Abstract
Background: Healthy Homes and Neighbourhoods (HHAN) is an integrated care initiative that commenced in 2015 in the Sydney Local Health District (SLHD), New South Wales (NSW), Australia. HHAN offers care co-ordination and place-based initiatives to families with children aged 0-17 years, where parents/carers have health and social care needs, requiring support from multiple services. Families enrolled in HHAN have multiple and complex needs requiring individualised family-centred care. There is no time limit for support and families can be engaged in flexible ways that best suit them. Evaluation of this initiative in 2017 highlighted huge success in engaging families and building effective relationships across NSW to help families received co-ordinated care, though areas of risk related to workforce capacity and capability were also identified.
Impact on workforce capacity and capability: Interviews with stakeholders were conducted as part of the evaluation and key themes identified included risk of dependency, ambiguity in role possibly leading to staff burn out, and a lack of trust in existing services. Indeed, over the course of the program staff have anecdotally reported that they felt the weight of responsibility for families allocated to them and an individual responsibility for professional relationships formed within the circle of care providers in the integrated care approach.
This is in the context that the referral criteria is broad to encompass a wide range of clients and ensure that the families who are most isolated can receive some support. This kind of service flexibility and creativity is necessary in an integrated care approach when engaging resistant and isolated clients so that clinicians have the ability to service clients’ needs at any point that they seek help. However, clinicians also reported that this inclusive approach has a risk of ambiguity in role definition which can have a profound impact on staff well being and could increase risks for vicarious trauma.
The other risk identified is one of dependency. In this role it is twofold; the clinician is responsible for creating the professional connections for integrated care approach and, they are responsible for engaging resistant clients with service providers. The evaluation results support the observed trend in HHAN where individual relationships with professionals underpin the integrated care approach. That is, individual staff members build connections with other staff to form pathways, and this is the basis for integrated care. It is our concern that this poses a risk to service continuity when staff move on.
Implications for practice and broader implementation: Whilst the work has been successful thus far, we have identified an opportunity to consider the sustainability of HHAN, and the impact on staff wellbeing. Currently, best practice for integrated care coordination have focused on, role clarity, shared risk and responsibility for professional relationships and safety for clients, and formalising pathways in NSW for integrated care. HHAN is seeking to embed this best practice through a practice framework that emphasises effective supervision models for staff and service wellbeing plan alongside the integrated approach for care co-ordination.