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The article describes a quality improvement project aimed at reducing the incidence of pressure injuries in children caused by peripheral intravenous cannulaes (PIVC), conducted at a general children's ward in a hospital in Far North Queensland. Topics discussed are pressure injuries specific to PIVC, modification of PIVC audit tool to observe the effect of the changes made to PIVC care, staff education and adoption of practice changes, and ethical considerations for conducting the project.

Objectives: To identify features of mental health services that affect the uptake of services among parents of children with chronic medical conditions, to inform the design of pathways into mental health care. Methods: A discrete choice experiment in which participants made choices between hypothetical mental health services described in terms of service features: cost, wait time, provider knowledge of chronic medical conditions, recommendations, opening hours, and travel time. Participants were parents of children attending The Royal Children's Hospital outpatient clinics for the management of a chronic medical condition who completed the online survey between August 2020 and January 2021. The uptake of mental health services with differing features was predicted based on regression models examining the relationship between choice and service features, and accounting for participant characteristics and unobserved heterogeneity. Results: The sample comprised 112 parents, of whom 52% reported unmet needs. The most influential service features were wait times, cost, recommendation from medical specialists, and mental health provider knowledge of chronic medical conditions. Predicted uptake of a realistic service showed inequalities across income, parental education, and single parent status. A service comprising preferred features was predicted to eliminate these inequalities. Conclusions: Reducing cost and wait time for mental health services could reduce unmet need among children with chronic medical conditions. Specific approaches to tackle the high levels of unmet needs in this group include equipping medical specialists to recommend mental health providers and training mental health providers on the impacts of chronic medical conditions on children. Offering preferred services could increase uptake and reduce inequalities in mental health care. What is known about the topic? Children with chronic medical conditions have high rates of unmet need for mental healthcare. Qualitative research has indicated features of mental health services that may be important to consider in service design to address these unmet needs. What does this paper add? A detailed understanding of parents' preferences for features of mental health services for children with chronic medical conditions, including their importance and prediction of uptake under different scenarios. What are the implications for practitioners? Parents preferred services with recommendation from specialists, mental health providers who understand the impact of chronic conditions, lower cost, and shorter wait time. Offering preferred mental health services is predicted to significantly reduce unmet needs and reduce inequalities in care. [ABSTRACT FROM AUTHOR]

Preference weights are widely used to score generic health states into utility indexes for estimation of quality adjusted life years (QALYs) and to aid health care funding decisions. To date, health state utilities are predominantly derived using stated preference methods based on decision utility. This paper tests an alternative and generates preference weights using experienced utility for children based on the Child Health Utility 9D (CHU9D) descriptive system. We estimate the relative values of the CHU9D health states with regard to experienced utility, where experienced utility is approximated by self-reported happiness. A nationally-representative longitudinal survey was used including 6090 Australian children aged 12–17 years surveyed over 2014–2018. The derived weights were then applied to calculate the utility decrements for a few common child health conditions. We found that the estimated utility decrements are largely similar to those estimated using the published CHU9D Australian adolescent weights based on decision utility, except for pain and depression. A smaller utility decrement for pain and a larger utility decrement for depression were indicated by experienced utility. We contribute to the literature by showing that using experienced utility methods to generate preference weights for health states is possible, and we discuss some important methodological challenges for future studies such as the impracticability of anchoring to 'dead' when utilizing experienced utility. • Established methods of valuing health states rely on decision utility. • We use experienced utility to generate preference weights for children. • The estimated decrements for health conditions are similar to published weights. • We see smaller impact for pain, larger for depression compared to published weights. • Feasibility is demonstrated using child experienced utility for preference weights. [ABSTRACT FROM AUTHOR]

