Professor Rachel Skinner [00:00:05] Good afternoon, everybody. I'm welcoming you to the Wellbeing Health and Youth Webinar for June, and I just want to first off say that this is part of the webinar series for the Wellbeing Health and Youth NHMRC Centre of Research Excellence in Adolescent Health. We acknowledge the support of the NHMRC and also our research partners across different universities and the Commonwealth Government. We also acknowledge the traditional owners of country throughout Australia and recognise their continuing connection to land, waters and culture. And we pay our respects to their elders, past, present and emerging. Now just a quick reminder that we have the WH&Y community of practice website where you'll find all of the past webinars that you can browse through and pick the ones that you enjoy. We have quite a library of those and all of the up to date resources that we become aware of and also that our research is producing. Just to remind everyone about the chat function. So you're all muted. You can't ask questions verbally on this platform, but you can please put in lots of chats, and also questions as we go through the webinar. And then at the end of it we'll highlight the questions that we can get to. So thank you for your contributions to that. 
 
Professor Rachel Skinner [00:02:03] I'm really very pleased to introduce our speaker for this month, Brianna McCoola. Brianna is the Principal Project Officer of the Queensland Child and Youth Clinical Network [QCYCN], and previously she worked as a radiation therapist in young adult oncology for more than 15 years. Brianna is passionate about improving the experience of care and health outcomes for young people across Queensland, and she values and prioritises collaboration through co-production with health professionals and consumers. Brianna was the lead author and facilitator of Optimising Adolescent and Young Adult Care in Queensland Strategy. Now, just before Brianna starts her talk, which will kick off with the next slide, I probably should introduce myself. So I'm Professor Rachel Skinner and I'm the Deputy Director of WH&Y and I'll be hosting these webinars over the next number of months while Kate's [Professor Kate Steinbeck] on leave. Okay. So, thanks, Brianna. You can take it from here. 
 
Brianna McCoola [00:03:15] Wonderful. Thank you so much, Rachel, for that lovely introduction. Good afternoon, everyone. Thank you so much for joining us today. And to the WH&Y for inviting me to speak. My name is Brianna McCoola. I'm a clinician and probably call myself a novice researcher in the area. I love working with adolescents and young adults and particularly have really enjoyed my time with the Queensland Youth Clinical Network on this work. So today I'd like to present the Optimising Adolescent Young Adult Care and Queensland Project and Design Statewide Strategy, the Queensland Child and Youth Clinical Network, or QCYCN, as I may call it at some stage during this presentation, are a collaboration of clinicians from across the health sector in Queensland that have been working really hard since 2020 to champion the needs of youth in health, with the ultimate goal to optimise the care that all adolescents and young adults receive in Queensland. And so before I  begin, I'd really like to pay my respects to the traditional custodians on the lands on which we are all here today, on which we work, walk, talk and live and acknowledge and pay my respects to the Aboriginal and Torres Strait Islander elders past, present and future. For me here in Brisbane, that is the Jagera and Turrbal people. So thank you so much for your knowledge and wisdom to guide us, particularly in this work. Before I go any further, I've got a little video that I'd like to start off with. This is just a little bit of a very short resource that we created last year to complement the work that we had been doing. It was co-designed, authentically engaging young people in conversations about their experiences and what they believe quality adolescent young adult care is. And from those beautiful interviews with a group of young people, we were able to craft a bit of a promotional resource. So I'll just play that now. 
 
Brianna McCoola [00:05:36] [video starts]:
 
Speaker 1 [00:05:36] I would often have to navigate the health care system on my own and would know enough to understand that there was more I could get out of the health care system. Even from the very start whether it was with the GP or it was with the mental health care professional, I wasn't being listened to and I wasn't being heard in terms of the issues that I was going through. Not even to mention the difficulties of accessing care at almost every point. 
 
Speaker 2 [00:06:03] The discussions for me were extremely stressful. I didn't have my parents here. I found growing up to be one of the most stressful experiences of my life and I didn't really know what was happening and didn't really know what's going to happen. If I had to stay the night, if I had to go home or anything.”
 
Speaker 3 [00:06:17] It's really easy for me to access psychoactive drugs, but it's very hard to find someone who's willing to listen and have a conversation with me. And believe me. 
 
Speaker 4 [00:06:29] I felt that I wasn't guided in the direction that I needed to be guided in order to get the answers and to access that level of health care that I really needed. 
 
Speaker 5 [00:06:39] I actually found a lot of the difficulties were the amount of information that was given to my parents as opposed to me. Difficulties with not being given the complete picture. Not really being provided enough information to choose between services. 
 
