Lisa Wood

Background: Paediatric recommendations to limit children's and adolescents' screen based media use (SBMU) to less than two hours per day appear to have gone unheeded. Given the associated adverse physical and mental health outcomes of SBMU it is understandable that concern is growing worldwide. However, because the majority of studies measuring SBMU have focused on TV viewing, computer use, video game playing, or a combination of these the true extent of total SBMU (including non-sedentary hand held devices) and time spent on specific screen activities remains relatively unknown. This study assesses the amount of time Australian children and adolescents spend on all types of screens and specific screen activities. Methods: We administered an online instrument specifically developed to gather data on all types of SBMU and SBMU activities to 2,620 (1373 males and 1247 females) 8 to 16 year olds from 25 Australian government and non-government primary and secondary schools.

This review examines evidence of the association between the neighborhood built environment, green spaces and outdoor home area, and early (0–7 years) child health and development. There was evidence that the presence of child relevant neighborhood destinations and services were positively associated with early child development domains of physical health and wellbeing and social competence. Parents' perceptions of neighborhood safety were positively associated with children's social–emotional development and general health. Population representative studies using objective measures of the built environment and valid measures of early child development are warranted to understand the impact of the built environment on early child health and development.

Background: Few studies have investigated associations between objectively measured crime and walking, and findings are mixed. One explanation for null or counterintuitive findings emerges from criminology studies, which indicate that the permeable street layouts and non-residential land uses that underpin walkable neighbourhoods are also associated with more crime. This study examined associations between objective crime and walking, controlling for the characteristics of walkable neighbourhoods. Methods: A population representative sample of adults (25–65 years) (n = 3,487) completed the Western Australian Health and Wellbeing Survey (2006–2008) demographic and walking frequency items. Objective environmental measures were generated for each participant's 400 m and 1600 m neighbourhood areas, including burglary, personal crime (i.e., crimes committed against people) in public space, residential density, street connectivity and local destinations. Log-linear negative binomial regression models were used to examine associations between crime and walking frequency/week, with progressive adjustment for residential density, street connectivity and local destinations.

Purpose. To examine the role o f pet play and dog walking in children' s and adolescents ' leisure time, and the relationship between these activities and physical activity. Design. The study design was observational. Setting. The study setting was metropolitan Perth and nonmetropolitan regions in Western Australia. Subjects. The study included 1097 primary school (mean age, 10.1 years; SD, 1.6 years) and 657 secondary school (mean age, 14.0 years; SD, 1.3 years) students. Measures. Validated measures o f total physical activity, dog walking, and pet play activity (prevalence and time) were calculated. Analysis. Generalized linear models tested fo r differences between proportions, while adjusting for socioeconomic status, age, and school-level clustering. Results. Approximately one third o f primary school and one quarter o f secondary school students reported that they walked the dog at least once in the last week. Pet play was the most common play activity fo r primary and secondary school girls, and the second and third most popular play activity fo r secondary and primary school boys, respectively. Secondary school students who walked the dog or played with pets spent an average o f 1 hour per week on each activity, and they were significantly more likely (p < .005) to meet national physical activity recommendations than secondary school students not reporting these activities. Conclusion. Given the significant proportion o f young people who frequently engage in dog walking and pet play, and the high level o f pet ownership in many Western countries, promotion o f these activities to support young people' s health is warranted. (Am J Health Promot 2015;29[6]:353-356.)

Declines in children's independent mobility are commonly attributed to parents' fear of strangers, yet few empirical studies have investigated this relationship. We examined: (1) the impact of parents' fear of strangers on children's independent mobility; and (2) whether informal social control (i.e., parents' confidence that other residents would look out for local children) mitigated any association. Gender stratified logistic regression models tested these associations for 10–12 year-olds and their parents (n ¼1231) in Perth, Australia. For girls, parental fear of strangers was associated with lower odds of independent mobility (OR ¼0.71, p¼ 0.002), and informal social control and other social and built environment variables had little attenuating influence. This pattern was consistent for boys; however odds ratios were lower and statistical significance weaker. Initiatives that target parental fears combined with interventions that normalise children's walking may help increase independent mobility.

Issue Addressed: Skate parks not only provide a venue for leisure and physical activity, but can also act as an important social space for young people (Jones, 2011). However, skate parks are often subjected to negative community stereotyping (Goldenberg & Shooter, 2009; Bradley, 2010; Weston, 2010, Taylor & Khan, 2011), and there has been a lack of empirical evidence to date to refute or support conjecture about the presence of anti- or pro-social behaviors. Methods: A community survey gathered data on use and perceptions of a skate park within an inner metropolitan suburb of Western Australia. Respondents (n = 387) were asked about the frequency at the skate park of a range of potentially occurring behaviors of both an anti-social (e.g. graffiti, conflict) and
pro-social (e.g. socialising, teaching) nature. Observational data of skate park use were also collected.
Results: Pro-social behaviours were much more likely to be reported as frequently occurring, with all six of the pro-social behaviors (cooperation, learning from others, socialising with
friends, respecting others, taking turns, teaching and helping) noted as occurring often by more than 50% of respondents. The anti-social behaviours asked about in the survey fall within
three thematic categories relating to physical space (eg crowding, collisions and injuries); property damage (eglittering, graffiti and vandalism); and drug use (smoking, drinking alcohol and illicit drug taking). Of these, behaviors relating to shared use of the physical space were more likely to be reported as occurring often or sometimes, in part reflecting the popular use of the relatively small skate park area. Overall, anti-social behaviors were more likely to be reported as rarely or
never occurring compared with pro-social behaviors. Conclusions: Concerns about undesirable social behavior often underlie opposition to skate parks or provision for skaters in cities and suburbs. However, actual evidence supporting these assertions is scant, and in this study, pro-social behaviors were far more commonly observed than anti-social behavior. Considered skate park location and planning, and engagement of young people in their design can minimise many per ceived problems. More broadly, the visible presence of skate parks and other youth amenity in our neighbourhoods, towns and cities, powerfully signals to young people that they too are welcome and a part of local place identity.

