Search

Given that the number of children and young people needing care keeps rising and fewer people are becoming foster carers, efforts to support carers and workers in foster caring are essential. This paper considers the experiences of carers and foster care agency workers involved in Australia's piloting of the Mockingbird Family. With a view understanding experience, data were collected via focus groups with carers and agency workers (n = 20) involved in piloting, implementation and evaluation. Deductive analysis applied the theory of experience to generate understanding of experience, as both intrinsic and extrinsic dimensions to capture strengths in the Mockingbird Family's foster caring networks. These dimensions of experience included collective passions of carers and workers; experiential change over time; collective experiences as a moving force; and experiences as transformational. Understanding of experience associated with the perceived strengths of the Mockingbird Family, including strategies to promote strong professional relationships between carers and workers, is an important element in strengthening environments of children and young people in care. Safe and stable environments are crucial for wellbeing. [ABSTRACT FROM AUTHOR]

Background: The implementation science literature acknowledges a need for engagement of key stakeholders when designing, delivering and evaluating implementation work. To date, the literature reports minimal or focused stakeholder engagement, where stakeholders are engaged in either barrier identification and/or barrier prioritisation. This paper begins to answer calls from the literature for the development of tools and guidance to support comprehensive stakeholder engagement in implementation research and practice. The paper describes the systematic development of the Implementation‐STakeholder Engagement Model (I‐STEM) in the context of an international, large‐scale empirical implementation study (ImpleMentAll) aimed at evaluating the effectiveness of a tailored implementation toolkit. The I‐STEM is a sensitising tool that defines key considerations and activities for undertaking stakeholder engagement activities across an implementation process. Methods: In‐depth, semistructured interviews and observations were conducted with implementers who were tailoring implementation strategies to integrate and embed internet‐based cognitive behavioural therapy (iCBT) services in 12 routine mental health care organisations in nine countries in Europe and Australia. The analytical process was informed by principles of first‐ and third‐generation Grounded Theory, including constant comparative method. Results: We conducted 55 interviews and observed 19 implementation‐related activities (e.g., team meetings and technical support calls). The final outcome of our analysis is expressed in an initial version of the I‐STEM, consisting of five interrelated concepts: engagement objectives, stakeholder mapping, engagement approaches, engagement qualities and engagement outcomes. Engagement objectives are goals that implementers plan to achieve by working with stakeholders in the implementation process. Stakeholder mapping involves identifying a range of organisations, groups or people who may be instrumental in achieving the engagement objectives. Engagement approaches define the type of work that is undertaken with stakeholders to achieve the engagement objectives. Engagement qualities define the logistics of the engagement approach. Lastly, every engagement activity may result in a range of engagement outcomes. Conclusion: The I‐STEM represents potential avenues for substantial stakeholder engagement activity across key phases of an implementation process. It provides a conceptual model for the planning, delivery, evaluation and reporting of stakeholder engagement activities. The I‐STEM is nonprescriptive and highlights the importance of a flexible, iterative approach to stakeholder engagement. It is developmental and will require application and validation across a range of implementation activities. Patient or Public Contribution: Patient contribution to ImpleMentAll trial was facilitated by GAMIAN‐Europe at all stages—from grant development to dissemination. GAMIAN‐Europe brings together a wide variety of patient representation organisations (local, regional and national) from almost all European countries. GAMIAN‐Europe was involved in pilot testing the ItFits‐toolkit and provided their views on the various aspects, including stakeholder engagement. Patients were also represented in the external advisory board providing support and advice on the design, conduct and interpretation of the wider project, including the development of the ItFits‐toolkit. Trial registration: ClinicalTrials.gov NCT03652883. Retrospectively registered on 29 August 2018. [ABSTRACT FROM AUTHOR]

