cross sector leadership table - logan together · alan bunce logan village state school...
TRANSCRIPT
Cross Sector Leadership Table Friday 14 October 2016
9:00am coffee for 9:30am. Meeting concludes at 12 noon – Note later finishing time.
Griffith University Logan Campus: Meadowbrook room Building L07 Room 4.07
Secretariat: Kellie Hinchy (e) [email protected] (ph) 3382 1163
Agenda
Item Time Papers / notes
1. Coffee and informal meet and greet
9:00am-9.30am
2. Acknowledgment of Country and welcome and introductions
9:30am-9:35am
3. Minutes and actions from previous meeting
9:35am-9:40am Attachment
4. Maternity project update on awesome progress
9:40am-9:50am Update paper and discussion from Project group
5. Project of the month: Early Detection and support for developmental vulnerabilities - Concept approval
9:50am-10:20am Draft proposal and presentation from Project group
6. Multidisciplinary support for Early Childhood Centres – Concept approval
10:20am-10:50am Presentation from Project group
Break 10:50am-11:05am
7. Play as a soft entry, universal, early intervention and prevention tool
11:05am– 11:30am Presentation from Deb Miscamble and Dr Kym Macfarlane
8. Project development and the role of project groups and the Leadership Table
11:30am-11:55am Group discussion Discussion prompt to be circulated
9. Wrap up and meeting close 12 noon
Membership Margaret Allison Chair [email protected] Alan Bunce Logan Village State School [email protected] Allison McClean Waterford West State School [email protected] Amanda Currie Dept. of Communities, Child
Safety & Disability Services [email protected]
Andrea World Community Representative [email protected] Angela TuiSamoa Community Representative [email protected] Brett Bricknell Logan Hospital [email protected] Cath Bartolo YFS [email protected] David Crompton Addition and Mental Health [email protected] Debbie Miscamble The Salvation Army /
Communities for Children [email protected]
Geoff Woolcock Logan Child-Friendly Community Consortium
Gracie Perry Community Representative [email protected] Jane Frawley Logan City Council [email protected] Janet Stodulka Dept. of Social Services [email protected] Jennifer Crimmins Child and Youth Community
Health Services [email protected]
Josephine Aufai Community Representative Karen Dawson Sinclair
Community Representative [email protected]
Kim Wright Kingston East Neighbourhood Group
Leith Sterling The Benevolent Society [email protected] Lesley Chenoweth Griffith University [email protected] Matthew Cox Logan Together [email protected] Melanie McKenzie Community Representative [email protected] Michael Jacobs Community Representative [email protected] Michael Tizard The Creche & Kindergarten
Assoc [email protected]
Niki Gouch Access Community Services [email protected] Pamela Fisher Ganyjuu [email protected] Aunty Robyn Williams
Community Representative [email protected]
Roger Marshall Logan East Community Neighbourhood Assoc.
Pastor Ross Smith The Vine Community Church [email protected] Sharyn Donald Dept. of Education and
Training [email protected]
Soraya Shah Anglicare Southern Queensland
Sue Scheinpflug Brisbane South PHN [email protected]
1 | P a g e
Cross Sector Leadership Table Friday 14 October 2016
9:30-12:00pm
Attendance: Note membership list attached to these minutes
Apologies: Brett Bricknell, Prof Lesley Chenoweth, Prof David Crompton, Amanda Currie, Jane
Frawley, Roger Marshall, Alison McClean, Sue Scheinpflug, Soraya Shah, Leith Sterling, Janet
Stodulka, Aunty Robin Williams
Proxies: Ruth Wall for Sue Scheinpflug, Luke Robinson for Janet Stodulka, Helene Fuller for
Amanda Currie, Amanda Trunley for Leith Sterling.
Visitors: Skye Frazer-Ryan, Queensland Health, Kylie Johnston, Dr Kym MacFarlane, Louisa
Whettam
MINUTES 2. Welcome and Introductions
Ms Margaret Allison, Chair, welcomed everyone to the October meeting of the Cross Sector Leadership Table and noted the apologies.
3. Minutes and Action from the previous meeting
The minutes from the September meeting were confirmed. With regards to the Action Register, Mr Matthew Cox reported the following:
• The Logan Community Response to Domestic and Family Violence action plan would be included on a future meeting agenda.
• Paster Ross Smith and Josephine Aufai are organising a meeting of Logan Faith groups. • A tour of Yarrabilba is being organised. Members will be advised shortly of a proposed
date. • The Community Mobilisation campaign will be included on a future meeting agenda. • Due to illness of the presenter, the project of the month: Decrease smoking, drinking and
drug consumption, will postponed to a future meeting.
4. Maternity project update
The Chair invited Matthew Cox to speak to this item. Matthew reminded members that two issues arose when this project was presented to the Committee at a previous meeting. One was transparency around amendments and approval of the project and the other was the development of a community governance structure. Meetings were held between the representatives of the project team and Queensland Health at which there was a unanimous agreement on a way forward which includes:
2 | P a g e
• A working group has been formed to which a Health Consumers Queensland representative has been appointed as Chair;
• Resources have been put aside for the appointment of a Project Director; and • Logan Together will develop a business case for the project.
Jennifer Crimmins requested that child development from 6 weeks to one year be more fully developed into the project to which Matthew Cox advised that this important focus would be the next set of issues for the project group to develop. Ms Crimmins also requested that the proposal be amended to include Child Health Queensland.
The Chair announced that Mr Brett Bricknell, who had played an important role in this project, was leaving Queensland Health and that a letter of acknowledgment would be sent to him on behalf of the Committee.
Action: Minor amendment to be made to the project proposal to include Child Health Queensland.
Action: Letter of acknowledgement to be sent to Mr Brett Bricknell.
5. Project of the month: Early detection and support for developmental vulnerabilities – concept approval.
The Chair welcomed Ms Kylie Johnston, Project facilitator, and Ms Skye Frazer-Ryan from the Centre for Children’s Health and Wellbeing.
Ms Frazer-Ryan presented the latest AEDC data stating that the data showed that over the past data period, Logan children showed consistent improvement in language and communication however there was reason for concern in relation to the emotional maturity and social competence domains.
Ms Johnston presented the proposed theory of change and the ideal model of early detection and support for Logan children along with a number of priority action areas all of which are detailed in the project proposal.
Decision: The Leadership Table endorsed in principle the project as outlined and supports further development of the project.
6. Multidisciplinary support for Early Childhood Centres – concept approval
The Leadership Table was briefed on the Multidisciplinary support for Early Childhood Centres and supports in principle the project as outlined. The Leadership Table recognizes that this project is in its infancy and supports progress to co-design and development of a model.
Decision: The Leadership Table endorsed the Multidisciplinary support for Early Childhood Centres project proposal in principal and supports progress towards the development of a co-designed model of delivery.
3 | P a g e
7. Play as a soft entry, universal, early intervention and prevention tool
The Leadership Table was briefed on the research work being undertaken between Griffith University and Communities for Children around play as a soft entry, universally accessible, early intervention and prevention practice model (SUEIP).
8. Project development and the role of project groups and the Leadership Table
This item was not discussed and will be carried forward to a future meeting.
9. General business
• Ross Smith suggested a working party be established to discuss how to engage community trust.
• Lori Rubenstein will be undertaking a review of Logan Together similar to that carried out by 99 Consulting earlier this year. Lori will seeking input to the review from Committee members.
• Matthew Cox is going on a trip to USA/Canada with Logan City Council Mayor Luke Smith to visit collective impact projects across those countries.
Meeting close
The Chair thanked all for attending. Meeting closed at 12.00pm. The next meeting of the Cross Sector Leadership Table is scheduled for Friday 11 November 2016.
4 | P a g e
Membership List
Margaret Allison Chair [email protected] Alan Bunce Logan Village State School [email protected] Allison McClean Waterford West State School [email protected] Amanda Currie Dept. of Communities, Child
Safety & Disability Services [email protected]
Andrea World Community Representative [email protected] Angela TuiSamoa Community Representative [email protected] Brett Bricknell Logan Hospital [email protected] Cath Bartolo YFS [email protected] David Crompton Addition and Mental Health [email protected] Debbie Miscamble The Salvation Army /
Communities for Children [email protected]
Geoff Woolcock Logan Child-Friendly Community Consortium
Gracie Perry Community Representative [email protected] Jane Frawley Logan City Council [email protected] Janet Stodulka Dept. of Social Services [email protected] Jennifer Crimmins Child and Youth Community
Health Services [email protected]
Josephine Aufai Community Representative Karen Dawson Sinclair
Community Representative [email protected]
Kim Wright Kingston East Neighbourhood Group
Leith Sterling The Benevolent Society [email protected] Lesley Chenoweth Griffith University [email protected] Lyndall Robertshaw Logan City Community
Housing [email protected]
Matthew Cox Logan Together [email protected] Melanie McKenzie Community Representative [email protected] Michael Jacobs Community Representative [email protected] Michael Tizard The Creche & Kindergarten
Assoc [email protected]
Niki Gouch Access Community Services [email protected] Pamela Fisher Ganyjuu [email protected] Aunty Robyn Williams
Community Representative [email protected]
Roger Marshall Logan East Community Neighbourhood Assoc.
Pastor Ross Smith The Vine Community Church [email protected] Sharyn Donald Dept. of Education and
Training [email protected]
Soraya Shah Anglicare Southern Queensland
Sue Scheinpflug Brisbane South PHN [email protected]
5 | P a g e
Action Register
Action Number
Date Action Who Due by
16 15/07/16 The Logan Community Response to Domestic and Family Violence action plan to be included on the agenda of the October 2016 meeting.
Secretariat Future meeting
21 09/09/16 A tour of Yarrabilba to be organised for interested members.
Secretariat Scheduled for 5 Dec
22 09/09/16 Community mobilisation campaign to be included on the agenda of a future meeting.
Secretariat Future meeting
23 09/09/16 Project of the month: Decrease smoking, drinking and drug consumption to be included on the agenda of a future meeting.
Secretariat Future meeting
24 14/10/16 Minor amendment to be made to the project proposal to include Child Health Queensland.
Matt Statham completed
25 14/10/16 Letter of acknowledgement to be sent to Mr Brett Bricknell.
Margaret Allison
completed
Decision Register
Decision Number
Date made
Decision
1 11/03/16 Accept the Terms of Reference as a working document. 2 11/03/16 To allow for additional proxy members as long as they are fully briefed
prior to attending the meeting. 3 13/05/16 A long-term Roadmap to be delivered at the end of 2016 4 10/06/16 The Leadership Table endorsed the statement of project priorities as
reflecting the Table’s views. 5 12/08/16 The Leadership Table endorsed the Maternity Continuity of Care proposal
in principal, subject to the detailed written proposal being finalised with stakeholders.
6 14/10/16 The Leadership Table endorsed the concept proposal for the Early detection and support for developmental vulnerabilities project and supports further development of the project.
7 14/10/16 The Leadership Table endorsed the Multidisciplinary support for Early Childhood Centres project proposal in principal and supports progress towards the development of a co-designed model of delivery
1
Community Maternity Centre proposal - update The Logan Together maternity proposal was tabled at the September CSLT. Whilst the core model proposed was supported, Project Group members had two main concerns they wanted addressed prior to endorsement (and progression to detailed design and implementation planning phase): 1. Transparency in discussions post proposal development 2. Establishment of a community governance group to oversee the project. There has also been feedback that the child health aspects of the proposal relating to the period from 6 weeks to 1 year should be more fully developed. Actions in response The actions in follow up to these issues for noting at the October Leadership Table are:
1. That Leadership Table will take the learning in relation to project development, process clarity and transparency. A discussion at the October Leadership Table will be an immediate follow up to this issue and will examine the processes that occur at project group level and CSLT level in progressing projects. The aim is to have a clearer pathway for project progression with more transparent accountabilities and decision-making processes.
2. There is acknowledge across Logan Together that the Project Group focussed on ‘-9 months to 1 year of babies life’ has discussed, designed and developed an initial proposal focussed on the ante-natal to the immediate post-natal period. Although the proposal touches on transitional elements to children’s health, it does not yet outline detailed strategies to improve infants and their families’ outcomes. This is recognised by the project group and the intention is to focus on this period during stage 2 of development. Logan Together is also considering presentations from the 0-3 years Early Development group and Early Detection of Developmental Vulnerabilities to understand the strategies identified/cross-over.
3. A representative party from the Logan Together maternity project group met with Logan Hospital Executive Director and senior executives, Obstetrics and Midwifery on 6 October to discuss a way forward on governance for the Community Maternity Centre project. The following actions were agreed upon: (a) Develop a working group out of the Logan Together maternity project group to
undertake the following: • Appoint Health Consumers Queensland (or similar organisation) to help develop the
detail of the shared governance model (Option 3 - attached) and provide neutral facilitation role in governance group
• Develop detail of the shared governance model • Make recommendations to the Cross Sector Leadership Table for the appointment
of a Governance Group to:
2
o Implement the agreed governance model o Establish overarching goals and processes o Develop a service level agreement among member organisations of the
Governance Group specifying purpose, roles and responsibilities to be reviewed regularly
o Oversee detailed design, implementation and review of the Community Maternity Centre
• Develop a position description or statement of duties and participate in the appointment or sourcing of an Interim Project Director to lead the ongoing co-design and implementation planning. The work of this position will be directed by the Governance Group during co-design and implementation planning.
(b) Logan Together develop a Business Case which outlines the following: • Overview of proposed model, business drivers, objectives and governance approach • Funding to support Community Maternity Centres, including:
o Director, Operations, once program goes live o Support for the participation of Governance Group members and neutral
facilitation o Operationalisation of the Community Maternity Centres with final costings
provided at the end of the detailed co-design and implementation planning o Support for continued partnership development.
(c) Metro South Health to confirm resources available for:
• Project Director • Independent organisation e.g. Health Consumers Queensland to support
development of shared governance model and products, act as neutral chair in governance group
• Allowance to support participation of unpaid governance group members.
To provide endorsement status of the Community Maternity Centre proposal and move from concept to detailed design and implementation planning, Logan Together suggests the following paragraph be inserted in the draft proposal and the final copy circulated with the October CSLT minutes.
Detail on governance for Project Proposal
On 6 October 2016, the Logan Together Maternity Project Group (7, 8, and 9) met with Logan Hospital executives and provided in-principle support for Option 3: Organisations commit to a common governance arrangement for a specific business purpose/overlap but maintain separate, independent governance and funding.
They felt that option 3 allows entities to have control over their own business/risks but at the same time being held accountable to the community and other stakeholders for implementation of agreed upon philosophical, clinical/practice and programmatic frameworks.
3
Option 3 promotes genuine collaboration and contains governance mechanisms including service level agreements to ensure accountability and effective dispute resolution. Below is an outline of the Option 3 scope. A representative working group will further the development and implementation of the model in conjunction with an independent organisation skilled in public health governance development.
Community governance group Metro South Health Program model Agreed to and reviewed Operationalised in partnership
with community sites (oversee midwifery staff and operations)
Philosophical approach
Developed and agreed Operationalised
Practice model and framework
Practice framework agreed to through service level agreement
Operationalised by Metro South Health – operational report back to Community Governance Group to ensure integrity of model
Risk – Risk management
Discussed through operational reports, practice examples
Managed through Metro South Health. Final decision-maker.
