Introduction:
Peak emergence of physical and mental health risks occurs between 12 and 17 years, however adolescents of this age are the least likely of any group to access primary care. To address this poor access, some jurisdictions are integrating healthcare within the education setting, including establishing general practice (GP) clinics on secondary school campuses. However, there is limited literature exploring how adolescents feel about accessing healthcare at school.
In Logan, Queensland, a secondary school principal approached Children’s Health Queensland and the local Primary Health Network to codesign a GP clinic on campus. Initial student and staff focus groups were conducted to determine how students and staff wanted to engage with the clinic, and seek suggestions on how to make it ‘adolescent friendly’.

Methods:
This qualitative research used purposive convenience sampling to recruit participants. Homogenous student focus groups were conducted with at least four students in each, and were based on age and gender. Another focus group was conducted with wellbeing and leadership staff, and semi-structured one-on-one interviews were conducted with the school-based nurse, two guidance officers and the principal.

Results:
Student focus groups revealed:
• students had limited understanding of what care a GP could provide, believing this to be limited to treating injuries or acute illness. Students were pleased to learn sexual and reproductive health concerns, risky behaviours, and mental health problems could be managed by a GP and thought this would be well received by the student cohort.
• concern about confidentiality;
• a desire for a comfortable space, including music, and distractions;
• importance of the GP being non-judgemental, trustworthy and visible around school.
Staff focus groups and interviews revealed:
• perceived barriers to students accessing care offsite include transport, financial constraints, cultural barriers, denial;
• belief that a school GP will expedite access to psychology services, reduce stigma and normalise mental health challenges and disability;
• a need for mental healthcare planning, STI screening, contraception, drug and alcohol support;
• desire for the GP to be ‘part of the school community’;
• concern that the service might not be sustainable.

Discussions:
The findings suggest a GP clinic on campus will be well received by all stakeholders and positively influence student access to healthcare and health literacy. Trust, visibility, parental acceptability and involvement of the GP in the school community will influence success of the model.

Conclusions:
This research provided an opportunity for students and staff to contribute to the design and implementation of the GP clinic, including how to make it adolescent-friendly, and how appointments should be managed.

Lessons learned:
Student opinion varied according to age and gender. This suggests information provided should vary according to year level.

Limitations:
Purposive convenience sampling meant we may not have heard from a representative population of students or staff.

Suggestions for future research:
Once operational, further research is needed to determine utilisation, student, staff and parent satisfaction, and impact on learning and health outcomes. This will inform whether the model should be scaled across Queensland high schools.

Background: Healthy Homes and Neighbourhoods (HHAN) is an integrated care program that supports families where adults have complex health and social needs, often impacting on their children. HHAN also aims to engage with and enhance capacity of partner agencies and the community served.

This prioritised pathway initially featured delivery of long term whole-of-family care coordination, flexible community visits, fast track Paediatric outreach clinics and consistent collaboration with schools. Over time, the pathway has been strengthened and the model of practice has been refined and expanded to address whole of school and community needs. The enhanced model includes indirect provision of consultation for a larger number of children and their families and the implementation of whole of school health promotion and community engagement initiatives.

Aim: To improve the established service pathway for families and the school community.

Method: Two local primary schools receive this pathway. The enhanced model uses qualitative measures in the health promotion programs commenced. Pre and post surveys will be completed by parents and students and semi structured interviews with school staff will be undertaken. Evidence of sustainability and incorporation into school operations will be recorded. The number of students receiving a consultative model will also be compared to the number of families referred for direct HHAN care coordination.

Results: This is a unique care coordination pathway linking professionals from the health, social and education sectors. Results had been previously demonstrated with families referred for care coordination through patient reported outcome measures .This has enabled trust between service providers, particularly education and healthcare providers, to develop over time and enabled the pathway to be reviewed. The expanded model of care benefits more students and the broader community.

Conclusion: Establishment of this pathway has challenged partners to develop a model using creative, non-standard methods of intervention. Families in these communities have multiple needs and face multiple barriers to care. This highlights the need for place-based integrated care initiatives such as Healthy Homes and Neighbourhoods to target the needs of disadvantaged communities. The enhanced model of practice is in early stages of implementation. Further study will focus on evaluation of these initiatives.

Introduction:
Adolescence is a developmental period characterised by unique mental, physical and social wellbeing needs. It is well understood that health engagement for this cohort is contingent on the availability, acceptability and accessibility of health services. To overcome barriers to service use and reduce adverse health outcomes in the immediate and longer term, early intervention and preventative measures are required.

