Young people transitioning from residential out-of-home care experience inequities across key life domains. To address this, transition planning is implemented for young people aged 15–17 years. This evidence-informed practice aims to prepare them for adulthood by addressing their social, material, and developmental needs. However, the intended health and social outcomes are not consistently realised. Examining indicators of implementation fidelity may help explain these gaps, as lower fidelity is associated with poorer outcomes. Therefore, this study examined two indicators of fidelity: (1) adherence to key components of transition planning; (2) the quality of transition plans. A multi-source design drew on administrative data (n = 77), a staff adherence survey (n = 102), and transition plan documents (n = 95). Findings revealed notable gaps between intended and actual practice. Across the 18 transition planning components, mean adherence was 71.9

ABSTRACT Background and Aims Normalisation Process Theory (NPT) seeks to describe and explain how a complex intervention can be embedded into an existing health and social care system. NPT is frequently used to evaluate interventions, and less frequently to design them. We demonstrate how NPT can be applied to exploratory qualitative data to understand the potential barriers and facilitators to the implementation of a new intervention in a health setting using the NPT framework. We illustrate this application using a case study of screening for homelessness and housing instability in Australian emergency department and primary care settings. Methods This qualitative study comprised semi‐structured interviews of healthcare workers and people with lived experience of homelessness. Our hybrid analysis involved an initial inductive reflexive thematic approach followed by deductive qualitative analysis guided by a theoretical framework, that is, the four domains of NPT: Coherence, Cognitive Participation, Collective Action and Reflexive Monitoring. Results 39 interviews were conducted with healthcare workers (n = 30) and people with lived experience of homelessness (n = 9). Healthcare workers differentiated screening for homelessness from their current work (Coherence) but had mixed views on the utility of screening (Cognitive Participation) and were reluctant to do the extra work (Collective Action). Healthcare workers from Aboriginal Community Controlled Health Organisations and community health centres demonstrated higher commitment and readiness to do this work than their counterparts in hospital or fee‐for‐service primary care settings. People with lived experience of homelessness wanted their healthcare workers to understand how their housing situation affected their health, and to adapt care accordingly. Conclusion This study demonstrates that NPT can be used in the very early planning of interventions. This application of NPT may support the intervention design that is better aligned to the expectations of people tasked with implementing the intervention, thus increasing uptake and facilitating normalisation.

PURPOSE:Evidence suggests that Psychologically Informed Environments (PIEs) may support positive outcomes for people experiencing homelessness and staff; however, limited research has examined PIE implementation. This study investigated staff perspectives of contextual factors influencing implementation of a PIE framework embedded for approximately ten years within a youth refuge. METHODS:Twenty-six staff from an Australian youth refuge participated in semi-structured interviews. Data were analyzed using reflexive thematic analysis and organized around six PRISM-informed intervention characteristics: acceptability, adaptability, complexity, usability, usefulness, and observability. RESULTS:A PIE was highly acceptable, with alignment between its principles and staff values supporting integration into practice. Implementation involved interconnected processes, with shared formulation providing common psychological understanding, reflection supporting its application and maintenance, and trauma-informed environmental design enabling psychologically informed practice. Training, experience, and informal learning supported increasingly intuitive practice, while flexibility enabled individualized responses. Staff perceived benefits for young people, staff, and the service, while organizational conditions influenced consistent enactment. CONCLUSIONS:Findings suggest that a PIE becomes embedded when mutually reinforcing core components are integrated within a shared psychological approach that provides consistency while enabling individualized practice. Formulation, reflection, and trauma-informed environmental design supported enactment, while organizational and service-system conditions could enable or constrain implementation. Future research should examine these barriers and enablers across contexts and implementation stages.