Legal Legal liability and insurances Financial sustainability
Shared ownership of funding sustainability and strategy
Owner of operational resources and funding/financial management (midwifery staff
Infrastructure
Shared through service level agreements – community agency
Client and community focus
An agreed co-production (co-design, co-construction and co-review process)
Service level agreement
Developed, agreed to and reviewed – including dispute resolution processes
1
Logan Together project proposal
Name of Project group:
Community maternity services project Incorporating project elements: Continuity of care, birthing choices and social and emotional well-being for birthing families and up to and including when the child is 1 year of age
2
Version No: 0.8
Date: 5 September 2016
Table of Contents
Overview ...................................................................................................................................................................................................... 5
What is the Project’s theory of change? ........................................................................................................................................................ 6 Exploring the issue (Summary of research, feedback from service providers and citizens). ........................................................................................... 6 Local Context ............................................................................................................................................................................................................. 7 Theoretical context .................................................................................................................................................................................................... 8 Community feedback – maternity support in Logan................................................................................................................................................... 10
Logan Together - proposed model .............................................................................................................................................................. 12 Evidence for Community midwifery caseload ............................................................................................................................................................ 15 Community feedback on the proposed model ........................................................................................................................................................... 16 Current activity ........................................................................................................................................................................................................ 17 Program logic ........................................................................................................................................................................................................... 18 Baselines and goals .................................................................................................................................................................................................. 20
Project plan outline .................................................................................................................................................................................... 21 Establishing the Model: Detailed design phase .......................................................................................................................................................... 22 Project Steering Committee ...................................................................................................................................................................................... 23 Philosophy ............................................................................................................................................................................................................... 24 Prototype sites ......................................................................................................................................................................................................... 24 Access to the proposed new community-based services ............................................................................................................................................ 26 Antenatal Care ......................................................................................................................................................................................................... 27 Intrapartum ............................................................................................................................................................................................................. 29 Postnatal ................................................................................................................................................................................................................. 29
Indicative Resourcing ................................................................................................................................................................................. 31
3
Options for Staffing .................................................................................................................................................................................................. 31 Community partner resources and staffing ............................................................................................................................................................... 32 Operational resources .............................................................................................................................................................................................. 33
Future considerations ................................................................................................................................................................................. 35
Implementation considerations .................................................................................................................................................................. 36
Primary stakeholders .................................................................................................................................................................................. 37
References ................................................................................................................................................................................................. 38
4
What life stage (population level) outcome and result will this project affect? What Logan Together Roadmap strategy did this project emerge from? Please circle
5
Overview
The Community Maternity Services project has looked at ways to further improve access to and the experience of support, healthcare and parent education services for parents from early in pregnancy, through birth, and up to the end of the first year of life.
This period is critical to laying the physical and neurological foundations necessary for wellbeing across the human life course. It is also a very important period in which opportunities to connect with parents and family members present so that support and care can be offered and a long term relationship established. A new baby is both a joyous and momentous event and parents are information-seeking at this time. There is clear evidence that the wellbeing of parents, particularly mothers, during this period has a big impact on long term mental health and wellbeing of both parent and baby, so positive experiences during this time of growth and change in family life have long term benefits.
In Logan approximately 1 in 10 women have little or no contact with support and healthcare services during their pregnancy – about double the average for Queensland. Internationally, the evidence shows that this is correlated with a wide range of risks and poor health and wellbeing outcomes for both parents and baby. The project group has focussed in on this issue as its first challenge to address.
The main strategy the group has identified is to provide relationship-based long-term continuity of midwifery care across pregnancy, labour and birth and post birth. This is to include a range of pre and post birth support services out into highly localised community settings that are currently accessed by parents in the target group for the project with home visits as required.
Recent research conducted by Metro South Health shows that around one quarter of all birthing women presenting at Logan Hospital are from a Maori and Pasifika cultural background, indicating a need to be particularly responsive to the needs of this part of the community.
It is noted that the first phase of this project has a predominant focus on the maternity and birthing pathway to support Healthy pregnancies and Healthy at birth Logan Together outcomes. Further development of phase 2 of the project will address the first year of life and associated Logan Together outcomes, such as developmentally on track at 1.
6
What is the Project’s theory of change?
Exploring the issue (Summary of research, feedback from service providers and citizens). Antenatal care is important to achieve positive health outcomes for the child and their mother. An antenatal visit in the first trimester of pregnancy is important to monitor the health of the mother and child and can help identify complications early to ensure appropriate management strategies are implemented. There is a strong relationship between regular antenatal care and positive child health outcomes. Receiving antenatal care at least 4 times, as recommended by the WHO, increases the likelihood of receiving effective maternal health interventions during antenatal visits (WHO 2011). If an antenatal visit in the first trimester of pregnancy does not occur, the health of the mother and child cannot be monitored. This means that complications that occur during this period cannot addressed in a timely way, impacting on birthing and health of the baby later.
The Council of Australian Governments identified that pregnant women receiving a minimum of one antenatal visit during the first trimester (first 13 weeks) of pregnancy is an important indicator of access to care in communities. If women do not access effective care, they may also not receive support to prevent or manage obesity in pregnancy – a major contributor to increased morbidity and mortality for both mother and baby. Pregnant women who are obese have an increased risk of thromboembolism, gestational diabetes, pre-eclampsia, post-partum haemorrhage, wound infections and caesarean section. In addition there is good evidence that the rates of congenital anomaly, stillbirth and neonatal death are higher in the population of babies born to this group of women (McIntyre et al, Feb 2012).
Perinatal depression is also a factor that impacts on mothers and babies health. Without appropriate care, perinatal depression can lead to psychological and physical morbidity, including poor birth outcomes and increased rates of suicide. The relationship between mother and baby may be compromised in the presence of postnatal depression, the effects of which influences a child’s physical and cognitive and social development. Conversely, depression in pregnancy effects a woman’s capacity for self-care, including inadequate nutrition, drug or alcohol abuse and poor antenatal clinic attendance. Without the application of universal and routine psychosocial assessment, much perinatal anxiety, depression and psychosocial morbidity can go unrecognised. Particular population groups are also at risk of poorer neonatal outcomes including Aboriginal and Torres Strait Islander community and multicultural populations due to fundamental social needs not being met (Utz, Johnston & Zarate, 2015; Neale & Wand, 2013, Thrift and Callaway, 2014).
The consequences of early adversity that can be caused through parental problems of substance misuse, mental illness and domestic abuse can affect children’s physical and emotional health, their learning and their capacity to form positive relationships throughout their lives. Pregnancy and infancy offers an opportunity for services that are committed to develop and implement early intervention models of care within families, improving outcomes for vulnerable children, to work in partnership. In responding, the whole family context needs to be taken into account. When addressing parental problems
7
such as mental illness, substance misuse and domestic abuse, we need to ensure that parents are supported to fulfil their parenting role and that children get the help they need.
In this context, practice and research point to the efficacy of a seamless continuum of care that spans:
• Early intervention, prevention and protection • Collaborative maternity and child health services that commences in the antenatal period, especially with mothers presenting with “at risk”
indicators. • Services tailored around families’ needs, not the other way around.
Local Context Improving access to best models of care is important for all women but specifically pertinent to Logan women because:
• Twice as many Logan women compared to the rest of the state either do not attend or have very low levels of antenatal care i.e. Around 500 pregnant women per year in Logan attend low numbers of ante-natal visits (less than 4 visits) representing 10.3% of all pregnant women in Logan (5,097). This is compared with 4.9% in Queensland. 1
• In some pockets of Logan, four times as many women are not receiving antenatal care compared to women in the rest of the state. This is particularly true in the suburbs of Logan Central, Woodridge, Kingston, Eagleby and Beenleigh, where over 16% of women (almost 1 in 6) are not receiving appropriate levels of antenatal support.
• Higher numbers of women smoke during pregnancy compared with other Queensland women E.g. in Logan 16.3% of women smoked during 1st 20 weeks and 13.6% smoked during second 20 weeks – well above the Queensland average. In a number of pockets in Logan, up to 1 in 3 women smoked during pregnancy.
• There is a higher incidence of low weight babies and an increased number of preterm babies. Again, in a number of pockets of Logan, over 15% of babies were pre-term compared to state average of 9.3% and over 9% for low weight babies compared to 6.6% state average.
• There is a high incidence of babies admitted to special care nurseries – in some areas over 20% compared to 17.9% state average and • Lower numbers of children are fully immunised at 12 months compared to Queensland averages (LTP, 2015).
Given the great cultural and demographic diversity in Logan, strategies which seek to support improved access must be centrally concerned with providing choice and localised, customised responses that meet preferences of different segments of the community. Of note in this context, recent research by the Access and Equity Team at Metro South Health highlighted the particular needs of the 25% of birthing families from Maori and Pasifika cultural backgrounds
1 2013-14 perinatal data set – Queensland Health. More up-dated data sets will be sourced for outcome measurement modelling in detailed design and implementation phase.
8
in Logan. Women from this part of our community have twice rate of GDM, have lower numbers of visits and have higher rates of no antenatal care compared to general population in Logan and high rates of preterm / SGA babies. Local forums to explore these issues found a range of prominent concerns:
• Women were not sure where they can be provided care or their care options • They were worried care is unaffordable • They wanted:
o culturally appropriate care o person-centred care from a female carer o care from the same midwife across the pregnancy
• Women also identified the need for childcare to attend appointments Hogan (2016) in his analysis of the relationship between perinatal risk factors and other childhood risk factors based on a sample of Logan data indicated potentially strong correlations between:
• mothers attending first antenatal visit in 3rd trimester and premature babies • mothers attending low total antenatal visits and premature babies as well as low APGAR after 5 minutes • mothers smoking in pregnancy and babies born prematurely and low APGAR after 5 minutes • obese mothers and babies born prematurely
• perinatal risk factors and developmental vulnerability – particularly physical health and language and cognitive ability (Australian Early Development Census).
Theoretical context Quality care is evidenced where the organisation of services are responsive to community expectations and need (WHO, 2006; Renfrew et al, 2014). Most specifically, quality maternity services are those that are culturally safe, motivated to supporting pregnancy and birth as a normal event, and encompass preventative and supportive care rather than being focused to identification of pathology (Renfrew et al, 2014).
The Queensland Review into Maternity Services (2005) identified five key concepts to improve maternity and neonatal outcomes:
• care is safe and feels safe • care is open and honest • care is local or feels local
9
• care belongs to families, and • carers work together and communicate (Hirst, 2005).
The National Maternity Plan reiterated those sentiments and emphasised that care be woman centred and evidenced based (AHMC, 2010).
The Australian Charter of Healthcare Rights states that “to obtain good health outcomes, it is important for patients and consumers to participate in decisions and choices about their care and health needs” (ACSQHC, 2009). The health and wellbeing of a mother and child at birth is seen as a determinant of future health and wellness of the entire family (WHO 2005). The ways which the woman experiences pregnancy and child birth is vital for the relationship with her child and her future childbearing experiences (Hauck et all 2007).
A majority of women (96%) want to be involved in making decisions about their labour and birth (Brown & Lumley, 1998). Respect for women's autonomy, control and participation in decision making and confidence in care providers are all factors considered by women as important in their birthing experience. Personal knowledge, social norms, flexible environment and cultural safety are all factors linked to women’s positive experience and satisfaction with subsequent birthing experiences.
Family Home Visiting Service (2014) notes that perinatal birthing choices should involve:
• the need to minimise fear, particularly women’s fear, and improve support throughout labour and birth • the importance of consistent and balanced information for women and health care providers regarding vaginal birth after caesarean section
operation and the potential risks associated with elective caesarean operation • the need to develop programs of care, both midwifery and medical, that focus on providing continuity of care2.
Schwartz, Toohill, Creedy, Baird, Gamble and Fenwick (2015)3 in a recent Australian study noted that for all women regardless of parity, significant relationships were found between childbirth self-efficacy, childbirth fear, scoring high for depressive symptoms, low childbirth knowledge, and experiencing a high level of discomfort in pregnancy. Further to this they note that increasing levels of childbirth self-efficacy may assist women to approach motherhood more positively, improve their general wellbeing, impact on reducing unnecessary birth interventions, and improve postnatal mental health. 2 Family Home Visiting Service Outline, Government of South Australia 2014 3 Schwartz. L, Toohill. J, Creedy. D, Gamble. J and Fenwick. J. (2015) Factors associated with childbirth self-efficacy in Australian childbearing women. BMC Pregnancy and Childbirth
10
Community feedback – maternity support in Logan The following information is a summary of qualitative feedback from women living in Logan LGA in relation to maternity support (antenatal, intrapartum and post-natal) who accessed a variety of care and birthing services within Logan and elsewhere.
It should be noted that this information is from a sample of women in Logan only and is not representative of all women’s views. Future community engagement and co-design tools will be developed jointly with all primary stakeholders.
The feedback does provide an opportunity for reflection however, particularly in relation to some of the themes presented.
Information sources
• Listening exercises – Queensland Community Alliance: 2015, 2016 • Social media feedback – Early 2016 • Feedback from community members and maternity advocates within the Logan Together project group
Size of sample: 100-150 women in Logan
Key feedback themes
The major theme that was identified was consistency of information, choice and control over antenatal, intrapartum and post-natal support. Some of the statements made by women are below and provide reflection opportunities on people’s experiences.
“I felt extremely supported my whole pregnancy and the after. I was in the MGP so I only saw one midwife the whole time. We built up a good relationship of trust. She got to know me and I got to know her. So when it came time for labour and birth the person helping me birth my baby was somebody I trusted whole heartedly”.
“The importance of having experienced antenatal care was a definite priority for me. I am a mum of 6 kids and after experiencing care that was not up to scratch for me with my third and fourth child, I was wanting more personal and consistent pregnancy care. My GP offered just that. It meant one doctor was there to help if there were any issues or problems. My antenatal care was up to date, check-ups performed and any issues that arise were dealt with through one person. Pregnancies with my fifth and sixth children were trouble and hassle free and the continued care for myself and my kids as been outstanding. She knows my family history and it has been my one stop for all my family's medical needs. I am only disappointed I did not make the change sooner to my GP”.
11
“Women should have the one midwife through the whole pregnancy so 1. You can grow a bond with them and 2. They know you and understand your concerns better. There's been so many times where I've told 1 midwife something and she's said it's completely normal, the next visit a different midwife tells me the opposite”.
“I feel that continuity of care would have picked up the fact that my baby had IUGR and if it wasn't for the fact that I was the one who said something didn't seem right, that it wouldn't have been picked up at all. Because everyone has their own way of doing things I feel this was missed, and this could have caused a lot of issues for my baby”.
“More guidance for first time mums from midwives after the birth of baby… More choices around the birth of your baby rather than obstetricians just saying no to something or actually taking the time to sort something out around the concerns rather than just being another appointment to get over and done with..”
“I honestly think the biggest thing for me though would be to have all the midwives on the same page in regards to breastfeeding, swaddling and co-sleeping. In the 24 hours post birth that I spent in hospital, I had 4 different midwives tell me 4 different things”.
“Continuity of care would have been great. As for why this is important, there is so much as mothers that we can't control. It would be nice to have the opportunity for choice to feel a little bit in control”.
12
Logan Together - proposed model
The Logan Together maternity project group developed a model to respond to the local context and needs for broader choice in terms of access to care and support. It has been informed by best practice evidence, service provider/hospital and consumer and community co-design. The model is summarised in the diagram over page.
