HEALTHY BEGINNINGS
Health Beginnings has a strong focus on early interventions, as well as the monitoring and assessment of the health and development of young children during their first years of life. This is a key priority area for South Western Sydney Local Health District (SWSLHD), NSW Health, and the Federal government’s ‘National Action Plan for the Health of Children and Young People 2020-2030’. Listed below are some of our projects under this initiative.
1) Strengths-based, tiered, accessible resources and supports (STARS) for Kids Program
The STARS for kids program aims to identify, link, and navigate families to the right services at the right place and time. This program will be co-designed with consumers and the community and developed by our team. This program consists of Universal Service via a ‘digital front door’ using the Watch Me Grow-Electronic (WMG-E) Platform, an innovative technology that provides unique opportunities to reach vulnerable families in their homes (critical during the current pandemic), or via opportunistic service contacts (such as GP clinic waiting rooms during vaccination or routine health contacts), early childhood education services such as supported play groups, or via multicultural, refugee or Aboriginal services etc. and enable an integrated approach to identify and then support the child’s developmental, parental mental health, and wellbeing needs. WMG-E has been tested for child development and we propose to expand this to screen and address parents’ mental health and psychosocial needs – optimising the family’s wellbeing. Further, the program will provide tiered service based on individual needs, ranging from anticipatory guidance and health literacy (Tier 1); b) targeted services as per need and risk level (Tier 2); c) specialised supports (Tier 3) including family life skills and complex psychosocial supports via service navigation at Integrated, place-based Child and Family Hubs.
Project value: 2021 MRFF Chronic Neurological Conditions Grant Opportunity funding of $1,964,141.99.
Expected project outcomes: The program aims to improve early identification of child development, parental mental health and family social care needs by engaging children and families via opportunistic contacts (with health, early childhood education and social service providers – both Government and Non-Government Organisations). The provision of a tiered model of care alongside wrap around social care for those families with complex psychosocial needs being trialled in three distinct communities across Australia (multicultural in Fairfield, South-Western Sydney; regional/rural and Aboriginal in Taree, NSW and a low socioeconomic community in Wanneroo in WA) will allow the scale up of the program across Australia.
2) The Integrated Kids Hubs – Ensuring Equity of Access for Children
The Integrated Kids Hubs – Ensuring Equity of Access for Children project aims to determine if integrated Hubs are effective in increasing access to child and family services for disadvantaged urban and regional families with children aged 3 years and under, thus improving early identification of developmental vulnerability, parental wellbeing and capacity, and addressing unmet psychosocial needs. If these issues are not identified and addressed early, these children will go on to struggle in school and life. We will use a pragmatic trial design (meaning the research is embedded in our usual practice), determine the social return on investment, and establish what is needed to scale up the Hubs across NSW and Australia.
Project value: ARC Linkage grant (ARC funding of $917,285 & Partners $641,158 = $1,558,443)
Expected project outcomes: We will produce the first large-scale Australian evidence on Hubs that support families in the first 1,000 days of their child’s life. By embedding a strong knowledge translation strategy into the project, this work will inform the scale-up of Hubs, nation-wide.
3) The Autism Spectrum Disorder (ASD) Surveillance Project: The Autism Surveillance Project (ASP) seeks to engage parents in early developmental assessments and integrate them into current practice.
Key findings: As a key outcome, 30 GP practices in SWS have been trained on Social Attention and Communication Surveillance to enable them in their practice to identify children with autism early (from 18 months of age). We are currently working with National Disability Insurance Scheme (NDIS) to develop an implementation plan for autism surveillance using the National Guideline for the Assessment and Diagnosis of Autism to be rolled out across Australia. Also see: Barbaro et al. A Multistate Trial of an Early Surveillance Program for Autism Within General Practices in Australia. Frontiers in Paediatrics. 2021;9:260.
4) Watch Me Grow (WMG) Integrated Project: NHMRC partnership grant project in partnership with NSW Health, Myhealth Oran Park, SWSLHD, SCHN, Queensland Health, and University of Queensland involving a cluster Randomised Controlled Trial (RCT) to develop a ‘universal’ surveillance of developmental problems in young children (18-24m). The trial of the WMG webapp in the GP practice setting has practice and policy implications for developmental surveillance to be done by the GP using the opportunistic contact during immunisation visits.
Key findings: The qualitative findings from the GP practices involved in the study has provided evidence base for a GP and Practice Nurse CPD module for developmental surveillance in collaboration with Royal Australian College of General Practitioners (RACGP) and Australian Primary Health Care Nurses Association (APNA). Further, the pilot work completed at Myhealth Oran Park was instrumental in obtaining leveraged funding from NSW Health for a Covid-19 grant to extend the use of the WMG weblink for parental mental health and social care needs.
