Professor Rachel Skinner [00:00:05] Welcome to the Wellbeing, Halth & Youth webinar for my. Thanks, everybody, for joining us. I'd just like to acknowledge the support of all of our funders over the years, and all of the research organisations and universities we partner with the wellbeing, health, and Youth Centre of Research Excellence in Adolescent Health. And I'd like to acknowledge the traditional owners of country throughout Australia and recognise their continuing connection to land, waters and culture. And, I pay my respects on behalf of everybody to elders past, present and emerging. And I'm joining everybody from Gadigal land.
 
Professor Rachel Skinner [00:01:04] I'd just like to remind everybody about our Wellbeing, Health and Youth community of practice. So, if you can access the website, you'll find it there. And you'll see, where all of our resources please check in every so often to see if there are any new resources that are applicable to you and your work. And again, just to give everybody, a bit of an idea about how this all works. You can you've got a chat function on the right, and you can, put in your questions and at the end, and you can have a conversation with other audience members as you like. But at the end, we will answer your questions. We'll go through and, we've got, Sharon Medlow here, who's helping us. We'll go through and identify all the questions, and we will have time to answer them.
 
Professor Rachel Skinner [00:02:02] So I'd like to welcome Doctor Dan Waller. Dan has a PhD in psychology and a background in health behaviour research. He's worked in several research and teaching roles in, university, hospital and not for profit organisations. And Dan's research focuses on improving the lives of young people, with a particular focus on health and education. Dan specialises in policy analysis, qualitative research, co-design, implementation, science evaluation, research and intervention mapping for health and education programs. Amazing. Dan, I'm hearing, your know, presentation. We do, incredible work.
 
Doctor Dan Waller [00:02:47] Oh. Thank you.
 
Professor Rachel Skinner [00:02:48] Welcome, Dan.
 
Doctor Dan Waller [00:02:50] Thank you. And thanks, Rachel, for such a lovely introduction. It looks like we've got a great turnout today, so thank you, everyone, for your time. It's really nice to have the opportunity to present. And so today I'm going to be talking a little bit about some of the research that we've done through the Centre of Research Excellence, around youth health policy. Before I jump in, I just want to again acknowledge country. Joining here today on Dark Land, I'm at West Mead. And this, artwork is actually from I, a PhD student at the essential that I am working at. The Transforming Education and Child health, research Centre at Western Sydney University. And the title of that artwork is Changing Through Voices, painted by Bradley Barnes. And so I thought it was a nice, image to kind of talk about, because this is really one of the central tenets of the wellbeing, Health and Youth Centre of Research Excellence is really trying to promote that, importance of the experiences and voice of young people.
 
Doctor Dan Waller [00:03:56] Today I'm going to watch for a bit of work that we've been doing. I'm hoping I can stick to time. But firstly, I want to talk a little bit about the current state of, Australian youth health policies and what the scope is there. Then move on to some of the current issues around, policy, development and implementation, and then have a bit of a chat about what we can do. So looking at implementation strategies. Youth involvement in policy, and health policy development approaches. So hoping I can get through all of that. So firstly, why does youth health matter? So a lot of us on the phone call are already fairly well versed in the issues surrounding youth health. But we know it's, adolescents and young adulthood is a really critical stage for health and wellbeing. There's a lot of changes socially and behaviourally at this time. People are getting a lot more responsibility in independence, and it's a time when there's a lot of, health behaviours and service engagement patterns start to really emerge. So how well a young person engages with, health behaviours and services at this stage can be quite predictive of long term engagement as well. It's also a period where there's a number of new health risks, emerge. And some of those are very behaviourally based. So, you know, things like suicidality, drug use, alcohol use, risky behaviours, and then also particular conditions that might appear at this time as well. And there's a lot of evidence to show that effective care prevention intervention during this time can have really strong, lifelong impacts for the young person.
 
Doctor Dan Waller [00:05:31] Then with that in mind, why does youth health policy matter? Well, policy shapes health systems work. Pretty good. Good health system and can at make an impact on health service delivery and can reduce entrenched inequities. We know that youth health is underrepresented in health care expenditure, research and practice innovations. And so we can use policy to try and prioritise the issues and, funding as well that's attached. It's a really good time to look at policy in the youth health space. A lot of nations are really varying stages of policy development. So it's nice to kind of look at what's Australia's doing, and where we're heading.
 
Doctor Dan Waller [00:06:10] What is the current state? So in 2019, we engaged a, in a scoping review of current policies to look at, and trying to determine the extent, range and nature of Australian policy specific to the health and wellbeing of young people. So we're really interested in, policies that we're looking at the general population of young people, and also policies that we're looking at general health and wellbeing. So not a specific group of young people or not a specific health condition like diabetes or mental health or some kind of other, condition. So we conducted the scoping review and we really focussed the scope around prospective policies, plans, strategies, blueprints or frameworks, which were coming from Australian federal, state or territory, government departments and looking at anything published between 20 2008 and 2019. And for us, our definition of youth we used was from anywhere from between 8 and 25 years, and we included expired or rescinded publications because they still impact the policy landscape that we're working in. So the real research questions were, what are the coverage of these policies and what are the key themes of those policies as well?
 