The major outputs of this model are:
• Early access and information regarding maternity options • Community-based continuity (known midwife carer) maternity clinics • Culturally appropriate antenatal and postnatal care for women for whom this is an important determinant of willingness to engage • Working relationships with community health providers providing bulk-billed scans • Connection with community-based soft-entry social, emotional and health programs. • Women-centred birthing plans • Relationship-based transitional support post-birth. • Partnership with other community services including child health
The immediate and medium-term outcomes of this model are:
• All Logan women attend at least one antenatal visit in their first trimester and at least a further four visits over the course of their pregnancy • Decreased rates of obesity during pregnancy • Decreased rates of smoking during pregnancy • Women increase their participation in pre-natal, intrapartum & post-natal care • Women are more informed about their pre-natal, intrapartum & post-natal care options • Women feel supported to access pre-natal, intrapartum & postnatal care of their choosing • Increased access and referral pathways to pre -natal, intrapartum & post-natal care • Women who require/seek additional support are provided with an integrated holistic response • Women receive continuity of care through pre-natal, intrapartum & post-natal period • Women are satisfied with the pre-natal, intrapartum & postnatal care options
13
• Integrated and culturally competent service responses • Increased community connection postnatal (e.g. childhood services) • Women have Increased knowledge and confidence • In time and effective referral pathways • Integrated service response
A significant component of the model that is being proposed is widely available access to a continuum of care with known support people. This is intended to be delivered in community-based environments with continuity of midwifery care as the principal service type.
14
Conception First antenatal visit
Continuity of carer – individualised, culturally appropriate women-centred care
Fifth antenatal visit
BIRTH Postnatal care and transition
• Hospital-based midwifery and obstetric care
• Community midwife (NEW)
• GP Shared Care • Private
Obstetrician • Private Midwife
Options
Access
Communication
Known carer – delivery/primary
support (emergency/ complications)
Early skin to skin/facilitate breastfeeding
Respectful birth team
Trauma support – engage as part of team
Respite support for mothers with children
As required 24-48 hours support post
birth – universal access
Community continuity up to 6 weeks post birth
Introduction to local community
support -playgroups, Child
Health
Postnatal mental health support
and family support soft transition
Targeted support groups – Dads, grandparents,
kinship
Choice Continuity Control Safe and supported
Parenting information woman/partner
Social and emotional support - screening tool, triage process
Birthing plan: pain management, emergency response plan, birthing type and environment (where possible), post-birth plan
Medical checks – evidenced based and woman centred
Communication plan - birth
Transparent advocacy and feedback loop
15
Evidence for Community midwifery caseload The central role of midwifery in the proposed model is a design feature strongly supported by the project group. Here’s a summary of evidence that group members identified as supporting this important aspect of the proposed model: In a systematic review of 461 studies “midwifery was associated with improved efficient use of resources and outcomes when provided by midwives who were educated, trained, licensed, and regulated, with midwives being the most effective maternity carers when integrated into the health system in the context of effective teamwork, referral mechanisms, and sufficient resources”(Renfrew, 2014:1130). The reported outcomes include reduced maternal and neonatal mortality and fetal loss, reduced maternal and neonatal morbidity including preterm birth, reduced use of interventions, improved psychosocial outcomes, improved public health outcomes, and improved organisational outcomes (Renfrew et al 2014:1133). Furthermore, a systematic review and meta-analysis of >17,000 women (15 studies) demonstrated that women were less likely for their baby to be born preterm, less likely to miscarry before 24 weeks, and less likely of their baby dying after 24 weeks of pregnancy where they received continuity of midwifery care across pregnancy, labour and birth and postnatally. Additionally, there is some evidence that women were more likely to be satisfied with their birth compared to other models of maternity care (Sandall et al., 2016). These are important outcomes and highlight the necessity for initiating and maintaining engagement with women to receive this best evidence model of care. In line with consumer needs and national maternity direction this care should be culturally safe and community based with links to support and higher level services as they are required (AHMAC, 2012; AHMC, 2010). There is also evidence to suggest that women in community maternity groups attend slightly more antenatal visits, and have fewer caesarean sections (Thompson & Wojcieszek 2012) and the enabling delivery of local, high quality service ensures a high level of access for a broad spectrum of people within the community (Queensland Health 2003).
Evaluation of continuity of care in a report by Enkin et al (2000) found women attended more antenatal education, felt more able to discuss concerns, felt more in control and felt staff were more supportive during labour. The stipulation seems to be that continuity of care is provided collaboratively by midwives and obstetricians (Sandall et al). That is, caseload midwifery provided within a clinical team working together in a community maternity clinic, and showing multidisciplinary team practices effective in safeguarding the health of the mother, family and child (Caroline S. E., et al 2001).
Conversely, it has been shown that where there was not opportunity for midwifery-led continuity to women, an inequity in access to services and increase in iatrogenic interventions occurs impacting unnecessary cost and producing sub-optimal outcomes (Renfrew 2014). A framework has been determined based on these systematic reviews identifying at what level a maternity health system should work to, with midwives as primary carers for women with referral to higher services and specialist carers as required to improve maternal and neonatal safety and outcomes (Refer Box 1).
16
Box 1: Components of a health system needed by all childbearing women and newborn infants
Community feedback on the proposed model Surveys and discussions conducted by Kingston East Neighbourhood Group (KENG) with support of School of Nursing and Midwifery Griffith University revealed that 89% of respondents wanted midwifery community care and antenatal groups with 62% wanting community antenatal/postnatal education with their support person.
17
It should be noted that community engagement and initial co-design has taken place to inform a universal, more general model of support. Further work is occurring to engage, in particular, with Aboriginal and Torres Strait Islander community, culturally and linguistically diverse community in particular refugees and new settlers as well as Pacific Islander and Maori people. More about this process will be outlined in the implementation section later in this report.
Current activity What is already going on in the community to improve the life stage outcome that this project will further support? The current models of maternity care available to pregnant women living in Logan City are:
1. Public hospital-based midwifery and obstetric care for the duration of pregnancy (Logan Hospital) 2. Private obstetric care, including giving birth out of area at one of Brisbane’s private hospitals (there are currently no private hospitals in Logan City) 3. Midwifery Group Practice (MGP) – a 24 hour, seven day a week, intensive caseload midwifery model made available to a limited range of women
(<3%) with more complex social, cultural, emotional and health needs, including geographically isolated women, teenage mothers, mothers with mental health and addiction conditions, women affected by domestic violence, and women with specific cultural needs. The primary midwife is available to the women in her case load 24 hours a day, seven days a week, undertakes antenatal and postnatal home visits as required, and attends the birth of their children.
4. Public Obstetrician – General Practitioner Shared Care – women within this model of care attend the hospital for milestone appointments with the obstetrician and for birth, with the majority of antenatal and postnatal care provided by the local general practitioner of their choice. GP shared care currently accounts for the majority of public hospital shared antenatal care in Logan. GP continuity of care may continue beyond the pregnancy and into the ongoing care of the family for years/generations (ref). It accounts for the largest percentage of women birthing at Logan Hospital
5. Private Midwifery Care – A number of accredited midwives (number of midwives or % births) have established practices in the Logan area and
provide continuity of antenatal care, labour and birth, and post-natal care in the community. This includes homebirth where safe and if elected by the woman. Some of these midwives also have an Agreement with Logan Hospital for women in their care to birth under their midwife’s care and handing over care to the hospital only when the birth is assessed as requiring obstetric and anaesthetist input.
18
Other initiatives aimed at improving maternal and neonatal outcomes include:
1. A number of initiatives in place or under development with local non-government providers to better address the needs of women from a culturally and linguistically diverse or Aboriginal and Torres Strait Islander background. For example Logan Hospital will shortly commence a community-based antenatal clinic in a new Access Community Services Inc facility under development in Logan Central.
2. The Mums and Bubs Post-natal Home Visiting Program – a government-funded initiative to ensure that all women living in the Metro South area can choose to have home visits by a midwife in the first / second and fourth week following birth. This is irrespective of whether or not they give birth in a private or a public hospital. In the Logan area this service is largely provided by contracted private practicing midwives. The Brisbane South Primary Health Care Network, which administers the program, also makes phone contact with these women throughout the first twelve months after birth to encourage them to attend their general practitioner for child health check-ups and immunisation schedule. This program is currently being evaluated.
3. Child Health Service offering post-natal support inclusive of extended home visiting, early feeding drop in clinics, child health checks and universal and targeted group support.
Program logic The logic model over page places the proposed model in its theoretical and local context and describes how community outcomes will be advanced.
19
20
Baselines and goals Collective impact approaches thrive on very clear, tangible and measurable goals guiding project activity. For the Community Maternity Services project, a range of very clear population level data illustrate the objectives of the project:
Population level impact
Low birthweight (<2500 grams) – First Goal: 7.4% to 6.6% OR 345 babies
Low APGAR 5 (<8) – First Goal: 3.9% to 1.7% OR 952 babies
Premature (<37 weeks) – 10.5% to 9.3% OR 518 babies
Immediate/medium term outcome
Low Antenatal visits- First Goal: 9.6% to 4.9% OR 525women per year
21
Project plan outline
Project title
Logan Community Maternity Centres
Maternity project group facilitator/s and participants
The following community members, practitioners, service providers and academics, provided their time, experiences, skills and knowledge to develop the below model of care.
The process to arrive at a model involved:
• Identifying the population level problem and identifying data sources • Building relationships across the group through developing an ideal model of support – informed by research, service provider and community
member experiences • Developing a working group to establish deliverables, outcomes and outputs • Making an observational visit to the Royal Brisbane Women’s Hospital to learn about their model • Aligning to the identified needs of the family.
Name Organisation/type of representation Dr Jocelyn Toohill FACILITATOR School of Midwifery, Griffith University Professor Jenny Gamble FACILITATOR School of Midwifery, Griffith University David Eastgate FACILITATOR Director, Metro South Health – Access and Equity Unit Karen Gould Clinical Consultant, Maternity team, Logan Hospital Amanda Spiers A/Midwifery Unit Manager, Logan Hospital Lisa Maher A/Nursing and Midwifery Director, Women and Children’s Service, Logan
Hospital Andrea World Community member and Queensland President, Maternity Choices Michael Hall Community member and Mid-wife, Beaudesert Hospital Melanie McKenzie CEO, Harrisons Little Wings Caitlin Withers Community member and local Mum Karen Sinclair Logan Together
22
Dr Kim Nolan GP, GP liaison/Clinical Lead (BSPHN) to Logan Hospital Holly Rynsent Community Development Worker, Communities for Children Kylie Jackson Coordinator, KENG Wendy Kastelein Nurse Unit Manager, Children Health Queensland Rani Scott Peach Trees Perinatal Wellness, Griffith University Andrew Mayfield Team Leader, Immunisation unit, Logan City Council Angela Kerslake Principal Child Protection Practitioner, Child Safety Ruth Wall PHN South Kris Saunders Logan Community Alliance Rosslyn Vroom Dads the Word Toni Randall Private Midwife, Midwives First
Establishing the Model: Detailed design phase It is proposed, based on best evidence, that a social model of care be made available that aligns to:
• women’s individual needs (is women-centred)4, • is delivered through primary continuity of midwifery care in community based maternity hubs that are culturally appropriate • providing soft entry to integrated holistic health services (for example social work, child health, drug and alcohol services, perinatal mental health
and grief services, childcare, housing, and programs that sustain social and couple relationship building) and • integrated to higher level hospital maternity, neonatal and support services within a strong clinical governance structure.
The principles underpinning the model are: safety (cultural and clinical), continuity, choice and control.
To progress the model a detailed design process will need to be undertaken and resourced. It may be desirable for the project manager identified to oversee the detailed design phase to then transition to a hands-on director of service role once the service is established, but this will be determined later.
The detailed design process will determine the precise shape, resourcing and operating arrangements for the model, but thinking on the core elements of the model is set out below.
4 Woman-centred care focuses on the woman’s unique needs, expectations and aspirations; recognises her right to self-determination in terms of choice, control and continuity of care; and addresses her social, emotional, physical, psychological, spiritual and cultural needs and expectations (ANMC 2006). It also acknowledges that a woman and her unborn baby do not exist independently of the woman’s social and emotional environment, and incorporates this understanding in assessment and provision of health care. Department of Health. Australian Government
23
Governance On 6 October 2016, the Logan Together Maternity Project Group (7, 8, and 9) met with Metro South Health - Logan Hospital and Child Health Queensland Health and Hospital Service executives (the statutory bodies responsible for birthing and baby health in Logan). The group provided in-principle support for Option 3: Organisations commit to a common governance arrangement for a specific business purpose/overlap but maintain separate, independent governance and funding.
They felt that option 3 allows entities to have control over their own business/risks but at the same time being held accountable to the community and other stakeholders for implementation of agreed upon philosophical, clinical/practice and programmatic frameworks.
Option 3 promotes genuine collaboration and contains governance mechanisms including service level agreements to ensure accountability and effective dispute resolution. Below is an outline of the Option 3 scope. A representative working group will further the development and implementation of the model in conjunction with an independent organisation skilled in public health governance development.
Community governance group Metro South Health
Program model Agreed to and reviewed Operationalised in partnership with community sites (oversee midwifery staff and operations)
Philosophical approach
Developed and agreed Operationalised
Practice model and framework
Practice framework agreed to through service level agreement
Operationalised by Metro South Health – operational report back to Community Governance Group to ensure integrity of model
Risk – Risk management
Discussed through operational reports, practice examples
Managed through Metro South Health. Final decision-maker.
Legal Legal liability and insurances
Financial Shared ownership of funding sustainability and Owner of operational resources and funding/financial
24
sustainability strategy management (midwifery staff
Infrastructure
Shared through service level agreements – community agency
Client and community focus
An agreed co-production (co-design, co-construction and co-review process)
Service level agreement
Developed, agreed to and reviewed – including dispute resolution processes
Philosophy The philosophy of the social model of maternity care should be clearly articulated, agreed and endorsed by the Steering Committee and be the ongoing reference point for ensuring decisions of the Committee remain consistent and directly aligned to this intent. The philosophy will be the beacon and glue for sustaining the model.
Prototype sites It is suggested that 6 sites be prototyped for application of this model, with the role out schedule dependent on funding availability. Once funding is secure and a governance process had been established, detailed co-design with community members from each site as well as implementation planning would take place prior to delivery.
An outline of the first three candidate sites follows. Each will need to be explored during the detailed design phase for suitability and operational requirements.
Kingston East Neighbourhood Centre (KENG)
Kingston East Neighbourhood Group Inc. (KENG) is a non-profit, non-government organisation that has served the Logan community for over 30 years. KENG provides an integrated service model that is inclusive of early parenting services, family hub, Communities for Children program, family support, counselling, HIPPY, emergency relief, transitional housing, community development and occasional childcare. KENG’s focus is to strengthen families through connection, empowerment, education and support.
25
KENG provides a number of soft-entry programs including early childhood education, baby massage, mother and baby clinics and playgroups. KENG has existing collaborative partnerships with many agencies in Logan including Communities for Children, Perinatal Wellness and Child Health.
Early Years Centre – The Benevolent Society
A one-stop-shop family hub in Browns Plains with everything from free drop-in infant health services to playgroups, cooking with kids classes and parenting support. Other on-site services include a wide range of parenting, early childhood education and care, and health services making life easier for families as well as some child care and kindergarten programs, which have a strong focus on the social and emotional development of young children.
The Early Years Centre has well-developed infrastructure and existing rooms which could easily be fitted out to support antenatal clinics.
The Family Place: Eagleby and Beenleigh – Wesley Mission
Wesley Mission provides a range of services for children, young people and families. Wesley Family Centres were established out of the recognition that the best way to care for children was to work with the whole family. The Beenleigh Family Centre Child Care is a long day centre that operates out of the Beenleigh Family Centre. The centre is small and unique offering care to children aged 2.5 to 5 years of age. There is a strong focus on building positive relationships with children, families and the community.
