Overview
Initiative type
Service Improvement
Status
Deliver
Published
June 2026
Topic
Summary
Yangah Adolescent Day Programme redesigned its single-entry model into staged pathways to improve access, reduce referral delays and enable earlier specialist intervention for adolescents.
Dates: 1 January 2025 - June 2026
Implementation sites: Robina Hospital
Partnerships: Department of Education, Schools, Families, Child safety, Paediatrics, NDIS
This project was presented as a poster at CEQ Showcase 2026 (PDF 131KB).
Aim
To create a more accessible and responsive pathway into specialist adolescent mental health and education care by implementing a staged model that enables earlier understanding of needs, proportionate support and structured transition to promote sustained recovery.
Outcomes
- 33% increase in concurrent service capacity within four months of implementation
- 80% completion rate for Pathway 1 engagement cohort
- 100% appropriate progression from Pathway 1 to next-stage care
- Earlier specialist formulation of school refusal presentations
- Clearer governance allocation across stages of care
Background
The Yangah Adolescent Day Program (ADP) provides specialist intervention for adolescents experiencing significant educational disengagement associated with complex mental health presentations.
Historically, ADP operated as a single six-month integrated health and education programme. While clinically robust, this model was designed for intensive participation and required young people to enter at a single point of high commitment.
As demand increased and presentations became more complex, statewide review findings (2023'2024) and local service reflection identified an opportunity to optimise patient flow by introducing proportionate entry points aligned to level of need. The challenge was not clinical effectiveness, but access design.
Young people experiencing school refusal often present with fluctuating readiness, anxiety-driven avoidance and functional impairment. A single intensive entry model limited flexibility and contributed to referral hesitation across the system.
Planning commenced in September 2024 to redesign the model in alignment with statewide priorities emphasising flexible engagement, continuity of care and supported transition across the recovery journey.
Pilot implementation commenced September 2025.
Methods
The redesign of the Yangah Adolescent Day Program (ADP) was guided by a shared commitment to making care more flexible, proportionate and responsive to the needs of young people experiencing school refusal. The Statewide Review of Adolescent Day Programs (2023-2024), along with local service reflection, identified opportunities to diversify access, strengthen early specialist engagement, clarify progression thresholds and improve continuity throughout the care journey. These insights shaped a respectful, compassionate redesign that built upon the strengths of the existing programme.
Using principles aligned with the Model for Improvement and iterative PDSA-style testing, the service developed a staged pathway model while preserving the strong safety and governance structures that underpin high-quality care. Established intake and triage processes were retained, ensuring continuity of clinical oversight and risk management.
A structured Intake MDT review was introduced to support consistent and collaborative decision-making. This process brings together multidisciplinary clinicians and a Department of Education Guidance Officer, ensuring that both health and education perspectives inform pathway decisions from the outset. Their involvement strengthens shared governance, enhances communication with schools and supports coordinated planning for young people and their families. These collaborative structures continue to develop as the model embeds.
Three pathways were created to provide proportionate levels of intervention aligned to readiness and complexity. Pathway 1 offers a brief, health-led intervention focused on early specialist formulation, identification of avoidance drivers and reduction of immediate barriers. Family participation is prioritised, supported by involvement from the Family Carer Peer Worker. This pathway creates a supported entry point and helps determine appropriate progression.
Pathway 2 preserves the well-established six-month combined health and education programme. Maintaining this core component ensures continuity of the integrated therapeutic and educational model while allowing earlier, lighter-touch engagement through Pathway 1 to improve appropriateness of entry.
Pathway 3 provides a structured transition phase focused on consolidation, school reintegration, relapse prevention and planned discharge. This pathway formalises transition supports and strengthens communication with community services and schools. Pathway 3 is scheduled for implementation in March 2026.
To support meaningful evaluation, standardised clinical and functional outcome measures (RCADS, SRAS-R, HoNOSCA, SDQ, FISC) were embedded across pathways at commencement and completion. These measures allow the service to track symptom change, functional improvement and educational engagement-areas that matter deeply to young people, families and the broader care system.
