Establishing the impact of a partnership between Centrelink & Western Health.Sarah Booth, Jessica Valentine, Sharon Summut, Nicole Lind, Kathryn Elliot and Riley Walsh

Overview

• Evidence relating to financial stress and health

• Why social work pursued a partnership with Centrelink

• The aims of the project

• Preliminary results

• Case studies

• Where to from here

Does financial stress impact health?

Long term financial stress has been linked to;

• poor health outcomes 1• higher mortality risk

• extended hospital stays 2• readmission to hospital 2

Low income groups are disproportionately impacted by financial stress.1,3.4

Low income and Centrelink payments

• In 2014 over 110, 000 people received Centrelink payments within WH catchment 5

• Many people who rely on a Centrelink allowance as their sole income.

https://www.theguardian.com/australia-news/2019/apr/15/australian-poverty-in-graphs-its-a-desperate-state-of-affairs

Poverty in the West

• 13% of Victorians are living in poverty. • Below is a chart of the Western region of Melbourne.

http://povertymaps.vcoss.org.au/

Why would we form a health social partnership between WH and Centrelink?

Centrelink communication pathways have shifted;• Increased focus on automated phone and online interfaces

• Traditional professional links between hospital and Centrelink social workers have diminished.

• Although the CLO’s were an existing resource for people in the west, patient access was not routinely available.

WH and Centrelink partnership

Evidenced suggests improved health outcomes if targeted income support and intervention is provided at a time of health deterioration 6, 7, 8

Partnering with consumers (NSQHS) and community services• A MoU was signed between Centrelink and Western Health to provide

• CLO on site for 3 hours per week.

• Access via social work referral, post psychosocial assessment

• Provision of complex system navigation, advocacy and as a conduit between the health service, patient and Centrelink.

• Aiming to form a ‘one stop shop’ responding to psychosocial needs of patients, including Health Justice and Centrelink partnerships.

Our project

The aims of our project are to ;• Explore how the patient experienced the on site Centrelink service, and their perception of

how the service impacted their situation.

• Explore the impact of onsite Centrelink services on social work clinicians, at Western Health

• Identify factors that impact the onsite Centrelink service at WH and identify future opportunities.

Convergent mixed method, utilising qualitative and quantitative data. • Phase 1 (results will be discussed today)

• Collection of quantitative data outlining patient demographics.

• Phase 2

• Focus group with SW

• Patient telephone survey

Phase 1

Service has been running for 6 months, over 100 referrals (n=106).

Demographics • 76% referrals come from inpatients

• 46-65 year olds (57%) and 25-45yo (24%).

• 42% born overseas

• The reason for referral is predominantly financial hardship.

Reason for referral53%

14% 12%6% 6% 6%

2% 1%0%

10%

20%

30%

40%

50%

60%

Of those referred, 29% did not

have a current income.

• 41% of people without an income, had dependents.

Phase 1 results

32

26

2

3

3

2

2

1

1

1

0 5 10 15 20 25 30 35

No current income

Newstart

NS Incapacitated

Aged Pension

Parenting Payment

DSP

Youth Allowance

Carers Payment

Carers Allowance

Family Tax benefit

Inco

me

Current income

38%

62%

Percentage of patients with dependent.

Yes No

Overall, 38% of patients referred to the service had dependents.

Interventions provided by CLO and SW

1) new claims

2) Information clarifying application status and eligibility was second.

3) Support to restart payments and fulfil mutual obligations

Phase 1 results

Case study – ‘Andee’

• 44yo man, transferred from another hospital to WH, after a stroke.

• Prior to hospitalisation, was in prison. Paroled while in hospital.

• English was 2nd language

• Psychosocial assessment identified:• Homeless, unable to live with wife and 2 young children (6yo and 9yo)

• Required interpreter for complex health and financial information

• No current income [working prior to arrest]

• No known bank account

• No identification

• Not able to access housing services, as no income.

