Dr Natalie Strobel
The University of Western Australia
Associate Professor Janya McCalman
James Cook University
Associate Professor Daniel McAullay
The University of Western Australia

The first 5 years of a child’s life are a critical time period for influencing growth, development and learning.1

What is the gap and why is it important?

Growth, development and learning are largely influenced by sociocultural factors, poverty, psychosocial and biological risk factors, and central nervous system development and function.2 Primary health care services are uniquely placed to deliver a wide variety of interventions to improve health and wellbeing outcomes for Aboriginal and/or Torres Strait Islander children. Data suggests that while the delivery of services, particularly child health checks, has improved over time, actions and follow-up after a health assessment still remain poor.3 4 Improving the quality of care delivered to Aboriginal and/or Torres Strait Islander children remains a challenging issue for primary health care services.

Family-centred care is a way of caring for children and their families within primary health care services that ensures care is planned around the whole family, not just the individual child/person, and that all family members are recognised as care recipients.5 Family-centred care can be achieved through a variety of interventions. These include environmental interventions (collaborative partnerships with the family and/or child resulting in the design or redevelopment of the home or primary health care environment to maximise parental involvement and enhance child-health and well-being), communication interventions (promoting parental participation in health education to plan antenatal or postnatal care), educational interventions with structured support for families and continuing education for staff, counselling interventions such as brief interventions, and family support interventions such as referral to community services. These interventions are flexible in their approach and can involve, but are not limited to, collaborative care pathways, health promotion, brief interventions, home visiting and referrals to community services for children and their families.

Family-centred care is an approach which could improve the health and well-being outcomes of children and their families. It is seen by families to have great potential, particularly during the antenatal period, as long as services are responsive and flexible to families’ needs, provide adequate, timely information and support, and provide opportunities to share ideas and suggestions.6 7 Although family-centred interventions are implemented in some primary health care services, they are not being delivered to their fullest extent within and across primary health care services, and many health care services are not meeting the needs of children and their families.8 Due to the historical disempowerment of Aboriginal and/or Torres Strait Islander families, the provision of culturally proficient and empowering health care services that enable family satisfaction and ownership over decision making in the health of their children are very much needed. 

What does the best available evidence tell us?

Family-centred care may improve the quality of care provided to children and their families, and provide broader advocacy by primary health care services to impact the social determinants of health, improving the way in which health care services are provided. There is limited evidence on the effectiveness of family centred care within primary health care services. Reviews completed on this topic are out of date or not specific to child health within primary health care services.9 10 

A recent scoping review found eighteen studies for family-centred interventions by primary health care services for Indigenous children aged up to 5 years in Australia, Canada, New Zealand and the USA.11 Three randomised controlled trials plus 15 qualitative or exploratory studies were identified, describing six key strategies for improving the health of families: supporting family behaviours and self-care, increasing maternal knowledge and skills, linking families to clinical services, building the Indigenous workforce, promoting cultural and community connectedness and advocating for social determinants of health. These strategies are enabled by conditions such as competent and compassionate staff, flexibility in access, continuity and integration of care and culturally supportive care. These were implemented to a varying degree across the studies. To provide additional evidence to support the delivery of family centred care, a systematic review was completed to determine the effectiveness of family-centred interventions for Indigenous children by primary health care services.12 

What is current practice or policy?

Primary health care services are delivered through a variety of private, state-based and Aboriginal Community Controlled Health Organisations (ACCHOs) for Aboriginal and/or Torres Strait Islander children and their families. As a result it is difficult to know the variants of the family-centred model of care being implemented or the extent of implementation. While there is evidence to suggest that models of family-centred care are being implemented in primary care health services in Australia,11 it is unclear the extent to which these services have achieved improved family satisfaction with healthcare, empowerment of families in the healthcare of their children, or health and well-being outcomes as a result of this model. One model of care, the Baby One Program, that is delivered throughout Cape York by Apunipima Cape York Council, is aimed at early and frequent attendance at antenatal clinics and regular postnatal check-ups through empowering their families.13 An evaluation of the program found uptake by 161 eligible families, with the key to effective implementation being the relationships formed between health practitioners, especially Indigenous Health workers, and families.6

The 'National Framework for Health Services for Aboriginal and Torres Strait Islander Children and Families' policy supports the implementation of child and family health service systems that include the delivery of family-centred care as a key approach to providing culturally safe and appropriate care for children and their families.14 Although this framework, in combination with other national policies, sets the national context of health service delivery for Aboriginal and/or Torres Strait Islander children, there still remains a substantive gap between policy and the realities of providing family-centred care.15-17
 
What would the impact be if the proposed action was implemented?

