South Western Sydney Local Health District (SWSLHD) and Tharawal Aboriginal Corporation (Tharawal) have collaborated to establish an integrated hub across two Tharawal early education centres, improving access to paediatric allied healthcare for Aboriginal children through a culturally-led partnership.
Tharawal provides two services tailored to the needs of children and families: Oorunga Wandarrah Multifunctional Aboriginal Children’s Services (MACS) Centre and Waranwarin Child and Family Centre. A 15-year partnership between Tharawal and SWSLHD has been achieved by applying of community partnership principles, creative use of workforce resources and investment in authentic partnerships.
Aboriginal Community Controlled Health Organisations (ACCHOs) such as Tharawal have embedded cultural knowledge, community connections and trust with their service communities. Through collaborative models, mainstream healthcare providers can build meaningful relationships with Aboriginal communities and build their own cultural competence. Genuine partnerships can support the creation of an environment in which Aboriginal and Torres Strait Islander peoples and communities can work towards self-determination.
Delivering co-designed models of care
The Australian Early Development Census (AEDC) uses 5 developmental domains to assess children's development, which include physical health and wellbeing; social competence; emotional maturity; language and cognitive skills; and communication skills and general knowledge. Children who fall below the 10th percentile of these domains are classed as developmentally vulnerable.
SWSLHD and Tharawal produced two co-designed models of care through the establishment of the integrated hub. The first model was aimed at primary prevention and early identification of developmental and health vulnerability, and the second offered direct care to vulnerable children under the age of five.
Primary prevention and early identification model
In this model, educators and allied health clinicians (including a psychologist, occupational therapist and speech pathologist) work collaboratively to support and promote children’s development within the classroom setting. This includes developing tailored strategies for individual children and classroom-based programs, which are co-facilitated by educators and clinicians. The model ensures that cultural safety is integrated into all aspects of the program, supporting educators to build capabilities in paediatric development, and clinicians to build cultural capability.
Direct care model
In this model, hildren identified with greater health or developmental needs can access a child and family health nurse, developmental paediatrician, psychologist, speech pathologist, occupational therapist and dietitian on site at Waranwarin. These services are enhanced by Waranwarin’s Aboriginal Child and Family Health Connector, a role that supports families through case management.
Improved support coordination across health, social and education systems
The hub delivered 542 individual appointments over the project timeframe (April 2023 – April 2024). All children in both models were identified early through the school setting or community-based screening as developmentally vulnerable.
On average, children receiving direct care demonstrate improvements in school readiness based on individual goal attainment.
In addition, the allied health teams have visited the early childhood centres weekly during school term to support staff and children enrolled. Across the classrooms at Waranwarin and Oorunga Wandarrah, 80 children were part of the primary prevention and early identification model.
The hub has improved coordination of support across health, social and education systems. The creation of the Aboriginal Child and Family Health Connector role has successfully facilitated 714 appointments through care navigation for 388 children and families across the project period. Most appointments focused on specialist support (n = 315), information, advice and referral (n = 286) and family capacity building (n = 111).
The hub has embedded systemic change within both organisations, enabled by true partnership, Aboriginal leadership, a shared commitment to closing the gap and a profound respect for culture and self-determination of the local Aboriginal community.
This work represents a scalable model for addressing inequities in health, development and care access for Aboriginal children applicable to other settings. The hub models have been scaled locally through funding enhancements and will be used to engage other local ACCHOs in SWSLHD. Furthermore, a shared allied health assistant training program has been developed to support the growth of local Aboriginal workforce.