Social Worker referred to Centrelink Liaison Officer who• Met with patient and ex wife with interpreter

• Discovered old CRN and linked bank account.

• Facilitated Newstart incapacitated income.

• The Centrelink service facilitated discharge and supported An’s reintegration.

Case Study – Rachel

• Admitted after a stroke which impacted her memory.

• Next of kin died suddenly while an inpatient, no other supports.

• Living in rental accomodation

• Unable to recall place of employment, entitlements or income.

• Social work worked with the CLO to facilitate• Face to face meeting

• Application for Sickness Allowance

• Assisted to access necessary documentation

• CLO assistance was required to facilitate payment which essentially facilitated discharge and stable housing.

Where to from here

• Phase 2 of the project which will include patient and clinician consultation.

• Advocacy for extension of the partnership and a sustainable model

• Continued focus on responding to patient’s psychosocial need through

partnerships with key services and organisations in the West.

We would like to acknowledge Rosemary Madden’s (Centrelink Liaison Officer) contribution and commitment to this partnership.

References

1. Ahnquist, J., Fredlund, P., & Wamala, S. P. (2007). Is cumulative exposure to economic hardships more hazardous to women's health than men's? A 16-year follow-up study of the Swedish survey of living conditions. Journal of Epidemiology and Community Health, 61(4), 331. doi:http://ezproxy.wh.org.au:2095/10.1136/jech.2006.049395

2. McGregor MJ, Reid RJ, Schulzer M, Fitzgerald JM, Levy AR, Cox MB. (2006) Socioeconomic status and hospital utilization among younger adult pneumonia admissions at a Canadian hospital. BMC Health Serv Res. 6:152. Published 2006 Nov 25. doi:10.1186/1472-6963-6-152

3. Hall G., Boddy J., Chenoweth L., & Davie K. (2012) Mutual Benefits: Developing Relational Service Approaches Within Centrelink, Australian Social Work, 65:1, 87-103, DOI: 10.1080/0312407X.2011.594956

4. Cuesta-Briand B, Saggers S, McManus A. (2014) “It still leaves me sixty dollars out of pocket”: experiences of diabetes medical care among low-income earners in Perth. Australian Journal Of Primary Health. 20(2):143-150. doi:10.1071/PY12096.

5. Department of Health and Human Services(DHHS) (2014) Australian Government. Centrelink payment statistics https://www.humanservices.gov.au/organisations/about-us/statistical-information-and-data/centrelink-payment-statistics#a1. [cited 25th March 2019; Updated 5th July 2018]

6. Sofaer S, Qualitative research methods (2002) International Journal for Quality in Health Care, Volume 14, Issue 4, Pages 329–336, https://doi.org/10.1093/intqhc/14.4.329

7. Regenstein, M., Trott, J., Williamson, A., & Theiss, J. (2018). Addressing social determinants of health through medical-legal partnerships. Health Affairs, 37(3), 378-385,385A. doi:http://dx.doi.org.ezproxy.lib.monash.edu.au/10.1377/hlthaff.2017.1264

8. Hajkowicz S., Mason C., & Spinks A. (2013) A Decision Model for Targeting Social Welfare Services: A Case Study of Intensive Customer Support, Administration in Social Work, 37:3, 297-311, DOI: 10.1080/03643107.2012.687705

9. Taylor, L. A., Tan, A. X., Coyle, C. E., Ndumele, C., Rogan, E., Canavan, M., Bradley, E. H. (2016). Leveraging the social determinants of health: What works? PLoS One, 11(8) doi:http://ezproxy.wh.org.au:2095/10.1371/journal.pone.0160217

10. Zhou, N. (2018) Centrelink automation hurting Australia's most vulnerable – Anglicare. [Internet] The Guardian. [cited Mar 2019; updated 2019] Accessed via https://www.theguardian.com/australia-news/2018/jun/25/centrelink-automation-hurting-australias-most-vulnerable-anglicare