Speaker 6 [00:06:52] I need to feel that I have all my options on the table. I need to feel like I know who, how, where and when to access a service and how those services actually work. 
 
Speaker 3 [00:07:05] Encourage me to help myself rather than tell me what to do. 
 
Speaker 5 [00:07:08] Young people are merging into their own agency and developing their own independence, and then if you're transitioning immediately from a pediatric framework to an adult framework, you're not actually providing the individual the skill set to move from one system to another. So I think it's about recognising the stage of life. I think it's about recognising the different illnesses that people experience at that age compared to children or adults. And also recognising that a little bit more proactive support can be required. And it's not necessarily a failure in the young person or reflection of their health status. It's just a very normal response in a very normal age group so that they can eventually become fully independent within the adult system. 
 
Speaker 6 [00:07:52] Having everything there to support people transitioning between those stages of their life. That is crucial because so many things change in that time frame. Your body is going through hormonal changes that can affect symptoms, that can affect medication dosages, treatments, consent changes as well. There's a lot of different things in that area that are really just glazed over. So, you know, helping to create better processes, transition of care and educating people on how to communicate to that demographic. I think it's so crucial to help you then manage your health care further as an adult and to better health care outcomes overall. 
 
Brianna McCoola [00:08:53] And so we hope that that little video resource is just a really nice reminder, I think, to the health system that what young people in the majority want from health services is not infrastructure, it's not independent hospitals that just have adolescents and young adults in it. It's about having developmentally adapted and appropriate care that is supported during these years, that they're not only interfacing with the health system but also growing into adulthood as young people. And we are so thankful to the young people that contributed and were part of that part of the project. 
 
Brianna McCoola [00:09:43] First off, I just thought I might provide a little bit of a background around Queensland Health. And from a systems level, I've learned a lot over the last two years, I suppose, in the difference between health care systems and structures around Australia. In Queensland we have 16 independent hospital and health services across our state, and so each hospital and health service is its own entity under the Department of Health. So you can see here on the left I've got a little bit of a graphic here around who is the Department of Health and what sections there  are within it. So the Department of Health has lots of individual sections that look after different pieces of the health system. And within the Department of Health, they also have the hospital and health service boards that flow down into each hospital and health service that we have in the state. So essentially we have 16 independent entities within Queensland that are all commissioned and all receive funding from the Department of Health but are in a lot of ways independently operated. The Queensland Child and Youth Clinical Network sits under  clinical excellence Queensland, which is about four down on the left hand side in the green box. Clinical Excellence Queensland has a network of clinical networks that have been set up since the early 2000s. These clinical networks are really that mechanism within our system to encourage cross-sector collaboration and cross HHS collaboration. The majority of the clinical networks are stream or discipline based, but we are population based with the Queensland Child and Youth. And so within our clinical network we have our membership, but then we have that governance pathway up through clinical excellence and then through to the director general and then the Department of Health. 
 
Brianna McCoola [00:11:48] And the journey that Queensland has been on over the last little while has been one of great growth from approximately 2010 to 2020 there were some incredible, really strong disciplines, specific or location specific initiatives happening across the state that were taking best practice evidence and applying quality care for adolescents and young adults. But they were isolated and they weren't as interconnected as I hoped. Potentially if we took a diagnostic across our system now with the work that we've done there is more connection between these pieces of work. Some of the initiatives that were really strong were out of oncology with the Queensland Youth Cancer Service, which I had been a part of clinically before coming into this role. And areas such as mental health have led the way for a long time in providing developmentally adapted appropriate care to adolescents in Queensland. Diabetes and renal have also done really excellent things to try and advance the agenda of young people within health. 
 
Brianna McCoola [00:12:58] In 2020, Clinical Excellence Queensland with these clinical networks, have a mechanism to hold a Clinical Senate meeting and they hold these three to four times a year and they tend to be around topics that are being brought up within high level strategic meetings as pinch points in our system. And so in December 2020, the Clinical Senate hosted the Adolescent to Young Adult Care doing Better meeting, which saw clinicians again from pediatric and the adult sector and right across the system come together to talk about how the system was going and how care was being provided to adolescents and young adults. We had the incredible Dr. Susan Sawyer provide a keynote address via Zoom in December 2020 with the environment that we were in at that point in time with COVID, and she was really able to elevate the evidence around adolescent and young adult care and that potentially some other states and territories are much further along in their journey in being able to optimise and improve care for young people. 
 
Brianna McCoola [00:14:10] The clinical Senate came out with a list of recommendations, and from that the Queensland Child and Youth Clinical Network were able to garner some funding to execute. Potentially it will start the journey towards execution of a couple of these recommendations. And Dr. Lucy Holland preceded me in this position and was incredible at bringing together some of the pieces of work. 
 
