Getting the complete picture : combining parental and child data to identify the barriers to social inclusion for children living in low socio-economic areas

Background: Childhood mental health problems are prevalent in Australian children (14–20%). Social exclusion is a risk factor for mental health problems, whereas being socially included can have protective effects. This study aims to identify the barriers to social inclusion for children aged 9–12 years living in low socio-economic status (SES) areas, using both child-report and parent-report interviews.

Methods: Australian-born English-speaking parents and children aged 9–12 years were sampled from a low SES area to participate in semi-structured interviews. Parents and children were asked questions around three prominent themes of social exclusion; exclusion from school, social activities and social networks.

Results: Many children experienced social exclusion at school, from social activities or within social networks. Overall, nine key barriers to social inclusion were identified through parent and child interviews, such as inability to attend school camps and participate in school activities, bullying and being left out, time and transport constraints, financial constraints and safety and traffic concerns. Parents and children often identified different barriers.

Discussion: There are several barriers to social inclusion for children living in low SES communities, many of which can be used to facilitate mental health promotion programmes. Given that parents and children may report different barriers, it is important to seek both perspectives.

Conclusion: This study strengthens the evidence base for the investments and action required to bring about the conditions for social inclusion for children living in low SES communities.

Science education in early childhood : a snapshot of Australian settings

In Australia, reform is occurring in the area of early childhood. It is in this time of reform, that a research project was instigated which studied the amount of science being undertaken in early childhood settings as well as how it was implemented. This highlighted some interesting differences across settings. This presentation will describe case studies of four pre-school settings and some of the activities undertaken by the children - both as part of the formal program and through incidental play. It will consider these through a socio-cultural framework, noting how teachers used their understandings of play and play theory, to enhance children’s understandings.

Evaluation of the questions used to elicit evidence about abuse from child witnesses : Australian study

This study provides one of the first objective evaluations of the performance of a group of Australian police officers when conducting interviews about child abuse. The interviews included 136 videotaped child witness statements, conducted between 2001 and 2007 by police officers from two jurisdictions of Australia. The results indicated many positive aspects of the interviewers' performance, including the use of ground rules at the outset of the interview, commencement of the free-narrative account by seeking the children's understanding of the purpose of the interview, and avoidance of suggestive questions. But the interviewers tended to raise issues of contention when the child did not provide an initial disclosure, and the proportion of open-ended questions was low relative to specific cued-recall and closed questions. Further many closed questions raised specific details not yet mentioned by the child. These behaviours were exhibited irrespective of the recency of interview or time since training. The implications of these findings are discussed.

Australian dental policy reform and the use of dental therapists and hygienists

Oral diseases including dental caries and periodontal disease are among the most prevalent and costly diseases in Australia today. Around 5.4% of Australia’s health dollar is spent on dental services totalling around $2.6 billion, 84% of which are delivered through the private sector (AIHW 2001). The other 16% is spent providing public sector services in varied and inadequate ways. While disease rates among school children have declined significantly in the past 20 years the gains made among children are not flowing on to adult dentitions and our aging population will place increasing demands on an inadequate system into the future (AHMAC 2001). Around 50% of adults do not received regular care and this has implications for widening health inequalities as the greatest burden falls on lower income groups (AIHW DSRU 2001). The National Competition Policy agenda has initiated, Australia-wide, reviews of dental legislation applying to delivery of services by dentists, dental specialists, dental therapists and hygienists and dental technicians and prosthetists. The review of the Victorian Dentists Act 1972, was completed first in 1999, followed by the other Australian states with Queensland, the ACT and the Northern Territory still developing legislation. One of the objectives of the new Victorian Act is to ‘…promote access to dental care’. This study has grown out of the need to know more about how dental therapists and hygienists might be utilised to achieve this and the legislative frameworks that could enable such roles. This study used qualitative methods to explore dental health policy making associated with strategies that may increase access to dental care using dental therapists and hygienists. The study used a multiple case study design to critically examine the dental policy development process around the Review of the Dentists Act 1972 in Victoria; to assess legislative and regulatory dental policy reforms in other states in Australia and to conduct a comparative analysis of dental health policy as it relates to dental auxiliary practice internationally. Data collection has involved (I) semi-structured interviews with key participants and stakeholders in the policy development processes in Victoria, interstate and overseas, and (ii) analysis of documentary data sources. The study has taken a grounded theory approach whereby theoretical issues that emerged from the Victorian case study were further developed and challenged in the subsequent interstate and international case studies. A component of this study has required the development of indicators in regulatory models for dental hygienists and therapists that will increase access to dental care for the community. These indicators have been used to analyse regulation reform and the likely impacts in each setting. Despite evidence of need, evidence of the effectiveness and efficiency of dental therapists and hygienists, and the National Competition Policy agenda of increasing efficiency, the legislation reviews have mostly produces only minor changes. Results show that almost all Australian states have regulated dental therapists and hygienists in more prescriptive ways than they do dentists. The study has found that dental policy making is still dominated by the views of private practice dentists under elitist models that largely protect dentist authority, autonomy and sovereignty. The influence of dentist professional dominance has meant that governments have been reluctant to make sweeping changes. The study has demonstrated alternative models of regulation for dental therapists and hygienists, which would allow wider utilisation of their skills, more effective use of public sector funding, increased access to services and a grater focus on preventive care. In the light of theses outcomes, there is a need to continue to advocate for changes that will increase the public health focus of oral health care.

