Introduction

Despite promising opportunities for addressing social need in frontline patient care, research shows health practitioners require further knowledge and support to increase their confidence to address the social conditions that underpin poor patient health. Dream Big, Act Big for Kids is an educational electronic publication that aims to increase health practitioner confidence and understanding of the SDoH in everyday practice.


Practice change implemented

• Advisory Group created as ‘brains trust’ for Dream Big, Act Big for Kids
• Evaluation plan created to assess impact of Dream Big, Act Big for Kids on practitioner understanding, confidence, practice, and culture
• Evaluation feedback from each article used to develop further support resources and sequential publications


Aim and theory of change

Dream Big, Act Big for Kids aims to increase health practitioner understanding of and confidence to address the social determinants of poor health and wellbeing in children and their families. Each publication contains a translation of current research on the SDoH and other relevant topics, accompanied by videos for inspiration, reflective practice questions, support for communities of practice, and ideation tools for practice change.


Targeted population and stakeholders

All CHQ staff and broader health and community practitioners.

Timeline

The first Dream Big, Act Big for Kids article was published in April 2019, with the second due to be released in August 2019. Four articles will be published per year for two years.


Highlights

• Tailoring translation of research to a local context and providing concrete examples of applications for practice
• Encouraging individual and team reflective practice
• Accompanying tools that support ideation and innovation
• An annual Dream Big, Act Big for Kids Service Award to recognise innovations for addressing the social determinants of health in practice


Comments on sustainability

Based on initial positive feedback, there is opportunity to keep producing Dream Big, Act Big for Kids articles to continue supporting health practitioners.

Comments on transferability

Dream Big, Act Big for Kids translates current research for best practice in patient care, but does so in the context of Queensland.

Conclusions

• The first Dream Big, Act Big for Kids article was opened by 67% (3490) of CHQ staff, in addition to 119 non CHQ subscribers
• Over 87% agreed that they learnt something new, with the remainder being neutral.
• 87% also reported that they planned on implementing changes in their practice based on what they had learnt in the article.
• Qualitative feedback was positive, and readers made requests for further information, support resources, and training.

Discussions

Dream Big, Act Big for Kids is in its early roll-out phase, but initial evaluation feedback confirms health practitioners require more information on the SDoH and other related topics, in addition to further development of resources to support changes in practice.

Lessons learned

Dream Big, Act Big for Kids has had a wide organisational reach and enabled the project team to understand and better respond to the needs of health practitioners in building their capacity to address the SDoH in everyday practice.

1. Introduction
In March 2019, Children’s Health Queensland Hospital and Health Service (CHQ) became the first organisation licenced to establish a Project ECHO Superhub in Australia. CHQ has successfully replicated and scaled the ECHO model since 2016 to a range of population health priorities in response to health needs of vulnerable child and youth populations across Australia and New Zealand. Having a locally-accessible Superhub in the Asia-Pacific region presents a convenient alternative for government, non-government and community organisations to access local, contextualised training and ongoing mentorship to replicate the ECHO model within their own jurisdictions.

2. Short description of practice change implemented
CHQ’s Project ECHO operations have demonstrated the model’s capacity to integrate care across the region through evidence-based, best practice hub-and-spoke knowledge sharing networks. As a Superhub, CHQ will train, license and mentor primary, secondary, tertiary health organisations and organisations beyond the healthcare sector to expedite ECHO’s potential. Emerging hub organisations will then deliver online, interactive case discussions via the ECHO model, empowering the interprofessional participants to practice at top of license.

3. Aim and theory of change
CHQ will train and mentor organisations across the Asia-Pacific Region to replicate the ECHO model. This will grow inter-agency collaborations across the broader system to achieve efficiencies and improve quality of care while addressing needs of vulnerable populations.

4. Targeted population and stakeholders
Teams of health, human service and education organisations across the Asia-Pacific Region.

5. Timeline
From August 2019 onward.

6. Highlights (innovation, Impact and outcomes)
• First Superhub in Australia;
• Timely, accessible and local access to mentorship and support for teams;
• Membership to the global metaECHO community;
• Participation in a global response to address disparities in an innovative and collaborative way.

7. Sustainability and Transferability
The Project ECHO model is a highly sustainable way to disseminate knowledge and support enhanced service delivery. ECHO’s interactive, bi-directional learning environment is cost-effective and scalable. ECHO’s potential benefits (cost, scalability, reliability, acceptability) exceed traditional alternative one-way education/practice development modalities (webinars, lectures) as the way forward in capacity building. The model eliminates geography as a participation barrier, and through its learner-centric approach responds to the needs of interprofessional participants.

8. Conclusions
The ECHO Superhub will:
• Increase the utilisation and replication of the ECHO model, which can enable integrated care across the Asia-Pacific;
• Provide a convenient, local alternative to access training;
• Foster collaborative, inter-agency partnerships; and
• Contribute to research, evaluation and knowledge dissemination.

9. Discussions
The ECHO model has been utilised in North America since 2003. By introducing an ECHO Superhub in Australia, organisations from across the Asia-Pacific region can now leverage local support and mentorship to replicate the model. Economic benefits will be realised by the whole of system over time.