The sites have been selected for prototyping for the following reasons:
• Good connections with highly vulnerable community members in safe and welcoming setting – more chance women will connect and attend antenatal visits, build consistency of relationship
• Already established soft-entry programs for parents and children at different ages e.g. playgroups • Centre of community – able to undertake outreach and have other services attend and provide support • Capacity to build further infrastructure and links to hospital support • Already providing a hub service with connecting services and outreaching to community • Has the space to support infrastructure • Services the population groups that are being targeted in this universal strategy.
Logan Together is also working with other population groups and sites across the community including Pacific Islander and Maori communities, ACCESS Community Services and the Aboriginal and Torres Strait Islander community to engage in co-designing models of support relevant to them. At this time, it is proposed to stagger the implementation of these sites after commencement of delivery starts on the first three above.
26
This approach does not exclude other sites from becoming prototypes into the future.
Partnership development
Given the wide range of stakeholders who will be coming together to deliver the proposed model, attention should be given to the partnering process itself as part of project development and the ongoing operation of the service. To this end a range of partnering development resources and workshops are available to stakeholders in coming months. The project group strongly endorses the notion that partners to the proposal avail themselves of these opportunities as a foundational element in project establishment.
Access to the proposed new community-based services The aim is to improve women’s choice and access to care. Women can:
• self-refer – may be opportunistic • GP refer – specifically disadvantaged women who are unlikely to engage • Hospital clinic referral • Referral from community centre/ community worker.
Detailed information about the maternity services available in the Metro South Hospital and Health Service area – including in Logan – is already available at Metro South Health’s maternity services home page. This will be adjusted to include the additional services proposed in this model, and can be used by Logan Together to promote their availability. Promotion of the prototype sites can also be supported by the Brisbane South Primary Health Network, particularly to local general practitioners and other health care providers.
Typically, referrals into the model should be focused on the service closest to the woman’s residence with exploration and support for a preference that varies to this. There may be cultural or social issues informing the woman’s decision-making. Women accessing the maternity hubs are to be provided with their options for care. Queensland women indicated they most preferred to decide for themselves on a model of care after talking over options with a care provider. Women most want to know all models of care options, pros and cons of these options, cost (including out of pocket expenses) and after hours contact support. (Stevens et al, 2016).
Program support workers will support with engagement of vulnerable and difficult to reach women in conjunction with non-government organisation staff and will connect already engaged pregnant women into the program.
The non-government organisations (in conjunction with community members) will develop/source information packages customised for local women and deliberate engagement and communication strategies regarding service/options.
27
Women will be supported to engage through home visits where required and other means.
Antenatal Care The schedule of care should aim to be consistent with the National Antenatal Care Guidelines – Modules 1 & 2 (AHMAC, 2012b, 2014) and recorded in the Queensland Health pregnancy handheld health record. The Guidelines complement the Australian Dietary Guidelines, the Australian Guidelines to Reduce Health Risks from Drinking Alcohol, the National Perinatal Depression Initiative and the Australian National Breastfeeding Strategy 2010-2015. However, care may only occur opportunistically if women are slow to engage. As such, both scheduled appointments and drop in clinics are intended to be provided and negotiated for applicability and frequency at each hub for integration with other services by each midwifery group practice.
Antenatal education and care for hard to reach groups are best provided within women centred/women led group sessions to promote social support (Rising, 1998). This is not a new concept for Logan Hospital but would be integrated to current maternity hub activities/services where women can engage with other women that enhance lifestyle choices, e.g., healthy cooking and eating activities. Supportive group sessions have shown improvements in perinatal outcomes i.e. increased birth weights in lower socio economic groups, reduced pre-term births, improved breast feeding uptake and retention, improved maternal confidence. This approach has also shown to improve education and support for women as well as provide antenatal continuity with a small group of midwives.
Ideally women of similar gestations would come together in small groups with a midwife/student facilitator of the group. Women’s antenatal learning occurs together and whilst the session would be around a theme e.g. managing labour or birth plans etc., it is the women that drive the discussion and they learn from each other rather than traditional didactic learning. Women are also encouraged to take an active role in their health; for example by recording their weight, blood pressure, baby’s heartbeat. Woman led group sessions would occur for 10 – 12 women per session over a period of 90 - 120mins, possibly 2 sessions a week for different groups dependant on demand, and coordinated to coincide to other hub activities (child health nurse, drug and alcohol support etc.). It would be expected that at a minimum 2 half days to a maximum of 2 full days per week (dependent on demand) would be required for woman led group sessions and appointments, but also availability to a midwife at the hub for women to talk to a midwife about care options. Therefore, the group practices may grow according to demand and oversight of this is required due to the midwives’ caseload numbers.
Midwife appointments would be scheduled alongside these sessions including for hospital booking-in appointments (to capitalise on contact with hard to engage women) and to schedule additional needs or support. Two midwives would be required to attend each clinic and should be inclusive of a midwifery student. This could specifically encourage midwifery student led clinics where one to one supervision of clinical care is directly provided to grow workforce readiness and capacity (Wagner et al, 2007). It is expected a minimum of 2 half days extending to 2 full days will occur as the model builds where group antenatal sessions along with scheduled 1:1 appointments are provided.
28
Negotiation with the communities accessing local hubs will determine if group or individual appointments are more appropriate, for example CALD women. However, opportunities for connected and meaningful interactions with other women should be instigated to build social capacity, reduce social isolation and improve perinatal mental health.
Antenatal couple / parenting sessions should be determined as an addition to the package of pregnancy group sessions, with partners encouraged (where the woman desires) to attend appointments. If required/assessed, it is also an opportune time to support couples/women and their partners to build stronger supportive relationships.
Childcare – sessions / appointments should coincide with onsite childcare where this is available.
Interpreter –women should be encouraged to hubs with this facility in place or ensure this has been booked. Interpreter services are already ‘free’ to women who attend government-provided health services. This includes any maternity services provided by Metro South Hospital and Health Service in a community setting. The same applies to women receiving care in general practices. These interpreter services are available by phone or in person, depending on urgency.
Booking in Appointments – Conducted within the hub within allocated antenatal appointment calendar, that should also have unallocated appointments to facilitate opportunistic presentations.
Pregnancy testing kits should be available within the hubs where women present uncertain and without resource to confirm a suspected pregnancy.
Pathology testing (routine bloods and urinalysis) would be undertaken by the midwives and arrangements in place with a local pathology service / hospital to facilitate delivery / processing and reporting of results. A link midwife at the hospital should be identified for tracking results if not immediately available or accessible to the caseload midwife. Bulk billing for these procedures is complex and needs to be investigated with local services. Midwives are responsible for following up results of any test they order.
Ultrasound - Where the woman has not had an ultrasound this is to be facilitated (ordered) by the midwife with arrangements in place with local providers.
Medical referrals - Where possible, referral to a doctor/obstetrician of identified pregnancy risk should be facilitated within the hub. If visits occur in the hospital, the midwife would attend these visits with the woman to maintain support and engagement. Pathways for this must be established in relation to contact for securing appointment and escalation of need where required (such as an identified link midwife in the hospital). Women with pregnancy loss or known pregnancies where the baby is incompatible with life are to remain within midwifery continuity and linked to community support (e.g. Harrison’s Little Wings).
Multidisciplinary case conferencing - Where there is a non-urgent requirement for referral the woman’s history and results of investigations would be relayed at the routine multidisciplinary case conference – this is to be clearly articulated with whom, where and when these regular meetings are to occur
29
upon setting up the model. Documentation of case conference discussions are to be documented in the woman’s medical record and communicated with the woman. Additional to obstetric case conferencing, social issues may warrant the midwife attending psycho-social case management meetings. A process for how this should occur is to be determined or if communication should occur through with appropriate psycho-social support by another means.
Birth planning should be discussed throughout pregnancy with introduction of recording the woman’s wishes within the Queensland Health pregnancy handheld record. The birth plan should be revisited where the woman’s health status changes to identify how best to facilitate the woman’s wishes and avoid disappointment or development of trauma symptoms where the woman is not prepared for the possibility of intervention.
Other support services – women should be introduced or offered referral to services e.g. child health, drug and alcohol services, preferably in partnership through soft handover. It may be that families identified to have social risk factors should be introduced during pregnancy to child health staff and supports.
Home visits – to assess social and home environment midwives should plan at least one home visit with the woman during pregnancy and this could specifically be to review the birth plan. Additionally, if the partner has not been involved in care to date, and has not met the midwife before, this visit will provide for this introduction, and also assist preparation for labour. Early labour assessment could also occur in the home or the midwife meets the woman at the hospital/hub dependent on the woman’s resources and clinical situation, and the location of the midwife at the time of contact.
Intrapartum Known carer for birth – the primary midwife will attend the woman in labour and birth unless off call. If off call the primary midwife’s group practice partner will attend or if her hours have expired for the day, another of the group practice partners is to attend. If the woman is within a student midwife’s caseload she will also attend. The local agreement will determine caseload numbers.
Place of birth – Women are to be fully informed of pros and cons of birth choices. At this time home birth is not an option within the hospital employed midwife caseload model.
Women may of course choose to separately engage an eligible midwife. Eligible midwives providing care within the Logan catchment can seek to arrange access rights at a hospital close to the woman’s residence.
Postnatal Women’s continuity with her primary caseload midwife (and backup caseload partner/s) continues to six weeks postnatal. Where appropriate, women may elect to have early hospital discharge at 6 hours following birth. Midwives are to be competent in newborn assessment. The midwife would provide all maternal and neonatal care including neonatal screening (e.g., newborn screening test, healthy hearing) and contraceptive advice. Support for breastfeeding would be facilitated through women having 24 hour access to support. In hubs where breastfeeding support services are established women would be also made aware of this. The schedule of visits to six weeks should be determined on the needs of the woman, baby and family with all visits in the first week occurring in the woman’s home. Visits after this time may be appropriate within the hub.
30
Well baby check with the GP and appointments with child health are to be facilitated by the midwife. Based on circumstances in partnership with child health may have been introduced to the woman during her pregnancy with intention of early postnatal contact with the family. As such the midwife in partnership with child health should co-ordinate care and ensure advice/information/support is not duplicated and is consistent in the management of care. Most hub sites have Child Health operating from these sites so introductions and appointments should be coordinated where possible.
Some families face additional challenges that can negatively impact on attachment. These include poverty, relationship conflict, domestic abuse, mental illness and substance abuse. Such families will require additional more intensive and coordinated support. Access to universal primary prevention and targeted secondary prevention programs across both pregnancy and during the first year of a child’s life is imperative. Intervention attachment theory programs such as, Circle of Security, which is designed to alter the developmental pathway of parents and their young children, (i.e. children’s use of the caregiver as a secure base from which to explore), can be offered in partnership within the community. It is accepted that depression related to pregnancy and birth can affect mothers, but it is important to remember that fathers/ partners are also at risk. Research shows that approximately five per cent of men experience depression in the year following the birth of their child. This risk increases if their partner is experiencing mental health problems. Depression and anxiety are common during pregnancy and in the first year after a baby is born. Depression affects up to one in 10 women during pregnancy, and almost one in seven women in the first year after the birth. Adjusting to this major life change, as well as coping with the day-to-day demands of a new baby, can make some people more likely to experience depression, anxiety or other mental health conditions at this time, particularly if they've experienced a mental health condition in the past. (Beyond blue). Women should be encouraged to attend postnatal group meetings with their baby to maintain and grow connection with other women and preferably at least one of these be facilitated within a group they formed during pregnancy. The family should also be provided and linked to additional supportive care or services promoting healthy relationships and early parent transitioning such as couple care baby massage and so forth. A number of these soft-entry programs are already available from child health services and other NGO’s within the prototype/hub sites.
The family should be encouraged to build community through resources available within the hub and Logan city. Therefore, the caseload midwife will utilise the knowledge of the host hub personnel to link families with available community services. The midwife will refer/escalate any medical or psycho-social issues requiring additional care with appropriate agencies or personnel with clear pathways in place and a documented plan. Where women have been reviewed within a case management team for psycho-social risk factors the midwife will negotiate her exit from this process ensuring appropriate plans are in place. A discharge summary will be provided to the GP and other relevant agencies. At discharge, the full set of notes will be stored in the woman’s hospital record. Women will have been advised the schedule of visits within the model at entrance and reminded early in the postnatal period that the last visit with her caseload midwife will be around 6 weeks where the midwife will work in partnership with child health to ensure a continuum of care for the woman and her baby. The midwife will ensure the immunisation schedule is understood, the woman is linked to child health and if she doesn’t have a GP is aware of where she can receive support for depression or other health issues. Where the woman has experienced pregnancy loss, stillbirth or neonatal death she will be linked to appropriate support services (e.g., social worker, SANDS).
31
Indicative Resourcing
Options for Staffing Staffing models and associated resources will be determined during the detailed design phase. Also, there is likely to be a scaling up process at the commencement of service delivery, so not all resources will be required from the outset. A further aspect of future project development will be the marketing and communication strategies to let women and local service providers know about these new options. However some indicative scope is offered here to bring some concrete form to the proposed model. Final resource requirements may vary substantially from these indicative figures.
Based on 2013-14 peri-natal data (Queensland Health), the below table provides a summary of potential annual demand.
This service will be universal in nature, in that, it is open to any women who would like to receive maternity support through community clinics. It is however, initially being targeted in communities where we know women are not engaging in safe levels of antenatal and post-natal support. Once the service is better known to the community, it is anticipated that the demand will meet supply.
To provide for higher fluctuating numbers of women accessing the service and avoid disengagement, consideration should be given to contracting the services of eligible midwives at high peaks of midwifery continuity demand. Where this demand is sustained, expansion of the model with recruitment of staff should not be delayed. Additionally, the model will be supported by midwifery students, graduate midwives, experienced academic clinicians/lecturers. Staff (paid or unpaid) providing care within the model are to meet agreed professional and safety requirements (to be determined by the governance committee).
Low Antenatal visits Annual target Logan LGA 525 KENG (focus on Kingston, Loganlea, Slacks Creek, Woodridge, and Springwood) 142 EYC (focus on Browns Plains, Regents Park, Park Ridge, Heritage Park, Marsden, Crestmead)
106
Family Place (focus on Eagleby, Eagleby South, Beenleigh) 71
Staff complement may vary according to cultural need (for example, a health worker may be integral to the woman’s care). Where women are being cared for with high psycho-social need or complex pregnancies the midwives caseload may vary from 35 to 40 women per year (as agreed within local agreement). However, all women are to receive care within a midwifery continuity arrangement, to ensure consistency of information, development of a trusting relationship, a known carer for labour and birth, and continued care to at least six weeks during which time women have been linked to ongoing services.
32
It is anticipated for a change in health outcomes to be demonstrated at the population level that the model will need to provide care for 525 women per annum. As such, the following staff complement is suggested for implementation initially across the three sites with expansion to three other sites – once a model of support is designed with further partners such as Hosanna Church, ACCESS Community Services and the Aboriginal and Torres Strait Islander community/Aboriginal and Torres Strait Islander Community Health Service. Staffing model servicing up to 6 community sites (at maturity)* *Indicative only for illustrative purposes and likely subject to significant variance. Not inclusive of services that work in partnership. Project Manager (transitioning to Services Manager)
1.0FTE $123,000 (plus on-costs)
Administration officer 1.0FTE $ 60,000 (plus on-costs) Health Worker 1.0FTE $ 60,000 (plus on-costs) Caseload Midwives 6.5FTE (NO6)
7.0 FTE (NO5) $780,000 $756,000
Practice Development Midwife 0.5FTE (NO7) $ 53,000 (plus on-costs) $1,832,000.00 approx The caseload model of care will exist within a partnership framework. Partnership arrangements may be negotiated between two or three midwives. This partnership will work in close unison allowing each midwife the opportunity to develop close relationships with their partner’s women. These relationships will be fostered through shared antenatal group sessions/education classes and antenatal clinics.