Brianna McCoola [00:14:38] And so, as I said before, of these 26 clinical networks across the system, the majority of them are stream or discipline specific. There are some population ones. There's the rural and remote clinical network, the Queensland Aboriginal and Torres Strait Islander Clinical Network and the Child and Youth. And the role of the clinical networks is really to be that collaborative lever for clinician expertise in the system to share research, to promote partnership and to execute and review evidence based and best findings, and be that voice of reference through to the Department of Health on specific topics. 
 
Brianna McCoola [00:15:23] This is our structure, the Queensland Child and Youth Clinical Network. So we are one of the biggest clinical networks in our system currently from what we understand. We then have sub networks that sit underneath our clinical network. So specifically the adolescent and young adult sub network was formed under Dr. Lucy Holland when she was in the role and continues to be a strong and incredible force today to really advise and work on all of the efforts that QCYCN produces when it comes to youth health work. We also have the Child Health Sub Network, the Child Development Sub Network, the Digital Child Health Sub Network. We have the Pediatric Palliative Care Working Group, school based youth health Nurse Sub Network, the Pediatric Palliative Care and Hematology and Oncology Clinical network. And we did previously have an Aboriginal and Torres Strait Islander clinical network as well. But this one is currently just going through a little bit of a restructure. 
 
Brianna McCoola [00:16:28] So our goals for adolescent young adult health care are really around creating that statewide all of HHS collaborative multi-sector approach and not just being from public health care. But being from private, primary, tertiary and NGOs as well. We really strive to elevate the evidence base and do that through the collective expertise of all of our clinicians. We are very much a knowledge sharing and confidence building platform. We hope, and really try to empower clinicians and make sure that we are putting forward those really strong advocacy efforts through to the Department of Health. So we really strive to make sure that we have got that statewide collaborative voice through to the Department of Health that works with Children's Health Queensland as a hospital and health service entity and elevates the needs of all families, children, infants and young people into all of the work that we try to do. 
 
Brianna McCoola [00:18:06] And so this was the Clinical Senate in 2020. It listed these great recommendations that our system would really benefit from actioning. The Clinical Senate is again, a collaborative function within our system and doesn't have any funding lever as such to be able to execute the recommendations. The first key recommendation was really around the co-design of a statewide system level strategy that clearly defined the adolescent and young adult group, address the care that they are currently receiving, provide the evidence around what care they should be receiving, and also promote that shared language within our health system. There are other recommendations there as well, including a systems level framework for adolescent young adult services supporting transition of care. Education and training was really key to come out of the clinical Senate meetings as well, because health professionals very much report that they often feel out of their depth potentially or don't feel as up to date with the information that they really need to advance or improve their practice when working with young people. 
 
Brianna McCoola [00:19:30] So the Queensland Child Youth Clinical Network sort of got straight to work. We were involved in the creation of those recommendations from the clinical Senate. And so we were given a small funding envelope to start the process. And first off the rank was that shared definition and being able to contextualise the evidence, international and national evidence, contextualise it and check it against Queensland and really gather that expertise through the AYA network to inform this foundational document. And so Dr. Lucy Holland was the lead author of this AYA care position statements, and this underpins everything that we do and that every young person 12 to 25 years should have access to the appropriate quality adolescent, young adult care regardless of where they live or receive care, whether that be mental health care or physical health care. And the ultimate goal is to make sure that young people are able to access this in all parts of our health care system in Queensland. And then we had the excellent opportunity through the clinical networks. We applied for, again, a small funding envelope to continue and build off this position statement to co-design the strategy and really meet that first recommendation that came out of the clinical Senate. 
 
Brianna McCoola [00:21:06] And so Dr. Lucy Holland and myself sat down and started to work out how we were actually going to create this strategy to meet all of the markers that we wanted it to meet. And so we developed it using a co-design mixed methodology. And this was really important to ensure that the evidence that we gathered and the evidence that is very much strongly put out through the literature is adaptive and justifiable in the context of the health system across our state. The design of the strategy was done over several stages with focus groups held during February of 2022, which was just after our borders opened. And so it was during a bit of a peak wave of COVID, which made us a little bit nervous. But we were absolutely delighted with the buy in that we had for not only consumers but health professionals during that point in time. 
 
Brianna McCoola [00:22:11] So we used a PDSA cycle, and because it was really important for us that consumers felt really comfortable to contribute their ideas and thoughts, we took this appreciative inquiry model to really talk about their experiences within health care and whether that's within the hospital and health system or whether that was in primary care or with an NGO. Dream about what could be in the future. Talk through those streams and think about how we could design them within the systems that we currently have and then actually be able to turn those experiences and those dreams into recommendations that are tangible at a system's level within a Queensland Health or a government strategic document. 
 
