Hospital to Home
Coordinated discharge support
For people leaving hospital who need stronger connections with disability, health, community or NDIS pathways - with or without an existing NDIS plan.
Learn moreProfessionals and Partners
Working together to help support take hold
We recognise the important work carried out every day by hospital teams, mental health services, Local Area Coordinators, housing and homelessness organisations, justice services, allied health professionals and community organisations.
Professionals are often supporting people through complex circumstances, limited timeframes and systems that do not always connect easily. Their knowledge, persistence and existing relationships with the person are an important part of building a stable pathway forward.
Marra Bridge works collaboratively with professionals and community organisations when a person has disability or complex psychosocial needs, very limited support around them, or needs that cross several systems.
Building on the work already underway
We begin by understanding what has already been arranged, which organisations are involved and where the current gap remains.
Marra Bridge can contribute additional coordination, follow-through and connection between disability, health, housing, justice, community and NDIS pathways.
The approach will depend on the person's circumstances and may include an initial consultation, a shared case discussion, transition planning, NDIS access assistance or coordination of agreed next steps.
When it may be useful to contact us
- A person has disability or complex psychosocial needs and very limited support around them.
- Several services are involved and stronger coordination between systems may help.
- Hospital discharge is approaching and community connections are still being developed.
- The person may be eligible for the NDIS and needs help understanding the process or gathering evidence.
- An NDIS application has been declined and the person needs help understanding possible next steps.
- The person has an NDIS plan but is struggling to establish or maintain appropriate supports.
- Disability, health, housing, justice, income and community needs are overlapping.
- The person is leaving hospital, correctional settings, school, family care or another significant life situation.
- A referral has been made, but coordination has not yet taken hold.
- A professional would like to discuss which Marra Bridge pathway may be relevant.
How we may work with your team
Every situation is different. We will begin by understanding the person's circumstances, the work already underway and the outcome everyone is working towards. From there, we can agree on the most useful contribution Marra Bridge may make.
- An initial professional or de-identified consultation.
- Discussion about the person's circumstances and current support network.
- Shared case discussions where appropriate.
- Coordination of agreed actions across organisations.
- NDIS Access and Evidence Support.
- Hospital to Home planning and follow-through.
- Correctional transition support.
- Life-transition support.
- Connections with disability, mainstream and community pathways.
- Updates and communication with the referring professional where appropriate.
Marra Bridge pathways at a glance
NDIS Access & Evidence Support
No cost, subject to capacity
Support to understand NDIS access, gather evidence, prepare an application, reapply, or consider next steps following a decision.
Learn moreCorrectional Transition Support
Non-judgemental, trauma-informed
For people preparing to leave correctional settings where disability, psychosocial, community and mainstream pathways need to be connected.
Learn moreLife Transition Support
Support through significant change
For turning 18, leaving school, moving home, or changes in capacity or in family and informal support.
Learn moreCase Management
No cost, subject to capacity
For people with disability or complex psychosocial needs who have very limited informal, community or formal support around them and are at risk of falling through gaps between systems. This is not a general case-management service for everyone.
Learn moreConsent, privacy and respectful communication
We value the person's choice, privacy and involvement in decisions about their support.
Wherever possible, we encourage professionals to discuss the proposed referral with the person and confirm that they are comfortable with Marra Bridge making contact.
We understand that some situations involve a guardian, nominee or authorised representative, and that there may also be circumstances where a professional would first like to discuss a possible pathway before sharing identifying information.
Professionals are welcome to contact Marra Bridge for a general or de-identified discussion. Together, we can consider the most appropriate next step and what consent or authority is required before personal information is shared or direct contact occurs.
Information is handled carefully and in accordance with the person's consent, applicable authority and Marra Bridge's privacy obligations. See our Privacy page for more detail.
What professionals can expect
- A respectful and collaborative response.
- Recognition of the work and information already gathered.
- Clear communication about the next practical step.
- Agreed roles and actions where several organisations are involved.
- Careful handling of personal and sensitive information.
- Interpreters and communication supports arranged for the person you are referring, on request.
- Honest communication about Marra Bridge's current capacity.
- A response within 2 business days.
- Clear information about relevant pathways and eligibility.
Marra Bridge can support preparation, coordination, applications and follow-up. Decisions about NDIS access, funding, housing, equipment and external services remain with the responsible agency or organisation.
Let's begin with a conversation
We appreciate the work your team is already doing and would welcome the opportunity to learn more about your organisation, the people you support and where our roles may connect.
Whether you have a particular person in mind or would simply like to understand Marra Bridge's pathways, you are welcome to contact us for an initial conversation. If another person or team would be better placed for us to connect with, we would be grateful if you could point us in the right direction.
Phone: 0493 114 104 - Email: info@marrabridge.com.au