Katarina Ostojic

Aim: To evaluate the evidence for swimming interventions for children with disability. Method: Seven databases were searched for studies of swimming intervention for children with disability (from inception to 2026). Intervention and outcome content, context, and dose were extracted and mapped to Royal Life Saving Australia's National Swimming and Water Safety (SWS) Framework. Results were synthesized according to synthesis without meta‐analysis guidelines. Results: Fifty‐five studies (59 papers), that is, six randomized controlled studies, six non‐randomized controlled studies, and 43 uncontrolled trials, met the criteria. Most included autistic children ( n = 28) or children with cerebral palsy ( n = 14) and were delivered by swimming teachers ( n = 27), physiotherapists ( n = 12), or multidisciplinary teams ( n = 6). Interventions included seven of eight Royal Life Saving Australia National SWS Framework constructs, most commonly swimming ( n = 51), underwater ( n = 40), and flotation ( n = 38). Outcomes were measured using standardized ( n = 28), custom ( n = 21), or swimming speed and distance ( n = 3) measures. All studies reported improved swimming, with significant outcomes in 31 of 33 studies reporting significance and medium‐to‐large effect sizes. Physical ( n = 14), social ( n = 11), psychological ( n = 11), or participation ( n = 5) outcomes improved in 29 of 31 studies. Interpretation: There is low‐to‐moderate‐certainty evidence that swimming interventions improve swimming skills for children with disability, with moderate certainty for autistic children and children with cerebral palsy or developmental coordination disorder. Future research should use rigorous designs that align standardized outcome measures to intervention content and participant skill level and evaluate broader physical literacy and participation benefits.

Migrant women and children can face significant barriers when accessing child and family health services. Child and family health hubs (hubs) represent a potential solution to simplify pathways between maternity, child, and social care services for migrant populations. However, how these hubs operate specifically for migrants remains underexplored. Our study addresses this gap by exploring what helps and hinders the establishment and delivery of hubs across three different contexts in New South Wales, Australia for migrant populations using a case study approach. While all sites found the hub model appropriate and acceptable, its feasibility varied. Challenges included limited resources, particularly the absence of a dedicated hub coordinator, governance issues, and personnel turnover. Success depended on clear leadership, dedicated coordination, systematic referral pathways, cultural sensitivity, and community engagement. The evidence from this study can be used within other contexts to plan and deliver hubs for migrant and potentially other priority population families with young children.

Approximately one-in-five children and adolescents experience chronic pain. Pain education, where people are provided with information, supports and skills to better manage pain, is a key component of effective pain management. This review identified and synthesised the content of existing chronic pain education programs/resources for individuals aged 5– 25 years and examined their accessibility for those with diverse abilities. Searches of research databases, publicly available websites, and a global call for innovations identified 89 records representing 69 unique programs/resources. The most frequently referenced were “Web-based Management for Adolescent Pain (Web-MAP)”, “The ComfortAbility Program”, and “iCanCope with Pain”. Programs/resources were analysed using content analysis and mapped to seven recommended chronic pain education categories (Partnerships, self-management skills, lifestyle habits, emotional coping, social role support, informed decisions, and explaining pain) and five accessibility domains (cognition, communication, vision, hearing and movement). Accessibility was assessed through content review by coding each resource for explicit or potential consideration of accessibility. Educational content was commonly delivered through websites or face-to-face sessions, and emerging digital approaches (including mobile applications, virtual reality, chatbots, podcasts, social media). Most delivery approaches were online and self-directed. Of the analysed programs/resources, only four addressed all seven recommended chronic pain education categories. The category most frequently addressed involved promoting active cognitive and behavioural strategies to improve function and reduce symptoms. Accessibility analysis suggested that while over half of the resources were likely suitable for individuals with diverse visual (56.5%), communication (82.6%), auditory (84.1%), or movement abilities (91.3%), accessibility for those with cognitive impairment was markedly underrepresented and by far the least addressed domain (14.5%). Overall, while many pain education programs and resources exist for young people with chronic pain, few address all recommended education domains. Future development should emphasise inclusive design and equitable accessibility, particularly cognitive accessibility, to ensure resources effectively meet diverse needs.

