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There is a growing recognition that the integration of health systems will benefit children in out-of-home care (OOHC), especially those who have experienced trauma. This paper examines the adaptation of existing health systems and the persistent barriers between rural health and child protection programs. It focuses on health systems integration for children aged 0–6 years in kinship care and their siblings.

The study applied a multi-methods qualitative approach involving individual interviews and focus groups with project members from operational or strategic reference groups, child protection personnel and the kinship carer program. We also reviewed documentary evidence.

We found evidence that health clinicians and child protection practitioners adapted and adjusted services as they collaboratively worked together to improve care delivery to children in kinship care. Yet, despite successful adaptations to systems and the appointment of a health navigator, systemic barriers remain. These include service and staff shortages in rural Australia, complications around information sharing, authority and power dynamics and siloed operations. Such barriers prevent better-integrated health systems and ultimately impair health outcomes for children in kinship care.

This paper contributes to knowledge and practice to improve the integration of child protection and healthcare services in Australian OOHC. It provides valuable insights into the challenges and successes of health systems integration, highlighting the need for continued collaborative effort to create effective, place-based models of care that benefit these children and their carers.