Evaluation of the Implementation of the MCH KAS Service Activity Framework Year 2 (2011) Progress Report Claire Jennings Centre for Community Child Health October 2011

Overview of slide presentation n Background and methodology n Sample characteristics n Nurse perceptions n Family perceptions n CALD family perceptions n 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 response n 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 Developmental assessment – PEDS91%93% SUDI & safe sleeping principles88%92% QUIT intervention & referral83%84% Promoting reading81%90% Family violence80%83% Oral health77%89% Developmental assessment – Brigance77%86% Post natal depression screening74%91% Sleep intervention74%83% Family Violence – safety plan68%72%

Family feedback Percentage 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 discussionYes, enough info Wanted more No, not necessary Immunisation (0-8w) n=24585%4%11% Sleeping on back (0-8w) n=24576%3%21% Immunisation (4-8m) n=18277%3%20% SIDS risk factors (4-8m) n=18247%3%50% Immunisation (12-18m) n=15388%2%10% Breastfeeding (12-18m) n=15541%2%57% Playing & talking (2-3.5y) n=144 78%3%19% Safe from injury (2-3.5y) n=14453%4%43%

Family satisfaction with KAS topics Topic of discussionYes, enough info Wanted more No, not necessary Local resources (0-8w) n=24361%15%24% Child development (0-8w) n=24578%13%9% Sun safety (4-8m) n=18136%16%48% Local resources (4-8m) n=18142%15%43% Local resources (12-18m) n=15537%13%50% Local resources (2-3.5y) n=14238%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 visit95% Discussing pack contents with nurse71% Reading pack at home87% Keeping pack79% “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 length n Most families kept the packs, although not all would refer to the packs n 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 2012 n Aiming for mid-year (May/June) data collection n Questions/comments: P: E:

Acknowledgements n 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