Evaluation of the Implementation of the MCH KAS Service Activity FrameworkYear 2 (2011) Progress Report

Claire Jennings

Centre for Community Child Health

October 2011

Overview of slide presentation

n Background and methodologyn Sample characteristicsn Nurse perceptions n Family perceptionsn CALD family perceptionsn What is happening in 2012?

Background to evaluation

n Centre for Community Child Health (CCCH) commissioned by DEECD to evaluate the implementation of the Revised MCH KAS Framework

n The evaluation commenced in Jan 2010 & will conclude in Nov 2012

n Data collected in 2010 will serve as a baseline for comparison to data collected in 2011 & scheduled for collection in 2012.

n 4 stakeholder groups: MCH nurses, families, MCH senior management & local service providers

n Nurses working within the 79 local government areas (LGAs) in Victoria were invited to complete an anonymous online survey

n 15 LGAs were selected for further data collection activities. These LGAs were chosen to represent the diversity of the population.

Methodology

Sample characteristics

n Nurses Nurse survey

562 respondents 375 metropolitan nurses 161 rural nurses

Nurse focus groups 66 participants across 15 municipalities 29 rural nurses, 37 metropolitan nurses

Sample characteristics continued

n Families Family survey

731 surveys returned 46% of respondents were first time parents 21% of respondents were born overseas 7% spoke another language at home

Family focus groups 92 families participated across 9 LGAs Involved 4 rural sites and 5 metro sites 8 Indigenous parents, 54 CALD parents

What helped implementation?

n 74% of nurses provided a responsen Discussion with colleagues & coordinator (formal

& informal) (n=131) “Peer support and discussion sessions during

our team M&CHN meetings have alleviated any confusion, once the revised KAS were put into practice.”

What helped implementation? cont.

n Initial training (n=110) “Thorough training before implementation.”

n KAS resources (including packs) (n=106) “Great resources and consistency of

information across all centres. The Practice Guidelines are my bible at visits.”

Nurse perspectives: Barriers

n 77% of nurses provided a response (n=433)

n Time allocation to visits is too low (n=134).

“I doubt any other health professional would undertake such a wide area of practice in the time we are allocated.”

Barriers to implementation continued

n KAS components most frequently identified: Brigance (n=110); Family Violence (n=95); and PEDS (n=86)

n Challenges using the Framework with CALD families (n=31) “It is difficult when working with the ethnic

groups where there is a language barrier (even with interpreters).”

Implementation of KAS (survey data)

KAS activities 2010 2011

Developmental assessment – PEDS 91% 93%

SUDI & safe sleeping principles 88% 92%

QUIT intervention & referral 83% 84%

Promoting reading 81% 90%

Family violence 80% 83%

Oral health 77% 89%

Developmental assessment – Brigance 77% 86%

Post natal depression screening 74% 91%

Sleep intervention 74% 83%

Family Violence – safety plan 68% 72%

Family feedbackPercentage of families reporting they were satisfied with their nurse during their most recent MCH visit in 2010 and 2011

Family satisfaction with KAS topics

Topic of discussion Yes, enough info

Wanted more

No, not necessary

Immunisation (0-8w) n=245 85% 4% 11%

Sleeping on back (0-8w) n=245 76% 3% 21%

Immunisation (4-8m) n=182 77% 3% 20%

SIDS risk factors (4-8m) n=182 47% 3% 50%

Immunisation (12-18m) n=153 88% 2% 10%

Breastfeeding (12-18m) n=155 41% 2% 57%

Playing & talking (2-3.5y) n=144 78% 3% 19%

Safe from injury (2-3.5y) n=144 53% 4% 43%

Family satisfaction with KAS topics

Topic of discussion Yes, enough info

Wanted more

No, not necessary

Local resources (0-8w) n=243 61% 15% 24%

Child development (0-8w) n=245 78% 13% 9%

Sun safety (4-8m) n=181 36% 16% 48%

Local resources (4-8m) n=181 42% 15% 43%

Local resources (12-18m) n=155 37% 13% 50%

Local resources (2-3.5y) n=142 38% 11% 51%

Family wellbeing questions

n Proportion of families who agreed they spoke about the following topics with their nurse (n=731) Health problems (family): 84% agreed Depression or sadness: 72% agreed Smoking: 66% agreed Changes in the home: 62% agreed Family violence: 51% agreed

Family wellbeing questions continued

n Focus group participants generally did not mind being asked these questions

n Families acknowledged nurses may have asked these questions, but they did not remember

n “They speak to you like you’re a real person and ask you how you are feeling so you feel like you are being looked after too.”

Resources for families

Proportion of families who report… % agree

Receiving pack at visit 95%

Discussing pack contents with nurse 71%

Reading pack at home 87%

Keeping pack 79%

“I think it’s good (that the nurse discusses the pack contents). It may not be relevant at the time, but if you need that information in the future, you know it’s in the pack.”

Resources for families continued

n Both families and nurses tended to advocate for the continuation of printed KAS resources

n Some support for the provision of mixed formats, to enable families to choose their preferred format during visits

n 58% of nurses agreed that online provision of information was a suitable alternative format

n Online provision only is not accessible for some families

PEDS – Family feedback

n 90% of families (4 month visit and over) agreed that they filled out a PEDS response form

n 90% of the families who completed PEDS agreed that they discussed their responses with their nurse

n 96% of families who discussed their responses with their nurse agreed that this discussion met their needs.

CALD families: Key findings

n Majority of families are satisfied with their nurse and the topics discussed during visits

n Families appreciate nurse efforts to communicate during visits; suggested that interpreters at the home visit would be useful

n Stronger focus on speech and language concerns

CALD families continued

n Families were happy with printed materials; many did not like the idea of website based information

n More likely to comment about KAS visit lengthn Most families kept the packs, although not all

would refer to the packsn Mixed reaction as to whether pack material

should be translated

CALD families continued

n CALD families were positive about PEDS when a discussion of their responses occurred

n CALD families were usually appreciative of referrals, although fewer followed up compared with other families

n CALD families were more likely to be interested in information about local services, particularly those families who had recently arrived in Australia

What happens next?

n Full Year 2 report and summary report to be finalised and released

n Surveys & focus group interviews in 2012n Aiming for mid-year (May/June) data collectionn Questions/comments:

P: 8341-5657 E: claire.jennings@mcri.edu.au

Acknowledgementsn The evaluation team would like to thank the following

people for their assistance in 2010/11: Survey and focus group participants

Nurses Families Local Service Providers MCH Senior Management

Staff within 15 LGAs who helped with the organisation of data collection activities

Central DEECD staff & Program and Service Advisors Reference and Governance Groups