'Everything's adaptable': A qualitative study of how nurses make decisions in sustained home-visiting care with mothers and children experiencing adversity.

AIMS: To explore nurse decision-making processes in the delivery of sustained home-visiting care for mothers of young children who are experiencing adversity. DESIGN: Qualitative descriptive research design using focus group interviews. METHODS: Thirty-two home-visiting nurses participated in four focus group interviews exploring their decision-making in the care they provide to families. The data were analysed using a reflexive thematic analysis approach. RESULTS: Four steps of a recurring stepwise decision-making process were identified: (1) information gathering; (2) exploring; (3) implementing; (4) checking. The facilitators and barriers to effective decision-making processes were also identified and included elements relating to good relationship skills, a good attitude, high quality training and mentoring and resources. CONCLUSION: The findings indicate that a recurring stepwise process of decision-making requires both analytical and intuitive approaches. The intuition required by home-visiting nurses is to sense unvoiced client needs and identify the right time and way to intervene. The nurses were engaged in adapting the care in response to the client's unique needs while ensuring the fidelity of the programme scope and standards. We recommend creating an enabling working environment with cross-disciplinary team members and having well-developed structures, particularly the feedback systems such as clinical supervision and case reviews. Enhanced skills to establish trusting relationships with clients can help home-visiting nurses make effective decisions with mothers and families, particularly in the face of significant risk. IMPACT: This study explored nurse decision-making processes in the context of sustained home-visiting care, which has been largely unexplored in the research literature. Understanding the effective decision-making processes, particularly when nurses customize or individualize the care in response to the client's unique needs, assists with the development of strategies for precision home-visiting care. The identification of facilitators and barriers informs approaches designed to support nurses in effective decision-making.

Parent satisfaction with sustained home visiting care for mothers and children: an integrative review.

AIM: To synthesise and analyse the existing literature regarding parent satisfaction with sustained home visiting care for mothers and children. BACKGROUND: Sustained home visiting is a service delivery mechanism of both prevention and intervention, in which people receive structured support services within their home environment over an extended period of months or years. For the purposes of this paper, sustained home visiting refers to in-home nursing support to address health inequities for mothers and young children. Sustained home visiting programs have been found to support improved health, wellbeing, and developmental outcomes for children and families. However, there is limited knowledge with regards to the level of parent satisfaction with care provided at home, and the factors and elements of care parents perceive to be critical to their satisfaction. It is important for healthcare practitioners to understand what practices and process parents consider to be a priority in securing their ongoing engagement. DESIGN: Integrative review. DATA SOURCES: PubMed/Medline, CINAHL, Embase, and PsycINFO. METHODS: A multi-step approach was used to search and retrieve peer-reviewed studies from the databases. Study selection, data extraction, data synthesis and critical appraisal were undertaken by two independent researchers. RESULTS: A total of 13 studies met the inclusion criteria, including nine quantitative and four qualitative studies. The review found that parents provided with home visiting interventions had higher levels of satisfaction with care than those who received routine or facility-based care. Service dose was a factor associated with parent satisfaction, however, the direction of impact on parent satisfaction was mixed. Other elements of care parents perceived as important to service satisfaction included the nurse-client relationship, being treated with respect, empowerment, and emotional support. CONCLUSION: While it is critically important that home visiting practitioners provide evidence-based care and interventions, it is equally important that services are delivered in the context of positive and empowering relationships. Further research is recommended to understand the care process and mechanisms that enhance parent satisfaction and positive experiences, providing optimal quality of care.

Does customised care improve satisfaction and positively enable parents in sustained home visiting for mothers and children experiencing adversity?

