Caring for Infants in Out-of-Home Care in New South Wales: Carers' Perspectives

This report presents the findings of an online survey and individual interviews which explored the experiences of carers providing out-of-home care to infants in New South Wales. While there is increasing research related to the care of children and young people requiring OOHC, there is comparatively less specifically related to the care of infants. Survey data was collected from 142 carers in NSW providing OOHC to infants, and 13 individual interviews were conducted to gain insight to their experiences

An exploration of the self-care practices of foster carers in Australia

Practising self-care is vital for foster carers to cope with the stresses of the caring role, provide the best care possible and continue in their task. This current study contributes to emerging research on the self-care practices of foster carers in Australia and worldwide. It used an exploratory design, surveying 148 foster carers about their self-care and conducting individual, semi-structured interviews enabling nine of them to elaborate on their self-care experiences. The results indicate that while the participants sometimes engage in self-care and value it as a way of maintaining their wellbeing and increasing their caregiving capacity, they face several barriers to doing this. These include the multiple responsibilities of the foster carer role, children’s commitments, employment and finances. Facilitators of self-care include social and family support, contact with other carers and carer respite. Foster care agencies and the out-of-home care system should aim to meet the self-care needs of carers by providing increased support, resources and education

Australian foster carers' views and concerns regarding maternal drug use and the safety of breastmilk

Parental substance misuse and mental health issues are major factors associated with infant placement into out-of-home care. Such placements may result in disruption and/or cessation of breastfeeding. Provision of breastmilk to infants in out-of-home care (OOHC) is desirable in terms of infant health and development, and also in supporting maternal caregiving. However, little is known about how breastfeeding is supported for infants in out-of-home care. This study used an online survey to explore the facilitation of breastfeeding in the context of OOHC and foster carers’ management of expressed breastmilk (EBM). Foster carers were generally open to the idea of maternal breastfeeding and infants in their care receiving EBM from their mothers. However, the majority of respondents expressed concern regarding the safety of EBM for infant consumption due to the possibility of harmful substances in the milk. Concerns regarding the safety of handling EBM were also prevalent. These concerns caused foster carers to discard EBM. Findings suggest foster carers’ may lack knowledge related to maternal substance use and breastmilk. Better integration between health care and social service systems, where the voices of mothers, foster carers and child protection workers are heard, is necessary to develop solutions enabling infants living in OOHC access to their mother’s breastmilk

Does customised care improve satisfaction and positively enable parents in sustained home visiting for mothers and children experiencing adversity?

Background: The Maternal Early Childhood Sustained Home-visiting program (MECSH) is a structured nurse-delivered program designed to address health inequities experienced by families experiencing significant adversity. There is strong evidence for the effectiveness of this program, but limited research exploring the practice and process elements that are core to positive parent outcomes. This study aimed to examine the relationship between customised care related to the mother’s risk factors and parent satisfaction and enablement in the delivery of a MECSH-based program. Methods: A cross-sectional study design was used. Program delivery data collected as part of a large randomised controlled trial of a MECSH-based sustained nurse home visiting program in Australia (right@home) were analysed. This study used the data collected from the intervention arm in the trial (n = 352 women). Parent satisfaction was measured at child age 24 months using the modified short-form Patient Satisfaction Questionnaire. Parent enablement was measured at child age 24 months by a modified Parent Enablement Index. Customised care was defined as appropriate provision of care content in response to four maternal risks: smoking, mental health, domestic violence and alcohol and drugs. Logistic analysis was performed to assess the impact of customised care on parent satisfaction and enablement while adjusting for covariates such as sociodemographic factors. A significance level of 95% was applied for analysis. Results: Our results indicated high levels of satisfaction with the care provided and positive enablement. There were several sociodemographic factors associated with satisfaction and enablement, such as language spoken at home and employment experience. The mothers who received customised care in response to mental health risk and domestic violence had significantly greater satisfaction with the care provided and experienced an increase in enablement compared to those who did not receive such care. Conclusion: This study contributes to the existing body of empirical research that examines the relationship between care processes and client outcomes in the delivery of home visiting services. It is essential for the sustained nurse home visiting service model to be flexible enough to cater for variations according to family circumstances and needs while maintaining a core of evidence-based practice

Variations in sustained home visiting care for mothers and children experiencing adversity

Objective: This study aimed to examine the variations in care received by mothers and families within a sustained home visiting program. We sought to identify the extent to which there were variations in home visiting care in response to the program schedule and families’ risk factors. Design and sample: Data collected within the right@home program, a randomized controlled trial (RCT) for a sustained nurse home visiting intervention in Australia, were analyzed. A total of 352 women comprised the intervention arm of the trial. Measurements: Visit content in the home visiting program, sociodemographic data, and families’ risk factors were used for analysis. Results: Our results confirmed that the majority of women received scheduled content on time or within an acceptable timeframe, except for the sleeping program. Women with identified risks were significantly more likely to receive content related to those risks than women without those risks (smoking: Odds Ratio [OR] = 15.39 [95%CI 3.7– 64.7], mental health: OR = 15.04 [1.8–124.0], domestic violence: OR = 4.07 [2.0–8.3], and drugs and alcohol: OR = 1.81 [1.1–3.0]). Conclusions: The right@home program had high compliance with the scheduled content. Capacity development in responding to mothers with the risk of domestic violence and drugs and alcohol is recommended. Further research is required to explore the relationship between variations in care and critical outcomes

Identification of families in need of support : correlates of adverse childhood experiences in the right@home sustained nurse home visiting program

