Tom McClean

Introduction: Children and families from priority populations (e.g. culturally and linguistically diverse and regional/rural communities) often experience significant psychosocial challenges and barriers to accessing health and social care. These inequities were further exacerbated during the COVID-19 pandemic. Integrating social care with health services has been proposed as an approach to improve service access and address unmet needs. Methods: A two-site parallel randomised controlled trial was conducted in Australia between August 2021 and 2023. Parents/carers of children from priority populations were recruited through Child and Family Health services (n = 288) and randomised to the Watch Me Grow–Electronic (WMG-E) intervention (n = 145) or care as usual (n = 143). The WMG-E program comprised digital developmental screening and community navigation to relevant health and social services via a service navigator. The primary outcome was change in unmet social needs measured using the WE CARE instrument. Intention-to-treat generalised linear mixed-effects models adjusted for child developmental concerns, parental mental health, and sociodemographic factors. Results: Unmet social needs decreased over time across both groups (β = –0.23, SE = 0.11, p = 0.036). At 12 months, the intervention group showed greater reductions in unmet needs than the control group (β = –0.35, SE = 0.17, p = 0.046), although the time × group interaction was not significant. Discussion: The WMG-E platform demonstrated feasibility as a digital developmental screening and navigation tool supporting families from priority populations. Conclusion: WMG-E shows promise in improving access to health and social care and reducing unmet social needs; however, further research is needed to assess sustained impacts across diverse settings. Trial registration: The study (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st 2021, and the trial results are being reported according to recommendations in the CONSORT Statement. Summary Box What is already known on this topic Significant inequities exist in the access to healthcare for priority population families with preschool children and this results in children missing opportunities for early identification and intervention for health and developmental problems. While addressing heath care inequities is critical for providing children a healthy start to life, there are no effective and systematic ways to reach such families as they do not engage with services early, and often experience significant barriers due to social care needs. Addressing health inequities by tackling social determinants of health alongside healthcare is critical to supporting families in priority population groups, aligning with the Sustainable Development Goals (SDGs) of the World Health Organization (WHO). What this study adds This study is one of the first Australian randomised controlled trials evaluating the effectiveness of a digital developmental screening program coupled with service navigation for improving unmet social care needs in multicultural and rural/regional communities. Significant reductions in unmet need scores were observed over time in both intervention and control groups, with a greater reduction in the intervention group, though no significant interaction between time and group was found. The Watch Me Grow Electronic (WMG-E) platform was shown to be a feasible and effective tool for developmental screening and navigation to address unmet social needs in diverse, priority population families.

Background: School-age care, such as outside school hours care (OSHC), is the fastest-growing childhood education sector in Australia. OSHC provides a unique opportunity to deliver programs to enhance primary school–age children’s social, emotional, physical, and cognitive well-being. Objective: This study aimed to pilot the co-designed Connect, Promote, and Protect Program (CP3) and conduct formative and process evaluations on how well the CP3 achieved its intended aims, ascertain areas for improvement, and determine how the CP3 model could be better sustained and extended into OSHC settings. Methods: A naturalistic formative and process evaluation of the CP3 implementation was undertaken at 1 and then 5 OSHC sites. Qualitative and quantitative feedback from stakeholders (eg, children, OSHC educators, volunteers, and families) was collected and incorporated iteratively for program improvement. Results: The formative and process evaluations demonstrated high program engagement, appropriateness, and acceptability. Co-design with children was viewed as highly acceptable and empowered children to be part of the decision-making in OSHC. Feedback highlighted how the CP3 supported children in the 4 CP3 domains: Build Well-being and Resilience, Broaden Horizons, Inspire and Engage, and Connect Communities. Qualitative reports suggested that children’s well-being and resilience were indirectly supported through the Broaden Horizons, Inspire and Engage, and Connect Communities CP3 principles. Matched-sample 2-tailed t tests found that children’s prosocial behaviors increased (mean difference=0.64; P=.04; t57=−2.06, 95% CI −1.36 to −0.02) and peer problems decreased (mean difference=−0.69; P=.01; t57=2.57, 95% CI 0.14-1.13) after participating in the CP3. Program feasibility was high but dependent on additional resources and CP3 coordinator support. Conclusions: To our knowledge, the CP3 is the first co-designed well-being program developed and evaluated specifically for OSHC services. This early evidence is promising. The CP3 may provide a unique opportunity to respond to the voices of children in OSHC and those that support them through creative and engaging co-designed activities. Our research suggests that CP3 provides OSHC with a framework and high-quality program planning tool that promotes tailored interventions developed based on the unique needs and preferences of those who will use them.

