Building healthcare workers' confidence to work with same-sex parented families.

This article reports on a qualitative study of barriers and access to healthcare for same-sex attracted parents and their children. Focus groups were held with same-sex attracted parents to explore their experiences with healthcare providers and identify barriers and facilitators to access. Parents reported experiencing uncomfortable or anxiety-provoking encounters with healthcare workers who struggled to adopt inclusive or appropriate language to engage their family. Parents valued healthcare workers who were able to be open and honest and comfortably ask questions about their relationships and family. A separate set of focus groups were held with mainstream healthcare workers to identity their experiences and concerns about delivering equitable and quality care for same-sex parented families. Healthcare workers reported lacking confidence to actively engage with same-sex attracted parents and their children. This lack of confidence related to workers' unfamiliarity with same-sex parents, or lesbian, gay and bisexual culture, and limited opportunities to gain information or training in this area. Workers were seeking training and resources that offered information about appropriate language and terminology as well as concrete strategies for engaging with same-sex parented families. For instance, workers suggested they would find it useful to have a set of 'door opening' questions they could utilize to ask clients about their sexuality, relationship status or family make-up. This article outlines a set of guidelines for healthcare providers for working with same-sex parented families which was a key outcome of this study.

Utilising implementation science in building research and evaluation capacity in community health.

It is becoming increasingly important for the community health sector to provide evidence of practice and program effectiveness. Unfortunately many community health centres do not have the capacity to provide such evidence and require the implementation of innovative changes within their organisation to develop their capacity to conduct research and evaluation. In this paper we present our project in which we utilised Donald Ely's model to build research and evaluation capacity in a community health centre. We utilised a qualitative research method that incorporated a co-operative inquiry action research design. Qualitative research methods incorporated data from semi-structured interviews, observations and the recording of relevant meetings. The data were analysed by means of thematic analysis. We found that to successfully build research and evaluation capacity entails the application of a model that is capable of not only addressing significant issues in implementation but that can also identify the conditions within an organisation that are important to achieve change. Ely's Conditions for Change model was most appropriate to implement the necessary changes.

Understanding resilience in same-sex parented families: the work, love, play study.

BACKGROUND: While families headed by same-sex couples have achieved greater public visibility in recent years, there are still many challenges for these families in dealing with legal and community contexts that are not supportive of same-sex relationships. The Work, Love, Play study is a large longitudinal study of same-sex parents. It aims to investigate many facets of family life among this sample and examine how they change over time. The study focuses specifically on two key areas missing from the current literature: factors supporting resilience in same-sex parented families; and health and wellbeing outcomes for same-sex couples who undergo separation, including the negotiation of shared parenting arrangements post-separation. The current paper aims to provide a comprehensive overview of the design and methods of this longitudinal study and discuss its significance. METHODS/DESIGN: The Work, Love, Play study is a mixed design, three wave, longitudinal cohort study of same-sex attracted parents. The sample includes lesbian, gay, bisexual and transgender parents in Australia and New Zealand (including single parents within these categories) caring for any children under the age of 18 years. The study will be conducted over six years from 2008 to 2014. Quantitative data are to be collected via three on-line surveys in 2008, 2010 and 2012 from the cohort of parents recruited in Wave1. Qualitative data will be collected via interviews with purposively selected subsamples in 2012 and 2013. Data collection began in 2008 and 355 respondents to Wave One of the study have agreed to participate in future surveys. Work is currently underway to increase this sample size. The methods and survey instruments are described. DISCUSSION: This study will make an important contribution to the existing research on same-sex parented families. Strengths of the study design include the longitudinal method, which will allow understanding of changes over time within internal family relationships and social supports. Further, the mixed method design enables triangulation of qualitative and quantitative data. A broad recruitment strategy has already enabled a large sample size with the inclusion of both gay men and lesbians.

Lesbian parents negotiating the health care system in Australia.

