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Kemp L, Bruce T, Elcombe EL, Byrne F, Scharkie SA, Perlen SM, Goldfeld SR. Identification of families in need of support: Correlates of adverse childhood experiences in the right@home sustained nurse home visiting program. PLoS One 2022; 17:e0275423. [PMID: 36190969 PMCID: PMC9529103 DOI: 10.1371/journal.pone.0275423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/31/2022] [Indexed: 11/07/2022] Open
Abstract
Background Little is known about the efficacy of pregnancy screening tools using non-sensitive sociodemographic questions to identify the possible presence of as yet undiagnosed disease in individuals and later adverse childhood events disclosure. Objectives The study aims were to: 1) record the prevalence of risk disclosed by families during receipt of a sustained nurse home visiting program; and 2) explore patterns of relationships between the disclosed risks for their child having adverse experiences and the antenatal screening tool, which used non-sensitive demographic questions. Design Retrospective, observational study. Participants and methods Data about the participants in the intervention arm of the Australian right@home trial, which is scaffolded on the Maternal Early Childhood Sustained Home-visiting model, collected between 2013 and 2017 were used. Screening data from the 10-item antenatal survey of non-sensitive demographic risk factors and disclosed risks recorded by the nurse in audited case files during the subsequent 2 year intervention were examined (n = 348). Prevalence of disclosed risks for their child having adverse experiences were analysed in 2019 using multiple response frequencies. Phi correlations were conducted to test associations between screening factors and disclosed risks. Results Among the 348 intervention participants whose files were audited, 300 were noted by nurses to have disclosed risks during the intervention, with an average of four disclosures. The most prevalent maternal disclosures were depression or anxiety (57.8%). Mental health issues were the most prevalent partner and family disclosures. Screening tool questions on maternal smoking in pregnancy, not living with another adult, poverty and self-reporting anxious mood were significantly associated with a number of disclosed risks for their child having adverse experiences. Conclusions These findings suggest that a non-sensitive sociodemographic screening tool may help to identify families at higher risk for adverse childhood experiences for whom support from a sustained nurse home visiting program may be beneficial.
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Affiliation(s)
- Lynn Kemp
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- * E-mail:
| | - Tracey Bruce
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Emma L. Elcombe
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Fiona Byrne
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Sheryl A. Scharkie
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Susan M. Perlen
- Population Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Sharon R. Goldfeld
- Population Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Centre for Community Child Health, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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Bohingamu Mudiyanselage S, Price AMH, Mensah FK, Bryson HE, Perlen S, Orsini F, Hiscock H, Dakin P, Harris D, Noble K, Bruce T, Kemp L, Goldfeld S, Gold L. Economic evaluation of an Australian nurse home visiting programme: a randomised trial at 3 years. BMJ Open 2021; 11:e052156. [PMID: 34873002 PMCID: PMC8650480 DOI: 10.1136/bmjopen-2021-052156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To investigate the additional programme cost and cost-effectiveness of 'right@home' Nurse Home Visiting (NHV) programme in relation to improving maternal and child outcomes at child age 3 years compared with usual care. DESIGN A cost-utility analysis from a government-as-payer perspective alongside a randomised trial of NHV over 3-year period. Costs and quality-adjusted life-years (QALYs) were discounted at 5%. Analysis used an intention-to-treat approach with multiple imputation. SETTING The right@home was implemented from 2013 in Victoria and Tasmania states of Australia, as a primary care service for pregnant women, delivered until child age 2 years. PARTICIPANTS 722 pregnant Australian women experiencing adversity received NHV (n=363) or usual care (clinic visits) (n=359). PRIMARY AND SECONDARY OUTCOME MEASURES First, a cost-consequences analysis to compare the additional costs of NHV over usual care, accounting for any reduced costs of service use, and impacts on all maternal and child outcomes assessed at 3 years. Second, cost-utility analysis from a government-as-payer perspective compared additional costs to maternal QALYs to express cost-effectiveness in terms of additional cost per additional QALY gained. RESULTS When compared with usual care at child age 3 years, the right@home intervention cost $A7685 extra per woman (95% CI $A7006 to $A8364) and generated 0.01 more QALYs (95% CI -0.01 to 0.02). The probability of right@home being cost-effective by child age 3 years is less than 20%, at a willingness-to-pay threshold of $A50 000 per QALY. CONCLUSIONS Benefits of NHV to parenting at 2 years and maternal health and well-being at 3 years translate into marginal maternal QALY gains. Like previous cost-effectiveness results for NHV programmes, right@home is not cost-effective at 3 years. Given the relatively high up-front costs of NHV, long-term follow-up is needed to assess the accrual of health and economic benefits over time. TRIAL REGISTRATION NUMBER ISRCTN89962120.
