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

Teresa Hall; Leanne Constable; Sarah Loveday; Suzy Honisett; Natalie Schreurs; Sharon Goldfeld; Hayley Loftus; Renee Jones; Andrea Reupert; Marie B H Yap; Sue Woolfenden; Alicia Montgomery; Kim Dalziel; Cate Bailey; Glenn Pringle; Jane Fisher; Suzie Forell; Valsamma Eapen; Ric Haslam; Lena Sanci; John Eastwood; Harriet Hiscock

doi:10.3389/fpubh.2023.1147721

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

Front Public Health. 2023 Sep 13:11:1147721. doi: 10.3389/fpubh.2023.1147721. eCollection 2023.

Authors

Teresa Hall¹, Leanne Constable¹, Sarah Loveday¹, Suzy Honisett¹, Natalie Schreurs¹, Sharon Goldfeld^{1

2}, Hayley Loftus¹, Renee Jones^{1

3}, Andrea Reupert⁴, Marie B H Yap^{3

5}, Sue Woolfenden^{6

7

8}, Alicia Montgomery⁹, Kim Dalziel¹⁰, Cate Bailey¹⁰, Glenn Pringle¹¹, Jane Fisher¹², Suzie Forell^{13

14}, Valsamma Eapen¹⁵, Ric Haslam², Lena Sanci¹⁶, John Eastwood⁹, Harriet Hiscock^{2

17

18}

Affiliations

¹ Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, VIC, Australia.
² Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.
³ Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.
⁴ School of Educational Psychology and Counselling, Faculty of Education, Monash University, Clayton, VIC, Australia.
⁵ Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia.
⁶ Sydney Institute Women, Children and their Families, Sydney Local Health District, Croydon, NSW, Australia.
⁷ Discipline of Paediatrics, University of New South Wales, Sydney, NSW, Australia.
⁸ Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
⁹ Sydney Institute Women, Children and Their Families, Sydney Local Health District, Camperdown, NSW, Australia.
¹⁰ Health Economics Unit, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.
¹¹ Innovation and Community Care, IPC Health, Wyndham Vale, VIC, Australia.
¹² Global and Women's Health, Monash University, Clayton, VIC, Australia.
¹³ Health Justice Australia, Darlinghurst, Sydney, NSW, Australia.
¹⁴ School of Law, University of New South Wales, Sydney, NSW, Australia.
¹⁵ Infant Child and Adolescent Psychiatry, University of New South Wales, Sydney, NSW, Australia.
¹⁶ Department of General Practice, The University of Melbourne, Parkville, VIC, Australia.
¹⁷ Health Services and Economics, Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, VIC, Australia.
¹⁸ Health Services Research Unit, The Royal Children's Hospital, Parkville, VIC, Australia.

Abstract

Background: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: child mental health; childhood adversity; community health service; integrated care; integrated health service; integrated hub; primary care.

Copyright © 2023 Hall, Constable, Loveday, Honisett, Schreurs, Goldfeld, Loftus, Jones, Reupert, Yap, Woolfenden, Montgomery, Dalziel, Bailey, Pringle, Fisher, Forell, Eapen, Haslam, Sanci, Eastwood and Hiscock.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia / epidemiology
Caregivers* / psychology
Child
Community Health Services*
Cross-Sectional Studies
Humans
Surveys and Questionnaires

Grants and funding

This research was supported by the Australian National Health and Medical Research Council and Beyond Blue grant number 1153419. Murdoch Children's Research Institute was supported by the Victorian Government's Operational Infrastructure Support Program. HH was supported by an NHMRC Practitioner Fellowship 1136222. SG was supported by an NHMRC Practitioner Fellowship 1155290. JF holds the Finkel Chair in Global Health which was supported by the Finkel Family Foundation. Clinical SW was supported by an NHMRC Career Development Fellowship 1158954.