Child and Family Hub update 

If the link above does not work, try copying the link below into your web browser:
https://redcap.mcri.edu.au/surveys/?s=8XMA939JTM94R49F&dist_loc=5

Please feel free to nominate any individual or organisation you think may be interested in this project through this survey contact form. There is also an opportunity to do so at the end of the survey.

We encourage you to consider lending your expertise to this really important work and thank you for the difference you are making to improve the lives of children who experience adversity, today and in the future.

What's the update
at the Marrickville (NSW) Child and Family Hub?

The Marrickville Hub have completed their 12-month data collection phase. They have started the final interviews for qualitative analysis for caregivers and interviews with service navigators will begin this month, with expected completion of all surveys by the end of November. 

Latest news from the eHub

The Child and Family eHub pilot site has gone into production. Some additional work is underway with clinicians to ensure that the service results brought back from the Infoxchange database, which the eHub connects to, brings back the anticipated results for caregivers. Once the Infoxchange database is updated from this review, recruitment of caregivers will commence to evaluate the eHub pilot across the three trial sites of Marrickville and Fairfield in NSW and Wyndham Vale in Victoria. We anticipate starting recruitment in October and plan to recruit 90 caregivers of children aged birth to 12 years from each of the trial sites. The eHub pilot site will be evaluated using a baseline and 6-month REDCap survey and meta data from the eHub site usage.

Achievements

Webinar Replays

The Common Approach is a universal approach for quality conversations with children and families around all aspects of wellbeing.  All four practices of the Common Approach - Holistic, child-centred, strengths-based, working in partnership - build positive trusting and responsive relationships between practitioners and families.

Key to the approach is acknowledging that child and family are experts in their own lives and empowering to take a lead role in their care and wellbeing.

Featured speaker

Dr Rebecca Goodhue
Lead, Capacity Building ARACY 
Starting her career as a Paediatric Speech-Language Pathologist, Rebecca worked for 15 years in early childhood centres, schools, homes, and sometimes in parks and playgrounds. After establishing a private practice in New Zealand, completing her PhD, and leading a Speech-Language Pathology team in rural, remote Western Australia, Rebecca moved into the policy, research and knowledge mobilisation space. In her current role, she has developed holistic wellbeing training which has received international uptake, managed the development of a national strategy regarding early language and literacy and is deeply involved in the evidence surrounding the wellbeing of children and young people.

Aims of Study

To describe, in two Australian community health services:

(1) the number of adversities experienced by caregivers,
(2) practitioner identification of caregivers experiencing adversity,
(3) practitioner response to caregivers experiencing adversity, and
(4) caregiver uptake of referrals.

Method

Survey of caregivers of children aged 0–8 years attending community health services in Victoria and New South Wales (NSW).

Analysis described frequencies of caregiver self-reported:

(1) experiences of adversity,
(2) practitioner identification of adversity,
(3) practitioner response to adversity, and
(4) referral uptake.

Analyses were sub-grouped by:

o three adversity domains

• inside the home (included challenges with social support, finances, housing and employment)
• outside the home (included challenges with family physical health or disability, mental health, parenting, relationships, family violence, alcohol and drugs, child neglect and child abuse)
• societal (included challenges with visas or migration, interaction with the criminal justice system, and discrimination or harassment)

o site (NSW; VIC)

Key Findings

349 caregivers (Victoria: n = 234; NSW: n = 115) completed the survey

• 88% reported experiencing one or more family adversities including childhood maltreatment, parental mental illness, family violence, socio-economic deprivation, bullying and discrimination
• The median number of adversities was 4 (ranged from 2 to 6)
• 43% of participants were directly asked about or discussed an adversity with a practitioner in the previous 6 months (Victoria: 30%; NSW: 68%)

o Amongst caregivers experiencing adversity:

• 30% received direct support (Victoria: 23%; NSW: 43%)
• 14% received a referral (Victoria: 10%; NSW: 22%) for at least one adversity
• Overall, 74% of caregivers accepted referrals when extended.

Conclusion

The needs of Australian families experiencing high rates of adversity are not systematically identified nor responded to in community health services. This leaves significant scope for reform and enhancement of service responses to families experiencing adversity.

These findings highlight the need to invest in models of care that improve the identification of, and response to, family adversity in community health services. Integrated health and social care Hubs have the potential to overcome some of the known barriers to identifying and responding to adversity. Hubs aim to provide a “one stop shop” and holistic multi-disciplinary care for families with complex health and social needs, with potential for more efficient arrangement and use of service resources than presently exists.¹

Next Steps

The same cohort of families are part of a broader research project that followed them over 12 months.

