Introduction: Healthy Homes and Neighbourhoods (HHAN), an integrated care programme in the Sydney Local Health District (SLHD), seeks to address the needs of disadvantaged families through care coordination, as one of its components. This research aims to determine for whom, when and why the care coordination component of HHAN works, and establish the reported outcomes for clients, service-providers and partner organisations. Methods: Critical realist methodology was utilised to undertake a qualitative evaluation of the impact of care coordination. Purposive sampling was used to select a total of 37 participants for interview, including consumers, service-providers and key stakeholders. Thematic analysis was undertaken to derive the major modes of intervention of HHAN, and data representing these elements was coded and summarised under contexts, mechanisms and outcomes. Results: Analysis indicates that care coordination has a positive impact on clients' sense of independence, self-awareness and outlook on life. Trust and favourable interpersonal relations were identified as major underlying mechanisms for a successful client-provider working relationship. The identified modes of intervention facilitating positive consumer outcomes included accessibility, flexibility and service navigation. Persistent siloes in health and systemic resistance to collaboration was seen to hinder effective care delivery. Conclusions: This study suggests that a care coordination model may be effective in engaging disadvantaged families in healthcare, assist them in navigating the health system and can lead to beneficial health and social outcomes. Successful implementation of care coordination requires flexible programme design and experienced and skilful clinicians to fulfil the care coordinator role. There is a need to appreciate the negative impact that the complex and siloed health system can have on disadvantaged families.
Despite the policy and academic interest in helping disadvantaged young people into employment and education, and towards a more positive future, little is known about the process of supporting positive transitions for young people. In Australia and internationally, youth work is increasingly considering alternatives to the traditional deficit-oriented and risk-averse approach to supporting young people experiencing social or material disadvantage. With an outset in youth practitioners' perspectives on their work and underpinned by key concepts drawn from the Positive Youth Development approach, this paper seeks to improve understandings of how best to support disadvantaged young people's ability to thrive, facilitate practitioner dialogue and strengthen practice. Qualitative interviews were conducted with twelve youth practitioners and a focus group run with an additional eight. The paper explores three concepts emerging from the analysis that were identified as key to understanding the unique potential youth work practitioners have to support positive transitions with and for disadvantaged young people: having an ecological focus, encouraging personal agency and fostering alternative possibilities. The findings propose new possibilities for working with young people with whom mainstream services struggle to engage. The paper concludes by discussing the practical implications and limitations of this approach.
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