Practice Change:
The Doctors in Secondary Schools (DiSS) Program is an initiative of the Victorian Department of Education and Training (DET). DET has commissioned Victoria’s six Primary Health Networks (PHNs) to appoint general practices to deliver primary health care services in 100 Victorian Government secondary schools to December 2021. Students enrolled in a participating school are provided access to a GP and Practice Nurse trained in adolescent health, up to one day per week. The objectives of DiSS are to:
• make primary health care more accessible to students;
• provide assistance to young people to identify and address any health problems early; and
• reduce the pressure on working parents.

Aim and Theory of Change:
Established in 2017 as pilot program, DiSS comprises an integrated service model design that organises and connects health services with a facet of the young persons’ social environment – their school. The model is underpinned by effective collaboration between two dynamic sectors (Health and Education) to establish and operationalise an adolescent responsive, school-based health service (SBHS). The service model addresses determinants of health inequity and resulting poorer health status by distributing SBHS’s across metro, regional and rural Victorian government secondary schools, at no cost to the young person or their family. DET has also engaged the University of Melbourne to deliver adolescent health training to the DiSS clinical workforce, covering aspects of youth engagement, consent and confidentiality. From a workforce development perspective, this training contributes to the development of primary care workforce competence in adolescent health beyond the school setting.

Outcomes and Key Learnings:
At 31 December 2018, 15,438 clinical consultations were provided to 6,583 young people, predominantly addressing mental health (40%) and physical health (45%) needs. Key learnings reveal that a successful SBHS is underpinned by positive, collegial and supportive relationships between the school and allocated general practice, as well youth participation in service promotion and improvement. Program sustainability is strengthened by developing linkages between the service, existing school health and wellbeing staff, curricula and referral pathways locally. Further, ongoing program evaluation and collective learning has supported cross-functional continuous improvement activities from program establishment through to operationalising. This has resulted in a suite of guiding documents and interactive resources that support knowledge management and transferability of the concept nationally.

Conclusion:
In conclusion, DiSS is an innovative and integrated model of care, operationalised by collaborative, multi-sectoral partnerships that seek to increase health access and preventative measures for young people. The program contributes to a growing evidence base on youth responsive health systems, with evaluation outcomes and implementation learnings providing insight for replication in other contexts.

Adverse childhood events are major contributors to the burden of disease overall in Australia (1). Thus, providing prompt support to children when vulnerability (health, social, and educational) is identified, may improve overall health throughout their life course.
The Family Referral Service is a program designed to connect vulnerable families to appropriate health and social care. Through a multi-agency partnership, the Family Referral Service in Schools (FRSIS) program was trialled successfully in 2016/2017 on the Central Coast, NSW, and extended in 2018, to reach three learning communities (total of 13 schools, both primary and secondary), with a combined student population of over 10,000 children and young people.
Stakeholders in this program are schools, the local Primary Health Network, the commissioned Non-Government Organisation, Departments of Education, Health, Family and Community Services and the Local Health District. Representatives from these stakeholders comprise the governance group, which coupled with local leadership in the school communities’ support the program’s operation.
The placement of the program within schools enables teachers to identify children at risk of educational disengagement and/or poor health and social outcomes, and offer assistance via the program. It represents a low-barrier soft entry to health and social care via supported referrals for families who find it difficult to access the care they need. The service model is an early intervention approach to health and social care.
As FRSIS has expanded, the operational delivery by the commissioned NGO has been stable, however, the governance group has experienced considerable membership change. The common core objective of supporting vulnerable children and their families’ has aided in keeping the multiple agencies engaged with and focused on supporting the program. However, sustainability and support of the program depend on the continued engagement of all members of this governance group, thus consideration of the goals of their corresponding organisations is relevant. The current evaluation is seeking to map and align these overlapping and changing objectives to that of the program, its metrics and the policy environment that supports it.
We postulate that building and sharing this coherent understanding will aid in program sustainability as it expands and experiences workforce change both at the operational and strategic oversight levels. Building school communities, with a common vision and strong strategic alignment, are factors that contribute to the programs sustainability as well as replicability and application in other school settings.
Analysis of the policy environment and keeping the strategic organisational alignment of objectives of the multiple agencies which support the program, has shown good harmony with those engaged with FRSIS. It will be important to continue to keep abreast of changes in policy, and organisational focus, and update the program’s narrative and review its operation as needed.
Children and their families are at the centre of the FRSIS model, not the services that support it. This has led to sustained engagement in schools and also at the strategic governance level, where multiple agencies balance their involvement against their organisational objectives.

1. Moore, SE et al(2015)Child Abuse Negl.48:208-220.