Key Publication: Kohlhoff J, Dadich A, Varghese J, McKenzie A, Ong N, Pritchard M, Tam M, Woolfenden S, Blight V, Eastwood J, Garg P, Jalaludin B, Liaw T, Murphy E, Schmied V, Williams K, Eapen V. Consumer and health professional perceptions of the ‘Watch Me Grow Electronic platform’ (WMG-E) for developmental surveillance in early childhood. Australian Journal of General Practice (in press)
5) WMG-E Covid-19 grant: A digital solution to address the mental health and psychosocial impacts of the pandemic for children and their parents in the first 2000 days. NSW Health Covid-19 grant
Key Publication: Eapen V., Woolfenden S., Schmied V., Jalaludin B., Lawson K., Liaw ST., Lingam R., Page A., Cibralic S., Winata T., Mendoza Diaz A., Lam-Cassettari C., Burley J., Boydell K., Lin P., Masi A., Katz I., Dadich A., Preddy J., Bruce J., Raman S., Kohlhoff J., Descallar J., Karlov L., Kaplun C., Arora A., Di Mento B., Smead M., Doyle K., Grace R., McClean T., Blight V., Wood A., Raine KH (2021). Watch Me Grow- Electronic (WMG-E) surveillance approach to identify and address child development, parental mental health, and psychosocial needs: study protocol. BMC Health Services Research 2021 Nov 17;21(1):1240. doi: 10.1186/s12913-021-07243-0
6) First 2000 Days Care Connect – A holistic first 2000 days model of care for migrant and refugee populations: Funded through NSW Health Translational Research Grant Scheme (TRGS) 2021-2023 and being rolled out across SESLHD, SWSLHD, and NSLHD. The model of care will be evaluated using a quasi-experimental trial. In addition, the team will carry out a detailed economic and implementation evaluation. The evaluation will assess effectiveness in increasing the number of children attending CFH checks in the first 12-months; improving the identification of developmental vulnerability, postnatal depression, and support for breastfeeding and other psychosocial needs compared to routine care; and health system savings and cost-effectiveness of the Hub model. The factors that help or hinder implementation of the Hub model to inform future adaptability and scalability of the new model of care.
Key Publication: Edwards, K., Fernandez, R., Rimes, T., Stephenson, L., Smith, R., Son, J., Sarkozy, V., Perkins, D., Eapen, V., Woolfenden, S. “Happy, Healthy, Ready – working with early childhood non-government organisations for developmental surveillance for vulnerable children”. AJAN 2020 Oct 8; 37(4).
Other ongoing projects:
7) Healthy Wealthy Families Fairfield (HWFF): Intervention combining financial counselling and service navigation in early childhood as a pilot feasibility trial addressing child poverty through health care service delivery.
8) Mouse model for ASD and Tourette’s Syndrome: Study of a new IMPLL mouse model for ASD and Tourette Syndrome at Ingham Institute in collaboration with Murray Killingsworth investigating the underlying genomic and pathogenetic processes.
9) Novel interventions in Tourette Syndrome: We are currently involved in leading clinical trials investigating the effectiveness of transcranial Direct Current Stimulation and medicinal cannabis in Tourette Syndrome.
HEALTH SYSTEMS RESEARCH, POPULATION CHILD HEALTH, AND HEALTH EQUITY
Health Systems Research aims to evaluate new integrated models of care, making sure that families can access the right level of care (e.g., GPs, specialists) when they need it. Our work targets health systems delivery for children with complex health needs and those with chronic health conditions, which is a priority area for SWSLHD. Listed below are some of our projects under these initiatives.
1) Psychosocial adversities in childhood and access to intervention and support in South Western Sydney – Pathways for amelioration: Early identification and intervention are key to reducing potential negative health impacts amongst vulnerable children and youth. SWSLHD Community Paediatric clinics already have an adverse childhood experiences (ACE) checklist in routine use. As part of a service improvement initiative, we aimed to assess the relationship between children’s exposure to early adversities, clinicians’ ability to respond to these, and children’s access to recommended interventions to optimise their development.
2) Health and developmental needs of refugee children and youth in South Western Sydney: are we meeting the changing needs: Aims of this project are to describe the health status of refugee children/young people in SWS over the last decade (2009-2019), including prevalence of chronic disease, neurodevelopmental disability, and mental health and wellbeing issues in this cohort.
3) Moving to Telehealth: Maintaining and improving access to quality developmental and diagnostic assessments: With the progression of the COVID-19 pandemic, Community Paediatrics re-organised our model of care to deliver paediatric developmental assessments and other clinical assessments by Telehealth (a combination of phone calls and videoconferencing) as much as possible. This project aimed to find out about consumer and clinician experiences regarding delivery of service provision for developmental assessments using telehealth, including barriers and enablers to telehealth and hybrid models of child developmental assessments.