Brianna McCoola [00:23:05] As I said, we ran these focus groups and their co-design methodology during that point in time, in February of 2022, we were so fortunate that we had an excellent amount of young people, carers, health professionals and chief executives from right across the state.  We had multiple young people from the same location in a few places. So the co-design process was done not only through the focus group we also incorporated a mixed methodology and also completed a statewide survey. So again, the survey was for young people, carers, health professionals or chief executives and allowed people to participate if they didn't have the capacity to deal with a real focus group. The outcomes of these two stages were collated to inform the draft of the strategy and the focus groups were facilitated by myself and Dr. Lucy Holland. But we also pooled the consumer focus groups, had the incredible Annie Christopherson, who presented with me at the AAAH last year, and so she helped lead the consumer focus groups as a lived experience facilitator, which was absolutely incredible to have her there to guide the conversation and Lucy and I to really be able to ask more questions and delve deeper to try and get really quality data. 
 
Brianna McCoola [00:24:52] I like to flesh out the consumer focus groups a little bit more. I really encourage other professionals to consider this approach. If you do ever have the opportunity to co-design something with young people. The OPAYAC focus groups, we only held three focus groups, which doesn't seem like a lot, but that nine hours of incredibly rich discussion gave us such an incredible base for analysis. As I mentioned, we had the lived experience facilitator and myself and Dr. Lucy Holland. We had two focus groups that were young people only, and we knew that that was really important for young people to be with other young people. But just because of scheduling and personal preference, one of the focus groups was a mix of carers and young people as well. We were really flexible with the time that we offered these focus groups. I think that the two consumer focus groups were at night time, that 7.00-7.30pm mark after work. They're all online via Zoom. And as I said before, we had that statewide survey to support any participant who wanted to spend 10 minutes answering some questions instead of a longer period of time. 
 
Brianna McCoola [00:26:13] The survey questions were a mix of open questions similar to what we asked in the OPAYAC strategy, but did also have a good amount of directed questions with the option for the consumers to always contribute their own ideas as well. All of the work that we have done has gone through the low risk ethics application with the idea that we will publish our results from this work in the future. And we had to fight a little bit, but we actually had ethics approval to engage anyone 15 years and older, which was a little bit of a discussion backwards and forwards with being able to get young people to participate in this work. 
 
Brianna McCoola [00:27:04] I've also just got this little bit of a diagram. I'm just keen to represent, I suppose, that continuous feedback loop that WH&Y champion all the time in all of their work in that the consumers were there right from the beginning in the first conversations we're having about creating this strategy and then we continuously feed back to them throughout the whole stages of creating the piece of work and the end product. 
 
Brianna McCoola [00:27:34] And so what did the participants tell us? We asked consumers and professionals about their experiences of receiving or providing care to young people and really what those barriers are within health for young people and what opportunities they believed might work towards optimising care for this population. So young people told us about feeling unsafe, unseen and not listened to. They felt disempowered when they engaged in health care and that their concerns were either not important enough or not relevant enough or acute enough to gain the support that they really wanted. The young people were incredibly brave with the stories that they shared, and they spoke about times when they felt like they didn't belong. And because they'd never seen someone else their age or didn't even think someone else their age may have the medical condition that they have. And so the health professionals across Queensland as well really echoed those sentiments and sort of put out there that they really recognised that the services in the majority didn't feel youth friendly or flexible, and they worried that young people get lost in our system and lost to follow up because of barriers that exist for the population. 
 
Brianna McCoola [00:28:55] And so this is just another little thematic diagram demonstrating how we came to be at the final product. We had the 81 participants in the focus groups with health professionals and the chief executives included. 107 participated in the statewide survey, and then we used those results of 188 people in stage one, and we looked at the evidence from all of the literature and matched it up against what we knew was quality, adolescent, young adult care and where the system should be heading. From this, we developed the strategy. And so this was done in concert with the adolescent and Young Adult Sub network, and particularly the co-chairs of the sub network worked quite hard on really refining the draft strategy, before it went out for consultation. I had the big job of I think we were sort of sitting in around the 110 page mark when I went to the co-chairs of the Sub network and the co-chairs of QCYCN and they were like, this is incredible and wonderful, but can we make it a 15 pager? And so doing that, taking something that was so big and robust and expansive and still attempting to not lose the meaning and all of the evidence was definitely a challenge. But definitely something I would recommend and I hope in the future I get the opportunity to continue to refine my skills in this space. 
 