  • Family-centred primary health care models that respect cultural context and empower families to make informed decisions concerning the health and wellbeing of their children. 
  • Primary health care-delivered family-centred care could significantly improve the health and wellbeing of Aboriginal and/or Torres Strait Islander children and their families.18 This could also increase satisfaction with, and utilisation of, healthcare services.  
  • At the core, family-centred care encompasses the importance of both immediate and extended family, and the home environment. It also reflects the decision making process of families. In its essence, family-centred care supports the holistic concept of care for young children and their families. 
  • Strategies such as supporting family behaviours and self-care, increasing maternal knowledge and skills, linking families to clinical services, building the Aboriginal and/or Torres Strait Islander workforce, promoting cultural and community connectedness and advocating for social determinants of health are a good basis for delivering family-centred care. 
  • Long-term vision, support, resourcing and change within primary health care organisations is needed.
  • Evaluation of the effectiveness of this model of care is needed.

References 

1 Shonkoff JP, Garner AS, Committee on Psychosocial Aspects of C, et al. The lifelong effects of early childhood adversity and toxic stress. Pediatrics 2012;129(1):e232-46. doi: 10.1542/peds.2011-2663

2 Walker SP, Wachs TD, Gardner JM, et al. Child development: risk factors for adverse outcomes in developing countries. Lancet 2007;369(9556):145-57. doi: 10.1016/S0140-6736(07)60076-2

3 Bailie J, Schierhout GH, Kelaher MA, et al. Follow-up of Indigenous-specific health assessments - a socioecological analysis. Med J Aust 2014;200(11):653-7.

4 McAullay D, McAuley K, Bailie R, et al. Sustained participation in annual continuous quality improvement activities improves quality of care for Aboriginal and Torres Strait Islander children. Journal of paediatrics and child health 2017 doi: 10.1111/jpc.13673

6 J. N. Family cohesion in families with an impaired child. Brisbane: University of Queensland, 1989.

7 Campbell S, McCalman J, Redman-MacLaren M, et al. Growing a relational and responsive family health promotion program: A grounded theory evaluation of the Baby One Program. BMC Pregnancy & Childbirth in press

8 Dodd J, Saggers S, Wildy H. Constructing the ‘ideal’ family for family‐centred practice: challenges for delivery. Disability & Society 2009;24(2):173-86. doi: DOI: 10.1080/09687590802652447

9 Eades SJ, Stanley FJ. Improving the health of First Nations children in Australia. Med J Aust 2013;199(1):12-3.

10 Griew R, Tilton E, J. S. Family centred primary health care: review of evidence and models funded by the Office for Aboriginal and Torres Strait Islander Health Department of Health and Ageing. Canberra: Robert Griew Consulting with JTAI Pty Ltd, 2007.

11 Shields L, Zhou H, Pratt J, et al. Family-centred care for hospitalised children aged 0-12 years. Cochrane Database Syst Rev 2012;10:CD004811. doi: 10.1002/14651858.CD004811.pub3

12 McCalman J, Heyeres M, Campbell S, et al. Family-centred interventions by primary healthcare services for Indigenous early childhood wellbeing in Australia, Canada, New Zealand and the United States: a systematic scoping review. BMC Pregnancy and Childbirth 2017;17(1):71. doi: 10.1186/s12884-017-1247-2

13 McCalman J, Campbell SK, Chamberlain C, et al. Family-centred interventions for Indigenous early childhood well-being by primary healthcare services (Protocol). Cochrane Database of Systematic Reviews 2016(12) doi: 10.1002/14651858.CD012463 (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012463/epdf/full)

14 Edmunds K, Searles A, Neville J, et al. Apunipima Baby Basket Program: a retrospective cost study. BMC Pregnancy & Childbirth 2016;16 doi: 10.1186/s12884-016-1133-3

15 Department of Health. National Framework for Health Services for Aboriginal and Torres Strait Islander Children and Families. In: Government A, ed. Canberrra, 2016.

16 Department of Health and Ageing. National Framework for Universal Child and Family Health Services. Canberra: Department of Health and Ageing, 2011.

17 Department of Health and Ageing. National Aboriginal and Torres Strait Islander Health Plan 2013-2023. Canberra: Commonwealth of Australia, 2013.

18 Australian Health Ministers’ Advisory Council. National Framework for Child and Family Health Services – secondary and tertiary services. Canberra: COAG Health Council, 2015.

19 Barlow A, Mullany B, Neault N, et al. Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children: 3-year outcomes from a randomized controlled trial. Am J Psychiatry 2015;17