Reflexivity: a concept and its meanings for practitioners working with children and families

Reflexivity is a concept that is increasingly gaining currency in professional practice literature, particularly in relation to working with uncertainty and as an important feature of professional discretion and ethical practice. This article discusses how practitioners working in child and family welfare/protection organisations understood and interpreted the concept of reflexivity for their practice, as one of the outcomes of larger, collaborative research project. This project was conducted through a series of workshops with practitioners. The overall research that aimed to expand practitioners’ practice repertoires from narrowly-defined risk assessment, to an approach that could account for the uncertainties of practice, included the concept of reflexivity as an alternative or a complement to instrumental accountability that is increasingly a feature in child welfare/protection organisations. This article discusses how the concept of reflexivity was explored in the research and how practitioners interpreted the concept for their practice. We conclude that while concepts like reflexivity are central to formal theories for professional practice, we also recognise that individual practitioners interpret concepts (in ways that are both practically and contextually relevant), thus creating practical meanings appropriate to their practice contexts.

Can Australain general practitioners tackle chidhood overweight/obesity? Methods and processes from the LEAP (live, eat, and play) randomized controlled trial

Background: General practitioners (GPs) could make an important contribution to management of childhood overweight. However, there are no efficacy data to support this, and the feasibility of this approach is unknown.

Objectives: To determine if GPs and families can be recruited to a randomized controlled trial (RCT), and if GPs can successfully deliver an intervention to families with overweight/obese 5- to 9-year-old children.

Methods: A convenience sample of 34 GPs from 29 family medical practices attended training sessions on management of childhood overweight. Practice staff trained in child anthropometry conducted a cross-sectional body mass index (BMI) survey of 5- to 9-year-old children attending these practices. The intervention focused on achievable goals in nutrition, physical activity and sedentary behaviour, and was delivered in four solution-focused behaviour change consultations over 12 weeks.

Results: General practitioners were recruited from across the sociodemographic spectrum. All attended at least two of the three education sessions and were retained throughout the trial. Practice staff weighed and measured 2112 children in the BMI survey, of whom 28% were overweight/obese (17.5% overweight, 10.5% obese), with children drawn from all sociodemographic quintiles. Of the eligible overweight/obese children, 163 (40%) were recruited and retained in the LEAP RCT; 96% of intervention families attended at least their first consultation.

Conclusions: Many families are willing to tackle childhood overweight with their GP. In addition, GPs and families can participate successfully in the careful trials that are needed to determine whether an individualized, family-based primary care approach is beneficial, harmful or ineffective.

Community's attitudes towards intimate partner homicide

The thesis aimed to explore the Victorian Community's attitudes towards intimate partner homicide committed in the context of jealousy and domestic violence. Results revealed that the immediacy of the accused's actions, the gender of the accused, and the gender of the participant interacted to influence participants' verdict and blame responses. The portfolio explored the complexities and challenges that face mental health professionals in deciding the appropriate weighting of child's wishes in child protection assessments. The four case studies presented were chosen due to the attention that was paid to the child's wishes throughout the assessments.

Perceptions of athletic competence and fear of negative evaluation during physical education

Background. Physical education (PE) aims to enhance self-esteem, develop sporting interests and to encourage a physically active life-style. However, little is known about how a fear of negative evaluation (FNE), the socially evaluative aspect of social anxiety, affects children's attitudes to PE.

Aim. The aim of the study was to investigate the relationships between perceived athletic competence and FNE within PE lessons, specifically looking at differences between boys and girls and primary and secondary schools.

Sample. The participants were 192 children in three primary schools (N=85, mean age=9.5±1.1 years) and two secondary schools (N=107, mean age=14.5±0.8 years) from rural areas of North Wales and the Midlands region of England.

Methods. The participants completed the Brief-FNE Scale and the Self-Perception Profile for Children immediately post-lesson on one occasion.

Results. Girls had higher FNE but lower perceptions of athletic competence than did boys. Older girls had higher FNE and lower perceived competence than the remaining three groups. Additionally, a significant and reverse but weak correlation was observed between girls' perceived athletic competence and FNE.

Conclusions. The findings suggest that girls with a high FNE report lower perceptions of their athletic competence. Individuals who are high in FNE behave in ways to avoid the prospect of being evaluated negatively. However, they may seek feedback from significant others as a signal that unfavourable evaluations have been avoided. Therefore, positive, encouraging feedback used in child-centred learning strategies may foster feelings of competence in boys and girls and could reduce the girls' social anxiety.

