La Trobe Rural Health School, La Trobe University, Shepperton, Victoria, Australia.
La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.
Aust J Rural Health. 2023 Aug;31(4):670-679. doi: 10.1111/ajr.12991. Epub 2023 May 2.
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.
Rural Northwest Victoria.
Sunraysia Community Health Services and the Department of Health and Human Services.
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.
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.
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.
本文旨在报告健康系统整合项目实施健康导航员角色的前 2 年中的促成因素和障碍。该项目旨在通过在儿童保护工作者和社区卫生服务临床医生之间设置健康导航员，改善澳大利亚农村地区离开家庭照顾的儿童和年轻人的健康结果。
维多利亚州西北部农村地区。
Sunraysia 社区卫生服务和卫生与人类服务部。
项目评估的定性设计涉及半结构化访谈和文件证据分析。对访谈和文件数据的分析表明，澳大利亚农村地区的服务提供存在隔离的挑战性，特别是在 COVID-19 多次中断期间。
组织优先事项和报告系统之间的有限协同作用阻碍了项目进展。缺乏对“健康”的共同定义，这对卫生临床医生和儿童保护工作者之间的有效合作以及健康导航员的角色构成了挑战。健康导航员通过项目参与、培训和全部门利益相关者的参与提高健康意识，导致对医疗保健的重视程度逐渐提高，儿童保护工作者的健康素养提高，以及基于区域的利益相关者的参与扩大，但并未转化为增加儿童获得健康计划的机会。
在健康导航员的支持下，跨越多个地点整合卫生系统显示出困难，特别是在 COVID-19 期间。该项目的第一阶段表明，共享治理和伙伴关系作为根本性变革的必要基础具有重要价值。整个项目过程中关系得到加强，从而更好地了解基于区域的优势，这反过来又支持为农村社区中离开家庭照顾的儿童和年轻人提供更好的医疗保健途径，并推动该 10 年项目的后续阶段。