Transition planning is mandated to support young people (YP) in residential out-of-home care (OoHC) to prepare them for independent living by age 18. Yet, it often falls short of meeting YP’s developmental and material needs, particularly for overrepresented cohorts with additional and intersecting needs. Two such cohorts are those living with disability and those from multicultural and multifaith (MCMF) backgrounds. The overall aim of this study was to generate knowledge to support the successful implementation of transition planning for these two cohorts of YP. The specific aims were to identify (a) barriers and enablers that prevent or facilitate successful implementation; and (b) strategies that improve the design and delivery of transition planning. Qualitative semi-structured interviews and focus groups were conducted with staff (n = 60) involved in supporting YP leaving residential OoHC in Victoria. Data were analysed using abductive approaches guided by the Consolidated Framework for Implementation Research (CFIR). We identified barriers and enablers across all CFIR domains: Outer Setting (6 factors, e.g., legislation), Inner Setting (4 factors, e.g., access to knowledge), Characteristics of Individuals (3 factors, e.g., capability), Innovation (5 factors, e.g., complexity), and Implementation Process (2 factors, e.g., engaging YP). Recommended strategies to improve the design and delivery of transition planning for YP with disability and from MCMF backgrounds included practice adaptations, legislative reform, cross-government agreements, and workforce capability building.

PURPOSE:Transition planning in residential out-of-home care (OoHC) is a legislated practice designed to prepare young people (YP) to live independently from the State by age 18. It involves multiple components, including the development of a transition plan, skills building, securing housing, and establishing formal and informal support networks. Despite this, many YP experience inequitable outcomes when they leave OoHC, indicating implementation challenges. MATERIALS AND METHODS:This study identified the barriers and enablers (determinants) shaping the implementation of transition planning and the strategies needed to improve it. Semi-structured interviews and focus groups were conducted with residential care and cross-sector staff (n = 46) across Victoria, Australia. Data were analyzed using abductive coding guided by the Consolidated Framework for Implementation Research (CFIR), encompassing determinants across the Outer Setting (structural factors), Inner Setting (organizational factors), Characteristics of Individuals (skills and motivation of staff), Innovation (design of transition planning), and Implementation Process (activities to implement it). RESULTS:Determinants were identified across all CFIR domains: Characteristics of Individuals (n = 4; e.g. capability), Outer Setting (n = 6; e.g. policies and laws), Innovation (n = 4; e.g. relative advantage), Inner Setting (n = 5; e.g. access to knowledge and information), and Implementation Process (n = 3; e.g. teaming). DISCUSSION:Findings highlight the need to enhance the perceived advantage of transition planning, strengthen workforce capability, and address systemic barriers. CONCLUSION:Future research should design and evaluate implementation strategies that harness the enablers and address the barriers.

Transition planning is a core child welfare practice designed to prepare young people (YP) in out-of-home care (OoHC) to live independently from Child Protection by age 18. It aims to address several domains shown to improve outcomes: active participation, housing, education and economic participation, independent living skills, and formal and informal support networks. Despite clear policy intent and evidence of what supports successful transitions, YP continue to experience inequitable outcomes after leaving OoHC. This study identified a range of structural and individual barriers and enablers influencing the implementation of transition planning and YP’s recommended strategies for improvement. Qualitative semi-structured interviews and one focus group were conducted with 27 YP currently living in, or recently transitioned from, foster, kinship, and residential OoHC in the Australian state of Victoria. The implementation of active participation was influenced by four factors (e.g., staff capability); education and economic participation by five factors (e.g., legislation); appropriate housing by three factors (e.g., housing availability); independent living skills by three factors (e.g., placement environments); and support networks by three factors (e.g., service design). Staff and carer capability was relevant across all domains, and legislation determined the parameters of support provided. Findings highlight the need to adapt transition-planning policy and service design to align with YP’s needs, strengthen workforce capability, enhance relational and placement stability, and increase access to safe housing and practical supports. Future research should co-design implementation strategies with YP and stakeholders to improve effective transition planning.