Doctor Dan Waller [00:07:22] We engaged in the escaping review as an alternative to a systematic review. It's great for exploratory research with broad topic areas and you can include non research articles. So great literature and policy documents. And that allows for qualitative analysis of those documents as well. And so really increasingly popular approach to literature. So we conducted thematic analysis in in vivo 12 identifying key themes using inductive coding so that we didn't have a preordained structure that we were doing. We just see that in the data speak for itself and we organise those into semantic themes.
 
Doctor Dan Waller [00:07:57] It's very hard to see the images there, but we basically started with about 790 original websites were identified through government directories and pantos, down to relevant websites, and looked at 126 of those. We then went through a process of searching those websites, and we also searched for peak body and policy websites, which are the Australian Policy Observatory, the Australian US Adolescent Association for Adolescent Health, the Student Wellbeing Hub and Youth policy.org. So that was our way of trying to find these documents.
 
Doctor Dan Waller [00:08:27] And what we found was, 12 policies relevant to the general health and wellbeing of young people that were available at the time.
 
Doctor Dan Waller [00:08:35] Again, this slide might be a little bit difficult for people to see, but what we can see is that there was a fairly good, spread across the states in terms of policies that have been developed. And we did have a couple of national policies as well. And if you look at it, you can see that there's quite a lot of policy development around this kind of 2015 to 20 1819 period. So it does seem to be an increasing area of interest.
 
Doctor Dan Waller [00:09:02] What we did see was an increase in area of interest. And also that there was a bit of variance in the timeline. So some of the policies were around three is, so looking very short term and some of them are around ten years. So a bit of a broader term, approach to policy development in that space. And again, there was variance in the age groups covered, some covered all the way from 0 to 25 years, some covered, you know, 10 to 25 or some actually included, other kind of groups as well. So it might be like maternal health and youth health or paediatric groups. But we did include those, because they did have mention of adolescent health and had a focus on that kind of youth segment.
 
Doctor Dan Waller [00:09:46] From that, we identified that there was three kind of key things that were coming out of the analysis of the policy documents. One was around appointing health, and we could see that there is this move towards an increasing strength based approach and this focus on life course approaches. So understanding that adolescence is a period of time where health behaviours are occurring, that they can have lasting impacts for the young person. And then the more newer policies really have this strength based approach in trying to build resilience for young people. In terms of policy consultation, all the policy documents were developed in consultation with clinicians or researchers or some kind of experts, considered experts. But unfortunately, only six of the 12 consulted with young people, which is a bit of a, concern. Then more newer policies were more likely to, include young people in their development.
 
Doctor Dan Waller [00:10:40] The research and evidence base, the majority of these were quite strong. A lot of them used epidemiological data to build their policy, or literature reviews of the research that are out there. And then a lot of them actually had engaged a specific research project to identify information to build that policy as well. So it was quite a good evidence base that we're working off. And then there was obviously links to other policies that were relevant for that might be national policies or other area specific policies. That might be relevant. So the second thing looked at youth health challenges.
 
Doctor Dan Waller [00:11:17] Identification of health concerns and at risk populations. And then some issues around the health system. And there's quite a bit of talk about the socio ecological determinants of health within a number of the policies and some discussion of intersectionality as well. So a lot of the youth health challenges are quite well understood and quite well, identified within the policies. And then thirdly, there is this thing around policy goals. So the three. By looking at all of these policies, they become these kind of very clear thematic, groups of different goals that are available within policy.
 
Doctor Dan Waller [00:11:54] So the first was supporting public health, looking at things like prevention, intervention and management of conditions. And that had a really strong focus on education and public education, so that maybe through advertising for schools.
 
Doctor Dan Waller [00:12:08] The other thing looked at promoting equity. So increasing access, affordability and availability of services for young people, really focusing on health literacy for at risk populations. And then some health workforce development, particularly for indigenous health workers to support, indigenous communities. And yeah, this this idea of social or ecological determinants, knowing that there are things out there that are affecting the health of young people, that are not necessarily just sitting within the health department kind of scope of practice.
 
Doctor Dan Waller [00:12:42] And then finally this this theme around improving the health service. And that was really looking at service quality and things like youth friendly health services, how health services collaborate and work together in the integration across different systems, whether they're able to share information very easily. And how that kind of process and navigation works for the young person, whether they can move from service to service across the health system in an easy and, easy to understand manner. There's a lot of talk about technology and in terms of, different approaches that might be available, some kind of focusing on regional and rural youth, but then also just utilising technology that young people are actually utilising as well. So focusing on things like SMS messaging rather than sending an email or sending a letter. And then again, this kind of focus on health workforce and developing a workforce who has real confidence in working with young people and the ability to kind of understand some of the issues affecting them.
 
Doctor Dan Waller [00:13:46] The key learnings from this scoping review really chart the development of policy in this space really does seem to be improving. There's an increased interest in increased development of policies when moving away from deficit models towards a strength based approach, and there is a real recognition of socially ecological factors. However, there's not necessarily action on this. There's really strong evidence base for the development of the policies, and growing youth participation, which looks to be a promising thing, is really three clear goals supporting public health, promoting equity, and improving the health system, which seem to be fairly universal across the policies and seem to be a good kind of framework for where we're heading.
 
