Introduction: Adolescents detained within the criminal justice system are distinguished by complex health problems, health risk behaviours, and high rates of premature death. We undertook a global synthesis of the evidence regarding the health of this population.

Theory/Methods: We searched Embase, PsycINFO, ERIC, PubMed, Web of Science, CINCH, Global Health, the Cochrane Database of Systematic Reviews, the Campbell Library, the National Criminal Justice Reference System Abstract Database, and Google Scholar for peer-reviewed journal articles that a) reported the prevalence of at least one health outcome in adolescents (aged <20 years) in detention, and b) were published between January 1980 and June 2018. Reference lists of published review articles were scrutinised for additional relevant publications.

Results: 231 articles (194 primary research, 37 reviews) were included, with most primary research (173; 89%) conducted in high-income countries. A high prevalence of health problems and risks was reported in detained adolescents including mental (3%-72%) and substance use disorders (37%-62%), suicidal behaviour (4%-43%), learning difficulties (10%-32%), infectious diseases (0%-25%), and sexual and reproductive conditions (pregnant by age 19 years: 20%-37%; abnormal cervical screening test result: 16%).

Discussion/Conclusions: Adolescents in detention are distinguished by poor physical and mental health. Complex co-morbidity requiring integrated care pathways is normative in this population.

Lessons learned: As many causes of poor health are strongly linked to contact with the criminal justice system, strategies to address these factors could reduce both rates of adolescent detention and adolescent health inequalities.

Limitations: Most evidence comes from high-income countries, despite most of the world’s adolescents living in low-to-middle-income countries.

Suggestions for future research: Improving the screening and detection of mental and physical disorders, providing appropriate interventions during detention, and optimising transitional health care following release from detention will maximise the health outcomes of these vulnerable adolescents.

Introduction
Children and young people with chronic and complex conditions are more likely to experience fragmented care due to the complexity of their conditions, their high healthcare utilisation, and the multitude of health and social care providers involved. Integrating care for these children and young people presents many challenges. There is limited literature that explores the experiences of healthcare providers who try to deliver integrated care to children with chronic and complex conditions, and this research aims to address this gap. It describes some of the barriers and enablers to delivering integrated care by exploring the experiences and perspectives of six healthcare providers.

Methods
This research used qualitative semi-structured in-depth interviews to explore the experiences of two hospital-based nurses, two hospital-based allied health professionals, a hospital-based general paediatrician and a community-based general practitioner. An Interpretive Phenomenological Analysis method was used to guide the interview schedule, drive the analysis and interpretation of the findings. All interviews followed a semi-structured interview schedule and were audio-recorded, transcribed verbatim and thematically analysed.

Results
The six superordinate themes derived from this research were:
• Traditional models of care
• Embracing child and family centred care
• Care coordination
• Communication
• Interprofessional practice
• Organisational influences
The participants described that the dominant model of care within the hospital remains a traditional medical model of care. The organisational culture and influences (systems and structures) were described as major barriers to providing integrated care. Care coordination, timely and consistent communication and interprofessional practice were all highlighted as opportunities to shift towards integrated child and family centred care. The superordinate themes had many overlaps and dependencies on each other.

Discussions
This research has provided valuable insights into the experiences of healthcare delivery in a large, state-wide tertiary paediatric centre. These insights will contribute to service planning and delivery and will have a direct effect on quality improvement processes.

Conclusions
A child and family centred approach, improved communication, and role clarity amongst healthcare providers could lead to better integrated care provision in a paediatric tertiary hospital. Interprofessional education and training, allocation of additional time for care coordination and communication, strong leadership (including executive and peer leadership), change champions, and streamlining of systems and processes are all required to shift the culture within the tertiary hospital. Organisational structures also need to be addressed to support the implementation of evidence-informed integrated care.

Lessons learned
Implementation of quality improvement activities as identified by the findings of this research needs to be scaffolded by organisational structures.

Limitations
The low sample size and research within a single institution limits generalisability of these findings.

Suggestions for future research
This research forms phase one of a larger research project which explores children, young people and their parents’ experiences of integrated care. In this mixed-methods research the perspectives of children, parents/carers and healthcare providers will be triangulated. The findings of this research will help to improve integrated healthcare service delivery, patient experiences and outcomes, as well as inform service providers about the effect use of healthcare resources.

Introduction:
Healthcare teams are responding to complex challenges to deliver quality, safe and cost-effective healthcare by transforming traditional approaches to healthcare delivery to incorporate Interprofessional practice (IPP), underpinned by Inter-professional education (IPE). To fully realise the benefits and efficiencies IPP and IPE can affect, it is imperative that healthcare services develop an organisation-wide understanding of principles of IPE and IPP. Children’s Health Queensland Hospital and Health Services (CHQHHS) has developed an organisation-wide IPE/IPP strategy including an evaluation framework to ensure internal consistency in longitudinal evaluation. Further, IPE and IPP are core to the CHQHHS’s Integrated Care Strategy (2018-2022).

