Early Childhood Development (ECD) services in the Southern Adelaide Health Service region.

This report documents the findings of a review conducted by the South Australian Community Health Research Unit (SACHRU) at the request of the Southern Adelaide Health Service (SAHS) into the provision of Early Childhood Development services in southern Adelaide. This review was undertaken between June and December 2006 and overseen by a Project Management group consisting of representatives from the SAHS, the primary health services managers, practitioners, an acute service manager and the researchers. The review examined the early childhood services provided by primary health services across the region, the models used, intake procedures and referral pathways. The findings were to be used for future service planning, implementation and resourcing

Families empowered: a strengths based approach. An evaluation of FEAT, Families Empowered to Act Together.

The South Australian Community Health Research Unit undertook an evaluation of the FEAT program to track the progress of a number of families through the Families Empowered to Act Together (FEAT) program and capture the experiences and perspectives of children, families and stakeholders. Interviews were undertaken with carers and children both currently in the program and those recently exited. The evaluation also documents the development of the FEAT model of service and its aims and objectives; relates the operation of FEAT to understandings in the current literature regarding best practice principles and models for family support programs; and identifies other agencies, programs and services that the FEAT program links with in order to meet the needs of referred families. The evaluation adopted an action research framework employing qualitative and quantitative methods, and has encouraged participation by key stakeholders in the research process

Transformational change in health systems: a road strewn with obstacles.

This research study assesses the impact on primary health care of the reform changes in the South Australian health system from 2005 to 2007. The research follows a pilot study conducted in one of the newly created health regions in 2005 to 2006 and reported in: Governance change in the southern metropolitan Adelaide health region: implications for Primary Health Care (Baum et al. 2006). Both studies were intended as scoping exercises to contribute towards the development of an evaluation framework for primary health care

Developing a good practice model to evaluate the effectiveness of comprehensive primary health care in local communities

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise statedBackground: This paper describes the development of a model of Comprehensive Primary Health Care (CPHC) applicable to the Australian context. CPHC holds promise as an effective model of health system organization able to improve population health and increase health equity. However, there is little literature that describes and evaluates CPHC as a whole, with most evaluation focusing on specific programs. The lack of a consensus on what constitutes CPHC, and the complex and context-sensitive nature of CPHC are all barriers to evaluation. Methods: The research was undertaken in partnership with six Australian primary health care services: four state government funded and managed services, one sexual health non-government organization, and one Aboriginal community controlled health service. A draft model was crafted combining program logic and theory-based approaches, drawing on relevant literature, 68 interview s with primary health care se rvice staff, and researcher experience. The model was then refined through an iterative process involving two to three workshops at each of the six participating primary health care services, engaging health service staff, regional health executives and central health department staff. Results: The resultant Southgate Model of CPHC in Australia model articulates the theory of change of how and why CPHC service components and activities, based on t he theory, evidence and values which underpin a CPHC approach, are likely to lead to indivi dual and population health outcome s and increased health equity. The model captures the importance of context, the mechanisms of CPHC, and the space for action services have to work within. The process of development engendered and supported collaborati ve relationships between researchers and stakeholders and the product provide d a description of CPHC as a whole and a framework for evaluation. The model was endorsed at a research symposium involving inv estigators, service staff, and key stakeholders. Conclusions: The development of a theory-based program logi c model provided a framework for evaluation that allows the tracking of progress towards desired outcomes and exploration of the particular aspects of context and mechanisms that produce outcomes. This is important because there are no existing models which enable the evaluation of CPHC services in their entirety

Governance change in the southern metropolitan Adelaide health region: implications for Primary Health Care.

This report describes a study aiming to assess the impact of the introduction of regional health structures to metropolitan Adelaide. The study was conducted in 2005 in the southern Adelaide region. Major research questions were: What is the most effective way to organise health service governance in order to promote and strengthen primary health care as a key focus of the health system? How does a change in health service governance affect the position of primary health care in relation to acute care services

The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints

The Commission on the Social Determinants of Health and the World Health Organization have called for action to address the social determinants of health. This paper considers the extent to which primary health care services in Australia are able to respond to this call. We report on interview data from an empirical study of primary health care centres in Adelaide and Alice Springs, Australia.This study was funded by an NH&MRC Project Grant 535041 and FB’s time is funded by an ARC Federation Fellowship. RL is funded by the Canada Research Chair program

Change management in an environment of ongoing primary health care system reform: A case study of Australian primary health care services

