It’s now five years since WH&Y was launched, creating a space for researchers and young people to work together on improving how we support the health and wellbeing of Australian teenagers.
WH&Y researcher, Dr Dan Waller, has been speaking with colleagues to gather their thoughts on the progress of the last five years: what we know now that we didn’t know then, and why it matters. These insights will inform a WH&Y Centre of Research Excellence (CRE) whitepaper, and provide guidance to Australian governments, health policy makers and practitioners, service providers and associated organisations. The whitepaper is still in development, but featured here are nine key insights.
Emergency Departments (EDs) are increasingly being used by young people for mental health challenges. The increase in young people presenting to EDs with mental health concerns is an ongoing area of focus for WH&Y researchers. Dr Sharon Medlow, WH&Y Research Translation Coordinator, notes the trend is troubling for two reasons: because it reveals a failure in early intervention, and because it suggests that young people with mental health challenges feel they have nowhere else to go. Sharon and WH&Y Research Affiliate Dr Patricia Cullen collaborated with colleagues including WH&Y Chief Investigator, Professor Rebecca Ivers, on a systematic review of ED-initiated mental health interventions to better understand how they impact health service efficiencies. They found that service level impacts were positive, including improved efficiency of care and decreased length of stay, but recommended that future research investigate outcomes from the perspective of both young people and staff. The results of such a study could inform the development of best-practice recommendations for ED-initiated mental health care for young people.
Young male drivers are more likely to be involved in a crash, but young female drivers are more likely to be hospitalised following a crash. Dr Patricia Cullen was also involved in the DRIVE Study, a large, longitudinal study of 20,000 drivers under the age of 25, led by Professor Rebecca Ivers. Patricia has long had an interest in the sex and gendered dimensions of adolescent health, and undertook a sex disaggregated analysis of the study to explore sex differences in crash and crash-related injury. She found that young men are at increased risk of crash, and that this risk persists even as they get older and gain more driving experience. However, she also found that, despite the lower risk of crash, women are at higher risk of crash-related injury and hospitalisation. The findings suggest there is more work to be done to understand how and why sex and gender contribute to a young person’s risk of injury.
Young people struggle to get the help they need from a disjointed health system, but ‘nurse navigators’, located within Emergency Departments (EDs), is a model that shows promise. Associate Professor Melissa Kang is a WH&Y Associate Investigator. Melissa is interested in how young people access the healthcare system, particularly those who are disadvantaged and face greater ill health and more barriers to health support. She has led a number of major studies on this theme, including the ED Nurse Navigator Pilot in 2018. The pilot showed that having easy access to a nurse trained to help young people access the support they need resulted in fewer return visits to the ED, especially for homeless and other vulnerable young people. The success of the pilot led to a permanent ‘nurse navigator’ being established in Western Sydney.
Virtual Reality has a role to play in making health services work better for young people. Research into how digital technology can be used to improve the experiences of young people in our health system has been a theme of WH&Y’s work since its inception. In 2021, a systematic review by Dr Brad Ridout and colleagues found that Virtual Reality (VR) can provide a safe and engaging way to reduce pain and anxiety in adolescents while in hospital. More recently, a WH&Y pilot study used VR immersion techniques to help ease the stress and anxiety of young people in EDs, and likewise showed promising results. The study was developed in response to concerns raised by ED staff about the level of distress being experienced by adolescent patients. The potential of VR to be used as a therapeutic tool in health care for young people has also been explored in WH&Y webinars, including VR Body Swap with Martin Brown, and Virtual Reality in 2021 for Medicine and Health with Associate Professor Andrew Campbell.