Perinatal mental illness is a known risk to maternal–infant attachment and healthy infant development. Mothers experiencing complex mental health issues in the first year following birth are less likely to become involved in parenting programs or day stay interventions because of their mental health difficulties and perceived stigma. Currently, most perinatal day or group treatment programs only include the mother and not their infant. This paper describes "Together in Mind," a perinatal and infant mental health day program developed by the Queensland Centre for Perinatal and Infant Mental Health, targeting mothers with moderate to severe mental illness and their infants under 12 months. The service model was a 6‐week, 1 day per week psychoeducation intervention. Psychoeducational material and support were provided across each day session by an adult perinatal mental health clinician, an infant mental health clinician, and a child health nurse working in collaboration. The program was trialed across seven Hospital and Health Service sites in Queensland, Australia, during 2016–18. In total, 24 group day programs were delivered with 84 mothers and their infants. Pre and post intervention quantitative measures and a post‐program qualitative survey about participant satisfaction were collected. Statistically significant improvements in all quantitative measures showed a large to medium effect size on the: Health of the Nation Outcome Scale (HoNOS) (d = 0.82; p <.000); Depression, Anxiety and Stress Scale (DASS‐21) (d = 0.5; p <.000); Karitane Parenting Confidence Scale (KPCS) (d = 0.63; p <.000); Maternal Postnatal Attachment Scale (MPAS) (d = 0.49; p <.000), Ages and Stages Questionnaire: Social‐Emotional (6 months) (d = 0.83; p <.000). The results indicate collaboration and early intervention contributes to strengthening the emerging development of the maternal–infant relationship within the context of complex maternal mental health issues. [ABSTRACT FROM AUTHOR]

Background: Middle ear disease (otitis media) is endemic among Aboriginal and Torres Strait Islander children in Australia and represents an important cause of hearing loss. The disease is the result of a mix of biological, environmental and host risk factors that interact in complex, non-linear ways along a dynamic continuum. As such, it is generally recognised that a holistic, systems approach is required to reverse the high rates of otitis media in Aboriginal and Torres Strait Islander children. The objective of this paper is to examine the alignment between efforts designed to address otitis media in Aboriginal and Torres Strait Islander children in Queensland, Australia and core concepts of systems thinking. This paper’s overall purpose is to identify which combination of activities, and at which level, hold the potential to facilitate systems changes to better support ear health among Aboriginal and Torres Strait Islander children. Methods: We began with a review of documents identified in consultation with stakeholders and an online search. In addition, key informants were invited to participate in an online survey and a face-to-face or phone interview. Qualitative interviews using a semi-structured interview guide were used to explore survey responses in more depth. We also undertook interviews at the community level to elicit a diverse range of views. Ideas, statements or activities reported in the documents and interviews as being performed under the Intervention Level Framework were identified using qualitative thematic and content analysis. A quantitative descriptive analysis was also undertaken, whereby data was extracted into an Excel spreadsheet and coded under the relevant strategic directions and performance indicators of the Framework. Subsequently, we coded activities against the five-level intervention framework developed by Malhi and colleagues, that is: 1) paradigm; 2) goals; 3) system structure; 4) feedback and delays; and 5) structural elements. Results: Overall, twenty documents were reviewed. We examined surveys and interviews with six key informants. Twenty-four individual and 3 group interviews were conducted across central and community level informants. One hundred and four items were coded from the 20 documents and 156 items from interview data. For both data sets, the majority of activities were coded at the structural elements level. The results suggested three key areas where further work is needed to drive sustained improvements: 1) build the governance structures needed for paradigm shift to achieve a multi-sectoral approach; 2) develop shared system level goals; 3) develop system-wide feedback processes. Conclusions: Sustained progress in improving ear health within Aboriginal and Torres Strait Islander children requires a holistic, system-wide approach. To advance such work, governance structures for multi-sectoral collaboration including the development of joint goals and monitoring and feedback are required. Intervening at these higher leverage points could have a profound effect on persistent public health issues. [ABSTRACT FROM AUTHOR]

