Safeguarding children in primary health care

Safeguarding children from harm has, until recently, been driven primarily by social work practitioners. With current shifts in child care and protection practice and policy, combined with an overwhelming message of 'working together', primary health care professionals have an increasingly central part to play. There is a strong argument that cases of suspected child abuse and neglect should warrant the same level of urgent response as any potentially fatal childhood illness. This book provides an overview of the challenges primary health care professionals now face in recognising and responding to concerns about a child's safety from abuse and neglect. It provides practical accounts and perspectives from a range of frontline practitioners working with children, parents and carers, backed up by theoretical insights from leading academics in the field. Issues explored include: media coverage of child abuse and neglect cases, inter-professional collaboration, competing professional priorities and resources, practical workload decisions and personal experiences and anxieties. Safeguarding Children in Primary Health Care is a useful training and development resource for all primary health care practitioners, such as paediatricians, community nurses and midwives, community psychiatric nurses, health visitors, dentists, general practitioners and allied health professionals

Safeguarding children in primary health care : an introduction

More than 90 per cent of contact the public has with health services takes place in primary care. Accordingly, primary health care and child health are currently at the centre of WHO vision and policies (Horton 2008a; World Health Organization 2007a). Primary health care in general, but also particularly when aimed at children, is seen widely as being the most promising vehicle to address today's most pressing health concerns, such as health inequalities, cost-explosions or access to high quality care (Horton 2008b). Children in countries with a less developed primary health care system had poorer health and survival outcomes than countries with better developed systems (UNICEF 2007). Primary care professionals are very well-placed to monitor children's wellbeing and safety and to liaise with relevant agencies within and beyond primary care (Carter and Bannon 2002; HM Government 2006)

Case study

Aimed at emerging researchers, including those in developing countries, this book also addresses cutting edge and newly developing research methods, which will be of equal interest to more experienced researchers. Case study is a research design linked with mixed methods and qualitative approaches to research that enables a rich, in-depth exploration of the phenomena of interest within a recognisable boundary such as a person, community, institution or diagnostic group. As a design, it defines what will be studied more than how the phenomena will be studied. Case study research involves a detailed understanding of the complexities of a single case or multiple cases as they occur in the context of real life over time. Methods already discussed in this book, including observation/ethnography, interviews, surveys and clinical audits, are used in case study research. When considering the reason for using a case study design, Stake takes a qualitative, constructivist perspective, seeking to make sense of what is happening rather than applying statistical methods to identify causal factors. From this subjective standpoint, three types of case study can be considered; intrinsic, instrumental and collective

Building blocks for social accountability: A conceptual framework to guide medical schools

Background: This paper presents a conceptual framework developed from empirical evidence, to guide medical schools aspiring towards greater social accountability. Methods: Using a multiple case study approach, seventy-five staff, students, health sector representatives and community members, associated with four medical schools, participated in semi-structured interviews. Two schools were in Australia and two were in the Philippines. These schools were selected because they were aspiring to be socially accountable. Data was collected through on-site visits, field notes and a documentary review. Abductive analysis involved both deductive and inductive iterative theming of the data both within and across cases. Results: The conceptual framework for socially accountable medical education was built from analyzing the internal and external factors influencing the selected medical schools. These factors became the building blocks that might be necessary to assist movement to social accountability. The strongest factor was the demands of the local workforce situation leading to innovative educational programs established with or without government support. The values and professional experiences of leaders, staff and health sector representatives, influenced whether the organizational culture of a school was conducive to social accountability. The wider institutional environment and policies of their universities affected this culture and the resourcing of programs. Membership of a coalition of socially accountable medical schools created a community of learning and legitimized local practice. Communities may not have recognized their own importance but they were fundamental for socially accountable practices. The bedrock of social accountability, that is, the foundation for all building blocks, is shared values and aspirations congruent with social accountability. These values and aspirations are both a philosophical understanding for innovation and a practical application at the health systems and education levels. Conclusions: While many of these building blocks are similar to those conceptualized in social accountability theory, this conceptual framework is informed by what happens in practice - empirical evidence rather than prescriptions. Consequently it is valuable in that it puts some theoretical thinking around everyday practice in specific contexts; addressing a gap in the medical education literature. The building blocks framework includes guidelines for social accountable practice that can be applied at policy, school and individual levels. © 2016 The Author(s)

How do contextual issues influence social accountability in medical education?

