Abstract
Background: Ngaramadhi Space (NS) is a school-based integrated care (SBIC) program co-designed with schools and the Aboriginal community within metropolitan Sydney to improve access and engagement with health services for young people experiencing problematic externalising behaviour (PEB) (1–3).
A qualitative evaluation to understand how collaborative partnerships between the health and education sector can improve health and wellbeing outcomes was conducted.
Co-Design and Partnerships: NS was co-designed with schools and the community and is embedded within the Healthy Homes and Neighbourhoods (HHAN) integrated care initiative (4,5). NS is a SBIC program established at a specialised secondary school for students experiencing PEB (6). A quantitative evaluation of NS showed improved access to healthcare for multiple physical health, mental health and social needs (7). Key stakeholders included an Aboriginal community reference group called ‘Wouwanguul Kanja’ who were actively involved in designing and evaluating the initiative. Education stakeholders were the Student Wellbeing team, area directors, school principals, school executive teams, networked specialist facilitators, social workers and school counsellors. Health stakeholders were community paediatrics, youth health services, psychiatry, and trauma-informed speech pathologists (SP) and occupational therapists (OT). The social care sector was represented by non-governmental organisations (NGO), other social workers and HHAN clinicians.
Intervention: Holistic, integrated, multidisciplinary child and family centred care was provided by a paediatrician, youth health nurse, social worker, school counsellor, SP, OT and psychiatrist. The team worked collaboratively to provide comprehensive medical and psychosocial assessments, recommendations and support.
Evaluation: A qualitative evaluation involving 29 semi-structured interviews with students, staff, and key stakeholders was conducted. The principles of the ‘Integrated People-Centred Health Service (IPCHS)’ framework and Looman et al’s implementation strategies for integrated care were considered (8,9).
Themes identified within the IPCHS framework:
Strategy 1. Engaging and empowering people and communities: community-driven models, improved access to healthcare, positive outcomes, ‘connection’, and culturally safe practice.
Strategy 2. Strengthening governance and accountability: system integration and developing evidence base
Strategy 3. Reorienting the model of care: shifting healthcare to schools reduces inequity
Strategy 4. Coordinating services within and across sectors: multidisciplinary collaboration and stable workforce
Strategy 5. Creating an enabling environment: leadership, stakeholder commitment, and adequate resourcing.
Relevance for the international audience: Potential strategies for implementing SBIC models have been identified and include community consultation and co-design; building multidisciplinary teams with new competencies and roles e.g. linkers and coordinators; collaborative and shared leadership; and alignment of operational systems while maintaining a balance between structure and flexibility.
High-level collaboration across sectors and with communities is required to provide a shift towards child and family centred care that improves engagement, access and outcomes in health delivery for children and families with complex needs. This integrated model of care can be widely adapted as a potential solution to access and engagement to health services for school-aged children, particularly as we navigate a post-pandemic era (10–14).
Future Steps: The SBIC team continue to provide leadership and work in partnership with schools and key stakeholders to inform scaling up the model of care and to align processes, policies and evaluation.