Short description:
A working group of interprofessional champions from CHQHHS was convened in 2018. An international partnership was formalised with the Centre for Interprofessional Education, University of Toronto and University of Queensland to support implementation, evaluation and research. The IP Working Group developed an evaluation framework cross-referenced to organisational learning effectiveness as described by Kirkpatrick-Phillips. Collaboration with an established Integrated Care Advisory Group fostered the development of an organisational-wide Integrated Care Survey (ICS), designed to capture a baseline measurement of the awareness, behaviour and knowledge of integrated care within the organisation, with targeted questions about IPP and IPE allowing for an integrated approach to measuring the organisation’s current state with a consistent message and goal. Consultation with CHQ staff and international partners was conducted, and a pilot of the ICS was undertaken with a sample population of workforce to refine its effectiveness. An ICS communication plan optimised workforce engagement and survey completion rates.

Aim:
To establish a consistent approach to evaluation of an IPE/IPP strategy and to monitor organisational understanding of IPP/IPE by sampling the workforce of CHQHHS longitudinally.

Targeted population and stakeholders:
All staff were invited to participate in the inaugural ICS.

Timeline:
The ICS was available to all staff for two months (February – April 2019). Analysis of the findings completed by mid-2019.

Highlights:
Collaboration between champions across disciplines, projects and programs of work who did not traditionally work together to streamline and deliver messages on IPP/IPE and the overarching goals of the organisation’s journey towards integrated family centred care.

Sustainability:
Collaboration and internal capacity building of interprofessional champions means that messages can be shared broadly, via a distributed leadership model, maximising reach and influence.

Transferability:
The findings of the evaluation to date can be utilised and implemented across different departments, based on individualised needs.

Conclusions:
257 respondents voluntarily completed the ICS. The major finding of how the organisation understands IPE/IPP demonstrates targeted messaging and capacity building planning around the definition of IPP including the patient and family as key members of the care team.

Discussions:
Findings from the evaluation framework and awareness survey will inform future planning for targeted IPE/IPP activity within existing and emerging workforce. Ongoing evaluation of IPE/IPP activities across horizons of implementation will be measured according to the evaluation framework.

Lessons learned:
Time investment is necessary for long-term organisational change.

Introduction

To deliver an integrated family-centred model of care it is necessary to address the underlying causes of poor health. Access to quality community-based healthcare, health literacy, access to material basics, social connectedness, parental stress, and domestic violence have significant impact on children and young people’s health and wellbeing and are not routinely addressed in an emergency department (ED). This study brings together several departments across the hospital and health service with an aim to identify the reasons families present to the Queensland Children’s Hospital (QCH) ED for non-urgent reasons. The hypothesis was that families and young people who present frequently to ED are lacking: access to material basics, connections with primary and community care, and experience fragmentation of health and social services.

Methods

Phase 1

100 surveys were conducted in the QCH ED during March-April 2019. Parents whose children were triaged as ‘non-urgent’ were recruited through convenience sampling. The survey questions were focused on: accessing healthcare; health literacy; access to material basics; parental stress; and domestic violence.

Phase 2

Currently in progress, expanding upon the findings from Phase 1.

(1) QCH ED staff survey and interviews assessing: perspectives on non-urgent ED presentations, awareness of community health services, comfort in asking and ability to address social determinants of health.

(2) Parents who have presented to ED 4 or more times in 12 months will be targeted with the survey and an additional qualitative semi-structured interview to explore their responses further.

(3) General Practitioners (GP) identified by the parents will be interviewed for their perspective on why families attend ED for non-urgent reasons and if/how/why they refer children to QCH ED.

Results

Phase 1 data demonstrated no clear link between frequent ED presenters and access to material basics. There was a link between higher socioeconomic area of residence and repeated visits. The data showed that 100% of frequent ED presenters have a regular GP, though reported higher parental coping concerns.

Discussions

The findings from Phase 1 suggest that parents are seeking healthcare from a range of services, including primary care, though are still presenting to ED. Perception of the urgency of their child’s condition is a key driver for ED presentation, as is their perception of quality care, and advice from their GP.

Conclusions

This is a complex issue which requires a multifaceted approach to understand and design interventions across the broader system to meet the needs of children and families who are frequently attending ED.

Lessons learned

Assumptions cannot be made for specific populations, such as families who present to ED frequently.

Limitations

Low sample size and single-site research may limit generalisability.

Future research

Phase 2 is currently underway. This will explore broader perspectives on families presenting frequently to ED as well as attitudes towards and ability to address the social determinants of health in a paediatric ED. These results will guide the organisation to improve integrated care for children and families.

Results will be available for presentation by November 2019.

Expansion to a second research site is in development.