为弱势家庭设计综合护理倡议：澳大利亚悉尼现实主义因果关系和项目理论的实施
Designing an Integrated Care Initiative for Vulnerable Families: Operationalisation of Realist Causal and Programme Theory, Sydney Australia.
作者信息
Eastwood John G, Shaw Miranda, Garg Pankaj, De Souza Denise E, Tyler Ingrid, Dean Lauren, MacSween Morag, Moore Michael
机构信息
School of Women's and Children's Health, The University of New South Wales, Sydney, NSW, AU.
Ingham Institute of Applied Medical Research, Liverpool, NSW, AU.
出版信息
Int J Integr Care. 2019 Jul 25;19(3):10. doi: 10.5334/ijic.3980.
INTRODUCTION
In July 2015 Sydney Local Health District (SLHD) implemented an integrated care initiative for vulnerable families in the Inner West region of Sydney, Australia. The initiative was designed as a cross-agency care coordination network that would ensure that vulnerable families: had their complex health and social needs met; kept themselves and their children safe; and were connected to society. We will describe the development of the design that drew on earlier realist causal and program theoretical work.
METHODS
Realist causal and program theory were used to inform the collaborative design of an initiative for vulnerable families. The collaborative design process included: identification of desirable and undesirable outcomes and contextual factors, stakeholder consultation, interagency planning, and development of a service proposal.
RESULTS
The design elements included: identification of vulnerable family cohorts; care coordination; evidence-informed intervention(s); general practice engagement and support; family health improvement; placed-based neighbourhood initiatives; interagency system change and collaborative planning; monitoring of individual and family outcomes; and evaluation.
CONCLUSIONS
The design study described advances toward the implementation of a whole-of-government integrated health and social care initiative. The initiative was designed as a cross-agency care coordination network that would ensure that vulnerable families: had their complex health and social needs met; kept themselves and their children safe; and were connected to society. In so doing we aim to break intergenerational cycles of poverty, violence and crime, poor education and employment opportunities, psychopathology, and poor lifestyle and health behaviours, through strengthening family resilience, improving access to services, and addressing the social determinants of health and wellbeing.
引言
2015年7月，悉尼地方卫生区（SLHD）在澳大利亚悉尼内西区为弱势家庭实施了一项综合护理计划。该计划旨在打造一个跨机构护理协调网络，以确保弱势家庭：其复杂的健康和社会需求得到满足；保障自身及子女安全；与社会建立联系。我们将描述该计划设计的发展过程，此设计借鉴了早期的现实主义因果关系和项目理论研究成果。
方法
运用现实主义因果关系和项目理论为弱势家庭计划的协同设计提供参考。协同设计过程包括：确定期望和不期望的结果以及背景因素、利益相关者咨询、跨机构规划以及制定服务提案。
结果
设计要素包括：确定弱势家庭群体；护理协调；循证干预措施；全科医疗参与和支持；家庭健康改善；基于社区的邻里计划；跨机构系统变革与协同规划；监测个人和家庭结果；以及评估。
结论
本设计研究阐述了在实施一项政府整体综合健康和社会护理计划方面所取得的进展。该计划旨在打造一个跨机构护理协调网络，以确保弱势家庭：其复杂的健康和社会需求得到满足；保障自身及子女安全；与社会建立联系。通过增强家庭复原力、改善服务可及性以及解决健康和幸福的社会决定因素，我们旨在打破贫困、暴力和犯罪、教育和就业机会匮乏、精神病理学以及不良生活方式和健康行为的代际循环。
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