Kalgal Burnbona - An evaluation of a school-based integrated care (SBIC) program in metropolitan Sydney (Combined with Paper 120)

Background: Kalgal Burnbona is a school-based integrated care (SBIC) program co-designed with schools and the Aboriginal community within metropolitan Sydney to improve access and engagement with health services for school-aged children (5-18 years).

In Australia, children and particularly Aboriginal children experience poor access to healthcare. The Covid19 pandemic has widened these disparities. Schools provide a safe, convenient and trusted environment for health service delivery.

Co-Design and Partnerships:The Kalgal Burnbona program was designed with schools and the community.  It is embedded within the Healthy Homes and Neighbourhoods (HHAN) integrated care initiative. Ngaramadhi Space (NS) is a SBIC initiative piloted at Yudi Gunyi School, which is a specialised secondary school for students experiencing problematic externalising behaviour. Evaluation of NS showed improved access to healthcare for multiple health and social needs.  These findings led to further stakeholder consultation including with an Aboriginal community reference group (Wouwanguul Kanja) who were actively involved in design and evaluation, providing insight into forming a holistic culturally-safe model of care as well as  impetus to scale up the initiative.  Education stakeholders were the Student Wellbeing team (Department of Education (DoE)), area directors, principals, executive teams, networked specialist facilitators, social workers and school counsellors. Health stakeholders were community paediatricians, youth health services, psychiatry, speech pathologists and occupational therapists.  The social care sector was represented by non-governmental organisations, other social workers and HHAN clinicians.

Intervention: Kalgal Burnbona includes 5 schools.  Each school has a ‘School Health Team’ consisting of health, education and social sector representatives e.g. paediatrician, school counsellor, and social worker. Each team regularly meets to discuss referrals and to gather information. Students then proceed to a comprehensive and multidisciplinary health and psychosocial assessment. Recommendations are followed up and reviewed by the team.

Evaluation: An evaluation of 128 students across 4 schools within Kalgal Burnbona between 2016-2022 showed a mean age of 9.2 years (2.8-16.2 years) with 44% Caucasian and 38% Aboriginal students. Multiple unmet physical health and social needs were identified:  Autism 9.4%; behavioural concerns 50%; child protection concerns 53%; developmental/learning concerns 71.3%; mental health diagnoses 75.4%; parental mental health diagnoses 26%; parental unemployment and social concerns 59%;  psychological trauma history 57.7% and physical health conditions 46%. 

Despite these high needs, 26.5% were known to a paediatrician or mental health service and of these 60% were engaged with the service. In contrast, attendance to the SBIC was high (7.9% failure to attend; 6% cancellation).

Relevance for the international audience: Kalgal Burnbona  has been co-designed with an Aboriginal community reference group and schools to provide a culturally safe way of improving access to health and social care for families with complex needs.  This integrated model of care can be widely adapted as a potential solution to access and engagement to health services for school-aged children, particularly as we navigate a post-pandemic era.

Future Steps: The Kalgal Burnbona team continue to provide leadership and work in partnership with DoE and other key stakeholders to scale up the model of care and to align processes, policies and evaluation.