Brianna McCoola [00:30:36] We then went out to community consultation and it was a short community consultation. It went out through the clinical networks, it went through all of the Stage one participants and went out really broadly by email. And I think I sat and worked out potentially how many email inboxes it hit, and it would definitely be the three or four thousand mark at that point in time. So this was sort of like June of 2022. They fedback either via providing feedback on the document or via a survey as well that they could feedback about what they thought of the actual strategy. And then we finalised the strategy in August, September. 
 
Brianna McCoola [00:31:16] And so this is our optimising adolescent young adult care in Queensland strategy. It defines the recommendations, the statistics and evidence of health care in Queensland for young people. And it briefly defines what quality adolescent young adult care is from the results of what the young people told us, the carers told us and the health professionals told us in those Phase one consultations. 
 
Brianna McCoola [00:31:44] The recommendations that were produced from the strategies, we defined them into pillars and said these pillars are optimising care for young people to really make sure that we're providing that integrated, consistent service across our system. The second pillar is maximising partnership and collaboration across our health services to make sure that there are secure and navigated pathways and they are so vital to improving the care we deliver to young people. It's also about maximising partnership and collaboration with young people and their families to make sure that what we are investing in is a health system that is relevant, and it's going to hit the mark. 
 
Brianna McCoola [00:32:30] The Empower and Educate was another pillar that we pulled out because, again, we had this very strong evidence to support that health professionals feel at a loss. Providing good quality care to young people and clinicians who feel disempowered by the system that largely remains in Queensland. A lack of systems recognition around adolescents and young adults as a unique cohort within health. And so therefore there is a lack of recognition of health professionals with specialist skills that effectively work with young people. 
 
Brianna McCoola [00:33:03] And then finally, systems change in order to make progress in an embedded and resourced way. We have a list of recommendations as well for the system. The OPAYAC participants identified all of these recommendations. They really talked about the fact that they didn't talk about infrastructure. They talked about models of care services and facilitating young people to feel more comfortable and and more at ease when they come into our health system. The recommendations were all split up for immediate short term, short to medium term and medium to long term. And the responsibilities for Queensland Health or the Hospital and Health Service. We also put in there some very light, a bit of an anticipated costing key as to what investment these areas will need in order to be able to execute these recommendations. 
 
Brianna McCoola [00:34:26] And as is sometimes the case, the strategy development did not come with a substantial funding envelope to execute the recommendations afterwards. I probably was a little bit hopeful that maybe there'd be a magic meeting that would come up after the produced strategy has been endorsed by the DG of Clinical Excellence Queensland, and that suddenly there would be a bucket provided to us to help the Department of Health consider how we can execute these findings. But one day we hope that this document will still continue to guide the health system to move to where the people who participated in creating it have really told us that it needs to go to make care better for young people. 
 
Brianna McCoola [00:35:20] So Queensland Health is really encouraging of using the existing systems levers, particularly through the Queensland Child Youth Clinical Network to continue to execute this work. So we've been supported with the carriage by the continual funding of the principal project of adolescents and young adults in Queensland, which is the position that I'm in and I'm happy to say, which I've only probably found out a couple of weeks ago, but that has been supported into 2023-24. So we will continue to have the opportunity to execute this through the FTE with the Queensland Child and Youth Clinical Network. My work or the work of QCYCN and the AYA sub network  have also been very much supported to execute any of the no cost recommendations or tweaking any of the low cost recommendations to find a way that we might be able to achieve them with no cost. So we are being encouraged to keep doing the work. We just haven't quite got as we all would like a big bucket of money to be able to really make some embedded big systems changes. One of the key recommendations in the clinical Senate and in the optimising adolescent Young adult Care in Queensland strategy was to move towards some systems recognition around transition for adolescents and young adults in health care and also around that health professional education piece. So that's what we've been concentrating on this financial year, 2022-23. 
 
Brianna McCoola [00:37:16] And so in March of 2023, we hosted this particular meeting or workshop, AYA Transitions Workshop, improving safe transfers of care into an adult health system. And we had the two incredible keynote speakers, Professor Dr. Kate Steinbeck and Associate Professor Dr. Simon Denny come and provide those keynote addresses around the evidence around transition, but also the evidence and clinical practice that's appropriate and works with adolescents and young adults. So we were very fortunate to host this event in March. We had just over 200 health professionals come in person and online. We were sold out for in-person tickets. And so not only with the keynote addresses, we had several presentations across the day identify and talk through barriers and enablers in our system, and also participate in the opportunity from each clinician's expertise, contribute what they thought was relevant for people, young people transitioning to their part of health care and elevating that expertise to sort of describe it as a whole of health care systems level. 
 
