Project Overview

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. The Royal Commission recommended that the Victorian Government fund four health services (Royal Children's Hospital, Monash Children's Hospital, Alfred Health and Orygen) to create, deliver and evaluate the first phase of an aftercare service for children and young people at risk of self-harm and suicide. The Royal Commission stipulated that the new service be informed by the experiences of children, young people, their families and carers, and by the program guidelines of the existing adult aftercare service known as the Hospital Outreach Post-suicidal Engagement (HOPE) program.

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. It is a psychosocial and clinical support service that delivers responsive outreach to individuals following a suicide attempt or for those considered to be at significant risk of suicide. HOPE teams support individuals and their personal support networks (family, friends and other carers) for up to three months helping them to identify and build protective factors against suicide.

The Department of Health (the Department), is responsible for implementing the Royal Commission’s recommendations. In 2021, the Department provided funding to the four health services to co-design a new Child and Youth HOPE service and engaged Portable as a coach to support the co-design process.

Project Commissioner

Department of Health, State Government of Victoria

Project Creator

Portable

Team

Olivia Gregory - Senior Producer
Jude Walta - Senior Design Strategist
Belinda Donald - Senior Design Strategist
Emily Pearce - Senior Content Strategist
Ryan Thompson - Senior Design Strategist
Cristiano Fantasia - Senior Experience Designer
Joanne Osbourne-Taylor - Lead Design Strategist
Ashlee West - Experience Design Lead
Allison Snow - Lead Producer

Project Brief

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 after self-harm, suicidal thoughts or a suicide attempt, and their carers and families (referred to as ‘lived experience’ throughout). Through this process, the health services and the Department sought to understand:

- The experiences of young people and their carers and families when receiving mental health and practical support after self-harm, suicidal thoughts or a suicide attempt, including what has worked and what hasn’t from their perspective.
- The service expectations of young people, their carers and families for a new Child and Youth HOPE service, the core characteristics of the service and the experience they wish to have.
- How a prototype of the service aligns with their expectations – what is working and not working and how the early model needs to change before the service is piloted.

The 4 health services were experienced in service design with 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, their families, carers and families, clinicians and service providers.

Project Innovation/Need

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, 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 and the justice system
Neurodivergent people

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.

Design Challenge

Our approach to ensuring participant safety included:

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

Future Impact

We coached the health service design teams through each stage of the co-design process. Coaching included:

1. Exploring the problem: Health services 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 and contextual interviews.

2. Defining the problem: Health services grouped their findings together in related themes and ideas. 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.

3. Exploring the solution: We encouraged lived experience participants to be as imaginative and unrestricted as possible in their thinking 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.

4. Making the solution work: Teams identified constraints, assessed and prioritised their ideas, and refined the prototype so that it was a balance of what was desirable, viable and feasible. The refined prototypes then informed a final Child and Youth HOPE Model of Care.

The co-design process has allowed teams to create feedback loops to continuously improve the Child and Youth HOPE model of care, and this will be built into the pilot and live service as teams apply the co-design mindsets and practises they learned during the project.

Service - Government

This award celebrates creative and innovative solution design for the successful delivery and provision of services. Consideration given to system integration, user experience, product design
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