Understanding the impact of legislative changes on child car seating and restraint practices in regional Queensland

Road crashes contribute to a significant amount of child mortality and morbidity in Australia. In fact, passenger injuries contribute to the majority of child crash road trauma. A number of factors contribute to child injury and death in motor vehicles, including inappropriate seating position, inappropriate choice of restraint, and incorrect installation and use of child restraints. Prior to March 2010, child restraint legislation in Queensland only required children twelve months and younger to be seated in a properly adjusted and fastened child restraint. This legislation left older infants and young children potentially suboptimally protected. From March 2010, new legislation specified seating position and type of child restraint required, depending on the age of the child. This research was underpinned by the Health Belief Model (HBM), which explores health related behaviour, behaviour change, environmental factors influencing behaviour change (including legislative changes) and is flexible enough to be used in relation to parents' health practices for their children, rather than parent health directly. This thesis investigates the extent to which the changes to child restraint legislation have led parents in regional areas of Queensland to use appropriate restraint practices for their children and determines the extent to which the constructs of the HBM, parental perceptions, barriers and environmental factors contribute to the appropriateness of child seating and restraint use. Study One included three sets of observations taken in two regional cities of Queensland prior to the legislative amendment, during an educative period of six months, and after the enactment of the legislation. Each child's seating position and restraint type were recorded. Results showed that the proportion of children observed occupying the front seat decreased by 15.6 per cent with the announcement the legislation. There was no decrease in front seat use at the enactment of the legislation. The proportion of children observed using dedicated child restraints increased by 8.8 per cent with the announcement of the legislation when there was one child in the vehicle. Further, there was a 10.1 per cent increase in the proportion of children observed using a seat belt that fit with the announcement when there was one child in the vehicle and with the enactment of the legislation regardless of the number of children in the vehicle (21.8 per cent for one child, 39.7 per cent for two children and 40.2 per cent for three or more children). Study Two comprised initial intercept interviews, later followed up by telephone, with parents with children aged eight years and younger at the announcement and telephone interviews at the enactment of the legislation in one regional city in Queensland. Parents reported their child restraint practices, and opinions, knowledge and understanding of the requirements of the new legislation. Parent responses were analysed in terms of the constructs in the HBM. When asked which seating position their child 'usually' used, parents reported child front seat use was nil (0.0 per cent) and did not change with the enactment of the legislative amendment. However, when parents were asked whether they allowed children to use the front seat at some point within the six months prior to the interview, reported child front seat use was 7 (5.4 per cent) children at T2 and 10 (9.6 per cent) at T3. Reported use of age-appropriate child restraints did not increase with the enactment of the legislation (p = 0.77, ns). Parents reported restraint practices were classed as either appropriate or inappropriate. Parents who reported appropriate restraint practices were those whose children were sitting in optimal restraints and seating positions for their age according to the requirements of the legislation. Parents who reported inappropriate restraint practices were those who had one or more children who were suboptimally restrained or seated for their age according to the requirements of the legislation. Neither parents' perceptions about their susceptibility of being in a crash nor the likelihood of severity of child injury if involved in a crash yielded significant differences in the appropriateness of reported parent restraint practices over time with the enactment of the legislation. A trend in the data suggested parents perceived a benefit to using appropriate restraint practices was to avoid fines and demerit points. Over 75 per cent of parents who agreed that child restraints provide better protection for children than an adult seat belt reported appropriately seating and restraining their children (2 (1) = 8.093, p<.05). The self-efficacy measure regarding parents' confidence in installing a child restraint showed a significant association with appropriate parental restraint practices (2 (1) = 7.036, p<.05). Results suggested that some parents may have misinterpreted the announcement of the legislative amendment as the announcement of the enforcement of the legislation instead. Some parents who correctly reported details of the legislation did not report appropriate child restraint practices. This finding shows that parents' knowledge of the legislative amendment does not necessarily have an impact on their behaviour to appropriately seat and restrain children. The results of these studies have important implications for road safety and the prevention of road-related injury and death to children in Queensland. Firstly, parents reported feeling unsure of how to install restraints, which suggests that there may be children travelling in restraints that have not been installed correctly, putting them at risk. Interventions to alert and encourage parents to seek advice when unsure about the correct installation of child restraints could be considered. Secondly, some parents in this study although they were using the most appropriate restraint for their children, reported using a type that was not the most appropriate restraint for the child's age according to the legislation. This suggests that intervention may be effective in helping parents make a more accurate choice of the most appropriate type of restraint to use with children, especially as the child ages and child restraint requirements change. Further research could be conducted to ascertain the most effective methods of informing and motivating parents to use the most appropriate restraints and seating positions for their children, as these results show a concerning disparity between reported restraint practices and those that were observed.

