Identifying and responding to family adversity in Australian community and primary health settings: a multi-site cross sectional study

Unaddressed family adversity has potentially modifiable, negative biopsychosocial impacts across the life course. Little is known about how Australian health and social practitioners identify and respond to family adversity in community and primary health settings.To describe, in two Australian community health services: (1) the number of adversities experienced by caregivers, (2) practitioner identification of caregivers experiencing adversity, (3) practitioner response to caregivers experiencing adversity, and (4) caregiver uptake of referrals.Survey of caregivers of children aged 0–8 years attending community health services in Victoria and New South Wales (NSW). Analysis described frequencies of caregiver self-reported: (1) experiences of adversity, (2) practitioner identification of adversity, (3) practitioner response to adversity, and (4) referral uptake. Analyses were sub-grouped by three adversity domains and site.349 caregivers (Victoria: n = 234; NSW: n = 115) completed the survey of whom 88% reported experiencing one or more family adversities. The median number of adversities was 4 (2–6). Only 43% of participants were directly asked about or discussed an adversity with a practitioner in the previous 6 months (Victoria: 30%; NSW: 68%). Among caregivers experiencing adversity, 30% received direct support (Victoria: 23%; NSW: 43%), and 14% received a referral (Victoria: 10%; NSW: 22%) for at least one adversity. Overall, 74% of caregivers accepted referrals when extended.The needs of Australian families experiencing high rates of adversity are not systematically identified nor responded to in community health services. This leaves significant scope for reform and enhancement of service responses to families experiencing adversity.

[1]  H. Hiscock,et al.  “A multitude of things”: A qualitative analysis of practitioner perceived barriers to identifying and responding to childhood adversity , 2023, Mental Health & Prevention.

[2]  S. Raman,et al.  Clinical Pathways for the Identification and Referral for Social Needs: A Systematic Review. , 2023, Pediatrics.

[3]  H. Hiscock,et al.  The feasibility of a Child and Family Hub within Victorian Community Health Services: a qualitative study , 2022, Australian and New Zealand journal of public health.

[4]  I. Katz,et al.  Utility of screening for adverse childhood experiences (ACE) in children and young people attending clinical and healthcare settings: a systematic review , 2022, BMJ Open.

[5]  K. Hegarty,et al.  Transforming health settings to address gender‐based violence in Australia , 2022, The Medical journal of Australia.

[6]  H. Hiscock,et al.  Do Integrated Hub Models of Care Improve Mental Health Outcomes for Children Experiencing Adversity? A Systematic Review , 2022, International journal of integrated care.

[7]  J. Fisher,et al.  Integrated Child and Family Hub models for detecting and responding to family adversity: protocol for a mixed-methods evaluation in two sites , 2022, BMJ Open.

[8]  H. Hiscock,et al.  Screening for Adverse Childhood Experiences in Children: A Systematic Review. , 2022, Pediatrics.

[9]  F. Baum,et al.  Advancing Action on Health Equity Through a Sociolegal Model of Health. , 2021, The Milbank quarterly.

[10]  L. Salvador-Carulla,et al.  Using Geospatial Analysis to Inform Development of a Place-Based Integrated Care Initiative: The Healthy Homes and Neighbourhoods Experience , 2021, International journal of integrated care.

[11]  M. Kelaher,et al.  Study protocol for the Healthier Wealthier Families (HWF) pilot randomised controlled trial: testing the feasibility of delivering financial counselling to families with young children who are identified as experiencing financial hardship by community-based nurses , 2021, BMJ Open.

[12]  Anthony F Jorm,et al.  The association between adverse childhood experiences and common mental disorders and suicidality: an umbrella review of systematic reviews and meta-analyses , 2021, European Child & Adolescent Psychiatry.

[13]  J. Bettger,et al.  A Community Resource Navigator Model: Utilizing Student Volunteers to Integrate Health and Social Care in a Community Health Center Setting , 2021, International journal of integrated care.

[14]  David R. Williams,et al.  Inequalities in the distribution of childhood adversity from birth to 11 years. , 2019, Academic pediatrics.

[15]  C. Karatekin,et al.  Expanding the Original Definition of Adverse Childhood Experiences (ACEs) , 2018, Journal of Child & Adolescent Trauma.

[16]  R. Shapiro,et al.  Integration of the Safe Environment for Every Kid (SEEK) Model Across Primary Care Settings , 2018, Clinical pediatrics.

[17]  H. Hiscock.  Responding to adverse childhood experiences: A paediatrician’s perspective , 2018, The Australian and New Zealand journal of psychiatry.

[18]  S. Hansen,et al.  Care Coordination for Vulnerable Families in the Sydney Local Health District: What Works for Whom, under What Circumstances, and Why? , 2018, International journal of integrated care.

[19]  Pankaj Garg,et al.  Designing Initiatives for Vulnerable Families: From Theory to Design in Sydney, Australia , 2017, International journal of integrated care.

[20]  W. Dietz,et al.  A New Framework for Addressing Adverse Childhood and Community Experiences: The Building Community Resilience Model. , 2017, Academic pediatrics.

[21]  M. Bellis,et al.  The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. , 2017, The Lancet. Public health.

[22]  J. Fortenberry,et al.  The hub-and-spoke organization design: an avenue for serving patients well , 2017, BMC Health Services Research.

[23]  N. Carter,et al.  Implementation and maintenance of patient navigation programs linking primary care with community-based health and social services: a scoping literature review , 2017, BMC Health Services Research.

[24]  L. Berliner,et al.  Trauma Informed Care , 2016, Child maltreatment.

[25]  Laura Gottlieb,et al.  A Randomized Trial on Screening for Social Determinants of Health: the iScreen Study , 2014, Pediatrics.

[26]  B. Farrant.  Mal adaptive Parenting and Child Emotional Symptoms in the Early School Years: Findings from the Longitudinal Study of Australian Children , 2014 .

[27]  M. McDonald,et al.  Developing the 'Parent Engagement Resource': A tool for enhancing parent-professional relationships and identifying psychosocial issues in families , 2012 .

[28]  J. Shonkoff,et al.  The Lifelong Effects of Early Childhood Adversity and Toxic Stress , 2012, Pediatrics.

[29]  A. Rosen,et al.  The future of community-centred health services in Australia: lessons from the mental health sector. , 2010, Australian health review : a publication of the Australian Hospital Association.

[30]  C. Dunst,et al.  Capacity-Building Family-Systems Intervention Practices , 2009 .

[31]  J T Hart,et al.  THE INVERSE CARE LAW , 1971 .

[32]  D. Maybery,et al.  Prevalence of parental mental illness in Australian families , 2009 .