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Background: School-age care, such as outside school hours care (OSHC), is the fastest-growing childhood education sector in Australia. OSHC provides a unique opportunity to deliver programs to enhance primary school-age children's social, emotional, physical, and cognitive well-being., Objective: This study aimed to pilot the co-designed Connect, Promote, and Protect Program (CP3) and conduct formative and process evaluations on how well the CP3 achieved its intended aims, ascertain areas for improvement, and determine how the CP3 model could be better sustained and extended into OSHC settings., Methods: A naturalistic formative and process evaluation of the CP3 implementation was undertaken at 1 and then 5 OSHC sites. Qualitative and quantitative feedback from stakeholders (eg, children, OSHC educators, volunteers, and families) was collected and incorporated iteratively for program improvement., Results: The formative and process evaluations demonstrated high program engagement, appropriateness, and acceptability. Co-design with children was viewed as highly acceptable and empowered children to be part of the decision-making in OSHC. Feedback highlighted how the CP3 supported children in the 4 CP3 domains: Build Well-being and Resilience, Broaden Horizons, Inspire and Engage, and Connect Communities. Qualitative reports suggested that children's well-being and resilience were indirectly supported through the Broaden Horizons, Inspire and Engage, and Connect Communities CP3 principles. Matched-sample 2-tailed t tests found that children's prosocial behaviors increased (mean difference=0.64; P=.04; t 57 =-2.06, 95% CI -1.36 to -0.02) and peer problems decreased (mean difference=-0.69; P=.01; t 57 =2.57, 95% CI 0.14-1.13) after participating in the CP3. Program feasibility was high but dependent on additional resources and CP3 coordinator support., Conclusions: To our knowledge, the CP3 is the first co-designed well-being program developed and evaluated specifically for OSHC services. This early evidence is promising. The CP3 may provide a unique opportunity to respond to the voices of children in OSHC and those that support them through creative and engaging co-designed activities. Our research suggests that CP3 provides OSHC with a framework and high-quality program planning tool that promotes tailored interventions developed based on the unique needs and preferences of those who will use them., (©Alyssa Clare Milton, Zelalem Mengesha, Kristin Ballesteros, Tom McClean, Saskia Hartog, Lucie Bray-Rudkin, Cathy Ngo, Ian Hickie. Originally published in JMIR Pediatrics and Parenting (https://pediatrics.jmir.org), 25.07.2023.)

Background: Globally, there are fundamental shortcomings in mental health care systems, including restricted access, siloed services, interventions that are poorly matched to service users' needs, underuse of personal outcome monitoring to track progress, exclusion of family and carers, and suboptimal experiences of care. Health information technologies (HITs) hold great potential to improve these aspects that underpin the enhanced quality of mental health care., Objective: Project Synergy aimed to co-design, implement, and evaluate novel HITs, as exemplified by the InnoWell Platform, to work with standard health care organizations. The goals were to deliver improved outcomes for specific populations under focus and support organizations to enact significant system-level reforms., Methods: Participating health care organizations included the following: Open Arms-Veterans & Families Counselling (in Sydney and Lismore, New South Wales [NSW]); NSW North Coast headspace centers for youth (Port Macquarie, Coffs Harbour, Grafton, Lismore, and Tweed Heads); the Butterfly Foundation's National Helpline for eating disorders; Kildare Road Medical Centre for enhanced primary care; and Connect to Wellbeing North Coast NSW (administered by Neami National), for population-based intake and assessment. Service users, families and carers, health professionals, and administrators of services across Australia were actively engaged in the configuration of the InnoWell Platform to meet service needs, identify barriers to and facilitators of quality mental health care, and highlight potentially the best points in the service pathway to integrate the InnoWell Platform. The locally configured InnoWell Platform was then implemented within the respective services. A mixed methods approach, including surveys, semistructured interviews, and workshops, was used to evaluate the impact of the InnoWell Platform. A participatory systems modeling approach involving co-design with local stakeholders was also undertaken to simulate the likely impact of the platform in combination with other services being considered for implementation within the North Coast Primary Health Network to explore resulting impacts on mental health outcomes, including suicide prevention., Results: Despite overwhelming support for integrating digital health solutions into mental health service settings and promising impacts of the platform simulated under idealized implementation conditions, our results emphasized that successful implementation is dependent on health professional and service readiness for change, leadership at the local service level, the appropriateness and responsiveness of the technology for the target end users, and, critically, funding models being available to support implementation. The key places of interoperability of digital solutions and a willingness to use technology to coordinate health care system use were also highlighted., Conclusions: Although the COVID-19 pandemic has resulted in the widespread acceptance of very basic digital health solutions, Project Synergy highlights the critical need to support equity of access to HITs, provide funding for digital infrastructure and digital mental health care, and actively promote the use of technology-enabled, coordinated systems of care., (©Haley M LaMonica, Frank Iorfino, Grace Yeeun Lee, Sarah Piper, Jo-An Occhipinti, Tracey A Davenport, Shane Cross, Alyssa Milton, Laura Ospina-Pinillos, Lisa Whittle, Shelley C Rowe, Mitchell Dowling, Elizabeth Stewart, Antonia Ottavio, Samuel Hockey, Vanessa Wan Sze Cheng, Jane Burns, Elizabeth M Scott, Ian B Hickie. Originally published in JMIR Mental Health (https://mental.jmir.org), 09.03.2022.)

