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There is an increasing demand for community-based palliative care services in regional Australia, but feasibility and economic benefits are unclear. This study describes the financial components of service delivery, economic viability from a provider perspective, and potential cost-savings from a health service perspective. We used case study methodology and obtained data from the service provider performance measurement data, annual reports, and internal records. Economic viability included an appraisal of all financial activity, cash on hand, total assets, and liabilities from July 2019 to June 2022. Direct service provision data determined the value for money given total costs and outcomes. Annual cost savings due to decreased utilisation of other healthcare services were estimated using case study data and cost estimates from the literature. The service is largely funded by the government (61%) and community donations & fundraising (34%). Applying a conservative cost estimate based on a reduction of healthcare use (hospitalisations and emergency admissions), cost savings are estimated to range from AU$730 000 to AU$980 000 per year for the cohort of n = 160 clients in the last year of life alone. Average costs per person per year of providing palliative care services were much lower for these clients (AU$6194) compared to the national average for in-home (AU$8000) or hospital-based palliative care services (AU$15 373). The case study site is a viable community-based service but is highly dependent on government funding. It provides excellent value for money from a health service perspective and provides cost saving. Future studies should investigate the generalizability of results. [ABSTRACT FROM AUTHOR]

Background: Little Haven is a rural, community-based specialist palliative care service in Gympie, Australia. Its goals are to provide highest quality of care, support and education for those experiencing or anticipating serious illness and loss. Families and communities work alongside clinical services, with community engagement influencing compassionate care and support of dying people, their families and communities. Public Health Palliative Care promotes community engagement by community-based palliative care services and is grounded in equal partnerships between civic life, community members, patients and carers, and service providers. This takes many forms, including what we have termed the 'citizen organization'. Objectives: This paper reports on an evaluation of Little Haven's model of care and explores the organization's place as a 'citizen' of the community it services. Design: A co-designed evaluation approach utilizing mixed-method design is used. Methods: Multiple data sources obtained a broad perspective of the model of care including primary qualitative data from current patients, current carers, staff, volunteers and organizational stakeholders (interviews and focus groups); and secondary quantitative survey data from bereaved carers. Thematic analysis and descriptive statistics were generated. Results: This model of care demonstrates common service elements including early access to holistic, patient/family-centred, specialized palliative care at little or no cost to users, with strong community engagement. These elements enable high-quality care for patients and carers who describe the support as 'over and above', enabling good quality of life and care at home. Staff and volunteers perceive the built-in flexibility of the model as critical to its outcomes; the interface between the service and the community is similarly stressed as a key service element. Organizational stakeholders observed the model as a product of local activism and accountability to the community. Conclusion: All participant groups agree the service model enables the delivery of excellent care. The construction of a community palliative care service as a citizen organization emerged as a new concept. Plain language summary: 'Citizen organization': an Australian community-based palliative care service model Little Haven is a rural, community-based specialist palliative care service in Gympie, Australia. It aims to provide highest quality of care, support and education for those experiencing or anticipating serious illness and loss. Families and communities work alongside clinical services, with community engagement influencing compassionate care and support of dying people, their families and communities. Public Health Palliative Care promotes community engagement by community-based palliative care services in equal partnerships between civic organizations, community members, patients and carers, and service providers. We undertook an evaluation of Little Haven's model of care by speaking with current patients, current and past carers, staff, volunteers and stakeholders about their experiences of Little Haven. We found that Little Haven's model contains the essential elements of a palliative care service and provides early access to holistic, patient/family-centred, specialized palliative care at little or no cost to users. They have strong community engagement with a strong background in community activism. We identified that Little Haven's 'being in the community' goes beyond service provision or even sentiment. We observed a symbiotic relationship between the organization and the community it supports in what we have termed the 'citizen organization'. The distinctive characteristic of the citizen organization is its inseparability from the community in which it dwells. [ABSTRACT FROM AUTHOR]

This paper presents an open inquiry that embraces curiosity and vulnerability in the anticipatory space of an art-led, Futures orientated PhD supervisory relationship. We use sandtray work to elicit an anticipatory aesthetic, recording emergent data and processes through the dialogical method of duoethnography, and the visual format of photography. We seek to generate an environment that rouses imagination, creativity and futures consciousness implicit in the Australian Research Council's definition of research. We use a duoethnographic method to collaborate, reflect and provide dialogical ways to surface deep meanings. There is a shared equity of understanding of the research process as a vehicle for engaging with the unknown. Both supervisor and supervisee hold explicit and implicit referent knowledge in relation to person and process. Therefore, it is a collaborative, reciprocal and fluid environment, where 1 + 1 = ∞ possibilities. We use sandtray to provide the location of open inquiry, dialogical reciprocation, reflection, and improvisation. This gives voice to the meaning that is made in the meandering paths between the words and an opportunity to loosen the shackles of business as usual. The sandtray moves not-known material into conscious awareness via somatic/intuitive symbol selection, engagement with metaphor, and projection; each privileging the unconscious. Introducing sandtray process into the supervisory relationship provides an alternative and adjunct modality of non-verbal inquiry that can support the calling of an anticipatory aesthetic through the Futures Senses. While there is rich, though sparse, literature describing the facilitation of sandtray work within the context of clinical supervision of mental health professionals, the introduction of such an approach within research supervision appears rare, or unique in relation to published research. [ABSTRACT FROM AUTHOR]

Tobacco smoking is the largest single preventable cause of death and disease in Australia. Reports suggest that up to 88% of people who have mental health problems of any kind continue to smoke, even when in acute mental health units. Some organisations have adopted smoking-free policies; however, implementation of smoking cessation programmes in acute mental health units has had varied levels of success. This qualitative study examined the second attempt to implement a smoke-free policy in an acute mental health service in Queensland, Australia, to explore the facilitators and barriers to change. Post-process interviews conducted with 10 clinicians and consumers revealed facilitators and barriers within themes of Culture, Wellbeing and Strategy. Key barriers included a negative institutional culture, fear and inconsistent application of the policy (associated with staff attrition, workloads, policy loopholes and resistance). Key facilitators were positive leadership, adequate resources, staff and consumer engagement, supportive formal policy and staff unity. Analysis also suggested benefits in cultivating a non-restrictive, healthy and respectful environment, and deploying a clear, consistent strategy that includes planning, preparation, implementation and maintenance phases. [ABSTRACT FROM PUBLISHER]