Finalist 2022

CY HOPE: A new HOPE for the mental health and wellbeing of young Victorians Co-design support package

Portable and the Victorian Department of Health

Co-designing a new HOPE for the mental health and wellbeing of young Victorians in need of after-care services and support.

The Royal Commission into Victoria’s Mental Health System (Royal Commission) released an Interim Report in November 2019 identifying a gap in suicide prevention services for children and young people at risk of suicide and self-harm. On Royal Commission’s recommendation, the Department of Health funded 4 health services (Royal Children’s Hospital, Monash Children’s Hospital, Alfred Health and Orygen) to create, deliver, and evaluate a new Child and Youth Hospital Outreach Post-suicidal Engagement (HOPE) service. Portable was engaged as a coach to guide the co-design process, ensuring that those with lived experiences were involved in the development of this critical service.

Design Brief

The HOPE program is a core component of Victoria’s suicide prevention framework 2016-25, which aims to halve Victoria’s suicide rate by 2025. HOPE teams support individuals and their personal support networks (family, friends and other carers) helping them to identify and build protective factors against suicide or self-harm. The project saw health services co-designing the new Child and Youth HOPE service with young people who have lived experience of receiving mental health support. The 4 health services were experienced in service design but each had differing levels of experience with co-design. Portable, given our expertise in co-design and co-design training, was engaged to build co-design capability at services with less experience and to support each health service in using a consistent approach to co-designing their local Child and Youth HOPE service, in partnership with children, young people, carers and families, clinicians and service providers.

This project was developed by:

Design Process

Beginning with a 2-day co-design training course, we introduced the Department of Health and the health services to key concepts with a practical application of design activities. The training also included mindsets for social co-design, Portable’s mental health design principles and ethical considerations for power-sharing and participant safety. We then individually coached the health service design teams through each stage of the co-design process, to support them in designing the service with people that have lived experience. Coaching at each stage included:

Exploring the problem: Health services immersed themselves in the experiences of those they are designing the Child and Youth HOPE service with. They used a range of methods and activities to gain a deep understanding of those with lived experience and those who provide professional support, including workshops, contextual interviews and emergency department data analysis.

Defining the problem: Health services organised all their findings and grouped them together in related themes and ideas. Then they started to build a picture of the current end-to-end journey people go through and what they need at each stage in order to feel supported.

Exploring the solution: We encouraged lived experience participants, lived experience leads and health service staff to be as imaginative and unrestricted as possible in their thinking at this stage, so that they could explore many possible ideas for solving the problem. Potential ideas for the new Child and Youth HOPE service were distilled into a concise and formulated concept, visualised as a prototype.

Making the solution work: As teams moved through the co-design process they identified constraints, assessed and prioritised their ideas to refine the prototype that would balance what was desirable, viable and feasible. Health services tested and iterated their prototype until it was developed enough to inform a final Child and Youth HOPE Model of Care.

Design Excellence

Given that the Child and Youth HOPE service is for young people who have self-harmed or are at-risk of suicide, this project tackled complex, traumatic and systemic problems that can be distressing for people to talk about with others. It was vital to create a safe space for people to share their experiences with confidence and trust, so that the process of co-design wouldn’t cause further harm.

Our approach to ensuring participant safety included:

  • Lived experience readiness screening process to ensure participants were ready to engage in co-design.
  • Psychological, peer and cultural support was provided to participants before, during and after co-design sessions.
  • Clinicians and lived experience leads designed activities from a trauma-informed lens to reduce the risk of activities.

Young people, families and carers were thoroughly briefed and gave informed consent before participating. To ensure cultural safety for Aboriginal and Torres Strait Islander participants, we partnered with Aboriginal consultancy Wan Yaari. Wan Yaari provided coaching and consultation to the health service design teams, advising on facilitating co-design activities with young Aboriginal people in a culturally safe way, and helping to ensure the Child and Youth HOPE Models of Care would be culturally appropriate and consider the needs of Aboriginal and Torres Strait Islander young people and families.

We also engaged agencies on the Department’s Partnership Advisory Group (PAG) who provided additional representation for the voices and lived experiences of groups at greater risk of suicide. This included representatives from organisations that advocate for young people, children in out of home care, Aboriginal & Torres Strait Islander, migrant & refugee, neurodivergent, trans and gender diverse, intersex, and LGBTIQ+ young people.

Design Innovation

Co-designing services with those who have lived experience is a growing practice in the mental health sector but it is not systemic. For the Child and Youth HOPE project, all health services employed lived experience leads in their design teams, who were equal members of the local co-design team, working alongside clinicians and other service providers. This required clinicians and managers to broaden their perspectives, practice sharing power, balance the needs of each group and create a safe and ethical approach to participation.

Across the four health services, we co-designed with a broad range of people who have lived experience of the mental health system. This included 24 carers, 20 young people, 7 children, 28 clinicians, external service providers including education institutions (public, independent, alternative), a primary school nurse, Headspace, and health service stakeholders including NDIS Leads, Aboriginal health services, and refugee health services.

Lived experience included representatives from the following groups:

  • Aboriginal & Torres Strait Islander people
  • Trans and gender diverse people
  • LGBTIQA+ people - People with experience of family violence
  • People with experience of the justice system
  • Neurodivergent people

Our engagement with the Department’s Partnership Advisory Group (PAG) at various points throughout the co-design process highlighted the main challenges facing young people in their communities, and provided feedback on the health services Child and Youth HOPE prototypes. This has opened up conversations and pathways for the health services to continue engaging with these groups for further input into their service models and Child and Youth HOPE staff training programs.

Design Impact

Portable’s co-design support, coaching and capability building has helped the Department and the health services to understand and advocate for the value of lived experience expertise in their Child and Youth HOPE models of care. As a result, lived experience peer support roles working alongside clinicians are now central to all 4 Child and Youth HOPE models. All 4 health services have now launched a Child and Youth HOPE service.

The co-design process empowered teams to create feedback loops to continuously improve the Child and Youth HOPE model of care, and this will be built into the service as teams apply the co-design mindsets and practices they learned during the project. In addition to the relationships that the health services teams have built with each other, new relationships have been fostered with community organisations representing groups at greater risk of suicide through the Partnership Advisory Group (PAG). Portable embedded regular reflective practice into the co-design coaching model, both with individual teams and across the health services.

Collaborating across the Department and the 4 health services to share and amplify learnings created a mini-community of practice. Teams appreciated the opportunity to share and learn from one another. The Department facilitated weekly informal gatherings for the health services to share their progress, learnings, questions and concerns. This reflective practice is continuing as teams refine and implement their models of care. The health service design teams have gained valuable experience in the co-design process and are now sharing best practice more broadly that can be integrated to improve other services too. This project has had a positive impact on the Child and Youth HOPE models of care, as well as broader health services and systems, paving the way for greater lived experience representation and safe co-design practise in Victoria’s mental health system.

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