Background High-quality preconception care can optimise health and wellbeing and reduce adverse maternal and infant outcomes. Larger-bodied preconception women are more likely to experience weight stigma and discrimination in healthcare due to their body size, and thus receive lower-quality care. General Practitioners (GPs) are key healthcare providers in preconception care, yet there is a limited understanding on their perspectives caring for larger-bodied preconception women. Objectives To better understand the experiences and viewpoints of GPs’ caring for larger-bodied preconception women. Design Descriptive qualitative study design using thematic analysis. Methods Semi-structed interviews with GPs (N = 15) who provided preconception care in Australia were conducted online via Zoom. Participants were purposively recruited via word of mouth, emailing digital flyers to GP clinics, and posting information on social media platforms. Interviews were audio recorded and transcribed verbatim. Thematic analysis was conducted and themes were continuously refined through collaborative discussions with the research team. Results Three overarching themes were identified: 1) narratives and assumptions about larger-bodied preconception women, with a focus on how these can prevail throughout general practice and contribute to weight stigmatising interactions with preconception women; 2) factors influencing GPs’ approaches to caring for larger-bodied women, highlighting how approaches to care are impacted by external factors within healthcare; and 3) challenges to providing non-stigmatising care to larger-bodied preconception women, emphasising that significant effort is required to contest common assumptions and narratives associated with higher body weight. Conclusion Findings demonstrated that whilst GPs have a strong desire to provide high-quality preconception care to all women, the pervasiveness of weight stigma in healthcare can impact the care they provide. Supporting GPs to provide non-stigmatising care to larger-bodied preconception women is urgently warranted to improve health outcomes for all women equitably.

Residential out-of-home care (OoHC) delivers a wide range of programs and practices intended to support the emotional, social and developmental needs of children and young people (CYP). Yet many CYP continue to experience inequitable life outcomes, indicating implementation gaps. Implementation science offers systematic approaches to strengthen delivery of practices, including identifying the barriers and enablers that influence successful implementation. A scoping review was undertaken to identify the barriers and enablers influencing successful implementation of practices in residential OoHC. Eight electronic databases were searched from 1 January 2010 to 3 November 2025. Peer-reviewed primary studies reporting barriers and enablers to implementing practices in residential OoHC were included. Data charting and analysis were guided by the Consolidated Framework for Implementation Research (CFIR) using a framework analysis approach. CFIR was selected because it supports the systematic identification of barriers and enablers across systemic, organisational, individual, practice and process factors. Thirteen studies were included following screening of titles and abstracts (n = 7,225) and full texts (n = 349). Most studies were published between 2022 and 2025 (n = 10) and conducted in Australia (n = 6). Almost all studies (n = 12) reported determinants within the Characteristics of Individuals (e.g., capability), Inner Setting (e.g., relational connections), and Innovation (e.g., relative advantage) domains. Seven studies reported Implementation Process determinants (e.g., engaging CYP) and five reported Outer Setting determinants (e.g., policies and laws). Findings can inform implementation planning, capability-building and organisational and system supports to strengthen delivery of innovations in residential OoHC.

Given the burden of growing global health inequities and calls to action for Implementation Science to become more equitable, a renewed approach to advancing knowledge and actions with equity is required. We introduce the Model of Equitable Transdisciplinary Implementation Science (METIS) as a novel response to support the journey of embedding equity, conceptually, methodologically, practically and relationally, at the heart of research, evidence generation, and implementation practice. METIS integrates knowledge systems (Transdisciplinary Science), implementation support systems (Implementation Science), and intrapersonal systems (Relational Theories) with Equity (conceptual, experienced and benchmarked). A theorizing process drives integration to create new equitable knowledge, evidence, practices and relationships which, together, inform the development of equitable implementation strategies and outcomes. METIS components are presented alongside an example of an Australian First Nations Framework reflecting alignment and providing an option for Implementation Science researchers and practitioners to utilize a model that is grounded in pluralistic epistemologies, relationality and context to provide real-world solutions to real-world challenges. A case study applying METIS to inform the development of an early parenting outcomes framework and its implementation plan is also outlined, as are recommendations for future research and evaluation.

