Introduction
As the sustainability of Australia’s health systems are challenged by increasing demand and cost, the importance of influencing the social determinants and our ability to integrate and innovate across sectors is critical.

Description of policy context and objective
The Queensland government has defined its agenda in the Our Future State – Advancing Queensland Priorities initiative. As part of this initiative, government is calling for agencies to collaborate and innovate to design new ways of working to shift the dial on a suite of population level indicators, including several indicators relating to children’s health and wellbeing.

Targeted population
Over six months in 2019, Children’s Health Queensland facilitated a whole of system piece of work to better understand the needs of parents and develop policy recommendations for government that will enable a more integrated and responsive service model that enables early identification and intervention for emerging child development concerns.

Highlights (innovation, impact and outcomes)
Through partnerships across the system and leveraging the strengths of 10 government departments, CHQ facilitated a human-centred design process which involved engagement with over 70 parents state wide, 58 front line staff (GPs, Child Health, Childcare workers, Child safety officers) and over 50 hours of cross-government solution design working sessions. By investing in engaging well with families and spending time working with partner agencies to design innovative and integrated responses to the issues, the policy recommendations were owned by the 10 agencies involved, leading to a unique opportunity to change the system.

The policy recommendations that were proposed included:
- A universal digital solution that integrates and consolidates existing government websites to create a more streamlined experience for parents where information is consistently managed through a content management system and presented in a coherent narrative.
- A suite of targeted solutions to meet the needs of the more vulnerable cohorts that optimise existing investment in services as well as capital infrastructure. These solutions identified a number of projects where multiple government departments could repurpose or reshape existing investment to collaborative in new ways that could have greater return on investment.

Comments on transferability
CHQ’s approach to this policy activity has challenged the status quo on how the system makes commissioning and investment decisions and the logic and methodology. The collaborative and human-centred approach can be generalised and applied to the adult population to address other complex issues that require acknowledgement of the social determinants of health.

Conclusions (comprising key findings)
By facilitating systemic and cross-sectorial integration at the policy level, CHQ has influenced thinking and decision making at the earliest stage of planning, which sets enabling conditions that support integrated service design and provision of care. Taking a genuinely collaborative approach and keeping the needs of children and families at the centre, CHQ has been able to align the priorities and perspectives of 10 government agencies to form an integrated policy perspective that sets the scene for service providers to break through traditional barriers to deliver life changing care for Queensland kids.

Introduction:

The National Disability Insurance Scheme (NDIS) is a transformational reform of Australia’s disability sector. The NDIS has seen complete disruption to the pathways linking health and disability sectors. Local solutions are required to resolve interface issues.

Children’s Health Queensland Hospital and Health Service (CHQ) is the quaternary health service for children and young people in Queensland and beyond and provides both diagnostic services and health interventions for children with new and/or emerging disability. CHQ has taken a proactive approach to understanding the NDIS and has forged a partnership with the Brisbane Region’s Early Childhood Early Intervention (ECEI) partner, The Benevolent Society (TBS), to support NDIS access and planning for young children who need disability services to enable a safe and timely discharge.

This has led to efficient and effective care transitions for children with complex conditions and long-term care needs within the context of an evolving health-disability interface.
Targeted population: Children aged 0-6years who have a new or newly diagnosed disability who are eligible for NDIS funded services and supports and who are an inpatient of the Queensland Children’s Hospital.

Timeline and highlights:

1. January 2019: Colocation of The Benevolent Society (TBS) staff at the Queensland Children’s Hospital for one day per week (MoU in place) to support staff and families of children who are inpatients of the hospital navigate the NDIS and progress along the inpatient pathway

2. January to June 2019:
• Partnership to support 53 children aged 0-6 and their families to transition from hospital to home with linkages to the disability sector in place (64% of total number of inpatients requiring NDIS related support at time of discharge)
• Whole of state focus:
o 43% were residents Greater Brisbane region
o 45% were residents Regional Queensland
o 11% live in other jurisdictions (NSW and WA)

3. Robust plans for new participants that often exceed industry expectations

4. No NDIS related delays to discharge for the 0-6 cohort at CHQ in 2019, despite extreme and complex disability requiring plans inclusive of in home support and assistive technologies

Sustainability and Transferability:

This initiative is sustainable due to cross sector commitment to an integrated approach to care which has reduced the burden on all stakeholders to ensure information is easily shared and barriers to discharge are understood. These learnings are transferable to older children (7+) and other like-organisations.

Conclusion:

The NDIS has been a catalyst for innovative partnerships. CHQ and TBS have forged such a partnership and the children of Queensland are benefiting from:
• Reciprocal and trusting relationships between health and disability providers based on an understanding of complimentary roles and responsibilities
• Accurate and timely information exchange for families and for health professionals
• Pathways that enable flexibility to manage barriers and challenges as they arise

Young people living in residential out-of-home care (OOHC) settings due to abuse and neglect are some of the most vulnerable Victorians. Many young people enter OOHC exhibiting complex behaviours, and often with high unmet health needs. These young people need regular health checks and specialist assessments but face barriers in accessing timely and appropriate care. Whilst various policy levers exist to support access, there is no central mechanism to guide or coordinate delivery.

South Eastern Melbourne Primary Health Network (SEMPHN), in partnership with Victorian Department of Health and Human Services, identified general practice as a trial environment to co-ordinate and integrate care, by establishing a medical home for each young person living in OOHC.

A medical home provides a systems response for addressing the following needs:
• improved service accessibility and responsiveness
• increased residential staff capability to complete OOHC Health Assessments
• improved youth engagement with health services
• improved data custodianship and integration across Child Protection, OOHC and care teams.

Young people (aged 12-17) in residential facilities under state custodianship/guardianship orders were selected for testing the model, as they currently face significant barriers to accessing primary care.

A 12-month trial was completed in 2017, with a scaling phase currently underway (2018-2019).

The pilot trialled three different approaches to compare varying levels of flexibility in primary care delivery. Each model included: care coordinator; trauma-informed care training to general practice; practice systems review to optimise access; clinical secondary consultation for residential care staff.

The key benefits of a medical home for vulnerable young people include comprehensive, whole-person care, and shared decision-making. The development of a relational approach to care has resulted in increased trust and engagement, which has led to increased health assessments, self-management and improved health literacy.

While early outcomes have demonstrated promising and important new ways of working, the key relationship which requires continued investment is between PHN and DHHS, to facilitate continuing integration efforts. Key inter-departmental levers also need to continue being enabled between DHHS, OOHC and Child Protection, particularly in terms of data linkage and workforce development.

The current focus should remain on residential OOHC environments and on scaling local capability of primary care practitioners and medical home numbers, to support the entire catchment. Future development opportunities for the OOHC sector include trialing the approach in foster care and kinship care environments.

The trial developed a systems model to drive a whole-of-practice approach to supporting young people in OOHC. This project has identified ten key building blocks to underpin primary care approaches to working with vulnerable population groups: practice systems review; enabled priority access; multidisciplinary collaboration; assertive contact; cultural safety; welcoming physical environment; data sharing; patient communications; emphasis on confidentiality and security.

Achieving improved outcomes for vulnerable populations can be challenging and resource intensive. Improving care across the continuum requires continuous quality improvement and investment to build the capacity of care providers. This also includes investment into change management support required at appropriate levels.