4) Electronic Practice Based Research Network/MedicineInsight: We are working with MedicineInsight, a data repository of data from 600+ general practices nationally, to determine its data quality and fitness for purpose for primary care research and development. By also harmonising MedicineInsight with a common data model that we have applied in the electronic Practice Based Research Network (ePBRN) work (this linked SWSLHD and GP data), we have a potential pathway to include GP data in the data observatory. In addition to this first step to large scale data linkage that includes BestSTART’s footprint, we have also established a secure research environment for digital health (SREDH) research that is compliant to UNSW and NPS standards for cybersecurity. This is a more flexible alternative to ERICA in terms of accommodating our library of open-source tools.
5) Aboriginal Health Service Mapping Exercise: Equity focussed pathways – Collaboration with Aboriginal Health mapping and addressing service gaps. An initial report of Aboriginal early intervention services was created in collaboration with Community paediatrics, Aboriginal Health, and Western Sydney University. This report is the foundation for further research into the quantitative analysis of services and the qualitative mapping of client experiences.
6) Improving the child and family health service system for Aboriginal Children and Young People in South West Sydney through culturally responsive, integrated pathways: This is a mixed-methods evaluation, involving an audit of clinical encounters, development of a Cultural Audit tool and qualitative interviews of staff via yarning circles.
7) Growing Healthy Kids: RCT evaluating the impact of the SWSLHD’s Growing Healthy Kids paediatric weight treatment service on the health of children and young people (CYP) aged 2 to 17 years with established obesity. Outcomes include change in BMI and weight-related lifestyle behaviours, cardio metabolic risk, and psychosocial wellbeing. In 2020, the work around population health has continued, including being adaptive with the design of GHK in response to COVID. This project supports a SWS allied health PhD.
8) Out of Home Care Service and Whole of Family Team, Ingleburn: The evaluation of this program as to whether assertive mental health care make a difference to children in out-of-home care has been completed.
9) Health and Education Partnerships: Designing and evaluating models of Health and education partnership across the District with Ashcroft High School and others. We are currently working with people at Ashcroft and Nowra East as they submitted and got a small grant from the Department of Education.
10) Gna Ka Lun intervention: An evaluation of a new triage system within the Gna Ka Lun adolescent in-patient mental health unit. The project is now finished, and the final report has been completed. Also evaluating a trauma-focused rapid CBT intervention for clients in an adolescent in-patient mental health unit.
11) COVID survey of children with neurodevelopmental disabilities (NDDs): Survey of ~300 parents of children with NDDs about their health and access to services. We are currently processing our findings into journal articles and reports.
Key publication: Please refer to Masi A et al. Impact of the COVID-19 pandemic on the well-being of children with neurodevelopmental disabilities and their parents. Journal of paediatrics and child health.
12) Transition from Paediatric to Adult Care for Young People with Intellectual Disabilities: Assessment of routine GP care, mapping of pathways and data analysis for this population in collaboration with NSW Agency for Clinical Innovation. NHMRC trials grant in submission following two national roundtable workshops.
13) Antenatal continuity of care in Fairfield: Project assessing satisfaction and cost-savings associated with continuity of care throughout pregnancy.
14) Exploring Inequity for Children with Neurodevelopmental Disabilities in South Western Sydney: SWS is a culturally and linguistically diverse region with marked social disadvantage. Using the best available data sources, we aimed to explore the prevalence of children with developmental disability and their access to disability support services through the National Disability Insurance Scheme and Department of Education.
INFRASTRUCTURE PLATFORMS
We are building a cross-agency, population-level child/youth data platform and systems that can monitor and evaluate the impact of new programs and services across the district in real-time. The two main components of this platform include Intervention Hub and Data Observatory. Listed below are some of our projects under this initiative.
1) Community consultation of the intervention hub (CCI): We are creating one-stop shops for families to access services and trials, facilitating service access and research engagement. We are consulting stakeholders to ensure “intervention hubs” satisfy real needs and currently working on a draft protocol and finalising a logistic model. We are working with young people from SWS to empower them to identify and execute solutions to their health-related problems.
2) Data Observatory: The BestSTART-SWS databank will include the district’s routinely collected data as well as information gathered throughout the studies families take part in. The data observatory aims to link available health data for all children born in South Western Sydney Local Health District (SWSLHD) so we can untangle the complex relationships leading to resilience and ill-health, map the trajectory of the district, and ensuring the district is at the cutting edge of big data, using it to inform services and solutions.