Youth homelessness is a global problem. Preventing youth homelessness has many individual and societal benefits. Internationally, a key response to youth homelessness is the provision of a standard youth refuge model which includes short-term accommodation staffed by support workers who provide case management and referrals, with other varying health, hygiene and crisis services attached. However, it is unclear what is offered within these settings, and whether youth refuge improves any outcomes for youth experiencing homelessness. Homelessness services have also been increasingly encouraged to embed trauma-informed or psychologically informed practice models into service delivery. Like broader evaluations of the standard model, little is currently known about the extent to which these practice models are being implemented, how they are implemented, and whether they improve outcomes beyond standard models. Therefore, this systematic narrative review aimed to: (1) identify what services youth refuges provide, and which practice models are used; and (2) examine how effective youth refuge practice models are in improving health, behavioural, psychosocial, and/or housing outcomes for youth experiencing homelessness. Database and grey literature searches identified ten articles to be included. Seven articles evaluated a standard refuge model, two included strengths-based practice models, and one included an empowerment philosophy. No practice model offered evidence of its efficacy above what was offered by the standard refuge model, and limited detail about implementation of any model was found. Two cohorts emerged within refuge: (1) a younger cohort who could reconcile with family with therapeutic intervention; and (2) an older cohort who needed other options. Generally, results demonstrated short- to medium-term improvements in all health, wellbeing, and housing outcomes, with most gains reported in vocational status and improved family relations. Housing stability was a key contributing factor for outcome achievement. Most studies were of low methodological quality hence more rigorous, standardised, mixed-methods research is needed before conclusions about the efficacy of youth refuge and any practice models can be made.

BackgroundGender disparities persist in health research, care and outcomes. The aim of this study was to identify and explore the health conditions and social issues that affect women and girls in Australia which are not well-understood, discussed or funded.MethodsA national exploratory mixed-methods study using a triangulation approach which included three phases: (1) survey of women and girls; (2) interviews with female subject matter experts including women's health and social care practitioners, organisational leaders, academics and policy makers; and (3) a desktop review of peer-reviewed research literature, grant funding and media content. The study was conducted between February - March 2025. The outcomes included participants' perceptions of health conditions and social issues which are overlooked or need further support and awareness. The proportion and type of conditions and issues researched, funded and in the public discourse was also assessed.Results2,203 eligible surveys were submitted; 23 experts participated in an interview. Although all conditions and issues were identified as important, several were perceived to be 'silent' and requiring a better response including those which only affect women and girls (e.g. endometriosis, peri/menopause, abortion) and affect them disproportionately (e.g. body image, eating disorders; mental health conditions; fibromyalgia) or differently (e.g. violence, cardiovascular disease) to men and boys. In contrast, the desktop review revealed most contemporary research literature, grant funding and media discourse has focused on women's reproductive health in contrast to other health conditions and social issues that disproportionately and differently affect women.ConclusionsMany health conditions and social issues affecting women and girls lack understanding, recognition and support. This 'silence' has resulted in discrepancies and adverse consequences for women's and girls' equitable access to health care, outcomes, and research participation.

Transition planning commonly falls short in meeting the mandated goal of supporting young people in residential out-of-home care (OoHC) to prepare for independence from the State by age 18. To explore why, this study used implementation science frameworks to examine staff perceptions of transition planning's feasibility, appropriateness and acceptability (implementation outcomes), and the barriers and enablers (determinants) influencing successful implementation. A cross-sectional survey was completed by 142 staff, from a residential OoHC provider (n = 102) and cross-sector teams (n = 40) in Victoria, Australia, enabling comparisons across work settings. Implementation outcomes were assessed using validated measures, and determinants were examined using the Consolidated Framework for Implementation Research (CFIR). Each outcome clustered near neutral, indicating partial implementation, with both shared and divergent perspectives across work settings. Various determinants were identified across all CFIR domains, with 13 significantly predicting implementation outcomes. Implications for practice include strengthening staff capability, co-designing youth-friendly tools, embedding active implementation processes, and aligning policies and practices with developmental needs. Future qualitative research is needed to deepen the understanding of the salient contextual factors influencing implementation and how CFIR constructs are expressed within transition planning in residential OoHC.

