Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Summary
The Townsville Youth Detention Integrated Health model is a collaborative response between Comprehensive Health Assessment service and the Integrated Youth Health Hub for young people in youth detention and post release.
Dates: January 2024 - ongoing
Implementation sites: Townsville Hospital and Health Service
Partnerships: Department of Youth Justice and Victim Support, Queensland Health Youth Justice Systems policy branch
HICOP
Aim
To provide a fast-tracked model of care aimed at improving the overall health and wellbeing of children and young people in contact with the youth justice system by delivering coordinated, trauma-informed healthcare that addresses their unmet complex physical, developmental and psychosocial needs.
Outcomes
Comprehensive Health Assessment service outcomes Dec 24-Jan 26:
- 292 comprehensive health assessments completed within youth detention.
Specialist referrals initiated following health assessments:
- Child Development Service - 97
- Mental Health - 33
- NGO - 5
- IYHH 75
- Other specialist referrals (e.g. ENT, Cardiac, Audiology, Orthopaedics) - 62
Confirmed diagnosis:
- Neurodevelopment (ADHD - 36, FASD - 7, ID - 6).
- Other medical/mental health diagnosis - 187.
Integrated Youth Health Hub (IYHH) outcomes Dec 24-Jan26:
- 134 health profiles completed post release from youth detention
Specialist referrals initiated:
- GP referrals/re referrals- 241,
- IYHH Paediatrician referrals - 41,
- Other medical referrals- 144,
- NGO and other non-medical service- 46
Confirmed diagnosis: 89
Background
Young people in Australian youth detention commonly present with complex and overlapping health needs, including high rates of physical and mental health conditions, substance use, trauma exposure and neurodevelopmental differences such as Attention Deficit Hyperactive Disorder, Autism Spectrum Disorder, Foetal Alcohol Syndrome Disorder and Speech and Language difficulties. These challenges are often compounded by significant social disadvantage which contributes to poorer health outcomes and increased vulnerability both during detention and when returning to the community. Accessing healthcare can be particularly difficult for these young people, who often face fragmented services, long wait times, stigma, transport barriers and limited youth-friendly environments.
Before the Townsville Youth Detention Integrated Health Model was established, health services in youth detention were largely focused on addressing immediate or acute issues. After release, follow-up care was inconsistently delivered across multiple sites with minimal coordination between limited providers, leaving young people to navigate a fragmented and complex health systems. This lack of integration led to duplication, disengagement and minimal continuity of care, ultimately resulting in many young people missing out on essential services, widening the existing gaps in healthcare access for this marginalised cohort and resulting in poorer health outcomes with potential long-term impacts.
The Townsville Youth Detention Integrated Health Model is a joint partnership between the Comprehensive Health Assessment Service (CHA) and the Integrated Youth Health Hub (IYHH) and was developed to ensure that young people entering detention receive comprehensive, holistic health assessments, with coordinated, fast-tracked referrals through specialist service pathways as required. The model also enables timely access to neurodevelopmental assessment and diagnostic formulation to better understand and support each young person's developmental needs and to promote equitable access to timely, high-quality healthcare. Cultural safety is embedded throughout service delivery, and the model is designed with flexibility to promote person centred care.
Importantly, the model is not constrained by the physical boundaries of detention. It extends into the community to support young people discharged from youth detention back home within the Townsville community; through a robust, collaborative partnership and discharge planning between CHA and IYHH. The Integrated Youth Health Hub offers assertive, mobile outreach to our cohort of young people, and their families (including siblings) and imbeds a ‘no-wrong-door' wrap around support and specialist coordination to enhance and improve engagement with primary and tertiary health services that best meet their physical, mental, neurodevelopmental, alcohol and other drugs (AOD), and psychosocial health needs.
Methods
The Townsville Youth Detention Integrated Health Model is a collaborative partnership between the Comprehensive Health Assessment (CHA) service and the Integrated Youth Health Hub (IYHH).
Comprehensive Health Assessment service:
The CHA service is funded through the Queensland Government Community Safety Plan project. The model was designed in partnership with Queensland Health Youth Justice Health System Policy Branch, Department of Youth Justice and Victim Support (DYJVS) and Townsville Hospital and Health Service (THHS).
Key implementation steps include:
- Enhancement of nursing, medical, health worker and administrative resources within the Cleveland Youth Detention Centre Medical Centre (CYDC-MC) team to support implementation of holistic comprehensive health assessment for young people entering detention.
