Jess Rojas

Project Manager

Women’s and Children’s Health Model of Care Project

“Bright Eyes - A Collaborative Approach to Caring for Mothers and Children”

Project Manager

Sinead Tierney and Christina AntonasTeam Leaders

Women’s and Children’s Health Social WorkSt George Hospital

July 2014

Jess Rojas

Project Manager – Social Worker

Women’s and Children’s Health Model of Care Project

A Collaborative Approach to Caring for Mothers and Children”

Project Manager – Social Worker

Sinead Tierney and Christina AntonasTeam Leaders

Women’s and Children’s Health Social WorkSt George Hospital

July 2014

Bright Eyes - A Collaborative Approach to Caring for Mothers and Children

COLLABORATION

OPENNESS

RESPECT

EMPOWERMENT

A Collaborative Approach to Caring for Mothers and Children

COLLABORATION

OPENNESS

RESPECT

EMPOWERMENT

St George Hospital NSW

St George Hospital (SGH) -Health District, Southern Sector

A major trauma and teaching hospital in NSW

2nd busiest Emergency Department in NSW

44 full time social work positions

The St George Area of Sydney is one of the most culturally diverse areas in NSW

St George Hospital NSW

South East Sydney Local Health District, Southern Sector

A major trauma and teaching hospital in NSW

busiest Emergency Department in NSW

44 full time social work positions

The St George Area of Sydney is one of the most culturally

Social Work in Women’s and Children’s Health

2500 births in 2013

SGH is a high risk birthing unit

Team of 3 full time Social Work positions Team of 3 full time Social Work positions

Paediatric ward, Antenatal clinics, Postnatal ward, Gynaecology ward, Special Care Nursery

Social Work in Women’s and Children’s Health

SGH is a high risk birthing unit

Team of 3 full time Social Work positions Team of 3 full time Social Work positions

Paediatric ward, Antenatal clinics, Postnatal ward, Special Care Nursery

Reasons for referral to Women’s and Children’s Social Work Team

Child protection – drug and alcohol, mental health, domestic violence (DV)

Domestic violence

Young parents

Adoption

Sexual assault /trauma/refugees

Significant anxiety and adjustment issues regarding pregnancy and parenthood

Reasons for referral to Women’s and Children’s Social Work Team

drug and alcohol, mental health,

/trauma/refugees

anxiety and adjustment issues regarding

Reasons for referral to Women’s and Children’s Social Work Team

Recent bereavement

Stillbirth/miscarriage /foetal abnormality

Poor prognosis/new diagnosis/disability Poor prognosis/new diagnosis/disability

Relationship breakdown

Significant social isolation, limited supports

Homelessness

Reasons for referral to Women’s and Children’s Social Work Team

Stillbirth/miscarriage /foetal abnormality

Poor prognosis/new diagnosis/disabilityPoor prognosis/new diagnosis/disability

Significant social isolation, limited supports

Background

An increase in birth rate (approximately 25% over 10 years) at SGH and NSW Government policy protection and domestic violence significantly the Social Work role in Women’s and Children’s Health.

Social Work staff needed to be enhanced to the increasing antenatal outpatient caseload

Statutory requirements were unable to be met due to the high volume of inpatient and outpatient referrals.

Background

rate (approximately 25% over 10 years) at SGH and NSW Government policy changes for child protection and domestic violence significantly increased

Women’s and Children’s Health.

staff needed to be enhanced to keep up with antenatal outpatient caseload.

Statutory requirements were unable to be met due to the high volume of inpatient and outpatient referrals.

Background

Antenatal outpatients were left on a wait list of up to 3 months before they received Social Work intervention

The average response to referrals was 2 - 8 weeks

56% of waitlist cases had Statutory requirements

Background

How could we demonstrate the need for enhancement in this current budgetary

climate?

Difficult to secure any additional funding for enhancements

Model of Care Project Model of Care Project

I. Evidence based practice

II. Keeping accurate stats

III. Business plan

How could we demonstrate the need for enhancement in this current budgetary

climate?

Difficult to secure any additional funding for enhancements

Outline of Project

The 6 month Model of Care (MOC) project reviewed activity and demand in this clinical area.

It has informed service delivery priorities so patients have greater access to high quality antenatal and inpatient care.

This innovative MOC enabled a new exclusive Antenatal Project Manager position to be trialled, offering specialised intervention to high risk women, in collaboration with midwifery staff and other hospital and community partners.

A new weekend Social Work service was also piloted as part of this MOC project, exclusively for Women’s and Children’s Health patients.

Outline of Project

6 month Model of Care (MOC) project reviewed activity and demand in this clinical area.

has informed service delivery priorities so patients have to high quality antenatal and inpatient care.

This innovative MOC enabled a new exclusive Antenatal Project Manager position to be trialled, offering specialised intervention to high risk women, in collaboration with midwifery staff and other hospital and community partners.