Doctor Dan Waller [00:14:24] However, the implementation process for the policy so the developments seems to be fairly clear, but the policy implementation processes aren't really discussing on the policy documents, which is fairly understandable. But it does mean that we really don't know, you know, what kind of methods we're going to be using to tackle these socio ecological determinants of health, what the budget or governance structures are going to look like, what the planning, monitoring, evaluation systems are like, how it's going to be implemented, and what kind of success measures are that we could use to determine whether this policy is actually effective and is, having a great impact for youth health. Since we've conducted the, policy scoping that it's important to note that there are new policy developments.
 
Doctor Dan Waller [00:15:07] Queensland have released a, youth strategy, around youth health. And in Australia, this federal government has the Australian Youth Policy Framework, which is trying to look at how some of the kind of, broader, department or interdepartmental issues might kind of come together to affect youth health. So it's going to be interesting to see how that plays out with some of the policies that are already in place.
 
Doctor Dan Waller [00:15:34] With that all in mind, what are the current issues around policy implementation and development? So whilst it's really useful to kind of look at what is out there in terms of scope scoping and the available policies, it's really difficult to identify how the policies are implemented from that document analysis, and it's hard to identify the context and mechanisms that have impacted both the development of that policy and the implementation of that policy as well.
 
Doctor Dan Waller [00:16:00] That's why we conducted some further qualitative research. The aim of that research was to identify general themes relevant to the development and implementation of policy from the perspective of policy workers. So we're really interested in the barriers and facilitators that impact both the development and the implementation of Australian youth health policies.
 
Doctor Dan Waller [00:16:21] WE conducted qualitative research, using semi-structured interviews via Zoom. And we had thematic analysis using deductive frameworks and inductive coding. So the deductive framework utilised was the consolidated framework for implementation research, which comes from the implementation science field which is quite useful to understand how things get implemented within systems. We included policy workers with experience in the development and implementation of youth health policies. And we utilise a convenient sampling and snowball recruitment approach. So we looked for the policy authors. If they were listed within the policy documents, we looked through, federal, state and territory health departments and agencies to try and see if there are people that we could find there.
 
Doctor Dan Waller [00:17:03] We actually relied quite a lot on LinkedIn to identify people because they're not necessarily, put onto a, department website. And then we utilise the networks that we already had as well to kind of try and identify people who might be able to participate, and then just snowballing from there, being able to kind of have someone who's already, participating, identify other people who might be worth talking to.
 
Doctor Dan Waller [00:17:31] A lot of people may not be necessarily, across the consolidated framework for implementation research or implementation science more generally, but basically it's arguing that implementation can be, affected by a number of factors and barriers of facilitators at different settings or contexts and levels of system settings. So within the outer setting, it's trying to understand patient needs and resources. What are the needs of the young person can be affected by cosmopolitanism. Cosmopolitanism which is kind of how different departments or agencies or organisations work. In relationship with others. And then things like external policies and incentives. So what is already out there in the policy landscape that may have an impact on the development or the implementation of a particular policy?
 
Doctor Dan Waller [00:18:21] Within the inner setting, there's things like networks and communications. How do people kind of discuss and talk and work with each other, specific cultures and climates for implementation and the readiness of, that and those things can include, particular resources available. And then those things are around the individual characteristics of the individual people, maybe potentially developing a policy or, responsible for the implementation. So that might be around the knowledges and beliefs of the policy, whether they think it has legs, whether they think it's going to work and how that impacts, the work that they may do, that house, some kind of impact on them.
 
Doctor Dan Waller [00:18:59] Then there's also the processes of implementation. And so that could be the implementation in return in terms of the development of that policy, or also the actual implementation of the the goals and specific objectives of that policy. So how was it planned where people engaged and how was that kind of execution process, rolled out? And then there's the actual characteristics of the policy itself. So is it fit for purpose? You know, do people think it's a good policy? Is it adaptable to new climates? That's kind of thing. So a lot there. But it's a very good model to be able to kind of look at, implementation as a things.
 
Doctor Dan Waller [00:19:37] We're able to, recruit 19 policy people. We had a really good spread across states, and also the federal government. So it was nice to be able to kind of capture a range of perspectives from a range of different health departments to see what the kind of issues were.
 
Doctor Dan Waller [00:19:57] When we looked at the inner setting, there's a number of kind of these factors from the implementation research, framework that were relative, and related. And one of those was, relative priority. And so what we found is that youth health often receives a lot of priority within health departments and within the health system generally. And we found that there was a bit of cannibalisation of attention from other related populations. And we saw that when we looked at the scoping review as well, where, often the policy was developed for paediatric groups and adolescent and young adults or maybe even maternal health and children and adolescents and young adults. And then also other policies in terms of, say, mental health, where there was a bit more funding going towards that kind of, approach in terms of tension for change. It's looking at whether a, there is a kind of, a bit of a movement to towards, some kind of change within a system.
 