Embedded research, where academic researchers are integrated into practice-based organisations, offers a promising approach to bridging the research-to-practice gap and driving better outcomes in the health, social care, and education sectors. However, little is known about the implementation factors that influence its success. This scoping review explores what barriers, enablers, and outcomes are associated with embedded research. A search of primary research literature published between 2019 and December 2024 was performed, and 18 studies were included. Implementation determinants were mapped to the Consolidated Framework for Implementation Research (CFIR 2.0), and outcomes were analysed inductively. Most barriers and enablers were associated with the Inner Setting domain of CFIR 2.0, particularly those related to relational connections, communication, and organisational structure. Tailored implementation strategies and stakeholder engagement further supported successful embedded research. Outcomes included enhanced evidence-based practice, improved research capacity, elevated knowledge production, and strengthened collaborative relationships. The review demonstrates that implementation of embedded research is influenced by a range of contextual and relational factors. These findings provide a theoretical foundation to inform future implementation efforts and support effective translation of research into practice.

BACKGROUND:Young people in out-of-home care experience complex mental health needs and may be prescribed psychotropic medications at a greater rate than those not living in care. The aim of this scoping review was to synthesise international literature to (1) understand the prevalence of psychotropic medication use among young people in out-of-home care and (2) identify the factors associated with a greater likelihood of prescribing and/or use. METHODS:This scoping review was conducted according to the Joanna Briggs Institute (JBI) methodological guidance. Five electronic databases were searched for relevant literature published from inception to September 2024. Synthesising the literature involved a mixed-method approach, utilising a proportional meta-analysis, narrative synthesis and content analysis. RESULTS:Sixty-one studies were eligible for inclusion. Meta-analysis calculated the pooled prevalence of any psychotropic medication as 42.16% (95% confidence interval [CI]: 31.76-52.93%). Pooled prevalence estimates for individual subclasses were 25.60% for stimulants (16.82-35.51%), 21.33% for antipsychotics (12.42-31.87%), 16.36% for antidepressants (10.35-23.42%), 8.57% for mood stabilisers (4.61-13.58%) and 2.24% for anxiolytics (1.12-3.72%). The most commonly examined predisposing factors suggested differences in prescribing practices associated with demographic characteristics such as age, sex and ethnicity. CONCLUSIONS:Psychotropic medication management in out-of-home care is complex; however, further research on the international prescribing practices outside the United States is needed. Improved cross-system coordination, caregiver support, meaningful youth involvement and trauma-informed, person-centred approaches to mental health care in out-of-home care are essential to ensure safe, effective and equitable psychotropic medication use.

Objective: Serious mental illness (SMI) remains a leading cause of disability worldwide. However, there is limited Australian evidence of community-based programs to enhance the psychosocial wellbeing of adults experiencing SMI. Foundations is a long-term community-based psychosocial outreach support program delivered in Tasmania, Australia. A longitudinal non-randomised controlled trial was conducted to examine the effectiveness of the Foundations program on adults’ psychosocial functioning, clinical symptomology, and hospital readmissions, in comparison to standard care only. Method: Participants were adults aged 18-64 years experiencing SMI. Control participants received standard clinical care only. Intervention participants were engaged in the Foundations program in addition to standard care. Data were collected at program commencement, midpoint, closure, and six-months post-closure. Linear mixed modelling was used to examine differences between groups. Results: Intervention participants achieved better psychosocial functioning in comparison to the control group by program closure and at six-month follow-up. No significant differences were observed for clinical mental health symptomology or hospital readmission rates. Length of readmission stay was significantly shorter for intervention participants. Conclusions: The findings highlight the additional value of community-based, recovery-oriented, psychosocial outreach support alongside clinical mental health care to enhance the psychosocial wellbeing of adults experiencing SMI.

