TOPIC: Practice
THEME: Empowering and Engaging people and communities
 Preventative care and health promotion
 Co-production

TITLE: Healthy Kids: Bringing Early Childhood Education and Care communities together to improve the health of Queensland Kids

Introduction
Early education benefits all children, especially those experiencing disadvantage. Early education produces the greatest return when it’s high quality. High quality services are less likely to be accessed by children from lower socioeconomic backgrounds, despite having the most to gain.

Healthy Kids brings together Health, Early Childhood, and Education sectors to deliver a free early childhood health and wellbeing workforce strategy for the early childhood education and care (ECEC) sector within identified communities.

Practice change implemented
Needs assessment of ECEC services, environmental scan of learning opportunities, and consultation of Early Childhood organisations revealed there was a lack of free, health-based PD available.

Aim & theory of change
Healthy Kids aims to enhance developmental outcomes of children in vulnerable communities through building capacity of ECEC sector to integrate key child development messages and strategies into everyday practice. This is achieved by coordinating free, quarterly webinars delivered in partnership with educators in local communities. Events includes a live webinar with content specialist, Q&A, networking, reflective practice, and newsletter.

Targeted population and stakeholders
Healthy Kids is delivered in ten communities across Queensland vulnerable in children’s outcomes and socio-economic status. Less children are “on track” across many developmental domains when compared to both Queensland and Australian results on the Australian Early Development Censes (AEDC).

Stakeholders involved include a range of key organisations with an early childhood focus, at both local and Advisory Group levels.

Timeline
Healthy Kids has been delivered from 2017-2019. CCHW is scoping communities and sector need for a further series.

Highlights
• Community capacity and ownership to deliver program
• Translation of strategies into daily practice
• Developing or reigniting community early childhood networks
• Increasing subscription numbers for each newsletter
• Requests for Healthy Kids by other communities
• Increased opportunities for collaboration amongst partners

Comments on sustainability
Whilst CCHW provided support and facilitation for initial events, capacity building and exit strategy has allowed communities to take over the local delivery. CCHW continues to source health content, oversee coordination of local events, and publication of each newsletter.

Comments on transferability
Use of technology to deliver consistent health promoting messages to the ECEC (or other) sectors across the state with a framework that promotes communities of practice.

Conclusions
Evaluation suggests participants found the program to be useful, relevant and of value to their role as an educator, increasing their knowledge and skills around specific topics and application to daily practice.

Discussions
The presence of local champions makes a positive impact in how Healthy Kids is accepted by educators, as does visible cross-sector networks and relationships.

Lessons learned
• Co-design of program between Health, Educators, and Early Childhood and Education-focused organisations
• Advisory group – guiding implementation, problem-solving, and sharing existing networks
• Creating a supportive environment to allow integration of different professional experiences

Introduction:
Evidence suggests communities experiencing high vulnerabilities do not easily engage with or reach available primary healthcare services. A Child Health “Pop-Up" clinic is an innovative and contemporary mobile health clinic, that moves the model of care directly to families. It utilises existing community infrastructure and incorporates integrated and coordinated care in service design and delivery.

Practice change implemented:
To manage the change process effectively, the team implemented:

1. Advisory Group (multidisciplinary Child Health experts)
2. Multiple Working Groups (local community stakeholders)
3. Co-designed best practice Child Health mobile clinics based on the needs of that community
4. Full Developmental Assessments offered by Child Health Nurses in a Pop-Up Clinic (up to 1 hour allocated for each child)

Aim & theory of change:
Child Health Pop-Up clinics aim to:
• Increase the number of developmental assessments within communities experiencing higher vulnerabilities
• Increase new registrations to Child Health Services
• Increase the number of sites families can access Child Health Services.

The targeted communities experience low utilisation of Child Health Services with extended waiting lists. Pop-Up Clinics are implemented in creative locations that are frequently accessed, including playgrounds, primary schools or neighbourhood centres.