Doctor Dan Waller [00:20:55] What we did say there is a groundswell in external attentions, which really helped, policymakers kind of get youth health on the radar. So things like the Lancet commission into, adolescent Health, the World Health Organisation guidelines, a number of advocacy groups, wellbeing, health and youth, CRE being one of those. And a number of academics working in this space. So those kind of things can really help, pursue others, to persuade others to kind of, develop a policy or then also argue for its implementation as well. Within the inner setting, we found that a lot of policy development in the youth health space, and particularly in implementation as well. It's it's working in a, a context of very limited resources, so limited staff and limited development, budget. So that's not necessarily very much, budget to develop a policy within the health space and then also limited budgets to actually implement that policy once it has been developed. A number of of the policies were developed and had some funding to do that, but then they didn't actually have any money to roll that policy out, and it just becomes a guidelines for the rest of the health service to pick up.
 
Doctor Dan Waller [00:22:17] There was this idea that mental health policy seemed to be better funded both for development and implementation as well. In terms of compatibility, there was, this issue around the variability in the degree of control over local implementation. So again, whilst this policy can kind of suggest what needs to occur within the health system doesn't necessarily have the power to mandate action. And there was this idea around a lack of power and authority to really mandate change.
 
Doctor Dan Waller [00:22:51] Then we looking at the outer setting. There was, it was fairly clear that the needs of patients in this case, young people was very well understood by the participants in this study. So the people developing their policies and implementing those policies as well really do have a great understanding of the key issues that are affecting young people for their health and well-being. But they often report that that was less well understood by governments, health departments and the broader health system. So there's still seems to be this kind of thing about, an understanding of the uniqueness and the unique needs of, young people when it comes to wellbeing in health.
 
Doctor Dan Waller [00:23:31]  Then again around the evidence strength and quality, which I, I guess I kind of touched on in that scoping review, is that there is a really strong evidence base for policy development. So there's a lot of research to show what the needs are for young people. However, there's limited implementation science utilisation. So in terms of implementing that policy, there's not very much research, and it's not very much research to identify particular programs or policy actions that might be, the best bang for buck in terms of what you could do to address a particular need. So there does seem to be a bit of a need for more research or some kind of way of gathering that evidence. So the policy, makers can really identify the best programs to help young people achieve health and well-being.
 
Doctor Dan Waller [00:24:21] Finally, there's a mixed approach to publication. A lot of the study, a lot of the policies, came with research attached to it. So they had some funding to develop research, which then get into the policy development. And some of the participants then went on to publish that, informal academic publications, whereas others, it turned into more of a internal, document that was great literature and pretty difficult to find or identify as an outsider. So, that has some implications for the broader academic, field, and that has some implications for replication of work and things like that.
 
Doctor Dan Waller [00:25:05] And finally this, this issue around cosmopolitanism. And so this is really mixed reports on external collaborations. So in this kind of issue around tackling social determinants of health from within the department. So this is kind of issues around being able to have limited authority to direct external services or departments. So, for example, working with a health and an education department or health and justice. There's these kind of cracks and silos between these departments, which make it very difficult. And because there's a clear lines of jurisdiction within the departments and what the, scope of work is. But a lot of these social determinants are sitting outside of that, those clear silos. And so there's this real tension on, what can be done from a specific department on issues that are having impacts on multiple ranges of outcomes, which could be health, education, justice, all these kind of things.
 
Doctor Dan Waller [00:26:05] However, there were mixed feelings on whole-of-government approaches. Some said we need a whole-of- government approach, a whole of government approach. Otherwise we're not ever going to be able to tackle the social determinants of health. And then there are others who had, misgivings and some, I guess, less positive experiences in working across departments. So it's clearly an issue that needs to be addressed in the future.
 
Doctor Dan Waller [00:26:30] In terms of engagement, there was a broad engagement, with youth from the participants. However, they did identify that there were still concerns around tokenism, and remuneration. So a lot of young people involved were not remunerated for their time. And then often there was not necessarily a fantastic feedback loop to the young people to say, this is what we heard and this is what we've done. And then also there was case concerns around marginalisation and that the people who really need the most help are probably less likely to have their voice heard, because they just don't have the time to kind of engage in these policy development, consultations. They've got other fish to fry.
 
Doctor Dan Waller [00:27:10] And then finally, this idea around monitoring and evaluation, there was this discussion that there's a lack of implementation and monitoring of the policies. And then listening to success measures, targets. Some of the policies had quite, advanced, monitoring and measurement frameworks where some of the others had very minimal. So there is a lot of variance in that. And, and I guess that's something to kind of think about in the future as well.
 
Doctor Dan Waller [00:27:41] In terms of this research, there are a number of limitations as a recruitment bias. So the policy work is, were primarily those involved, involved in development of policy rather than those implementing. And they were all from health department funded employees. So you can getting a very narrow perspective of, policy development and implementation for my specific cohort, which can be a strength and can be a weakness as well.
 
Doctor Dan Waller [00:28:08] There is the risk of reporting bias. These are people working in governments and policy. They have reputations. So there is potential for some reporting bias. And we weren't able to do any kind of international comparisons, as yet. But I think that could be an interesting thing to look at. And then obviously these things take time. Qualitative research is a time consuming process. So it's not necessarily easy to come over and over again.
 