A new weekend Social Work service was also piloted as part of this MOC project, exclusively for Women’s and

Goals of the Project Create a 7 day week service ensuring continuity of care for

patients

Positive impact on patient care and safety

Patients have greater access to high quality antenatal and inpatient careinpatient care

Reduce unnecessary length of stay

Safer and quicker discharge for Midwifery Support Program

Increase weekend and Monday discharges

Positive impact on patient flow in meeting NEAT & NEST targets

Goals of the ProjectCreate a 7 day week service ensuring continuity of care for

Positive impact on patient care and safety

access to high quality antenatal and

Reduce unnecessary length of stay

Safer and quicker discharge for patients eligible for

Increase weekend and Monday discharges

Positive impact on patient flow in & NEST targets

Goals of the project

Decrease wait list for Antenatal women requiring Social Work services

Meet all Statutory requirements in accordance with NSW Health, Child Protection and Domestic Violence Policies

Improve multidisciplinary team work Improve multidisciplinary team work

Formalise partnerships with various community agencies

Creation and implementation of innovative ideas

Collect & analyse data on social work referrals, interventions and typology

Goals of the project

Decrease wait list for Antenatal women requiring Social

all Statutory requirements in accordance with NSW Health, Child Protection and Domestic Violence Policies

Improve multidisciplinary team workImprove multidisciplinary team work

Formalise partnerships with Child Protection Services and community agencies

Creation and implementation of innovative ideas

Collect & analyse data on social work referrals,

Outcomes of Weekend Service Weekend referrals to SW increased by 56.4%

We demonstrated that this service facilitated the discharge of 67 patients on a weekend or Monday morning, over the 6 month trial period.

There was a total potential saving of $46,854 There was a total potential saving of $46,854

Cost for the weekend service for the 6 month period was $17,649

The safety benefits and cost effectiveness of the 7 day/week service were recognised by the Hospital Executive and the Weekend service built into 2014 budget

Outcomes of Weekend ServiceWeekend referrals to SW increased by 56.4%

We demonstrated that this service facilitated the discharge of 67 patients on a weekend or Monday morning, over the

potential saving of $46,854 potential saving of $46,854

Cost for the weekend service for the 6 month period was

The safety benefits and cost effectiveness of the 7 day/week service were recognised by the Hospital Executive and the Weekend service built into 2014 -15

Outcomes for Antenatal position

Early intervention

Improved care coordination

Equity and access to services Equity and access to services

Improved patient and staff experience

Continuity of social work care for antenatal patients when they birth in the hospital

Outcomes for Antenatal position

and integration of services

servicesservices

Improved patient and staff experience

Continuity of social work care for antenatal patients when

Outcomes of Antenatal position

100% of Statutory requirements are now being met in accordance with priority guidelines of 72 hours72 hours

100% of cases are assessed prior to the 36 week review

Increase in referrals of 54.8% since commencement of MOC project

Outcomes of Antenatal position

Innovation – Management

Developed to ensure that all high risk antenatal cases have a step by step plan in place prior to delivery

case management which is streamlined and coordinated

improved access to relevant information

more effective partnerships with other

implemented across the Sector at St George and Sutherland Hospitals.

Management Plans

all high risk antenatal cases have a step by step plan in place prior to delivery

case management which is streamlined and coordinated

access to relevant information

effective partnerships with other disciplines

implemented across the Sector at St George and

Patient Journey

Antenatal booking in visit

Referral to MCDReferral to MCD Allocated to Social Work

Management plan

Disclosed DV at 32 weeks

Psychosocial and Child Protection AX

Information gathering - Federal Police, FACS, solicitor

Frequent SW Intervention and DV

counselling

Patient Journey - Rebecca

Management plan completed in

collaboration with Complex Care

CMC

Postnatal Assessment done in delivery suite

Discharged to safe

house on MSP from delivery

suite

SW Antenatal Case Management

Ongoing liaison with FACS

Innovation- Staff Survey

“Since the commencement of the new Social Work Antenatal role, I have noticed a significant improvement in the identification and support process of the women. I feel it is a vital aspect of women centred care

“It is comforting to know that we have social workers over the weekend who know the area and problems faced by our clients and ourselves…Whereas before we had to consult emergency social workers” (Nurse)

Staff Survey

the commencement of the new Social Work Antenatal role, I have noticed a significant improvement in the identification and support process of the women. I feel it is a vital aspect of women centred care” (Midwife)

It is comforting to know that we have social workers over the weekend who know the area and problems faced by our clients and ourselves…Whereas before we had to consult

” (Nurse)

What we achieved

Through evidence based practice we were able to demonstrate the benefits to patients, staff and cost effectiveness of the 7 day/week service and increases to antenatal service.

We were given the opportunity to showcase the project to hospital executives and submitted a business plan.

What we achieved

Through evidence based practice we were able to demonstrate the benefits to patients, staff and cost effectiveness of the 7 day/week service and increases to

We were given the opportunity to showcase the project to hospital executives and submitted a business plan.

What we achieved

We were successful in securing funding of a weekend service which now continues to generate a high level of referrals and facilitates patient flow.

An Allied Health review has been conducted across St An Allied Health review has been conducted across St George Social Work Department. Clinical allowed for 2 days permanent to be allocated to the antenatal caseload.

What we achieved

We were successful in securing funding of a weekend service which now continues to generate a high level of

and facilitates patient flow.

review has been conducted across St review has been conducted across St epartment. Clinical redesign has

allowed for 2 days permanent to be allocated to the