Care Coordination for Vulnerable Families in the Sydney Local Health District: What Works for Whom, under What Circumstances, and Why?

Abstract

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.

Integrated Child and Family Hub models for detecting and responding to family adversity: protocol for a mixed-methods evaluation in two sites

“…Second, we reviewed the HHAN programme theories and other relevant realist literature focused on integrated care for children and families experiencing adversity23 30 56–59 to identify key CIMO configurations relevant to the Hubs. HHAN provided a useful starting point because our study builds on the HHAN model of care.…”

“…Emerging evidence exists for outcomes of Hub models of care. For example, the Healthy Homes and Neighbourhoods (HHAN) initiative in Sydney, New South Wales (NSW), is a multi-component cross-agency care coordination network with a centralised Hub nested within a broader place-based initiative and has been shown to increase service access for families experiencing adversity 29 30…”

The feasibility of a Child and Family Hub within Victorian Community Health Services: a qualitative study

“…Another important value expressed by CHS was providing a strengths‐based approach, i.e. focusing on the strengths and resources of consumers 33 . This was seen as particularly important to reduce stigma and judgement of families who may be experiencing chaotic lives and assist in engaging positive relationships.…”

Formulating Initial Programme Theories of the Healthy Homes and Neighbourhoods Integrated Care Initiative

“…Step 4: Reviewing available programme theories related to the HHAN initiative Since the inception of the idea of developing HHAN, the critical realist approach to understanding how it will work, for whom and under what health system conditions has been considered [7,26]. The explanatory models were developed using the CIMO heuristic tool, which facilitated our theory development.…”