1. Introduction
Navigate Your Health (NYH) is a two-year pilot program that commenced in March 2018, aiming to improve the health and wellbeing of children and young people in out of home care (C&YP) in Brisbane. It is a partnership between Children’s Health Queensland Hospital and Health Service (CHQ), Department of Child Safety Youth and Women (DCSYW) and Aboriginal and Torres Strait Islander Community Health Service Brisbane (ATSICHS).

2. Description
The pilot has improved service delivery and organisational culture change to facilitate health care for >500 C&YP to date. Introducing four new Health Navigator positions alongside dedicated models of care has facilitated prioritised referrals, healthcare assessments and coordination for this vulnerable population.

3. Aim and Change Theory
Consumers’ feedback pre-implementation highlighted that C&YP often lack routine health screening and assessment, leading to under-/mis-diagnosis of conditions/disabilities, and experience barriers to coordinated care. This collaborative interagency response will facilitate large-scale systemic change to meet the health needs of C&YP.

4. Targeted population and stakeholders
• C&YP;
• Families and carers;
• Child Safety workforce;
• Health Navigators;
• General Practice, Aboriginal and Torres Strait Islander Health Services;
• Child Protection, specialist paediatric services, Oral Health, Child and Youth Mental Health, Immunisation.

5. Timeline
The pilot concludes in January 2020.

6. Highlights
• Evidence of new model of care addresses unmet health needs of over 500 C&YP;
• More C&YP entering care meeting National Clinical Assessment Framework’s targets;
• 86 annual health assessments facilitated during the pilot;
• 964 referrals facilitated for ongoing healthcare needs;
• Immunisation rates increased from 65% to 85% of pilot cohort (general population is 90%);
• Improved culturally responsive and integrated support for Indigenous families accessing local Aboriginal Medical Services;
• Earlier intervention for C&YP aged 0-5 years;
• Increased health literacy for Child Safety staff and consumers;
• Improved access via inter-Hospital and Health Service pathways for oral health services, specialist paediatric services; and
• Sustained interagency cultural change.

7. Sustainability and transferability
CHQ and DCSYW have committed to expand the model across additional Queensland locations.

8. Conclusions
NYH demonstrates positive improvement in C&YP's health needs across:
• Immunisation rates;
• Systematic Prioritisation (seen as Cat 1 <30 days);
• Health literacy;
• Inter-organisational cultural change;
• Routinised health and developmental assessments; and
• Completion of health management plans for ongoing care delivery.

9. Discussions
NYH’s economic benefits are yet to be calculated and will likely be realised over the long-term. Economic benefits to early intervention and prevention of diseases, chronic conditions, improved oral health are significant across the lifespan for this cohort. Emerging evidence demonstrates earlier intervention and sustained engagement. Prospective improvements in C&YP’s long-term health benefits communities by reducing service demands for adult emergency care and acute services, ultimately supporting their health and wellbeing through transition to adulthood.

10. Lessons learned
This co-designed pilot shifted culture and practice through a partnership model between government agencies, primary care and consumers. Successes relied on collaborative cross-agency leadership, joint funding and developmental evaluation processes to capture pilot’s achievements.

1.Introduction
The current health trajectory for children and young people in care is not positive. Evidence shows that children and young people in care are likely to have poorer physical, mental and developmental health than their peers.

‘Strengthening health assessment pathways for children and young people in care’ is a joint initiative between the Department of Child Safety, Youth and Women (DCSYW), Queensland Health and Primary Health Networks (PHNs) aimed at improving both the child safety and health sector responses to the health needs of children and young people in care.

Funded by DCSYW, Queensland PHNs and Child Safety Service Centres are leading this key system reform at a local level. This is in direct response to the findings of the Queensland Child Protection Commission Inquiry which recommended every child in care is given a Comprehensive Health and Developmental Assessment within 3 months of placement (Recommendation 7.7).

2.Practice change implemented
With a focus on coordination and collaboration, this partnership is improving the way the child safety and health sectors integrate, through the development of localised health pathways to improve access, timeliness and quality of health assessments for children and young people in care.

3. Aim and theory of change
To support this reform, Brisbane South PHN has been working with partners to:
• support the development of regional digital health pathways for general practitioners working with children and young people in care – providing step-by-step management guidelines on how to conduct assessments
• implement a training program for general practitioners, primary care clinicians, child safety representatives and partners which enables the sharing of information about clinical assessments and health management, trauma-informed practice and child safety practices
• successfully advocate for dedicated Medicare Benefits Schedule item numbers to incentivise quality health assessments by general practice and health team collaboration
• establish localised Communities of Practice which integrate child safety services and the health sector, build localised health pathways for children and young people in care and act as a support for general practices with a special interest in supporting children and young people who are in state-based care and experience vulnerability.

4.Targeted population and stakeholders
• Children and young people in the child protection system, their carers and families.
• DCSYW; Health and Hospital Services; Aboriginal Medical Services; primary care and other health providers; foster and kinship agencies.

5.Timeline
2018-2022

6.Highlights
This work is making an impact on the lives of children and young people in care and the work practices of child safety and health sectors to care for these children and young people. Some of the immediate impacts have been reduced wait times for service access and higher quality and earlier interventions by providers.

