It's all a bit wishy washy : the challenge of building partnerships for effective mental health evaluation

Mental wellbeing and social connectedness is a key health priority in Victoria. Actions and interventions that may contribute to the promotion of community level mental wellbeing and social connectedness often occurs in other, non-health sectors. Including evidence from these sectors in evaluations of community based interventions around mental wellbeing and social connectedness is important to ensure comprehensive evaluation, and the development of best practice in this health priority area. However, published evaluation material of community based interventions around this health topic is limited, and rarely captures information from non-health sectors. This pilot study investigated the capacity of health promotion practitioners and other key stakeholders working in this area in Victoria to undertake evaluation of community based mental wellbeing and social connectedness interventions, issues and barriers faced in evaluation, and practitioners’ needs to be able to conduct effective and comprehensive evaluations.

Qualitative methods including semi-structure interviews and document analysis were used. Data was coded and analysed inductively, and key themes developed.

Results indicate that evaluating such interventions is challenging for practitioners due to the broad nature of the topic, and the measurement tools available. Many practitioners would like to conduct more comprehensive evaluation and include evidence from other sectors. Managerial and organizational support to develop partnerships both within the health sector and inter-sectorally was identified as a need in order to develop evaluation skills and facilitate more comprehensive evidence gathering.

This study underscores the importance of inter-sectoral partnerships for developing best evidence-based practice in community health. Partnerships are necessary for conducting comprehensive and effective evaluation to contribute to the evidence base. However, developing effective partnerships is challenging, and acts as a barrier to effective evaluation in a key health area for some community health practitioners. The findings also highlight an agenda for more action by managers to facilitate the development of relevant inter-sectoral partnerships.

Evaluation of partnership working in cities in phase IV of the WHO healthy cities network

An intersectoral partnership for health improvement is a requirement of the WHO European Healthy Cities Network of municipalities. A review was undertaken in 59 cities based on responses to a structured questionnaire covering phase IV of the network (2003–2008). Cities usually combined formal and informal working partnerships in a pattern seen in previous phases. However, these encompassed more sectors than previously and achieved greater degrees of collaborative planning and implementation. Additional WHO technical support and networking in phase IV significantly enhanced collaboration with the urban planning sector. Critical success factors were high-level political commitment and a well-organized Healthy City office. Partnerships remain a successful component of Healthy City working. The core principles, purpose and intellectual rationale for intersectoral partnerships remain valid and fit for purpose. This applied to long-established phase III cities as well as newcomers to phase IV. The network, and in particular the WHO brand, is well regarded and encourages political and organizational engagement and is a source of support and technical expertise. A key challenge is to apply a more rigorous analytical framework and theory-informed approach to reviewing partnership and collaboration parameters.

Building capacity for rural health : the role of boundary crossers in coalition maturity for partnerships with external agents

The concept of partnership has entered policy rhetoric and is urged as good practice in a variety of domains including health. Rural communities tend to have fewer resources available for the provision of services such as health than their metropolitan counterparts, and so could be expected to benefit from partnerships with external agencies. Indicators of coalition maturity for working in partnership with external agents in order to build stronger communities are distilled from the group development and partnership research literature and considered in the light of the experiences of the University Department of Rural Health in community engagement. The chapter draws on experiences of two rural community coalitions working to plan and negotiate health service provision. The coalitions were analysed against the indicators. A key indicator of maturity and readiness for working in partnership with external agents is related to the behaviour of ‘boundary crossers’. Boundary crossers are defined as people who move freely between two or more domains and who understand the values, cultures and language, and have the trust, of both. Domains can be within a community or be the community and an external sector. Community health professionals, especially those in senior positions, often act as boundary crossers between the community and broader domains such as regional/state health services or policy, although other community members can fill the role. Other key indicators of coalition maturity for working in partnership with external agents include local leadership that empowers the community, a willingness of community coalitions to take risks and mould opportunities to meet their vision, and a culture of critical reflection and evaluation of past actions.

This chapter analyses the impact of boundary crossing behaviour on community readiness and partnerships with external agents that are intended to build rural community capacity to plan and negotiate health service provision. It is argued that the characteristics and modus operandi of boundary crossers who are members of rural community coalitions affect the level of maturity of the coalitions and community readiness to work with external agents. An understanding of the characteristics and modus operandi of boundary crossers provides valuable insights for external agents in designing their approach to partnerships that build rural community capacity for health.

