Changing the Trajectory Client Journey Project: A collective care approach to map client journey against different risk levels and service responses using the Initial Assessment and Referral Tool (IAR)

Abstract Background Evidence suggests that early identification and integrated ‘whole-of-person’ care could lead to better outcomes for children and families, particularly those experiencing child abuse and neglect from priority populations. The aim of this research was to explore the views and experiences of a range of service providers on how child and family services could be better integrated by adopting shared language, processes, and care pathways. Methods Participants from a range of child and family services providers in South West Sydney participated in the two day workshop to express their perspectives and map clients’ journey using case scenarios from a variety of services against different risk levels and service responses using the Initial Assessment and Referral (IAR) Tool. Data collected included field notes at the workshop and post-workshop activities with anonymous online surveys. Data were thematically analysed. Results The qualitative data revealed some of the benefits including improved efficiency and shared understanding about the child and the family’s needs across the eight domains of the IAR framework. Emphasis was placed on the necessity of cross-service utilisation of the framework to achieve the intended purpose of establishing a common language and reaching a broader audience including education and social services. Identified gaps included ambiguity in classifying cases into specific care levels, particularly as it relates to children/adolescents given the impact of the family and the wider systems rather than just relying on the presenting complaints and diagnostic determination. The potential of this approach to prioritise services based on care levels coupled with a stepped care approach to match referrals and service responses across a range of services was acknowledged by participants, thereby providing optimism about achieving an Integrated Continuum of Connect and Care (I-CCC) model of service provision. Conclusion This report highlights the perceived usefulness, gaps, and challenges as well as opportunities of I-CCC, an integrated service model incorporating the IAR tool. Widespread adoption across services is crucial alongside a stepped care approach with effective integration and service navigation support as well as addressing staffing, data harmonisation and access, and referral pathway challenges for improved child and family service system response.