BACKGROUND: The Maternal Early Childhood Sustained Home-visiting program (MECSH) is a structured nurse-delivered program designed to address health inequities experienced by families experiencing significant adversity. There is strong evidence for the effectiveness of this program, but limited research exploring the practice and process elements that are core to positive parent outcomes. This study aimed to examine the relationship between customised care related to the mother's risk factors and parent satisfaction and enablement in the delivery of a MECSH-based program. METHODS: A cross-sectional study design was used. Program delivery data collected as part of a large randomised controlled trial of a MECSH-based sustained nurse home visiting program in Australia (right@home) were analysed. This study used the data collected from the intervention arm in the trial (n = 352 women). Parent satisfaction was measured at child age 24 months using the modified short-form Patient Satisfaction Questionnaire. Parent enablement was measured at child age 24 months by a modified Parent Enablement Index. Customised care was defined as appropriate provision of care content in response to four maternal risks: smoking, mental health, domestic violence and alcohol and drugs. Logistic analysis was performed to assess the impact of customised care on parent satisfaction and enablement while adjusting for covariates such as sociodemographic factors. A significance level of 95% was applied for analysis. RESULTS: Our results indicated high levels of satisfaction with the care provided and positive enablement. There were several sociodemographic factors associated with satisfaction and enablement, such as language spoken at home and employment experience. The mothers who received customised care in response to mental health risk and domestic violence had significantly greater satisfaction with the care provided and experienced an increase in enablement compared to those who did not receive such care. CONCLUSION: This study contributes to the existing body of empirical research that examines the relationship between care processes and client outcomes in the delivery of home visiting services. It is essential for the sustained nurse home visiting service model to be flexible enough to cater for variations according to family circumstances and needs while maintaining a core of evidence-based practice.

Variations in sustained home visiting care for mothers and children experiencing adversity.

OBJECTIVE: This study aimed to examine the variations in care received by mothers and families within a sustained home visiting program. We sought to identify the extent to which there were variations in home visiting care in response to the program schedule and families' risk factors. DESIGN AND SAMPLE: Data collected within the right@home program, a randomized controlled trial (RCT) for a sustained nurse home visiting intervention in Australia, were analyzed. A total of 352 women comprised the intervention arm of the trial. MEASUREMENTS: Visit content in the home visiting program, sociodemographic data, and families' risk factors were used for analysis. RESULTS: Our results confirmed that the majority of women received scheduled content on time or within an acceptable timeframe, except for the sleeping program. Women with identified risks were significantly more likely to receive content related to those risks than women without those risks (smoking: Odds Ratio [OR] = 15.39 [95%CI 3.7-64.7], mental health: OR = 15.04 [1.8-124.0], domestic violence: OR = 4.07 [2.0-8.3], and drugs and alcohol: OR = 1.81 [1.1-3.0]). CONCLUSIONS: The right@home program had high compliance with the scheduled content. Capacity development in responding to mothers with the risk of domestic violence and drugs and alcohol is recommended. Further research is required to explore the relationship between variations in care and critical outcomes.

Oral health status, behaviours, food and beverage consumption of aboriginal children in Australia.

ISSUE ADDRESSED: Dental decay is prevalent among Australian Aboriginal children, yet little is known about their oral health-related behaviours. This study explored the oral health status, behaviours, food and beverage consumption of Aboriginal school children aged 7-9 years in Sydney, Australia. METHODS: Parents who were part of an existing longitudinal birth cohort ("Gudaga") were surveyed when their child was between 7 and 9 years. Children (n = 110) also received oral health screening by a trained nurse. RESULTS: A number of children (62%-91%) had at least one visible oral health problem across the 2 years. Around two thirds (62%-67%) of parents rated their child's oral health as excellent/very good and less than half the children (32%-45%) had received dental check-ups. Most children (79%-90%) brushed their teeth and drank water (97%) but more than half (57%-70%) also drank sugar sweetened beverages daily. CONCLUSIONS: Parents are instilling good oral health behaviours, however, the oral health screening suggests children are experiencing oral health issues of which parents may be unaware. Parents also seem to be unaware of beverage consumption practices that can increase the risk of childhood decay. SO WHAT?: The findings highlight the need for greater oral health awareness among Aboriginal families on how to recognise early symptoms dental decay and risk factors like sugar sweetened beverages among school going children. This suggests that existing health promotion strategies may not be reaching many Aboriginal families in the urban areas and more culturally appropriate programs may be needed.

The effectiveness of a sustained nurse home visiting intervention for Aboriginal infants compared with non-Aboriginal infants and with Aboriginal infants receiving usual child health care: a quasi-experimental trial - the Bulundidi Gudaga study.

