Integrating health systems for children and young people in out of home care: Challenging the nature of siloed service delivery in rural Australia

Abstract:- Objective: The purpose of this paper is to report on enablers and barriers during the first 2 years of the health systems integration project that included the implementation of a health navigator role. The project aims to improve health outcomes for children and young people residing in out of home care in rural Australia with a health navigator co- located between child protection practitioners and community health services clinicians.Setting: Rural Northwest Victoria.Participants: Sunraysia Community Health Services and the Department of Health and Human Services.Design: The qualitative design of the project evaluation involved semi- structured interviews and documentary evidence analysis. Analyses of interviews and documentary data demonstrate the challenging nature of siloed service delivery in rural Australia, particularly during a time that comprised multiple interruptions due to COVID-19.Results: A limited synergy between organisational priorities and reporting systems hindered project progress. The lack of a shared definition of ‘health’ challenged the effective collaboration between health clinicians and child protection practitioners and the role of the health navigator. The health navigator raising health awareness through project involvement, training and sector- wide stakeholder engagement resulted in a slow but steady process of increased prioritisation of health care, increased health literacy among the child protection workforce, and broadening participation of area- based stakeholders, but did not translate to increased access to health plans for children. Conclusion: Integrating health systems across multiple sites with support of a health navigator revealed difficulties, particularly during COVID- 19. The first phase of the project demonstrated the value of shared governance and partnerships as an imperative foundation for fundamental change. Relationships strengthened throughout the project, leading to a better understanding of area- based strengths, which in turn supports improved pathways to health care for children and young people in OOHC within rural communities and driving the subsequent phases of the 10-year project.