Re-think, Re-prioritise, Re-design for Child and Family Health (Triple-R for CAF)

Child and Family Health Services (CFHS) in Sydney Local Health District (SLHD) has experienced an increase in demand, rising client complexity and acuity. CFHS is comprised of three clinical streams, a total of nine disciplines, and a centralised intake team.

The current process of managing clients is inconsistent across the various disciplines within CFHS. Due to the amount of specialty services within CFHS, working in silos has become an issue.  This limits cross-disciplinary collaboration and can impact the quality and safety of care for clients, particularly families with complex social risks and needs. There is an urgent need to review current workflows and processes, to ensure clients have timely and equitable access to child and family health care. As of April 2024, clients across CFHS currently experienced wait times between one month to -12 months.

Children with multiple developmental concerns wait an average of 168 days to be assessed in the multidisciplinary assessment clinic. In the clinic, assessment time for a client is at least two hours (on average) and involves four clinicians (on average) from different disciplines to conduct a multidisciplinary assessment. Each case requires five hours (on average) for the clinical team and a further four hours to prepare for a clinic, conduct case reviews and complete paperwork. This can take longer if the client is experiencing psychosocial risks and has other unmet social needs that require further service navigation.

Enhancing access through addressing inefficiencies

Timely access to CFHS has a significant impact on outcomes relating not only to a child’s development, but also the wellbeing of their family.¹ The Re-think, Re-prioritise, Re-design for Child and Family Health (Triple-R for CAF) project aims to enhance service access by streamlining workflows and processes. The project team conducted comprehensive diagnostic activities to identify pain points and inconsistencies in the intake, allocation and prioritisation processes. A multi-faceted approach was used, including:

• online surveys and interviews on client and staff experience with Centralised Intake Service.
• interviews about multidisciplinary care
• focus groups, consultation workshops and interviews
• IMS+ system consumer feedback and incident reports.

Data from the diagnostic activities allowed the project team to conduct a root-cause analysis which identified two key issues:

• Inconsistent and outdated Models of Care (MoC) across disciplines leading to inefficiency, services working in silos, and staff confusion at Centralised Intake.
• Despite staff reporting an increased presentation of psycho-socially complex clients, there are no systematic ways to record this data.

The project team held solution identification activities that included one focus group and three consultation workshops with 34 staff members. From these, two key solutions were identified:

• Solution one: Revise outdated MoC and develop a new MoC for the multidisciplinary assessment clinic that include consistent criteria on priority populations, psychosocial risks and unmet social needs, and clearer eligibility, prioritisation criteria and referral pathways.
• Solution two: Develop e-Solutions to support referral, triage, identification and screening that aligns with solution one, including a REDCap online referral form (accessible by clients, referrers and staff), and two new electronic medical record (eMR) features to support wait list and prioritisation management, as well as cross-disciplinary collaboration.

Project team to improve data management

In June 2024, revision and development of the MoC commenced. To inform the revision process, 73 staff members completed a baseline survey on their views of the current MoC. Staff reported 59% satisfaction with ‘handling of client referrals’, and the project team aims to increase this to 80% by February 2025. Additionally, only four out of the nine disciplines currently document clients’ psycho-social risks and needs (an equivalent of 31.7% clients) and these are documented inconsistently and on various platforms. The project team aims to increase the recording of this data to 100% of clients by February 2025.

It is anticipated that implementation of the revised and new MoC will commence in August 2024. Survey evaluation will be administered in November 2024 (three-months post implementation), and in February 2025 (six-months post implementation). A prototype of the REDCap online referral form has been developed after extensive consultation with key stakeholders. Pilot testing of this online referral form will commence in August 2024.

The implementation of the new eMR feature will commence in August 2024. The project team will work together with the Health Information Manager to develop training resources and deliver staff training. Data captured from the e-Solutions will identify the number of clients that require services from multiple disciplines and who have complex psychosocial risks and needs, which will further support intake and prioritisation decisions.

View this project's poster from the Centre for Healthcare Redesign graduation August 2024.

References