BACKGROUND: In Australia there is commitment to developing interventions that will 'Close the Gap' between the health and welfare of Indigenous and non-Indigenous Australians and recognition that early childhood interventions offer the greatest potential for long term change. Nurse led sustained home visiting programs are considered an effective way to deliver a health and parenting service, however there is little international or Australian evidence that demonstrates the effectiveness of these programs for Aboriginal infants. This protocol describes the Bulundidi Gudaga Study, a quasi-experimental design, comparing three cohorts of families from the Macarthur region in south western Sydney to explore the effectiveness of the Maternal Early Childhood Sustained Home-visiting (MECSH) program for Aboriginal families. METHODS: Mothers were recruited when booking into the local hospital for perinatal care and families are followed up until child is age 4 years. Participants are from three distinct cohorts: Aboriginal MECSH intervention cohort (Group A), Non-Aboriginal MECSH intervention cohort (Group B) and Aboriginal non-intervention cohort (Group C). Eligible mothers were those identified as at risk during the Safe Start assessment conducted by antenatal clinic midwives. Mothers in Group A were eligible if they were pregnant with an Aboriginal infant. Mothers in Group B were eligible if they were pregnant with a non-Aboriginal infant. Mothers in Group C are part of the Gudaga descriptive cohort study and were recruited between October 2005 and May 2007. The difference in duration of breastfeeding, child body mass index, and child development outcomes at 18 months and 4 years of age will be measured as primary outcomes. We will also evaluate the intervention effect on secondary measures including: child dental health; the way the program is received; patterns of child health and illness; patterns of maternal health, health knowledge and behaviours; family and environmental conditions; and service usage for mothers and families. DISCUSSION: Involving local Aboriginal research and intervention staff and investing in established relationships between the research team and the local Aboriginal community is enabling this study to generate evidence regarding the effectiveness of interventions that are feasible to implement and sustainable in the context of Aboriginal communities and local service systems. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12616001721493 Registered 14 Dec 2016. Retrospectively registered.

The oral health behaviours and fluid consumption practices of young urban Aboriginal preschool children in south-western Sydney, New South Wales, Australia.

ISSUE ADDRESSED: Australian Aboriginal children have a higher risk of dental caries yet there is limited focus on oral health risk factors for urban Aboriginal preschool children. This study examined the oral health behaviours and fluid consumption practices of young children from an urban Aboriginal community in south-western Sydney, Australia. METHODS: In total, 157 Aboriginal children who were recruited to the "Gudaga" longitudinal birth cohort participated in this study. A survey design was employed and parents responded to the oral health questions when their child was between 18 and 60 months. RESULTS: Few parents (20%) were concerned about their child's oral health across the time period. By 60 months, only 20% of children had seen a dentist while 80% were brushing their teeth at least once daily. High levels of bottle use were seen up to 30 months. Consumption of sugary drinks was also very high in the early years, although this was replaced by water by 36 months. CONCLUSIONS: While there are some encouraging findings, such as the rates of tooth brushing and increasing rates of water consumption, the findings do highlight the poor uptake of dental services and high levels of bottle usage among urban aboriginal children during their early years. SO WHAT?: Targeted oral health promotional programs are needed in the urban Aboriginal community to better support parents understanding of good oral health practices in the early years and engagement with dental health services.

The role of formal support in the lives of children of mothers with intellectual disability.

BACKGROUND: Mothers with intellectual disability face socioeconomic disadvantage and social isolation, which is associated with poorer child outcomes. Social services feature prominently in the lives of mothers with intellectual disability especially those without informal support; however, the role of formal support in the lives of their children has not been explored. METHODS: Seven children aged 7-11 years took part in semi-structured interviews to explore their social experiences. Stories about interactions at home, school and with peers were analysed to illuminate influences, including social support, in their lives. RESULTS: Formal support can provide an enduring relationship for children from socially restricted homes when it focuses on the child's abilities, interests and needs as distinct from those of their mother. Child-focused support can be from a paid worker or volunteer. CONCLUSIONS: Family support services need to apply a child focus to improve the well-being of children in vulnerable families.

Structured social relationships: a review of volunteer home visiting programs for parents of young children.