Background: Out of school hours care (OSHC) services provide a unique opportunity to deliver early intervention programs to enhance primary school-aged children's social, emotional, physical, and cognitive well-being; however, such programs are currently lacking., Objective: This study aims to address the lack of well-being programs for children accessing OSHC services in the research literature by using participatory design (PD) to collaboratively develop and test an OSHC well-being program-the connect, promote, and protect program (CP3)., Methods: The study employed methods of PD, user (acceptance) testing, and iterative knowledge translation to develop a novel well-being program framework-CP3-with key stakeholders (eg, children, OSHC staff, volunteers, families, clinicians, educators, and researchers). Thematic techniques were used to interpret and translate the qualitative information obtained during the research and design cycles., Results: The co-design process generated the CP3 model, which comprises a group-based mentoring approach to facilitate enhanced activities in OSHC settings. Activities are underpinned by 4 key principles of program delivery: build well-being and resilience, broaden horizons, inspire and engage, and connect communities., Conclusions: To our knowledge, the CP3 program is the first co-designed well-being program developed specifically for OSHC services. This co-design process is key to ensuring local community needs-particularly those of young people accessing OSHC-are met and that these individuals are meaningfully and actively involved in all stages of the research and design process, from conception to implementation, evaluation, and continuous improvement., (©Alyssa C Milton, Elizabeth Stewart, Laura Ospina-Pinillos, Tracey Davenport, Ian B Hickie. Originally published in JMIR Pediatrics and Parenting (http://pediatrics.jmir.org), 12.04.2021.)

Background: Although numerous studies have demonstrated sex differences in the prevalence of suicidal thoughts and behaviors (STB), there is a clear lack of research examining the similarities and differences between men and women in terms of the relationship between STB, transitional life events, and the coping strategies employed after experiencing such events when they are perceived as stressful., Objective: This study aims to examine the differences between men's and women's experiences of STB, sociodemographic predictors of STB, and how coping responses after experiencing a stressful transitional life event predict STB., Methods: A web-based self-report survey was used to assess the health and well-being of a voluntary community-based sample of men and women aged 16 years and older, living in Australia, Canada, New Zealand, the United Kingdom, and the United States, who were recruited using web-based social media promotion and snowballing., Results: In total, 10,765 eligible web-based respondents participated. Compared with men, a significantly greater proportion of women reported STB (P<.001) and endorsed experiencing a transitional life event as stressful (P<.001). However, there were no gender differences in reporting that the transitional life event or events was stressful for those who also reported STB. Significant sociodemographic adjusted risk factors of STB included younger age; identifying as a sexual minority; lower subjective social connectedness; lower subjective intimate bonds; experiencing a stressful transitional life event in the past 12 months; living alone (women only); not being in employment, education, or training (women only); suddenly or unexpectedly losing a job (men only); and experiencing a relationship breakdown (men only). Protective factors included starting a new job, retiring, having a language background other than English, and becoming a parent for the first time (men only). The results relating to coping after experiencing a self-reported stressful transitional life event in the past 12 months found that regardless of sex, respondents who reported STB compared with those who did not were less likely to engage in activities that promote social connections, such as talking about their feelings (P<.001). Coping strategies significantly explained 19.0% of the STB variance for men (F 16,1027 =14.64; P<.001) and 22.0% for women (F 16,1977 =36.45; P<.001)., Conclusions: This research highlights multiple risk factors for STB, one of which includes experiencing at least one stressful transitional life event in the past 12 months. When individuals are experiencing such events, support from services and the community alike should consider using sex-specific or targeted strategies, as this research indicates that compared with women, more men do nothing when experiencing stress after a transitional life event and may be waiting until they experience STB to engage with their social networks for support., (©Alyssa Clare Milton, Tracey A Davenport, Frank Iorfino, Anna Flego, Jane M Burns, Ian B Hickie. Originally published in JMIR Mental Health (http://mental.jmir.org), 11.09.2020.)

