Family member and service provider experiences and perspectives of a digital surveillance and service navigation approach: A qualitative study with a culturally diverse community (preprint)

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 formed part of a larger, two-site, randomised controlled trial of the WMG-E program. A reflexive thematic analysis approach 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 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 develops and increases knowledge around navigating the health and social care services.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.

Parent and Service Provider Perspectives of a Digital Developmental Surveillance and Service Navigation Program, Watch Me Grow Electronic (WMG-E), in Rural and Regional Australia: A Qualitative Study (preprint)

Background Encouraging healthy childhood development and aiding the early identification of developmental difficulties are crucial to providing the best possible outcomes. Young children in rural areas are at a higher risk of missing timely developmental screening than their non-rural counterparts. This study examined the feasibility and acceptability of a digital developmental surveillance program with a service navigator, Watch Me Grow-Electronic (WMG-E), trialled in rural Australia via a randomised controlled trial (RCT).Methods Ten parents who participated in the RCT and six service providers were interviewed. All parents completed the WMG-E weblink questionnaire on their digital devices. Five parents in the intervention group received ongoing support from a service navigator after completing the questionnaire. Transcripts were analysed via reflexive thematic analysis.Results The study revealed barriers and enablers of both the existing Child and Family Health Services (CFHS) and the WMG-E program comprising of a weblink and service navigation. Enablers of the CFHS included the flexible service options and comprehensive support model, while also acknowledging the resource barriers and service capacity limitations during the COVID-19 pandemic. Enablers of WMG-E weblink included its valuable feedback on child development, digital accessibility benefits, and user-friendly interface. Barriers of the WMG-E weblink included limited clinician oversight during survey completion, and technological barriers related to the digital format. Enablers of the WMG-E service navigation included the ability to address service gaps by connecting families to local services, provide support during waitlist periods, and alleviate the strain on understaffed remote healthcare facilities.Conclusions Access to digital support was perceived as particularly valuable during the COVID-19 pandemic when services were closed. The WMG-E program offers a promising avenue to improve the accessibility and uptake of developmental screening services in rural Australia when functioning in harmony with existing care providers.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.

General practitioners’ perspectives regarding early developmental surveillance for autism within the Australian primary healthcare setting: A qualitative study (preprint)

Background:Significant challenges remain in the early identification of child developmental conditions in the community. Implementing supports and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental conditions including autism. As part of a cluster randomised controlled trial, this study seeks to examine and compare the perspectives and experiences of Australian general practitioners (GPs) in relation to a digital developmental surveillance program for autism and usual care pathway, in general practice clinics. Methods:A qualitative research methodology (semi-structured interviews and thematic analysis) was utilised in this study. All GPs from South Western Sydney (NSW) and Melbourne (Victoria) who participated in the main program (“GP Surveillance for Autism”) were invited to the interview. GPs who provided consent were interviewed either over online or in-person meeting. Interviews were audio-recorded, transcribed, and coded using NVivo12 software.Inductive interpretive approach was adopted and data were analysed thematically. Results:Twenty-three GPs across the two sites (NSW: n=11; Victoria: n=12) agreed to be interviewed; data saturation had reached following this number of participants. Inductive thematic coding and analysis yielded nine major themes and highlighted common enablers such as the role of GPs in early identification and intervention, enhanced communication between clinicians/professionals, relationship-building with patients, and having standardised screening tools. Specific facilitators to the feasibility and acceptability of a digital screening program for the early identification of developmental conditions, including the early signs of autism, and encouraging research and education for GPs. However, several practical and socioeconomic barriers were identified, in addition to limited knowledge and uptake of child developmental screening tools as well as COVID-19 lockdown impacts. Common and specific recommendations involve supporting GPs in developmental/paediatrics training, streamlined screening process, and funding and resources in the primary healthcare services. Conclusions: The study highlighted the need for practice and policy changes, including further training of GPs alongside sufficient time to complete developmental checks and appropriate financial remuneration through a Medicare billing item. Further research is needed on implementation and scale up of a national surveillance program for early identification of developmental conditions including autism.

The impact of ongoing COVID-19 lockdown on family finances and mental health (preprint)

ObjectivesAustralias public health restrictions ( lockdown) in 2020 successfully contained the spread of COVID-19. These included a national initial lockdown (March-May), and ongoing lockdown (July-November) for metropolitan Victorian residents only. Australias experience offers an opportunity to assess impacts of lockdown on families with children, in the relative absence of disease morbidity and mortality. This study (1) described the experience of initial lockdown and (2) evaluated the impact of ongoing lockdown, on family finances and mental health. MethodsData were drawn from the June and September 2020 Royal Childrens Hospital National Child Health Polls. Caregivers of children from the states of Victoria and New South Wales reported on job/income loss; material deprivation (inability to pay for essential items); income-poverty; mental health (Kessler-6); impact on caregiver/child mental health; and caregiver/child coping. Data from N=1207/902 caregivers in June/September were analyzed; Aim (1) with weighted descriptives; Aim (2) with Difference-in-Difference adjusted linear regression models (New South Wales provided the comparator). ResultsFollowing initial lockdown, one-quarter of families reported job/income loss; one-third reported material deprivation. Negative impacts on mental health were reported for half the caregivers and one-third of children. Few caregivers or children had difficulties coping. During Victorias ongoing lockdown, job/income loss increased by 11% (95%CI: 3-18%); Kessler-6 poor mental health by 6% (95%CI: 0.3-12%) and negative mental health impacts by 12% for caregivers (95%CI: 6-23%) and 14% for children (95%CI: 4-20%). Female (versus male) caregivers, metropolitan (versus regional/rural) families, and families with elementary school-aged children (versus pre-/high-school) were most affected. ConclusionsOngoing lockdown had negative impacts on mental health, employment, and income, but not deprivation or poverty, likely because of the government income supplements introduced early in the pandemic. Balancing the benefits and harms of lockdown requires planned responses to outbreaks, and evidence-informed financial and mental health supports.