Midwives will carry mobile phones to enable women to contact them at all times. Home visiting for antenatal and postnatal visits and possibly early labour assessments is a feature of the model of care, and particularly for hard to reach (engage) women.
The midwives will share an on call roster system whereby they are on standby to provide care for their partner’s women as well as their own. This equates to a system whereby each midwife, when on call, could be on call for up to 12 women.
As a partnership, each midwife is available to take over care of their partner’s labouring women or undertake their appointments if either is required to work for more than 12 hours straight or per EB agreement.
Community partner resources and staffing Part-time program support workers would be employed by non-government host organisations and assist community midwives through the following:
• Engaging women, particularly more vulnerable women from the community • Providing general information about choices for maternity support
33
• Supporting transportation of women to and from home and appointments • Supporting the transition of women into other soft-entry programs within the site and outside of.
Non-government organisations would also receive a percentage of funding to support managerial time invested in the governance, reception and housing of the service.
Resourcing per site for community partners*
**indicative only for illustrative purposes and likely subject to significant variance Program Support Worker 0.4 FTE (SACS 4 – QLD ) $20,000 (plus on-costs) approx Manager 0.2 FTE (SACS 8 - QLD) $15,000 (plus on-costs) approx Administration support 0.4 FTE (SACS 2 – QLD) $13,000 (plus on-costs) approx Occupancy and operational costs Provisional estimate $20,000 approx
Operational resources The following resources would also be required to support the projects (and not inclusive of partnering or follow-on support service equipment):
• Organisational costs e.g. photocopy equipment, telephones, electricity, and examination room set-up, room for group sessions, tea and coffee, food preparation, insurances. This would be provided to the organisation supporting the midwives. $ TBC.
• IT - Internet connection, IPad for recording psycho-social screening (ICOPE) for each midwife, IT for ICHOM – International Consortium for Health Outcomes Measurement (this represents a significant system change across service and considerable IT investment with support required from Queensland Health,. $ TBC.
• Maternity Hub for coordinating community based primary maternity centre (including meetings – e.g. team, audit, case review etc. – CPD, store equipment, etc).
• Educational equipment and resources - consumer decision aids pamphlets/videos, list of support services and resources in the area, emergency contact numbers/folders, additional education sessions that can be accessed within and outside of the hub such as couple classes, VBAC classes
• Midwife equipment – approx. $60,000 for setup $20,000 per annum thereafter • Clinical needs – midwife bag , handheld records, scales, urine testing, pathology equipment including pathology requests slips, disposable gloves,
blood containers and sharps, thermometers, disposable speculums, examination table (linen and/ or disposable covers), good lighting source, doppler, sphygmomanometer and stethoscope, educational materials, access to hospital records (electronic or paper based), diaries
• Mobile phones - each midwife and manager are to carry a mobile phone (13 phones) – $TBC.
34
• Vehicles - The industrial agreement would outline if midwives would use personal vehicles and receive reimbursement or if cars would be leased. If cars are to be leased one vehicle per hub should be available for home visits and transportation of equipment and clients. Approx. $7,000/vehicle lease/year
• Access to interpreter service – investigation if additional services required.
Indicative estimated total resourcing
Per Site (6): $364,000
Total – 6 sites: Between $2-2.5M.
35
Future considerations
As noted, further co-design work will be undertaken with Hosanna Church, ACCESS Community Services and the Aboriginal and Torres Strait Islander, and Pacific Islander communities to understand what model of support is appropriate for them and also how this might work with existing services. The model and resourcing estimates above provide a guide only in this instance.
There is also strong interest from community stakeholders in the future development of a community-sited birthing centre in the Logan area. This was identified by community within community forums as being one of the three top initiatives requested. Subsequent discussions amongst participants of the Logan Together Action groups 7,8,9 confirmed agreement for this initiative however, agreement by potential funders and existing government maternity service providers is yet to be achieved.
There should also be consideration given to strengthening GP shared care in prototype areas as an option for women and strategies identified to engage GP’s further.
36
Implementation considerations
The following table provides an outline of milestones and timeframes for detailed design and implementation – across the 6 sites.
Milestone Timeframe CSLT endorsement 14 October 2016 Initial co-design Phase 2 sites August – December 2016 Detailed co-design, costing and implementation planning –Phase 1 sites Jan-June 2017 Establishment of working group and governance group October – December 2016, January 2016 Design and develop shared outcome framework January – June 2017 Detailed co-design, costing and implementation planning –Phase 2 sites January-June 2017 Commence delivery Mid 2017
37
Primary stakeholders
Organisation What is the reason for engagement? Metro South Health Management of community midwives, member of governance – midwifery, obstetrics, paediatrics; case conferencing
coordination Non-government organisations
Hosting of community midwives, managing of program support officers, partner to Metro South Health in delivery, provision of infrastructure/hub, linking to other programs, member of governance, co-production coordination across community groups
Griffith University Research, Community and professional engagement, Provide pre-midwife registration and registered midwife professional development, Member of governance, Advice of best practice, Partner to governance, outcome framework, reviews
Consumer representative e.g. Maternity Choices
Provision of consumer feedback, engaging and feedback processes in conjunction with NGO and Metro South Health, member of governance, advocate for women
Child Health Provision of child health services and post-natal transition with NGO/midwives, member of governance Community members Member of governance, member of co-design, co-implementation, co-review processes Queensland Health Sponsor oversight, implementation oversight Logan City Council Immunisations GP representative Interface with Logan GPs, referrals, shared care PHN South Service integration, GP networks
38
References
Allen J, Kildea S & Stapleton H. 2016. How optimal caseload midwifery can modify predictors for preterm birth in young women: integrated findings from a mixed methods study. Midwifery, http://dx.doi.org/10.1016/j.midw.2016.07.012.
Australian College of Midwives. 2013. National Midwifery Guidelines for Consultation and Referral. 3rd Ed, Issue 2. Australian Capital Territory.
Australian Health Ministers’ Advisory Council (AHMAC). 2012a. National Maternity Services Capability Framework. Standing Council on Health and Community & Disability Services: Commonwealth of Australia.
Australian Health Ministers Conference (AHMC), 2010. National Maternity Services Plan. Australian Health Ministers’ Advisory Council: Commonwealth of Australia.
Australian Health Ministers’ Advisory Council (AHMAC). 2012b, Clinical Practice Guidelines: Antenatal Care – Module 1. Australian Government Department of Health, Canberra http://www.health.gov.au/antenatal
Australian Health Ministers’ Advisory Council 2014, Clinical Practice Guidelines: Antenatal Care – Module II. Australian Government Department of Health and Ageing, Canberra. http://www.health.gov.au/antenatal
Centering Healthcare Institute. Accessed 26th July 2016. https://www.centeringhealthcare.org/what-we-do/centering-pregnancy
Durack L. 2016. Logan plans for a Health and Knowledge Precinct. Griffith News. https://app.secure.griffith.edu.au/news/2016/07/15/logan-plans-for-a-health-and-knowledge-precinct/
Gray R, Bick D & Chang Y. 2014 Health in pregnancy and post-birth:contribution to improved child outcomes. Journal of Children’s Services. 9 (2), 109-127.
Harris J & Wells M. 2016. State of Australia’s Mothers. Save the Children Australia. www.savethechildren.org.au
Hirst C. (2005). Rebirthing - Report of the Review of Maternity Services in Queensland. Queensland Government: Brisbane.
International Consortium Healthcare Outcome Measures (ICHOM). 2016. Pregnancy and Childbirth. http://www.ichom.org/medical-conditions/pregnancy-and-childbirth/
Kingston East Neighbourhood Group. 2015. Draft Findings: Women’s preference for place of maternity care survey.
39
Logan City Council. 2016. Logan City SEIFA - disadvantage by Local Government Area. Accessed 26th July, 2016. http://profile.id.com.au/logan/seifa-disadvantage.
Logan Together Project (2015). https://logantogether.org.au/
Metro South Health. 2016. Draft Report Maori and Pasifika Women and Newborn Health Forum, 18th April 2016
Menke J, Fenwick J, Gamble J, Brittain H & Creedy D. 2014. Midwives perceptions of organisational structures and processes influencing their ability to provide caseload care to socially disadvantaged and vulnerable women. Midwifery. 30, 1096–1103.
Midwifery and Maternity Provider Organisation Australia (MMPOA). http://www.mmpoa.com.au/
Neale A & Wand A. 2013. Issues in the evaluation and treatment of anxiety and depression in migrant women in the perinatal period. Australasian Psychiatry 21(4) 379–382.
Priday A & McAra-Couper J. 2016. A successful midwifery model for a high deprivation community in New Zealand: A mixed methods study. Intentional Journal of Childbirth. 6(2), 78-92).
Renfrew M, McFadden A, Bastos M, Campbell J, Channon A et al. 2014. Midwifery and quality care: findings from a new evidence informed framework for maternal and newborn care. Lancet. 384: 1129–45.
Rising S. 1998. Centering pregnancy. An interdisciplinary model of empowerment. J Nurse Midwifery. 43(1):46-54.
Ryerson University. 2016. Ryerson midwifery professor supports Inuit women to bring birth back to Nunavik. Research news. http://www.ryerson.ca/research/news/2016/0505.html
Sandall J, Soltani H, Gates S, Shennan A & Devane S. (2016) Midwife-led continuity models versus other models of care for childbearing women. Cochrane Library. DOI: 10.1002/14651858.CD004667.pub5
Stevens G, Miller, Y, Watson B & Thompson, R. 2016. Choosing a Model of Maternity Care:
Decision Support Needs of Australian Women. Birth, 43 (2), 167-175.
Utz M, Johnston T & ZarateD. 2015. Trends in stillbirths and deaths among babies born to Indigenous and non-Indigenous women in Queensland, 1989-1993 to 2009-2013. Statbite#64. Health Statistics Branch: Queensland Health.
40
Van Wagner V, Epoo B, Nastapoka J & Harney E. 2007. Reclaiming birth, health, and community: midwifery in the Inuit villages of Nunavik, Canada. J Midwifery Womens Health. 52(4):384-91. DOI: 10.1016/j.jmwh.2007.03.025.
WHO. 2006. Quality of care: A process for making strategic choices in health systems. Geneva: World Health Organization.
1
Early Detection and Support for Developmental Wellbeing
DRAFT MODEL & DIRECTIONS
Logan Together Early Detection and Support Project Group
October 2016
2
Contents
1. Introduction .............................................................................................................................. 3
2. Foundation roadmap connections .................................................................................... 4
3. Population snapshot .............................................................................................................. 6
4. Potential measures for development .............................................................................. 7
4.1. Process Measures ................................................................................................................... 7
4.2. Target Outcomes .................................................................................................................... 7
5. Earlier detection and support for Logan kids – proposed theory of change ... 8
6. Overarching principles ....................................................................................................... 10
6.1. Proportionate Universalism .............................................................................................. 10
6.2. Reflective Practice ................................................................................................................ 10
6.3. Evidence Based Practice .................................................................................................... 10
6.4. No Wrong Door ..................................................................................................................... 10
6.5. Innovation ............................................................................................................................... 11
6.6. Multiple Strategies ............................................................................................................... 11
7. Ages and settings ................................................................................................................. 12
7.1. Birth to 12 months .............................................................................................................. 12
7.2. 12 months to 5 years ......................................................................................................... 12
7.3. 5 years to 8 years ................................................................................................................ 13
8. Priority action areas ............................................................................................................ 15
8.1. Data Mapping and Collection Project ............................................................................ 15
8.2. Better Referral Capability ................................................................................................. 16
8.3. Parents as First Teachers Initiative ............................................................................... 18
8.4. Build the capacity of early education and care settings via multidisciplinary
support ..................................................................................................................................... 19
8.5. Maximise participation in early detection services.................................................. 20
8.6. Integration with existing and emerging platforms, programs, networks and
settings .................................................................................................................................... 21
8.7. Community wide public health social marketing campaign ................................ 22
8.8. Develop appropriate and effective governance structures .................................. 22
8.9. Risks .......................................................................................................................................... 23
3
1. Introduction
The early years of a child’s life provide the foundation for future heath,
development and wellbeing. There are many elements that contribute to a positive
start in life including secure attachment, safe environments, breastfeeding, good
nutrition, and access to health services and early learning opportunities but to
name a few.
These elements directly influence children’s physical, social and emotional
wellbeing, as well as their ability to develop the skills and personal resources they
need to live happy, healthy lives. When a child experiences health and
developmental challenges, it is critically important that they be identified and
appropriately responded to as early as possible to minimise longer term outcomes.
Families in Logan already benefit from a wide range of services which support a
good start. During pregnancy, parents can access maternity services through both
government and non-government organisations which support healthy pregnancy
for mother and baby. From the day of birth, newborns are screened for normal
growth and development. Home visits can be provided by midwifery and child
health services and are available to families from the time they leave hospital.
Child health clinics are available in communities and provide a universal service
for all families. Both the home visiting services and child health services provide
support for family and baby in regards to physical and emotional health and
wellbeing. When concerns arise during visits, referral processes are in place which
can connect families to the support they need to manage their child’s ongoing
care. There is also a wide range of programs and services provided by not for
profits, primary health care and non-government agencies which support children
and families in a variety of settings to promote optimal health and wellbeing.
Unfortunately, despite these considerable measures, some children continue to
“fall through the cracks” of the early identification and support system. For a range
of reasons that we are working to better understand, a proportion of children in
Logan are either not accessing, or not sufficiently benefiting from the services and
programs in place. For some kids, health and developmental issues go un-noticed,
un-diagnosed, or under-managed, sometimes until school age where they are
expected to participate and learn like other children. This places them at a
significant disadvantage, and diminishes their life chances before formal education
has even begun.
These concerns where echoed and during Logan Together’s community wide
consultation for the development of the Foundation Roadmap, and have
subsequently been prioritised for action through the establishment of the Early
Detection and Support Project Group.
4
2. Foundation roadmap connections
The Early Detection and Support Project and its priority action areas are pivotal to
the achievement of Logan Together’s overarching goal of closing the gap in rates
of healthy development for Logan children at age 8. Earlier detection, and the
provision of appropriate earlier intervention supports will result in reduced
numbers of kids with health and developmental vulnerabilities and concerns at
every age, and contribute to Logan Together’s Big Result targets.
Figure 1 & 2. The BIG results
5
The Foundation Roadmap identifies Big Influences which are further measures of
important determinants of child development and wellbeing. The Early Detection
and Support Project also aims to contribute to the following Big Influences:
Table 1. Big influences of relevance to the Early Detection and Support Project
Figure 3. Prioritised Strategies
- Attachment - % of Bubs forming a secure bond of attachment with a primary care giver
- Breastfeeding – % of children breast fed for 6 months or longer
- Social emotional wellbeing - % of children reaching social emotional wellbeing benchmark at
age 3
- Learning support
o % of children attending pre-school readiness programs
o % of children whose parents support their reading at home (AEDC)
o % of children whose parents support their learning at home (AEDC)
- Achieving child development milestones - % of children achieving developmental milestones
sampled at agreed intervals
- Prep attendance - % of students attending prep
- Physical Health - % of children with unaddressed hearing, vision, speech or general health
issues at prep/school
o % of children receiving holistic development and health checks at agreed intervals
o Year 3 Social and Emotional Wellbeing Index - % of children’s reaching social and
emotional wellbeing benchmarks
6
3. Population snapshot
Logan is a vibrant, young, ethnically and culturally diverse city. Logan's residents
represent approximately 217 different nationalities and ethnic groups, making it
one of the most culturally and linguistically diverse communities in Australia
Every year, approximately four thousand babies are born in the Logan City region.