Background: Home visiting programs are implemented in high income countries to improve outcomes for families with young children. Significant resources are invested in such programs and high quality evaluations are important. In the context of research trials, implementation quality is often poorly reported and, when reported, is variable. This paper presents the quality of implementation of the right@home program, a sustained nurse home visiting intervention trialled in Australia, and delivered in a ‘real world’ context through usual child and family health services. right@home is structured around the core Maternal Early Childhood Sustained Home-visiting (MECSH) program, which is a salutogenic, child focused prevention model. Method: At each visit right@home practitioners completed a checklist detailing the client unique identifier, date of contact and activities undertaken. These checklists were collated to provide data on intervention dose, retention to program completion at child age 2 years, and visit content, which were compared with the program schedule. Quality of family-provider relationship was measured using the Session Rating Scale. Exploratory factor analysis was conducted to identify clusters of activities and allow qualitative assessment of concordance between program aims and program delivery. Results: Of 363 intervention families offered the program, 352 (97·0%) commenced the program and 304 (87·3%) completed the program to child age 2 years. 253 of 352 (71·9%) families who commenced the program received more than 75 percent of scheduled visits including at least one antenatal visit. Families rated the participant-practitioner relationship highly (mean 39.4/40). The factor analysis identified six antenatal and six postnatal components which were concordant with the program aims. Conclusions: The right@home program was delivered with higher adherence to program dose, schedule and content, and retention than usually reported in other home visiting research. Program compliance may have resulted from program design (visit schedule, dose, content and delivery flexibility) that was consistent with family aims. [ABSTRACT FROM AUTHOR]

In terms of public health, childhood vaccination programs have benefits that far outweigh risks. However, some parents decide not to vaccinate their children. This paper explores the ways in which such parents talked about the perceived risks and benefits incurred by vaccinating (or not vaccinating) their children. Between 2013–2016 we undertook 29 in-depth interviews with non-vaccinating and/or ‘vaccine hesitant’ parents in Australia. Interviews were conducted in an open and non-judgmental manner, akin to empathic neutrality. Interviews focused on parents talking about the factors that shaped their decisions not to (or partially) vaccinate their children. All interviews were transcribed and analysed using both inductive and deductive processes. The main themes focus on parental perceptions of: 1. their capacity to reason; 2. their rejection of Western medical epistemology; and 3. their participation in labour intensive parenting practices (which we term salutogenic parenting). Parents engaged in an ongoing search for information about how best to parent their children (capacity to reason), which for many led to questioning/distrust of traditional scientific knowledge (rejection of Western medical epistemology). Salutogenic parenting spontaneously arose in interviews, whereby parents practised health promoting activities which they saw as boosting the natural immunity of their children and protecting them from illness (reducing or negating the perceived need for vaccinations). Salutogenic parenting practices included breastfeeding, eating organic and/or home-grown food, cooking from scratch to reduce preservative consumption and reducing exposure to toxins. We interpret our data as a ‘logic of care’, which is seen by parents as internally consistent, logically inter-related and inter-dependent. Whilst not necessarily sharing the parents’ reasoning, we argue that an understanding of their attitudes towards health and well-being is imperative for any efforts to engage with their vaccine refusal at a policy level. [ABSTRACT FROM AUTHOR]

The factors underlying poor child health in remote Australian Indigenous (Aboriginal and Torres Strait Islander) communities are complex. There is a lack of consistent and reliable information that allows: (i) the identification of priorities or areas of particular need at household and community levels; (ii) monitoring progress over time; and (iii) the assessment of the impact of interventions. This paper describes the process and methods used to identify the factors that underlie high rates of poor child health in remote Aboriginal communities in the Northern Territory (NT). This work has led to the development of indicators and tools suitable for use within a continuous quality improvement programme. Indigenous and non-Indigenous individuals from a range of disciplines and backgrounds participated in study activities. This allowed for a range of perspectives, including scientific, lay and Aboriginal perspectives, to be accommodated and reflected in study outcomes and outputs. Study participants identified a wide range of physical and social factors that they believe underlies poor child health in remote Aboriginal community contexts in the NT. The approach taken in this study provides some confidence that the indicators developed will be seen as meaningful and appropriate by the residents of remote communities and key stakeholders. Two tools have been developed and are now in use in the practice setting. One assesses social determinants of health at the community level, for example water supply, food supply. The second applies to individual households and assesses the social and environmental indicators that are recognized as placing children at greater risk of poor health and development outcomes. [ABSTRACT FROM AUTHOR]