Strengthening connections around the young person was a central focus. Enhanced communication pathways were developed between CYMHS referrers and Department of Education Guidance Officers, helping ensure clear expectations at referral, accurate pathway allocation and coordinated transition planning. These processes continue to evolve with increasing structure and consistency.
Implementation occurred through staged rollout, MDT feedback loops, real-time refinement and close collaboration between health and education partners. This progressive, relational approach ensured safe, responsive change while keeping the needs of young people and their families at the centre of the redesign.
Discussion
The success of this project was supported by a strong governance environment, a skilled multidisciplinary team and a shared readiness for service innovation. The Statewide Review of Adolescent Day Programs (2023'2024), combined with internal service reflection, identified clear opportunities to introduce proportionate entry points aligned to need, strengthen early specialist engagement, clarify progression thresholds and improve continuity from referral through transition. These findings provided the strategic and clinical context for redesign, ensuring that the staged pathway model directly responded to statewide priorities and local system pressures.
Several lessons emerged during implementation. Earlier specialist engagement proved essential for adolescents presenting with school refusal, many of whom experience fluctuating readiness and significant anxiety-driven avoidance. The introduction of Pathway 1 demonstrated that brief, proportionate engagement can support formulation, build trust and determine appropriate progression without overwhelming families. Establishing structured MDT progression thresholds improved fairness, transparency and confidence in pathway allocation. Limitations include the short timeframe for evaluating changes in school re-engagement and the need for ongoing refinement of outcome-measure collection processes.
Strengths of the project included improved patient flow, enhanced governance clarity and a 33% increase in concurrent service capacity'achieved without additional staffing. The staged approach allowed the service to maintain the integrity of the core six-month programme (Pathway 2) while adding flexibility at entry and exit points. Weaknesses included the initial administrative load of establishing new communication pathways and the resource intensity of implementing outcome measurement across all stages. Opportunities include developing shared-care frameworks with CYMHS teams, further co-design with young people and carers, and strengthening collaboration with school Guidance Officers to improve transition planning.
If repeated, the project would benefit from earlier and more formalised co-design with young people, families and carers. While lived experience informed the redesign through clinical engagement and transition planning, a dedicated pre-implementation co-design phase may have improved communication materials and built even stronger stakeholder ownership. Earlier staff training on structured formulation for school refusal presentations and change-management principles would also have supported smoother implementation.
The model is highly transferrable across Queensland Health services that support adolescents with functis.onal impairment, school disengagement or complex mental health presentations. It could be adapted for other adolescent day programs, youth step-up/step-down settings, community CYMHS teams seeking proportionate engagement options, and services experiencing delays associated with single-point entry systems. Next steps include completing the first 12-month evaluation cycle, analysing pre- and post-redesign data and refining progression criteria based on emerging outcomes. Strengthening communication pathways with referrers and education partners.
References
Institute for Healthcare Improvement. (n.d.). Improving improvement: IHI toolkit (Model for Improvement & PDSA cycles). https://www.iitoolkit.com/improvement/ihi.html [iitoolkit.com]
Johns Hopkins Medicine. (2023). Quality improvement: Definitions, history and models. https://www.hopkinsmedicine.org/nursing/center-nursing-inquiry/nursing-inquiry/quality-improvement [hopkinsmedicine.org]
Public Health Wales ' Improvement Cymru. (2023). Model for Improvement toolkit guide. https://phw.nhs.wales/services-and-teams/improvement-cymru/improvement-cymru-academy1/resource-library/academy-toolkit-guides/model-for-improvement-toolkit-guide/ [phw.nhs.wales]
Queensland Health. (2020). Adolescent Day Program Statewide Model of Service. Mental Health Alcohol and Other Drugs Branch.
Queensland Health. (2023'2024). Statewide Review of Adolescent Day Programs. Child and Youth Mental Health Services.
The W. Edwards Deming Institute. (n.d.). The PDSA Cycle (Plan -Do- Study -Act). https://deming.org/explore/pdsa/ [deming.org]
Key contact
Lisa Du Plessis
Clinical Nurse Consultant
Gold Coast Hospital and Health Service