Rethinking attachment : fostering positive relationships between infants, toddlers and their primary caregivers

This article provides a synthesis of current theory and research in relation to attachment between infants/toddlers and their caregivers. Worldwide statistics show that there are a significant number of women working in the global labour market. In Australia, recent research also found that over 300,000 children aged 0-5 years are currently attending long day child care, and a child can spend up to 12,500 hours in child care before starting school (based on attendance of 50 hours per week for five years). In order to understand the importance of developing secure relationships that build on the first transition from home to child-care centre, semi-structured interviews were conducted to collect views from parents and child-care staff. Results showed that most participants in the sample were in favour of using a primary caregiver approach. Implications for the implementation of this approach will be discussed.

Assessing free-living physical activity using accelerometry : practical issues for researchers and practitioners

Physical activity is an integral component of a healthy lifestyle, with relationships documented between physical activity, chronic diseases, and disease risk factors. There is increasing concern that many people are not sufficiently active to benefit their health. Consequently, there is a need to determine the prevalence of physical activity engagement, identify active and inactive segments of the population, and evaluate the effectiveness of interventions. The aim of the present study was to identify and explain a number of methodological and decision-making processes associated with accelerometry, which is the most commonly used objective measure of physical activity in child and adult research.

Specifically, this review addresses:
(a) pre-data collection decisions,
(b) data collection procedures,
(c) processing of accelerometer data, and
(d) outcome variables in relation to the research questions posed.

An appraisal of the literature is provided to help researchers and practitioners begin field-based research, with recommendations offered for best practice. In addition, issues that require further investigation are identified and discussed to inform researchers and practitioners of the surrounding debates.

Overall, the review is intended as a starting point for field-based physical activity research using accelerometers and as an introduction to key issues that should be considered and are likely to be encountered at this time.

Building the capacity of family day care educators to promote children’s social and emotional wellbeing : an exploratory cluster randomised controlled trial

Background: Childhood mental health problems are highly prevalent, experienced by one in five children living in socioeconomically disadvantaged families. Although childcare settings, including family day care are ideal to promote children’s social and emotional wellbeing at a population level in a sustainable way, family day care educators receive limited training in promoting children’s mental health. This study is an exploratory wait-list control cluster randomised controlled trial to test the appropriateness, acceptability, cost, and effectiveness of “Thrive,” an intervention program to build the capacity of family day care educators to promote children’s social and emotional wellbeing. Thrive aims to increase educators’ knowledge, confidence and skills in promoting children’s social and emotional wellbeing.
Methods/Design: This study involves one family day care organisation based in a low socioeconomic area of Melbourne. All family day care educators (term used for registered carers who provide care for children for financial reimbursement in the carers own home) are eligible to participate in the study. The clusters for randomisation will be the fieldworkers (n = 5) who each supervise 10-15 educators. The intervention group (field workers and educators) will participate in a variety of intervention activities over 12 months, including workshops; activity exchanges with other educators; and focused discussion about children’s social and emotional wellbeing during field worker visits. The control group will continue with their normal work practice. The intervention will be delivered to the intervention group and then to the control group after a time delay of 15 months post intervention commencement. A baseline survey will be conducted with all consenting educators and field workers (n = ~70) assessing outcomes at the cluster and individual level. The survey will also be administered at one month, six months and 12 months post-intervention commencement. The survey consists of questions measuring perceived levels of knowledge, confidence and skills in promoting children’s social and emotional wellbeing. As much of this intervention will be delivered by field workers, field worker-family day care educator relationships are key to its success and thus supervisor support will also be measured. All educators will also have an in-home quality of care assessment at baseline, one month, six months and 12 months post-intervention commencement. Process evaluation will occur at one month, six months and 12 months post-intervention commencement. Information regarding intervention fidelity and economics will also be assessed in the survey.
Discussion: A capacity building intervention in child mental health promotion for family day care is an essential contribution to research, policy and practice. This initiative is the first internationally, and essential in building an evidence base of interventions in this extremely policy-timely setting.

A randomised group comparison controlled trial of 'preschoolers with autism': a parent education and skills training intervention for young children with autistic disorder

Aim
To determine the effect of parent education on adaptive behaviour, autism symptoms and cognitive/language skills of young children with autistic disorder.

Method
A randomised group comparison design involving a parent education and counselling intervention and a parent education and behaviour management intervention to control for parent skills training and a control sample. Two rural and two metropolitan regions were randomly allocated to intervention groups (n = 70) or control (n = 35). Parents from autism assessment services in the intervention regions were randomly allocated to parent education and behaviour management (n = 35) or parent education and counselling (n = 35).