Building capacity for rural health : the role of boundary crosser and the impact of their behaviours on community readiness partnerships

The concept of partnership has entered policy rhetoric and is urged as good practice in a variety of domains including health. Rural communities tend to have fewer resources available for the provision of services such as health than their metropolitan counterparts, and so could be expected to benefit from partnerships with external agencies. Indicators of coalition maturity for working in partnership with external agents in order to build stronger communities are distilled from the group development and partnership research literature and considered in the light of the experiences of the University Department of Rural Health in community engagement. The chapter draws on experiences of two rural community coalitions working to plan and negotiate health service provision. The coalitions were analysed against the indicators. A key indicator of maturity and readiness for working in partnership with external agents is related to the behaviour of ‘boundary crossers’. Boundary crossers are defined as people who move freely between two or more domains and who understand the values, cultures and language, and have the trust, of both. Domains can be within a community or be the community and an external sector. Community health professionals, especially those in senior positions, often act as boundary crossers between the community and broader domains such as regional/state health services or policy, although other community members can fill the role. Other key indicators of coalition maturity for working in partnership with external agents include local leadership that empowers the community, a willingness of community coalitions to take risks and mould opportunities to meet their vision, and a culture of critical reflection and evaluation of past actions.

This chapter analyses the impact of boundary crossing behaviour on community readiness and partnerships with external agents that are intended to build rural community capacity to plan and negotiate health service provision. It is argued that the characteristics and modus operandi of boundary crossers who are members of rural community coalitions affect the level of maturity of the coalitions and community readiness to work with external agents. An understanding of the characteristics and modus operandi of boundary crossers provides valuable insights for external agents in designing their approach to partnerships that build rural community capacity for health.

Our health in our hands : building effective community partnerships for rural health service provision

This paper reports findings from a study in two small Tasmanian rural communities that examined the process of developing and sustaining partnerships between health services and their communities. It identifies a generic framework for partnership development that appears to be common to partnerships, regardless of their purpose or of partners involved. The framework comprises ten predictors or indicators of effectiveness, and a sequential nine-stage partnership development process. Integral to the framework are social capital, and the leadership practices of health service and community leaders. The influence of context on the partnership development process is also examined, with reference to historical precedent, age or maturity of the partnership, and community readiness.

Health and disability : partnerships in action

Matthew is a 15-year-old adolescent boy who lives with his parents, Boon Hock and Guek, and brother Benjamin in Melaka Malaysia. Matthew loves exercising in the park, going to school and dressing smartly like his brother. Matthew has an intellectual disability and autism, and attends a special school. In this story, Matthew's parents reflect on the time around the diagnoses of his disabilities, and their experiences with health care professionals. They describe the changes in Matthew as he has grown from child to adolescent. The impact of Matthew's developmental disabilities on his likfe and that of his brother and parents are explored, and their hopes and plans for the future are discussed

Medical-legal partnerships: the role of mental health providers and legal authorities in the development of a coordinated approach to supporting mental health clients' legal needs in regional and rural settings

INTRODUCTION: Medical-legal partnerships (MLP) are a model in which medical and legal practitioners are co-located and work together to support the health and wellbeing of individuals by identifying and resolving legal issues that impact patients' health and wellbeing. The aim of this article is to analyse the benefits of this model, which has proliferated in the USA, and its applicability in the context of rural and remote Australia.

METHODS: This review was undertaken with three research questions in mind: What is an MLP? Is service provision for individuals with mental health concerns being adequately addressed by current service models particularly in the rural context? Are MLPs a service delivery channel that would benefit individuals experiencing mental health issues?

RESULTS: The combined searches from all EBSCO Host databases resulted in 462 citations. This search aggregated academic journals, newspapers, book reviews, magazines and trade publications. After several reviews 38 papers were selected for the final review based on their relevance to this review question: How do MLPs support mental health providers and legal service providers in the development of a coordinated approach to supporting mental health clients' legal needs in regional and rural Australia?

CONCLUSIONS: There is considerable merit in pursuing the development of MLPs in rural and remote Australia particularly as individuals living in rural and remote areas have far fewer opportunities to access support services than those people living in regional and metropolitan locations. MLPS are important channels of service delivery to assist in early invention of legal problems that can exacerbate mental health problems.

Empowering partnerships: nurses and those they care for

This chapter:
• explores the traditional roles of nurses and those they care for;
• discusses the concepts of empowerment and partnerships as they apply
   to the provision of health care;
•examines the key concepts of a partnership model:
  a) non-patronising empowerment;
  b) collaborative decision making;
  c)  valuing diversity and individuality; and
  d) mutually beneficial relationship; and
•  identifies the threat to each characteristic of the partnership model.

Why primary health care offers a more comprehensive approach to tackling health inequities than primary care.

As governments attempt to focus more intently on how to deal with alarming measures of health disadvantage and inequities, a reformist gaze seems to have settled on the primary care sector. Simultaneously, in literature about this area, whether intended or not, primary health care and primary care are terms that are increasingly interchanged. This article argues that the slippage in language is counter-productive, first because it disguises the transformative potential of strategies and approaches that can make the fundamental changes necessary to improve health status, and second because the structures and practices of the primary care sector are not necessarily compatible with notions of comprehensive primary health care. There is much to be lost if primary health care and health promotion are disguised as primary care, and not understood for their capacity to make a difference to health inequities although of course in some circumstances, comprehensive primary health care is interdependent with services provided by primary care. In this article, characteristics of primary care and primary health care are juxtaposed to show that if the strengths and limitations of each model are understood, they can be mobilised in collaborative partnerships to deal more effectively with health inequities, than our system has so far been able to do.

