Literature Collection

OBJECTIVES: Adverse childhood experiences (ACEs) are significant contributors to the burden of disease and remain a serious concern for the health and wellbeing of children in Australia. To address ACEs, we co-designed and implemented two integrated health and social care hubs (Child and Family Hubs [CFHs]). This study explores the experiences of caregivers who received care from the CFHs, including the way they were asked about ACEs and the services offered to address identified ACEs. DESIGN: A qualitative study design was used. Using a semistructured interview guide, 29 in-depth interviews were conducted with caregivers of children who were experiencing a range of adversities, including maltreatment and household dysfunction, child neglect, parent mental illness, domestic violence, family conflict, community dysfunction, discrimination, poverty or financial hardship. A thematic analysis approach was used to analyse textual data. Triangulation of investigators and sources of data improved validation of the findings. NVivo (V.12) was used to organise, index and retrieve data. SETTINGS: This study was conducted in two Child and Family Hubs (CFHs) in Australia-IPC Health, Wyndham Vale, Melbourne, and Marrickville Health Centre, Sydney, between May and October 2023. PARTICIPANTS: Participants (n=29) were the caregivers of children living with adverse childhood experiences (ACEs). RESULTS: Four themes were identified which reflected the caregivers' experiences of being asked about adversities and how they linked to the support and services both in the CFHs and outside the CFH. These themes were as follows: (i) trusting relationships are fundamental; (ii) expectations play a role in talking about adversities; (iii) barriers to open discussion of adversities and (iv) barriers to accessing services. CONCLUSIONS: Consultations between caregivers and hub practitioners can effectively identify and address ACEs despite certain barriers. Establishing a trusting relationship where caregivers feel heard and supported is vital, highlighting the hub model's potential impact in Australia and similar contexts. Enhancing consultation duration, and service availability and accessibility may further improve caregivers' experiences in identifying and addressing adversity.

Provider groups taking on risk for the overall costs of care in accountable care organizations are developing care management programs to improve care and thereby control costs. Many such programs target “high-need, high-cost” patients: those with multiple or complex conditions, often combined with behavioral health problems or socioeconomic challenges. In this study we compared the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management. We found that effective programs customize their approach to their local contexts and caseloads; use a combination of qualitative and quantitative methods to identify patients; consider care coordination one of their key roles; focus on building trusting relationships with patients as well as their primary care providers; match team composition and interventions to patient needs; offer specialized training for team members; and use technology to bolster their efforts.