Doctor Dan Waller [00:28:38] Concluding from these last two studies, we know the retail policy department has increased. They're very well researched, particularly for development at least. And a lot of work goes into their development. Youth engagement has increased also. However, there are still concerns around tokenism and what that means. What is co-design? What is consultation? And then there's this issue around the lack of clout in the form of funding, resources and political power to dictate or not recommended policy action. So really implementation challenge.
 
Doctor Dan Waller [00:29:10] There's difficulty working across departments, jurisdictions and silence. Limited monitoring and evaluation of that is variable. Limited ability comprehensively respond to the social determinants of health. And we really need a pretty strong political will, implementation plans and monitoring mechanisms required, with policy going forward.
 
Doctor Dan Waller [00:29:33] So with that in mind, what can we do? So I thought, I talked about a few different things. One of the things that I think is really useful about using implementation science approaches to policy is that there is some research that looks at these kind of, different barriers and facilitators to interventions in implementation, and then that can be matched up into solutions and in different ways that have, varying effectiveness for those challenges.
 
Doctor Dan Waller [00:30:06] I've listed a publication there that kind of talks about some of these, and it's still in the very early stages, but it does give us some kind of idea of where we can go once we have identified particular challenges. So when we're thinking about the tension for change and whether, you know, there's enough of a build up for us to really kind of steam forward with, an approach to youth health, one of the things that we can try and do is identify and prepare a champion. So that could be someone within a, particular department and inform local opinion leaders when looking at patient needs, using patient consumer feedback involving patients and consumers in the development or the implementation. And then preparing them to be active participants. So having that really kind of youth focussed approach.
 
Doctor Dan Waller [00:30:55] In terms of cosmopolitanism, you can build a coalition. So getting a kind of strong, group of people all interested in the same thing, which I think y has done very well. And then promoting that club network waving. So looking at ways to join potentially state departments and federal departments and people who are kind of working within this space to to know who each other are and be able to discuss the kind of issues that they're affecting them. And then also developing academic partnerships.
 
Doctor Dan Waller [00:31:23] In terms of available resources or where's the funding issue? Trying to lobby for funding. But then in these kind of resource constrained areas, developing resource sharing. So having some kind of resources that can be shared across departments or across states, and capturing that kind of shared local knowledge as well, and being able to kind of help each other, to, to address the kind of issues that we're all kind of facing.
 
Doctor Dan Waller [00:31:48] And then finally evaluation and monitoring and developing tools for quality monitoring, auditing and providing feedback. And so these things are nothing new. And a lot of this is already happening in the policy space. And it's a lot of it. And it's some of the things that the Wire Commission and the, ICRA are really trying to champion as well.
 
Doctor Dan Waller [00:32:09] Not, you know, groundbreaking solutions, but at least it kind of gives us an area to focus in on and say, well, this is what we're trying to change and this is how we're going to do it.
 
Doctor Dan Waller [00:32:20] So with that in mind, I also, I thought some good resources for youth voice and co-design that can be, utilised for policymakers. There's the Why Youth Engagement Framework and Guidebook, which will be available on the Y, website. And then there's a Young and Resilient Research Centre code research toolbox, which again, can be kind of proxy for policy development as well.
 
Doctor Dan Waller [00:32:43] The the young Resilient Research Centre has just a huge amount of tools and resources available, and I would encourage everybody to have a look at that. There's some fantastic stuff that they're doing, which is really relevant to youth health.
 
Doctor Dan Waller [00:33:01] Then finally I thought I would finish, with a bit of a case study on policy development in action. And this is working from some stuff that's a little bit old now, but it does have a bit of a, I guess, a how to involve young people in the development of policy. So the access three studies, we're engaged the New South Wales Health, engaged, some of our researchers from the y Commission as y cra through competitive tender to conduct the access three studies. And there was a number of studies which really focussed on youth health access and navigation in the New South Wales Health System. So that can, that's included a youth survey with about 1500 young people in it, a longitudinal, qualitative study of young people's journeys through the health system, some health professional interviews, and then a knowledge translation activity, which I think I'll present today.
 
Doctor Dan Waller [00:34:03] The knowledge translation activity consisted of a one day facilitated form. And so what had happened is that the larger studies had already been conducted. And then from that there was a synthesis of that, evidence from the research team. And then utilising that, there was a, the idea that we were going to do a facilitated forum. And so pulling all this information together for the participants, and then having this knowledge translation activity. So that they ran there was forum presentations by a number of people, like including young people and researchers and policy people. And then people would. The participants were split up into smaller discussions. So I think it was about 64, people involved, and there was eight themes and eight tables.
 
Doctor Dan Waller [00:34:54] After the small group discussions, there was a workshop evaluation to see what people thought of the day. And then later on, there was a synthesis and submission of those policy recommendations that came out of the day. So the table on the right shows the themes that had emerged from the access three studies. And they were the things that were given to, the forum participants to kind of consider and then discuss on the day.
 