Results
Parent education and behaviour management resulted in significant improvement in adaptive behaviour and autism symptoms at 6 months follow-up for children with greater delays in adaptive behaviour. Parent education and behaviour management was superior to parent education and counselling. We conclude that a 20-week parent education programme including skills training for parents of young children with autistic disorder provides significant improvements in child adaptive behaviour and symptoms of autism for low-functioning children.

Just call me dad: health and social benefits to fathers and their children

In the past 20 years, social change and expectations for both maternal and paternal responsibilities have highlighted the need for services for families to better understand the role of a father in family relationships. In Australia, as well as internationally, there have been many contested understandings about what constitutes ‘good fathering’ in research, social media and in the political sphere. More specifically, there has also been an emerging trend to understand the challenging task of recruiting and maintaining men's involvement in child and family services programmes, particularly those fathers who are deemed a risk to children and mothers, violent or have been separated from their children. That many child and family/welfare services have exercised dedicated effort to work with fathers is still a relatively recent phenomenon, and has only emerged following criticism that services have been too geared towards working only with mothers. Despite this increasing interest, there is still ongoing need for more research to be undertaken in Australia. An important area of focus is the views of professionals about their perception and engagement of fathers, particularly the views of fathers who are described as being absent from family-based services. The purpose of this article is to report briefly on a study undertaken to examine how child and family welfare workers engage fathers in their work. First, this paper will describe some of the social and health benefits to fathers and their children, focusing on the key role of attachment through play. Research into effective service delivery involving fathers will then be presented, concluding with key practice factors necessary for fathers to be involved in family life.

A review of the relationship between socioeconomic position and the early-life predictors of obesity

A range of important early-life predictors of later obesity have been identified. Children of lower socioeconomic position (SEP) have a steeper weight gain trajectory from birth with a strong socioeconomic gradient in child and adult obesity prevalence. An assessment of the association between SEP and the early-life predictors of obesity has been lacking. The review involved a two-stage process: Part 1, using previously published systematic reviews, we developed a list of the potentially modifiable determinants of obesity observable in the pre-natal, peri-natal or post-natal (pre-school) periods; and part 2, conducting a literature review of evidence for socioeconomic patterning in the determinants identified in part 1. Strong evidence was found for an inverse relationship between SEP and (1) pre-natal risk factors (pre-pregnancy maternal body mass index (BMI), diabetes and pre-pregnancy diet), (2) antenatal/peri natal risk factors (smoking during pregnancy and low birth weight) and (3) early-life nutrition (including breastfeeding initiation and duration, early introduction of solids, maternal and infant diet quality, and some aspects of the home food environment), and television viewing in young children. Less strong evidence (because of a lack of studies for some factors) was found for paternal BMI, maternal weight gain during pregnancy, child sleep duration, high birth weight and lack of physical activity in young children. A strong socioeconomic gradient exists for the majority of the early-life predictors of obesity suggesting that the die is cast very early in life (even pre-conception). Lifestyle interventions targeting disadvantaged women at or before child-bearing age may therefore be particularly important in reducing inequality. Given the likely challenges of reaching this target population, it may be that during pregnancy and their child's early years are more feasible windows for engagement.

Maternal depressive and anxiety symptoms, self-esteem, body dissatisfaction and preschooler obesity: a cross-sectional study

The primary aim of the present study was to cross-sectionally examine the associations between maternal psychosocial variables, child feeding practices, and preschooler body mass index z-score (BMI-z) in children (aged 2–4 years). A secondary aim was to examine differences in child weight outcomes between mothers scoring above and below specified cut-offs on the psychosocial measures. Two hundred and ninety mother–child dyads were recruited from Melbourne, Australia, and completed questionnaires examining demographic information, mothers’ depressive and anxiety symptoms, self-esteem and body dissatisfaction, restrictive and pressure child feeding practices, and preschoolers’ BMI-z scores. Independent t-tests and hierarchical multiple regression were employed to analyse the data. In the final regression model, none of the maternal psychosocial measures or feeding practices predicted child BMI-z scores; maternal body mass index and employment status were the only predictors of preschooler BMI-z. However, independent t-tests revealed that children of mothers with elevated body dissatisfaction scores had significantly higher BMI-z scores than children of mothers without elevated scores. The results suggest that psychosocial variables are not related, cross-sectionally, to preschooler weight outcomes; however, further research is needed to replicate the group differences noted between mothers with and without body dissatisfaction, and to track these relationships longitudinally.

Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

Background: Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Findings Global life expectancy for both sexes increased from 65·3 years (UI 65·0-65·6) in 1990, to 71·5 years (UI 71·0-71·9) in 2013, while the number of deaths increased from 47·5 million (UI 46·8-48·2) to 54·9 million (UI 53·6-56·3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased.For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10·7%, from 4·3 million deaths in 1990 to 4·8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. Interpretation For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.

Cognitive control as a moderator of temperamental motivations toward adolescent risk-taking behavior

Few studies have directly examined whether cognitive control can moderate the influence of temperamental positive and negative affective traits on adolescent risk-taking behavior. Using a combined multimethod, latent variable approach to the assessment of adolescent risk-taking behavior and cognitive control, this study examined whether cognitive control moderates the influence of temperamental surgency and frustration on risk-taking behavior in a sample of 177 adolescents (Mage = 16.12 years, SD = 0.69). As predicted, there was a significant interaction between cognitive control and frustration, but not between cognitive control and surgency, in predicting risk-taking behavior. These findings have important implications and suggest that the determinants of adolescent risk taking depend on the valence of the affective motivation for risk-taking behavior.

Screen-time weight-loss intervention targeting children at home (SWITCH): a randomized controlled trial study protocol

BACKGROUND: Approximately one third of New Zealand children and young people are overweight or obese. A similar proportion (33%) do not meet recommendations for physical activity, and 70% do not meet recommendations for screen time. Increased time being sedentary is positively associated with being overweight. There are few family-based interventions aimed at reducing sedentary behavior in children. The aim of this trial is to determine the effects of a 24 week home-based, family oriented intervention to reduce sedentary screen time on children's body composition, sedentary behavior, physical activity, and diet.

METHODS/DESIGN: The study design is a pragmatic two-arm parallel randomized controlled trial. Two hundred and seventy overweight children aged 9-12 years and primary caregivers are being recruited. Participants are randomized to intervention (family-based screen time intervention) or control (no change). At the end of the study, the control group is offered the intervention content. Data collection is undertaken at baseline and 24 weeks. The primary trial outcome is child body mass index (BMI) and standardized body mass index (zBMI). Secondary outcomes are change from baseline to 24 weeks in child percentage body fat; waist circumference; self-reported average daily time spent in physical and sedentary activities; dietary intake; and enjoyment of physical activity and sedentary behavior. Secondary outcomes for the primary caregiver include change in BMI and self-reported physical activity.

DISCUSSION: This study provides an excellent example of a theory-based, pragmatic, community-based trial targeting sedentary behavior in overweight children. The study has been specifically designed to allow for estimation of the consistency of effects on body composition for Māori (indigenous), Pacific and non-Māori/non-Pacific ethnic groups. If effective, this intervention is imminently scalable and could be integrated within existing weight management programs..

A novel treatment resource for co-occurring symptoms

This paper describes the development of a novel integrative self-directed treatment tool which uses cognitive behavioural therapy techniques to reduce anxiety symptoms in patients presenting to treatment for alcohol-related problems. More specifically, the purpose of this paper is to explore patient and health practitioner perceptions of the booklet, in order to determine its suitability and utility in the context of existing alcohol treatment services. The extent of cross-informant agreement between patient and health practitioner responses is also examined. – This research utilises a cross-sectional qualitative research design using semi-structured interview methods with patients presenting to hospital for alcohol-related diseases/illnesses/accidents/injuries (n=15) and practitioners (n=10) working at inpatient, outpatient and residential substance treatment facilities. – The present study found that the majority of patients (80 per cent) and practitioners (90 per cent) expressed a motivation to utilise the proposed booklet, agreeing that the booklet was a practical, achievable and educational resource for patients suffering from co-occurring anxiety symptoms in substance abuse facilities. Participants outlined limitations of the resource, suggesting that the booklet would be most suitable for patients with moderate to high cognitive ability, who also exhibit a motivation to change alcohol consumption and have access to additional support. – Findings from the present study suggest that the booklet may be most effective in improving treatment accessibility and patient treatment seeking behaviours; rather than reducing practitioner-patient contact. – This paper focuses on the development and utility of a novel resource suitable for substance abuse treatment facilities. The findings and feedback produced from the present study can assist with modifications of the intervention and in improving the effectiveness of future trials.