In Australia, there are more than 46 000 children in out‐of‐home care (OOHC). Most of these children have been in OOHC for more than 2 years. Similarly, there are more than 407 000 children in the United States and over 80 800 in England who are 'looked after' with approximately one third of these children being in OOHC for more than 2 years. This paper concerns 'looked after' children's rights to contact with their birth parents. The United Nations Convention on the Rights of the Child (UNCRC) requires child protection systems to recognize the rights of children to maintain contact with their families except where this is not in the child's 'best interests'. In this paper, we report on a qualitative study conducted in Australia exploring legal and family support practitioners' perceptions of barriers to contact between children in OOHC and their birth parents. The thematic analysis identified four themes: These were as follows: a focus on systems driven responses; lack of cultural recognition and responsiveness; carers' disconnection from birth parents; and parents' exclusion. We discuss the implications of these findings for understanding and recognizing children's right to contact with birth parents. [ABSTRACT FROM AUTHOR]

Introduction: Older carers or 'care partners' of older people experiencing care needs often provide essential support, at times while neglecting their own health and well‐being. This is an increasingly frequent scenario due to both demographic changes and policy shifts towards ageing in place. Multiple community stakeholders within the care and support ecosystem hold valuable expertise about the needs of older care partners, and the programme and policy responses that may better support their health and well‐being. The aim of this study was to identify the perspectives of stakeholders obtained through the codesign phase of a multicomponent research project investigating new models of care and support for older care partners suitable for the Australian context. Methods: Principles of codesign were used to engage a purposeful sample of older care partners, health professionals, researchers, policy makers and health service administrators. Participants took part in a series of three codesign workshops conducted remotely via video conferencing. The workshops were supported with briefing material and generated consensus‐based summaries, arriving at a preferred service model. Findings: This paper reports the research design and structure of the codesign panels, the range of findings identified as important to support the health and well‐being of older carers of older people, and the resulting service model principles. The codesigned and preferred model of care is currently being prepared for implementation and evaluation in Australia. Public Contribution: This study was conducted using codesign methodology, whereby stakeholders including older care partners and others involved in supporting older carers, were integrally involved with design, development, results and conclusions. [ABSTRACT FROM AUTHOR]

Introduction: Facilitators to implement shared cancer follow‐up care into clinical practice include mechanisms to allow the oncologist to continue overseeing the care of their patient, two‐way information sharing and clear follow‐up protocols for general practitioners (GPs). This paper aimed to evaluate patients, GPs and radiation oncologists (ROs) acceptance of a shared care intervention. Methods: Semi‐structured interviews were conducted pre‐ and post intervention with patients that were 3 years post radiotherapy treatment for breast, colorectal or prostate cancer, their RO, and their GP. Inductive and deductive thematical analysis was employed. Results: Thirty‐two participants were interviewed (19 patients, 9 GPs, and 4 ROs). Pre intervention, there was support for GPs to play a greater role in cancer follow‐up care, however, patients were concerned about the GPs cancer‐specific skills. Patients, GPs and ROs were concerned about increasing the GPs workload. Post intervention, participants were satisfied that the GPs had specific skills and that the impact on GP workload was comparable to writing a referral. However, GPs expressed concern about remuneration. GPs and ROs felt the model provided patient choice and were suitable for low‐risk, stable patients around 2–3 years post treatment. Patients emphasised that they trusted their RO to advise them on the most appropriate follow‐up model suited to their individual situation. The overall acceptance of shared care depended on successful health technology to connect the GP and RO. There were no differences in patient acceptance between rural, regional, and cancer types. ROs presented differences in acceptance for the different cancer types, with breast cancer strongly supported. Conclusion: Patients, GPs and ROs felt this shared cancer follow‐up model of care was acceptable, but only if the RO remained directly involved and the health technology worked. There is a need to review funding and advocate for health technology advances to support integration. Patient or Public Contribution: Patients treated with curative radiotherapy for breast, colorectal and prostate cancer, their RO and their GPs were actively involved in this study by giving their consent to be interviewed. [ABSTRACT FROM AUTHOR]

Objective: This paper reports findings from a study that sought to better understand the experiences of parents and their children with emergent mental health challenges following the parent's participation in a nurse-led therapeutic group. Design: This was an explorative qualitative study using semi-structured interviews which were then thematically analysed. Setting: Findings from this single-site study are drawn from regional Australia. Participants: Twenty parents and seven of their children aged between 13 and 24. Interventions: Family systems based therapeutic group intervention delivered to the parents of young people attending headspace. Main outcome measure: In line with qualitative research approaches, the participants lived experience was the outcome measure. Result: Three key themes were found in the data: (a) improved parent-child relationships, (b) understanding and being understood and (c) multi-generational perspectives. Conclusion: Regional and remote regions are challenged with comparatively fewer and less diverse services for youth mental health than in urban centres. Findings from this exploratory study highlight that young people can experience therapeutic gains where their parents are the recipients of the intervention. Recommendations from these findings include pursuing further research on the therapeutic gains of parental family system-based groups. [ABSTRACT FROM AUTHOR]