Brianna McCoola [00:38:36] And so from that meeting and under the expertise of a statewide transition's working group that we've had during 2022-23, we have created another position statement. And we really hope that this will be a foundation to advise and move forward discussions in Queensland around what supported transition care is. The position statement presents the evidence. It gives details about what's currently happening in Queensland, but most importantly it brings together those 200 clinician views around what are the principles, approaches, practices and the roles and responsibilities when it comes to a young person moving around within the health system. So this is pending approval. This draft is going to the AYA sub network this afternoon straight after this meeting. So it will be going out for systems consultation in hopefully the next 4 to 6 weeks and we hope to have this published by early August. 
 
Brianna McCoola [00:39:47] The other thing that we've been working on is the health professional education piece. We've been executing this in two ways and we have been working with our university partners and we hope to have some exciting announcements in the near future with UQ and QT. But I've also been working with eight incredible young people to create a practice guide for health professionals. So this is really expanding on that very foundational small piece that was a part of the OPAYAC strategy optimising adolescent mental care strategy and really fleshing out what do young people want to tell health professionals about how they want to be cared for? What are the tips and tricks and what's important to them? And so this guide has been co-produced by young people we had at our last meeting this Friday. They will probably be renaming it as well. But this is where we're currently at with our best shot with the name of it. They will be designing the look and the feel of it as well. So it has been an absolute pleasure to learn and work with these young people and talk through things like communication, consent, confidentiality, psychosocial assessments, youth friendly environments, flexibility and partnership. So it's been an incredible process. Watch this space. Again, this will be going out for systems consultation hopefully in the next month and a half. And we hope to have this published in September, October. 
 
Brianna McCoola [00:41:31] And where are we heading next year now that we know that we will have an avenue to execute some pieces. The second key recommendation from the clinical Senate meeting and something that was definitely brought up by health professionals and chief executives as a part of the OPYAC strategy was around creating a systems level framework or guide to support health services to better deliver quality care to young people. So New South Wales Health has the role of Integration of Clinical Services Guide, which outlines scope, service requirements, workforce and minimum linked services. Here in Queensland we have separate modules and these are called Clinical Services Capability Frameworks, and each module is on a specific topic. Currently Queensland have some children's frameworks and we do have quite a lot of adult frameworks. And the children's modules really do champion the safety and quality needs of adolescents in health. But with many young adults and many adult services caring for adolescents, those 15 and 16 year olds that are being seen in whole of life, HHSs or hospital and health services across Queensland, what we find or what we've definitely heard is that the safety and quality needs of those young people, those adult or whole of life HHSs don't recognise the children's or the pediatric framework as relevant to their service delivery. We do have frameworks specific to mental health and alcohol and other drugs for youth. That's a sector about health care that's really well developed and quite well embedded, but nothing else that is a broad system, a whole of health care framework that defines care delineation and best practice for young people within health. So this is pending approvals. We're still waiting to see where this lands. But we have had success in the last couple of weeks, we have gotten through another checkpoint in our journey to get the approval to actually start executing this work. 
 
Brianna McCoola [00:43:55] Queensland continues to have really strong local initiatives across the state with some streams and some specific services achieving really great things to meet the needs of young people and doing wonderful things, applying best practice. So the Queensland Child & Youth Clinical Network is definitely not the only player in adolescent and young adult health care in Queensland, but I think that that's part of the reason why, from a systems perspective, levers such as clinical networks or collaboratives of clinicians are really important to continue to invest in and nourish. Our membership is very important to us and the work of the AYA  sub network over these last two years has been incredible. 
 
Brianna McCoola [00:44:42] In Queensland we also have a new Health Minister and she has a very strong portfolio, including women and girls, youth justice in the first 2000 days. And all of these topics really have a strong prevention and holistic lens and response from health. So the Queensland Child & Youth Clinical Network is still really working out where is the best fit for this work and for potentially elevating the strategy in the future to see if we can secure some sort of funding mechanism to actually execute some of the recommendations. But we're still really working out where that best aligns with our current changes within Queensland Health and within the Queensland Government. 
 
Brianna McCoola [00:45:36] And that's nearly the end. I just would like to acknowledge the many young people, carers and health professionals that co-designed the strategy with us. Without their input, insight, wisdom, none of this work could have been possible. And every stakeholder organisation, NGO, professional service that contributed to the strategy has created something that's quite meaningful, I think, across the system. Simple but meaningful. And we really hope that this  definitely underpins a conversation for the future. So a huge congratulations again to the AYA Sub network and all the members that contributed their expertise and we're really pleased we have this strategy and continue to be supported in this work in Queensland. Thank you. 
 