Family food environments as determinants of children's eating : implications for obesity prevention

The prevalence of childhood obesity is escalating rapidly and it considered to be a major public health problem. Diet is a recognised precursor of fatness, and current evidence supports the premise that in Westernised countries, the dietary intakes of children are likely to be important in obesity genesis. However, we have a relatively poor understanding of the environments in which a child’s eating is learnt and maintained. Much of the existing work in this area is based on small-scale or experimental studies, or has been derived from homogeneous populations within the USA. Despite these limitations, there is evidence that aspects of the child’s family environment are likely to be important in determining obesity risk in children. This thesis examines the impact of the family food environment on a child’s eating through two related studies. The first study, titled the Children and Family Eating (CAFÉ) study comprised three phases. Phase one involved qualitative interviews with 17 parents of 5-6 year-old children to explore parental perceptions regarding those factors in a child’s environment believed to influence the development of their child’s eating habits. These interviews were used to inform the development of quantitative measures of the family food environment. The second phase involved the development of a Food Frequency Questionnaire (FFQ) to assess dietary intake in 5-6 year-olds. The FFQ was informed by analysis of 1995 Australian National Nutrition Survey data. In the final phase the relationships between dietary intakes of 5-6 year-old children, and potential predictors of dietary intake were examined in a cross-sectional study of 560 families. Predictors included measures of: parental perceptions of the adequacy of their child’s diet; food availability and accessibility; child-feeding; the opportunities for parental modelling of food intake; a child’s television exposure; maternal Body Mass Index; and maternal education. Analysis of the CAFÉ data provides unique information regarding the relationships between a child’s family food environment and their food consumption. Models developed for a range of dietary outcomes considered to be predictive of increased risk for obesity, including total energy and fat intakes, vegetable variety, vegetable consumption, and high-energy (non-dairy) fluid consumption, explained between 11 and 20 percent of the variance in dietary intake. Two aspects of the family food environment, parental perception of a child’s dietary adequacy, and the total minutes of television viewed per day, were frequently found to be predictive of dietary outcomes likely to promote fatness in these children. The second study, titled the Parent Education and Support (PEAS) Feeding Intervention Study, was a prospective pre/post non-randomised intervention trial that assessed the impact of a feeding intervention to 240 first-time mothers of one-year-old children. This intervention focused on one aspect of the family food environment, child-feeding, which has been proposed as influential in the development of obesogenic eating behaviours. In this study, Maternal and Child Health Nurses (MCHNs), using a ‘Division of Responsibility’ model of feeding, taught parents to provide nutritious food at regular intervals and to let children decide if to eat and how much to eat. Thus parents were encourages to food their child without exerting pressure, or employing coercion or rewards (controlling behaviours). The aim was to influence parental attitudes and beliefs regarding child-feeding. Through the use of these feeding techniques, this intervention also aimed to increase the variety of fruits and vegetables a child consumed by teaching parents to persist with offering these foods, over the year of the intervention, in non-emotive environments. Fruits and vegetables were chosen in this intervention because they are likely to be protective in the development of obesity. Analysis of the PEAS data suggests that this low-level feeding intervention, delivered through existing Maternal and Child Health services, was modestly effective in changing parental attitudes and beliefs regarding the feeding of young children. Further, the validity of fruits offered to intervention group children increased. This thesis expands the existing knowledge base by providing a comprehensive analysis of the relative impact of aspects of the family environment on dietary intakes of 5-6 year-olds. Further, the analysis of a feeding intervention in first-time parents provides important insights regarding the potential to influence child-feeding and the impact this may have on the promotion of eating behaviours protective against obesity.