Get real : the development, implementation and evaluation of an intervention for primary aged children with High Functioning Autism

Children with Autism Spectrum Disorder experience difficulty in communication and in understanding the social world which can have negative consequences for their relationships, in managing emotions, and generally dealing with the challenges of everyday life. This thesis examines the effectiveness of the Active and Reflective components of the Get REAL program through the assessment of the detailed coding of video-recorded observations and longitudinal quantitative analysis. The aim of Get REAL is to increase the social, emotional, and cognitive learning of children with High Functioning Autism (HFA). Get REAL is a group program designed specifically for use in inclusive primary school settings. The Get REAL program was designed in response to the mixed success of generalisation of learning to new contexts of existing social skills programs. The theoretical foundation of Get REAL is based upon pedagogical theory and learning theory to facilitate transfer of learning, combined with experiential, individualised, evaluative and organisational approaches. This thesis is by publication and consists of four refereed journal papers; 1 accepted for publication and 3 that are under review. Paper 1 describes the development and theoretical basis of the Get REAL program and provides detail of the program structure and learning cycle. The focus of Paper 1 reflects the first question of interest in the thesis which is about the extent to which learning derived from participation in the program can be generalised to other contexts. Participants are 16 children with HFA ranging in age from 8-13 years. Results provided support for the generalisability of learning from Get REAL to home and school evidenced by parent and teacher data collected pre and post participation in Get REAL. Following establishment of the generalisation of learning from Get REAL, Papers 2 and 3 focus on the Active and Reflective components of the program in order to examine how individual and group learning takes place. Participants (N = 12) in the program are video-taped during the Active and Reflective Sessions. Using identical coding protocols of video data, improvements in prosocial behaviour and diminishing of inappropriate behaviours were apparent with the exception of perspective taking. Data also revealed that 2 of the participants had atypical trajectories. An in-depth case study analysis was then conducted with these 2 participants in Paper 4. Data included reports from health care and education professionals within the school and externally (e.g., paediatrician) and identified the multi-faceted nature of care needed for children with comorbid diagnoses and extremely challenging family circumstances as a complex task to effect change. Results of this research support the effectiveness of the Get REAL program in promoting pro social behaviours such as improvements in engaging with others and emotional regulation, and in diminishing unwanted behaviours such as conduct problems. Further, the gains made by the participating children were found to be generalisable beyond Get REAL to home and other school settings. The research contained in the thesis adds to current knowledge about how learning can take place for children with HFA. Results show that an experiential learning framework with a focus on social cognition, together with explicit teaching, scaffolded with video feedback, are key ingredients for the generalisation of social learning to broader contexts.

End-of-life care in the critical care setting : nurses' practices and factors affecting these practices