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Affiliation(s)
| | - Anna M H Price
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Fiona K Mensah
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Hannah E Bryson
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Susan Perlen
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Francesca Orsini
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia
- Melbourne Children's Trials Centre, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Harriet Hiscock
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Penelope Dakin
- Australian Research Alliance for Children and Youth, Canberra City, ACT, 2601, Australia
| | - Diana Harris
- Australian Research Alliance for Children and Youth, Canberra City, ACT, 2601, Australia
| | - Kristy Noble
- Australian Research Alliance for Children and Youth, Canberra City, ACT, 2601, Australia
| | - Tracey Bruce
- Ingham Institute, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Lynn Kemp
- Ingham Institute, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Sharon Goldfeld
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Lisa Gold
- School of Health and Social Development, Deakin University, Burwood, VIC, 3125, Australia
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Bryson H, Mensah F, Price A, Gold L, Mudiyanselage SB, Kenny B, Dakin P, Bruce T, Noble K, Kemp L, Goldfeld S. Clinical, financial and social impacts of COVID-19 and their associations with mental health for mothers and children experiencing adversity in Australia. PLoS One 2021; 16:e0257357. [PMID: 34516564 PMCID: PMC8437268 DOI: 10.1371/journal.pone.0257357] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/30/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Australia has maintained low rates of SARS-COV-2 (COVID-19) infection, due to geographic location and strict public health restrictions. However, the financial and social impacts of these restrictions can negatively affect parents' and children's mental health. In an existing cohort of mothers recruited for their experience of adversity, this study examined: 1) families' experiences of the COVID-19 pandemic and public health restrictions in terms of clinical exposure, financial hardship family stress, and family resilience (termed 'COVID-19 impacts'); and 2) associations between COVID-19 impacts and maternal and child mental health. METHODS Participants were mothers recruited during pregnancy (2013-14) across two Australian states (Victoria and Tasmania) for the 'right@home' trial. A COVID-19 survey was conducted from May-December 2020, when children were 5.9-7.2 years old. Mothers reported COVID-19 impacts, their own mental health (Depression, Anxiety, Stress Scales short-form) and their child's mental health (CoRonavIruS Health and Impact Survey subscale). Associations between COVID-19 impacts and mental health were examined using regression models controlling for pre-COVID-19 characteristics. RESULTS 319/406 (79%) mothers completed the COVID-19 survey. Only one reported having had COVID-19. Rates of self-quarantine (20%), job or income loss (27%) and family stress (e.g., difficulty managing children's at-home learning (40%)) were high. Many mothers also reported family resilience (e.g., family found good ways of coping (49%)). COVID-19 impacts associated with poorer mental health (standardised coefficients) included self-quarantine (mother: β = 0.46, child: β = 0.46), financial hardship (mother: β = 0.27, child: β = 0.37) and family stress (mother: β = 0.49, child: β = 0.74). Family resilience was associated with better mental health (mother: β = -0.40, child: β = -0.46). CONCLUSIONS The financial and social impacts of Australia's public health restrictions have substantially affected families experiencing adversity, and their mental health. These impacts are likely to exacerbate inequities arising from adversity. To recover from COVID-19, policy investment should include income support and universal access to family health services.
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Affiliation(s)
- Hannah Bryson
- Centre for Community Child Health, The Royal Children’s Hospital, Parkville, VIC, Australia
- Population Health, Murdoch Children’s Research Institute, Parkville, VIC, Australia
| | - Fiona Mensah
- Population Health, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Anna Price
- Centre for Community Child Health, The Royal Children’s Hospital, Parkville, VIC, Australia
- Population Health, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Lisa Gold
- School of Health and Social Development, Deakin University, Burwood, VIC, Australia
| | | | - Bridget Kenny
- Centre for Community Child Health, The Royal Children’s Hospital, Parkville, VIC, Australia
- Population Health, Murdoch Children’s Research Institute, Parkville, VIC, Australia
| | - Penelope Dakin
- Australian Research Alliance for Children and Youth, Canberra City, ACT, Australia
| | - Tracey Bruce
- Ingham Institute, Western Sydney University, NSW, Australia
| | - Kristy Noble
- Australian Research Alliance for Children and Youth, Canberra City, ACT, Australia
| | - Lynn Kemp
- Ingham Institute, Western Sydney University, NSW, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, The Royal Children’s Hospital, Parkville, VIC, Australia
- Population Health, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
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Hart LM, Bond KS, Morgan AJ, Rossetto A, Cottrill FA, Kelly CM, Jorm AF. Teen Mental Health First Aid for years 7-9: a description of the program and an initial evaluation. Int J Ment Health Syst 2019; 13:71. [PMID: 31788023 PMCID: PMC6858708 DOI: 10.1186/s13033-019-0325-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A teen Mental Health First Aid training course for high school students in years 10-12 (tMHFA 10-12) has previously been evaluated in uncontrolled and randomized controlled trials and found to improve Mental Health First Aid intentions, mental health literacy and to reduce stigma. This 3 × 75-min course has more recently been adapted for younger students in years 7-9 (tMHFA 7-9). The present study reports an initial uncontrolled trial of this new training course which aimed to assess feasibility and acceptability of the course and test effects on knowledge, attitudes and behaviour. METHODS An uncontrolled trial was carried out in five schools with measures taken at pre-test, post-test and 3-month follow-up. The outcomes measured were: quality of first aid intentions to help peers, confidence in helping, stigmatising attitudes, recognition of anxiety disorder, number of adults thought to be helpful, help-seeking intentions, quality of support provided to a peer, quality of support received, and psychological distress. Questions were also asked about satisfaction with the course. RESULTS There were 475 students (mean age 13.86 years) who provided data at baseline, with 76% of these providing data at post-test and 75% at follow-up. Sustained changes at follow-up were found for: number of adults thought to be helpful, some components of stigma, recognition of anxiety disorder, and quality of support provided to a peer. However, there was an unexpected decline in willingness to tell others about a mental health problem. Most students found the information presented to be new, easy to understand, and useful. CONCLUSIONS The tMHFA 7-9 training course produced some positive changes that were sustained over 3 months. However, the changes were not as strong as previously found for older high school students, suggesting the need for further refinement of the course.