Background: The social determinants of health contribute to health inequities experienced by children with neurodisability and pose barriers to engaging with healthcare systems. At an individual level, adverse social determinants of health are experienced as unmet social needs (USNs), for example, housing insecurity and financial hardship. Emerging evidence supports social prescribing interventions that systematically identify USNs and refer families to services to address these needs. This study aims to evaluate the effectiveness of a co-designed social prescribing programme to address the USNs of children with neurodisability and their parents/carers, its cost-effectiveness and cost-utility, and implementation and translation across the healthcare system. Methods and analysis: The study will be conducted at the tertiary Paediatric Rehabilitation Services in New South Wales, Australia. A standardised screening tool will identify parents/carers experiencing USNs. Parents/carers who report one or more USN and consent will be eligible to participate in the randomised controlled trial. Participants will be randomised to an active control group or social prescribing intervention group (total sample size=392). The active control group will receive self-navigation via a resource pack containing information about services that can address USNs. The social prescribing intervention group will receive in-person Community Linker support, in addition to the resource pack. The screening tool, resource pack, and social prescribing intervention were co-designed with parents/carers of children with cerebral palsy and their healthcare professionals. The primary outcome is the effectiveness of interventions in reducing USNs. Secondary outcomes include parent/carer referrals to and engagement with support services, out-of-pocket expenses, child/young person and parent/carer health-related quality of life, parent/carer psychological distress, and child/young person hospital service use and emergency department presentations. Trial registration number: ACTRN12625000324415.

Background: Swimming is a common goal for children with disability, and the most popular sport for children in Australia. This study explored swimming and rehabilitation professionals’ perceptions of swimming for Australian children with disability. Methods: Rehabilitation and swimming professionals with recent experience working with children with disability completed an online survey. Quantitative data from binary and Likert-scale questions were analysed descriptively. Qualitative data from open-ended questions was evaluated using reflexive thematic analysis and mapped to the family of Participation-Related Constructs (fPRC). Results: Ninety-one swimming and 55 rehabilitation professionals (n = 146) responded. Most were confident supporting children with disability with swimming goals (rehabilitation = 71.6%, swimming = 73.8%) but had neutral–very low knowledge of para-swimming eligibility and classification (rehabilitation = 75%, swimming = 77.7%). Ten themes (33 code groups) covering all core elements of the fPRC were identified. Barriers/facilitators included pool accessibility (physical and sensory); program availability; affordability; acceptability (of content and culture); and having accommodating professionals and programs. Professionals believed that swimming programs should develop children’s confidence, water-safety, swimming skills, and fitness. Conclusion: Rehabilitation and swimming professionals should review existing programs to ensure they meet the needs of children with disability. Further research is needed to create an action plan to improve swimming participation for Australian children with disability.

Background and Objective: Migrant and refugee women, families, and their children can experience significant language, cultural, and psychosocial barriers to engage with child and family services. Integrated child and family health Hubs are increasingly promoted as a potential solution to address access barriers; however, there is scant literature on how to best implement them with migrant and refugee populations. Our aim was to explore with service providers and consumers the barriers, enablers, and experiences with Hubs and the resulting building blocks required for acceptable Hub implementation for migrant and refugee families.Design, Setting and Participants: This project was undertaken in Sydney, New South Wales, in communities characterised by cultural diversity. In this qualitative study, we used semi‐structured interviews guided by the consolidated framework for implementation research, with service providers from health and social services (32 participants) and migrant and refugee parents (14 parents) of children who had accessed Hubs.Research and Discussion: Our initial qualitative data themes were developed into step‐by‐step building blocks, representing a way to address contextual determinants to establish and sustain a Hub that can support migrant and refugee families. These include the setting‐up phase activities of buy‐in and partnership development, which outlines mechanisms to foster collective action and collaboration between health and social services. Following this, our orientation model articulates the need to establish Hub coordination and navigation, activities that enhance a Hub's relevance for migrant and refugee families and ongoing integration mechanisms, such as engagement of same‐language general practitioners. This is the first study to explore the building blocks required for acceptable Hub implementation to meet the needs of migrant and refugee families in the first 2000 days of a child's life—a critical time to optimise child development and health.Patient or Public Contribution: The research questions were developed based on qualitative research undertaken with Hub participants, community members, and service providers. The original investigator team had a consumer representative who has since relocated and consultation was undertaken with local Hub partner services. The researchers also consulted multicultural health services, including cultural support workers, to ensure research materials were culturally nuanced. Patients or participants have not directly been involved in the current study design.Clinical Trial Registration: This trial was registered with the Australian New Zealand Clinical Trials (ACTRN12621001088831).

To explore (i) the impact of unmet social needs on children with cerebral palsy and their families; (ii) enablers-, and (iii) barriers to addressing unmet social needs. Eligible participants attended or worked at one of the three Paediatric Rehabilitation Departments including: children with a diagnosis of cerebral palsy; parents/carers; and clinicians. One-on-one interviews were conducted with parents/carers and focus groups with clinicians. Interview and focus group transcripts were deductively thematically analysed according to the social model of disability. A total of 44 participants (8 parents and 36 clinicians) took part. No children consented to participate. Analysis of the qualitative data identified four main themes and 14 sub-themes. The main themes were: Unmet social needs are pervasive; An inequitable health system with no roadmap; Everyone suffers as a result of unmet social needs; and It takes a village to raise a child. Unmet social needs have profound impacts on families. The experiences of unmet social needs are intensified by the extra complexities of raising a child with disability. Societal barriers including inequitable systems and the fragmented services are barriers impeding on families receiving support and ultimately limiting their wellbeing.

