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

Community volunteer support for families with young children: Protocol for the volunteer family connect randomized controlled trial

Background: Use of community volunteers to support vulnerable families is a widely employed strategy with a long history. However, there has been minimal formal scientific investigation into the effectiveness of volunteer home visiting programs for families. There is also a need for research examining whether volunteer home visiting leads to improved outcomes for volunteers. Objective: The objective of this paper is to describe the research protocol for a pragmatic randomized controlled trial (RCT) of the Volunteer Family Connect intervention, a volunteer home visiting program designed to support families of young children who experience social isolation or a lack of parenting confidence and skills. The project is being conducted in partnership with 3 leading not-for-profit organizations, designed to contribute to the body of evidence that informs decisions about appropriate family support services according to the level of need. It is the first study to examine outcomes for both the families and the volunteers who deliver the service. Methods: The RCT is being conducted in 7 sites across Australia. We aim to recruit 300 families to the study: 150 control (services as usual) and 150 intervention (services as usual + volunteer home visiting) families. Intervention families will receive the service for 3-12 months according to their needs, and all participants will complete 6 data collection points over 15 months. A minimum of 80 volunteers will also be recruited, along with a matched community comparison group. The volunteers will complete 3 data collection points over 12 months. Primary outcomes include community connectedness and parenting competence. Secondary outcomes include parent physical and mental health; general parent well-being; parent empowerment; the child-parent relationship; sustainability of family routines; child immunization; child nutrition or breastfeeding; number of accidental injury reports; and volunteer health, well-being, and community connectedness. Results: This effectiveness trial was funded in 2016, and we aim to complete data collection by the end of 2018. The first results are expected to be submitted early in 2019. Conclusions: There is a need to rigorously assess volunteer home visiting and whether it has a unique and important role on the service landscape, complementary to professional services. This research is the first trial of a volunteer home visiting program to be conducted in Australia and one of the largest of its kind worldwide

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

Measuring oral health during pregnancy: Sensitivity and specificity of a maternal oral screening (MOS) tool

Background: Being the parent of a severely injured child involves many stressors throughout the trauma journey. Internationally, little is known about the experiences or levels of emotional distress, parenting stress, quality of life, and resilience for parents of injured children. The aim of this study is to investigate the experiences, unmet needs and outcomes of parents of physically injured children 0–12 years over the 2 year period following injury. Methods/design: This is a prospective longitudinal study using an embedded mixed methods design. This design has a primary qualitative strand which incorporates supplementary quantitative data on child quality of life, and parental quality of life, parenting stress, emotional distress, and resilience at four time points; the acute hospitalisation phase, and at 6, 12 and 24 months following injury. The primary sample are parents of injured children 0–12 years hospitalised in the Australian states of New South Wales, Queensland, Victoria and South Australia. Primary data sources are child and parent demographic data; survey data; and semi-structured interview data across a 24 month period. Discussion: This study aims to address the existing gap in knowledge on the experiences and unmet support needs of parents in the 2 years following child injury to provide guidance for care provision for these families. There is a lack of evidence-based recommendations for supporting parents and families of injured children and strengthening their capacity to address the challenges they face

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

Hippocampal volume in older persons ‘at risk’ of dementia: Relationships with cognitive function and modifiable risk factors

With Australia’s ageing population and the increasing number of people diagnosed with dementia, understanding the factors that may delay or prevent cognitive decline and dementia is increasingly important. This thesis encompasses various methodologies including magnetic resonance imaging, detailed clinical and neuropsychological assessment and a cognitive intervention to assess participant’s levels of cognition, modifiable risk factors and hippocampal structure. The hippocampus, an area of the brain often affected early in the progress of disease, is a key area of interest in this work due to its capacity to undergo neurogenesis. This thesis examines the relationships between volumetric changes of the hippocampus in relation to ageing, cognitive decline and lifestyle factors in elderly persons ‘at risk’ of dementia. Results showed that smaller hippocampal volumes were associated with poorer sleep efficiency, diabetes, diastolic blood pressure and longer-term untreated depression. Further investigation into the effects of a cognitive training program found that hippocampal volume change over the 2-month intervention program was associated with participant’s levels of general functioning, global cognition, depressive symptom burden and measures of cognitive reserve. The findings within this thesis demonstrate that a wide range of modifiable risk factors are associated with hippocampal volume and highlight that through the modification of risk and protective factors, hippocampal neurogenic and neuroplastic processes may be altered. Further research utilising other imaging modalities may give insights into the pathophysiological mechanisms by which these factors operate, and may provide a deeper understanding of how these factors contribute to neurogenesis or neurodegeneration. At the primary prevention level, further prospective studies examining these modifiable risk factors in mid-life may help to generate targeted early intervention programs for cognitive decline and dementia

Child participation and family engagement with early childhood education and care services in disadvantaged Australian communities

To support national policy initiatives in early childhood education and to determine reasons for low enrolment in services from families in disadvantaged areas, the authors investigated the views and practices of 101 families from disadvantaged communities. Families with a child aged 3-5 years were recruited from urban, rural and remote areas of NSW, Australia. Researchers interviewed primary carers in their home or other preferred location to explore barriers and facilitators to participate in early childhood education and care services. In addition to asking parents directly about barriers and facilitators, the interview included a questionnaire and investigated family engagement in and response to services using questions guided by Ecocultural theory. The relationships between service enrolment and family engagement with other family variables were investigated. Families emphasised quality above cost as the primary factor influencing participation in services. Child enrolment in an early childhood service and higher levels of family engagement with the service were significantly more likely when families perceived childcare to be safe, when there were high levels of family connectedness, and when families were involved in other professionals (e.g. social welfare). The findings highlight the importance of taking a community- and family-focused approach to understand more fully the barriers and facilitators to family involvement in early childhood services.28 page(s