The two community health services in this study have now implemented Hub models of care. In both sites, Hubs involve co-location and clinical integration of interdisciplinary staff. The Hubs are also providing clearer service linkages and referral pathways for both families and practitioners. Both Hubs have also implemented a wellbeing coordinator role that involves care navigation and social prescribing (i.e. linkages to social and/or community services).

In addition, a health-justice partnership between the community health service and local legal services has been piloted at both Hubs to address the gap around identification or, and response to legal needs detected in this study. These Hubs may offer a non-stigmatizing “front door” to a range of holistic services for families experiencing adversity.

¹Elrod JK, Fortenberry JL Jr. The hub-and-spoke organization design: an avenue for serving patients well. BMC Health Serv Res. (2017) 17:457. doi: 10.1186/s12913-017-2341-x

Meet our team

Introducing Tamara Morris

Tell us about yourself...

My name is Tammy (Tamara) Morris. I am a paediatrician from South Africa, recently arrived in Sydney. I work as a doctor in the Community Paediatrics Team in Sydney Local Health District (SLHD), leading our research team, a component of which is involved in the Marrickville CRE.  My clinical role in the district includes working with priority populations with intellectual disability and providing  youth health services. I am also a research associate at UNSW where I have been working on the integrated GP-Paediatrician model of care, Strengthening Care for Children (SC4C)  NHMRC partnership grant, and now an online version called SUSTAIN reaching beyond urban to regional, rural and remote settings.

What is something people don't know about you? 

I am fascinated by diverse cultures, I love the multicultural aspects of the areas where I live and work in Sydney and I enjoy travelling to new places. I lived in Hong Kong prior to coming to Sydney and had wonderful exposure to diverse settings in Asia. I loved the exposure to African culture that was part of my life and work in South Africa where I grew up and lived for most of my life.

What do you hope the CRE will achieve? 

I am optimistic that the CRE will illustrate how an interdisciplinary approach may  help to prevent or intervene early in childhood adversity, by identifying families in need and directing them to the services they need in a timely manner.

What are you currently working on in the CRE?

As research lead I oversee the activities of the Marrickville CRE. I have a wonderful team who are making great strides in obtaining the data we need to demonstrate the efficacy of the model. COVID was a significant barrier at our site, but this year our team has embedded themselves in the fabric of the Marrickville Community Health centre, and their presence has resulted in more understanding and engagement in the model by the staff on the ground at the health centre.

What inspires your work? 

I have always been interested in helping children, young people and their families access health services in an equitable manner. I especially enjoy working with families from priority populations, ensuring that they do not get left behind when it comes to having their needs met over and above health. I place great value on collaborating with other disciplines and agencies to address inequities for children, youth and their families.  

Recent publications

1. Hall T., Constable L., Loveday S., Honisett S., Schreurs N., Goldfeld S., Loftus H., Jones R., Reupert A., Yap M., Woolfenden S., Montgomery A., Dalziel K., Bailey C., Pringle G., Fisher J., Forell S., Eapen V., Haslam R., Sanci L., Eastwood J., Hiscock H., 2023. 'Identifying and responding to family adversity in Australian community and primary health settings: a multi-site cross sectional study', Frontiers in Public Health, vol.11.
   doi: https://doi.org/10.3389/fpubh.2023.1147721
2. Baek Y., Ademi Z., Tran T., Owen A., Nguyen T., Luchters S., Hipgrave D.,Hanieh S., Tran T., Tran H., Biggs B., Fisher J., 2023. 'Promoting early childhood development in Viet Nam: cost-effectiveness analysis alongside a cluster-randomised trial', Lancet Global Health, August;11(8):1269-1276.
   doi: https://doi.org/10.1016/S2214-109X(23)00271-1
3. Baek Y., Ademi Z., Fisher J., Tran T., Owen A., 2023. 'Equity in Economic Evaluations of Early Childhood Development Interventions in Low-and Middle-Income Countries: Scoping Review', Matern Child Health J, Jun;27(6):1009-1029. doi: 10.1007/s10995-023-03650-3. 
4. Fisher J., Tran T., Tran H., Luchters S., Hipgrave D., Nguyen H., Tran T., Hanieh S., Simpson J., Biggs B., Tran T., 2023. 'Structured, multicomponent, community-based programme for women's health and infant health and development in rural Vietnam: a parallel-group cluster randomised controlled trial', Lancet Child Adolesc Health, May;7(5):311-325. doi: https://doi.org/10.1016/S2352-4642(23)00032-9
5. Lin PI., Eapen V., 2023. 'New insights into the link between childhood adversity and epigenetic changes',[Editorial] Lancet Child Adolesc Health, Aug;7(8): 520-521.
   doi: https://doi.org/10.1016/S2352-4642(23)00106-2

For a full list of publications, please visit our website!