Flinders University and the Northern Ontario School of Medicine are very pleased to partner again in delivering this conference, Muster 2014 at Uluru. We acknowledge the Traditional Owners of the land and the Elders past, present, and future. Thank you for welcoming us to your lands. Thank you for starting our journey by performing the Inma, a very significant cultural ceremony. With the theme of Aboriginal Health as a key component of this conference, we are delighted to be holding Muster 2014 in a resort owned by an Indigenous organization intent on doing exactly what we want to do in medical education, but in hostelry and tourism, so that we will have many opportunities to learn as we go about the conference, in and out of the sessions. I am particularly excited by the generous offer of the Ngangkaris to be with us throughout the conference, the opportunity to visit the Training College on Wednesday, and the Purple Truck (mobile dialysis unit) on Thursday. We have over 200 people attending Muster 2014 which is fourth in the series of conferences on Global Community Engaged Medical Education, and the second Muster held here in Australia. For those of you who attended the first Muster in the Barossa—welcome back! And for those of you who have attended ICEMEN or Rendez- Vous 2012 in Canada—welcome to the heart of Australia, here in Uluru. For those who are new to these conferences and new to the underpinning concepts of community engagement, longitudinal learning and socially accountable medical education— this is a very important conference that will be the start of an exciting learning journey for you, just as it is a continuing learning journey for the rest of us. Don’t be afraid to join in and have your say! We intend to try and map your learning journeys in the report of the conference, so we invite you to have your say in many ways—blogs, twitter, quotes, evaluation, photos, maps (geographic and learning) etc—and put them all in to a portfolio style to record the memories. Please help us do this so that it will be meaningful to you. It always has struck me that we could further maximize the expertise at a conference and so this year we have a new feature: Deans Unplugged! Sadly, Eric Clapton isn’t with us but I am sure the Deans will step up and try to be as heartfelt. This is an opportunity where, unfettered by a desk and piles of paperwork, you will find a number of Deans at the poolside, willing and able to discuss any issue you might want to raise with them. This is an occasion where you ask for forgiveness rather than ask for permission. As the conference program grew, I kept wanting to clone myself to be able to attend everything. I hope you will find it easier to decide what to attend! A big thank you to all of the reviewers and the Organising and Scientific Committees. We have tried to make the program easy to follow with a program outline at a glance; a small booklet with the program abstract titles; and the full program and full abstracts on the website which you can access by scanning the QR code, or via the USB provided. We have kept the coloured themes from the previous conferences, however many presentations cover more than one theme, so check all the abstracts for a list of themes covered. Key features are the plenary sessions (blue) which I hope you will all be able to drag yourselves away from the outdoors to attend. Over the three days, we traverse from ideas to theory then putting it into practice with a final session in the last afternoon on the future. We have been able to engage great partners who have helped us to keep the program on track: The Consortium for Longitudinal Integrated Curricula (CLIC), The Federation of Rural Australian Medical Educators (FRAME), James Cook University (JCU), and The Training for Health Equity Network (THEnet). We are very grateful to our sponsors for their support to ensure that the conference happens this year against a climate of so many cutbacks. A huge thank you to the Muster admin team: Lila, Eliza, Monica, Sylvie, Kim, and Kiri who have held this all together over the last eighteen months and managed to work across the world effectively without borders! I recommend Muster 2014 to you and look forward to receiving your comments during and after the conference

The benefits of community participation in rural health service development: Where is the evidence?

The term ‘community participation’ is commonly understood as the collective involvement of local people in assessing their needs and organising strategies to meet those needs. The importance of community participation in rural health service development is uncontested. The rural health policy framework Healthy Horizons Outlook includes the principle, ‘participation by individuals, communities and special groups in determining their health priorities should be pursued as a basis for successful programs and services to maintain and improve their health’. The document also states that ‘social capability and the physical capacity to plan and implement local programs are required for communities to improve and maintain their health

From personal to global: Understandings of social accountability from stakeholders at four medical schools

Aim: This paper addresses the question of how social accountability is conceptualised by staff, students and community members associated with four medical schools aspiring to be socially accountable in two countries. Methods: Using a multiple case study approach this research explored how contextual issues have influenced social accountability at four medical schools: two in Australia and two in the Philippines. This paper reports on how research participants understood social accountability. Seventy-five participants were interviewed including staff, students, health sector representatives and community members. Field notes were taken and a documentary analysis was completed. Results: Overall there were three common understandings. Socially accountable medical education was about meeting workforce, community and health needs. Social accountability was also determined by the nature and content of programs the school implemented or how it operated. Finally, social accountability was deemed a personal responsibility. The broad consensus masked the divergent perspectives people held within each school. Conclusion: The assumption that social accountability is universally understood could not be confirmed from these data. To strengthen social accountability it is useful to learn from these institutions’ experiences to contribute to the development of the theory and practice of activities within socially accountable medical schools. © 2016 Taylor & Francis

