Family member and service provider experiences and perspectives of a digital surveillance and service navigation approach in multicultural context: a qualitative study in identifying the barriers and enablers to Watch Me Grow-Electronic (WMG-E) program with a culturally diverse community.

BACKGROUND: Children and families from priority populations experienced significant psychosocial and mental health issues to the COVID-19 pandemic. Yet they also faced significant barriers to service access, particularly families from culturally and linguistically diverse (CALD) backgrounds. With most child and family health nurse clinics ceasing in-person consultations due to the pandemic, many children missed out on health and developmental checks. The aim of this study was to investigate the perspectives and experiences of family members and service providers from an urban, CALD community regarding the implementation of a digital, developmental surveillance, Watch Me Grow-Electronic (WMG-E) program. METHODS: Semi-structured interviews were conducted with 17 family members, service navigators, and service providers in a multicultural community in South Western Sydney, Australia. This qualitative study is an implementation evaluation which formed as part of a larger, two-site, randomised controlled trial of the WMG-E program. A reflexive thematic analysis approach, using inductive coding, was adopted to analyse the data. RESULTS: Participants highlighted the comprehensive and personalised support offered by existing child and family health services. The WMG-E was deemed beneficial because the weblink was easy and quick to use and it enabled access to a service navigator who support family access to relevant services. However, the WMG-E was problematic because of technology or language barriers, and it did not facilitate immediate clinician involvement when families completed the weblink. CONCLUSIONS: Families and service providers in this qualitative study found that using WMG-E empowered parents and caregivers to access developmental screening and learn more about their child's development and engage with relevant services. This beds down a new and innovative solution to the current service delivery gap and create mechanisms that can engage families currently not accessing services, and increases knowledge around navigating the health and social care services. Notwithstanding the issues that were raised by families and service providers, which include accessibility challenges for CALD communities, absence of clinical oversight during screening, and narrow scope of engagement with available services being offered, it is worth noting that improvements regarding these implementation factors must be considered and addressed in order to have longevity and sustainability of the program. TRIAL REGISTRATION: The study is part of a large randomised controlled trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.

Supporting Children's Social Connection and Well-Being in School-Age Care: Mixed Methods Evaluation of the Connect, Promote, and Protect Program.

BACKGROUND: School-age care, such as outside school hours care (OSHC), is the fastest-growing childhood education sector in Australia. OSHC provides a unique opportunity to deliver programs to enhance primary school-age children's social, emotional, physical, and cognitive well-being. OBJECTIVE: This study aimed to pilot the co-designed Connect, Promote, and Protect Program (CP3) and conduct formative and process evaluations on how well the CP3 achieved its intended aims, ascertain areas for improvement, and determine how the CP3 model could be better sustained and extended into OSHC settings. METHODS: A naturalistic formative and process evaluation of the CP3 implementation was undertaken at 1 and then 5 OSHC sites. Qualitative and quantitative feedback from stakeholders (eg, children, OSHC educators, volunteers, and families) was collected and incorporated iteratively for program improvement. RESULTS: The formative and process evaluations demonstrated high program engagement, appropriateness, and acceptability. Co-design with children was viewed as highly acceptable and empowered children to be part of the decision-making in OSHC. Feedback highlighted how the CP3 supported children in the 4 CP3 domains: Build Well-being and Resilience, Broaden Horizons, Inspire and Engage, and Connect Communities. Qualitative reports suggested that children's well-being and resilience were indirectly supported through the Broaden Horizons, Inspire and Engage, and Connect Communities CP3 principles. Matched-sample 2-tailed t tests found that children's prosocial behaviors increased (mean difference=0.64; P=.04; t57=-2.06, 95% CI -1.36 to -0.02) and peer problems decreased (mean difference=-0.69; P=.01; t57=2.57, 95% CI 0.14-1.13) after participating in the CP3. Program feasibility was high but dependent on additional resources and CP3 coordinator support. CONCLUSIONS: To our knowledge, the CP3 is the first co-designed well-being program developed and evaluated specifically for OSHC services. This early evidence is promising. The CP3 may provide a unique opportunity to respond to the voices of children in OSHC and those that support them through creative and engaging co-designed activities. Our research suggests that CP3 provides OSHC with a framework and high-quality program planning tool that promotes tailored interventions developed based on the unique needs and preferences of those who will use them.

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.

LGBTI attitudes towards and experiences of aged care: Results of an exploratory survey.

