Introduction: Education and health historically work separately when trying to manage children with behavioural issues. The UK NICE Conduct Disorder guidelines recommend an integrated approach to care 1. A school-based interagency and community partnership was established at Green Sqaure School (GSS), in inner Sydney, to strengthen service delivery for students experiencing challenges with their behaviour.
Short description of practice change implemented: ‘Ngaramadhi Space’, was established in consultation with the local Aboriginal and school communities. ‘Ngaramadhi’ means ‘active listening’ in the Dharawal language and was gifted by the local Aboriginal community. A person-centered interagency multidisciplinary approach is used to address the physical health, learning, psychological and social issues experienced by students and their families while developing innovative and integrating teaching practices.
Aim and theory of change:
a) Supplement the educational opportunities by providing access to health and social support services
b) Undertake interagency multidisciplinary planning, review and implementation of personalised learning and development plans
c) Connect teachers with health practitioners to build their health literacy and universal therapeutic techniques
d) Enabling teachers to transfer skills to mainstream classrooms
e) Provide an educational opportunity for families
Targeted population and stakeholders: Targeted Population: Students and families referred from regional primary schools due to significant behavioural concerns.
Stakeholders: Aboriginal Land Council, schools principals, teachers, private therapists, social services, non-government agencies, local government, mental health, drug health, youth health and community paediatrics.
Timeline: This approach was conceptualised in 2016 with the first students seen on 26 July 2016.
Highlights (innovation, Impact and outcomes): The students were predominantly male with almost half identifying as Aboriginal. Around 34% of students had an open case with child welfare agencies (Family and Community Services). The failure to attend rate was 34% which was considered low given for this high risk group. Trauma informed practice is being translated to mainstream school classrooms.
Comments on sustainability: The clinic continues to be sustainable based on the commitment by health and education to provide staffing for the Ngaramadhi Space.
Comments on transferability: We are now working towards including another school into the local program and the development of a similar initiative in another region.
Conclusions (comprising key findings): The Ngaramadhi Space has been successful in improving access to health for students and families experiencing significant behavioural concerns. The partnership between health and education has led to a more holistic and coordinated approach to the student’s needs on a long-term basis.
Discussions: This initiative is an example of whole of system collaboration with knowledge translation
Lessons learned: A collaborative approach between health and education requires communication and development of a shared vocabulary.
Health is able to build on the trust and security created by the school environment to improve access to health services in hard to reach groups.
1. Kendall T, Taylor E, Perez A, Taylor C. Guidelines: diagnosis and management of attention-deficit/hyperactivity disorder in children, young people, and adults: summary of NICE guidance. BMJ: British Medical Journal. 2008 Sep 27;337(7672):751-3.