Introduction/Background Globally, health reforms continue to be high on the health policy agenda to respond to the increasing health care costs and managing the emerging complex health conditions. Many countries have emphasised PHC to prevent high cost of hospital care and improve population health and equity. The existing tension in PHC philosophies and complexity of PHC setting make the implementation and management of these changes more difficult. This paper presents an Australian case study of PHC restructuring and how these changes have been managed from the viewpoint of practitioners and middle managers. Methods As part of a 5-year project, we interviewed PHC practitioners and managers of services in 7 Australian PHC services. Findings Our findings revealed a policy shift away from the principles of comprehensive PHC including health promotion and action on social determinants of health to one-to-one disease management during the course of study. Analysis of the process of change shows that overall, rapid, and top-down radical reforms of policies and directions were the main characteristic of changes with minimal communication with practitioners and service managers. The study showed that services with community-controlled model of governance had more autonomy to use an emergent model of change and to maintain their comprehensive PHC services. Conclusions Change is an inevitable feature of PHC systems continually trying to respond to health care demand and cost pressures. The implementation of change in complex settings such as PHC requires appropriate change management strategies to ensure that the proposed reforms are understood, accepted, and implemented successfully

Early childhood educators’ understanding of early communication: Application to their work with young children

This paper has been published in final form at http://dx.doi.org/10.1177/0265659016630034 Copyright © 2017 SAGE Publications.Reprinted by permission of SAGE PublicationsYoung children need rich learning experiences to maximize their potential. Early childhood educators (ECEs) working in childcare have knowledge of individual children as well as skills and professional knowledge that afford opportunities to provide language-rich environments for learning. To successfully work in partnership with ECEs, speech-language pathologists need to understand what they know about early communication development and how they apply it in their work. This study explored ECEs’ understanding of early communication development in childcare contexts, and how they related this to the education and care they provided. In this exploratory study we conducted three focus groups with 19 ECEs who were employed in eight different childcare centres in low socio-economic areas in metropolitan Adelaide, South Australia. Data were analysed thematically revealing three core themes: ‘Knowing and doing in context’; ‘ECEs’ role’; and ‘ECEs’ challenges’. Participants articulated understanding of early communication development and the importance of strong relationships between ECEs, children and their families. These ECEs’ skills and knowledge of children in their care was the basis from which they provided language-rich learning environments with individually tailored educational programmes to support all children, including those experiencing communication difficulties. They highlighted challenges in delivering this care, including the need for more explicit support from speech-language pathologists. There is potential to further develop interdisciplinary partnerships between ECEs in childcare and other professionals, such as speech-language pathologists, to maximize early developmental opportunities for children attending childcare

Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners

This is the accepted version of the following article: [Freeman, T., Edwards, T., Baum, F., Lawless, A., Jolley, G., Javanparast, S. and Francis, T. (2014), Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners. Australian and New Zealand Journal of Public Health, 38: 355–361. ], which has been published in final form at doi: 10.1111/1753-6405.12231. This item was under embargo for a period of 12 months from the date of publication, in accordance with the publisher's policy.Objective. There is little literature on health service level strategies for culturally respectful care to Aboriginal and Torres Strait Islander Australians. We conducted two case studies: , one Aboriginal community controlled, and one state government managed primary health care service to examine cultural respect strategies, client experiences, and barriers to cultural respect. Methods. Data were drawn from 22 interviews with staff from both services, and four community assessment workshops, with a total of 21 clients. Results. Staff and clients at both services reported positive appraisals of the achievement of cultural respects. Strategies included being grounded in a social view of health, including advocacy and addressing social determinants, employing Aboriginal staff, creating a welcoming service, supporting access through transport, outreach, and walk-in centres, and integrating cultural protocol. Barriers included communication difficulties, racism and discrimination, and externally developed programs. Conclusions. Service level strategies were necessary to achieving cultural respect. These strategies have the potential to improve Aboriginal and Torres Strait Islander health and wellbeing. Implications. Primary health care’s social determinants of health mandate, the community controlled model, and the development of the Aboriginal and Torres Strait Islander health workforce need to be supported to ensure a culturally respectful health system

Childcare educators’ understandings of early communication and attachment

This article has been published in final form at http://www.earlychildhoodaustralia.org.au/our-publications/australasian-journal-early-childhood/index-abstracts/ajec-vol-40-no-4-december-2016/childcare-educators-understandings-early-communication-attachment/Giving voice to the discipline-specific knowledge and pedagogical practices of childcare educators, this paper attempts to explore new ways of defining educators’ work with young children, given the post-structural turn in Australian and international early childhood policy. Three focus groups (n = 8 children’s education and care services; n = 19 educators) were held in metropolitan Adelaide (South Australia) to explore their professional understandings of early communication and attachment development. Childcare educators described the relational and communicative elements of their work that supported or constrained their capacity to understand individual children’s socio-emotional needs at enrolment, during transitions and in day-to-day routines. Whether attachment relationships were forged or being built, these educators explained how emotional reciprocity and an understanding of the child through secure attachment relationships enabled them to notice young children’s communication abilities and needs, and vice versa. While the findings illuminate the expertise childcare educators bring to their work, we argue that there is a need to further explore how this expertise shapes their programs, practices and professional development needs