OBJECTIVE: To gather views of older LGBTI (Lesbian, Gay, Bisexual, Transgender and Intersex) people on their experiences and expectations of aged care. METHODS: An online survey of participants recruited through a large provider in NSW, Australia, and three organisations in the LGBTI community. RESULTS: Respondents were older members of the LGBTI community, with a range of kinds of experience of aged care (including as clients, workers and advocates). They were somewhat skewed towards regional areas and many reported different kinds of vulnerability. They reported feeling safe to disclose their LGBTI status when engaging with services and not having difficulties on that basis. However, most disagreed that services currently meet the needs of LGBTI people. They said visible signs of welcome, inclusive language, treating disclosures sensitively and managing relations with partners and family were most important for older LGBTI people. Their own choices about aged care would be influenced by service inclusiveness and quality. There were no clear trends by demography, vulnerability or other characteristics. CONCLUSIONS: Providers should continue to focus on inclusiveness, and improve support for managing relations with family.

Quality of life measurement in community-based aged care - understanding variation between clients and between care service providers.

BACKGROUND: Measuring person-centred outcomes and using this information to improve service delivery is a challenge for many care providers. We aimed to identify predictors of QoL among older adults receiving community-based aged care services and examine variation across different community care service outlets. METHODS: A retrospective sample of 1141 Australians aged ≥60 years receiving community-based care services from a large service provider within 19 service outlets. Clients' QoL was captured using the ICEpop CAPability Index. QoL scores and predictors of QoL (i.e. sociodemographic, social participation and service use) were extracted from clients' electronic records and examined using multivariable regression. Funnel plots were used to examine variation in risk-adjusted QoL scores across service outlets. RESULTS: Mean age was 81.5 years (SD = 8) and 75.5% were women. Clients had a mean QoL score of 0.81 (range 0-1, SD = 0.15). After accounting for other factors, being older (p < 0.01), having lower-level care needs (p < 0.01), receiving services which met needs for assistance with activities of daily living (p < 0.01), and having higher levels of social participation (p < 0.001) were associated with higher QoL scores. Of the 19 service outlets, 21% (n = 4) had lower mean risk-adjusted QoL scores than expected (< 95% control limits) and 16% (n = 3) had higher mean scores than expected. CONCLUSION: Using QoL as an indicator to compare care quality may be feasible, with appropriate risk adjustment. Implementing QoL tools allows providers to measure and monitor their performance and service outcomes, as well as identify clients with poor quality of life who may need extra support. TRIAL REGISTRATION: Australian and New Zealand clinical trial registry number: ACTRN12617001212347 . Registered 18/08/2017.

Social Participation Among Older Adults Receiving Community Care Services.

Aged care services have the potential to support social participation for the growing number of adults aging at home, but little is known about the types of social activities older adults in community care are engaged in. We used cluster analysis to examine the current profiles of social participation across seven domains in 1,114 older Australians, and chi-square analyses to explore between-group differences in social participation and sociodemographic and community care service use. Two distinct participation profiles were identified: (a) connected, capable, older rural women and (b) isolated, high-needs, urban-dwelling men. The first group had higher levels of engagement across six social participation domains compared with the second group. Social participation among older adults receiving community care services varies by gender, age, individual care needs, and geographical location. More targeted service provision at both the individual and community levels may assist older adults to access social participation opportunities.

Feasibility of Using a Risk Assessment Tool to Predict Hospital Transfers or Death for Older People in Australian Residential Aged Care. A Retrospective Cohort Study.

Residents of Aged Care Facilities (RACF) experience burdensome hospital transfers in the last year of life, which may lead to aggressive and potentially inappropriate hospital treatments. Anticipating these transfers by identifying risk factors could encourage end-of-life discussions that may change decisions to transfer. The aim was to examine the feasibility of identifying an end-of-life risk profile among RACF residents using a predictive tool to better anticipate predictors of hospital transfers, death or poor composite outcome of hospitalisation and/or death after initial assessment. A retrospective cohort study of 373 permanent residents aged 65+ years was conducted using objective clinical factors from records in nine RACFs in metropolitan Sydney, Australia. In total, 26.8% died and 34.3% experienced a composite outcome. Cox proportional hazard regression models confirmed the feasibility of estimating the level of risk for death or a poor composite outcome. Knowing this should provide opportunities to initiate advance care planning in RACFs, facilitating decision making near the end of life. We conclude that the current structure of electronic RACF databases could be enhanced to enable comprehensive assessment of the risk of hospital re-attendance without admission. Automation tools to facilitate the risk score calculation may encourage the adoption of prediction checklists and evaluation of their association with hospital transfers.