Objective: The need for more Remote Area Nurses in the Northern Territory is clear. This paper investigates the perspectives of Remote Area Nurse workforce issues among multiple stakeholders. The aim is to identify how Remote Area Nurse staffing issues are perceived by clinic managers, Remote Area Nurses themselves, Aboriginal colleagues and community members in seven remote communities in the Northern Territory. Design: This is a qualitative study that uses interviews and focus groups to identify key messages of local stakeholders about Remote Area Nurse workforce issues. A content analysis was used for data analysis. Setting: Seven diverse remote Aboriginal communities in the Northern Territory with government‐run health clinics were visited. Participants: Non‐random sampling techniques were used to target staff at the clinics at the time of field work. Staff and community members, who agreed to participate, were interviewed either individually or in groups. Interviews were conducted with 5 Managers, 29 Remote Area Nurses, 12 Aboriginal staff (some clinics did not have Aboriginal staff) and 56 community residents. Twelve focus groups were conducted with community members. Results: Content analysis revealed that participants thought having the "right" nurse was more important than having more nurses. Participants highlighted the need for Remote Area Nurses to have advanced clinical and cultural skills. While managers and, to a lesser extent, Remote Area Nurses prioritised clinical skills, Aboriginal staff and community residents prioritised cultural skills. Conclusions: Participants identified the importance of clinical and cultural skills and reiterated that getting the "right" Remote Area Nurse was more important than simply recruiting more nurses. Thus, retention strategies need to be more targeted and cultural skills prioritised in recruitment. [ABSTRACT FROM AUTHOR]

Introduction: Colorectal cancer (CRC) has the second highest cancer mortality rate in Australia. The Australian National Bowel Cancer Screening Program (NBCSP) aims to increase early detection of CRC by offering free Faecal Occult Blood Testing (FOBT), although uptake is low for culturally and linguistically diverse (CALD) groups. Aim of paper: To present data on trust and mistrust in the NBCSP by population groups with low uptake and thus to highlight areas in need of policy change. Methods: A qualitative study was undertaken in South Australia, involving interviews with 94 people from four CALD groups: Greek, Iranian, Anglo‐Australian, and Indigenous peoples. Results: Our study highlights the complexities of institutional trust, which involves considerations of trust at interpersonal, local and national levels. In addition, trust and mistrust was found in more abstract systems such as the medical knowledge of doctors to diagnose or treat cancer or the scientific procedures in laboratories to test the FOBTs. The object of institutional (mis)trust differed between cultural groups – Anglo‐Australian and Iranian groups indicated a high level of trust in the government, whereas Indigenous participants were much less trusting. Conclusion: The level and nature of trust in the screening process varied between the CALD groups. Addressing program misconceptions, clarifying the FOBT capabilities and involving medical services in collecting and transporting the samples may increase trust in the NBCSP. However, broader and more enduring mistrust in services and institutions may need to be dealt with in order to increase trust and participation. [ABSTRACT FROM AUTHOR]

Little empirical research has been conducted in Australia on what constitutes as effective practice with interpreters in child protection matters. This study aimed to address this gap. Qualitative interviews were conducted with 29 non–English‐speaking background (NESB) client families and 17 child protection caseworkers (as part of a larger study). Four examples of good practice (e.g. accurate translation) and 14 examples of ineffective practice emerged. The examples of poor practice were consequently grouped as issues with: (i) interpreters (e.g. inaccurate translation); (ii) caseworkers (e.g. insufficient time); (iii) NESB families (e.g. refusing to use an interpreter); and (iv) resources (e.g. insufficient face‐to‐face interpreters). As expected, the results largely replicate the (scant) national and international literature, indicating that features of good practice, and barriers to them, are similar across multicultural countries. This paper does however argue that training for interpreters dealing in such sensitive matters and training for caseworkers on working effectively with interpreters seem to be at the heart of good practice. This study is significant because it draws on the richness of data that qualitative methods offer to identify the full range of relevant variables and provide empirical support for principles of good practice. [ABSTRACT FROM AUTHOR]