Objective The aims of the present paper were to: (1) review the research literature that contributes to an understanding of the role of volunteer home visiting programs in supporting the health and well being of families with young children; and (2) propose a conceptual model outlining service pathways for families in need of additional support. Methods An integrative literature review method was used, with a mix of electronic and manual search methods for the period January 1980-January 2014. Forty-five studies were identified that met the inclusion criteria for review and were coded according to themes developed a priori. Results There is little formal research that has examined the effectiveness of volunteer home visiting programs for supporting family health and well being. The available research suggests that volunteer home visiting programs provide socioemotional support through structured social relationships; however, there is limited empirical evidence to explicate the factors that contribute to these outcomes. Conclusion In recognition of the importance of peer support for new parents, the not-for-profit sector has been involved in providing volunteer home visiting services to families for decades. However, the body of research to support this work is characterised by methodological limitations, and rigorous evidence is limited. What is clear anecdotally and qualitatively from the existing research is that parents who are in need of additional support value engagement with a community volunteer. These structured social relationships appear to fulfil a service need within the community, helping build bridges to support social networks, and thus complementing professional services and relationships. Overall, structured social relationships in the form of volunteer home visiting programs appear to provide an important pathway to support family health and well being. Findings from the existing research are mixed and often characterised by methodological limitations, pointing to a need for further rigorous research. What is known about the topic? Volunteer family support programs have been an important part of the service landscape for vulnerable families, both nationally and internationally, for many years. Anecdotal reports suggest that this is a valued form of support that increases a sense of community connectedness and breaks down barriers for families in accessing other community support services. What does this paper add? This paper proposes a model identifying broad service pathways impacting on family health and well being that takes into account the importance of structured social relationships and social connectedness. What are the implications for practitioners? The proposed model may encourage discussion by practitioners and organisations interested in models of support for families who are socially isolated and/or in need of assistance to access and engage with services within the community.

A community-embedded approach to increasing the health literacy of Aboriginal children in a regional area: processes of co-design and local implementation.

Purpose: This research explores the implementation of a child-centred, co-designed, community-embedded program called 'Young Doctors for Life' (YDFL). YDFL is designed to improve health and wellbeing outcomes for Aboriginal children in the middle childhood years. Focus is given in this paper to the processes of program adaptation of the YDFL to ensure local cultural relevance, drawing on the experiences and perspectives of children, parents, schoolteachers, and the implementation team. Method: Two focus groups with program stakeholders were convened. The first group consisted of three members from the local Aboriginal implementation team, and the second group comprised two members of the program design team. Children (n = 22) and schoolteachers (n = 2) participated in semi-structured interviews. Parent survey data (n = 16) were also collected and included. The data was analysed, guided by the five elements of implementation as outlined in the Hexagon Implementation framework (Capacity; Fit; Need; Usability; Support; and Evidence), which served as a priori themes. Results: YDFL provides a promising example of how programs can be adapted with and for Aboriginal communities to support child health. Successful adaptation and implementation of this program required a co-design approach engaging program designers and the local implementation team. Community collaboration was also essential to identifying and addressing local community goals and aligning new programs with local service and cultural contexts. Conclusion: Health programs to support positive child outcomes are more likely to be successful when they share their focus between the risks and challenges within a community, and the positive, protective factors that can be leveraged to support children to flourish. Stakeholder engagement and community leadership are necessary to achieve meaningful program adaptation and implementation in Aboriginal communities.

Stay home, stay safe? Public health assumptions about how we live with COVID.

The COVID pandemic has had an uneven impact on families and communities, exacerbating existing structural disadvantage. We demonstrate that the construction of the pandemic by policymakers as primarily a medical problem has shaped the public health response in such a way as to hide the resulting lack of access to necessities for many and deterioration in people's wellbeing. We interviewed social welfare service providers in an urban area of high cultural and linguistic diversity and low socioeconomic advantage, about their experiences in the 2021 lockdown period. Our findings highlight the unanticipated impacts of the public health response on people who cannot be recognised in the normative subjects constructed by policy. We bring to the fore the hidden experiences behind the government-reported COVID health statistics and explore the (dis)integration of services that support survival. To avoid worsening structural disadvantage, policy responses to crisis require conceptualising the problem and its solutions from diverse standpoints, built on an understanding of the different elements that shape who we are and the way we live.