In the 2016 Social Progress Index, Australia ranked 4th overall, a view that supports the well-worn descriptor of Australia as ‘the lucky country’. However, digging a little deeper, the report draws attention to relative weaknesses that include the provision of shelter, the availability of affordable housing and the foundations of wellbeing, which includes health and wellness.

Australians that live with serious mental illness, those struggling with drug and alcohol issues and those who are homeless, or at risk of homelessness continue to struggle with a disconnected, complex and fragmented health and social service system.

The 2014 National Review of Mental Health Programmes and Services by the National Mental Health Commission drew attention to the need for local planning of care for people with a lived experience of mental illness in Australia and the relevance of a bottom-up approach to understanding “services available locally [in] the development of national policy”. It also called for responsiveness to the diverse local needs of different communities across Australia (NHMC, 2014).

The creation of this Integrated Atlas of Mental Health, Alcohol and Other Drugs (AOD) and Homelessness for South Eastern Melbourne (‘The Atlas’) aligns with these recommendations.

This Atlas, commissioned by the South Eastern Melbourne Primary Health Network (SEMPHN) is the first in the world to present a critical analysis of the pattern of mental health, AOD and homelessness services together.

The Atlas uses a standard classification system, the "Description and Evaluation of Services and Directories in Europe for Long-Term Care" model (DESDE-LTC), to map the services. By utilising this internationally recognised and evidence-based tool as its supporting methodology, it is possible to derive benchmarks and comparisons with other regions both within Australia and internationally. This will provide a sound basis for long-term service planning and development and significantly advance efforts towards integrated care and achieving improved outcomes for all service users.

The ‘integrated care model’ frames the Integrated Atlas. This model has challenged the way health- related care should be assessed and planned. Through focusing on possibilities for integration it enables us to identify new routes for linked-up, consumer-centred approaches to care. Greater integration relies on a global picture of all the services available, regardless of which sector is funding them (i.e. Health, Social Welfare and Family, Employment, Criminal Justice).

Integrated Atlases allow policy planners and decision makers to understand the landscape in which they work (including areas of gap or over-supply), make bridges between the different sectors and to better plan and allocate services. This is particularly important as services become more ‘person-centred’ (placing the person and their needs at the centre of their care), with an increasing emphasis on ‘choice and control’ and public investment focuses on service integration and care coordination programs such as Partners in Recovery (PIR) or the National Disability Insurance Scheme (NDIS). 

Data collection for this Atlas took place in 2016. In total, 38 providers had service delivery teams that satisfied the criteria for inclusion in the Atlas. Health services make up 36% of these and non-government organisations (NGOs) 65%.

A total of 373 service delivery ‘teams’ were identified providing 414 Main Types of Care (MTC) across 47 different classifications as defined by the DESDE-LTC model. Of the 414 MTC, 204 (49.2%) are mental health service delivery teams, 79 (19%) are AOD and the remaining 131 (31.6%) are delivering homelessness services.

Data indicates that health sector teams are generally larger than NGO teams, with an average of 12.68 full time equivalent staff (FTE) versus 7.33 FTE, respectively. Teams working within the mental health sector are generally larger (10.85 average FTE) than homelessness services teams (3.99 average FTE) and AOD teams (the smallest at 2.96). The majority of services are for the adult (and general) population, being 312(76.8%). Child and adolescent teams account for 73 (18.0%) of the MTCs and older adults, 20 (4.9%).

Overall, there are some consistencies in the patterns of care for mental health, homelessness and AOD service systems. Services are outpatient focused with a strong community based service response. There is very low availability of day programs across all three service types.
This is a time of significant change within the social care sector across Australia. Disruption is evident across all service systems, driven by a range of shifts, pressures and systems changes including:
• The introduction of the NDIS and the entry of new providers
• The tightening of budgets at State and Federal level
• The introduction and empowerment of PHNs
• The ageing population
• Participant choice and empowerment, and
• Technological advancements and digital disruption, with its associated impacts: Ground up, crowd-sourced, crowd-designed programs and services; Entry of start-up ‘disrupters’; Shifts in the way information is consumed and utilised and help and support is accessed; and the sharing economy.

With change comes opportunity. It will be inevitable and indeed welcome to see new entrants and influencers come into play. This is perhaps our greatest opportunity for lasting and impactful systems change, especially for the mental health sector.

For SEMPHN, the creation of this Atlas provides greater awareness and understanding of the local infrastructure and the opportunity to best target its resources to meet population needs on a regional basis. This will allow it to work in partnership with service providers in its region to apply targeted, cost efficient interventions, to try new approaches and to innovate across the continuum of mental ill-health, AOD and homelessness to best support the health and wellbeing of its community.