Background: The rapid uptake of information and communication technology (ICT) over the past decade-particularly the smartphone-has coincided with large increases in sexting. All previous Australian studies examining the prevalence of sexting activities in young people have relied on convenience or self-selected samples. Concurrently, there have been recent calls to undertake more in-depth research on the relationship between mental health problems, suicidal thoughts and behaviors, and sexting. How sexters (including those who receive, send, and two-way sext) and nonsexters apply ICT safety skills warrants further research., Objective: This study aimed to extend the Australian sexting literature by measuring (1) changes in the frequency of young people's sexting activities from 2012 to 2014; (2) young people's beliefs about sexting; (3) association of demographics, mental health and well-being items, and internet use with sexting; and (4) the relationship between sexting and ICT safety skills., Methods: Computer-assisted telephone interviewing using random digit dialing was used in two Young and Well National Surveys conducted in 2012 and 2014. The participants included representative and random samples of 1400 young people aged 16 to 25 years., Results: From 2012 to 2014, two-way sexting (2012: 521/1369, 38.06%; 2014: 591/1400, 42.21%; P=.03) and receiving sexts (2012: 375/1369, 27.39%; 2014: 433/1400, 30.93%; P<.001) increased significantly, not sexting (2012: 438/1369, 31.99%; 2014: 356/1400, 25.43%; P<.001) reduced significantly, whereas sending sexts (2012: n=35/1369, 2.56%; 2014: n=20/1400, 1.43%; P>.05) did not significantly change. In addition, two-way sexting and sending sexts were found to be associated with demographics (male, second language, and being in a relationship), mental health and well-being items (suicidal thoughts and behaviors and body image concerns), and ICT risks (cyberbullying others and late-night internet use). Receiving sexts was significantly associated with demographics (being male and not living with parents or guardians) and ICT risks (being cyberbullied and late-night internet use). Contrary to nonsexters, Pearson correlations demonstrated that all sexting groups (two-way, sending, and receiving) had a negative relationship with endorsing the ICT safety items relating to being careful when using the Web and not giving out personal details., Conclusions: Our research demonstrates that most young Australians are sexting or exposed to sexting in some capacity. Sexting is associated with some negative health and well-being outcomes-specifically, sending sexts is linked to suicidal thoughts and behaviors, body image issues, and ICT safety risks, including cyberbullying and late-night internet use. Those who do sext are less likely to engage in many preventative ICT safety behaviors. How the community works in partnership with young people to address this needs to be a multifaceted approach, where sexting is positioned within a wider proactive conversation about gender, culture, psychosocial health, and respecting and caring for each other when on the Web., (©Alyssa C Milton, Benjamin A Gill, Tracey A Davenport, Mitchell Dowling, Jane M Burns, Ian B Hickie. Originally published in JMIR Mental Health (http://mental.jmir.org), 17.06.2019.)

Background: Web-based self-report surveying has increased in popularity, as it can rapidly yield large samples at a low cost. Despite this increase in popularity, in the area of youth mental health, there is a distinct lack of research comparing the results of Web-based self-report surveys with the more traditional and widely accepted computer-assisted telephone interviewing (CATI)., Objective: The Second Australian Young and Well National Survey 2014 sought to compare differences in respondent response patterns using matched items on CATI versus a Web-based self-report survey. The aim of this study was to examine whether responses varied as a result of item sensitivity, that is, the item's susceptibility to exaggeration on underreporting and to assess whether certain subgroups demonstrated this effect to a greater extent., Methods: A subsample of young people aged 16 to 25 years (N=101), recruited through the Second Australian Young and Well National Survey 2014, completed the identical items on two occasions: via CATI and via Web-based self-report survey. Respondents also rated perceived item sensitivity., Results: When comparing CATI with the Web-based self-report survey, a Wilcoxon signed-rank analysis showed that respondents answered 14 of the 42 matched items in a significantly different way. Significant variation in responses (CATI vs Web-based) was more frequent if the item was also rated by the respondents as highly sensitive in nature. Specifically, 63% (5/8) of the high sensitivity items, 43% (3/7) of the neutral sensitivity items, and 0% (0/4) of the low sensitivity items were answered in a significantly different manner by respondents when comparing their matched CATI and Web-based question responses. The items that were perceived as highly sensitive by respondents and demonstrated response variability included the following: sexting activities, body image concerns, experience of diagnosis, and suicidal ideation. For high sensitivity items, a regression analysis showed respondents who were male (beta=-.19, P=.048) or who were not in employment, education, or training (NEET; beta=-.32, P=.001) were significantly more likely to provide different responses on matched items when responding in the CATI as compared with the Web-based self-report survey. The Web-based self-report survey, however, demonstrated some evidence of avidity and attrition bias., Conclusions: Compared with CATI, Web-based self-report surveys are highly cost-effective and had higher rates of self-disclosure on sensitive items, particularly for respondents who identify as male and NEET. A drawback to Web-based surveying methodologies, however, includes the limited control over avidity bias and the greater incidence of attrition bias. These findings have important implications for further development of survey methods in the area of health and well-being, especially when considering research topics (in this case diagnosis, suicidal ideation, sexting, and body image) and groups that are being recruited (young people, males, and NEET)., (©Alyssa C Milton, Louise A Ellis, Tracey A Davenport, Jane M Burns, Ian B Hickie. Originally published in JMIR Mental Health (http://mental.jmir.org), 26.09.2017.)