Role of Psychological Stress and Choroidal Thickness in Central Serous Chorioretinopathy.

INTRODUCTION: Central serous chorioretinopathy (CSCR) is a disease with a multifactorial aetiology. OBJECTIVES: To evaluate the role of psychological stress and choroidal thickness in patients with CSCR. MATERIALS AND METHODS: This was a hospital-based, analytical cross-sectional study, conducted at Christian Medical College, Vellore, India, from 2018 February to 2019 September, after the approval of the Institutional Review Board and Ethics Committee. Patients who satisfied the eligibility criteria of the study, were selected from the outpatient clinics of the Department of Ophthalmology. Twenty-five patients with unilateral CSCR (Group 1 - cases), and 50 age and gender-matched patients without CSCR (Group 2 - controls), randomly selected in a 1:2 ratio, were enrolled after obtaining informed consent. Psychological stress was assessed using Cohen Perceived Stress Scale (PSS-10). All patients had a Swept Source optical coherence tomography scan of the macula. Subfoveal choroidal thickness (SFCT) of both eyes of all participants was measured using a standard protocol. The data were collated and analysed, using Independent samples t-test and Chi-square/ Fisher's exact test, as appropriate, with IBM SPSS Statistics for Windows, version 21 (IBM Corp., Armonk, N.Y., USA). RESULTS: There was a significant difference between the two groups in mean stress scores (p <0.01), as well as stress categories (p <0.01). Although there was no significant difference in the prevalence of hypertension between the two groups (p = 0.33), there was a significant difference both in the mean systolic (p <0.01) and diastolic (p <0.01) blood pressure between the two groups. We found a significant difference between mean SFCT of CSCR eyes (421+/- 78.34 µm) and control eyes (314.24 +/- 52.48 µm, p <0.01), as well as between fellow eyes (396.20 +/- 68.79 µm) and control eyes (314.24 +/- 52.48 µm, p <0.01). However, there was no significant difference in the mean SFCT of CSCR eyes and fellow eyes (p =0.24). CONCLUSION: The findings reiterate the concept that the underlying pathophysiological changes leading to CSCR involve both the eyes of the patient. Psychological stress and hypertension may be factors that play an important role in the etiopathogenesis of the pachychoroid-related changes leading to CSCR. Stress relief measures, with a holistic approach to management, should be an integral part of the therapeutic strategies for CSCR.

Feasibility of linking universal child and family healthcare and financial counselling: findings from the Australian Healthier Wealthier Families (HWF) mixed-methods study.

OBJECTIVES: 'Healthier Wealthier Families' (HWF) seeks to reduce financial hardship in the early years by embedding a referral pathway between Australia's universal child and family health (CFH) services and financial counselling. This pilot study investigated the feasibility and short-term impacts of HWF, adapted from a successful Scottish initiative. METHODS: Setting: CFH services in five sites across two states, coinciding with the COVID-19 pandemic. PARTICIPANTS: Caregivers of children aged 0-5 years experiencing financial hardship (study-designed screen). DESIGN: Mixed methods. With limited progress using a randomised trial (RCT) design in sites 1-3 (March 2020-November 2021), qualitative interviews with service providers identified implementation barriers including stigma, lack of knowledge of financial counselling, low financial literacy, research burden and pandemic disruption. This informed a simplified RCT protocol (site 4) and direct referral model (no randomisation, pre-post evaluation, site 5) (June 2021-May 2022). INTERVENTION: financial counselling; comparator: usual care (sites 1-4). Feasibility measures: proportions of caregivers screened, enrolled, followed up and who accessed financial counselling. Impact measures: finances (quantitative) and other (qualitative) to 6 months post-enrolment. RESULTS: 355/434 caregivers completed the screen (60%-100% across sites). In RCT sites (1-4), 79/365 (19%-41%) reported hardship but less than one-quarter enrolled. In site 5, n=66/69 (96%) caregivers reported hardship and 44/66 (67%) engaged with financial counselling; common issues were utility debts (73%), and obtaining entitlements (43%) or material aid/emergency relief (27%). Per family, financial counselling increased income from government entitlements by an average $A6504 annually plus $A784 from concessions, grants, brokerage and debt waivers. Caregivers described benefits (qualitative) including reduced stress, practical help, increased knowledge and empowerment. CONCLUSIONS: Financial hardship screening via CFH was acceptable to caregivers, direct referral was feasible, but individual randomisation was infeasible. Larger-scale implementation will require careful, staged adaptations where CFH populations and the intervention are well matched and low burden evaluation. TRIAL REGISTRATION NUMBER: ACTRN12620000154909.