Risk exposures and predictions of child development outcomes typically estimate the independent effects of individual exposures. As a rule though, children are not exposed piecemeal to individual or single risks but, rather, they are exposed to clusters of risk. Many of these clusters of risks are better thought of as comprising a developmental “circumstance” with a substantial duration, over which period, additional risk exposures also accumulate. In this paper we examined the distribution of 16 single risk exposures for low language ability using latent class analysis across a sample of approximately 4000 children from the Longitudinal Study of Australian Children. The best fitting model identified six distinct classes. 46% of children were in a Developmentally Enabled group, 20% were in a group typified as Working Poor families, 10% of children were in group typified as Overwhelmed group, 9% of children were in a group defined by Child Developmental Delay, 8% of children were in a group defined by Low Human Capital, and 7% of children were in a group defined by Resource Poor non-English Speaking background families. These groups had quantitatively and qualitatively distinct patterns of risk factors and showed different onward trajectories of receptive vocabulary. Our results demonstrate a range of multiple risk profiles in a population-representative sample of Australian children and highlight the mix of risk factors faced by children. Children with distinct patterns of risk factors have different onward trajectories of receptive vocabulary development. [ABSTRACT FROM AUTHOR]

Australia has a well-accepted system of universal child and family health ( CFH) services. However, government reports and research indicate that these services vary across states and territories, and many children and families do not receive these services. The aim of this paper was to explore professionals' perceptions of the challenges and opportunities in implementing a national approach to universal CFH services across Australia. Qualitative data were collected between July 2010 and April 2011 in the first phase of a three-phase study designed to investigate the feasibility of implementing a national approach to CFH services in Australia. In total, 161 professionals participated in phase 1 consultations conducted either as discussion groups, teleconferences or through email conversation. Participants came from all Australian states and territories and included 60 CFH nurses, 45 midwives, 15 general practitioners ( GPs), 12 practice nurses, 14 allied health professionals, 7 early childhood education specialists, 6 staff from non-government organisations and 2 Australian government policy advisors. Data were analysed thematically. Participants supported the concept of a universal CFH service, but identified implementation barriers. Key challenges included the absence of a minimum data set and lack of aggregated national data to assist planning and determine outcomes; an inconsistent approach to transfer of information about mothers and newborns from maternity services to CFH nursing services or GPs; poor communication across disciplines and services; issues of access and equity of service delivery; workforce limitations and tensions around role boundaries. Directions for change were identified, including improved electronic data collection and communication systems, reporting of service delivery and outcomes between states and territories, professional collaboration, service co-location and interprofessional learning and development. [ABSTRACT FROM AUTHOR]

Background The mental health of carers is an important proximate factor in the causal web linking housing conditions to child health, as well as being important in its own right. Improved understanding of the nature of the relationships between housing conditions, carer mental health and child health outcomes is therefore important for informing the development of housing programs. This paper examines the relationship between the mental health of the carers of young children, housing conditions, and other key factors in the socio-physical environment. Methods This analysis is part of a broader prospective cohort study of children living in Aboriginal communities in the Northern Territory (NT) of Australia at the time of major new community housing programs. Carer's mental health was assessed using two validated scales: the Affect Balance scale and the Brief Screen for Depression. The quality of housing infrastructure was assessed through detailed surveys. Secondary explanatory variables included a range of socio-environmental factors, including validated measures of stressful life events. Hierarchical regression modelling was used to assess associations between outcome and explanatory variables at baseline, and associations between change in housing conditions and change in outcomes between baseline and follow-up. Results There was no clear or consistent evidence of a causal relationship between the functional state of household infrastructure and the mental health of carers of young children. The strongest and most consistent associations with carer mental health were the measures of negative life events, with a dose-response relationship, and adjusted odds ratio of over 6 for carers in the highest stress exposure category at baseline, and consistent associations in the follow up analysis. Conclusions The findings highlight the need for housing programs to be supported by social, behavioral and community-wide environmental programs if potential health gains are to be more fully realized, and for rigorous evaluation of such programs for the purpose of informing future housing initiatives. [ABSTRACT FROM AUTHOR]

