Search

Introduction: People with histories of illicit drug use often have myriad unmet health and psychosocial issues and many live in profound social disadvantage. Fear of stigmatisation, of being perceived as undeserving and unworthy citizens, and historic and systemic discrimination of those engaged in socially stigmatised and criminalised behaviour, create barriers to social and health services for people who use drugs. In light of these service barriers, health services are increasingly focusing on offering more consumer appropriate and integrated care services. A health justice partnership (HJP) model is one such model which involves the provision of legal services within a health service. Aims, Objectives, Theory or Methods: This study focused on such a partnership located at a drug treatment clinic within a major inner-city hospital in Sydney, Australia. Intake files were analysed to examine characteristics of clients accessing the service and clients' experience and satisfaction with the service was gleaned through in-depth qualitative interviews. With clients' consent, HJP solicitor provided an overview of clients' legal records and the research team reviewed clients' medical records (2017-2018). Convenience sampled interviews were also conducted with clients who had used the HJP. Highlights or Results or Key Findings: Between December 2014 and May 2018, 427 clients presented to the HJP. Most clients were women (79%) and Aboriginal people were overrepresented (39%). Clients presented for a range of reasons including child protection issues (27%), family law (17%), tenancy issues (15%), debt and fines (12%) or family and domestic violence (8%). Disadvantaged clients were over-represented and thus the service was accessed by the key target groups. Qualitative interviews with 12 clients (eight females and four males aged 28-52) revealed mutual respect, trust and honesty; accessibility and flexibility; and continuity-of-care as key aspects of HJP success identified by clients. Legal privilege - the ability to seek help without risk of mandatory reporting - was also an important feature of the service. Other benefits included personal self-belief, earlier intervention, de-escalation of legal issues, skills for operating in other health and mainstream services, and positive social, material and health outcomes, directly and indirectly, related to the legal issue being addressed. Conclusions: The HJP was highly accessed by disadvantaged clients. These clients were seeking justice in the areas influencing their social determinants of health including child protection, housing and debt related issues and the service was able to provide non-judgmental compassionate care in a flexible and accessible manner. Implications for applicability/transferability, sustainability, and limitations: Drug treatment services appear to be excellent homes for HJPs, and especially beneficial for people who use drugs as immediate concerns about illegality may take precedence over health concerns. However, findings pertain to consumers experiences with solicitors operating within a drug treatment service, so caution should be applied to generalisations. [ABSTRACT FROM AUTHOR]

Introduction: Health and community youth services are increasingly criticised for being sites of disempowerment of young people. Disadvantaged young people are particularly vulnerable to poor outcomes and service system disengagement. The growing recognition of the need for alternative approaches to youth services has seen an increase in service models centred upon youth-led peersupport practices and youth participation. While consensus is gradually growing about the importance of meaningfully engaging young people as peers, research-based knowledge on how to do this effectively is still developing. It is essential to understand how peers work effectively with young people if we are to maximise the benefits young people can gain from participating in peersupport programs. Methods: Ethnographic research was conducted in an Australian non-government peer-support service that supports young people with a range of needs, including physical health and mental health challenges, homelessness, anxiety, depression, social isolation, unemployment, and alcohol and drug misuse. Between January 2019 and March 2020, interviews were conducted with 20 young people and 11 adult professionals. In addition, a focus group was run with four young people and four adult professionals. One-year follow-up interviews were conducted with 11 young people and 3 staff. Selected aspects of constructivist grounded theory were used to thematically analyse the data. Key Findings: A peer-support model supports a less structured person-centered approach, where those with lived experience mirror alternative pathways to coping, healing and empowerment. Through the mechanisms of relatability, similarity, normalisation of needing and asking for support, and the strategic use of personal past life events, new possibilities and hope were created. At the core of peer-support efforts was an attempt to increase social integration and a commitment to notions of equality and respect and the eradication of unequal power relations. Peer-support provided scaffolding for young people to gradual repositioning themselves as survivors and experts, no longer victims of circumstances. Participants' ability to help others negotiate their challenges further engendered a sense of efficacy and self-worth and in this way contributed to their sense of agency. Risks of peer-support were also identified including over-reliance on personal experience, risk of burnout and compassion fatigue and the potential for the perpetuation of unhealthy coping strategies. Conclusions: Achieving health equity requires ensuring service engagement and access for all young people, including those most disadvantaged. The findings contribute knowledge on effective strategies for increasing retention of socioeconomically disadvantaged young people in health services, thereby contributing to health practice for a consumer group generally considered "hard-to-reach". Implications for applicability and limitations: Peer-support approaches may be especially beneficial to disadvantaged young people whose voices are rarely heard in program development and delivery. However, as long as service models are framed by conceptualisations of youth as passive recipients of services, young people's contributions to decision-making, program delivery and problem-solving will remain under-valued. [ABSTRACT FROM AUTHOR]

Introduction: Healthy Homes and Neighbourhoods (HHAN), an integrated care programme in the Sydney Local Health District (SLHD), seeks to address the needs of disadvantaged families through care coordination, as one of its components. This research aims to determine for whom, when and why the care coordination component of HHAN works, and establish the reported outcomes for clients, service-providers and partner organisations., Methods: Critical realist methodology was utilised to undertake a qualitative evaluation of the impact of care coordination. Purposive sampling was used to select a total of 37 participants for interview, including consumers, service-providers and key stakeholders. Thematic analysis was undertaken to derive the major modes of intervention of HHAN, and data representing these elements was coded and summarised under contexts, mechanisms and outcomes., Results: Analysis indicates that care coordination has a positive impact on clients' sense of independence, self-awareness and outlook on life. Trust and favourable interpersonal relations were identified as major underlying mechanisms for a successful client-provider working relationship. The identified modes of intervention facilitating positive consumer outcomes included accessibility, flexibility and service navigation. Persistent siloes in health and systemic resistance to collaboration was seen to hinder effective care delivery., Conclusions: This study suggests that a care coordination model may be effective in engaging disadvantaged families in healthcare, assist them in navigating the health system and can lead to beneficial health and social outcomes. Successful implementation of care coordination requires flexible programme design and experienced and skilful clinicians to fulfil the care coordinator role. There is a need to appreciate the negative impact that the complex and siloed health system can have on disadvantaged families., Competing Interests: JE, SH, ET, EM, MLM, PF were employees of Sydney Local Health District at the time of the research. EM is manager of HHAN. JE is Director of HHAN. SD and DDS have no competing interests., (Copyright: © 2020 The Author(s).)