Connecting Healthcare with Income Maximisation Services: A Systematic Review on the Health, Wellbeing and Financial Impacts for Families with Young Children.

Financial counselling and income-maximisation services have the potential to reduce financial hardship and its associated burdens on health and wellbeing in High Income Countries. However, referrals to financial counselling services are not systematically integrated into existing health service platforms, thus limiting our ability to identify and link families who might be experiencing financial hardship. Review evidence on this is scarce. The purpose of this study is to review "healthcare-income maximisation" models of care in high-income countries for families of children aged between 0 and 5 years experiencing financial difficulties, and their impacts on family finances and the health and wellbeing of parent(s)/caregiver(s) or children. A systematic review of the MEDLINE, EMBase, PsycInfo, CINAHL, ProQuest, Family & Society Studies Worldwide, Cochrane Library, and Informit Online databases was conducted according to the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) statement. A total of six studies (five unique samples) met inclusion criteria, which reported a total of 11,603 families exposed to a healthcare-income maximisation model. An average annual gain per person of £1661 and £1919 was reported in two studies reporting one Scottish before-after study, whereby health visitors/midwives referred 4805 clients to money advice services. In another UK before-after study, financial counsellors were attached to urban primary healthcare centres and reported an average annual gain per person of £1058. The randomized controlled trial included in the review reported no evidence of impacts on financial or non-financial outcomes, or maternal health outcomes, but did observe small to moderate effects on child health and well-being. Small to moderate benefits were seen in areas relating to child health, preschool education, parenting, child abuse, and early behavioral adjustment. There was a high level of bias in most studies, and insufficient evidence to evaluate the effectiveness of healthcare-income maximisation models of care. Rigorous (RCT-level) studies with clear evaluations are needed to assess efficacy and effectiveness.

Study protocol for the Healthier Wealthier Families (HWF) pilot randomised controlled trial: testing the feasibility of delivering financial counselling to families with young children who are identified as experiencing financial hardship by community-based nurses.

INTRODUCTION: Poverty and deprivation can harm children's future health, learning, economic productivity and societal participation. The Australian Healthier Wealthier Families project seeks to reduce the childhood inequities caused by poverty and deprivation by creating a systematic referral pathway between two free, community-based services: universal, well-child nursing services, which provide health and development support to families with children from birth to school entry, and financial counselling. By adapting the successful Scottish 'Healthier Wealthier Children' model, the objectives of this Australian pilot are to test the (1) feasibility of systematising the referral pathway, and (2) short-term impacts on household finances, caregiver health, parenting efficacy and financial service use. METHODS AND ANALYSIS: This pilot randomised controlled trial will run in three sites across two Australian states (Victoria and New South Wales), recruiting a total of 180 participants. Nurses identify eligible caregivers with a 6-item, study-designed screening survey for financial hardship. Caregivers who report one or more risk factors and consent are randomised. The intervention is financial counselling. The comparator is usual care plus information from a government money advice website. Feasibility will be evaluated using the number/proportion of caregivers who complete screening, consent and research measures, and access financial counselling. Though powered to assess feasibility, impacts will be measured 6 months post-enrolment with qualitative interviews and questionnaires about caregiver-reported income, loans and costs (adapted from national surveys, for example, the Household, Income and Labour Dynamics in Australia Survey); health (General Health Questionnaire 1, EuroQol five-dimensional questionnaire, Depression, Anxiety, Stress Scale short-form); efficacy (from the Longitudinal Study of Australian Children); and financial service use (study-designed) compared between arms. ETHICS AND DISSEMINATION: Ethics committees of the Royal Children's Hospital (HREC/57372/RCHM-2019) and South West Sydney Local Health District (2019/ETH13455) have approved the study. Participants and stakeholders will receive results through regular communication channels comprising meetings, presentations and publications. TRIAL REGISTRATION NUMBER: ACTRN12620000154909; prospectively registered. Pre-results.