Professor Rachel Skinner [00:46:32] Thanks so much, Brianna. That was really so interesting. And I must say that, you know, it's particularly interesting for me because I'm also in my other job working as senior clinical adviser in youth health with the New South Wales Ministry of Health. And so we've been doing a lot of similar work, I suppose, over the years,  and it's interesting to see different health systems, how in many ways they have different needs to the different parts of their structures. They're quite similar really and the challenges to bring and raise the profile I think of young people within a health system that originally was probably not developed with young people in mind, the younger age group perhaps. And the older age group definitely, but not so much the adolescent age group. 
 
Briana McCoola [00:47:29] Definitely not. And, you know, looking back on how we've evolved as a society and how adolescence has come to be, I know that pediatric health care certainly didn't have its own little sector, you know, back in the 1930s and 1940a. And really over the past 50 years in health care, it's evolved to be the incredible system that it is today. And I'm really hopeful that continued work in this space and coming after champions such as yourself and Kate and all of the incredible clinicians that do this work with young people, that one day we may move to a system that really meets the needs of the young people that are coming through. 
 
Professor Rachel Skinner [00:48:13] And your work is contributing to that, which is wonderful. 
 
Brianna McCoola [00:48:16] Tiny little bit. Fingers crossed. 
 
Professor Rachel Skinner [00:48:20] So we'll get to questions. Daniel Waller, I think has got a question and so we'll ask that first. "Has there been any challenges or benefits of being a population based rather than condition based clinical network?" 
 
Brianna McCoola [00:48:41] Absolutely. It makes everything so broad and I think there are  negatives and positives. So we are able to make, I suppose, all of the work that we put forward relevant to everyone, which is a real enabler in being able to say that we aren't just a specific piece of the puzzle. I think one of the barriers within potentially any health system, but definitely in ours, is that there are these pockets of excellence that are happening in different streams and sectors and so therefore they feel only relevant for that sector or that population. Diabetes has done an incredible job of creating really clean transition pathways between pediatric and adult services. Renal have followed their steps, but other parts of health care haven't or potentially don't have the actual mechanisms or systems in place to be able to do that. So it's not only about, I suppose, the want and the desire, but it's also about where our system currently is. There's lots of places within the adult health system where young people don't have a mirrored service that they might have in the pediatric system. So that's definitely a challenge for those specific streams. But I think finding that commonality and me coming from oncology, you know, to start with, I did do the whole, I'm just a clinician from a small part of oncology, what have I got to contribute? But when I was able to take a step back and think about the work that's been done nationally and internationally in oncology and adolescent young adult care, I realised the relevance. It's all the same. And being able to really push that message that we can do this collaboratively as a whole system I think has really energised people to be able to continue their discussions and the advocacy work in their own specific spaces. 
 
Professor Rachel Skinner [00:50:50] That's great. Thank you. Right. So we have another question from David. "How many young people were specifically involved in every stage of co-design, including the position statement? Were the Queensland Prevention Stream  involved? Did you consider the unheard voice in the room?"
 
Brianna McCoola [00:51:21] Absolutely. Great question, David. Young people, we're really fortunate in some of the mechanisms that we have in order to be able to engage young people in a really meaningful way through the sub network where we have the opportunity to pay consumers. So those consumers have actually been involved in all of the pieces of work and sit within our clinical experts to be able to participate in all of the pieces. So specifically the position statements go to consumers as well as a consumer agency called Champion Health Agency here in Queensland. We're quite involved in the production of the position statement. With the OPYAC strategy we had a project envelope, a funding envelope and a timeframe for execution. And like I said, we did the focus groups in February of 2022. So it was very much trying to take on that coalition of the willing. So in that original phase there was a small number of young people that we really heard from, and I think that was part of the reason why we actually asked for it to be a longer focus group, to make sure that we really heard from these young people and they had the opportunity to contribute. So there was a small number, there were quite a few more that participated in that statewide survey because of the fact that they didn't want to come to a three-hour meeting. And again, the survey was voluntary, but the focus groups were remunerated. So there were some systemic structures, I suppose, that stopped us from being able to extend the consultation for months and months as well as we only had a finite amount of funding that we could actually allocate to consumer remuneration. 
 
Brianna McCoola [00:53:25] But since then, and something I didn't mention, the creation of the practice manual with the young people that I'm working with, when we re-engaged these eight young people, we retested the  OPYAC data to validate whether or not it was relevant for them. And then we also went out to the Create Foundation, which is the leading NGO of Out of Home Care for young people here. And we actually helped another focus group with the Create Foundation to  again ask those questions that we asked in the OPYAC strategy and see if it was relevant to them and pull those familiar themes, those same themes from all of those different focus groups. We've definitely reached out to Aboriginal and Torres Strait Islander youth groups, the Child and Youth Mental Health Working Consumer Group that we have here in Queensland. So we've definitely reached out and hoped that people would be interested in participating in our work. We do have to find a bit of a balancing act I think, and be able to execute these pieces. It's part of the reason I wanted to spend six months working with young people as well on creating the practice manual. I wanted to spend the time to make sure that that co-design piece was done really authentically, properly. 
 