Background: Critical care units are designed and resourced to save lives, yet the provision of end-of-life care is a significant component of nursing work in these settings. Limited research has investigated the actual practices of critical care nurses in the provision of end-of-life care, or the factors influencing these practices. To improve the care that patients at the end of life and their families receive, and to support nurses in the provision of this care, further research is needed. The purpose of this study was to identify critical care nurses' end-of-life care practices, the factors influencing the provision of end-of-life care and the factors associated with specific end-of-life care practices. Methods: A three-phase exploratory sequential mixed-methods design was utilised. Phase one used a qualitative approach involving interviews with a convenience sample of five intensive care nurses to identify their end-of-life care experiences and practices. In phase two, an online survey instrument was developed, based on a review of the literature and the findings of phase one. The survey instrument was reviewed by six content experts and pilot tested with a convenience sample of 28 critical care nurses (response rate 45%) enrolled in a postgraduate critical care nursing subject. The refined survey instrument was used in phase three of this study to conduct a national survey of critical care nurses. Descriptive analyses, exploratory factor analysis and univariate general linear modelling was undertaken on completed survey responses from 392 critical care nurses (response rate 25%). Results: Six end-of-life care practice areas were identified in this study: information sharing, environmental modification, emotional support, patient and family-centred decision making, symptom management and spiritual support. The items most frequently identified as always undertaken by critical care nurses in the provision of end-of-life care were from the information sharing and environmental modification practice areas. Items least frequently identified as always undertaken included items from the emotional support practice area. Eight factors influencing the provision of end-of-life care were identified: palliative values, patient and family preferences, knowledge, preparedness, organisational culture, resources, care planning, and emotional support for nurses. Strong agreement was noted with items reflecting values consistent with a palliative approach and inclusion of patient and family preferences. Variation was noted in agreement for items regarding opportunities for knowledge acquisition in the workplace and formal education, yet most respondents agreed that they felt adequately prepared. A context of nurse-led practice was identified, with variation in access to resources noted. Collegial support networks were identified as a source of emotional support for critical care nurses. Critical care nurses reporting values consistent with a palliative approach and/or those who scored higher on support for patient and family preferences were more likely to be engaged in end-of-life care practice areas identified in this study. Nurses who reported higher levels of preparedness and access to opportunities for knowledge acquisition were more likely to report engaging in interpersonal practices that supported patient and family centred decision making and emotional support of patients and their families. A negative relationship was identified between the explanatory variables of emotional support for nurses and death anxiety, and the patient and family centred decision making practice area. Contextual factors had a limited influence as explanatory variables of specific end-of-life care practice areas. Gender was identified as a significant explanatory variable in the emotional and spiritual support practice areas, with male gender associated with lower summated scores on these practice scales. Conclusions: Critical care nurses engage in practices to share control with and support inclusion of families experiencing death and dying. The most frequently identified end-of-life care practices were those that are easily implemented, practical strategies aimed at supporting the patient at the end of life and the patient's family. These practices arguably require less emotional engagement by the nurse. Critical care nurses' responses reflected values consistent with a palliative approach and a strong commitment to the inclusion of families in end-of-life care, and these factors were associated with engagement in all end-of-life care practice areas. Perceived preparedness or confidence with the provision of end-of-life care was associated with engagement in interpersonal caring practices. Critical care nurses autonomously engage in the provision of end-of-life care within the constraints of an environment designed for curative care and rely on their colleagues for emotional support. Critical care nurses must be adequately prepared and supported to provide comprehensive care in all areas of end-of-life care practice. The findings of this study raise important implications, and informed recommendations for practice, education and further research.

GO423 - the second Game On / brIGDA Independant Game Symposium

GO423 was initiated in 2012 as part of a community effort to ensure the vitality of the Queensland Games Sector. In common with other industrialised nations, the game industry in Australia is a reasonably significant contributor to Gross National Product (GNP). Games are played in 92% of Australian homes and the average adult player has been playing them for at least twelve years with 26% playing for more than thirty years (Brand, 2011). Like the games and interactive entertainment industries in other countries, the Australian industry has its roots in the small team model of the 1980s. So, for example, Beam Software, which was established in Melbourne in 1980, was started by two people and Krome Studios was started in 1999 by three. Both these companies grew to employing over 100 people in their heydays (considered large by Antipodean standards), not by producing their own intellectual property (IP) but by content generation for off shore parent companies. Thus our bigger companies grew on a model of service provision and tended not to generate their own IP (Darchen, 2012). There are some no-table exceptions where IP has originated locally and been ac-quired by international companies but in the case of some of the works of which we are most proud, the Australian company took on the role of “Night Elf” – a convenience due to affordances of the time zone which allowed our companies to work while the parent companies slept in a different time zone. In the post GFC climate, the strong Australian dollar and the vulnerability of such service provision means that job security is virtually non-existent with employees invariably being on short-term contracts. These issues are exacerbated by the decline of middle-ground games (those which fall between the triple-A titles and the smaller games often produced for a casual audience). The response to this state of affairs has been the change in the Australian games industry to new recognition of its identity as a wider cultural sector and the rise (or return) of an increasing number of small independent game development companies. ’In-dies’ consist of small teams, often making games for mobile and casual platforms, that depend on producing at least one if not two games a year and who often explore more radical definitions of games as designed cultural objects. The need for innovation and creativity in the Australian context is seen as a vital aspect of the current changing scene where we see the emphasis on the large studio production model give way to an emerging cultural sector model where small independent teams are engaged in shorter design and production schedules driven by digital distribution. In terms of Quality of Life (QoL) this new digital distribution brings with it the danger of 'digital isolation' - a studio can work from home and deliver from home. Community events thus become increasingly important. The GO423 Symposium is a response to these perceived needs and the event is based on the understanding that our new small creative teams depend on the local community of practice in no small way. GO423 thus offers local industry participants the opportunity to talk to each other about their work, to talk to potential new members about their work and to show off their work in a small intimate situation, encouraging both feedback and support.