In 2014, the ABS reported a population of 25120 0-4-year-old children living in
Logan. Babies and pre-schoolers (up to 4 years) represent an emerging population
group in Logan, representing more than 8.2% of the total Logan population, as
compared with 7% of the greater Brisbane population.
Logan children have relatively high rates of participation in long day care and
structured pre-school education programs with over 80% of children attending a
service prior to commencement of school.
Recent AEDC data reports have demonstrated a positive downwards trend in
developmental vulnerabilities. For instance, between 2009 and 2015, there was a
4.1% reduction in Logan children who were developmentally vulnerable across
two or more domains and a reduction in each of the five domains, with an
outstanding reduction of 9.5% occurring in Language vulnerability.
Whilst this is a very positive result, Logan children continue to experience
significantly higher rates of developmental vulnerability across each of the five
domains (Physical, Social, Emotional, Language and Communication), and
vulnerabilities across 2 or more domains compared to Queensland and Australia.
To reduce the gap in healthy child development for Logan kids, the earliest
possible identification of health and developmental issues, and appropriate and
timely services and supports are required.
Our preliminary understanding of the reasons contributing to late detection
include:
• Non-participation in child health services and programs, particularly after a
child reaches 12 months of age
• Limited community awareness and shared understandings regarding healthy
child development and its significance across the life course
• Limited community awareness regarding the importance of regular checks and
sustained participation in child health services for children aged 12 months –
5 years
• Limited community awareness regarding how to respond effectively to
developmental vulnerabilities and delays
• Limited capacity, support and resources to enable effective referral within
education and care settings
• Barriers for families accessing available services
7
Through the collective effort and commitment of families, service providers, educators and other
key stakeholders, the Early Detection and Support Project will achieve its goal to:
Enable earlier detection of health and developmental vulnerabilities and delays, enabling
appropriate early intervention and full participation in education and community life for
Logan kids.
4. Potential measures for development
4.1. Process Measures • Raise awareness amongst parents, carers and educators of the importance of
healthy child development and its significance across the life course
• Develop skills and shared understandings regarding how to respond effectively
to children with developmental vulnerabilities and delays
• Reduce identified barriers to participation in child health services for families
• Increase confidence in ability to respond effectively to children with
developmental vulnerabilities and concerns amongst parents and carers
• Increase confidence in ability to respond effectively to children with
developmental vulnerabilities and concerns amongst the ECEC workforce
4.2. Target Outcomes • Reduce the percentage of children presenting to prep year with health and
developmental vulnerabilities (Requires baseline data)
• Increase participation in child health services and developmental assessment
and screening in the 12 months to 5-year cohort (requires baseline data)
• Reduce the healthy development gap for Logan children at age 8
8
5. Earlier detection and support for Logan kids – proposed theory of change
Current Situation Inputs & Requirements Activities/Initiatives Short term outcomes
Medium - Long term outcomes
Kids presenting to prep with health and developmental concerns impacting their ability to participate and learn Higher rates of single and multiple AEDC domain vulnerabilities than the QLD and National average Limited understanding of healthy child development amongst parents and in early childhood settings Drop off in child health service participation in children aged 12-months to 5 years including developmental screening and assessment and follow up support services Limited ECEC capacity (resources, partnerships & skills) to identify and respond to developmental and behavioural vulnerabilities Limited (shared) understanding of appropriate referral pathways across service providers and sectors
Coordination of Early Detection and Support Key Initiatives Initiative specific cross sector partnerships & governance Baseline child health service participation data (12mo-5) Baseline screening and assessment participation data (12mo-5) Baseline population level prevalence data (Health & developmental vulnerabilities and delays at prep age) Community Engagement – Better understanding service decline, barriers to accessing services & participation in assessment and follow up supports Support the inclusion of localised service information within the new SpotOnHealth
Multidisciplinary Support to ECECs Whole of community Public Health/Social Marketing campaign re Healthy Child Development Supporting parents to promote healthy child development through Parents as first Teachers Initiative Promotion, training and development in emerging referral system platform SpotOnHealth/Health Pathways for key workforces eg. GPs, ECECs, Schools, Community Centres
Higher rates participation in child health services Higher rates of participation in screening and assessment Improved referrals from a range of settings and providers Higher rates participation in follow up supports Increased confidence in identifying and responding to developmental challenges within ECEC sector & settings
Parents confident and skilled in supporting healthy child development Strengthened partnerships between Parents, ECECs, Schools, Community Hubs and service providers Earlier diagnosis and intervention in health and developmental vulnerabilities and delays Children are ready to participate and learn, and have a positive start to school
Reduction in health and developmental vulnerabilities at age 8
9
Figure 1. summarises key features of the proposed Ideal Model of Early Detection
and Support for Logan, ranging from individual level health promoting practices
through to community inclusions and system enablers that will help equip every
child in Logan with the best chance to participate fully in their education and the
life of their community.
10
6. Overarching principles
A range of practice principles were introduced and agreed by project group
members and underpinned the development of the proposed model. A
commitment to these principles is evident in the proposed activities, and will
continue to be reflected at each stage of the model’s progression.
6.1. Proportionate Universalism The principle of proportionate universalism characterises service provision or
intervention which is provisioned universally with a scale and intensity that is
proportional to need. The concept is particularly relevant and applicable in our
endeavours to improve outcomes for young children in Logan, where high rates of
developmental vulnerability is impacting life chances and long term health and
wellbeing. Ref
6.2. Reflective Practice The principle of reflective practice relates to the ability to reflect on actions to
engage in a process of continuous learning. It involves paying critical attention to
the practical values and theories which inform decisions and actions, by examining
practice reflectively and reflexively leading to developmental insight. A key
rationale for reflective practice is that experience alone does not necessarily lead
to learning; deliberate reflection on experience is required. Combined with
reflective practice It enables the professional to work to their highest scope of
practice to achieve healthy outcomes. Ref
6.3. Evidence Based Practice Evidence based practice entails making decisions about how to promote health or
provide care by integrating the best available evidence, practitioner expertise,
population demographic and prevalence data with the stated needs, values and
preferences of those who will be affected. This is done in a manner that is
compatible with the environmental and organizational context. Ref
6.4. No Wrong Door Navigating complex support service systems which don’t share information and
communicate with each other is a major barrier to accessing services for families.
Having to repeat backgrounds and stories, a lack of consistency in eligibility
criteria, fragmented referral systems, geographically dispersed services and
11
complicated paperwork all contribute to unintentionally deterring people from
attending services. Ref
In practice, a “no wrong door” means that services are accessible from multiple
points of entry. Services respond to the individual's needs by linking people to or
providing referral pathways with appropriate practitioners and/or services.
Integrated, non-competitive collaboratives of agencies and professionals working
together to achieve the best outcomes for children families will ensure that the
burden of the complexity of service navigation will rest with service provider not
Logan families. Ref
6.5. Innovation Despite the apparent high quality health and education systems Logan continues
to experience high levels of health and social inequity. Disparities in health and
changing needs of the population means that traditional approaches to service
delivery should be challenged by innovative, evidenced based thinking. Services
and collective initiatives need to invest in and evaluate new ways of working with
communities and families to overcome complex social issues such as closing the
gap on healthy development of Logan children. Ref
6.6. Multiple Strategies The factors contributing to the comparatively high levels of developmental
vulnerabilities identified amongst kids in Logan are complex and multi-faceted.
Influential factors include access to and participation in early detection and
support services, community awareness, family stress, parenting practices, home,
care and education settings, and adverse childhood experiences. The range of
strategies needs to reflect this complexity and address the various determinants
influencing outcomes. Ref
12
7. Ages and settings
7.1. Birth to 12 months Fortunately, available service data indicates high rates of participation in child
health and development checks in the birth the 1-year age group. Most
diagnosable health and developmental challenges are picked up during this period.
This group is however an important target for prevention and early intervention
efforts, particularly focused on continuity of care and maintaining engagement
with services up until school age.
Potential measures may include:
• Raise parental awareness of the importance of continued participation in child
health services and the range of service options available to them
• Review and update existing information resources (eg the RedBook) to ensure
they include sufficient information on health risks and protective factors and
the importance of regular child health and development checks
Programs and initiatives of interest:
• Text messaging project Connecting2U – Centre for Children’s Health and
Wellbeing
• Other existing /emerging opportunities?
7.2. 12 months to 5 years This is a period where participation in child health services declines. Whilst it is
important to seek understanding regarding why this drop occurs, and to
implement strategies for increasing uptake of services, alternative settings for
checking the health and developmental wellbeing of children is also a key
consideration for improving coverage and is accordingly prioritised in the model.
Further consultation with families is necessary to better understand service access
issues, and action that would support their engagement.
ECEC services provide an excellent opportunity for reaching large numbers of
children and families in this age group due to the relatively high rates of
attendance in day care, kindergarten and preschool programs. A comprehensive
system for early detection and support recognises ECECs as an important setting
for reaching maximum numbers of kids before school, and invests in workforce
development and other organisational capacity building measures.
The Early Detection and Support Project Group is currently co-developing a
proposal with the Social and Emotional Development Project Group to provide
multidisciplinary support within ECEC settings (See priority 4).
13
It is important to acknowledge however that some population groups are less likely
to send their children to ECEC services and so alternative settings for need to be
prioritised. Community Hubs are favoured by many parents as settings for
services, particularly for groups from NESB and new arrivals and Aboriginal and
Torres Strait Islander Peoples
Programs and initiatives of interest:
• The CHQ 4-5-year-old Health Checks, including a hearing screening
• Centre for Children’s Health and Wellbeing ECEC workforce development
project – Healthy Kids PD and reflective practice quarterly sessions
• Outreach health services including screening and assessment undertaken in
settings such as community centres, in particular the Access Community
Service Wellbeing Programs
• Brisbane South PHN (PEDS) developmental assessment and support work in
ECECs
• Department of Education’s Workforce Development Strategy
• Logan Together’s Social and Emotional Early Development Project
• Hear and Say’s Early Education School Readiness Program - Ready Set Shine
7.3. 5 years to 8 years The first few years at school are critical for the long term well-being of children.
Unfortunately, some children in Logan are not having a positive start to formal
education due to previously undiagnosed, untreated or under managed health and
developmental issues which impact their ability to participate and learn. The scale
of this particular problem in Logan is however not well understood. Whilst there is
a great deal of anecdotal data indicating schools are coping with high levels of
developmental issues and delays, no data is actually available on this other than
the broader AEDC vulnerability measures which are collected every 3 years.
The prep year represents the first opportunity where children universally come
together with approximately 98% participation. This makes schools an ideal
setting for reaching children whose vulnerabilities and delays have not yet been
picked up and collecting baseline prevalence data for measuring longer term
outcomes.
There are currently a number of universal prep screening programs being
introduced in schools across Logan.
Programs and initiatives of interest:
• Children’s Health Queensland Universal Vision Screening Trial (validation
phase)
• Hear and Say’s Universal Prep Hearing Screening (launched mid 2016)
• Other age/setting related initiatives?
14
Whilst it was previously suggested that these could form the basis of an integrated
developmental assessment, this was ultimately not supported by all group
members. These programs do however offer opportunities for the Early Detection
and Support Project including:
• Supporting families with prep aged children that have been identified as having
a vulnerability or delay with effective referral and follow up
• Provide a baseline measure of prevalence to better understand the proportion
of kids enrolled in prep with health and developmental challenges
• Potential to enhance the Hear and Say’s hearing screening program with a 6–
8 week follow up of children who initially presented with middle ear problems
to distinguish between transient and chronic issues, recommend
necessary referrals and develop comprehensive treatment & prevention plans
• Strengthening relationships between school communities, parents’ services,
programs and other resources in the broader community
• Provide ongoing practical support and advice on health and developmental
issues to schools
• Deliver training is the emerging information and referral platform being
developed by Metro South Health – SpotOnHealth Health Pathways.
Aside from working within school settings, the 5-8 age group can also be
supported through the promotion of existing child health services, the provision
of outreach clinics, services and programs in community settings, as well as
providing additional practical supports to families and communities.
15
8. Priority action areas
The following action areas are broadly supported by the Early Detection and
Support Project Group members and endorsement for their further development
and progression will be sought from the Cross Sector Leadership. Sections
highlighted in grey represent areas of consensus and priority for development.
8.1. Data Mapping and Collection Project The Early Detection and Support Project group has prioritised increased capacity
for data informed decision making. In particular, there is a need to collate and
analyse existing service participation and prevalence data, and to collect data
where there are currently gaps, to establish baselines, understand service
utilisation barriers and enablers, and track trends and changes
Without accurate data demonstrating both the prevalence of health and
developmental issues, and participation rates in early detection and support
services it is difficult to plan an effective response. For instance, the consideration
of additional services and programs which seek to address barriers to service
uptake for specific population groups must be informed by current service models
and Logan families not currently accessing services. Similarly, an understanding
of the numbers of Logan children presenting to prep with health and
developmental challenges will enable the tracking of progress toward earlier
identification and appropriate intervention and support.
Priority concept for development:
The project group has discussed data requirements and recommend the following
priority questions for consideration within a data collection and mapping project:
• What percentage of children in each age group are assessed for health and
developmental well-being by suburb and population group?
• What % of children are presenting to prep with health and developmental
vulnerabilities or concerns?
• What suburbs are most likely to have higher/lower rates of child health service
utilisation?
• Which population groups are particularly at risk, and which groups are less
likely to participate in child health services?
• What is the capacity of (different stakeholders and sectors eg ECEC) to identify
and respond to children presenting with developmental concerns or
vulnerabilities?
• What % of children presenting with health and developmental challenges are
likely to be eligible for NDIS – early intervention
• What prevents parents from taking their children to child health services?
16
• What would make it more likely that parents would attend child health
services?
It is understood that some of this data may already exist but has to date been
inaccessible to the project group members. Some questions however may need to
be answered via additional data collection from service providers, schools, and
parents and carers.
Logan Together – Does this project sit naturally within a broader LT
initiative? The Asset Mapping? Other Data projects? Need to avoid se
8.2. Better Referral Capability Connecting families with appropriate services at the right time has been identified
as a significant challenge for the collective child health and development service
system, and the education and care sector. Better, easier to navigate referral
resources and pathways are required to connect families quickly and easily with
necessary supports. Shared service information resources and a shared
understanding of paediatric referral pathways would go some way toward enabling
educators and practitioners to respond with standardised, effective referral advice,
ultimately removing a major barrier to participation in child health services for
families.
A comprehensive, easy to navigate, shared referral information resource would
also effectively support the operationalisation of the No Wrong Door principle, with
professionals across a range of services and settings all accessing the same
referral advice
Fortunately, there are emerging initiatives aimed at better equipping partitioners
and other key workforces to refer appropriately in Logan which offer Logan
Together a timely opportunity.
SpotOnHealth https://www.spotonhealth.org.au/
The SpotOnHealth online resource coordinated by Metro South Health currently
represents the best opportunity for enhanced referral capacity across sectors and
workforces.
SpotOnHealth is part of a comprehensive strategy aimed at supporting
patients, carers, the community and health professionals toward better health
and wellbeing in the Metro South Health region. Containing a wealth of
information including localised evidence-based care pathways, patient and
clinical resources, referral information and quick links, professional
development resources and more, SpotOnHealth Professional is helping GPs
and health professionals to deliver integrated care so that patients enjoy a
seamless health care experience of the highest possible quality, no matter
where the care journey takes them.
