Capital Health Network

Capital Health Network

CHN’s Needs Assessment 2021-2024 highlighted social determinants of health as a major barrier to accessing health care in the ACT. The absence of adequate support for individuals with complex social and health needs becomes particularly apparent when they are trying to access and move between health services.

As a first in Australia, CHN, ACT’s PHN funded 4 general practices in the ACT to participate in the Social Workers in General Practice Pilot, with Social Workers as an integrated part of their general practice team. A total of 4 Social Workers were employed and embedded in Interchange Health Co-op, Next Practice Deakin, Fisher Family Practice and Wakefield Gardens. The Social Workers received support from funded professional clinical supervision and initially, a community of practice. The pilot program also provided funding for a nominated GP champion in each practice. The Social Workers were involved in various activities that directly supported patients, such as counselling, assisting with health care systems, and educating practice staff and patients on the role of Social Workers in general practice. This has resulted in improved referral.   

Over the last year: 

  • 651 patients were seen by a Social Worker 
  • 500 referrals were received  
  • 229 Care Plans were contributed to by a Social Worker. 

Social Workers are addressing barriers to health care access by coordinating additional help from social, welfare or community support. Their work focuses on ensuring people who are at risk of poor health outcomes receive the right care, in the right place, and at the right time.   

Early results from the trial reveal that the inclusion of Social Workers in general practice has had a positive impact in:   

  • patient support, including psychological support, counselling, advocacy   
  • navigation of health care system and government services e.g. My Aged Care, Centrelink, NDIS 
  • continuity of care 
  • integration of social work in general practice teams  
  • additional capacity of practice teams to offer specialty services  
  • improved capacity of GPs to focus on the clinical side of health care  
  • education of practice teams in changes to Government programs and/or limitations of services. 
Social Worker Barbara Shone, Next Practice Deakin is involved in the Social Workers in General Practice Pilot.

Client Story

A Social Worker supported a client who had experienced domestic violence and trauma and her 3 children to move into a new 4-bedroom rental home. The home is subsidised by the Rent Start Safely Program, where 75% of the rent for the home is paid for by the NSW Department of Communities and Justice. Previously, the client’s eldest teenager had to live with her maternal grandmother, as she could not fit in the family’s previous rental accommodation. 

 

Under the Escaping Violence Program, the Social Worker was able to connect this patient with $5,000 worth of funding to assist her. The home has recently been furnished with $3,500 of new furniture and $500 worth of Woolworths’ goods to cover the family through the Christmas period. The client reported being “excited and happy” and her children all now settled back under the one roof, representing 12 months’ worth of social work provision.