Development of a children's acute cough specific quality of life questionnaire (Pac-Qol)

The high burden of parental concern in children with chronic cough has been well documented. Acute cough in children (lasting less than 2 weeks) also has a significant impact on families, reflected by the number of doctor visits for cough. Currently there is no validated acute cough specific quality of life (QOL) measure for children. The objective of this study is to develop and validate an acute cough specific QOL questionnaire (PAC-QOL) for paediatric use. Here we present our data on item selection. Methods Two independent focus groups were conducted to determine relevant items. Parents discussed the impact of their child’s current or previous episodes of acute cough on their child, themselves and their family functioning. Transcripts were analyzed to determine whether discussions had reached an item saturation point. Items were also compared against our previously validated parent-centred children’s chronic cough specific QOL questionnaire (PC-QOL), which was used as a model. The newly developed acute cough specific QOL questionnaire is designed to assess the level of frequency of parents’ feelings and worry related to their child’s acute cough, using a 24-h time-point reference. Results Newly identified acute cough specific items include parental worry around whether or not they should take their child to a doctor or emergency department, and frequency of seeking assistance from friends and family. Conclusions While there are similarities between items identified for both acute and chronic cough, there are distinct features. Further data will be collected for item reduction and validation of this children’s acute cough specific QOL questionnaire.

The development of chronic cough in children following presentation to a tertiary paediatric emergency department with acute respiratory illness : study protocol for a prospective cohort study

Background Acute respiratory illness, a leading cause of cough in children, accounts for a substantial proportion of childhood morbidity and mortality worldwide. In some children acute cough progresses to chronic cough (> 4 weeks duration), impacting on morbidity and decreasing quality of life. Despite the importance of chronic cough as a cause of substantial childhood morbidity and associated economic, family and social costs, data on the prevalence, predictors, aetiology and natural history of the symptom are scarce. This study aims to comprehensively describe the epidemiology, aetiology and outcomes of cough during and after acute respiratory illness in children presenting to a tertiary paediatric emergency department. Methods/design A prospective cohort study of children aged <15 years attending the Royal Children's Hospital Emergency Department, Brisbane, for a respiratory illness that includes parent reported cough (wet or dry) as a symptom. The primary objective is to determine the prevalence and predictors of chronic cough (>= 4 weeks duration) post presentation with acute respiratory illness. Demographic, epidemiological, risk factor, microbiological and clinical data are completed at enrolment. Subjects complete daily cough dairies and weekly follow-up contacts for 28(+/-3) days to ascertain cough persistence. Children who continue to cough for 28 days post enrolment are referred to a paediatric respiratory physician for review. Primary analysis will be the proportion of children with persistent cough at day 28(+/-3). Multivariate analyses will be performed to evaluate variables independently associated with chronic cough at day 28(+/-3). Discussion Our protocol will be the first to comprehensively describe the natural history, epidemiology, aetiology and outcomes of cough during and after acute respiratory illness in children. The results will contribute to studies leading to the development of evidence-based clinical guidelines to improve the early detection and management of chronic cough in children during and after acute respiratory illness.