17
Metro South Health’s SpotOnHealth platform is undergoing a major redevelopment
involving its consolidation with Health Pathways and the recently developed
Clinical Prioritisation Criteria.
Health Pathways https://melbourne.healthpathways.org.au
The State Government Department of Health has obtained a licence for Health
Pathways, a web-based information portal supporting primary care clinicians to
plan patient care through primary, community and secondary health care systems.
HealthPathways provides support in assessing and managing patients (including
accessing specialist advice and support) and clear referral pathways for their
patients to general community and secondary care services. The pathways are
designed to be used during consultations, and are jointly developed in
collaboration between general practitioners, specialists, nurses, and allied health
professionals across all sectors
Paediatric Pathway Development
Till now, SpotOnHealth hasn’t had a specific paediatric referral and care pathway
for children with diagnosed or potential developmental vulnerabilities and delays.
Metro South Health and the Brisbane South Primary Health Network are leading
the development of the care pathway and are in consultations with other key
stakeholders such as Children’s Health Queensland.
Clinical Prioritisation Criteria https://cpc.health.qld.gov.au/
The Clinical Prioritisation Criteria (CPC) is a clinical decision making support tools
that will support referring practitioners, including GPs, when referring patients to
Specialist Outpatient Services. Once implemented, the CPC will help ensure
patients referred for public specialist outpatient services in Queensland are
assessed in order of clinical urgency.
The implementation of this criteria will also serve as a mitigation strategy for those
services concerned with increased demand as a result of higher numbers of
children being assessed and diagnosed with developmental vulnerabilities and
delays. Appropriate service referrals may avoid “bottlenecking” any one point in
the system.
In summary, the consolidation of SpotOnHealth, Health Pathways, and the Clinical
Prioritisation Criteria, in conjunction with the Paediatric Referral Pathway
development, will improve the accessibility, quality, and localisation of
SpotOnHealth referral and information support resource.
18
Priority concept for development:
Logan Together and its partners have the opportunity to promote, and build
capacity for the use of SpotOnHealth across key workforces by contributing in the
following ways:
• Participating in the development of the Paediatric Referral Pathway
• Promoting the SpotOnHealth resource across services and sectors
• Providing training and development in SpotOnHealth for prioritised workforces
across Logan
• Contributing to the collation of relevant community assets and supports
including practitioner and service information
8.3. Parents as First Teachers Initiative Parents and families are a child’s first and most influential teacher. Broadly
speaking, Parents as First Teachers (PaFT) is an approach which values and
enables parent’s role in promoting healthy child development at home and in daily
life. The approach has been positively evaluated in the United States and the
United Kingdom, and is advocated by the Australian Research Alliance for Children
and Youth as being a well-supported, evidenced based strategy for supporting
healthy development in the 0-3 age group (ARACY, 2015).
PaFT programs have been implemented with positive results in various
communities nationally and internationally. Each of the below examples
emphasises different PaFT approaches with a similar intention to build the capacity
of parents to support their children’s development and school readiness:
- Australia – see Far North Queensland’s Families as First Teachers which
focuses on developing relationships between families and schools to support
reading and writing skills and school transitions
http://farnorthqld.eq.edu.au/index.php/indigenous-support/families-as-first-
teachers
- New Zealand – see Plunket’s Parents as First Teachers program which is
implemented universally via Parent Educators and the home visiting program
https://www.plunket.org.nz/what-we-do/what-we-offer/parenting-
education/parents-as-first-teachers/ and
http://www.kiwifamilies.co.nz/articles/parents-as-first-teachers-2/
- United States – See Memphis’s Urban Child Institute Parents as First Teachers
philosophy which focuses on secure attachment and brain development
http://www.urbanchildinstitute.org/articles/research-to-
policy/practice/parents-are-a-childs-first-teacher
19
Priority concepts for development:
The overarching aim of the Logan Together PaFT initiative would be to provide
education and support to parents of children aged 0-8. A trial of PaFT may include
the following elements:
• Developing a shared understanding of healthy child development and its
significance across the life course
• Develop parental confidence in their ability to effectively participate in their
child’s development and education
• Building knowledge and skills to enable earlier identification and effective
responses to children experiencing developmental challenges
• Connecting families with local services and supports
• Promote the importance of quality early education
• Strengthening partnerships between parents and schools
• Promotion of in-home practices that contribute to school readiness – i.e.
supporting the development of home learning environments
• A Logan wide social marketing campaign promoting the value of parents and
their role as a child’s first teachers (See priority 7)
8.4. Build the capacity of early education and care settings via
multidisciplinary support Early education and care settings have the potential to contribute substantially to
a comprehensive system of early detection and support (ARACY 2015).
Specifically, ECECs offer an ideal setting to facilitate:
• the provision of information relating to healthy child development to families
• earlier identification of health and developmental vulnerabilities and delays
• universal and targeted screening and assessment services
• linkages and referral to required support services
Staff working in ECECs are ideally situated to notice when young children exhibit
signs of vulnerabilities and delays. Increasing the capacity of workforces in these
settings to identify and respond effectively to concerns, and connect children and
families with appropriate services quickly and easily is a key feature of an effective
early detection and support system.
Priority concept for development:
Multidisciplinary Support within ECEC Settings
This initiative will be a joint initiative with the Logan Together Social and Emotional
Development Project and may involve trialling the following elements:
20
• Provide education and training to workforces located in key early childhood
settings
• Engagement with parents of children in participating ECECs
• Relationship development & linking of local and regional services with
participating ECECs
• Integrated developmental assessment, referral and follow up
• Creation of healthy physical and social ECEC environments
• NDIS preparedness i.e. Determining the role of ECECs and enabling them to
transition effectively and support parents with NDIS engagement
• Potential enhancement of existing education resources including Early Years
Connect
• Support the development of early detection and support policies and processes
in education and care settings
• Strengthen relationships between ECEC settings and services
8.5. Maximise participation in early detection services Services offering health and developmental screening and assessment, and
support for identified issues are widely available to families in Logan. There is
however a significant drop off in participation in these services after 12 months of
age which contributes to the late identification of health and developmental
challenges, delays appropriate intervention and support, and impact’s children’s
opportunities to have a positive start to school. To increase participation in
essential services, including developmental checks, common barriers must be
identified, understood, and addressed.
Some information has already been provided relating to barriers to access and
participation in services via face to face interviews and conversations with parents
via social media pages. Amongst the most common messages were issues relating
to:
• The physical convenience of services
• Work commitments during service hours of operation
• Confidence and levels of comfort whilst in health facilities
• Perceptions that if everything “appeared fine”, health checks were not
necessary
• A belief that any issues and concerns would be addressed once school
commenced
• A belief that if anything was wrong the GP would have identified it.
Whilst the preliminary consultations have provided some useful themes, more
conversations with parents are now required to properly understand the nature
and scale of the problem and develop appropriate strategies for increasing
participation in early detection services.
21
Priority concepts for development:
• The development of a Continuity of Care and Engagement Plan encompassing
pre-conception to 8 years
• Consultation with parents of children of different ages to understand what
prevents and promotes participation and disengagement in child health
services
• Addressing barriers to access and participation which emerge as part of the
consultation
• Effective marketing and promotion of available child health services and
programs to parents
• Development and provision of responsive service models including use of
community settings
• Opportunistic developmental screening during routine visits to health
practitioners
Maximising uptake of services is both a stand-alone priority, and an objective that
can be progressed within related initiatives such as the Better Referral Strategy
and the Multidisciplinary Support within ECEC Settings.
8.6. Integration with existing and emerging platforms,
programs, networks and settings The Early Detection and Support Project has alignments with many other services
and programs working to improve outcomes for kids and families in Logan.
Government, non-government, not for profit and private sector agencies all make
valuable contributions. It makes better sense to work together, streamlining
access points for families, sharing, preserving and attracting resources, and
avoiding unnecessary duplication of services and programs.
Priority concepts for development:
• Collaboration with the Logan Together Assets Mapping Project on potential data
gathering and analysis
• Partnering with Metro South Health on development and promotion of
SpotOnHealth (see priority 2)
• Collaboration on complimentary initiatives such as the Logan Together
Maternity Project and Early Development Project
• An emerging and important opportunity involves the roll out of NDIS set to
commence in Logan July 2018. Children up to 6 years of age who have a
diagnosed development delay can access NDIS funding for therapy and
support. Identifying kids with developmental vulnerabilities and delays in
Logan before the commencement of NDIS will ensure they get assessed for
eligibility for NDIS funding and support
22
8.7. Community wide public health social marketing campaign Families, community groups, educators, practitioners and local businesses can all
benefit from a better understanding of healthy child development, and can all
make a valuable contribution to the wellbeing of Logan children.
In particular, shared understandings regarding the factors that promote
developmental well-being, and a community wide culture supporting the
importance of child rearing, are important elements of a comprehensive approach
to the prevention, early detection, and support for developmental vulnerabilities.
Priority concept for development
A Logan wide social marketing campaign is proposed for development with key
partners. It is imperative that a social marketing campaign of this nature
resonates with Logan families, recognises their strengths and diversity and uses
messages and strategies which are culturally sensitive.
Key campaign messages:
• Healthy childhood development and its significance across the life course
• Valuing parents as a child’s first and most important teacher
• How to access information and support
• Home and community based practices that promote healthy child development
i.e Secure attachment, Reading, Play based learning, Outdoor play
8.8. Develop appropriate and effective governance structures Governance structures that are representative, responsive, and provides
accountability to sponsors and the community will be an important feature of the
model for early detection and support at every stage. The agreed structures will
reflect a shared commitment to maintaining the integrity of the agreed model and
its specific initiatives, and will be inclusive of consumers, key stakeholders and
service providers.
Governance structures and processes for their establishment are yet to be
explored in depth. This will become a priority once the ideal model has achieved
principle support from the Cross Sector Leadership Table and consumers, and the
key initiatives requiring appropriate governance have been authorised and
sponsored.
23
8.9. Risks The key intention of the Early Detection and Support project is to identify and
respond effectively to children with health and developmental challenges as early
as possible. If the project is successful in achieving this objective, it is likely that
additional strain will be placed on services as more families have these issues
properly assessed and managed. To mitigate this risk, the following strategies
have been considered:
• Minimise service system disengagement in the first two years of life
• Strengthen relationships and coordination with the not for profit sector;
primary health care services and others providing comparable early detection
and support services to children and families
• Effective implementation of the Clinical Prioritisation Criteria across service
providers in Logan
• Preparedness for a range of potential outcomes of baseline measures of
prevalence and participation
• Strengthen the capacity of key workforces and families to support and manage
children exhibiting challenging behaviours
• Attract sustainable funding for services to meet the needs of children in Logan
A project update on behalf of the Early Detection and Support Project Group October 2016 Early Detection and Support for Logan Kids
Population snapshot Roadmap connections Project process and progress What would we like to change? Identified opportunities and priorities for action Theory of change
Early Detection and Support for Logan Kids
Early Detection and Support for Logan Kids
• Approximately 4000 births each year • Immunisation rates approximate 91% (95% QLD Target) • Babies and pre-schoolers (up to 4 years) - emerging
population group in Logan, representing more than 8.2% of the total Logan population
• Young mums (under 25) 26% compared with 17% national average
• 80+ % kids attend some form of early childhood education and care service
• 3347 prep students in 2015
Australian Early Development Census
• Population measure of how children are developing
• Reports percentages of children
who are developmentally • On track (above the 25th
percentile) • At risk (between 10th – 25th
percentile) • Vulnerable (below the 10th
percentile)
Early Detection and Support for Logan Kids
Early Detection and Support for Logan Kids
Early Detection and Support for Logan Kids
Attachment - % of Bubs forming a secure bond of attachment with a primary care giver
Breastfeeding – % of children breast fed for 6 months or longer
Social emotional wellbeing - % of children reaching social emotional wellbeing benchmark at age 3
Learning support
% of children attending pre-school readiness programs
% of children whose parents support their reading at home (AEDC)
% of children whose parents support their learning at home (AEDC)
Child development milestones - % of children achieving developmental milestones sampled at agreed intervals
Prep attendance - % of students attending prep
Physical Health - % of children with unaddressed hearing, vision, speech or general health issues at prep/school
% of children receiving holistic development and health checks at agreed intervals
Year 3 Social and Emotional Wellbeing Index - % of children’s reaching social & emotional wellbeing benchmarks
What does this mean? We need to influence the environments where children live, grow, learn and play before they commence school. This will include: • During the pre-conception period • During the antenatal period • During the early years • During the first years of school
• The Early Detection and Support
group are focusing on the environments children are in during the early years
Mission: Development of an Ideal Model of Early Detection and Support Monthly(ish) meetings Meetings with key stakeholders unable to attend meetings Scan of existing service environment / comparative analysis (Plunket) Scan of emerging complimentary initiatives and collaborative opportunities Collation of available prevalence & participation data Evidence reviews Draft documents circulate/feedback/review Agreement on immediate / short term priorities
Logan Together - Early Detection and Support for Logan Kids October 2016
Child health services are available to families including regular health and development checks & home visits High rates of participation in child health services in the first year of life Decline in participation in child health services from 12 months - Preliminary understandings via consultation with
parents implicates: Access issues – Return to work/conflict of hours, “comfort” with clinical setting Limited understanding regarding healthy child development and the importance of sustained engagement with
services Belief that if everything “appears fine” checks are not necessary Belief that any issues will get “picked up at school” and managed from there
ECEC sector report limited capacity (knowledge, skills, resources etc) to identify and respond effectively to health and developmental issues in children
Schools report high numbers of children presenting to prep with unaddressed developmental issues and difficulties engaging parents in appropriate action to address them (anecdotes re teachers using lunch break to take kids to clinics)
Trial prep age hearing screen (single stage) in Logan schools indicate high levels of hearing issues (9-40% fail rate amongst 8% of total prep age population)
Existing referral pathways difficult to navigate
Early Detection and Support for Logan Kids
Early Detection and Support for Logan Kids
Non-participation in child health services and programs, particularly after a child reaches 12 months of age
Limited community awareness and shared understandings regarding healthy child development and its significance across the life course
Limited community awareness regarding the importance of regular checks and sustained participation in child health services for children aged 12 months – 5 years
Limited community awareness regarding how to respond effectively to developmental vulnerabilities and delays
Limited capacity, support and resources to enable effective referral within education and care settings
Barriers for families accessing available services
Early Detection and Support for Logan Kids
Early Detection and Support for Logan Kids
Better understanding of service access issues for families and what would help Reduce % of kids presenting to prep with health and developmental concerns impacting their ability to participate and learn
Increase % of kids developmentally on track at prep and through to age 8 Increase understanding of healthy child development – parents, ECECs, Schools, Whole of
community Reduce the decline in child health service participation in children aged 12-months to 5 years
including developmental screening and assessment and follow up support services Increase % of kids receiving holistic health and development checks Increase ECEC capacity (knowledge, resources, partnerships & skills) to identify and respond to
developmental and behavioural vulnerabilities Develop (shared) understandings of appropriate referral pathways across service providers & sectors
Early Detection and Support for Logan Kids
1. Data mapping and collection project including extensive consultation with families
2. Better Referral Capability – SpotOnHealth Health Pathways 3. Parents as First Teachers Initiative 4. Build capacity of ECEC settings via Multidisciplinary Support Project 5. Maximise participation in early detection services 6. Integration of existing and emerging platforms, programs, networks and
settings 7. Community wide public health social marketing campaign 8. Develop appropriate and effective coordination and governance
structures
Early Detection and Support for Logan Kids
Complex service & programmatic system = Overlaps & tension Further stakeholder engagement and a commitment to partnerships
required to avoid tripping over each other, to maintain inclusivity & integrate where possible
No consistent community member participation in the development of the model Further/extensive community engagement and concept testing required
Complex data requirements for baseline and tracking – population based prevalence, population based participation in services etc
Early Detection and Support for Logan Kids
Brisbane South Primary Health Network Children’s Health Queensland Child Development Service Healthy Hearing Program Centre for Children’s Health and Wellbeing Child Health Services
Hear and Say Metro South Health Access Community Services Logan City Special School Woodridge State School
Early Detection and Support for Logan Kids
Early Detection and Support for Logan Kids
Transdisciplinary Support for ECEC
Proposal for development of a Logan Together Initiative
Opportunity in ECEC
A large body of evidence from social science, psychology and neuroscience, demonstrates the importance of early years for later development
Investments in human capital yield the highest returns in the pre-school stage
ECECs are an important setting for reaching high numbers of children before the commencement of school
3,347 Logan Children Entered Prep in 2016
53.9% of Children in Logan accessed ECEC in 2015
7% of Australia’s children have diagnosed disability (AIHW 2013 p12, 202)
20% of Australia’s children have additional health and developmental needs in first year of school (AEDC 2015)
Logan Together Roadmap Our BIG Ideas
The importance of early childhood
Prevention and early intervention
Collective impact – working collaboratively
Logan Together Roadmap (Page 7)
Logan Together Roadmap (Pages 8-9)
This is significant because…
Logan Together Roadmap (Page 6 and Page 18)
Importance of early learning and support
Influencing Factors in early childhood (Logan Together Roadmap p23)
Early detection of hearing, sight and speech problems leading to the right support
Attending kindergarten to get ready for school
Childcare services provide high quality care and learning environment
Logan Together Roadmap (Page 17)
What’s wrong – defining the problem
community conversations from across the region Community members don’t value ECEC’s as a formal place of Education
Parents think that when children enter formal Education System at Prep if there is anything wrong (developmentally) the Education System has everything it needs to fix their child’s problem
The Cost of sending a Child to Kindy is outside of peoples budgets
It cheaper to keep the kids at home and we can do low cost activities like ones we see on Nick Jrn
Cultural factors children don’t leave the family home until the enter the formal education system
Families from CALD communities are not always able to access CCB
We want people to explain things to us in simple ways that we understand and not feel silly cause we don’t know what they are talking about
Just because we don’t read and write the best doesn’t mean we don’t love our children and want the best for them so I wish people would just make it easier to help us make it better for our kids
No transport and cost of public transport is expensive for a round trip twice a day just for kids to go one day to kindy
What’s wrong – defining the problem
ECEC – Early Childhood Education and Care Services We don’t have time to attend meetings in operational hours
70% of ECEC’s stated that they don’t look at the ADEC data
We don’t know about a lot of community support services in the community as they change so much
30-40% of most enrollments are children who have complex needs – ( Behavioral needs)
Child maternal health services is a nightmare to support parents with we tell them just go to the GP and get a referral
Staff need and want more PD that is aimed at practical classroom support
Most ECEC staff have to attend PD training in their own time service’s don’t have the capacity to replace staff so that they can attend training in working hours
Logan is over serviced with providers and if parents don’t want to listen to you rising a concern about their child they just move center's
School Readiness ‘Equation’
Ready families + Ready early childhood services + Ready communities + Ready schools = Ready children (Kagan & Rigby, 2003; Rhode Island KIDS COUNT, 2005)
Life trajectories for children become increasingly difficult to change as differences in skills and abilities become entrenched and initial differences between school ready and school unready children are amplified (Cunha et al, 2006)
The transition to school is particularly problematic for vulnerable children (Feinstein & Bynner, 2004; Sylva et al, 2004)
Traditional concepts of school readiness have placed emphasis on a child's skills; however, skill-based assessments of children's functioning have been shown to be poor predictors of subsequent school adjustment and achievement (La Paro & Pianta, 2001; Pianta & La Paro, 2003)
More recent thinking about the transition to school recognises that "school readiness does not reside solely in the child, but reflects the environments in which children find themselves" (Kagan & Rigby, 2003, p. 13 and Dockett & Perry, 2006)
School Readiness
All children arrive at primary school with knowledge and experiences from growing up within the context of family, neighbourhood, service and community environments.
