PDF(Pubmed)
Abstract：
BACKGROUND: Adverse childhood experiences can impact physical and mental health throughout the lifespan. To support families experiencing adversity and improve child health and developmental equity, an integrated, multi-sector response is required. Child and Family Hubs (Hubs) are a feasible and acceptable approach to providing such a response. In the Australian context, a number of federal and New South Wales (NSW) state policies support an integrated, multi-sector response using Hubs to support families experiencing adversity. This study examined NSW policy stakeholder and health service manager perspectives on the barriers and enablers to translating policy into practice in the implementation of Child and Family Hubs.
METHODS: Semi-structured interviews were conducted with 11 NSW government policy stakeholders and 13 community health service managers working in child and family policy and planning or child and family community-based services. Interviews were of 30-60 min duration and explored stakeholder knowledge, perspectives and experiences around childhood adversity, and barriers and enablers to operationalizing policies supporting Hubs. Analysis of barriers and facilitators to implementation of Hub models of care was undertaken using the Consolidated Framework for Implementation Research (CFIR).
RESULTS: Key barriers that emerged included short-term and inconsistent funding, lack of resourcing for a Hub co-ordinator, limited support for evaluation and insufficient time to plan for Hub implementation. Key enablers included flexibility and adaptability of Hub models to meet local needs, formal change management processes, strong governance structures and engagement among Hub practitioners. Key insights included the importance of targeted strategies to support sustained individual practice change and the need for organization-wide commitment to enable the successful adoption and maintenance of the Hub model of care.
CONCLUSIONS: This study provides valuable insights and contributes evidence around what is needed to strengthen and support the operationalization and scalability of the Hub model of care. Key recommendations for Hub practitioners include the importance of formal change management processes and establishment of strong governance structures, while key recommendations for policymakers include the need for sustainable Hub funding and a standardized, evidence-based framework to support Hub implementation and evaluation.
METHODS: Semi-structured interviews were conducted with 11 NSW government policy stakeholders and 13 community health service managers working in child and family policy and planning or child and family community-based services. Interviews were of 30-60 min duration and explored stakeholder knowledge, perspectives and experiences around childhood adversity, and barriers and enablers to operationalizing policies supporting Hubs. Analysis of barriers and facilitators to implementation of Hub models of care was undertaken using the Consolidated Framework for Implementation Research (CFIR).
RESULTS: Key barriers that emerged included short-term and inconsistent funding, lack of resourcing for a Hub co-ordinator, limited support for evaluation and insufficient time to plan for Hub implementation. Key enablers included flexibility and adaptability of Hub models to meet local needs, formal change management processes, strong governance structures and engagement among Hub practitioners. Key insights included the importance of targeted strategies to support sustained individual practice change and the need for organization-wide commitment to enable the successful adoption and maintenance of the Hub model of care.
CONCLUSIONS: This study provides valuable insights and contributes evidence around what is needed to strengthen and support the operationalization and scalability of the Hub model of care. Key recommendations for Hub practitioners include the importance of formal change management processes and establishment of strong governance structures, while key recommendations for policymakers include the need for sustainable Hub funding and a standardized, evidence-based framework to support Hub implementation and evaluation.
摘要：
背景：不良的童年经历会影响整个生命周期的身心健康。支持经历逆境的家庭，改善儿童健康和发展公平，一个综合的，需要多部门响应。儿童和家庭中心（Hubs）是提供此类响应的可行且可接受的方法。在澳大利亚的背景下，一些联邦和新南威尔士州(NSW)的国家政策支持一体化，使用Hubs支持经历逆境的家庭的多部门反应。这项研究考察了新南威尔士州政策利益相关者和卫生服务经理对将政策转化为实施儿童和家庭中心的障碍和促成因素的看法。
方法：对11名新南威尔士州政府政策利益相关者和13名从事儿童和家庭政策和规划或儿童和家庭社区服务的社区卫生服务管理人员进行了半结构化访谈。面试时间为30-60分钟，探索了利益相关者的知识，围绕童年逆境的观点和经验，以及实施支持集线器的政策的障碍和推动者。使用实施研究综合框架（CFIR）对实施中心护理模型的障碍和促进者进行了分析。
结果：出现的主要障碍包括短期和不一致的资金，缺乏集线器协调员的资源，对评估的支持有限，计划集线器实施的时间不足。主要促成因素包括Hub模型的灵活性和适应性，以满足本地需求，正式的变更管理流程，强大的治理结构和集线器从业者之间的参与度。关键见解包括有针对性的战略以支持持续的个人实践变化的重要性，以及需要全组织承诺以成功采用和维护中心护理模式。
结论：这项研究提供了有价值的见解，并提供了有关加强和支持Hub护理模式的可操作性和可扩展性所需的证据。对枢纽从业人员的主要建议包括正式变更管理流程和建立强大的治理结构的重要性，虽然政策制定者的主要建议包括需要可持续的枢纽资金和标准化，基于证据的框架，以支持Hub的实施和评估。
方法：对11名新南威尔士州政府政策利益相关者和13名从事儿童和家庭政策和规划或儿童和家庭社区服务的社区卫生服务管理人员进行了半结构化访谈。面试时间为30-60分钟，探索了利益相关者的知识，围绕童年逆境的观点和经验，以及实施支持集线器的政策的障碍和推动者。使用实施研究综合框架（CFIR）对实施中心护理模型的障碍和促进者进行了分析。
结果：出现的主要障碍包括短期和不一致的资金，缺乏集线器协调员的资源，对评估的支持有限，计划集线器实施的时间不足。主要促成因素包括Hub模型的灵活性和适应性，以满足本地需求，正式的变更管理流程，强大的治理结构和集线器从业者之间的参与度。关键见解包括有针对性的战略以支持持续的个人实践变化的重要性，以及需要全组织承诺以成功采用和维护中心护理模式。
结论：这项研究提供了有价值的见解，并提供了有关加强和支持Hub护理模式的可操作性和可扩展性所需的证据。对枢纽从业人员的主要建议包括正式变更管理流程和建立强大的治理结构的重要性，虽然政策制定者的主要建议包括需要可持续的枢纽资金和标准化，基于证据的框架，以支持Hub的实施和评估。
