Study protocol for a real-world evaluation of an integrated child and family health hub for migrant and refugee women

Abstract

Introduction: Continuity of child and family healthcare is vital for optimal child health and development for developmentally vulnerable children. Migrant and refugee communities are often at-risk of poor health outcomes, facing barriers to health service attendance including cultural, language, limited health literacy, discrimination and unmet psychosocial needs. 'Integrated health-social care hubs' are physical hubs where health and social services are co-located, with shared referral pathways and care navigation.

Aim: Our study will evaluate the impact, implementation and cost-benefit of the First 2000 Days Care Connect (FDCC) integrated hub model for pregnant migrant and refugee women and their infants.

Materials and methods: This study has three components. Component 1 is a non-randomised controlled trial to compare the FDCC model of care with usual care. This trial will allocate eligible women to intervention and control groups based on their proximity to the Hub sites. Outcome measures include: the proportion of children attending child and family health (CFH) nurse services and completing their CFH checks to 12 months of age; improved surveillance of growth and development in children up to 12 months, post partum; improved breastfeeding rates; reduced emergency department presentations; and improved maternal well-being. These will be measured using linked medical record data and surveys. Component 2 will involve a mixed-method implementation evaluation to clarify how and why FDCC was implemented within the sites to inform future roll-out. Component 3 is a within-trial economic evaluation from a healthcare perspective to assess the cost-effectiveness of the Hubs relative to usual care and the implementation costs if Hubs were scaled and replicated.

Ethics and dissemination: Ethical approval was granted by the South Eastern Sydney Local Health District Human Research Ethics Committee in July 2021 (Project ID: 020/ETH03295). Results will be submitted for publication in peer-reviewed journals and presented at relevant conferences.

Trial registration number: ACTRN12621001088831.

Keywords: Community child health; Maternal medicine; Organisation of health services; PAEDIATRICS; PUBLIC HEALTH.

Figure 1

First 2000 Days Care Connect implementation evaluation logic model. CFH, child and family health; CFHN, child and family health nurses; ED, emergency department; LHD, local health district; NGO, non-government organisations; NSW, New South Wales.

Figure 2

First 2000 Days Care Connect governance structure. CAG, Clinical Academic Group; ELDOH, Early Life Determinants of Health; LHD, local health district; NSLHD, Northern Sydney Local Health District; SESLHD, South Eastern Sydney Local Health District; SWSLHD, South Western Sydney Local Health District. UNSW, University of New South Wales.