Abstract
Background: Healthy Homes and Neighbourhoods (HHAN) was designed and implemented in the Sydney Local Health District (SLHD), Australia since 2015, funded initially by an innovation grant to drive locally driven solutions. HHAN offers care co-ordination and place-based initiatives in areas of need. Eligible families include parents/carers who have complex health and social care needs, with children aged 0-17 years, and require family-centred support from multiple services. Intersectoral partnerships across agencies such as education, justice, housing, community services and health are a core component of the initiative to improve holistic care of families. However, partnerships can be complex and challenging, and ongoing monitoring and evaluation is required for systems strengthening.
Approach and impact: A social network analysis was done in 2016 to examine the scope, quality, and extent of interorganisational trust across HHAN partners. It found that most respondents rated the quality of these relationships as good (trusted) or excellent (highly trusted), and there was variation in the scope of interorganisational extent of collaboration (from being unidirectional, to more collaborative discussions). Interviews with managers from partner organisations found important themes about the need to take time to carefully establish and maintain interpersonal relationships, to mutually understand and respect the diversity of roles, to keep track of performance business performance indicators which may be different across the sectors, the importance to have clear directive and supportive infrastructure, and the importance in having to navigate the complexity of organisational expectations.
However, integration across siloes, systems change is difficult work, and barriers were identified which have to be carefully considered. At the systems level, historical fragmentation of services in the context of intergenerational trauma and institutional racism persists, and there is need to continually review for cultural safety, and ensure ongoing interagency collaboration and trust.
Indeed, a focus on governance and reporting mechanisms has been crucial. This includes 1) HHAN steering committee comprising of leadership across the different sectors (health, housing, department of communities and justice). This governance structure sought to facilitate a common vision, prioritising intersectoral partnerships. 2) HHAN management committee which comprising of senior management staff at SLHD with portfolios that cover community health, community paediatrics and integrated initiatives for priority populations, ensuring accountability for a whole of health approach. Moving forward, a priority for HHAN is to strengthen partnerships with the community including primary care and the Aboriginal community-controlled sector.
Implications for practice and broader implementation: To better serve families with complex needs, existing and new health and social services have to be fully mapped out, utilised and integrated. Respectful and trusting relationships across individuals, and also at the organisational level is required. As a learning health system, a multi-disciplinary collaborative group across NSW Ministry of Health, SLHD, primary care, a Aboriginal and Torres Strait Islander research program and academic institutions was formed, to conduct a multi method evaluation to identify gaps, co-design and co-evaluate implementation strategies to optimise the intersectoral partnerships in HHAN to best provide culturally safe seamless care across acute and community health and social sectors.