Conceptualizing the association between community participation and CQI in Aboriginal and Torres Strait Islander PHC Services

Drawing from Australian Aboriginal and Torres Strait Islander perspectives, we conceptualize the association between community participation and continuous quality improvement (CQI) processes in Indigenous primary health care (PHC) services. Indigenous experiences of community participation were drawn from our study identifying contextual factors affecting CQI processes in high-improving PHC services. Using case study design, we collected quantitative and qualitative data at the micro-, meso-, and macro-health system level in 2014 and 2015 in six services in northern Australia. Analyzing qualitative data, we found community participation was an important contextual factor in five of the six services. Embedded in cultural foundations, cultural rules, and expectations, community participation involved interacting elements of trusting relationships in metaphorically safe spaces, and reciprocated learning about each other’s perspectives. Foregrounding Indigenous perspectives on community participation might assist more effective participatory processes in Indigenous PHC including in CQI processes. © The Author(s) 2019

WOmen's action for Mums and Bubs (WOMB) trial protocol: A non-randomized stepped wedge implementation trial of participatory women's groups to improve the health of Aboriginal and Torres Strait Islander mothers and children in Australia

Introduction: In Australia, there have been improvements in Aboriginal and Torres Strait Islander maternal health, however inequities remain. There is increasing international evidence illustrating the effectiveness of Participatory Women's Groups (PWGs) in improving Maternal and Child Health (MCH) outcomes. Using a non-randomized, cluster stepped-wedge implementation of a complex intervention with mixed methods evaluation, this study aims to test the effectiveness of PWGs in improving MCH within Indigenous primary care settings in Australia and how they operate in various contexts. Methods: This study takes place in ten primary health care services across Australia and involves the recruitment of existing PWGs or the setting up of new PWGs. Services are paired based on geography for practical reasons and two services commence the PWG intervention at three monthly intervals, with the initial four services being those with existing women's groups. Implementation of the PWGs as an intervention involves training local facilitators of PWG groups, supported engagement with local MCH data through workshops, PWGs identifying and prioritizing issues and strengths and co-implementing solutions with health services. Outcomes are measured with yearly MCH audits, a cost-effectiveness study, and process evaluation of community participation and empowerment. Discussion: This study is the first to formally implement and quantitatively, yet with contextual awareness, measure the effect of applying a community participation intervention to improve the quality of Aboriginal and Torres Strait Islander MCH in Australia. Findings from this work, including detailed theory-producing qualitative analysis, will produce new knowledge of how to facilitate improved quality of MCH care in Indigenous PHC settings and how to best engage community in driving health care improvements. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618000945224. Web address: http://www.ANZCTR.org.au/ACTRN12618000945224.asp

How and why do participatory women’s groups (PWGs) improve the quality of maternal and child health (MCH) care? A systematic review protocol

Introduction Community-based Participatory Women’s Groups (PWGs) have proven to be an effective intervention to improve maternal and child health (MCH) outcomes in low/middle-income countries (LMICs). Less is known about how PWGs exert their effects in LMICs and virtually nothing is known about the contextual issues, processes and power relationships that affect PWG outcomes in high resource settings. The aim of this systematic review is to synthesise and critically analyse the current evidence on how and why PWGs improve the quality of MCH care. We aim to demonstrate how PWGs function and why PWG interventions contribute to social and health outcomes. Methods and analysis The protocol will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. The databases Medline (Ovid): Cumulative Index to Nursing and Allied Health Literature (Ebsco); Informit health suite Scopus, Australian HealthInfoNet, the Cochrane Library and other sources will be searched under broad categories: intervention, context and outcomes to 30 June 2019. Ethics and dissemination As only secondary data will be analysed; ethical approval is not required. The review will be disseminated to relevant organisations and presented in peer-reviewed papers and at conferences. This will be the first attempt to summarise the current available evidence on the characteristics, contextual influences and mechanisms that are associated with the outcomes and effectiveness of PWGs