programmes delivery that met the interests of the participants.

This is an ongoing match with a group that has been collaborating for 10 years and has regular virtual meetings between matches where leaders share new research or innovation. Bronwyn organises and coordinates these meetings via Werry Workforce Whāraurau and has done so for eight years.

This match was designed to support the sharing of international innovations in service planning, development and delivery in child and youth mental health, which will potentially lead to the implementation of new and innovative child, youth and family-focused service developments. The breadth of development includes organization, service, infrastructure and practice; in participant countries.

The match in New Haven attracted a mixture of former participants as well as people new to IIMHL meetings.  The average group size is 10, which was reflected in the New Haven meeting.  Participants come with a variety of interest areas across primary and secondary levels of service delivery and across sectors.  The range of perspectives ensures rich discussion and learning. 

The leaders who participated in the Yale Child Study Center Child and Youth match came from five countries (USA, Canada, Ireland, Australia and New Zealand) and brought perspectives from Child and Adolescent Psychiatry, Workforce Development, Mental Health Commissioning, Family and Carer involvement, Mental Health Nursing, Funding and Development.  Participants had interest in, and/or responsibility for delivery across services and sectors (Primary and Secondary level services, and other agencies: justice, education and welfare). Developments in primary level service delivery and integration across services and sectors were areas of interest shared by everyone, with access being a key issue.

Three new perspectives to the match

First, the participation from a family/carer involvement agency (Tandem in Victoria, Australia) was a new focus for this match and provided an excellent and levelling opportunity to consider service delivery from the perspectives of families, encouraging co-design/co-production activity which includes families. 

Second, whilst the perspectives of young people weren’t directly present, the commitment of all participants to co-design/co-produce activity inclusive of a child and youth voice ensured a focus on an inclusive process of multi-perspective planning and delivery. 

Third, another fresh focus in this match was the discussion and shared innovations on increasing service delivery to include a ‘well-being’ focus and translating it to access to programmes from a preventative perspective.  

In addition to the focus on ‘well-being’ described above, a range of projects, programmes and community initiatives were presented by Dr Nathalie Szilagyi and her colleagues at the Yale Child Study Center.  All of the presentations led to significant discussion with a focus on how the ideas presented could translate into service developments in the participants’ own countries.  Here are four examples of the many initiatives that inspired discussion:

1. Trauma-informed system support (The Child Health and Development Institute of Connecticut-CHDI).  CHDI has successfully implemented a range of processes aimed at the development of a trauma-informed system.
2. The MOMS Partnership®: A programme supporting mothers experiencing depression to receive interventions such as stress management courses, parenting courses, vocational programmes and one-on-one coaching.  Innovations in this programme include access for mothers to a diaper bank in recognition that the prohibitive cost of diapers for some families creates significant stress.  An evaluation identifies successes such as a 67 per cent drop in parenting stress for participants of this programme, the doubling of part-time employment and the decrease in depressive features.  Access at supermarkets and other community locations is key to the programme’s success.
3. Fathers for Change: An integrated intervention for fathers with histories of IPV and/or substance misuse: The presenters discussed a rationale for working with violent fathers which includes the likelihood of the fathers continuing presence in the family and the improved outcomes for children where these fathers receive support.  Fathers participate in a clinical treatment programme of 16-24 weeks.  Partners are included in the programme with safety being an absolute consideration.  The evaluation outlines a decrease in abusive behaviours measured with the inclusion of multi-informants.
4. ACCESS Mental Health: A programme offering access to primary care physicians (PCPs) seeking assistance for young people presenting with mental health/well-being concerns.  The Yale Hub ACCESS Mental Health consultation team are a multi-disciplinary group, including a peer specialist, who are on-call to provide support either via telephone or face-to-face to PCPs and triage of the young people and their families referred by their PCP.  The team’s triage processes and relationships with other services enable timely access for young people experiencing well-being concerns.  The team’s role includes primary and community-level education for the professionals using the service for young people and well-being.

Since being back in Aotearoa, Bronwyn and Sue have reported the following:

• We talked to our parenting team about the mothers’ programme (MOMS Partnership®) which is being delivered in places like supermarkets – and the related link between maternal stress and access to basics like nappies.  The MOMS Partnership®) might be a model for how future parenting programmes can be rolled out.
• We talked to PHOs and primary care about the services (ACCESS Mental Health)  in Connecticut which provides child and youth mental health advice to primary care and links families directly to NGOs in their area, as well as providing upskilling to primary practices.  We think this might be a useful model to be adapted for upskilling primary care - especially those who don’t get funded under the current access and choice round.  
• We got a great preview of some ACE work and resources as well from the Yale Childhood Violent Trauma Center.
• We made great connections to our Mental Health Commission of Canada colleagues and Tandem, whom Bronwyn is working with on a match for the 2021 IIMHL Leadership Exchange.