Kings Cross Youth At Risk Project
South East Sydney Illawarra Area Health Service
Abstract
Kings Cross attracts significant numbers of young people who are at risk of becoming entrenched in a high risk lifestyle involving long term homelessness; substance abuse issues; mental health; violence; problematic sex work; criminal activity; and self harm.
The Kings Cross Youth at Risk Pilot Project was established in 2005 at Kirketon Road Centre as a coordinated interagency early intervention strategy for young people. Data compiled from the pilot demonstrates that by intervening early these young people and their dependants can be protected from the development of long term health issues and dependence on services.
Other positive outcomes of the project include improved referral pathways and collaboration between SESIH, other government departments and community based service providers.
Aim
The project aims to improve the immediate and long-term outcomes for at risk young people in Kings Cross and improve collaboration between health and other services.
Nature of the Problem
Kings Cross attracts significant numbers of young people at risk. A number of health and other organisations operate in the area and provide a range of healthcare, accommodation, support and counselling as well as outreach and referral services. There are opportunities for better coordination of these services, particularly in increasing collaboration between existing service providers in order to streamline services, reduce duplication, enhance access and improve outcomes for at risk young people and their dependants. The inherent risk of not improving service coordination is that young people at risk in the Kings Cross area may become part of the long-term homeless community and become long-term dependant users of health services.
Extent of the Problem
Young people in Kings Cross are subject to risk factors or life circumstances that seriously jeopardise their health and wellbeing. These include substance abuse, violence, criminal activity, self-harm, mental health issues, social isolation, homelessness and problematic sex work.
Young adults aged 18 to 24 have the highest prevalence of mental disorders (27%) of all age groups (ABS, 1998).
Of the estimated 100,000 homeless people in Australia more than one in three are young people aged 12-24 years. This is the largest proportion of the homeless population.
In a study of 1677 individuals it was found that 80% experienced long-term homelessness and 60% developed substance use problems. Most of this group of young people had tried to get out of homelessness but they did not have the long term support needed to help them stay out (Chamberlain and Johnson, 2008).
The project has assisted 369 young people in its first two years.
Strategic Importance
The project aligns to the NSW State Plan and the NSW Youth Action Plan and relates to the following Strategic Directions of relevant Health Plans.
NSW Health Plan:
- Make prevention everybody’s business
- Create better experiences for people using health services
- Strengthen Primary health and continuing care in the community
- Make smart choices about the costs and benefits of health and health support services.
SESIH Area Clinical Services Strategic Plan:
- Protect promote and maintain the health of and reduce health inequities between our diverse communities.
SESIH Population Health Plan:
- Health problems of homeless people minimised via working with clinical services and key partners.
Planning and Implementing Solutions
The Project has been piloted in the Kings Cross area since 2005. The project involves three key strategies:
- Coordination:
A Project Coordinator is based at the Kirketon Road Centre to work across 12 partner agencies to implement coordinated case management; joint service planning; data collection and administration of the project - Joint Outreach Sweeps:
Joint Outreach Sweeps are conducted at night by staff from partner agencies. In the first 12 months of the pilot sweeps were conducted monthly. Sweeps are now conducted on a quarterly basis as a snapshot. Surveys are completed with young people during the sweeps to gain data on the number of young people in the area; their age; where they have come from; and the range of risk factors faced by them. In the first 12 months of the project 248 young people participated in the survey (83% participation rate). Of these 112 young people reported living in unstable accommodation; 38 young people identified as sex workers and 53 young people reported involvement in drug related activities. - Brokerage:
Brokerage funding is available to partner agencies of the project to support at risk young people. This enables young people in emergency situations and after hours to access appropriate services to reduce their immediate risk. Brokerage packages are also available to support long term case plans managed by partner agencies. Brokerage enables access to services that are otherwise unavailable and supports sustainable long-term outcomes for young people with complex needs. During the first 2 years of the pilot 806 brokerage applications were approved and administered to 369 individuals. Key issues addressed through brokerage included: health and medical needs; accommodation; support for young people who were pregnant or parents; and transport out of area.
Outcomes and Evaluation
The project has provided evidence of enhanced access to appropriate services through early intervention, better referral pathways, reduced duplication of services, reduced ‘service surfing’ by young people, and improved cost effectiveness of services.
Data gathered on the number of young people in the area, the services they access and the issues they face has enabled evidence-based outreach planning for the future. Two data reports have been published on the project;
- Report on Brokerage Applications Administered through the Kings Cross youth At risk Project July 2005- July 2007 and
- Report on the Findings of the Kings Cross youth at risk Outreach Sweeps.
Updates to this data will be made annually to allow comparison over time.
Participating agencies are asked to complete quarterly evaluations of the Kings Cross Youth At Risk Project, agencies are asked to comment on the role of the coordinator, participation in the outreach coordination committee, sweeps and access to brokerage. To date all feedback has been positive.
Clients who have been assisted to move out of the area are monitored for return to the area through outreach and the outreach coordination committee.
Records are kept to indicate the number of clients returning to the Kings Cross area. To date only 2 individuals have returned.
Sustaining Change
The intersectoral nature of this project has required the development and maintenance of effective partnerships with stakeholders. This has been achieved through the project management structures of the Steering Committee and the Outreach Coordination Committee. Partnerships are working well between the 12 partner agencies and this has sustainable impacts on the relationships between health services in the area working with community based and other government service providers. Improved referral pathways that have resulted from the project will be maintained for the benefit of health clients. The collocation of this project within a health facility has had positive sustainable impacts on youth friendly service delivery.
Future Scope
The Kings Cross Youth At Risk Project has plans to develop targeted strategies to address the four key issues identified in the first two years: young people requiring support with health and medical needs; young people who are pregnant and parenting; young people in need of accommodation; and young people requiring transport out of area.
The project will also continue to collect data to measure ongoing impacts of the project on service delivery overtime.
The project plans to promote the Kings Cross youth at risk project as a model for coordination of services in other high needs communities.
References
- Australian Bureau of Statistics. (1998) Mental Health and Wellbeing: Profile of Adults, Australia. Canberra: ABS (4326.0)
- Chamberlain, C. Johnson, G & Theobald, J. (2008) Homeless in Melbourne: Confronting the Challenge. Centre for Applied Social Research, RMIT University.
- King Cross Community Solutions Steering Committee. (2004) Improved services for young people at risk in the Kings Cross area.
- Petersen, C and Janssen, C. (2007) - Report on Brokerage Administered through the Kings Cross Youth At Risk Project.
- Petersen, C and Janssen, C. (2007) - Report on the Findings of the Kings Cross youth at risk Outreach Sweeps.
Contact
Quality Collaborative Manager, Clinical Governance Unit
South Eastern Sydney Illawarra Area Health Service
Phone: 02 4253 4936
This project was entered in the 2008 NSW Health Awards, Strengthen Primary Health and Continuing Care in the Community category.
