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Purpose: While Australia has continued to invest in polices and strategies aimed at improving rural health service provision, many communities still confront a disproportionate share of the rural workforce shortage. The NSW Rural Doctors Network (RDN) contributes its perspectives about the importance of a whole of life career and the meandering stream concept to support the retention of health professionals rurally. We unpack these concepts and examine how they bring to light a new and useful approach to addressing rural workforce challenges and potentially contribute to building a stronger integrated care approach. Design/methodology/approach: The approach used involved tapping into RDN's 30-years of experience in recruitment and retention of remote and rural health professionals, combined with insights from relevant existing and emerging evidence. Findings: We suggest that reframing retention to consider a life stage approach to career will guide more effective targeting of rural health policies, workforce planning, collaborative approaches and allocation of incentives. We posit that an understanding and acceptance of modern lifestyles and career pathways, and a celebration of career commitment to serving rural communities, is necessary for successful recruitment and retention of Australia's future rural health workforce beyond the training pipeline. Originality/value: We outline and visually represent RDN's meandering stream approach to building and retaining a capable rural health workforce through addressing life cycle and workforce level needs. This perspective paper draws on RDN's direct experience in the field. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to describe and discuss the variables which have contributed to the adoption of positive behaviour support (PBS) and applied behaviour analysis (ABA). Differences and similarities are highlighted, applications to contemporary issues in the UK and Australia are emphasised, and considerations posed for their improved adoption. Design/methodology/approach: A conceptual framework for diffusion of innovations theory is used to guide the analysis of three sets of articles, and application of the framework is guided by narrative analysis. Findings: Eight variables from the conceptual framework were identified, and the communication networks for PBS and ABA are argued to be distinct. There has been a positive change in the perception of PBS by the ABA field, but PBS has leveraged diffusion more successfully. ABA appears to have been separated from PBS in the UK while Australia is yet to fully benefit from the contributions of ABA. Those working in the fields of PBS and ABA should further collaborate for their mutual benefit. Practical implications: Greater attention to the factors which promote diffusion can assist PBS and ABA to improve their adoption. Originality/value: This is the first paper to use diffusion of innovations theory to analyse the adoption of PBS and ABA. [ABSTRACT FROM AUTHOR]

Purpose: Approximately 20 per cent of Australian children live with a parent who experiences mental illness. These children have poorer health and psychosocial outcomes than their peers. While family-focused practice (FFP) can improve these outcomes, family-focused service provision is inconsistent. The purpose of this paper is to understand clinicians' experiences of FFP and associated workplace factors. Design/methodology/approach: In-depth interviews were conducted with ten community mental health clinicians. Interviews were audio recorded and transcribed. Data were analysed using thematic analysis. Findings: A global theme of "navigating rocky terrain" captured clinicians' experiences of working with families. The rocky terrain encompassed both family complexity and workplace barriers to FFP. Clinicians navigated this terrain by using multiple strategies to support families, working in partnership with families and other clinicians and services, and drawing on personal resources. Interactive approaches to enhancing knowledge and skills were preferred over paper-based information. While an organisation-wide approach to support FFP was beneficial, clinicians continued to feel challenged in implementing FFP. Research limitations/implications: Working with families in which parents experience mental illness is affected by systemic issues at the family and organisational levels. Systemic approaches to both delivering and supporting this work are required. Partnership working and organisation-wide capacity building strategies emphasising interactive approaches to learning appear to have positive effects. Originality/value: This study explores the challenges of FFP in a real-world multidisciplinary context where there has been a systemic approach to enabling this work. It highlights the challenges clinicians face in family-focused practice in spite of substantial organisational supports and suggests some approaches that might be effective. This is a topic which has received minimal attention in the literature. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to investigate the experiences of staff during the development and implementation of an Australian-first, family-focussed service addressing the mental health needs of young people (aged 12–25 years) with an intellectual disability. This study aims to understand the challenges and successes of the staff team when navigating their way in a new program working with a complex client group. Design/methodology/approach: This study used a thematic analysis on data collected from focus groups at two time points in the implementation phase of the new program. Thematic analysis of the data was conducted to identify important themes relating to the staff's challenges, successes and learning. Findings: The findings showed that there was a lot of adaptation needed for staff members trained in either mental health, or disability, but not both. Another key finding was the importance of working with the young person's family system as well as their existing system of support services. This major focus of the work for staff could be challenging due issues arising in the family unit and a lack of collaboration between services. Working with this complex client group was viewed as challenging and stress inducing; however, the motivation and attitudes of staff were found to be positive factors in the running of the program. Originality/value: This paper makes an original contribution to the field, as it provides a unique look at staff experiences when needing to adapt to a new and challenging workplace that was the first-of-its-kind in Australia. [ABSTRACT FROM AUTHOR]