Separate spheres and public policy : the role of women in the development of children's services in Victorian local government, 1840-1992

The thesis is an explanation of the development of pre-school children's services (infant welfare, kindergartens and child care) at local government level in Victoria. The critical framework of analysis focuses on three dimensions of public policy: 1) the socio-historical environment; 2) the political processes involved in the development of the specific children's service; and 3) the major individuals and groups that exerted pressure for children's service, The argument is threefold. Firstly it is argued that the political environment of children's services has been dominated by the practice of separate spheres of public and private, in which the care of children is primarily the role of women. Secondly, it is argued that the political processes surrounding the development of local children's services have involved all levels of government in what is termed a local state. Thirdly, it is argued that the development of these children's services in local government has resulted mainly from the work of women both individually and collectively. Since the three services of infant welfare, kindergartens and child care all became a normal function of children's services at different times, the circumstances that surrounded each development exhibited different aspects of the three major arguments. The periodisation is broken into four phases: 1) the establishment of local government with no children's services in the nineteenth century; 2) the establishment of infant welfare services in local government in the early part of the twentieth century; 3) the incorporation of kindergartens into local government after the second world war; and 4) the incorporation of child care into local government in the 1970s and 1980s. The thesis concludes by arguing that the existence of children's services in local government in Victoria is testimony to the remarkable work of those women who have pursued the issue both individually and collectively. It has been the identification of children's services as a women's issue in Australian politics that has enabled women's groups at different times to influence the policy makers in diverse ways. However, while the establishment of children's services as a legitimate political concern brings the matter onto the public agenda, the separate spheres still remains a contested issue in the public policies of children's services.

Examination of the validity and usefulness of the video suggestibility scale for children

The Video Suggestibility Scale for Children (VSSC) was developed by Scullin and colleagues (Scullin & Ceci, 2000; Scullin & Hembrooke, 1998) as a tool for discriminating between children who have different levels of suggestibility. The scale requires children to view a 5-minute video about a birthday party, and to subsequently participate in an interview consisting of 18 yes/no questions. The VSSC consists of two main subscales; Yield (a measure of children's willingness to respond affirmatively to misleading questions about the video) and Shift (a measure of the children's tendency to change their responses after negative feedback from the interviewer). Preliminary research by Scullin and colleagues suggested that the scale possesses satisfactory internal consistency and that children's scores on the VSSC can predict their performance in another suggestibility paradigm. This thesis presents two studies, which further examine the validity and usefulness of the VSSC in an Australian sample of 3- to-5-year-old children. In Study One, children's performance on the VSSC (N = 77) was compared to their performance using other measures of suggestibility. These measures included children's willingness to assent to a false event as well as the number of false interviewer suggestions and new false details that the children provided in their accounts about an independent true-biased and an independent false (non-experienced) event. An independent samples t-test revealed that those children who assented to the false activity generated higher scores on the Yield measure. This pattern was also observed for the Shift subscale although it was not significant. Hierarchical regression analyses revealed that Yield was a significant predictor of the number of false details reported about the false activity, but not the true-biased activity. There was no significant relationship between the Shift Vlll subscale and any of the dependent variables. Overall this study provided partial support for the construct validity of the VSSC. However, it indicated that children's performance on this scale may not be generalisable across different contexts and interview paradigms, and that the Yield subscale is more generalisable than the Shift subscale. Study Two examined whether various group and individual factors that have previously been shown to relate suggestibility (i.e., age, IQ, memory, socio-economic status, gender, temperament) could predict suggestibility as measured by the VSSC. Two hundred and twenty children were recruited from kindergartens, and were divided into two broad socio-economic categories (based predominantly on income). Hierarchical regression analyses revealed that age, intelligence and memory inversely predicted children's Yield suggestibility. Further, children of low socio-economic backgrounds were more suggestible than children of high socio-economic background, and boys were more suggestible than girls on the Yield measure. Although shyness and other internalised and externalised characteristics were explored, no reliable significant relationships were found with Yield. With regard to the Shift subscale, no reliable relationships were found for any of the independent variables except for SES. Overall, results of Study 2 indicated that the VSSC is a potentially useful measure for discriminating between children's suggestibility on the basis on their individual characteristics, although benefits were observed mainly in relation to the Yield subscale. With reference to the findings of these two studies, the potential contribution of the VSSC for research and applied forensic contexts was discussed.