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Affiliation(s)
- Laura M. Hart
- Population Mental Health Group, Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Kathy S. Bond
- Population Mental Health Group, Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- Mental Health First Aid Australia, Parkville, Australia
| | - Amy J. Morgan
- Population Mental Health Group, Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Alyssia Rossetto
- Population Mental Health Group, Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- Mental Health First Aid England, London, UK
| | | | - Claire M. Kelly
- Mental Health First Aid Australia, Parkville, Australia
- School of Psychology, Deakin University, Geelong, Australia
| | - Anthony F. Jorm
- Population Mental Health Group, Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- Mental Health First Aid Australia, Parkville, Australia
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Diaz A, Baade PD, Valery PC, Whop LJ, Moore SP, Cunningham J, Garvey G, Brotherton JML, O’Connell DL, Canfell K, Sarfati D, Roder D, Buckley E, Condon JR. Comorbidity and cervical cancer survival of Indigenous and non-Indigenous Australian women: A semi-national registry-based cohort study (2003-2012). PLoS One 2018; 13:e0196764. [PMID: 29738533 PMCID: PMC5940188 DOI: 10.1371/journal.pone.0196764] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/19/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Little is known about the impact of comorbidity on cervical cancer survival in Australian women, including whether Indigenous women's higher prevalence of comorbidity contributes to their lower survival compared to non-Indigenous women. METHODS Data for cervical cancers diagnosed in 2003-2012 were extracted from six Australian state-based cancer registries and linked to hospital inpatient records to identify comorbidity diagnoses. Five-year cause-specific and all-cause survival probabilities were estimated using the Kaplan-Meier method. Flexible parametric models were used to estimate excess cause-specific mortality by Charlson comorbidity index score (0,1,2+), for Indigenous women compared to non-Indigenous women. RESULTS Of 4,467 women, Indigenous women (4.4%) compared to non-Indigenous women had more comorbidity at diagnosis (score ≥1: 24.2% vs. 10.0%) and lower five-year cause-specific survival (60.2% vs. 76.6%). Comorbidity was associated with increased cervical cancer mortality for non-Indigenous women, but there was no evidence of such a relationship for Indigenous women. There was an 18% reduction in the Indigenous: non-Indigenous hazard ratio (excess mortality) when comorbidity was included in the model, yet this reduction was not statistically significant. The excess mortality for Indigenous women was only evident among those without comorbidity (Indigenous: non-Indigenous HR 2.5, 95%CI 1.9-3.4), indicating that factors other than those measured in this study are contributing to the differential. In a subgroup of New South Wales women, comorbidity was associated with advanced-stage cancer, which in turn was associated with elevated cervical cancer mortality. CONCLUSIONS Survival was lowest for women with comorbidity. However, there wasn't a clear comorbidity-survival gradient for Indigenous women. Further investigation of potential drivers of the cervical cancer survival differentials is warranted. IMPACT The results highlight the need for cancer care guidelines and multidisciplinary care that can meet the needs of complex patients. Also, primary and acute care services may need to pay more attention to Indigenous Australian women who may not obviously need it (i.e. those without comorbidity).
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Affiliation(s)
- Abbey Diaz
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Peter D. Baade
- Cancer Council Queensland, Spring Hill, Queensland, Australia
| | - Patricia C. Valery
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- QIMR Berghofer Medical Research Institute, Queensland, Australia
| | - Lisa J. Whop
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Suzanne P. Moore
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Julia M. L. Brotherton
- Victorian Cytology Service, Carlton, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dianne L. O’Connell
- Cancer Council NSW, Cancer Research Division, Kings Cross, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Karen Canfell
- Cancer Council NSW, Cancer Research Division, Kings Cross, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of NSW, Sydney, New South Wales, Australia
| | | | - David Roder
- Cancer Epidemiology & Population Health, University of South Australia, Adelaide, South Australia, Australia
| | - Elizabeth Buckley
- Cancer Epidemiology & Population Health, University of South Australia, Adelaide, South Australia, Australia
| | - John R. Condon
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
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