Alternative service delivery models for families with a new speech generating device: perspectives of parents and therapists

Purpose: Research has revealed limitations in the provision of in-person services to families with a new speech generating device (SGD), both in Australia and overseas. Alternative service models such as parent training, peer support and telepractice may offer a solution, but their use with this population has not been researched to date.

Method: Using interviews and focus groups, this study explored the experiences and opinions of 13 speech-language pathologists and seven parents regarding alternatives to in-person support and training for families with a new SGD. Data were analysed using grounded theory. Themes explored in this paper include the benefits and drawbacks of alternative service models as well as participants’ suggestions for the optimal implementation of these approaches.

Result: Participants confirmed the utility of alternative service models, particularly for rural/remote and underserviced clients. Benefits of these models included reduced travel time for families and therapists, as well as enhanced information access, support and advocacy for parents.

Conclusion: Participants viewed the provision of ongoing professional support to families as critical, regardless of service modality. Additional issues arising from this study include the need for development of organizational policies, resources and training infrastructure to support the implementation of these alternative service models.

The Australian middle class and education: a small-scale study of the school choice experience as framed by ‘My School’ within inner city families

With the launch of the ‘My School’ website in 2010, Australia became a relative latecomer to the publication of national school performance comparisons. This paper primarily seeks to explore the school choice experience as framed by ‘My School’ website, for participating middle-class families. We will draw on Bourdieusian theory of cultural capital and relationship networks and Australian-based school choice research in order to contribute to understandings regarding the application of ‘My School’ data within participating families. Data collection consisted of qualitative, semi-structured, in-depth interviews with five families, each based within inner-city suburbs of Melbourne, Victoria. The findings of this small-scale study indicate that participating middle-class families possessed highly developed strategies for locating and achieving enrolment in school-of-choice and therefore did not seek to apply available data on ‘My School’ to decision-making, despite each participant reviewing the available data.

Teeth Tales: a community-based child oral health promotion trial with migrant families in Australia

OBJECTIVES: The Teeth Tales trial aimed to establish a model for child oral health promotion for culturally diverse communities in Australia. DESIGN: An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from migrant backgrounds. Mixed method, longitudinal evaluation. SETTING: The intervention was based in Moreland, a culturally diverse locality in Melbourne, Australia. PARTICIPANTS: Families with 1-4-year-old children, self-identified as being from Iraqi, Lebanese or Pakistani backgrounds residing in Melbourne. Participants residing close to the intervention site were allocated to intervention. INTERVENTION: The intervention was conducted over 5 months and comprised community oral health education sessions led by peer educators and follow-up health messages. OUTCOME MEASURES: This paper reports on the intervention impacts, process evaluation and descriptive analysis of health, knowledge and behavioural changes 18 months after baseline data collection. RESULTS: Significant differences in the Debris Index (OR=0.44 (0.22 to 0.88)) and the Modified Gingival Index (OR=0.34 (0.19 to 0.61)) indicated increased tooth brushing and/or improved toothbrushing technique in the intervention group. An increased proportion of intervention parents, compared to those in the comparison group reported that they had been shown how to brush their child's teeth (OR=2.65 (1.49 to 4.69)). Process evaluation results highlighted the problems with recruitment and retention of the study sample (275 complete case families). The child dental screening encouraged involvement in the study, as did linking attendance with other community/cultural activities. CONCLUSIONS: The Teeth Tales intervention was promising in terms of improving oral hygiene and parent knowledge of tooth brushing technique. Adaptations to delivery of the intervention are required to increase uptake and likely impact. A future cluster randomised controlled trial would provide strongest evidence of effectiveness if appropriate to the community, cultural and economic context. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12611000532909).

Exploring child dental service use among migrant families in metropolitan Melbourne, Australia

Abstract Background This study describes and explores factors related to dental service use among migrant children. Methods A cross-sectional analysis of baseline data from Teeth Tales, an exploratory trial implementing a community based child oral health promotion intervention. The sample size and target population was 600 families with 1-4 year old children from Iraqi, Lebanese and Pakistani backgrounds residing in metropolitan Melbourne. Participants were recruited into the study using purposive and snowball sampling techniques. Results Most (88%; 550/625) children had never visited the dentist (mean (SD) age 3.06 years (1.11)). In the fully adjusted model the variable most significantly associated with child dental visiting was parent reported 'no reason for child to visit the dentist' (OR = 0.07, p < 0.001). Of those children whose parents reported their child had no reason to visit the dentist, 22% (37/165) experienced dental caries with 8% (13/165) at the level of cavitation. Conclusions Dental service use by migrant preschool children was very low. The relationship between perceived dental need and dental service use is currently not aligned. One in 10 children of select migrant background had visited a dentist, which is in the context of 1 in 3 with dental caries. To improve utilization, health services should consider organizational cultural competence, outreach and increased engagement with the migrant community.