Doctor Dan Waller [00:35:25] So for each of those small group discussions, the workshops, tables were given a number of questions. So how does the group understand and support the theme? Which groups or locations or health settings is the theme particularly relevant for who would need to be involved in implementation? How can the theme be implemented and what difference would it make and what would support implementation. So some pretty broad questions. And there we got this 64 participants within the group. So engaging eight young people, a number of New South Wales health, services people, academics, policy people, general practitioners and one mental health clinician as well.
 
Doctor Dan Waller [00:36:10] Fom the, workshops, there was 25 individual policy recommendations that came out of those which were developed across the tables. And they fell into six broad themes of technology solutions, integrated care and investment, Medicare structures, workforce, youth participation and quality systems. So with those policy recommendations, there was a version process where people were able to vote on what they thought were the most important, policy recommendations. And all of that information was then delivered to the access research team to try and synthesise the information and try and come up with some policy recommendations within presented to the New South Wales Health Department, the Ministry.
 
Doctor Dan Waller [00:36:58] The evaluation of the, the dye in the form, 70% of the participants who were there completed an evaluation form, and 93% of those who did complete that evaluation thought that the workshop meaningfully contributed to knowledge translation, and 88% were. So it felt they were able to contribute to the small group discussions.
 
Doctor Dan Waller [00:37:22] This slide's fairly difficult for people to read, but basically what we then did was a post hoc analysis of the recommendations that were coming out of that, workshop form, and then mapping that onto the New South Wales Youth Health Framework, which was the policy that was, developed from these access studies. So, this is just a few examples of how we think that the recommendations from the policy forum would then transitioned into a specific, section of that youth health policy. So it's interesting to kind of look at that and see where the translations kind of occurred.
 
Doctor Dan Waller [00:38:03] With all this in mind. So what? But I thought that, the access study is a good kind of identification of how we can move from research and knowledge translation into policy development. And then also include the voice of young people. Admittedly, it's a small voice at the policy development workshop, but there was a large, focus on the the inclusion of marginalised young people, particularly in the research. So we were able to kind of pull that youth voice into that, development of that policy.
 
Doctor Dan Waller [00:38:38] And again, what we're saying is that overall youth health policy is heading in the right directions. We do need to try and figure out this approach to, youth participation and what that means, what is when should we consult, when should we co-design, and how do we include young people in the implementation of the policy, not just necessarily the development of that policy? As always, if anywhere funding resources, those things are very important. And so as the knowledge translation of this research, we need to have evaluation and monitoring of the policies. And research partnerships can be quite useful for developing that.
 
Doctor Dan Waller [00:39:21] And then I guess I thought I should also touch on the fact that health service review is quite important in, 2019. The review review was established, which is a review of health services for children, young people and families within the New South Wales Health System. And if you read that review, you can see that a lot of the recommendations are really echoing what we have here and goes into a lot more detail as well as a very extensive review. And so I think sometimes we need to just look at what the research is already saying or the what the reviews are already saying and saying. Well, how can we then implement this into a system? And I think that's where things like implementation science approaches can actually be really useful, because it starts to kind of move us away from just identifying this issue with the problems and then going, okay, well, what are we going to do?
 
Doctor Dan Waller [00:40:10] So, from this work, we've got, three open access publications which are all available, so you can go online to free to access. And in terms of that kind of like building, relationships between states, organisations, workers, all these kind of things. We do have a triple H policy workshop on the 19th of June, which is open to policymakers specifically. And we're hoping that that kind of becomes one of those steps within the implementation, trial, where we start to kind of really have the ability to share these resources, understand, issues across the board, and develop those kinds of relationships as well. So I think there's, some promising work ahead.
 
Doctor Dan Waller [00:40:52] I think I'm going to cut there. I just would like to acknowledge that this work was funded through the Wellbeing, Health and Youth Centre for Research Excellence from the NHMRC, and also, acknowledge and celebrate the life and work of Professor Fiona Brookes, who was my supervisor at UTS when I was doing this work. And she was a lovely person and, really helped me with my postdoctoral journey. So, and she just really cared a lot, about continuing education and wellbeing of young people. So I just wanted to acknowledge her work. And then again, acknowledging the research participants and the funding from the agency. And I think I can, finish up in.
 
Professor Rachel Skinner [00:41:39] Now I am here even though I'm not a on camera for some reason. Not sure why, but, thank you very much. Turned up with so fabulous presentation, I knew that it was going to be amazing. And, also nice to reflect on the life of Fiona at the end there. And I just wanted to say I don't think I introduced myself, but, I'm Rachel Skinner and, deputy director of wellbeing, Health and Youth and, professor at Sydney Uni and also, a clinical strain director for priority populations at the Sydney Children's Hospitals Network.
 
Professor Rachel Skinner [00:42:15] Now we have some questions. So I'm going to bring them up for you. So first up we have, actually, yeah. So we'll start with Helen. I think there was another question, actually. So Helen's a comment really just about, tokenism and, that she noted that in the National Obesity Strategy published in 2022, they talked about the importance of adolescent consultation. But funnily enough, though they didn't actually consult with adolescents, I just consulted with the young adults. So and I mean, I've certainly experienced this as well, that, you know, development of policies around the health issue, that where young people are identified as a priority area, that the absence of the youth voice in the consultation process. So that's that's happened in my experience, around these various youth health policies.
 
