Background:
The Yarrabilba Family and Community Place (YFCP) is a purpose-built integrated community facility on the grounds of Yarrabilba State School. This innovative cross-agency initiative which opened in October 2018, is led by an allied health project team at Children's Health Queensland (CHQ) and focuses on the provision of inclusive and flexible health, education and social services in a safe and supportive environment that encourages community connectedness and improves outcomes for children, families and the broader community.

Practice change implemented:
The hub utilises soft entry approaches to engage with the community and deliver a range of support services. The literature reflects that early disadvantage can have lifelong effects - the first years of a child’s life provide the foundations for health and wellbeing. Children who have a poor start in life are more likely to develop problems and these problems can have a cumulative effect over their lives.

Aim:
The Yarrabilba community sits within a region of increased risk but many of these risk factors are modifiable and preventable. Cross sector collaboration and an early investment in prevention is required to ensure that this emerging community does not progress down a path of disadvantage. The collaboration allows stakeholders to work together to address complex issues not easily addressed by working alone to deliver on the vision of the hub to be a welcoming place that supports the community to stay safe, healthy and social connected.

Targeted population and stakeholders:

Vulnerable families living in the Yarrabilba community are the target population for the hub. Significant collaboration and co-design with key stakeholders of the hub has included:
• CHQ, Department of Premier and Cabinet, Queensland Treasury, Department of Communities, Department of Education, Metro South HHS, Department of Social Services, Logan City Council, Logan Together, Lendlease, Brisbane South PHN
• ChaPs (DSDMIP)
• Community members

Timeline:
• Conception of the hub was born from the Premier’s commitment early in 2018
• Collaboration and co-design commenced immediately and is ongoing
• The doors to the Yarrabilba opened in October 2018

Highlights:

• 2000 children and their families are entering the hub each month, many of which are experiencing social isolation and complex social and health issues
• Full evaluation of implementation outcomes is underway and is expected by the end of 2019.
• Documented model of Service delivery


Transferability:
Early signs indicate that this model of service delivery is effective and though integrated community hubs are typically successful they only form one piece of the puzzle in shifting the dial on outcomes for children and families. Replication or transferability would rely on local needs-assessment to determine context.

Conclusions:
The YFCP is an exciting and innovative initiative that showcases shared service delivery to improve outcomes for children and their families. Supporting parents before conception, during pregnancy and in the early years of a child’s life has significant positive impacts on health and wellbeing.

Lessons learned:
Collaboration and co-design with the local community and service providers is integral to providing a suitable, sustainable community hub.

Introduction
As the sustainability of Australia’s health systems are challenged by increasing demand and cost, the complex relationship of health and well-being with wider social determinants and our ability to deliver value-based care is critical.

Short description
Children’s Health Queensland (CHQ) has been working with partners across sectors to establish a common evidence base to support population-based planning that is responsive to the social determinants of health. Insights are visualised in an interactive dashboard that translate this conceptual framework into a practical tool that integrates over 30 data sets to describe the health and wellbeing status of Queensland children at a local community level to inform planning.

Aim
This initiative breaks down traditional models for health service planning, by taking a population-based perspective that is underpinned by the social determinants of health.

Targeted population and stakeholders
This initiative has inspired a range of stakeholders to consider the role of population health intelligence in planning for better outcomes. Alongside traditional planning methodologies, CHQ’s population health initiative has informed the work of a number of agencies outside of CHQ.

Timeline
The initiative has been designed and developed within business as usual resourcing over the 18 month development phase which has required collaboration as well as focus and commitment across multiple parts of the organisation.

Highlights (innovation, impact and outcomes)
A key objective of this initiative is to identify opportunities to refine investment and service models to improve their reach and impact. By offering insights about community level (SA2) need, service utilisation and outcomes on a range of health and wellbeing indicators (including the social determinants of health), the dashboard provides actionable insights about which communities have greater need and utilisation of public sector funded services.

Using infographics and data packs, supported by strategic population-based planning advice, CHQ has supported several agencies to identify and harness opportunities to reinvest, repurpose, and reallocate existing resources to optimise their impact.

Comments on sustainability
This initiative has offered the Queensland system a practical approach to decision makers across sectors to make integrated and value-based decisions that are oriented to the needs of the population.

Comments on transferability
This initiative is challenging the status quo on how the system makes commissioning and investment decisions and the logic and methodology can be generalised and applied to the adult population, as well as outside of the health sector.

Conclusions (comprising key findings)
By weaving the principles of social equity, integrated care and proportionate universalism through the design of the dashboard and supporting collateral, CHQ is offering clinical teams, planners and commissioners practical strategies and tools that enable population-based infrastructure, workforce and service planning.

Discussions
Reliable population health data equips leaders with person-centred insights and evidence to support prioritization of health challenges, policy development, resource deployment/investment and measurement of success.

Lessons learned
The learnings from the incubation and development stages of this population health innovation can now inform CHQ’s approach to innovation and improvement, including the enabling conditions, processes and structures that promote innovative thinking and creative problem solving.