Aim: To determine the frequency, type, clinical, and sociodemographic associations of unmet social needs in children with cerebral palsy (CP).Method: We conducted a cross‐sectional study of parents and carers of children with CP attending a specialist hospital clinic between July and September 2022. Unmet social needs were self‐identified using a survey, guided by the WE CARE survey instrument and adapted to the local context. Sociodemographic and clinical data were obtained from medical records. We performed descriptive analysis of participants' unmet social needs, sociodemographic factors, and clinical factors, and examined for associations using a χ² test and logistic regression.Results: A total of 105 parents and carers completed the survey. Of these, 68 (64.8%) reported one or more unmet social need, with 24 (22.9%) reporting three or more unmet needs. A higher number (three or more) of unmet needs was associated with Gross Motor Function Classification System levels IV and V (odds ratio [OR] = 3.77, 95% confidence interval [CI] = 1.44–9.86) and intellectual disability (OR = 4.63, 95% CI = 1.61–13.31), but were not significant when corrected for neighbourhood socioeconomic disadvantage. The greatest socioeconomic disadvantage was associated with housing concerns (p = 0.002), food (p = 0.026), and financial insecurity (p = 0.02).Interpretation: Unmet social needs are experienced by most families of children with CP. This study highlights the importance of systematic pathways to identify and address unmet social needs.

Aim: To co‐design a social prescribing intervention (the EPIC‐CP programme: Equitable Pathways and Integrated Care in Cerebral Palsy) with children with cerebral palsy (CP), their families, and clinicians to address unmet social needs.Method: The study was conducted (August 2021 to March 2023) at the paediatric rehabilitation departments of the three tertiary paediatric hospitals in New South Wales, Australia. Eligible participants attended or worked at one of the departments, including children with CP, parents/caregivers, and clinicians. Mixed‐methods co‐design was used in intervention co‐production and prototyping. The project was overseen by research advisors with lived experience of CP.Results: More than 200 participants contributed to the co‐design research. Families experienced a substantial burden of unmet social needs. Co‐designed interventions involved systematic identification of unmet social needs with (1) targeted community resources and (2) engagement with a ‘community linker’ who supported children/young people and their families to access health, education, and social services that matched their identified needs and preferences. Research participants co‐developed the programme logic model and prototype. This was piloted in research action cycles and iteratively refined until consensus was achieved.Interpretation: We co‐designed a social prescribing programme responsive to the needs of its end‐users and purposefully developed to be embedded in the Australian health setting. A pilot randomized controlled trial will further evaluate this intervention.

Introduction The social determinants of health contribute to poorer health outcomes for children with cerebral palsy (CP) and are barriers to families accessing health services. At an individual level, social determinants of health are experienced as unmet social needs, for example, unsafe housing conditions. There is emerging evidence that clinical pathways for the systematic identification and referral to services for unmet social needs can support families to address these needs. These clinical pathways have not been implemented for children with CP. The objectives are to investigate the feasibility and acceptability of two co-designed social needs clinical pathways for parents/caregivers of children with CP—social prescribing (ie, Community Linker plus resource pack) compared with resource pack only. Methods and analysis This pilot randomised controlled trial will run at the three tertiary paediatric rehabilitation services in New South Wales, Australia. A total of 120 participants will be recruited, with randomisation stratified by study site. A survey tool will be used to identify families experiencing unmet social needs. Parents/caregivers who report one or more unmet social need/s and consent will be eligible. The active control group will receive a resource pack containing information on community services to support unmet social needs. The social prescribing intervention group will receive one-on-one Community Linker support, in addition to the resource pack. The survey tool, intervention, logic model, and resource pack were co-designed with patient families and their healthcare workers. Feasibility of the research design and the clinical pathways will be evaluated using the number/proportion of parents/caregivers who complete the survey tool, consent, engage with the intervention, and complete research measures. Acceptability will be evaluated using questionnaires and qualitative interviews. Ethics and dissemination Human research ethics approval was granted by the Sydney Children’s Hospitals Network Human Research Ethics Committee (2022/ETH01688). Participants and stakeholders will receive updates and findings via regular communication channels including meetings, presentations, and publications. Trial registration number Australia New Zealand Clinical Trials Registry: 12622001459718.