Connecting healthcare with income maximisation services, and their financial, health and well-being impacts for families with young children: a systematic review protocol.

INTRODUCTION: Poverty has far-reaching and detrimental effects on children's physical and mental health, across all geographies. Financial advice and income-maximisation services can provide a promising opportunity for shifting the physical and mental health burdens that commonly occur with financial hardship, yet awareness of these services is limited, and referrals are not systematically integrated into existing healthcare service platforms. We aim to map and synthesise evidence on the impact of healthcare-income maximisation models of care for families of children aged 0-5 years in high-income countries on family finances, parent/caregiver(s) or children's health and well-being. METHODS AND ANALYSIS: To be included in the review, studies must be families (expectant mothers or parents/caregivers) of children who are aged between 0 and 5 years, accessing a healthcare service, include a referral from healthcare to an income-maximisation service (ie, financial counselling), and examine impacts on child and family health and well-being. A comprehensive electronic search strategy will be used to identify studies written in English, published from inception to January 2021, and indexed in MEDLINE, EMBase, PsycINFO, CINAHL, Proquest, Family & Society Studies Worldwide, Cochrane Library, and Informit Online. Search strategies will include terms for: families, financial hardship and healthcare, in various combinations. Bibliographies of primary studies and review articles meeting the inclusion criteria will be searched manually to identify further eligible studies, and grey literature will also be searched. Data on objective and self-reported outcomes and study quality will be independently extracted by two review authors; any disagreements will be resolved through a third reviewer. The protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. ETHICS AND DISSEMINATION: Ethical approval is not required. The results will be disseminated widely via peer-reviewed publication and presentations at conferences related to this field. PROSPERO REGISTRATION NUMBER: CRD42020195985.

Effectiveness of the Volunteer Family Connect Program in Reducing Isolation of Vulnerable Families and Supporting Their Parenting: Randomized Controlled Trial With Intention-To-Treat Analysis of Primary Outcome Variables.

BACKGROUND: Volunteer home visiting is a widely adopted community-based approach to support families by linking isolated or vulnerable families with community volunteers who visit their homes weekly over approximately 12 months. This study seeks to robustly evaluate the effectiveness of this model of support for families with young children. OBJECTIVE: This paper reports the intention-to-treat analysis of primary and secondary outcomes for a pragmatic randomized controlled trial (RCT) of the Volunteer Family Connect intervention, a volunteer home-visiting program designed to support families with young children who experience social isolation or a lack of parenting confidence and skills. METHODS: The RCT was conducted across seven sites in Australia. Overall, 341 families were recruited: 169 intervention (services as usual+volunteer home visits) and 172 control (services as usual) families. Intervention families received the program for 3-12 months. Participants were invited to complete six data collection points over a 15-month period. Primary outcomes were community connectedness and parenting competence. Secondary outcomes included parent physical and mental health, general parent wellbeing, parent empowerment, the sustainability of family routines, and the parent-child relationship. According to the protocol, the program would be judged to be effective if at least one of the primary outcomes was significantly positive and the other was neutral (ie, intervention families did not demonstrate positive or negative outcomes compared to the control group). RESULTS: The intervention group demonstrated significant improvement in the primary outcome variable parenting sense of competence as compared to the control group. Overall, there was no significant difference between the intervention and control groups with regard to the primary outcome variable community connectedness, other than on the "Guidance" subscale of the Social Provisions Scale. Because there were statistically significant findings for the total score of one primary outcome variable "parenting sense of competence" and largely neutral findings for the primary outcome variable "community connectedness," the program met the previously defined criteria for program effectiveness. In relation to secondary outcomes, intervention families reported significantly higher wellbeing and were significantly more likely to feel that life was improving. CONCLUSIONS: The Volunteer Family Connect intervention was considered an effective intervention, with a role to play on the landscape of services available to support vulnerable families with young children. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN12616000396426; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370304.

A case study of well child care visits at general practices in a region of disadvantage in Sydney.

