Findings are structured around the six intervention types and the themes and sub themes for enabling factors and barriers to their implementation in Wyndham. Participant quotes are labelled as: caregiver (CG) and service provider (SP).
Three of the six evidence-based intervention types included in this study reached consensus: nurse home visiting programs, parenting programs and community-wide programs. Table 3 displays the proportion of stakeholders who rated each intervention as a high or very high priority for Wyndham as well as the proportion per stakeholder group. Given the small sample size, the group proportions should be interpreted as trends.
Table 3. Rated priority of six evidence-based interventions
Stakeholder type
|
n
|
Interventions
|
|
|
Parenting programs
|
School-based anti-bullying programs
|
Psychological therapy for children exposed to trauma
|
Community-wide programs
|
Nurse home visiting programs
|
Economic and social programs
|
Service providers
|
|
% high or very high priority (n)
|
Health
|
3
|
100 (3)
|
66.7 (2)
|
33.3 (1)
|
100 (3)
|
100 (3)
|
33.3 (1)
|
Child and family
|
3
|
100 (3)
|
33.3 (1)
|
66.7 (2)
|
33.3 (1)
|
100 (3)
|
66.7 (2)
|
Social sector
|
2
|
100 (2)
|
50.00 (1)
|
100 (2)
|
100 (2)
|
100 (2)
|
100 (2)
|
Early education and disability inclusion
|
7
|
71.4 (5)
|
71.4 (5)
|
85.7 (6)
|
100 (2)
|
85.7 (6)
|
85.7 (6)
|
Drug and alcohol
|
2
|
100 (2)
|
50.00 (1)
|
100 (2)
|
100 (2)
|
100 (2)
|
100 (2)
|
Caregivers
|
2
|
100 (2)
|
100 (2)
|
50 (1)
|
50 (1)
|
100 (2)
|
50 (1)
|
Overall
|
19
|
89.5* (17)
|
63.2 (12)
|
73.7 (14)
|
84.2* (16)
|
94.7* (18)
|
73.7 (14)
|
Note: *consensus reached when interventions were rated as high or very high priority by 75% or more participants.
Nurse home visiting
All but one participant endorsed nurse home visiting programs as a high or very high priority (94.7%). During the discussion, both caregiver participants reported finding the nurse home visiting programs they had accessed useful. One caregiver explained this was because nurse home visiting had helped her to learn how to parent her child and resolved other concerns that were impacting her wellbeing:
“And home visiting programs should be there because during that first month or some period, you need some help from the nurses and we have no idea how to take care of baby. […] I got some problems during that period, but it was resolved by the nurse.” (CG2)
Service providers from across sectors explained that nurse home visiting programs act as a gateway for identification of adversities and coordinating other necessary responses for families:
“the nurses that are visiting someone's home, that are going to drive some of those other programs, so they might be there to do some of that early intervention work” (SP18 drug and alcohol)
An essential part of this gateway was building trust and relationships with families over time, as one child and family worker explained:
“When the nurse visits, she gets the vibe of the house or she gets to know the environment. She might not get a clear picture in the first visit or so, but obviously if she's on her third visit, she would have a better idea to sense the situation, if things are going well or if mum needs an extra support or to help in the best possible way” (SP06 child and family)
Parenting programs
Parenting programs were endorsed as a high or very high priority by 17 out of 19 participants (89.47%). Similarly to nurse home visiting programs, caregiver participants felt parenting programs could address the knowledge gap for new parents and provide support to their transition to parenthood. One health service provider described the potential for parenting programs to socialise parents to the service system and help them to learn fundamental skills which freed up their time spent with allied health to focus on other challenges:
“So if they are already being linked in with some of those parenting programs from a younger age, then by the time that they come to us, maybe we're not seeing those issues as a first thing …] the psychologist has time to work on some other things” (SP37 health)
While recognising the promise of parenting programs, multiple service providers also described the difficulty of engaging parents living with adversity in these programs:
“[Vulnerable communities are] much harder to recruit and continue and also [ensure that they] have the headspace to be able to utilize the information.” (SP36 education and disability)
Community-wide programs
Community-wide programs were endorsed as a high or very high priority by 84.22% of participants (n=16). Consistent with the reasoning for nurse home visiting and parenting programs, caregivers and services providers across sectors felt that community-wide programs acted as a gateway to engage families, for families to find out about available services and supports, and link in with such services. One caregiver explained that: “when you have community-wide programs you could make aware what the community could offer for the mental health services.” (CG1). A health professional emphasized the importance of community as a platform for holistic, multi-disciplinary service provision:
“we can't do any of this without community. I think that it's the glue to holding everything together in terms of information sharing and collaboration and being the medium of sharing of different skill sets and different professional lenses.” (SP17 health)
However, there were mixed perspectives on community-wide programs. While some service providers saw community-wide programs as a place for families to connect and engage with each other and available supports, caregivers and other service providers felt that these programs were less relevant in Wyndham because the community is already close-knit and mobilised. One caregiver explained that “I also gave a low priority to the community-wide program because we have already some community and we have some events with our community.” (CG2). The other caregiver also felt that community-wide programs might be less useful because they are “almost like a fun event rather than having any real purpose” (CG1).