Aim The aims of this paper are to describe the growth of urban Australian Aboriginal infants from birth to 24 months of age and to identify the proportion of these infants experiencing rapid weight gain ( RWG) and overweight/obesity. Methods The Gudaga Study is a longitudinal birth cohort of 159 Australian Aboriginal children born on the urban fringe of Sydney. Birthweight and length were extracted from hospital data. Children with a birthweight >1500 grams were included in the analysis ( n = 157). Weight, length and head circumference were measured at 2-3 weeks and then six-monthly until 24 months of age. Age- and gender-specific Z-scores were determined from the Centers for Disease Control (CDC) 2000 growth charts for weight, length, head circumference and body mass index ( BMI). The proportion of children experiencing RWG (an increase in weight-for-age Z-scores ≥0.67 between birth and 12 months) was calculated. The association between RWG and ≥85th CDC percentile for BMI at 24 months was tested using Pearson's χ2. Results The mean weight of Gudaga infants was less than the CDC mean length-for-age at birth and 2-3 weeks of age but greater than CDC mean length-for-age and weight-for-age at 18 and 24 months of age. Overall, 42 infants (34.4%) experienced RWG, and 45 infants (36.9%) were overweight/obese at 24 months of age. A greater proportion of those who experienced RWG (61.9%) were overweight/obese at 24 months than those who did not experience RWG (23.8%). Conclusion Our study suggests a concerning proportion of urban Indigenous infants experience RWG and overweight/obesity in early childhood. [ABSTRACT FROM AUTHOR]

Nurses and midwives play a key role in providing universal maternal, child and family health services in Australia. However, the Australian federation of states and territories has resulted in policy frameworks that differ across jurisdictions and services that are fragmented across disciplines and sectors. This paper reports the findings of a study that reviewed and synthesised current Australian service policy or frameworks for maternity and child health services in order to identify the degree of commonality across jurisdictions and the compatibility with international research on child development. Key maternity and child health service policy documents in each jurisdiction were sourced. The findings indicate that current policies were in line with international research and policy directions, emphasising prevention and early intervention, continuity of care, collaboration and integrated services. The congruence of policies suggests the time is right to consider the introduction of a national approach to universal maternal, child health services. [ABSTRACT FROM AUTHOR]

Abstract: Preventoria were established in the early part of the twentieth century at fresh air sites away from cities for the purposes of rest cures for children, usually for those who were at risk of contracting tuberculosis. This paper discusses preventoria in relation to their general landscapes, and outlines the types of landscapes in which preventoria are found, namely woods and forests, ocean, rivers and lakes, and agricultural settings. The preventorium movement is placed in historical landscape context, with urban planning, national parks, and other nineteenth century trends. Fresh air was the driving force of both treatment and locations of preventoria and sanatoria. Current movements in child health to combat obesity and ‘nature-deficit-disorder’ also call for greater engagement with fresh air, and stress the therapeutic value of natural landscape. Australia’s oldest preventorium is examined as a case study of preventoria and the challenges which old preventoria are facing today to re-invent themselves in predominantly rural landscapes. [ABSTRACT FROM AUTHOR]

