Figure 1
The five interdependent strategies of the WHO Framework on integrated people-centred health services (IPCHS) [14].
Figure 2
The 10 implementation mechanisms for integrated care for multi-morbidity [16].
Figure 3
Diagram showing the design of the research study.
Table 1
Table showing the anticipated and actual number of study participants.
| SITE | PARTICIPANT GROUP (ABBREVIATION) | ACTUAL PARTICIPANTS/ANTICIPATED PARTICIPANTS |
|---|---|---|
| Ngaramadhi Space (NS) | School Principal (SP) | 1/1 |
| School Executive (SE) | 2/2 | |
| School Teacher (ST) | 6/7 | |
| Social Worker (SW) | 1/1 | |
| Occupational Therapist (OT) | 1/1 | |
| Speech Pathologist (SP) | 1/1 | |
| Paediatrician (PD) | 1/1 | |
| Aboriginal Community Member (ACM) | 2/3 | |
| School Student (SS) | 3/5 | |
| Parents/Caregiver (PC) | 0/4 | |
| School A | School Counsellor (SC) | 2/2 |
| Social Worker (SW) | 2/2 | |
| School B | School Principal (SP) | 1/1 |
| School Counsellor (SC) | 1/1 | |
| Paediatrician (PD) | 1/1 | |
| Community of Practice (COP) | Director of Community Paediatrics (DCP) | 1/2 |
| Rural General Practitioner (RGP) | 1/1 | |
| Director of Non-Governmental Organisation (DNG) | 1/1 | |
| Researcher (RES) | 1/2 | |
| Total | 29/39 |
Table 2
Characteristics of schools included in this study.
| SCHOOL CHARACTERISTICS | SYDNEY LOCAL HEALTH DISTRICT | SOUTHWESTERN SYDNEY LOCAL HEALTH DISTRICT | ILLAWARRA SHOALHAVEN LOCAL HEALTH DISTRICT | SOUTHERN NSW LOCAL HEALTH DISTRICT | ||
|---|---|---|---|---|---|---|
| SCHOOL A | SCHOOL B | YUDI GUNYI SCHOOL | ||||
| Type of School | Government | Government SSP* | Government SSP* | Government | Government | Government |
| Year Group (K-12)** | K-12 | K-6 | 6–12 | K-6 | K-6 | 7–12 |
| Location | Major Cities NSW | Major Cities NSW | Major Cities NSW | Major Cities NSW | Inner Regional NSW | Outer Regional NSW |
| Number of students (n) | 1034 | 34 | 27 | 287 | 454 | 563 |
| Female (n %) | 448 (43%) | 6 (18%) | 6 (22%) | 138 (48%) | 223 (49%) | 253 (45%) |
| Male (n %) | 586 (57%) | 28 (82%) | 21 (78%) | 149 (52%) | 231 (51%) | 310 (55%) |
| Indigenous students (%) | 17% | 24% | 52% | 13% | 51% | 12% |
| CALD background***(%) | 57% | 43% | 25% | 75% | 4% | 5% |
| ICSEA score and centile^ | 1037 (64th) | 934 (18th) | 851 (4th) | 880 (7th) | 783 (2%) | 946 (23rd) |
| SEA Distribution^^ | ||||||
| 19% | 46% | 63% | 71% | 80% | 48% |
| 19% | 23% | 24% | 20% | 14% | 31% |
| 28% | 16% | 9% | 8% | 5% | 14% |
| 34% | 16% | 4% | 1% | 1% | 6% |
| IRSD^^^ 1 = most disadvantaged 5 = least disadvantaged | 5 | 3 | 4 | 1 | 1 | 1 |
[i] *SSP = School for Special Purposes.
**K-12 = Kindergarten to Year 12.
***CALD = Culturally and linguistically diverse.
^ ICSEA = Index of Community Socio-Emotional Advantage. The Australian average is 1000 [24].
^^ SEA = Socioeconomic Advantage. The Australian average is 25% for each quartile [24].
^^^IRSD = Index of Relative Socio-Economic Disadvantage (IRSD) ranking for surrounding suburbs to school [25].
Table 3
Summary of themes mapped to IPCHS framework and Looman’s implementation strategies with implementation actions for SBIC models.
| IPCHS FRAMEWORK | THEMES FROM ANALYSIS | LOOMAN’S IMPLEMENTATION STRATEGIES | SBIC IMPLEMENTATION ACTIONS |
|---|---|---|---|
| Strategy 1: Engaging and Empowering People and Communities | Theme 1: Community-Driven Models of Care Theme 2. Improved Access to Healthcare Theme 3. Positive outcomes for children and families Theme 4: Connection Theme 5. Marginalised Population | 1. Leadership and governance: Applying collaborative governance by engaging all stakeholders | Community consultation and co-design |
| Strategy 2: Strengthening governance and accounatbility | Theme 1: Integration of Systems Theme 2. Developing a Robust Evidence Base | 1. Leadership and governance: Applying collaborative governance by engaging all stakeholders | Policy and governance alignment Develop committee of leaders and community reference group |
| Strategy 3: Reorienting the model of care | Theme 1. Shifting Healthcare to Schools Theme 2: Cultural Safety | 1. Workforce: Build a multidisciplinary team culture with mutual recognition of each other’s roles | Develop a ‘School Health Team’ within each school Understanding each other’s role Joint clinical meetings and professional development sessions Co-location |
| 2. Service delivery: Incremental growth model | Stepwise implementation with regular review process | ||
| 3. Service delivery: Balance between flexibility and formal structures of integration | Flexible approach with structure around roles and responsibilities | ||
| Strategy 4: Coordinating services within and across sectors | Theme 1: Integrated care Theme 2. Coordination and Stability of the Workforce | 1. Workforce: Stimulate the development of new roles and competencies for integrated care | Develop new ‘integrator’ roles Develop skills for working in SBIC |
| Strategy 5: Creating an enabling environment | Theme 1: Leadership Theme 2. Commitment of stakeholders and staff Theme 3. Operational processes and resourcing | 1. Leadership and governance: Distributed leadership throughout the system | Shared leadership across sectors |
| 2. Financing: Securing long-term funding and innovative payments | Leaders to work collaboratively to ensure sustainability | ||
| 3. Overarching mechanism: Alignment work across the different sectors | Formalising roles and responsibilities e.g. MOU Policy and process alignment | ||
| 4. Information and Communications Technology (ICT): Developed to support collaboration and communication | 2a. Adopt integrated digital systems | ||
| 5. Information and Research: Feedback loops and a continuous monitoring system | 3a. Resourcing for evaluation and research |