Care Coordination for Vulnerable Families in the Sydney Local Health District: What Works for Whom, under What Circumstances, and Why?

John G Eastwood; Suzannah Dewhurst; Sally Hansen; Elaine Tennant; Erin Miller; Maja Lindegaard Moensted; Penelope Fotheringham; Denise De Souza

doi:10.5334/ijic.5437

Care Coordination for Vulnerable Families in the Sydney Local Health District: What Works for Whom, under What Circumstances, and Why?

Int J Integr Care. 2020 Dec 2;20(4):22. doi: 10.5334/ijic.5437.

Authors

John G Eastwood^{1

2

3

4

5}, Suzannah Dewhurst¹, Sally Hansen⁵, Elaine Tennant⁵, Erin Miller⁵, Maja Lindegaard Moensted⁶, Penelope Fotheringham⁵, Denise De Souza⁷

Affiliations

¹ School of Women's and Children's Health, The University of New South Wales, Sydney, NSW, AU.
² Ingham Institute of Applied Medical Research, Liverpool, NSW, AU.
³ Charles Perkins Centre, Menzies Centre for Health Policy, Discipline of Child and Adolescent Health, and School of Public Health, University of Sydney, Sydney, NSW, AU.
⁴ Sydney Institute for Women, Children and their Families, Camperdown, NSW, AU.
⁵ Community Health Services, Sydney Local Health District, Camperdown, NSW, AU.
⁶ Drug Health Services, Sydney Local Health District, Camperdown, NSW, AU.
⁷ Centre for Research in Education (CRED), Torrens University Australia, Melbourne, VIC, AU.

Abstract

Introduction: Healthy Homes and Neighbourhoods (HHAN), an integrated care programme in the Sydney Local Health District (SLHD), seeks to address the needs of disadvantaged families through care coordination, as one of its components. This research aims to determine for whom, when and why the care coordination component of HHAN works, and establish the reported outcomes for clients, service-providers and partner organisations.

Methods: Critical realist methodology was utilised to undertake a qualitative evaluation of the impact of care coordination. Purposive sampling was used to select a total of 37 participants for interview, including consumers, service-providers and key stakeholders. Thematic analysis was undertaken to derive the major modes of intervention of HHAN, and data representing these elements was coded and summarised under contexts, mechanisms and outcomes.

Results: Analysis indicates that care coordination has a positive impact on clients' sense of independence, self-awareness and outlook on life. Trust and favourable interpersonal relations were identified as major underlying mechanisms for a successful client-provider working relationship. The identified modes of intervention facilitating positive consumer outcomes included accessibility, flexibility and service navigation. Persistent siloes in health and systemic resistance to collaboration was seen to hinder effective care delivery.

Conclusions: This study suggests that a care coordination model may be effective in engaging disadvantaged families in healthcare, assist them in navigating the health system and can lead to beneficial health and social outcomes. Successful implementation of care coordination requires flexible programme design and experienced and skilful clinicians to fulfil the care coordinator role. There is a need to appreciate the negative impact that the complex and siloed health system can have on disadvantaged families.

Keywords: care coordination; critical realism; disadvantaged families; evaluation; integrated care.