Background Little is known about the efficacy of pregnancy screening tools using non-sensitive sociodemographic questions to identify the possible presence of as yet undiagnosed disease in individuals and later adverse childhood events disclosure. Objectives The study aims were to: 1) record the prevalence of risk disclosed by families during receipt of a sustained nurse home visiting program; and 2) explore patterns of relationships between the disclosed risks for their child having adverse experiences and the antenatal screening tool, which used non-sensitive demographic questions. Design Retrospective, observational study. Participants and methods Data about the participants in the intervention arm of the Australian right@home trial, which is scaffolded on the Maternal Early Childhood Sustained Home-visiting model, collected between 2013 and 2017 were used. Screening data from the 10-item antenatal survey of non-sensitive demographic risk factors and disclosed risks recorded by the nurse in audited case files during the subsequent 2 year intervention were examined (n = 348). Prevalence of disclosed risks for their child having adverse experiences were analysed in 2019 using multiple response frequencies. Phi correlations were conducted to test associations between screening factors and disclosed risks. Results Among the 348 intervention participants whose files were audited, 300 were noted by nurses to have disclosed risks during the intervention, with an average of four disclosures. The most prevalent maternal disclosures were depression or anxiety (57.8%). Mental health issues were the most prevalent partner and family disclosures. Screening tool questions on maternal smoking in pregnancy, not living with another adult, poverty and self-reporting anxious mood were significantly associated with a number of disclosed risks for their child having adverse experiences. Conclusions These findings suggest that a non-sensitive sociodemographic screening tool may help to identify families at higher risk for adverse childhood experiences for whom support from a sustained nurse home visiting program may be beneficial

Australian foster carers' views of supporting maternal breastfeeding and attachment in out-of-home care

Background: Breastfeeding supports infant health, growth and development, and promotes maternal attachment and sensitive caregiving. Maternal separation due to child protection concerns can result in termination of breastfeeding with associated adverse outcomes. How to preserve breastfeeding when infants are placed in out-of-home care is an issue of concern. Objective: To consider the views of foster carers towards provision of breastmilk and breastfeeding for infants in their care. Participants and setting: Foster carers (including kinship carers), in Australia, who had cared for at least one infant in the years 2013–2018 completed an online survey. Methods: Foster carer's views were collected via an online survey and subjected to content analysis. Results: Respondents (n = 184) expressed mixed views about; mothers breastfeeding during contact visits, increased frequency of contact visits for breastfeeding; and the provision of expressed breastmilk to infants in their care. Concerns were raised about the safety of breastmilk from mothers abusing substances and the value of breastfeeding if reunification was not possible. Because of these concerns, some carers discarded expressed breastmilk and resisted frequent contact. Conversely, breastfeeding was also viewed positively as a way for mothers to maintain attachment with their infants, where reunification of the mother-infant dyad was the goal. Conclusions: This study highlights foster carers' view of breastfeeding as a facilitator of attachment between mothers and their infants. While fosters carers were largely supportive of breastfeeding as a way to improve infant health and facilitate mother-infant attachment, they held concerns regarding the safety of breastmilk supplied to them

The general health of a cohort of Aboriginal children (0-7 years) in Sydney

In both urban and rural locations, the health of Indigenous children is worse than that of non-Indigenous Australian children. General data on the health of urban Indigenous children are scarce. Here we describe reports by parents about specific common childhood illnesses in urban Aboriginal children and parental responses to these illnesses

Hippocampal volume in older adults at risk of cognitive decline : the role of sleep, vascular risk, and depression

Background and Objectives: Decreased hippocampal volume in older adults is associated with neurodegenerative and psychiatric diseases. Several modifiable risk factors have been associated with the size of this structure, however the relative contribution of these factors to hippocampal atrophy is unclear. This study aimed to examine the relationship between modifiable risk factors and hippocampal volume in older adults at risk of cognitive decline. Methods: Two hundred and eighteen participants (mean age = 67.3 years, MMSE = 28.6) with mood and/or memory complaints underwent clinical and neuropsychological assessment, and magnetic resonance imaging. Measures of depression, global cognitive functioning, exercise, vascular health, cognitive reserve, sleep, and memory were collected. Hippocampal volumes were derived using image segmentation as implemented by FMRIB Software Library. Results: Smaller hippocampal volumes were strongly associated with poorer verbal learning and memory as well as diagnoses of either multiple or amnestic mild cognitive impairment. Based on univariate correlations, multivariable regressions were performed (controlling for age and total intracranial volume) to determine which modifiable risk factors were associated with hippocampal volume. For the left hippocampus, poor sleep efficiency and greater than five years untreated depressive illness remained significant predictors. For the right hippocampus, diabetes and low diastolic blood pressure remained significant predictors. Conclusions: Although their contribution is small, lower sleep efficiency, low blood pressure, diabetes, and untreated depression are associated with reduced hippocampal volumes. Studies exploring the impact of early intervention for these risk factors on hippocampal integrity are warranted

Clinical and cognitive correlates of structural hippocampal change in "at-risk" older adults

With estimates of dementia expected to rise over the coming decades, there is interest in understanding the factors associated with promoting neuroprotection and limiting neurodegeneration. In this study, we examined the change in the volume of the hippocampus over a 2-month period in 34 older people ‘‘at risk’’ of cognitive decline (mean age = 66.8 years, 38% male). Factors that were examined included cognitive reserve, neuropsychological functioning, depression as well as a lifestyle (cognitive training) intervention. The results showed that over a 2-month period, increases in hippocampal size were associated with having higher premorbid intellect, greater occupational attainment, superior memory, and higher levels of functioning. Conversely, depression and disability were associated with decreases in hippocampal volume. Cognitive training was not associated with changes in hippocampal volume. These findings suggest that factors associated with cognitive reserve, cognition and depression may play an integral pathophysiological role in determining hippocampal volumes in ‘‘at-risk’’ older adults