Use of health services by preschool-aged children who are developmentally vulnerable and socioeconomically disadvantaged: testing the inverse care law

Woolfenden, Sue; Galea, Claire; Badland, Hannah; Smithers‐Sheedy, Hayley; Williams, Katrina; Kavanagh, Anne; Reddihough, Dinah; Goldfeld, Sharon; Lingam, Raghu; Badawi, Nadia; O’Connor, Meredith

doi:10.1136/jech-2019-213384

Cited by 12 publications

(11 citation statements)

References 27 publications

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“…All staff are trained to deliver culturally safe care, which includes routine use of Aboriginal Liaison and Koorliny Moort 52 services, and interpreters for culturally and linguistically diverse families. We did find children living in lower SEIFA quintiles were at risk of higher DNA rates and had higher odds of being exposed to ACEs, reinforcing existing evidence that children living in social disadvantage use less health services 32 33 and are at higher risk of ACEs. 27 34 Assessment of the social determinants of health that impact each family’s capacity to engage and care coordination roles are already embedded in the EI service to improve access and adherence to health care.…”

Section: Discussionsupporting

confidence: 84%

From guidelines to practice: A retrospective clinical cohort study investigating implementation of the early detection guidelines for cerebral palsy in a state-wide early intervention service

et al. 2022

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ObjectivesTo report on knowledge translation strategies and outcomes from the implementation of the early detection guidelines for cerebral palsy (CP) in a state-wide tertiary early intervention (EI) service and investigate the impact of social determinants on clinical services.DesignRetrospective longitudinal cohort study.SettingThe Western Australia tertiary paediatric EI service.ParticipantsEI clinicians, consumers and children using the EI service.Outcome measuresKnowledge translation strategies including consumer perspectives, clinician training and Communities of Practice (CoP) guided implementation. We measured changes in referral number and age, delivery of early detection and intervention following the implementation of the guidelines. Exposure to adverse childhood experiences (ACEs), appointment non-attendance (DNA) rates, remoteness and socioeconomic quintiles were used to measure social determinants of health using negative binomial (Incidence Rate Ratios, IRR) and logistic regression (Odds Ratios, ORs).ResultsTen consumers participated in Focus Groups, 100 clinicians were trained and 22 clinicians established a monthly CoP. Referrals increased fourfold to 511 children. Corrected gestational age at referral decreased from a median of 16.1 to 5.1 months (p<0.001) and at first appointment from 18.8 to 6.8 months (p<0.001). Children living in social disadvantage had the highest DNA risk (quintile 1 vs 5: IRR 2.2, 95% CI 1.1 to 4.6, p=0.037). Children exposed to ACEs had higher odds of living in social disadvantage (quintile 1 vs 5, OR=3.8, 95% CI 1.4 to 10.0, p=0.007). No significant association was found between remoteness and DNA rate or ACE score.ConclusionsImplementation strategies reduced referral age and improved the delivery of early detection assessments. Further investigation of the association between social disadvantage, DNA risk and ACE score is required in the development of a state-wide early detection network.

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Section: Discussionsupporting

confidence: 84%

From guidelines to practice: A retrospective clinical cohort study investigating implementation of the early detection guidelines for cerebral palsy in a state-wide early intervention service

et al. 2022

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“…23 However, there is increasing evidence that families experiencing psychosocial stressors have less capacity and resources to provide psychosocial stimulation and there are structural barriers to their access to services for their child with a neurodevelopmental disorder. 24…”

Section: Psychosocial Risk Factorsmentioning

confidence: 99%

Delivering paediatric precision medicine: Genomic and environmental considerations along the causal pathway of childhood neurodevelopmental disorders