7.Sustainability
The project is embedding practice within the existing service infrastructure

8.Transferability
This activities of this project have transferability within and outside of the state

9.Conclusions
Integration between Child safety and health sectors through the development of localised health pathways improves access, timeliness and quality of health assessments for children and young people in care.

1. Introduction
Most children and young people (CYP) have unmet health and developmental needs on entering out-of-home care (OOHC). Queensland’s Child Protection Reform specifies that CYP receive health and developmental assessments on entering care. This General Practitioner(GP) engagement project to support high quality clinical assessment represented Queensland’s first investment in integrated care for this cohort, supported by the government’s Integrated Care Innovation Fund.
2. Practice change implemented
A Health Assessment Toolkit project produced GP-friendly, digitised templates for preliminary and comprehensive health assessments (consistent with the National Clinical Assessment Framework for CYP in OOHC) ready for integration into GP software. Proactive GP liaison supported Toolkit dissemination.
3. Aim and theory of change
The project aimed to use Health IT to increase GP efficiency and adherence to clinical guidelines in their clinical assessments of CYP in OOHC at the point of care. The approach to engaging GPs was pragmatic, collaborative, and multi-agency.
4. Targeted population and stakeholders
The target population was GPs serving CYP aged 0-17 years entering care within the Brisbane North and Brisbane South Primary Health Networks (PHNs). Stakeholders included Children’s Health Queensland, primary practices, an Aboriginal and Torres Strait Islander Community Health Service, and the Queensland Department of Child Safety, Youth and Women.
5. Timeline
The project commenced in January 2017, with the toolkit implemented from January 2018.
6. Highlights
The assessment templates were well received by GPs although telephone or face-to-face support was often required. The impact of the toolkit was enhanced by its use within two associated integrated care pilot projects; a case co-ordination model, and a community of practice model across several Queensland sites.
7.Sustainability
GP engagement requires ongoing investment in maintenance of the templates and a clinical advisory function to support continued statewide rollout. PHNs have increasingly taken a major role thereby supporting long-term sustainability.
8. Transferability
This project is highly replicable in other sites around Australia and may also have relevance to other vulnerable populations of young people such as those in the youth justice system.
9. Conclusions
GPs can be effectively engaged in health and developmental assessments of CYP in OOHC. Additional support is needed for the flow of information between primary practice, child safety services, and the public health system. Support options (not mutually exclusive) include:
o health professional case co-ordination;
o communities of practice;
o further digital integration.
10. Discussion
Key questions arising from this research include what further system changes could have a positive impact on GP engagement in the health of CYP in OOHC and could further GP upskilling enhance other aspects of CYP health care?
11. Lessons learned
Many lessons have been learned through this project, such as:
• The effectiveness of various methods of engaging GPs.
• The significant investment required in personnel and digital development to support integrated care.
• The need for local flexibility in models of integrated care when working across agencies.

INTRODUCTION
Mildura is a regional city in the Mallee area, a major horticultural centre in north-west Victoria with one of the highest rates of children in statutory care in Victoria. Aboriginal and Torres Strait Islander children are over-represented. Although it is accepted that children in statutory care are more likely to experience complex and chronic health conditions, lack of area-level data about child healthcare needs has hampered health services planning.

PRACTICE CHANGE IMPLEMENTED
Multi-agency project governance and clinical governance groups are steering the development of an integrated, area-based approach to health care delivery for children and young people in statutory care in the Mildura LGA. New health workforce positions have been created to support improved health care coordination, health systems navigation and record keeping. An area-based senior program advisor in the Victorian Department of Health & Human Services (DHHS) plays a key coordinating role.

AIM AND THEORY OF CHANGE
Our aim is to enhance the accessibility and effectiveness of health care and improve continuity of care, coordination and patient safety. We have identified nine discrete systems where change is needed for care integration including child registration, health records, referrals and clinical assessment. The theories of change stem from chronic care and population health approaches.

TARGETED POPULATION AND STAKEHOLDERS
Community Health Centre leaders, the Primary Health Care Network, Out-of-Home Care services and DHHS are actively engaged. In the first phase, the child population has been segmented. We need to test new systems designs while at the same time ensuring a direct benefit for the child. The test cases are children aged 4-18 years living in kinship care who are prescribed medications by a health professional. These children are at heightened risk of medication-related adverse events or less than optimal management of symptoms.

TIMELINE
Integrated care planning began in 2017 with an innovation grant from the Department of Health & Human Services in 2018-2019. A further year of funding is supporting business case development for a 3-5 year innovation program and additional funding enables prospective evaluation.

HIGHLIGHTS
Senior leadership is vital for progress to be made and sustained. We have successfully engaged local executives, clinicians and practitioners. Professional development across the disciplines has begun. Standardised clinical assessment tools have been adopted. Child identification and tracking has begun.

SUSTAINABILITY
This approach moved quickly from its origins as a small, time-limited project to an area-based approach with a 10-year vision and multi-agency engagement.

TRANSFERABILITY
Our objective is to redesign and integrate the systems of interest to the extent that they are fit for purpose, whether for 5 or 500 children from statutory care.

LESSONS LEARNED
Rural areas have an advantage in more rapid uptake of joint working when stakeholders are well known to each other. Appreciation of the complexity of systems change continues to grow along with joint commitment to work for sustainable solutions. Academic input has helped our work have a sharper focus.