We are seeing progress in how adolescent health is researched and supported, but the gains can be undermined by systemic failings. Over the last five years, WH&Y has helped to lead improvements in the way young people’s health is researched and supported in Australia. Key to this have been the contributions of Chief Investigator Professor Pip Collin and the young research advisors of the WH&Y Commission. Their work together has improved our understanding of the benefits of youth engagement in health research and service design, and demonstrated the feasibility of youth engagement with significant bodies including government departments. Meanwhile, Chief Investigator Professor Lena Sanci has been part of a team researching whether a Medicare rebate for an adolescent and young person’s health assessment in general practice would advance health care in a cluster randomised controlled trial. Nonetheless, significant systemic issues continue to slow progress in adolescent health research. WH&Y Researcher, Dr Dan Waller, raises concerns over the persistence of binary policy approaches that see adolescents tacked on to either paediatric or adult-focussed health policies, neither of which align with the distinct health needs of young people. Dan has published a review of relevant Australian health policies to support these concerns. And WH&Y Director Professor Kate Steinbeck observes there are ongoing issues with the risk-averse approaches of Human Research Ethics Committees (HREC), and a reluctance to recognise adolescents’ developing consent capabilities. This does hinder research in younger adolescents and is also coupled with a lack of clear guidance on consent in research guidelines. Research in this area, lead by Chief Investigator Professor Angus Dawson, will be published in 2023.
School-based mental health programs are more beneficial for students and more achievable for schools when they are thoughtfully embedded into school systems. Professor Lena Sanci is co-lead of WH&Y Policy and Practice, a research stream focussed on working with decision-makers to establish evidence-based foundations for a transformation in adolescent healthcare. Lena has been closely involved with Doctors in Secondary Schools (DiSS), a Victorian government program that has established on-campus, primary care clinics at 100 schools in areas of socioeconomic disadvantage. Her work, including a recent literature review, shows that programs like DiSS that are thoughtfully and effectively integrated into school systems have great potential to deliver meaningful and sustainable benefits for young people, while also being relatively easy for schools to implement and maintain.
Digital health literacy among young people is good – but not as good as it could or should be. How young people access and appraise health information online is an area of research currently being led by Research Affiliate, Associate Professor Karen Scott. A paper authored by PhD student Melody Taba and others was particularly focused on how young people’s perception of their skills compared with their demonstrated ability to evaluate information found through internet searches, and via social media. The research indicated that digital health literacy was high, although perceived skills were higher than demonstrated skills. The authors also learned that adolescents were unlikely to act on online health information without first consulting with a parent or health professional. A co-designed educational app is now in development, with early results showing that young people’s digital health literacy improves after using the app.
Digital health innovations need to be designed collaboratively with young people to ensure they support adolescent health, rather than creating a new set of barriers. WH&Y Researcher, Dr Teresa Swist, has worked closely with Professor Pip Collin and the WH&Y’s youth collaborators to help establish the WH&Y Commission. Research undertaken by Teresa and the WH&Y Commissioners reveals that, while digital technologies are very much embedded in young people’s lives, the implications of how health data is collected and used are as yet unclear, both to young people and to adult stakeholders. A recent synthesis of a narrative review and WH&Y Commission workshops, just published, recommends that future research should have priorities such as exploring young people’s views on data, privacy, and the environmental impacts of technology; the limits and possibilities of Artificial Intelligence; and the social implications of real-time monitoring across health systems. These insights will be key for the co-development of digital health futures that deliver genuine benefits to young people.
Young people have the interest and capacity to be enthusiastic, valuable, long-term contributors to youth health research. WH&Y Associate Investigator, Professor Leon Straker, is the former Scientific Director of the Raine Study, Australia’s longest-running public health study, and one of the most extensive studies of health over the life course, anywhere in the world. Leon observes that the young people who were recruited to the participant advisory groups as 13-year-olds have maintained their involvement, and in some cases have intensified their commitment, occupying places on the Board and the Scientific Review Committee. The WH&Y Commission, the young collaborators at the heart of the WH&Y CRE, have likewise shown their propensity not only to stay involved, but to develop their skills and deepen their connection. Betty Nguyen is just one of multiple examples, having come on board to the WH&Y Commission in 2018, and now attached to the CRE as a research assistant.