Sink or Swim? : Revising Ophelia in contemporary young adult fiction

Shakespeare’s Hamlet has in recent years been used by a number of young adult novels to define and authorise representations of gendered adolescent subjectivity. In so doing, these novels attend not only to Shakespeare’s play but also to other adaptations of the play. For example, the long cultural history of Ophelia being used as a template for depicting adolescent femininity as risky or dangerous is as influential as the play itself in early twenty-first century novels. This paper reads such novels for the ways in which codes of gender and of genre circulate in adolescent fiction when linked explicitly with Shakespearean texts and traditions.

What makes juvenile offenders different from adult offenders?

Historically, children in criminal justice proceedings were treated much the same as adults and subject to the same criminal justice processes as adults. Until the early twentieth century, children in Australia were even subjected to the same penalties as adults, including hard labour and corporal and capital punishment (Carrington & Pereira 2009). Until the mid-nineteenth century, there was no separate category of ’juvenile offender’ in Western legal systems and children as young as six years of age were incarcerated in Australian prisons (Cunneen & White 2007). It is widely acknowledged today, however, both in Australia and internationally, that juveniles should be subject to a system of criminal justice that is separate from the adult system and that recognises their inexperience and immaturity. As such, juveniles are typically dealt with separately from adults and treated less harshly than their adult counterparts. The United Nations’ (1985: 2) Standard Minimum Rules for the Administration of Juvenile Justice (the ‘Beijing Rules’) stress the importance of nations establishing a set of laws, rules and provisions specifically applicable to juvenile offenders and institutions and bodies entrusted with the functions of the administration of juvenile justice and designed to meet the varying needs of juvenile offenders, while protecting their basic rights. In each Australian jurisdiction, except Queensland, a juvenile is defined as a person aged between 10 and 17 years of age, inclusive. In Queensland, a juvenile is defined as a person aged between 10 and 16 years, inclusive. In all jurisdictions, the minimum age of criminal responsibility is 10 years. That is, children under 10 years of age cannot be held legally responsible for their actions.

The impact of mining and smelting activities on property values : a study of Mount Isa city, Queensland, Australia

Much publicity has been given to the problem of high levels of environmental contaminants, most notably high blood lead concentration levels among children in the city of Mount Isa because of mining and smelting activities. The health impacts from mining-related pollutants are now well documented. This includes published research being discussed in an editorial of the Medical Journal of Australia (see Munksgaard et al. 2010). On the other hand, negative impacts on property prices, although mentioned, have not been examined to date. This study rectifies this research gap. This study uses a hedonic property price approach to examine the impact of mining- and smelting-related pollution on nearby property prices. The hypothesis is that those properties closer to the lead and copper smelters have lower property (house) prices than those farther away. The results of the study show that the marginal willingness to pay to be farther from the pollution source is AUS $13 947 per kilometre within the 4 km radius selected. The study has several policy implications, which are discussed briefly. We used ordinary least squares, geographically weighted regression, spatial error and spatial autoregressive or spatial lag models for this analysis.

Suicide and the therapeutic coroner : inquests, governance and the grieving family

This study of English Coronial practice raises a number of questions about the role played by the Coroner within contemporary governance. Following observations at over 20 inquests into possible suicides and in-depth interviews with six Coroners, three preliminary issue emerged, all of which pointed to a broader and, in many ways, more significant issue. These preliminary issues are concerned with: (1) the existence of considerable slippages between different Coroners over which deaths are likely to be classified as suicide; (2) the high standard of proof required and immense pressure faced by Coroners from family members at inquest to reach any verdict other than suicide, which significantly depresses likely suicide rates, and; (3) Coroners feeling no professional obligation, either individually or collectively, to contribute to the production of consistent and useful social data regarding suicide, arguably rendering comparative suicide statistics relatively worthless. These concerns lead, ultimately, to the second more important question about the role expected of Coroners within social governance and within an effective, contemporary democracy. That is, are Coroners the principal officers in the public administration of death; or are they, first and foremost, a crucial part of the grieving process, one that provides important therapeutic interventions into the mental and emotional health of the community?