Fresh kids: the efficacy of a health promoting schools approach to increasing consumption of fruit and water in Australia

The Fresh Kids programme utilized the Health Promoting Schools (HPSs) framework to design a whole-of-school, multifaceted intervention targeting specific behaviours to promote healthy eating and reduce the risk factors associated with childhood obesity. The aim of the programme was to evaluate the effectiveness of the HPS framework to increase fruit and water consumption among primary school-aged children over a 2-year period. The study design was an interrupted time series. Four primary schools in the inner west of Melbourne, Australia, participated in the programme intervention. Baseline data were collected using a lunch box audit to assess the frequency of children with fresh fruit, water and sweet drinks, either brought from home or selected from canteen lunch orders. The lunch box audit was repeated periodically for up to 2 years following programme implementation to assess the sustainability of dietary changes. Across all participating schools, significant increases between 25 and 50% were observed in the proportion of children bringing fresh fruit. Similarly, all schools recorded increases between 15 and 60% in the proportion of students bringing filled water bottles to school and reductions between 8 and 38% in the proportion of children bringing sweet drinks. These significant changes in dietary patterns were sustained for up to 2 years following programme implementation. Targeting key nutrition behaviours and using the HPS framework is an effective and simple approach which could be readily implemented in similar childhood settings. Effective strategies include facilitating organizational change within the school; integrating curriculum activities; formalizing school policy and establishing project partnerships with local community nutrition and dietetic services.

Supermarkets as a setting to promote health eating : some lessons learnt in Victoria

Issue addressed: Supermarkets are a potential setting in which to deliver nutrition promotion to the community. A pilot project was able to examine the requirements for health authorities to form partnerships with other sectors and opportunities and limitations of using industry- based communication strategies to promote healthy eating messages. Methods: Pre-intervention interviews helped determine communication strategies. Post-intervention interviews were used to assess content and appropriateness of nutrition resources, collaboration between key participants, satisfaction with training and barriers/promoters to implementation. An intercept survey with consumers measured the impact of the intervention. Results: The survey of more than 1,120 women indicated only limited success. 12% of respondents from the intervention supermarkets had watched demonstrations and 20% had noticed the recipe leaflets, with only 5% able to name the promotion. Supermarket owners, representatives from participating food companies and demonstrators were supportive of the concept and content used in the promotion and qualitative analysis provides indicators for similar promotions. Conclusions: Health authorities considering 'partnerships' with the food/supermarket industry should recognise the diversity of roles and responsibilities of the organisations involved in the supply of food through the retail market and allow for long term planning when working with them. Head office of the supermarket group has a key coordinating role, however, individual supermarkets will be driven by financial returns. So what?: The recognition and trust in the name of health authorities by consumers means that organisations value an association with them.

‘Be yourself and have a ball’ : using a school and community based health education model to build young women’s resilience and connectedness

Recognition of the important role schools play in the promotion of student wellbeing can be seen in the growing number of polices and programs being implemented in schools across the Australia. This paper reports on some initial data from focus group interviews with year 9 and 10 girls involved in the pilot of a health and physical activity intervention designed to connect them to their local community and reconnect them with their school and their peers. The aim of the program was to build connectedness and resilience by engaging young women in non-traditional physical activities whilst providing them with a sound understanding of health issues relevant to adolescent girls. Situated in a relatively isolated rural community 200 kilometers south east of Melbourne the program was overwhelmingly delivered by regional and local agencies in conjunction with the local secondary school. The intervention was built on a partnerships model designed with the purpose of increasing participation and access for young women whilst building a sustainable program run in partnership between the school and local agencies and services. The initial data from this pilot indicates the program is having a positive impact on the young women’s sense of self and their bodies, their relationships with their peers and in reducing bullying behaviour amongst the girls. However the data raises some important questions around the adequacy of school-based health education, and the sustainability of approaches designed to be delivered by outside agencies rather than classroom teachers.

Nutrition and mental health research in Australia and New Zealand: A review of progress and directions for the future

This review summarises nutrition and mental health research in Australia and New Zealand between 1986 and 2006. The method used to identify papers for inclusion was a search of computerised databases: Medline, Cinahl and Meditext 1986–2006, with subsequent bibliographical review. Key search words were nutrition, diet, mental disorder, mental illness, weight, physical health, Australia and New Zealand. Inclusion criteria included: English language, original data in peer reviewed journals, and examination of some component of nutrition in people with a mental illness. The review of thirteen papers found that the evidence base for dietetic practice in mental health has developed through small assessment and interventional research, often with multidisciplinary collaboration. Future research should include quality and outcome measures with intersectoral partnerships. Dietitians are well positioned to lead and participate in mental health research and to implement research findings to improve the nutritional status of this vulnerable group.