Logan context (AEDC 2015)
In Logan, as many as 1,000 start Prep each year with a disability or development delay (33%)
LOGAN (%) Physical Social Emotional Language Communication One or more vulnerability
2 or more vulnerabilities
Australia 9.7 9.9 8.4 6.5 8.5 22 11.1
QLD 12.4 12.4 10.1 8 10.5 26.1 14
Logan 14.2 15 12.3 12.1 13.4 33 17.7
Issues in ECECs Review of the 2011–2014 Early Childhood Education and Care Workforce Action Plan
The exact number of Queensland children in ECEC settings with complex emotional and social behaviours is not known. These children may or may not have a diagnosed disability.
There are identified gaps in current skills and knowledge and educators believe there are shortfalls in the adequacy of existing qualifications and training to sufficiently prepare them to respond to the needs of children with complex emotional and social behaviours and their families.
Educators consistently reported that the number of children with complex emotional and social behaviours in their services has increased.
‘Children arrive on our doorstep undiagnosed and we are the first
port of call in addressing their needs [with] little support
from outside agencies.’
http://deta.qld.gov.au/earlychildhood/pdfs/wap-research-complex-behaviours.pdf
Review of the 2011–2014 Early Childhood Education and Care Workforce Action Plan
Although training is available on recognising and guiding children with complex social and emotional behaviours:
69% indicated they had attended training
31% indicated they had not received any specific training
Many respondents indicated that, despite completing training, they still felt they had skill deficits in this area.
The capacity, competence and confidence of educators to provide feedback to parents about their child’s complex needs was identified in the research as a critical skill needed.
‘I feel like I’m not knowledgeable to help them (child) and their family.’
http://deta.qld.gov.au/earlychildhood/pdfs/wap-research-complex-behaviours.pdf
Links to allied health professionals Review of the 2011–2014 Early Childhood
Education and Care Workforce Action Plan further identified the need for skills development in transdisciplinary practice, enabling educators to develop confidence in working professionally across disciplines at a local level.
Educators have proposed mentoring arrangements with allied health workers at a local level to build these relationships, whilst gaining practical skills and advice in guiding children with complex social and emotional needs.
http://deta.qld.gov.au/earlychildhood/pdfs/wap-research-complex-behaviours.pdf
Opportunities in ECECs in Logan
Local consultations with ECECs in Logan have revealed that:
Most staff have limited knowledge about healthy child development
Many centres are not equipped to identify and respond appropriately to children with vulnerabilities or delays
Policies and procedures to support staff to do the above are not embedded in many centres
Transdisciplinary Support for ECEC
The task of building transdisciplinary support in ECEC is a team effort.
It involves approved ECEC providers, service supervisors and management, and educators working with families and allied health professionals to help children participate in meaningful ways.
http://www.earlyyearsconnect.com.au/wp-content/uploads/2016/05/EYC-Info-sheet-01.pdf
Theory of Change
Children with developmental delay in
ECECs identified
Families understand their child’s needs
Families are supported to navigate the system
Families can make better choices
Families are able to be proactive about child’s
needs
ECECs have adequate skills to identify
children with development delay and
deal with families
Allied health services provide direct services
in ECEC for identification and
training
Child receives appropriate allied
health support
Child receives appropriate support in
the ECEC
ECEC inclusive of child’s needs
Child physically, socially and emotionally and developmentally
ready to start school
Program Logic
Key elements for the Logan Together Transdisciplinary Support for ECEC initiative
Training and development activities for ECEC staff to develop their capacity
Engagement with parents of children in participating ECECs
Relationship development & linking of local and regional services with participating ECECs
Integrated developmental assessment, referral and follow up
Creation of healthy physical and social ECEC environments
NDIS preparedness i.e. determining the role of ECECs and enabling them to transition effectively and support parents with NDIS engagement
Potential enhancement of existing education resources including Early Years Connect
Transdisciplinary Support for ECEC Prototype sites (chosen based on AEDC data)
Browns Plains
Kingston
Eagleby
% Physical Social Emotional Language Communication One or more vulnerability
2 or more vulnerabilities
Australia 9.7 9.9 8.4 6.5 8.5 22 11.1 QLD 12.4 12.4 10.1 8 10.5 26.1 14
Logan 14.2 15 12.3 12.1 13.4 33 17.7
Browns Plains 8.7 18.5 13 10.9 12 30.4 18.5
Kingston 18 17.5 15.2 15.6 11.8 35.5 22.7
Eagleby 18.9 22.6 13.4 13.4 17.5 36.9 25.8
Elements of the proposal for trial sites
The following services may be provided:
information and support that addresses the individual needs of the child and family
standardised and play-based assessments for children (across a range of developmental areas)
play-based education and therapy programmes
transition support for children and their families for school readiness
linking families to services and providing access and co-ordination of services
collaboration with local early childhood education and care services, other child and family services and the broader community to improve access and participation of children with disabilities / developmental delays
culturally responsive and inclusive programmes to facilitate access to services
education, training and workshops for:
families
local early childhood education and care services
other child and family services
the broader community
Thank You
Questions?
Play as a soft entry, universal, early intervention and prevention tool Associate Professor Kym Macfarlane and Ms Charmaine Stubbs
The Family Place Approach: Utilising soft, entry, universal early intervention and prevention practice
• Funded by The Salvation Army/Griffith University Knowledge Partnership and the Department of Social Services (Australia) Innovation Fund on behalf of Communities for Children (Logan)
• With acknowledgement to Ms Debbie Miscamble, Ms Melinda Nelson, Mr Glenn Hodgson, Mr Barry Watson, Ms Kym Kukulies, Ms Holly Rynsent and Ms Elise Parker
Developing a Framework of practice
• Funded to develop a Framework of Practice for utilising soft entry, universal, early intervention and prevention practice
• Based on The Family Place Approach – Community Centre for families in the Logan region
The Family Place Approach
What is the Family Place? How is high quality play included?
The Family Place
Building on Moore & McDonald (2013)
• Be relationships based • Involve partnerships between parents and clients • Target goals clients see as important • Provide clients with choices regarding strategies • Build client competences • Be non-stigmatising • Demonstrate cultural awareness and sensitivity • Maintain continuity of care
Theories
Builds on the work of
Vygotsky (1962, 1978) – Zone of Proximal Development and scaffolding Bourdieu (1984) - habitus Bronfenbrenner (1979) – ecological systems theory Foucault (1981, p. 13) Practice “in the real”
Research
• Systematic literature review – higher theoretical ideal • Focus group with original Communities for Children Logan
staff – CfC funded C&K staff and CfC CD workers • Workshop with CfC funded C&K staff, CfC CD workers –
what does practice look like ‘in the real’ (Foucault, 1981:13) • Workshop with CfC funded C&K staff and CfC CD workers-
final document – Why is each principle important and what does each look like?
• Pre and post survey x 1 • Focus group with parents
Research
Circles of Change Revisited
Based on the notion of Learning Circles with a embedded critical reflection model built in. Deconstruct – detail all the facts Confront – question all taken-for-granted understandings Theorise – bring what you know to the space Think Otherwise – think about how the situation might be otherwise by going to the space of the ‘unthinkable’ Most Significant Change Theory (Davies & Dart, 2009)
Principles of Practice
13 principles of practice were developed and mapped against a higher theoretical ideal (remembering that these
principles are developed alongside a high quality play framework)
Disposition Choice
Unconditional Positive regard Relationships first
A Strong Sense of Justice A Non-Stigmatising Environment
Co-design, Co-construct, Co-implement Informality/Calm
Planned Disclosure Intentionality
Shared Mission Cultural Sensitivity and Awareness
Serendipity
Principles of Practice
• Why is each important? • What does each look like?
Principles of Practice
• Disposition – works on the notion of disposition to practice – staff have their own version of practice (habitus, Bourdieu, 1984, 2001) based on their own understandings of what high quality practice is. They also have a shared version of practice (doxa, Bourdieu, 1984, 2001). This needs to be mapped to a higher theoretical ideal.
• Choice – parents are able to construct and choose their own support program – children choose through play and involve parents in emergent play scaffolded by FP workers
Principles of Practice
• Unconditional positive regard – view people as essentially good and so they are held in high esteem by workers
• Relationships first – key approach, which involves the building of trust prior to disclosure or negative approaches
• A strong sense of justice – more than social justice it is about “Walking the talk”
Principles of Practice
• A non-stigmatising environment – there is limited or low criteria eligibility for families by undertaking to support universality. Therefore, a non-stigmatising environment works with a strong sense of justice and the notion of cultural sensitivity and awareness to ensure that everyone is treated equitably
• Co construct, co-design, co-implement – enabling families to construct their own family support package, to construct the environment that surrounds them and to work with children to build play expereinces.
Principles of Practice
• Informality/calm – producing a deliberately calm approach to practice – lessen levels of stress and break down barriers to practice
• Planned disclosure – facilitates safety and trustworthiness eg, fruit cutting
• Intentionality – modeling and shared thinking. Ensuring practice remains focused and real
• Shared mission – partners guided by similar motives (Kania and Kramer, 2011)
Principles of Practice
• Cultural sensitivity and awareness – Works with the notion of a non-stigmatising environment - cultural competence – allowing each family to live according to their unique customs and traditions eg, playgroup and African families
• Serendipity – what happens by accident?
Principles Diagram
• Informality/calm • Non stigmatising • Cultural awareness and
sensitivity
• Choice • Intentionality • Shared Mission • Informality/Calm • Co-construct, co-design, co-
implement
• Informality/calm • Intentionality • Planned disclosure • Serendipity
• Co-construct, co-design, co
implement • Serendipity • Intentionality • Informality/calm
Disposition Relationships first
Unconditional Postive regard
A Strong sense of justice
Results
• To allow high quality play and high quality soft entry, universal, early intervention and prevention (SUEIP) approaches to be enacted together
• For families and staff to build strong relationships and develop trustworthiness so hard to reach families can be engaged
• For families to co-construct their environment and their own family support package
Implications for practice
• There is a need for practitioners and professionals to understand the importance of a Relationships first approach and a Strong Sense of Justice (Macfarlane & Cartmel, 2008)
• This will enable them to ‘walk the talk’ and to development authenticity in their practice.
Learning through Play
References
Bronfenbrenner, U. (1979) The ecology of human development: Experiments by nature and design. Harvard University Press. Davies, R., & Dart, J. (2005). The ‘Most Significant Change’ (MSC) Technique. A guide to its use. Foucault, M. (1981) ‘Questions of method: An interview with Michel Foucault’, Ideology and Consciousness, vol. 8, pp. 3-14. Macfarlane, K. & Cartmel, J. (2008) Playgrounds of learning: Valuing competence and agency in 0-3 years old, vol. 33, no. 2. Moore, T.G. and McDonald, M. (2013) Acting Early, Changing Lives: How prevention and early action saves money and improves wellbeing. Prepared for The Benevolent Society, Parkville, Victoria: Centre for Community Child Health at The Murdoch Children’s Research Institute and The Royal Children’s Hospital. Vygotsky, L. (1962) Thought and language, Cambridge: Massachusetts: The MIT Press Vygotsky, L. (1978) Mind in Society: The development of high psychological processes, Cambridge, Ma: Harvard University Press