Improving primary care access for young people living in residential care: will a ‘medical home’ model work?

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Developing trial funding and care models to engage young people living in residential care with primary health care.

Client context

SEMPHN’s key objectives include increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes; and improving coordination of care to ensure patients receive the right care in the right place at the right time. SEMPHN works directly with general practitioners, other primary health care providers, secondary care providers and hospitals to achieve these objectives.

The challenge

There are over 4000 children in out-of-home-care (OOHC) settings in Victoria, which includes approximately 100 children and young people living in residential care in south eastern Melbourne.

Young people in residential care are some of the most vulnerable members of the community. Their level of severe trauma (neglect, sexual abuse, physical abuse) is disproportionately higher and they often have further complications such as substance use issues and a series of special (and often unmet) needs.

General practice has an important role to play in preventing, diagnosing and addressing the range of physical, neurological, developmental, psychological and behavioural issues that present in many children in these settings. However, GPs and health providers face many challenges in responding to the complex health needs of children in OOHC[1].

SEMPHN was keen to understand the challenges that general practice face in responding to the health needs of children in OOHC, and to better equip and support GPs.

The response

Larter conducted a needs assessment with local stakeholders to better understand the issues and develop recommended models of care. Key to this was consultation with residential care service providers and young people with lived experience of residential care, GPs and headspace centres to assess local need.

We worked with a Project Advisory Group (PAG) which included DHHS and sought academic support from Dr Susan Webster to develop appropriate funding and care models and recommendations for a future pilot models.

The outcome

The needs assessment provided an opportunity to layer the existing knowledge base on primary care in OOHC with locally-sourced experience and problem-solving. The triangulated approach to data collection ensured that the models developed addressed the barriers identified by young people, their residential care homes and primary care providers all at once.

Some of the key considerations which emerged to inform model development include:

  • Engaging young people living in residential care with primary health care is the greatest challenge with service and funding models needed to address the key barriers.
  • The primary health care system is unfamiliar with frameworks guiding OOHC health care including the relevant clinical guidelines.
  • The residential care staff need to build confidence and capacity to be able to prioritise the completion of the Preliminary Health Checks; the Comprehensive Health and Developmental Assessments, through to the development of a Health Management Plan and ongoing assessment and monitoring processes for each young person in their care.
  • Youth friendly and residential care-friendly doctors and clinics need to be identified in the south east Melbourne region and be offered training to become preferred providers.
  • Models of care need to have sufficient flexibility to cater for the varying and complex needs of young people.
  • Each young person in residential care should have a ‘medical home’, with strong systemic support for continuity of health care. The medical home will facilitate a continuing relationship with a particular GP/GPs, supported by a practice team and other clinical services wrapped around the patient and their residential staff carers. The medical home will provide ongoing, comprehensive, whole-person care.

Larter developed three types of models for piloting, all of which are underpinned by three layers of intervention: young people engagement, residential staff support and collaborative care approaches. Underpinning all three models is workforce capacity building and development of a network across south east Melbourne to develop resi-friendly services; onsite residential engagement activities; a care navigator role for young people; and clinical secondary consultation for residential care staff.

Larter brings expert knowledge, technical skills and experience to support health organisations to assess health need, secure financing, deliver programs and educate the health workforce. Contact us to discuss your consulting needs.


[1] Webster, S (2015). Children and young people in out-of-home care: canaries in the coal mine of healthcare commissioning, Australian Journal of Primary Health; Tremellen & Webster (2010), General Practice provision of comprehensive health assessments for children in out-of-home care: A Victorian Pilot, AGPN Forum 2010.

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