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

Abstract

BackgroundUnaddressed 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.ObjectiveTo 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.MethodsSurvey 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.Results349 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.ConclusionThe 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.

Moving from idea to reality: The barriers and enablers to implementing Child and Family Hubs policy into practice in NSW, Australia

“…Exposure to ACEs has been shown to significantly impact physical and mental health throughout the lifespan, with multiple ACEs cumulatively impacting health risk [ 4 , 5 ]. Childhood adversities are common, with 52.8% of Australian children aged 10–11 years [ 6 ] and 75% of caregivers of children aged 0–8 years in New South Wales (NSW) reporting the experience of two or more adversities [ 7 ]. There is increasing evidence that positive childhood experiences, including stable and nurturing relationships and environments, and early interventions to identify and address childhood adversity can have a significant impact on health, wellbeing and productivity in adulthood despite exposure to ACEs [ 8 , 9 ].…”