Doctor Dan Waller [00:43:11] So I think there are lots of challenges in bringing young people's voices to bear on things just around the recruitment. And we do have another question about this. There's also ethics challenges as well. So we've got another question down here. From Louise, recruitment of young people. Can you clarify age of young people curious to know processes for recruiting if school age. So I think and were you hoping for more than young people in your study? So I suppose just a general question about youth, participation in the development of, of, of these health policies and your, and then your experience.
 
Doctor Dan Waller [00:43:54] Yeah. I guess there's a few things. So, in terms of age, yeah, there's definitely an ethics, issue there. So, I guess the definition, even our definitions of youth are different across different jurisdictions that anyone from 8 to 25 would probably sit within that youth category for me. So that does bring along its own kind of ethical issues around consent and getting potential parental consent. And I do understand that it's a it's a real challenge, particularly for policy makers rather than researchers, because researchers have the time to invest in those kind of things, because that's kind of the core business. Whereas, that policy makers just have to work with what they have in a lot of ways.
 
Doctor Dan Waller [00:44:42] In terms of tokenism and things like that. Again, that there is this kind of, balancing act, and, and the young and resilient Research Centre has some really nice slides on, on that around, you know, when does it always have to be code co-design? Can it just be consultation in these consultations such a bad thing. So there is a real balance. And that really, comes down to what is the purpose of what you're doing. And I guess even further than that is is there a genuine concern or is this done in a genuine manner? And I think that's really at the crux of it is which becomes an ethics issue. Is are you doing this because you genuinely want to do it or is it a tick box exercise? And I think the, you know, people care. So it's it's more comes down to the, the, the resource constraints and, and the kind of areas that they're working in.
 
Doctor Dan Waller [00:45:35] In regards to the access study, I was noting I was not directly involved in that. I know that they were able to get some young people to be involved who were, part of the, the broader study. And I think they engaged those people because they had particular skills or the ability to kind of sit in that space. And so there are, again, things around being able to support young people if they are going into these kind of settings where they are expected to, engage with clinicians and policy makers, and they think there's a set of skills that are required there as well. So yeah, I can't speak as towards the recruitment, but I think again, there's a there's a number of kind of things that need to be thought out. And it's, it's going to be always on a case by case basis. Hope that means a simple question.
 
Professor Rachel Skinner [00:46:27] Great. Thanks, then. Yes. Really important to get young people and their voices heard. I think despite the extra work and cost. Just because it really pays off.
 
Professor Rachel Skinner [00:46:40] So, Susan, I jumped over before. Monitoring requires setting targets, which can also be a future advocacy tool when targets aren't met. I'm assuming that there was little evidence of targets for any indicators within these policies. I think you mentioned that briefly, Dan, but if you could elaborate, and I also want to just adding a question there. I noted that, a number of the policies, had had a focus on resilience and, strengths and, and well-being rather than deficits. And I was wondering if there were any, measurement indices, indicators for resilience or for wellbeing and strengths, because that's sort of an area that I found challenging in research.
 
Doctor Dan Waller [00:47:31] Yeah. Thank you. I guess part of the issue around monitoring and evaluation for these policies are that they're so broad that looking at general health and wellbeing, so it becomes like it's such a big area that sometimes these kind of things are difficult to set up. So those kind of things around targets in terms of the people that I talk to and in terms of the publications that we reviewed, there's a lot of variance, I say.
 
Doctor Dan Waller [00:47:57] So some of these policies do have their their kind of monitoring framework published within the back of the kind of appendix, where some of that they just didn't have anything that was really mentioned.
 
Doctor Dan Waller [00:48:08] Again, that doesn't mean it's not there. It just means it's not easily available to researchers to be able to see. But when we're talking to the policy development people, they do kind of tend to indicate that, there's a difficulty around setting targets and not necessarily. Resources to be able to implement or to be able to set up these kinds of monitoring systems. And then again, in terms of, positive outcomes for young people, a lot of it was around, I guess, this kind of sense of community and belonging and feeling that they have a sense of purpose in life and then things like resilience as well.
 
Doctor Dan Waller [00:48:54] But again, I don't think there's any hard and fast measures that are used across the board or in some kind of uniform in a way. So it's again, it's difficult, it's easy to point fingers and say, you know, these are things that need to happen, but the actual thought and process of trying to get these things done is very difficult. So, you know, it's not it's not an easy task.
 
Professor Rachel Skinner [00:49:18] No, I thank you for those informed words. So, we've got a question from Emma. Just. So this is exciting. New South Wales Health are currently undertaking a review of the youth Health framework. So the New South Wales New Health Framework and the Matilda Centre is facilitating a consultation forums on the 28th of June, including opportunities for in-person attendance. I look at it with made and regional virtual participation in various various locations. So that's really just a call out, a shout out to people who are interested in this, especially this audience who would be, quite knowledgeable and have a lot to contribute to, please, to join. So maybe, Emma, you could provide some sort of information to us and we'll send that out to everybody on the. On the call. And, I just wanted to also say that Maya has. From triple H that, just a not a shout out again to this event. So developing youth. So this this is the event. Sorry, guys. You guys, it must be. Is it is it the event or is that something different anyway? Well, we'll we'll we'll transmit all of this information to you. That's a different one to glitch. Okay. Can I ask another question? Because we do have just a few. We do have some more minutes to go. I'm sorry.
 