Abstract: The positive relationship between household income and child health is well documented in the child health literature but the precise mechanisms via which income generates better health and whether the income gradient is increasing in child age are not well understood. This paper presents new Australian evidence on the child health–income gradient. We use data from the Longitudinal Study of Australian Children (LSAC), which involved two waves of data collection for children born between March 2003 and February 2004 (B-Cohort: 0–3 years), and between March 1999 and February 2000 (K-Cohort: 4–7 years). This data set allows us to test the robustness of some of the findings of the influential studies of Case et al. [Case, A., Lubotsky, D., Paxson, C., 2002. Economic status and health in childhood: the origins of the gradient. The American Economic Review 92 (5) 1308–1344] and Currie and Stabile [Currie, J., Stabile, M., 2003. Socioeconomic status and child health: why is the relationship stronger for older children. The American Economic Review 93 (5) 1813–1823], and a recent study by Currie et al. [Currie, A., Shields, M.A., Price, S.W., 2007. The child health/family income gradient: evidence from England. Journal of Health Economics 26 (2) 213–232]. The richness of the LSAC data set also allows us to conduct further exploration of the determinants of child health. Our results reveal an increasing income gradient by child age using similar covariates to Case et al. [Case, A., Lubotsky, D., Paxson, C., 2002. Economic status and health in childhood: the origins of the gradient. The American Economic Review 92 (5) 1308–1344]. However, the income gradient disappears if we include a rich set of controls. Our results indicate that parental health and, in particular, the mother''s health plays a significant role, reducing the income coefficient to zero; suggesting an underlying mechanism that can explain the observed relationship between child health and family income. Overall, our results for Australian children are similar to those produced by Propper et al. [Propper, C., Rigg, J., Burgess, S., 2007. Child health: evidence on the roles of family income and maternal mental health from a UK birth cohort. Health Economics 16 (11) 1245–1269] on their British child cohort. [Copyright &y& Elsevier]

This paper uses examples to illustrate the challenges to health and law professionals interested in public health interventions to reduce the negative impact of companies making money by selling products that put children and young people at risk. Examples included are folate to prevent neural tube defects, with issues around the food industry attempting to block mandatory fortification of flour with folate; fetal alcohol syndrome and hazardous drinking in young people, with a focus on the actions of the alcohol industry including vendors; smoking and the ways in which the tobacco industry still target children; and childhood obesity, with problems again from the food and drink industries including vendors. [ABSTRACT FROM AUTHOR]

Background: A healthy start predicts better health in later life. Many remote-living Aboriginal and Torres Strait Islander Australian families lack access to consistent, culturally-safe health services. This paper presents a study of implementation of the Baby One Program (BOP). The BOP was designed as a family-centred, Indigenous Healthworker-led, home-visiting model of care focused on promoting family health to give children the best start to life. It was developed by Aboriginal community-controlled Apunipima Cape York Health Council and delivered in Queensland Cape York remote communities. We aimed to determine how the BOP was implemented, enablers, strategies used and formative implementation outcomes.Methods: The qualitative approach utilised theoretical and purposive sampling to explore people's experiences of a program implementation process. Data were generated from semi-structured interviews with four family members enrolled in the BOP and 24 Apunipima staff members. In addition, twenty community members, including two program users, participated in a men's community focus group. The findings are presented according to themes arising from the data.Results: The BOP was rolled out in nine remote Cape York communities between July 2014 and December 2015 and there was high uptake. Indigenous Healthworkers were supported by midwives and maternal and child health nurses to deliver health education to 161 eligible families. The key to effective implementation of family-centred care appeared to be the relationships formed between health practitioners, especially Indigenous Healthworkers, and families. The data revealed the following themes: challenging environments for new families and valuing cultural ways, resourcing program delivery, working towards a team approach, negotiating the cultural interface, engaging families, exchanging knowledge through 'yarning', strengthening the workforce, and seeing health changes in families. Healthworker education and training, and knowledge exchange between Healthworkers, midwives and nurses was critical to program effectiveness. The program continues to grow despite substantial logistic, financial and practical challenges.Conclusions: This study describes an evolving process and explores how health providers connect with families and how the program responds to family and cultural issues. Program development is ongoing; strengthened by more community-level involvement, embedded strategies for ongoing self-evaluation and continuous quality improvements that are responsive to family needs. [ABSTRACT FROM AUTHOR]