Recovering from the earthquake : early childhood teachers and children collaboratively telling stories about their experiences

Purpose – Traumatic events can cause post-traumatic stress disorder due to the severity of the often unexpected events. The purpose of this paper is to reveal how conversations around lived experiences of traumatic events, such as the Christchurch earthquake in February 2011, can work as a strategy for people to come to terms with their experiences collaboratively. By encouraging young children to recall and tell of their earthquake stories with their early childhood teachers they can begin to respond, renew, and recover (Brown, 2012), and prevent or minimise more stress being developed. Design/methodology/approach – The study involved collecting data of the participating children taking turns to wear a wireless microphone where their interactions with each other and with teachers were video recorded over one week in November 2011. A total of eight hours and 21 minutes of footage was collected; four minutes and 19 seconds of that footage are presented and analysed in this paper. The footage was watched repeatedly and transcribed using conversation analysis methods (Sacks, 1995). Findings – Through analysing the detailed turn-taking utterances between teachers and children, the orderliness of the co-production of remembering is revealed to demonstrate that each member orients to being in agreement about what actually happened. These episodes of story telling between the teachers and children demonstrate how the teachers encourage the children to tell about their experiences through actively engaging in conversations with them about the earthquake. Originality/value – The conversation analysis approach used in this research was found to be useful in investigating aspects of disasters that the participants themselves remember as important and real. This approach offers a unique insight into understanding how the earthquake event was experienced and reflected on by young children and their teachers, and so can inform future policy and provision in post-disaster situations.

Placement Trajectory : mapping the journeys of children and young people in out-of-home care

Significant problems confront our child protection out-of-home care system including: high costs; increasing numbers of children and young people entering and remaining in care longer; high frequency of placement movement; and, negative whole-of-life outcomes for children and young people who have exited care. National policy and research agendas recognise the importance of enhancing the evidence base in out-of-home care to inform the development of policy, programs and practice, and improve longitudinal outcomes of children and young people. The authors discuss the concept of placement trajectory as a framework for research and systems analysis in the out-of-home context. While not without limitations, the concept of placement trajectory is particularly useful in understanding the factors influencing placement movement and stability. Increasing the evidence base in this area can serve to enhance improved outcomes across the lifespan for children and young people in the out-of-home care system.

A comparison of children's needs models in the Australian and Chinese context

The diverse needs of children have been drawing global attention from both academic and practitioner communities. Based on semi-structured interviews with 23 kin caregivers and five school personnel in the Shijiapu Town of Jilin Province, China, this paper presents a needs model for rural school-age children left behind by their migrant parents. This Chinese model is compared to the needs identification mechanism developed by the Australian Research Alliance for Children and youth. The paper outlines the common needs of children in different contexts, and also highlights the needs that are not explicit in the Australian Research Alliance for Children and Youth framework, such as empowerment and agency or perhaps given insufficient weight, such as education. In discussing relationships among different needs, aspects that are missing in the framework it is argued that culture should be more explicitly recognised when defining need.

Public Space and the Marginalisation of Children and Young People

Throughout much of the world, urban and rural public spaces may be said to be under attack by property developers, commercial interests and also attempts by civic authorities to regulate, restrict, reframe and rebrand these spaces. A consequence of the increasingly security driven, privatised, commercial and surveilled nature of public space is the exclusion and displacement of those considered ‘flawed’ and unwelcome in the ‘spectacular’ consumption spaces of many major urban centres. In the name of urban regeneration, processes of securitisation, ‘gentrification’ and creative cities initiatives can act to refashion public space as sites of selective inclusion and exclusion. The use of surveillance and other control technologies as deployed in and around the UK ‘Riots’ of 2011 may help to promote and encourage a passing sense of personal safety and confidence in using public space. Through systems of social sorting, the same surveillance assemblages can also further the physical, emotional and psychological exclusion of certain groups and individuals, deemed to be both ‘out of time and out of place’ in major zones of urban, conspicuous, consumption. In this harsh environment of monitoring and control procedures, children and young people’s use of public spaces and places in parks, neighbourhoods, shopping malls and streets is often viewed as a threat to social order, requiring various forms of punitive and/or remedial action. Much of this civic action actively excludes some children and young people from participation and as a consequence, their trust in local processes and communities is eroded. This paper discusses worldwide developments in the surveillance, governance and control of the public space environments used by children and young people in particular and the capacity for their displacement and marginality, diminishing their sense of belonging, wellbeing and rights to public space as an expression of their social, political and civil citizenship(s).