Implementation of a model to embed culturally appropriate care for indigenous children and young people within the Connected Care Program at Children’s Health Queensland.

Practice Abstract:
The Connected Care Program is designed to streamline the health care of QLD’s most medically complex children. We recognise that, increasingly, the public health system has become large and intricate and many families struggle to independently navigate.
Most families with a medically complex child face daily stressors in relation to the healthcare of that child. This can include having to travel to access specialist care, having to care for more than one complex child, encountering access barriers to essential medications or medical equipment, juggling appointments with specialists, and having to access healthcare from multiple locations. This often results in fragmented care and can have a significant impact on the family’s ability to manage their child’s health care requirements. The Connected Care Program utilise a chronic condition management framework to support families to manage their child’s care requirements.

The Connected Care Program have successfully imbedded two new roles within the service to enhance and improve the coordination of care for families who identify as first nation Australian’s. The Connected Care Program is committed to providing an exemplar service to indigenous clients through the provision of specialised case management services within a culturally safe framework.

The Connected Care Program aims to improve care outcomes for children who identify as indigenous. We recognise that first nation Australians require a culturally sensitive approach, and that this often involves out of the box thinking to ensure holistic care is provided to the whole family. The Connected Care Program now has two identified positions who have provided education to the whole team regarding culturally safe care and act as case managers for children with complex health care needs.

The targeted group is Children currently under the care of the Connected Care Program. 16% of the total caseload identify as indigenous. This body of work has had and will continue to have significant impact for this cohort.

This body of work began in Feb 2018 with the introduction of the first identified role to the Connected Care Program. This work is ongoing and will continue to grow and evolve to meet the needs of the families.

The introduction of two indigenous roles has seen an increase in access to health care for vulnerable Queenslanders. The Connected Care Program has expanded the knowledge and linking with Aboriginal Health Services across the state therefore working in an integrative manner to ensure seamless care for indigenous families.

The Connected Care Program provides services to children with complex and chronic health care needs and their families. Through the introduction of two identified positions to work with our vulnerable indigenous families we have greatly improved the care provision to indigenous families utilising a culturally safe framework. Through a new model of care, we expect to see improved health outcomes and increasing patient experience from families involved with our service.

Introduction: For many families caring for children with complex and chronic conditions, accessing health services is a considerable challenge. To attend regular follow up appointments at the hospital can mean repeated time off work and school; finding alternative care for siblings; and long periods of waiting in clinic for an appointment that may only take fifteen minutes. This challenge is exacerbated in rural and regional areas, where families can incur costs for overnight travel, and experience significant disruption to their work and family life.
Practice change: Sydney Children’s Hospitals Network (SCHN) has implemented a Network-wide Telehealth strategy that provides the capability to deliver consultations remotely – to children in their homes, with their GPs and at their local hospital.
Aim: To provide patient-centred care closer to home by adopting and promoting Telehealth across SCHN.
Targeted population: Families caring for children with complex and chronic conditions.
Timeline: January 2018–June 2019
Innovation: Technological innovation, such as the use of technology to deliver health services remotely (Telehealth), is seen by SCHN as a key enabler for the delivery of patient-centred care. Telehealth is delivered through a web-based video-consultation platform accessible to all clinicians across the Network in a ‘business as usual’ model recommended under the NSW Health Telehealth Strategy. It’s been adopted by diverse services across SCHN, including physiotherapists who are even using it to deliver guided physio sessions for cystic fibrosis patients at home.
Impact/Outcomes: The widespread adoption of Telehealth across the Network is benefiting children and families in reducing the cost and inconvenience of travel, and the disruption to work, school and family life. Over 40 services across SCHN are utilising Telehealth with a total of 959 telehealth sessions conducted in 2018, resulting in SCHN being the top Telehealth user in NSW. The Hospital in the Home service have had a total of 43 patients with multiple appointments seen via Telehealth which resulted in 39,249kms of travel and 605 hours saved. An unanticipated benefit has been the development of capacity in local GPs and the medical and allied health staff at secondary hospitals, who ‘host’ Telehealth sessions with the patient close to home. Host clinicians who regularly take part in sessions express more confidence in their ability to manage the child’s condition locally.
Sustainability: It’s a cost-effective program which has benefits for clinicians and patients. It’s easy to use with few upfront costs for clinicians apart from headsets and cameras. Cost analysis data indicates significant income and cost savings to the Network. Families can access their Telehealth consultation via their smart phone, and are not required to purchase expensive equipment.
Transferability: Telehealth has continued to be rolled out across the Network with over 40 services now using this method of patient consultation.
Conclusions: Telehealth has resulted in improved access to SCHN services with a significant reduction in travel time and associated costs for families, enabling care closer to home.
Lessons learned: Implementation of Telehealth is strengthened by having dedicated Telehealth staff and identifying champions; strong sponsorship, IT support and infrastructure.