Empowerment in early childhood intervention : perspectives of parents of children with disabilities

There have been various changes to the manner in which early intervention services for children with disabilities have been provided in recent decades. One of the most significant paradigm shifts that has accoured pertains to a change in the level of family involvement in early intervention, so that families are now required to be equal partners with professionals in the service provision process. It is now policy in Victoria that early intervention services follow a family-centred model of practice. Services adopting this model aim to empower parents, so that they may have impact on their lives, and the lives of their family members, both during and beyond the years of direct service participation. Much of what is known about empowerment to date is based on theory, author opinion, and research that is largely survey-based. There has been little interview-based research, particulary involving parents of children with disabilities, as well as little Australian research conducted regarding empowerment. To the researcher's knowledge, there has been no interview-based research that specifically asked parents of children with disabilities about their perspectives on empowerment and disempowerment. Parents of children with disabilities are not invited to contribute their opinions in services and research. Empowerment is an individual concept and this research provided parents with an opportunity to express their views on this topic. Parent's perspectives on empowerment are vital for service providers who aim to follow the intervention model required by policy. This research, which was guided by the principles of ecological theory and critical theory, involved to individual semi-structured interviews with 37 Victorian families of children with disabilities. Twenty-one of these families had children currently participating in early intervention services, and 16 families had children of mid-primary school age, who had previously participated in early intervention experiences; the factors that they believe influence empowerment and disempowerment; and helpful and unhelpful experiences with early intervention staff and other people in their lives. Data were analysed primarily inductively, in the context of grounded theory. Responses from the two groups of parents were then compared, as were different emergent themes according to helpfulness and empowerment. The nature of enduring empowerment, one of the key objectives of early childhood intervention, was also considered. From the analysis of data, several themes emerged as influential in the empowerment process for both groups of parents including: information, education and knowledge; meeting and talking with other families of children with disabilities; decision-making and choice; having confidence; participation, involvement and input; meeting or addressing families' practical needs; and having a child with a disability. The results of this research provide valuable information for parents, professionals, agencies, organisations, and the wider community, regarding how families can be supported more effectively and how power can be more equitably balanced.

Population monitoring of language and cognitive development in Australia : the Australian early development index

The Australian Early Development Index (AEDI) is a population measure of child development. The AEDI measures Language and Cognitive Development, Social Competence, Emotional Maturity, Physical Health and Wellbeing, and Communication Skills and General Knowledge. In Australia these data are collected by teachers for children in their first full time year of schooling. The aim of this paper is to aid people's understanding and interpretation of population measures such as the AEDI. With a greater awareness of the merits and complexities of population data clinicians and allied health professionals can play a vital role in aiding communities and policy makers to interpret and act upon the data in an intelligent way. This paper is primarily descriptive providing background information on the development and use of the instrument utilizing one of the 5 developmental domains (Language and Cognitive Development) as an example. The results show a complex relationship between children residing in differing socio-economic regions, children with English as their primary or secondary language and children who are able or not able to effectively communicate in English.

A healthy diet consistent with Australian health recommendations is too expensive for welfare-dependant families

Objective: Examine the cost of healthy food habits for welfare-dependent families in Australia.

Method:  A seven-day meal plan was developed, based on Australian public health recommendations, for two typical welfare-dependent families: a couple-family (two adults, two children) and a one-parent family (one adult, two children). The cost of the meal plan was calculated using market brand and generic brand grocery items, and total cost compared to income.

Results: In Australia, the cost of healthy food habits uses about 40% of the disposable income of welfare-dependent families. Families earning an average income would spend only 20% of their disposable income to buy the same healthy food. Substituting generic brands for market brands reduced the weekly food cost by about 13%. This is one of few economic models to include generic brands.

Conclusion: Compared with average-income Australian families, healthy food habits are a fiscal challenge to welfare-dependent families.

Implications: These results provide a benchmark for economic and social policy analysis, and the influence disposable income has on prioritising healthy food habits.

A cost-effectiveness analysis of the management of sore throat in children in Australia

For the first time a cost-effectiveness analysis of the management of sore throat in Australian children has been conducted using accurate epidemiological data generated from recent Australian studies.

Matilda's last dance: death, gender, sexuality and Australian adolescent literature

This thesis examines representations of death in a selection of contemporary texts for Australian adolescent audiences. It demonstrates that, although death is a complex subject, a characteristically Australian 'way of death' is identifiable in these fictions and it is invariably associated with issues of sexuality, gender and power.

Experiences of the stolen generation : laws and inequalities

Examines the inequalities of the Aboriginal Australian and politics, government, history, legal status and the effects of Aboriginal institutions in Western Australia. The researcher found that the destruction and disappearance of documents, files and records greatly impacted the thesis.