Twenty Australian lesbian-parented families were interviewed in multigenerational family groups about the interface between their public and private worlds. Experiences of the health care bureaucracy were difficult, whereas many participants found individual providers to be approachable and caring. Three strategies were used for disclosure of their sexual orientation to health care providers: private, proud, and passive. Influences on the strategy used included family formation, role of the non-birth parent, geographic location, and expected continuity of care. Parents displayed a high degree of thoughtful planning in utilizing their preferred disclosure strategy in order to optimize safety, particularly for their children.

Families living with acquired brain injury: a multiple family group experience.

Although the use of multifamily group work is well established within the mental health field, it remains an underutilised method of treatment for families affected by brain injury. This paper reports on a pilot project exploring multifamily group work with families with a parent with an acquired brain injury. Six families met for a total of 12 sessions over a period of 6 months, with session themes informed by the Bouverie Family tasks model of adaptation post-ABI. The project was evaluated using qualitative and quantitative research methods, with pre, post group and 3 month follow up measures of individual, couple and family functioning. Parents reported generally reduced levels of personal distress at follow up but continuing high levels of marital and family dysfunction. Children were generally reported to be well functioning, although parents were particularly concerned about the impact of family disruption and violence on their children. Families were unequivocally positive about their participation in the group with benefits including reduced feelings of shame and isolation, provision of mutual support, increased understanding of brain injury, sharing of difficult experiences and movement from blame to compassion. Further research is warranted on the specific applications of multifamily group work with acquired brain injury.

Multiple-family group treatment for English- and Vietnamese-speaking families living with schizophrenia.

OBJECTIVE: This study, which was the first evaluation in Australia of multiple-family group treatment, explored the effectiveness of this approach for a newly arrived non-English speaking migrant group, first-generation Vietnamese families, and for English-speaking families. METHODS: Thirty-four pairs of English-speaking consumers and family members and 25 Vietnamese-speaking pairs were randomly assigned to a multiple-family group or a control group. All consumers had a diagnosis of schizophrenia. The multiple-family group intervention (26 sessions over 12 months) was delivered as an adjunct to case management services, which all consumers received. Outcomes, which were measured immediately after treatment and 18 months later, included the number of relapse episodes; the presence and severity of symptoms, as measured by the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Negative Symptoms; and social functioning, as measured by the Family Burden Scale, the Health of the Nation Outcome Scale, and the Quality of Life Scale. RESULTS: Relapse rates immediately after treatment were significantly lower for the multiple-family group than for the control group (12 and 36 percent), and relapse rates were also lower during the follow-up period (25 and 63 percent). BPRS ratings were significantly lower for participants in the multiple-family group, and vocational outcomes also improved. The reductions in relapse and symptoms were similar for the English-speaking and the Vietnamese-speaking family groups; sample size precluded statistical analysis of differences. CONCLUSIONS: Multiple-family group treatment is an effective cognitive-behavioral intervention in the treatment of schizophrenia. The findings suggest continued application of and research on family interventions for non-English speaking migrant populations.

Through children's eyes: children's experience of living with a parent with an acquired brain injury.

While previous literature on brain injury reports high levels of stress and burden in primary caregivers, the impact on children has been overlooked. This paper reports on an in-depth, qualitative research project exploring the experiences of four children living with fathers with an acquired brain injury (ABI). The findings indicate that these children were negatively impacted and at risk of emotional and behavioural difficulties. The children reported a complexity of feelings associated with the trauma and multiple losses, including profound grief, social isolation and fear of family disintegration and violence. Despite the difficulties they faced, the children also demonstrated resilience and reported positive outcomes such as having greater independence. Although only a small pilot study, the current findings highlight the need for both clinicians and researchers to be more proactive in questioning their clients and families about the level of violence following ABI and that disclosure may be more likely to occur with on-going involvement and support. The study concludes that early intervention and systemic support is required to minimize the trauma for these children. Further research is recommended, not only to replicate these findings in a larger sample, but also to explore in-depth children's experience of living with a parent with a brain injury.