Background Very little research has examined the role of parenting in managing behavioural side-effects of cancer treatment. The purpose of this paper was to explore parent perceptions of (a) parenting in the context of childhood cancer; (b) the parenting strategies used in the context of managing child behavioural side-effects of cancer treatment; and (c) the perceived impact that cancer-specific parenting strategies have on child behaviour. Methods Participants were 15 mothers of children aged 2-6 years in the maintenance phase of treatment for acute lymphoblastic leukaemia at the Royal Children's Hospital Children's Cancer Centre, Melbourne, Australia. Mothers participated in a one-on-one semi-structured telephone interview using an interview guide which included questions on parenting in the context of childhood cancer, specifically in relation to behavioural side-effects (problems with behaviour, sleep and eating) and any perceived impact cancer-specific parenting may have on the ill child. Results Many parents reported that following their child's cancer diagnosis, they had to implement a suite of 'new' strategies that 'pre-diagnosis' were used only in moderation, if at all. The most salient theme that emerged was parents' perception that their parenting became more lax since their child's diagnosis. Parents further reported specific parenting strategies for each of the main child behavioural side-effects of cancer treatment. Conclusion Data from the current qualitative exploratory study highlight the role of specific parenting strategies in managing or assisting child behavioural side-effects of cancer treatment. Further quantitative research is needed to more fully examine the association between parenting and child behavioural outcomes in order to develop modifiable approaches to improving child behavioural side-effects in a paediatric oncology context. [ABSTRACT FROM AUTHOR]

Aim Evaluation or assessment of competence is an important step to ensure the safety and efficacy of health professionals, including dietitians. Most competency-based assessment studies are focused on valid and reliable methods of assessment for the preparation of entry-level dietitians, few papers have explored student dietitians' perceptions of these evaluations. The present study aimed to explore the perceptions of recent graduates from accredited nutrition and dietetics training programs in Australia. It also aimed to establish the relevance of competency-based assessment to adequately prepare them for entry-level work roles. Methods A purposive sample of newly graduated dietitians with a range of assessment experiences and varied employment areas was recruited. A qualitative approach, using in-depth interviews with 13 graduates, was undertaken. Graduates were asked to reflect upon their competency-based assessment experiences as a student. Data were thematically analysed by multiple authors. Results Four themes emerged from the data analysis: (i) transparency and consistency are critical elements of work-based competency assessment; (ii) students are willing to take greater responsibility in the assessment process; (iii) work-based competency assessment prepares students for employment; and (iv) the relationship between students and their assessors impacts student experience and assessment performance. Conclusions Understanding this unique perspective of students can improve evaluation of future health professionals and assist in validating competency-based assessment approaches. [ABSTRACT FROM AUTHOR]

Background Social support is essential for physical and mental health and well-being. Evidence indicates that social and peer support is particularly important and beneficial for the well-being of those who care for children with chronic illness or disability in improving personal well-being and influencing parent-child play opportunities and child behaviour and development positively. MyTime is a government-funded Australia-wide facilitated peer support group program for carers of children with special needs. Aim The aim was to investigate the barriers and promoters of participation in this peer support group program. Method A qualitative approach was adopted where semi-structured telephone interviews were conducted with 20 group members, four group facilitators and three play helpers. Interviews were recorded and transcribed. Inductive thematic analysis of the transcripts was conducted. Results Most group members described gaining significant social support from group participation. Good group facilitation, the availability of play helpers, access to disability-related information and expertise, and the mutual exchange of support between members emerged as the most important promoters of group participation. Barriers included insufficient funding to run the program throughout the year, too much diversity in group members' socio-economic position and severity of their children's disability. Conclusion The facilitated peer support group program described in this paper appears to confer significant benefits to carers of children with disabilities and may be a model for other nations to consider in their strategies to improve services for carers of children with special needs. [ABSTRACT FROM AUTHOR]