Woolfenden

Farrar

Eapen

et al. 2022

Develop Med Child Neuro

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Precision medicine refers to treatments that are targeted to an individual's unique characteristics. Precision medicine for neurodevelopmental disorders (such as cerebral palsy, attention‐deficit/hyperactivity disorder, obsessive–compulsive disorder, Tourette syndrome, and autism spectrum disorder) in children has predominantly focused on advances in genomic sequencing technologies to increase our ability to identify single gene mutations, diagnose a multitude of rare neurodevelopmental disorders, and gain insights into pathogenesis. Although targeting specific gene variants with high penetrance will help some children with rare disease, this approach will not help most children with neurodevelopmental disorders. A ‘pathway’ driven approach targeting the cumulative influence of psychosocial, epigenetic, or cellular factors is likely to be more effective. To optimize the therapeutic potential of precision medicine, we present a biopsychosocial integrated framework to examine the ‘gene–environment neuroscience interaction’. Such an approach would be supported through harnessing the power of big data, transdiagnostic assessment, impact and implementation evaluation, and a bench‐to‐bedside scientific discovery agenda with ongoing clinician and patient engagement. What this paper adds Precision medicine has predominantly focused on genetic risk factors. The impact of environmental risk factors, particularly inflammatory, metabolic, and psychosocial risks, is understudied. A holistic biopsychosocial model of neurodevelopmental disorder causal pathways is presented. The model will provide precision medicine across the full spectrum of neurodevelopmental disorders.

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“…Families with greater disadvantage are at greater risk of developmental vulnerability and poorer maternal mental health and other health problems. These families are less likely to engage with health services, particularly health promotion programmes like CFH checks 2–4 15 32–36…”

Section: Background and Rationalementioning

confidence: 99%

Study protocol for a real-world evaluation of an integrated child and family health hub for migrant and refugee women

Hodgins

Ostojic

et al. 2022

BMJ Open

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IntroductionContinuity of child and family healthcare is vital for optimal child health and development for developmentally vulnerable children. Migrant and refugee communities are often at-risk of poor health outcomes, facing barriers to health service attendance including cultural, language, limited health literacy, discrimination and unmet psychosocial needs. ‘Integrated health-social care hubs’ are physical hubs where health and social services are co-located, with shared referral pathways and care navigation.AimOur study will evaluate the impact, implementation and cost-benefit of the First 2000 Days Care Connect (FDCC) integrated hub model for pregnant migrant and refugee women and their infants.Materials and methodsThis study has three components. Component 1 is a non-randomised controlled trial to compare the FDCC model of care with usual care. This trial will allocate eligible women to intervention and control groups based on their proximity to the Hub sites. Outcome measures include: the proportion of children attending child and family health (CFH) nurse services and completing their CFH checks to 12 months of age; improved surveillance of growth and development in children up to 12 months, post partum; improved breastfeeding rates; reduced emergency department presentations; and improved maternal well-being. These will be measured using linked medical record data and surveys. Component 2 will involve a mixed-method implementation evaluation to clarify how and why FDCC was implemented within the sites to inform future roll-out. Component 3 is a within-trial economic evaluation from a healthcare perspective to assess the cost-effectiveness of the Hubs relative to usual care and the implementation costs if Hubs were scaled and replicated.Ethics and disseminationEthical approval was granted by the South Eastern Sydney Local Health District Human Research Ethics Committee in July 2021 (Project ID: 020/ETH03295). Results will be submitted for publication in peer-reviewed journals and presented at relevant conferences.Trial registration numberACTRN12621001088831.

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Use of health services by preschool-aged children who are developmentally vulnerable and socioeconomically disadvantaged: testing the inverse care law

Cited by 12 publications

References 27 publications

From guidelines to practice: A retrospective clinical cohort study investigating implementation of the early detection guidelines for cerebral palsy in a state-wide early intervention service

From guidelines to practice: A retrospective clinical cohort study investigating implementation of the early detection guidelines for cerebral palsy in a state-wide early intervention service

Delivering paediatric precision medicine: Genomic and environmental considerations along the causal pathway of childhood neurodevelopmental disorders

Study protocol for a real-world evaluation of an integrated child and family health hub for migrant and refugee women

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