The feasibility of a Child and Family Hub within Victorian Community Health Services: a qualitative study

Abstract

Objectives: Explore the feasibility of an integrated Child and Family Hub within Victorian Community Health Services (CHS) to identify and respond to family adversities as preventable determinants of child mental health problems. Methods: Thirteen Victorian CHS staff and government policy makers (PMs), recruited via snowball sampling, participated in semi‐structured interviews exploring: 1) barriers and facilitators for implementing a hub; 2) feasibility of a proposed integrated hub; and 3) resources needed to scale and sustain a hub. Transcripts were analysed employing framework analysis. Results: 1) Barriers included inadequate and activity‐based funding, inability to fund community paediatricians and inadequate workforce competencies. Facilitators included CHS engagement with vulnerable communities and readiness to act. 2) The proposed hub model was identified as feasible to implement. Local co‐design, co‐location, and virtual delivery would support hub implementation. 3) To sustainably scale a hub, clear policy leadership and workforce and funding model reviews are needed. Conclusions: A hub was perceived as feasible when based in CHS; however, local and system‐wide issues need consideration to support its sustainable scaling. Implications for public health: Findings will inform the scaling of hub models of care across Victoria and other states to potentially optimise broader child and family health outcomes.

Moving from idea to reality: The barriers and enablers to implementing Child and Family Hubs policy into practice in NSW, Australia

“…This study adds important evidence on the key barriers and enablers to operationalizing Hubs, especially in the policy ready environment of NSW. While previous studies have provided evidence of the feasibility of this model of care to identify and address adversity [ 15 ], this is the first study to utilize CFIR [ 27 , 28 ] to examine the challenges and enablers to its operationalization and scalability. In addition to contributing to the current evidence base on barriers to Hub implementation around funding, information-sharing infrastructure, Hub co-ordinator resourcing and evaluation support [ 15 , 22 , 30 ], we provide new insights into the importance of formal change management processes, engagement among Hub practitioners, enabling organizational structures and time to plan, strengthen intersectoral collaboration and support effective Hub implementation.…”

“…As highlighted by participants in the current study, lack of long-term, secure funding significantly undermines the opportunity for service growth and development, and system stability. A recent study examining the feasibility of the Hub model of care in the Community Health Services setting in Victoria, Australia, also highlighted the challenges of funding models such as activity-based funding, siloed funding and other inflexible funding approaches [ 15 ]. While these funding models were identified as a challenge by some participants in the current study, overwhelmingly, there was an emphasis on the implications of short-term funding on service provision, staff development and service planning.…”

“…An interview guide was adapted from Honisett et al. [ 15 ] (see Additional file 1 ) and piloted by the study team. Interviews examined stakeholder knowledge and understanding of childhood adversity, and perspectives and experiences around barriers and enablers to operationalizing policies supporting the Hub model of care.…”

“…While Hubs will vary depending on setting, emerging research suggests that core components to facilitate engagement include co-design with communities, family-centred care, parental capacity building, co-location of services, workforce development and local leadership [ 12 ]. Hubs have demonstrated benefits for child wellbeing, child development outcomes [ 13 ] and child mental health outcomes [ 14 ] and have been shown to be feasible [ 15 ] and acceptable and to facilitate improved access and engagement with services. [ 16 ]…”

Identifying and responding to family adversity in Australian community and primary health settings: a multi-site cross sectional study

“…With large amounts of funding going to the provision of direct mental health services ( 35 ), we are missing an opportunity to support families early in a child's life and earlier in their healthcare journey by better detecting and responding to family adversities. Policy and practice directives support a “one stop shop” Child and Family Hub ( 34 , 44 ) to provide earlier mental health care. Hub models may be ineffective if they do not also address family adversities as an upstream determinant of mental health.…”