New Era for Child Development in Cape York and Torres Strait

Aim

In February 2024, the Torres and Cape Hospital and Health Service (TCHHS) launched the Child Development Service (CDS), supporting children and their families with complex developmental needs. The service works closely with families to understand the child’s developmental profile, provide recommendations and connect families with local community resources for additional support. This empowers families to ensure their child has the best start to life. The service is directly targeted at ‘Closing the Gap’ of access to care and improving health equity for First Nations communities in TCHHS, focussed on reducing developmental vulnerability.

Outcomes

• A mixed method qualitative and quantitative approach to service evaluation is being undertaken. The evaluation measures include:
  • Service Level Activity -responding to and meeting the need
  • Clinical indicators – to measure the improvement and access
  • Demand – reflects the need of the service and the specialty
  • Data from the evaluation measures are captured through current sources systems including Smart referrals and Best Practice
• Early service evaluation demonstrates high levels of satisfaction from families and the transdisciplinary team including. In the first year of operating (February 2024 to February 2025) the mobile service provided:
  • 23 visits to a total of 21 communities of 35 across the TCHHS region (Weipa, Marpoon, Naprunum, Aurukun, Kowanyama, Pomrp, Bamaga, Umagico, Seisia, New Mapoon, Injinoo, Lockhart River, Coen, Thursday Island and Saibai, Murray, Warraber, Darnley, Horn, St Pauls and Cubin).
  • The adoption of the services is evidenced by the sustained surge of referrals, with 252 referrals received exceeding the KPI targets by 432%, reflecting the confidence of stakeholders and community to engage with services.
  • The clinicians have provided over 881 consults and 1723 occasions of service in the first twelve months of operation and continue to have high rates of service and attendance rate (e.g. up to 100% in most recent March Cooktown cluster and Weipa cluster clinics.
  • Of the 31 referrals that have had their service completed in the 12-month period, five children were eligible for NDIS supports, 5 children eligible for Early Childhood Approach supports and eight linked in with Rural Generalist Allied Health team.
• The feedback from families and staff is very supportive of the program for example:
  • “I didn’t know much about anxiety in kids and behaviours that present in children. Not only has my parenting changed but so has my relationship with her dad. We have been able to put our differences aside and commit to putting our child’s needs first. I have noticed improvements in my child’s behaviour and their ability to talk about their feelings and worries.” (Mother)
  • “We can now start dream-big type planning to improve care for kids. We still have a long way to go with families, but it is fantastic to have the allied health team to be able to make a start now.” (TCHHS general and developmental paediatricians)
  • “Prior to CDS starting there were limited services for those children who had more complex and global developmental delays. From a child health perspective, it is comforting knowing that there is more access to clinical services. It is wonderful that we all collaborate and maintain open communication channels.” (Clinical nurse consultant, Thursday Island)

Background

• Before the CDS was established, there was no specialist child development service supporting children and their families across the TCHHS catchment. There were some government, community and private service supporting some communities however the  existing services model were limited and inadequate to meet the proportion of disadvantage and developmental vulnerability seen in the TCHHS population compared to Queensland peers.
• Cairns Hospital and Health Service ceased outreach service support to TCHHS in 2016 as they had no capacity for this team to accept referrals from TCHHS in Cairns.
• TCHHS had the lowest Clinical Services Capability Framework (2) in all HHS’s. Child Development ACT Now 2.

The CDS initiative had been identified as a top priority identified in TCHHS’s Local Area Needs assessment including:

• 85% of the TCHHS population are represented in the lowest Socio-Economic Indexes for Areas (SEIFA) and when compared to all Queenslanders; mothers, infants, and children in TCHHS generally experience poorer health results across most measures
• 28.3% of the children in the region are aged under 14 years
• extensive stakeholder/community consultation and review of empirical evidence identified that both child health service provision and availability of skilled staff in the area of child development as a highest priority health need
• TCHHS paediatricians, allied health and nurse navigators complied an Issues paper and brief to TCHHS Executive in December 2022, highlighting the inadequacy of Child Development and Allied Health services and resulting low numbers of referrals to allied health and paediatricians for children in the region in comparison to the burden of developmental vulnerability, complex conditions and chronic disease
• with TCHHS executive support and sponsorship, the CDS was launched after Torres and Cape Hospital and Health Service successfully obtained more than $3.6 million through the State Government’s Connected Community Pathways funding program for the initiative
• the approach supported a family-centred service including a speech pathologist, occupational therapist, physiotherapist and psychologist who work in collaboration with local Aboriginal and Torres Strait Islander Health Worker staff
• under the Putting Queensland Kids First Initiative, the service also received funding for two  dditional allied health positions. The CDS recruited an additional occupational therapist and psychologist to meet the increased demand for these services, in particular cognitive assessments.

Discussion

Success environment

• The establishment of the TCHHS integrated CDS has improved closing allied health service gaps to remote, predominantly First Nations communities across the Torres Strait and Cape York region.
• Families with young children have benefited from the increased access to specialist child development assessment and early intervention services, with potentially significant changes to a child’s life course trajectory.
• The achievement of the project objectives reflects an implementation strategy founded on community co-design and co-implementation through extensive community and stakeholder engagement. Utilising a First Nations community engagement officer established connection and provided education on the role and health benefits of allied health within community.
• Developing and sustaining strong connections with external stakeholders and primary care providers has been a success enabler .
• An investment in training and development for the new clinicians, as well as existing allied health rural generalists, has led to a more highly skilled workforce that is confident to work within inter and trans-disciplinary models of care that are responsive to the needs of families.
• Establishing a regular presence in community has increased stakeholder confidence in services, not only for community members, but for referral partners and partner organisations as well.
• This approach to a mobile service reduces the cost and stress of travelling away from home for families and provides care closer to home.

Lessons learned

• Utilising a community engagement officer during the consultation process was immensely successful. Future service enhancement will utilise a Health worker rolethrough all phases of the project through to evaluation. This would allow repeated connection with community and the building of strong relationships where frank and fearless feedback can be provided on service design and community needs.
• Challenges associated with recruitment and onboarding led to delays in service commencement. A key lesson has been to allow additional time for the recruitment and onboarding process.
• Negotiating clinical spaces in busy primary health services that have a lot of visiting services to accommodate.
• Barriers to implementation have reflected challenges common to remote workforces including recruitment, travel to geographically dispersed communities and data capture. Overcoming barriers has required innovation, creativity and whole of HHS changes in medical records systems.

Next steps:

• The service plans to recruit a dedicated Health Worker to the team. This will provide a vital link between the CDS and community, helping families feel supported in the most culturally informed way.
• A sustainable and consistent minimum data set reporting approach for the program is being finalised
• An allied health service-critical workforce framework implementation project is underway to develop an action plan, addressing recruitment pressure point.
• The service model is in final draft and will be available to share to support similar services to implement a CDS

References

The integrated CDS proposal strongly aligns to the following key strategic documents:

• TCHHS Local Area Needs Assessment 2022-2025
• TCHHS Strategic Plan 2023 – 2027 (under development) – Priority: Enhance Maternal Child Health services to support the first 2000 Days
• Queensland Clinical Senate Endorsed plan “The first 2000 days – The opportunity of a lifetime”
• Child Development Services in Queensland Hospital and Health Services: 2Act Now for kids 2morrow 2021-2030
• TCHHS Health Equity Strategy 2022-2025
• TCHHS Workforce Strategy 2021-2026
• TCHHS Clinical Services Plan 2019-2029
• Northern Queensland First 1,000 Days of Life Framework
• 25062024_preterm_followup_guideline.pdf