BACKGROUND:The transition out of inpatient mental health is a crucial time for adults experiencing concurrent mental illness and homelessness, yet evidence regarding effective support options is mixed. Choices is an intensive 3-month psychosocial outreach and crisis accommodation support programme for adults experiencing mental illness and homelessness, delivered by Baptcare in Tasmania, Australia. This study examined the effect of Choices on adults' psychosocial functioning, clinical symptomology and psychiatric readmissions in comparison to standard care only. METHOD:Participants were adults aged 18-64 years experiencing mental illness and homelessness, recruited upon discharge from a psychiatric admission. Intervention participants (n = 124) received the Choices programme. Control participants (n = 122) received standard care, clinical assessment and treatment from hospital-based Mental Health Services. Outcomes were psychosocial functioning (primary), clinical symptomology, hospital readmission rate and readmission length of stay. Outcomes were assessed at programme commencement and closure (3 months) and 3 months post-closure (intervention group only). Analysis of covariance was used to analyse differences between groups at closure, while controlling for baseline differences. RESULTS:Intervention participants had significantly improved social functioning (encompassing living conditions, social relationships, self-esteem/confidence), overall psychosocial functioning, symptoms of depression and anxiety and shorter hospital readmission length of stay in comparison to the control group. Intervention participants experienced further improvements in social and overall psychosocial functioning 3 months post-closure. CONCLUSION:The Choices programme is effective in enhancing the psychosocial functioning of adults experiencing concurrent mental illness and homelessness. These findings support the ongoing delivery of this combined accommodation and wrap-around psychosocial model of intensive support.

OBJECTIVE:This rapid review aimed to identify (1) key frameworks and components underpinning the effective implementation of Health and Social Care (HSC) programs for Aboriginal and Torres Strait Islander children; and (2) participatory and co-design frameworks guiding the implementation. METHODS:Four databases were searched for peer-reviewed English-language articles published between 2015 and 2021. The focus was on HSC models, frameworks, projects or services with an implementation focus for Aboriginal and Torres Strait Islander children aged 0-12 years. RESULTS:Seven studies identifying components supporting effective implementation of Aboriginal and Torres Strait Islander HSC programs were included. Continuous Quality Improvement was the most widely applied approach. Most studies described participatory and co-design approaches to ensure suitability for Aboriginal and Torres Strait Islander children and families. CONCLUSIONS:There remains a paucity of evidence on the effective implementation of Aboriginal and Torres Strait Islander children's HSC programs. Implementation approaches that foster cultural safety and Aboriginal and Torres Strait Islander leadership, support diverse partnerships and promote localised application may facilitate the effective implementation of HSC programs. IMPLICATIONS FOR PUBLIC HEALTH:Future research in this area would benefit from greater consideration of appropriate implementation frameworks and co-design approaches, and emphasis on reporting interventions, implementation frameworks and co-design approaches for HSC programs for Aboriginal and Torres Strait Islander children.

Background: Stakeholders play a pivotal role in the generation and mobilization of evidence-based change in organisations. However, few case studies capture the different relational approaches within and between stakeholder groups that enable complex change, in a complex health system. Our aim is to explain our approach to optimising stakeholder relationships in a large-scale project on advancing women in leadership within the Australian healthcare setting. Methods: We use a case study approach, underpinned by stakeholder theory to demonstrate how stakeholder relationships are understood in the Advancing Women in Healthcare Leadership (AWHL) project. We highlight the methods and interactions across five stakeholder groups including: women in the workforce; academic institutions; healthcare service providers; Medical and Nursing Colleges; and government agencies. Implications: Lessons drawn from this case study are transferrable to other settings, with comparable organisational-level change goals. Conclusion: This chapter provides insights that benefit organisations aiming to optimise stakeholder relationships to improve gender equity outcomes for women in leadership.