INTRODUCTION: Well-Child Care (WCC) is the provision of preventive health care services for children and their families. Prior research has highlighted that several barriers exist for the provision of WCC services. OBJECTIVES: To study "real life" visits of parents and children with health professionals in order to enhance the theoretical understanding of factors affecting WCC. METHODS: Participant observations of a cross-sectional sample of 71 visits at three general practices were analysed using a mixed-methods approach. RESULTS: The median age of the children was 18 months (IQR, 6-36 months), and the duration of visits was 13 mins (IQR, 9-18 mins). The reasons for the visits were immunisation in 13 (18.5%), general check-up in 10 (13.8%), viral illness in 33 (49.2%) and miscellaneous reasons in 15 (18.5%). Two clusters with low and high WCC emerged; WCC was associated with higher GP patient-centeredness scores, younger age of the child, fewer previous visits, immunisation and general check-up visits, and the solo general practitioner setting. Mothers born overseas received less WCC advice, while longer duration of visit increased WCC. GPs often made observations on physical growth and development and negotiated mothers concerns to provide reassurance to them. The working style of the GP which encouraged informal conversations with the parents enhanced WCC. There was a lack of systematic use of developmental screening measures. CONCLUSIONS: GPs and practice nurses are providing parent/child centered WCC in many visits, particularly when parents present for immunisation and general check-ups. Providing funding and practice nurse support to GPs, and aligning WCC activities with all immunisation visits, rather than just a one-off screening approach, appears to be the best way forward. A cluster randomised trial for doing structured WCC activities with immunisation visits would provide further evidence for cost-effectiveness studies to inform policy change.

Community Volunteer Support for Families With Young Children: Protocol for the Volunteer Family Connect Randomized Controlled Trial.

BACKGROUND: Use of community volunteers to support vulnerable families is a widely employed strategy with a long history. However, there has been minimal formal scientific investigation into the effectiveness of volunteer home visiting programs for families. There is also a need for research examining whether volunteer home visiting leads to improved outcomes for volunteers. OBJECTIVE: The objective of this paper is to describe the research protocol for a pragmatic randomized controlled trial (RCT) of the Volunteer Family Connect intervention, a volunteer home visiting program designed to support families of young children who experience social isolation or a lack of parenting confidence and skills. The project is being conducted in partnership with 3 leading not-for-profit organizations, designed to contribute to the body of evidence that informs decisions about appropriate family support services according to the level of need. It is the first study to examine outcomes for both the families and the volunteers who deliver the service. METHODS: The RCT is being conducted in 7 sites across Australia. We aim to recruit 300 families to the study: 150 control (services as usual) and 150 intervention (services as usual + volunteer home visiting) families. Intervention families will receive the service for 3-12 months according to their needs, and all participants will complete 6 data collection points over 15 months. A minimum of 80 volunteers will also be recruited, along with a matched community comparison group. The volunteers will complete 3 data collection points over 12 months. Primary outcomes include community connectedness and parenting competence. Secondary outcomes include parent physical and mental health; general parent well-being; parent empowerment; the child-parent relationship; sustainability of family routines; child immunization; child nutrition or breastfeeding; number of accidental injury reports; and volunteer health, well-being, and community connectedness. RESULTS: This effectiveness trial was funded in 2016, and we aim to complete data collection by the end of 2018. The first results are expected to be submitted early in 2019. CONCLUSIONS: There is a need to rigorously assess volunteer home visiting and whether it has a unique and important role on the service landscape, complementary to professional services. This research is the first trial of a volunteer home visiting program to be conducted in Australia and one of the largest of its kind worldwide. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN12616000396426; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370304 (Archived by WebCite athttp://www.webcitation.org/70q42fU7V). REGISTERED REPORT IDENTIFIER: RR1-10.2196/1000.

Group B streptococcal infection in a tertiary hospital in India--1998-2010.

This retrospective study was done to determine the incidence of neonatal Group B streptococcal sepsis among newborn between 1998 and 2010. Among 107,692 babies born during this period, the overall incidence of Group B streptococcal sepsis was 0.76/1000 live births with the incidence of early onset sepsis being 0.68 (95% confidence interval: 0.52-0.83)/1000 live births. The overall rate of early onset sepsis decreased to 0.55/1000 live births with introduction of intrapartum antibiotic policy.