Implementation, Mechanisms of Effect and Context of an Integrated Care Intervention for Vulnerable Families in Central Sydney Australia: A Research and Evaluation Protocol

Abstract

Introduction: In March 2014, the New South Wales (NSW) Government (Australia) announced the NSW Integrated Care Strategy. In response, a family-centred, population-based, integrated care initiative for vulnerable families and their children in Sydney, Australia was developed. The initiative was called Healthy Homes and Neighbourhoods . A realist translational social epidemiology programme of research and collaborative design is at the foundation of its evaluation. Theory and Method: The UK Medical Research Council (MRC) Framework for evaluating complex health interventions was adapted. This has four components, namely 1) development, 2) feasibility/piloting, 3) evaluation and 4) implementation. We adapted the Framework to include: critical realist, theory driven, and continuous improvement approaches. The modified Framework underpins this research and evaluation protocol for Healthy Homes and Neighbourhoods . Discussion: The NSW Health Monitoring and Evaluation Framework did not make provisions for assessment of the programme layers of context, or the effect of programme mechanism at each level. We therefore developed a multilevel approach that uses mixed-method research to examine not only outcomes, but also what is working for whom and why .

A Critical Realist Evaluation of an Integrated Care Project for Vulnerable Families in Sydney, Australia

“…Through qualitative data collection, CMO configurations for key HHAN programme components were developed in order to explain and refine the initial programme theories and for future service evaluations. The study forms part of a larger programme of continuous research, design and evaluation (13), informed by the UK Medical Research Council (MRC) Framework for evaluating complex health interventions of 1) development, 2) feasibility/piloting, 3) evaluation and 4) implementation. The framework has been adapted to include: critical realist, theory driven, and continuous improvement approaches (13).…”

“…Self-identity Presence of domestic violence The concept of "wrap-around care" was a key design element of the programme theory (13) operating at the contextual levels of Self (identity/individual experience), Situated Activity (face-toface activity) and Intermediate (service organisation) levels. HHAN CCs often tried to engage with the spouse, children and grandparents to provide support to the whole family.…”

“…The HHAN initiative aims to break intergenerational cycles of disadvantage and trauma within affected communities in Sydney Local Health District (SLHD). The programme's family-partnership approach draws on a theory of change model that has been previously reported (13).…”

A critical realist evaluation of an integrated care project for vulnerable families in Sydney, Australia

“…The initiative also includes local elements through deliberate recruitment of families and service partnerships in the City of Canterbury and City of Sydney local government areas. This last component enabled the development of ‘demonstration-site’ place-based partnerships with local general practice, schools, family support agencies, local government, religious and faith-based organisations and community members.” [ 36 ].…”

“…This manuscript reports the qualitative findings of a pilot evaluation of HHAN, focusing on the care coordination component of the programme, using a critical realist case study approach. Realist evaluation draws on principles of critical realism and social theory [ 36 – 39 ]. The approach can be readily applied to the discipline of translational social epidemiology for the purpose of evaluating complex interventions such as HHAN [ 25 ] and developing implementation and programme theories [ 40 ].…”