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Objective: Stepped care as a model of provision of mental health services has been frequently described from clinical or health administration perspectives, but less is known about the consumer perspective of stepped models of care. Method: Qualitative interviews were undertaken with 18 consumers across a range of residential mental health services in Melbourne, Australia. Interviews were designed to help understand consumers' needs and experiences in navigating different services to meet their needs at different times in their mental health journey. Results: Consumers experience fluctuations in their mental state that are best responded to by having access to a range of services, as well as to services that can respond flexibly to changing needs. Consumers do not necessarily progress through stepped care in a linear or step-up, step-down fashion. Conclusion: Stepped care services need to be flexible in accommodating people along a continuum of care and responsive to where the consumer is at on their journey, rather than predetermining the trajectory of care. What is known about the topic?: Stepped care has been identified as a critical component of comprehensive mental health care, bridging the gap between primary care and acute mental health services. The components of effective stepped care models have been broadly articulated, but the experience of moving through different components of care in response to changing needs has not previously been well described. What does the paper add?: This paper presents consumer perspectives on a model of stepped care that is designed to respond flexibly to the changing needs of consumers, rather than representing a linear model of progress through the system. What are the implications for practitioners?: Mental health services are increasingly grappling with provision of care to the 'missing middle': people with chronic mental illness yet not in an acute phase requiring in-patient hospital care. This paper presents a model of stepped care that responds to the fluctuating needs of consumers [ABSTRACT FROM AUTHOR]

Objective: This study determined caregivers' evaluations of telehealth consultations for their child, preference over in-person consultations and potential cost savings by child condition, family socioeconomic status and location. Methods: A survey was conducted of 2436 caregivers attending a telehealth consultation with their child for a broad group of conditions between 3 June and 25 August 2020 at a tertiary paediatric hospital in Melbourne, Australia. Results: Most caregivers found telehealth consultations convenient, acceptable, safe and private, and capable of answering their questions and concerns. However, caregivers who spoke a language other than English and patients attending for behavioural and mental health, developmental or other (e.g. allied health) concerns were more likely to prefer in-person consultations over telehealth. Mean (±s.d.) reported cost savings on caregiver time were A$144.98 ± 99.04 per family per consultation, whereas mean (±s.d.) transport cost savings were A$84.90 ± 100.74 per family per consultation. Cost savings were greatest for families living in low and middle socioeconomic areas and regional or rural areas. Conclusions: Paediatric telehealth video consultations were largely viewed favourably by caregivers, except for those attending for behavioural and mental health or developmental concerns. What is known about the topic?: Adult consumers of telehealth consultations view them as useful, convenient and cost saving, but less is known about caregivers' evaluations of telehealth consultations and potential cost savings for paediatric patients, and whether these differ by family location, socioeconomic status or child condition. What does this paper add?: This is the first Australian paper to report on caregivers' evaluations across a range of paediatric conditions and locations. Most caregivers found telehealth consultations convenient, safe, acceptable, able to answer their questions and concerns about their child's health and cost saving. What are the implications for practitioners?: Caregivers of children with behavioural, mental health or developmental problems were less likely to prefer telehealth over in-person consultations, so practitioners should consider providing such consultations in person. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess the acceptability of a novel, integrated general practitioner (GP)–paediatrician model of care, aiming to reduce referrals to hospitals and improve primary care quality. Methods: A pre-post study was conducted with five general practice clinics in north-west Melbourne. Over 12 months, 49 GPs and 896 families participated in the intervention that included weekly to fortnightly paediatrician–GP co-consultation sessions at the general practice, monthly case discussions and telephone or email clinical support for GPs. GPs and families completed surveys or interviews at three time points (before the intervention, after running the model for 4 months and at the end of the implementation). Non-identifiable consultation data were extracted from general practice medical records. Results: All GPs found the model acceptable. Although not significant, there was a trend towards a lower proportion of referrals to private paediatricians after the intervention (from 34% to 20%) and emergency departments (from 19% to 12%). Outpatient clinic referrals remained steady, and then increased as the paediatrician left the clinics (31% vs 47% before and after the intervention respectively). Unnecessary prescribing of acid suppression medications decreased by 20% (from 29% to 9%). GPs reported improved confidence in paediatric care (88% vs 100% before and after the intervention respectively). Families reported increased confidence in GP care (78% vs 94% before and after the intervention respectively). Model cost estimates were A$172 above usual care per child seen in the co-consultations. Conclusions: This novel model of care is acceptable to GPs and families and may improve access and quality of paediatric care. What is known about the topic?: A GP–paediatrician integrated model of care appears effective in reducing hospital burden in England, but has not been implemented in Australia. What does this paper add?: This pilot, an Australian first, found that a GP–paediatrician integrated model of care is feasible and acceptable in Australia's primary healthcare system, improves GP confidence and quality of paediatric care, may reduce paediatric referrals to outpatient clinics and emergency departments and improves family confidence in, and preference for, GP care. What are the implications for practitioners?: This model may reduce hospital burden and improve quality in GP paediatric care while potentially producing cost savings for families and the healthcare system. [ABSTRACT FROM AUTHOR]