The COVID pandemic has had an uneven impact on families and communities, exacerbating existing structural disadvantage. We demonstrate that the construction of the pandemic by policymakers as primarily a medical problem has shaped the public health response in such a way as to hide the resulting lack of access to necessities for many and deterioration in people's wellbeing. We interviewed social welfare service providers in an urban area of high cultural and linguistic diversity and low socioeconomic advantage, about their experiences in the 2021 lockdown period. Our findings highlight the unanticipated impacts of the public health response on people who cannot be recognised in the normative subjects constructed by policy. We bring to the fore the hidden experiences behind the government-reported COVID health statistics and explore the (dis)integration of services that support survival. To avoid worsening structural disadvantage, policy responses to crisis require conceptualising the problem and its solutions from diverse standpoints, built on an understanding of the different elements that shape who we are and the way we live.

BACKGROUND School-age care, such as outside school hours care (OSHC), is the fastest-growing childhood education sector in Australia. OSHC provides a unique opportunity to deliver programs to enhance primary school–age children’s social, emotional, physical, and cognitive well-being. OBJECTIVE This study aimed to pilot the co-designed Connect, Promote, and Protect Program (CP3) and conduct formative and process evaluations on how well the CP3 achieved its intended aims, ascertain areas for improvement, and determine how the CP3 model could be better sustained and extended into OSHC settings. METHODS A naturalistic formative and process evaluation of the CP3 implementation was undertaken at 1 and then 5 OSHC sites. Qualitative and quantitative feedback from stakeholders (eg, children, OSHC educators, volunteers, and families) was collected and incorporated iteratively for program improvement. RESULTS The formative and process evaluations demonstrated high program engagement, appropriateness, and acceptability. Co-design with children was viewed as highly acceptable and empowered children to be part of the decision-making in OSHC. Feedback highlighted how the CP3 supported children in the 4 CP3 domains: Build Well-being and Resilience, Broaden Horizons, Inspire and Engage, and Connect Communities. Qualitative reports suggested that children’s well-being and resilience were indirectly supported through the Broaden Horizons, Inspire and Engage, and Connect Communities CP3 principles. Matched-sample 2-tailed t tests found that children’s prosocial behaviors increased (mean difference=0.64; P=.04; t57=−2.06, 95% CI −1.36 to −0.02) and peer problems decreased (mean difference=−0.69; P=.01; t57=2.57, 95% CI 0.14-1.13) after participating in the CP3. Program feasibility was high but dependent on additional resources and CP3 coordinator support. CONCLUSIONS To our knowledge, the CP3 is the first co-designed well-being program developed and evaluated specifically for OSHC services. This early evidence is promising. The CP3 may provide a unique opportunity to respond to the voices of children in OSHC and those that support them through creative and engaging co-designed activities. Our research suggests that CP3 provides OSHC with a framework and high-quality program planning tool that promotes tailored interventions developed based on the unique needs and preferences of those who will use them.

Objective: To gather views of older LGBTI (Lesbian, Gay, Bisexual, Transgender and Intersex) people on their experiences and expectations of aged care.Methods: An online survey of participants recruited through a large provider in NSW, Australia, and three organisations in the LGBTI community.Results: Respondents were older members of the LGBTI community, with a range of kinds of experience of aged care (including as clients, workers and advocates). They were somewhat skewed towards regional areas and many reported different kinds of vulnerability. They reported feeling safe to disclose their LGBTI status when engaging with services and not having difficulties on that basis. However, most disagreed that services currently meet the needs of LGBTI people. They said visible signs of welcome, inclusive language, treating disclosures sensitively and managing relations with partners and family were most important for older LGBTI people. Their own choices about aged care would be influenced by service inclusiveness and quality. There were no clear trends by demography, vulnerability or other characteristics.Conclusions: Providers should continue to focus on inclusiveness, and improve support for managing relations with family.

Residents of Aged Care Facilities (RACF) experience burdensome hospital transfers in the last year of life, which may lead to aggressive and potentially inappropriate hospital treatments. Anticipating these transfers by identifying risk factors could encourage end-of-life discussions that may change decisions to transfer. The aim was to examine the feasibility of identifying an end-of-life risk profile among RACF residents using a predictive tool to better anticipate predictors of hospital transfers, death or poor composite outcome of hospitalisation and/or death after initial assessment. A retrospective cohort study of 373 permanent residents aged 65+ years was conducted using objective clinical factors from records in nine RACFs in metropolitan Sydney, Australia. In total, 26.8% died and 34.3% experienced a composite outcome. Cox proportional hazard regression models confirmed the feasibility of estimating the level of risk for death or a poor composite outcome. Knowing this should provide opportunities to initiate advance care planning in RACFs, facilitating decision making near the end of life. We conclude that the current structure of electronic RACF databases could be enhanced to enable comprehensive assessment of the risk of hospital re-attendance without admission. Automation tools to facilitate the risk score calculation may encourage the adoption of prediction checklists and evaluation of their association with hospital transfers.