A longitudinal evaluation of the resilient families randomized trial to prevent early adolescent depressive symptoms

This study aimed to evaluate whether an intervention prevented the development of depressive symptoms through the early years of secondary school (Grades 7 to 9 - mean ages 12.3 to 14.5 years) in Victoria, Australia. Twelve schools were randomized to a universal preventative intervention (including a student social relationship/emotional health curriculum, and parent/caregiver parenting education); 12 were randomized as control schools. Multivariate regression analyses used student self-report to predict depressive symptoms at 26-month follow-up (13-months after intervention completion) from baseline measures and intervention status (N = 2027). There was no overall intervention effect on depressive symptoms. However, intervention students with moderate symptoms whose parents attended parent education events had a significantly reduced risk of depressive symptoms at follow-up. Future evaluations of interventions of this type should investigate: therapeutic processes; methods to increase recruitment into effective parent education events; and the potential to target assistance to students with high depressive symptoms.

Socioeconomic position in young adulthood is associated with BMI in Australian families

BACKGROUND: Low socioeconomic position (SEP) is associated with increased cardiovascular (CV) disease risk, but the relative importance of SEP in childhood and adulthood, and of changes in SEP between these two life stages, remains unclear. Studies of families may help clarify these issues. We aimed to assess whether SEP in young adulthood, or change in SEP from childhood to young adulthood, was associated with five continuously measured CV risk factors. METHODS: We used data from 286 adult Australian families from the Victorian Family Heart Study (VFHS), in which some offspring have left home (n = 364) and some remained at home (n = 199). SEP (defined as the Index of Relative Socioeconomic Disadvantage) was matched to addresses. We fitted variance components models to test whether young adult SEP and/or change in SEP was associated with systolic blood pressure, diastolic blood pressure, body mass index (BMI), total cholesterol or high-density lipoprotein cholesterol, after adjustment for parental SEP and within-family correlation. RESULTS: An increase in SEP of 100 SEIFA units from childhood to adulthood was associated with a lower BMI (β = -0.49 kg/m(2), P < 0.01) only. CONCLUSIONS: These results suggest that a change in SEP in young adulthood is an important predictor of BMI, independent of childhood SEP.

School based education programme to reduce salt intake in children and their families (School-EduSalt): cluster randomised controlled trial

Objective To determine whether an education programme targeted at schoolchildren could lower salt intake in children and their families. Design Cluster randomised controlled trial, with schools randomly assigned to either the intervention or control group. Setting 28 primary schools in urban Changzhi, northern China. Participants 279 children in grade 5 of primary school, with mean age of 10.1; 553 adult family members (mean age 43.8). Intervention Children in the intervention group were educated on the harmful effects of salt and how to reduce salt intake within the schools' usual health education lessons. Children then delivered the salt reduction message to their families. The intervention lasted for one school term (about 3.5 months). Main outcome measures The primary outcome was the difference between the groups in the change in salt intake (as measured by 24 hour urinary sodium excretion) from baseline to the end of the trial. The secondary outcome was the difference between the two groups in the change in blood pressure. Results At baseline, the mean salt intake in children was 7.3 (SE 0.3) g/day in the intervention group and 6.8 (SE 0.3) g/day in the control group. In adult family members the salt intakes were 12.6 (SE 0.4) and 11.3 (SE 0.4) g/day, respectively. During the study there was a reduction in salt intake in the intervention group, whereas in the control group salt intake increased. The mean effect on salt intake for intervention versus control group was -1.9 g/day (95% confidence interval -2.6 to -1.3 g/day; P<0.001) in children and -2.9 g/day (-3.7 to -2.2 g/ day; P<0.001) in adults. The mean effect on systolic blood pressure was -0.8 mm Hg (-3.0 to 1.5 mm Hg; P=0.51) in children and -2.3 mm Hg (-4.5 to -0.04 mm Hg; P<0.05) in adults. Conclusions An education programme delivered to primary school children as part of the usual curriculum is effective in lowering salt intake in children and their families. This offers a novel and important approach to reducing salt intake in a population in which most of the salt in the diet is added by consumers.

Engaging patients and families in communication across transitions of care: an integrative review protocol

AIM: To describe an integrative review protocol to analyse and synthesize peer-reviewed research evidence in relation to engagement of patients and their families in communication during transitions of care to, in and from acute care settings.

BACKGROUND: Communication at transitions of care in acute care settings can be complex and challenging, with important information about patients not always clearly transferred between responsible healthcare providers. Involving patients and their families in communication during transitions of care may improve the transfer of clinical information and patient outcomes and prevent adverse events during hospitalization and following discharge. Recently, optimizing patient and family participation during care transitions has been acknowledged as central to the implementation of patient-centred care.

DESIGN: Integrative review with potential for meta-analysis and application of framework synthesis.

REVIEW METHOD: The review will evaluate and synthesize qualitative and quantitative research evidence identified through a systematic search. Primary studies will be selected according to inclusion criteria. Data collection, quality appraisal and analysis of the evidence will be conducted by at least two authors. Nine electronic databases (including CINAHL and Medline) will be searched. The search will be restricted to 10 years up to December 2013. Data analysis will include content and thematic analysis.

DISCUSSION: The review will seek to identify all types of patient engagement activities employed during transitions of care communication. The review will identify enablers for and barriers to engagement for patients, families and health professionals. Key strategies and tools for improving patient engagement, clinical communication and promoting patient-centred care will be recommended based on findings.