- Embedding dedicated allied health (psychology, speech pathology and occupational therapy) and Paediatric medical resources within the CYDC-MC to enable completion of comprehensive neurodevelopmental assessment and diagnostic formulation supports for young people with suspected neurodevelopmental differences/disability.
- Implementation of a multidisciplinary multi-agency case conference to enable comprehensive intake and collection of relevant collateral to inform care planning.
- Streamlining information sharing pathways in line with legislative requirements to enable timely communication with relevant key stakeholders and efficient service delivery, mitigating the risk of service duplication.
- Standardising onward referral processes (including comprehensive discharge summaries) for young people discharging home to ensure continuity of care with other health services and agencies.
- Onward referral to IYHH to support ongoing assessment and facilitated access to health services, specifically for a sub-set of young people identified by Department of Youth Justice and Victim Support as being at high risk for re-offending.
Integrated Youth Health Hub:
The IYHH was developed using a strategic co-design approach in partnership with Queensland Health Youth Justice Health System Policy Branch, DYJVS and THHS.
Key initiatives included:
- Establishment of a multidisciplinary team including Team Leader/Clinical Lead, Clinical Nurse Consultant, Senior Allied Health Clinician, Consultant Paediatrician and Administration support. IYHH model also funds a local community primary health service for young people to have priority access to a GP and other primary health services.
- IYHH permanently co-locates specialised health clinicians across Townsville Youth Justice Service Centres.
- Development of a single intake and triage pathway in partnership with Comprehensive Health Assessment for Serious Repeat Offenders who were exiting Cleveland Youth Detention Centre (CYDC).
- Provide comprehensive care and follow-up through an assertive and mobile community outreach model to ensure health services are accessible and remove transport and distance as a barrier.
- Facilitate priority access to primary care services, through the funded primary health partnership model or other primary care providers.
- Prioritise facilitated access to specialist and sub-specialist priority pathways to ensure young people can access required services in a timely manner and mitigate the risk of them continuing to exhibit challenging behaviour in the community; and
- Support early intervention by delivering ancillary contact with siblings and families where necessary to extend this standardised, specialist health care and support.
Discussion
The successful establishment of the Townsville Youth Detention Integrated Health Model was underpinned by strong executive leadership and cross-sector collaboration between Queensland Health and the Department of Youth Justice and Victim Support. A supportive organisational culture that prioritised integrated, youth-centred healthcare created the conditions needed for the model to take shape and embed within a complex service environment.
Both arms of the model regularly report on key performance indicators, including activity, referrals, stakeholder engagement, and health outcomes. Governance and reporting pathways are managed within the THHS Women's and Children's Service Group, ensuring accountability, risk management and continuous improvement (bi-monthly steering committee). Formal quarterly evaluation is conducted by the Youth Justice Health Policy Branch, Department of Health to assess the effectiveness of the programs.
Key lessons emerged throughout implementation including:
- Embedding clear and well-communicated referral pathways between multiple services helped reduce duplication and minimise confusion for both staff and young people.
- A flexible workforce capable of adapting to rapidly changing needs within youth justice settings was essential to achieving timely and responsive care, including establishing an assertive mobile service and fast-tracked GP and Paediatric service within IYHH and CHA.
- The experience also highlighted the need for early, embedded data collection processes to strengthen reporting, evaluation and continuous improvement for future investment opportunities.
Despite the strengths of the model, several limitations were identified. Workforce capacity constraints and challenges with sustaining funding created barriers to consistent delivery, while difficulties integrating information systems across agencies impacted communication and continuity of care. These limitations reflect broader systemic issues common across youth justice and health interfaces, emphasising the need for long-term structural solutions.
The model shows strong potential for replication across other Hospital and Health Services across Queensland, particularly in regions experiencing high rates of youth recidivism or fragmented service coordination. Its flexible, integrated approach positions it well to enhance access, reduce service duplication and address longstanding gaps in neurodevelopmental and primary health support for young people involved in the youth justice system.
Next steps are dependant in securing future funding by demonstrating the effectiveness and value of this health model within the Townsville region and potential upscale state-wide.
References
- Queensland Health Youth Justice Health Programs, November 2025
- Townsville Youth Justice Health Pilot Proposal, Queensland Health, November 2024
Key contact
Matt Shanks
Team Leader
Townsville Hospital and Health Service