Professor Rachel Skinner [00:54:56] Great. Thanks. One part of David's question sort of sparked interest from my perspective, and that is how well were you able to engage the different systems within government, across Queensland government. So I mean, David's mentioned the prevention health, I think or  population health or whatever that is called. And those are the parts of Queensland Health and also potentially across government even. 
 
Brianna McCoola [00:55:29] I think in the first phase of creating the strategy because we're not a new entity but we were probably newly playing in this space, there was definitely that, that's great that you guys are doing this, but it wasn't a really engaging piece. The Queensland Prevention Stream or Strategy branch of the Department of Health were incredible at providing really valued feedback in that Stage three consultation piece and were really able to put some beautiful edits into the strategy as well as other parts of the government and the NGOs here in Queensland. So they were definitely involved in the strategy, the final publication of the strategy, and we've really strengthened our partnership with the youth sector of the Queensland Government, particularly since publishing the strategy. I think that the publication is a little bit of evidence that we're a player in the game and we really are an avenue for any part of the system to gain that clinician expertise on specific topics. I think that answers your question. 
 
Professor Rachel Skinner [00:56:44] Yes, excellent. Thank you. So we have a few other questions. Philip: "I wonder how it is going engaging young males because, you know, typically young females are more easily engaged in a health consultation." 
 
Brianna McCoola [00:57:00] Yes absolutely. We have had more young females, adolescents and young adults that are female participate in all phases of the work. As you saw in the video, we had two incredible young men contribute to the production of the video and we've had a few more that weren't in that video. One of the young people that's on the current project identifies as he / him. And so it's definitely not none, but it's not 5:050 either. So we continue to just really promote this. I should say that when we put out the expression of interest for the practice manual, because the practice manual, you know, I really wanted young people to help author it. We put out an expression of interest and we wanted to keep it to a sort of small team. But we had 45 young people from across Queensland apply to be in this practice manual group and the applications were about 50:50 young men and young females. And it was just that when we looked at wanting to make sure that we had really good diversity in our group and diversity of experience, that we did end up with a few more females than than we did the singular male in our group. But the interest is there. And I suppose for me as a person working in this space, it's potentially about me making sure that I continue to consider that as a potentially a barrier for young men engaging in this work and continue to promote and nourish it. 
 
Professor Rachel Skinner [00:58:37] So maybe quickly, Jeremy's question. "Can you clarify your ethics challenge and was it around obtaining approval for the 15 year old consumers to be able to provide their own informed consent?"
 
Brianna McCoola [00:58:52] Yes. And you've hit the nail on the head. Children's Health Queensland. Even though we're under the Department of Health, as a clinical network, I'm actually employed by Children's Health Queensland, the Hospital and Health Service and Children's Health Queensland have some policy and guidelines around not engaging a patient independently under the age of 18. And then it would always be through the parents for this particular line of work. So yes, we pulled out the definitions around Gillick's competence and we talked about informed consent and luckily we did have Dr. Simon Denny, I believe, may have participated in a little bit of a hallway chat about our project, and we were very pleased to be able to offer anyone over the age of 15 the opportunity to apply. And we still received and drafted consent forms for the parents to consent to the participation in the focus group and facilitated anything the young person wanted. So if they did want their parents to actually come to the focus group or come to a meeting with myself and Dr. Lacey beforehand as well, we just really tried to meet those young people with where they're at with their needs to participate in this work. How can we write a strategy about 12 to 25 year olds when we can only include 18 plus? That was our frustration at the time. So we're really happy that we did fight it. And as much as we'd like to include down to 12, we will still continue to be a little bit of a champion in that space. 
 
Professor Rachel Skinner [01:00:38] Yeah, and you've set the precedent, so that's great. Really wonderful. Now we have reached the end of our hour,  I'm so grateful that you've joined us today and shared all of the wonderful work that you're doing with Queensland Health. It's just really fantastic to hear about it and I really wish you and we all wish you the very best with this new strategy. And yes fingers crossed, it takes on a life of its own. So thanks to everybody for their engagement and we hope to see you in a month's time for our next exciting webinar. So we'll see you all then. Bye bye. 
 
Brianna McCoola [01:01:26] Wonderful. Thank you very much, everyone.