Professor Rachel Skinner [00:50:59] There we go. You mentioned that that in the policy in the health system and policy funding space, that, youth health kind of gets drowned out by other areas of, health and policy development. And it's just a small area. And I know that from my experience working as a senior clinical advisor for the New South Wales Ministry of Health over the years, I could observe that, you know, youth health is a small, much tiny, tiny area of of, you know, the health system and New South Wales Health system and its funding, etc. and that applies not just any health, but also applies across child, health as well, and paediatrics quite a whole lot. We've got a small, area of health. So I'm not sure, how we can. I know you mentioned a few strategies that we can all come together and keep and, try to create that tension for for change and give some very good advice on that. But I'm not sure if you want to mention and talk about this ongoing issue for us.
 
Doctor Dan Waller [00:52:06] Yeah, I, I look, I think it, it comes down to this kind of idea of relative priority in terms of what are the most important things that we need to focus on. And, you know, it's understandable that there are other kind of issues happening that that need attention. But I think if we're able to kind of change this narrative around the fact that adolescents, healthy, and that you can wait for them to become unhealthy later on in life, and if you can kind of shift that narrative around the fact, like, look, early intervention is a lot cheaper than, having these issues of later on down the track and the kind of changes that it can have on the young person's quality of life and the cost to the health system. If we can really kind of emphasise that message, I think that's important. But then again, the things like that requires that advocacy and building coalitions. And I think putting, I think there's a real value in putting people working across health departments and across different states in this space could be a quite a useful thing, because I think people are all struggling with the same challenges. And people have built in and identified their own solutions. And sometimes I think there's a lot to be learned from others who are already working in the space.
 
Doctor Dan Waller [00:53:21] So yeah, I think again, it's, it's it's very much just trying to win the hearts and minds. But if you look at the even just the development of policy over the years, there is clearly wins being had. We are kind of, you know, we are growing attention and things like just even the fact that we are consulting with young people and including them in co-design projects, through governments shows that, you know, we are actually on the right track and hopefully we could just, grow 910 and maintain that.
 
Professor Rachel Skinner [00:53:55] Thank you. That was excellent. Now, because, sorry, I'm just, you know, take my chairs for a minute here and continue the conversation. Ten. That's all right. So you don't have any other other questions from the floor, but, yeah. So I'm very interested to, to, to think about, and to sort of work out. Well, what what would be, the levers do you think to. I mean, you've mentioned quite a, a number of them. And to get the attention, I mean, I suppose it's an iterative process. If you said building on what we've already got, but is there, a way to influence, you know, the funding envelope or the policy sort of level political, you know, like, how do we, how can we and why what could we do, going forward to sort of to get more attention on details.
 
Doctor Dan Waller [00:54:51] Okay. I think, I think the workshop that we're doing, for triple H, will be useful one for putting people in touch with each other and to try and build that kind of correlation. These things like the way. Again, it's all about building coalition and then trying to determine advocacy approaches. And it's probably people on my or I'm looking at you who would be, probably better better versed in advocacy and things like that, which is probably what's needed a lot of and then but I think if we can kind of use research to clearly identify the implementation issues and have that is very clearly defined, at least shows where, where the work needs to go. And so by having those kind of identified, we can kind of go to funders or we can, you know, work within ourselves to kind of say, well, these are the things that need to change to get to the next level. And I think, that kind of approach is, really useful. And I hope we can kind of continue to go through that.
 
Professor Rachel Skinner [00:55:53] Yeah. Great. So, James, the squeezed in a question at the end, do you have any suggestions for building more effective collaborations across youth health? Sorry, youth policy portfolios, education, justice, digital safety?
 
Doctor Dan Waller [00:56:08] Yeah, this is my my biggest kind of, I guess, question around these kind of areas because I'm working in education space now as well. And it's this is how how do you know? We all know that there's these social determinants of outcomes that are there sit within a department. They across the board. And so how can you you get these kind of departments to work on these issues. South Australia has a health in all policies, approach. So it'd be interesting to look at how effective that has been. Because they, they try to kind of identify health issues within their different portfolios. I don't know what that experience has been like, but it'd be interesting to talk. To some of those people and see what their experience has been, and that maybe the way that has to happen is that you have to have some kind of cross portfolio approaches. But again, I'm sure that there's policy people in here who've got much, knowledge and understanding of the processes required.
 
Professor Rachel Skinner [00:57:07] Thanks. Thanks, Dan. So we might. That's really fabulous. You've just really. I think, you're one of the absolute experts in evaluating policy and implementation of youth health policy. So, it's really wonderful that we have you amongst us. So. And thank you so much for for sharing your wisdom. So I just wanted to thank everybody for their attention too. And and that, please join us in a month's time for the next wellbeing, Health and Youth webinar. We will send out information. It'll be another exciting topic so I don't have it in front of me, but, yeah. So thank you and hope you all have a fabulous afternoon. Thank and thanks, Dan.