An ‘equity’ domain could strengthen the utility of a framework for assessing care coordination for Australian Aboriginal families

Abstract

Improving the health of Aboriginal people is a national priority and improving coordination of services for Aboriginal families is critical to achieving this goal. A care coordination framework has been developed from a limited range of clinical settings. We reflect on the utility of this framework for assessing service coordination for Aboriginal families in Australia. We conducted stakeholder consultation, service mapping and in-depth interviews with service providers and an Aboriginal mother, using a tool based on the framework domains. A fragmented range of services support Aboriginal families with complex and changing needs, highlighting the importance of care coordination. Relationships underpinned care coordination; however, we identified few opportunities for developing relationships and several factors that undermined relationships, including unclear accountability mechanisms, resource constraints, anxiety about follow-up and transfer of information to child protection. The Care Coordination Framework enabled a ‘systems-perspective’ of the main care coordination domains for Aboriginal families from individual experiences. However, there were some limitations in capturing subtle historical and cultural dimensions affecting care coordination in this context where health care practice in large institutions is framed by the dominant culture. An additional ‘equity’ domain would capture these dimensions, address a growing international policy challenge and strengthen the framework.