Targeted population and stakeholders:
Pop-Up Clinics are in 6 South-Queensland communities experiencing greatest vulnerabilities, utilising 15 creative locations.
Stakeholders include 8 local primary schools and 22 key community groups (government and non-government).


Timeline:
Child Health Pop-Up Clinics are scheduled from November 2018 to December 2019.

Highlights:
• 45 Pop-Ups scheduled from 2018-2019
• Increase in new registrations to Child Health Services
• Increase in additional appointments for younger siblings (new registrations)
• High attendance rate for clinical developmental assessments
• Multiple referrals for children seen during developmental assessments
• Increased demand for Pop-Ups in additional sites

Sustainability:
Based on immediate success, there is opportunity to scale-up to additional communities and broadly integrate into existing model of care.


Transferability:
This successful Pop-Up model can been applied to different outpatient health services.

Conclusion:
Child Health Pop-Up clinics are a successful model in reaching children and families from communities experiencing great vulnerabilities. It uses a contemporary and innovative approach, reaching those that have never accessed Child Health before, through integrating with existing community infrastructures.

Discussion:
Pop-Ups primarily focus on 4-5 year developmental health assessments. There is a need for developmental assessments to be conducted in the earlier years (e.g 18months old) to prevent developmental delays well before children start school. Finding a way to reach families earlier will be critical.

Lessons learned:
• Utilising and engaging existing relationships and trust that community partners have with families is a significant strength.
• Follow-up of families to provide wrap around support before and after referral
• Developmental Assessments for younger years

Introduction: Across North East Melbourne, each year more than 500 five-year old children are identified as vulnerable in one or more domain of development.

In 2018, the wait-time to see a paediatrician at Austin Hospital was more than 365 days, children were on multiple health and disability wait-lists, there were various confusing eligibility criteria and pathways but no map or overarching model of care, and communication between care providers was limited. The 'system' was characterised by gaps in some areas but duplication in others, drop-offs, disengagement and hand-offs, and lack of coordination. Families and providers alike were confused and frustrated. There was room for improvement in all four quadrants of the Quadruple Aim.

Practice change: Acknowledging the evidence that the child's longer term developmental, secondary health and psychosocial trajectory can be improved by providing early support and services for infants, young children and their families where there are concerns about the child's development, Better Health North East Melbourne (BHNEM) has embarked on a program of work to evolve a transformative, integrated, place-based model of care to ensure that by age five each child is receiving the right care at the right time in the right place to optimise their school readiness.

Aim and theory of change: BHNEM is a collaboration of health commissioners and providers across primary care and community health (through Eastern Melbourne Primary Health Network, North Western Melbourne Primary Health Network, Banyule Community Health, healthAbility, and Your Community Health), acute and secondary care (through Austin Health) with support and representation from the Victorian Department of Health and Human Services (North East Melbourne Area). It covers the local government areas of Banyule, Darebin and Nillumbik.

In 2018, BHNEM’s leadership set the target that by 2023 the wait-time to see an Austin Health paediatrician would have reduced from 365 to 90 days. With BHNEM’s Executive Officer, the BHNEM Executive Sponsor oversees, drives and manages the program of work. The contemporary frameworks employed are the quadruple aim and value-based healthcare. A new model is being developed that fully incorporates the consumer voice.

Each of the five current workstreams is led by clinicians from BHNEM’s member organisations partnering with other key stakeholder organisations. The workstreams are exploring and embracing improvement, transformative and other project methodologies, such as LEAN, Agile and PDSA cycles.

BHNEM’s member organisations are growing, stretching and learning about integration and how to achieve better value for people and populations from the ‘top down’ through the leadership of the Governance Group and from the ‘bottom up’ through the clinical leadership evidenced in the workstreams.

Conclusions and challenges: Shining a spotlight on the ‘problem’ has already resulted in change and investment such that the wait-time to see an Austin Health paediatrician is within the targeted 90 days.

BHNEM Governance Group's leadership is an enabler to success; it gives the permission and commitment for organisational change ‘within’ and ‘between’ in order to create and deliver an integrated model of care delivering connected healthcare for children under five with developmental delay.