10. Lessons learned
Implementing CHQ’s ECHO Superhub relied on a strong, sustainable partnership with the ECHO Institute, University of New Mexico. Demand from new organisations wishing to adopt the ECHO model to support addressing vulnerable populations within their local jurisdictions is growing.

1. Introduction:
In partnership between Children’s Health Queensland Hospital and Health Service (CHQ) and the Queensland Department of Education’s Autism Hub (DoE), a Project ECHO-enabled community of practice has been developed to support education professionals working with students diagnosed with Autism Spectrum Disorder (ASD) across Queensland and is an Australasian first. The community of practice is known as Autism Edu-ECHO and will be delivered from a hub site in Brisbane.

2. Short description of practice change implemented:
Project ECHO is a guided practice model that exponentially increases access to best-practice care and reduces health disparities, through hub-and-spoke knowledge sharing networks. Online, interactive case discussions provide a platform for collaborative learning by primary care clinicians, educators, and social care providers, to empower providers to practice at the top of their scope.

3. Aim and theory of change:
By creating a knowledge network to support educators across Queensland, students diagnosed with ASD can have their learning and developmental needs better supported by fostering integrated partnership between health and education experts.

4. Targeted population and stakeholders:
• Students diagnosed with ASD
• Families
• Educators

5. Timeline:
The pilot will run for twelve months, with the view for extension.

6. Highlights:
• Australasian first;
• Rapid roll-out across Queensland state schools;
• Customised curricula to meet the objectives of education professionals;
• Engaged, sustainable partnership between CHQ and DoE’s Autism Hub.

7. Comments on sustainability and transferability:
Project ECHO is a highly sustainable way to disseminate knowledge and support enhanced practice for improved health and educational outcomes for this target population. In comparison to traditional models of learning, ECHO presents a cost-effective and immediately scalable alternative that eliminates geography as a rate-limiting factor to address the needs of this vulnerable population, and the professional workforce seeking to support them.

CHQ has scaled the ECHO model since 2016 to address seven vulnerable populations or health priorities. The Autism Edu-ECHO demonstrates transferability of the model and how strategic inter-agency partnerships can co-fund scalable, sustainable solutions to address unmet needs.

8. Conclusions:
Autism Edu-ECHO seeks to demonstrate positive improvement across:
• Increased school attendance rates;
• Reduced exclusion rates (suspension, expulsion);
• Increased staff job satisfaction, knowledge and confidence;
• Increased parent/carer satisfaction;
• Increased student satisfaction; and
• Increased education outcomes for students.

9. Discussions:
Autism Edu-ECHO’s benefits to children, young people and education professionals cover a myriad of metrics linked to education outcomes. By facilitating a community of practice made up of health and education professionals it is anticipated that more collaborative, practical and customised interventions can be designed and implemented to support approximately 20,000 students with ASD statewide. Improving students’ health and education outcomes is expected to reduce challenges faced in adulthood, including isolation, education drop-out, unemployment and poor health and wellbeing.

10. Lessons learned:
This co-designed pilot shifted culture and practice through a partnership model between government agencies. Successes relied on collaborative cross-agency leadership, joint funding and evaluation to capture the pilot’s maturity over time.

Since the opening of the Queensland Children's Hospital in November 2017, Children’s Health Queensland Hospital and Health Service and the Starlight Children's Foundation have enjoyed a strong partnership. The Starlight Express Room is nestled on the 6th floor of the Queensland Children's Hospital and bustles with life and laughter as children interact with the Captain Starlights throughout their day.
Children's Health Queensland is a specialist state wide hospital and health service providing high-quality, family-centred care for children and young people from across Queensland and northern New South Wales, Australia and from regions further afield. The Starlight Children's Foundation in-hospital programs provide a positive impact on seriously ill children, young people and their families.
In 2013, Starlight collaborated with health services in Western Australia and the Northern Territory to develop the Healthier Futures Initiative to support the health of children in remote Aboriginal and Torres Strait Islander communities. Through an integrated care approach, partnering with health services, Starlight has provided many positive benefits including improved health clinic attendance, decreased anxiety in children being hospitalized, health message promotion, and early intervention.
By 2016, Captain Starlight was seeing 8,667 during their health partner visits to children living in remote Aboriginal and Torres Strait Islander communities in Western Australia and Northern Territory.
In 2019, Starlight received their first federal grant to fund a Healthier Futures Initiative expansion into Queensland and South Australia. Children's Health Queensland welcomed this opportunity and in March 2019, Starlight launched their Queensland Healthier Futures program work in Cherbourg, working alongside the Children's Health Queensland's Deadly Ears specialist team. The visit was an outstanding success, and Starlight was invited to join the Mornington Island Deadly Ears outreach specialist clinic soon after.
The strength of the Children's Health Queensland-Starlight partnership has opened up the chance to collaborate with a broad range of clinical teams across Queensland, and this work is supporting health professionals to trial some novel approaches to providing healthcare.
This presentation will discuss the new Queensland arm of the Healthier Futures initiative, the scope of work being supported, and the benefits and challenges of working in partnership to support clinical teams.