Purpose In recent years, the employment of peer providers (PPs) has grown with the wider acceptance of lived experience expertise in recovery-oriented service provision. Although its effectiveness, theoretical foundations and factors influencing outcomes have been studied, a framework accounting for the dynamics of the PP–peer relationship has yet to be formulated. The purpose of this paper is to employ a qualitative approach to explore the journeys undertaken by PPs with their peers and form it into a cohesive framework of understanding.Design/methodology/approach In-depth interviews were conducted with PPs who were employed specifically to use their lived experience in supporting someone through mental distress. These interviews were recorded, transcribed and coded using a framework approach. To enhance rigour, this framework was verified with the latter author and three other participants recruited after data analysis.Findings A stepped model of peer provision practice was crafted to capture the non-linearity of recovery, as well as the PP–peer relationship. This model is founded upon trust in the milieu of shared experience and involves: creating a safe place – a stage of building trust and rapport to a point where a PP is given permission to enter into their peer's headspace; a working partnership – stage of setting and working towards goals collaboratively; and stepping out – a stage marked by the termination of the PP–peer relationship.Originality/value This paper proposes a tangible framework underpinning the dynamics of peer provision practice, which furthers our understanding and complements current practice models in peer provision services. [ABSTRACT FROM AUTHOR]

Purpose: Self-direction–also known as participant direction, personalization and self-directed care–is a service delivery model that enables people to manage their personal budget and purchase services and supports tailored to their needs based on a person-centered plan. This paper, the outcome of an international learning exchange on self-direction, describes approaches across four countries' successful strategies, unresolved questions and recommendations to enhance self-direction globally. Design/methodology/approach: The findings are a product of discussions at the 2019 International Initiative for Mental Health Leadership and International Initiative for Disability Leadership Exchange on Advances in Self-Direction. Participants included people who are self-directing, providers and caregivers who support people who are self-directing, advocates, fiscal agents and public managers who administer self-direction from the United States, England, Australia and New Zealand. Findings: In all four countries, people who self-direct exercise high levels of choice and control and are able to individualize their services and supports to promote a good life in the community. The exchange also revealed challenges and possible solutions to improve and expand self-direction. Practical implications: The results of the meeting provide guidance for public managers, providers and advocates for initiating and expanding self-direction. Originality/value: This international meeting was a unique opportunity to compare self-direction across four different countries and across multiple perspectives, including people with disabilities, caregivers, providers and administrators. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to summarise the initial experiences of Australia’s National Disability Insurance Scheme (NDIS). It highlights some of the main challenges being faced by participants, service providers and government, and demonstrates how research can contribute to the ongoing implementation and success of the scheme.Design/methodology/approach The historical basis for the need for a new approach to disability funding in Australia is explored. The opportunities that exist and the difficulties that are being encountered by those entering and working within the new scheme are discussed.Findings Several problems were identified including difficult transitions between existing support frameworks to new “NDIS plans”, and the risk of market failure. Both the problems and their solutions are discussed and it is hoped that collaboration between the Commonwealth Government, service users, their families, service providers and universities can lead to a number of lasting improvements.Practical implications The new funding framework provides exciting opportunities for increasing the funding of people with intellectual and physical disabilities in Australia. Developments in technology, service provision in rural and remote areas and the opportunity to meet aspirational life goals exist alongside a number of challenges, including the need to ensure that those with multiple and complex disabilities retain existing levels of support.Originality/value The implementation of the NDIS is still underway, and opportunities exist to implement changes to the scheme where required. Research findings have an important role to play in the national debate regarding how best to improve quality of life for people with a disability in Australia. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide a UK perspective on the article by Mason et al. on Australia’s National Disability Insurance Scheme (NDIS).Design/methodology/approach A commentary on the main article, drawing on the author’s knowledge and experience of the implementation of personalisation in the UK and information gleaned during a recent visit to Australia.Findings There is a major risk that the implementation of NDIS will repeat some of the failings of personalisation in the UK. Specifically, the failures of public bodies to invest in supporting people to take effective control over the resources available to them, and to instigate action to manage the emerging market in ways that promote innovative community options, risk the forces of the free market economy undermining disabled people’s ability to make maximum use of any new choice and control open to them.Originality/value This is a personal perspective, backed by experience, on a current policy development that is of international interest. [ABSTRACT FROM AUTHOR]