Interventions that did not reach consensus
School-based anti-bullying programs, psychological therapy for children exposed to trauma, and economic and social programs did not reach consensus. While some service providers identified that psychological therapies could provide a “fresh air” for families to “leave those challenging things at home and […] spend one-on-one time” (SP15 education and disability), other providers and caregivers felt that these interventions were not a priority because they were not the first course of action and were not readily available due to long waitlists. One caregiver explained that unlike home visiting, the effectiveness of psychological therapy also depended on the level of awareness and engagement of the parent as well as their connection to the professional:
“because this [is a] psychological thing, initiation from the self doesn't happen that quickly. It might be very hard for me to realize that I am having some issues […] it really depends on when you get that right therapist. […].” (CG1)
Economic and social supports were not seen as a priority because service providers and caregivers felt that these supports were already provided in Wyndham: “Because there's a lot of help in terms of the Centrelink and […] a lot of stuff with just helping through the economic and social service programs.”(CG1). The school-based anti-bullying program had less endorsement because it did not involve early intervention. In reference to the anti-bullying school program, one service provider said: “I'm a huge advocate for naught to five. […] all of my career there's been a huge emphasis on infant mental health.” (SP 17 health).
Enabling factors and barriers to the implementation of interventions to support families living with adversity in Wyndham
Several key enabling factors and barriers occurring at the family, service and systems levels were identified for the implementation of interventions to support families. The main themes are summarised in Figure 2. See Supplementary Table A for quotations relevant to each theme.
Family and community level
Knowledge and awareness of available supports
Caregiver and service providers stated that many families did not know what was available to them:
“a part of the challenges that families experiencing, particularly those that come from low incomes, or migrant and with refugee backgrounds, […] don't know what [they]'re entitled to. [they] don't know how to ask for it cause [they] don't know what it is.” (SP25 social)
Participants offered suggestions for facilitating knowledge and awareness of available supports and services, including through community groups on social media, word of mouth, through General Practitioners (GPs), maternal and child health nurses, shopping centres and libraries. Multiple participants highlighted the need to provide information in multiple languages given the cultural and linguistic diversity of Wyndham.
Parent engagement
Service providers expressed that often the complexity of challenges facing families were an obstacle to their engagement with the agency to uptake services:
“…families that are faced with life challenges, they don't always choose the options that are on offer to them. It could be a financial barrier. It could be a mental health barrier. It could be a number of things that are sort of in the way.” (SP11 education)
These complexities were highlighted for families with previous negative experiences with the service system (e.g. child protection) and families who were not eligible for Medicare (Australia’s government-funded, free healthcare scheme) or other services due to their temporary visa status. Strategies to promote parent engagement emerged as a key enabler to successful uptake of interventions by all types of services and families, including providing after-hours and outreach service options.
Service level
People-centred approach to services
A people-centred approach to services was identified as a key enabler to supporting families living with adversity in Wyndham. Specifically, a focus on the needs and preferences of families through providers taking time to build trust and relationships with families. Participants highlighted the need to focus on families’ strengths and assets rather than engaging with families around “something is broken and we need to fix it" (SP10 social). Service providers and caregivers also emphasized that services should include the whole family, in particular fathers, as well as grandparents, kinship carers and siblings. Participants positioned this in contrast to the way that many services continued to focus exclusively on mothers. This was seen to be crucial for ensuring cultural safety for Aboriginal and Torres Strait Islander peoples and diverse communities in Wyndham: “[programs] have to encompass and be mindful of cultural differences.” (SP9 education).
Service funding and modality
Participants identified inflexible service models and service funding models as a key barrier to the provision of services for families living with adversity in Wyndham. Specifically, the provision of services during business hours at a service location. Service providers identified the possilibities of a diverse service offering online service delivery and outreach to better meet the needs of families, albeit recognising the inequities of digital access in Wyndham:
“Certainly what I'm seeing now is that for those families that score really highly, they may not feel they can commit to a face to face service because they're anxious, or because of family violence, they can't actually access that service. […] those families with those increased vulnerabilities are requesting home services” (SP17 health)
Key barriers to service access for families in Wyndham were related to workforce competencies and supports. Several service providers identified a lack of cultural diversity of the workforce and knowledge about how to work with culturally diverse clients: “… one of the things that's really important to improve on and in our area and in this industry is that cultural knowledge, diversity.” (SP025 social)
Additional access barriers for families included any cost for service and services being located in areas with poor public transport access. One service provider participant providing long-term support for clients described the “luxury” of time (SP16 drug and alcohol) which corroborated with other providers acknowledgement that they had increasingly less time allocated with clients over their time working in Wyndham.
System level
Navigating the system
Support for families to navigate intersectoral services was identified as a key enabler to family access, including comprehensive assessment, care navigation and pathway planning. A caregiver said it would have been helpful if her GP had linked her with all available programs at the beginning of her pregnancy: “Saying, ‘Hey, for the life journey of you and your kid for the next eight years, these are the programs which the gov[ernment] offers." (CG1).
Outreach services and ‘soft entry’ setting
Caregivers and most service providers saw outreach services as a gateway to service access, particularly for families with complex life circumstances:
“a lot of families that feel completely overwhelmed by parenting in general and the day to day expectations of them as parents, of community members, of families […] more outreach type services would be the answer to that.” (SP12 education)
Providers described getting to know families in a safe environment and linking them to a range of supports as the family felt comfortable to share their experiences over time.
Intersectoral collaboration
Siloing of services was a key barrier identified by multiple service provider participants. Some providers said they were unaware of all programs available in Wyndham. “Red tape” also limited the ability for providers to share client information that would enable clients to seamlessly transition between services. Other providers identified shared network meetings and other mechanisms for information sharing as enablers of collaborative practice: “[it’s] been great to say, ‘What's going on in your space? What's going on in our space?’” (SP13 education)
Available services
A lack of available services, particularly allied health, was identified as a key barrier by several service providers: One education service provider explained: “We're supposed to be capacity building educators to support these families in these situations, but we're suggesting things [services] that there's a bottleneck or just an absolute stop. I think that's still a big gap.” (SP13 education).