An exploration of the extent to which an Australian metropolitan service model for specialist (Level 2) Child and Family Health services can be implemented in diverse settings

Stockton, Deborah A.

An exploration of the extent to which an Australian metropolitan service model for specialist (Level 2) Child and Family Health services can be implemented in diverse settings

Stockton, Deborah A.

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Publication Type:: Thesis
Issue Date:: 2022

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Field	Value	Language
dc.contributor.author	Stockton, Deborah A.
dc.date.accessioned	2023-03-13T00:02:48Z
dc.date.available	2023-03-13T00:02:48Z
dc.date.issued	2022
dc.identifier.uri	http://hdl.handle.net/10453/167110
dc.description	University of Technology Sydney. Faculty of Health.	en_US.UTF-8
dc.description.abstract	Community-based Child and Family Health (CFH) services work collaboratively with parents to support optimal child development and positive parent-child relationships so children can thrive. They play an integral role in the identification and response for children and families with increasingly complex developmental and psychosocial health needs. Inequity, however, in health and social outcomes is pervasive, with poorer outcomes identified in rural communities. An international call to action to address the health outcomes gap for those living in disadvantaged regions has been emphasised by the World Health Organization (WHO), highlighting the need to adapt interventions and develop contextualised service models for lower resourced settings. This thesis describes doctoral research comprising of three discrete studies. The aim of the research was to explore the extent to which an Australian metropolitan service model for specialist (Level 2) CFH services can be implemented in rural and regional areas. A scoping study and an integrative review informed the three studies which were as follows: (i) Participatory Action Research (PAR) in a rural setting in New South Wales (NSW) Australia to review the fit of an established metropolitan CFH service model for local context; (ii) a Modified eDelphi Study to identify elements to be considered when adapting CFH service models for rural community contexts; and (iii) a second PAR study in a different rural community setting to test a draft framework to guide the adaptation of CFH service models. PAR and Delphi approaches were used to engage consumers and a range of key stakeholders to foster inclusivity and address the power differential that can occur between researchers and participants. The results of the three studies informed the development of the framework for Collaborative Adaptation of Service Models for Child And Family Health in Diverse Settings (CASCADES Framework). The CASCADES Framework, which includes a toolkit of resources, uses the analogy of a waterfall, with the water cascading from one tier to another, to represent and support the iterative collaborative community co-design process. This research identified that established specialist CFH service models can be implemented in diverse contexts, however scope for adaptation must be built into such service models. Flexibility and time are required to effectively engage, consult with and co-produce innovative and culturally safe service adaptations, drawing on community strengths while addressing local need. Research findings identified the benefits of community participatory co-design extend beyond the immediate service implementation to service sustainability, integration and community capacity building.	en_US.UTF-8
dc.format	Thesis (PhD)
dc.language.iso	en_US	en_US.UTF-8
dc.relation	https://opus.lib.uts.edu.au/bitstream/10453/167110/2/02whole.pdf
dc.rights	info:eu-repo/semantics/openAccess
dc.rights	The author owns the copyright in this thesis including all reproduction and reuse rights for the work. The work may not be altered without the permission of the copyright owner. Attribution is essential when quoting or paraphrasing from this thesis.
dc.rights	© 2022 Deborah A. Stockton
dc.rights	au.edu.uts.lib/ppc
dc.title	An exploration of the extent to which an Australian metropolitan service model for specialist (Level 2) Child and Family Health services can be implemented in diverse settings	en_US.UTF-8
dc.type	Thesis
utslib.copyright.status	open_access	*

Abstract:

Community-based Child and Family Health (CFH) services work collaboratively with parents to support optimal child development and positive parent-child relationships so children can thrive. They play an integral role in the identification and response for children and families with increasingly complex developmental and psychosocial health needs. Inequity, however, in health and social outcomes is pervasive, with poorer outcomes identified in rural communities. An international call to action to address the health outcomes gap for those living in disadvantaged regions has been emphasised by the World Health Organization (WHO), highlighting the need to adapt interventions and develop contextualised service models for lower resourced settings. This thesis describes doctoral research comprising of three discrete studies. The aim of the research was to explore the extent to which an Australian metropolitan service model for specialist (Level 2) CFH services can be implemented in rural and regional areas. A scoping study and an integrative review informed the three studies which were as follows: (i) Participatory Action Research (PAR) in a rural setting in New South Wales (NSW) Australia to review the fit of an established metropolitan CFH service model for local context; (ii) a Modified eDelphi Study to identify elements to be considered when adapting CFH service models for rural community contexts; and (iii) a second PAR study in a different rural community setting to test a draft framework to guide the adaptation of CFH service models. PAR and Delphi approaches were used to engage consumers and a range of key stakeholders to foster inclusivity and address the power differential that can occur between researchers and participants. The results of the three studies informed the development of the framework for Collaborative Adaptation of Service Models for Child And Family Health in Diverse Settings (CASCADES Framework). The CASCADES Framework, which includes a toolkit of resources, uses the analogy of a waterfall, with the water cascading from one tier to another, to represent and support the iterative collaborative community co-design process. This research identified that established specialist CFH service models can be implemented in diverse contexts, however scope for adaptation must be built into such service models. Flexibility and time are required to effectively engage, consult with and co-produce innovative and culturally safe service adaptations, drawing on community strengths while addressing local need. Research findings identified the benefits of community participatory co-design extend beyond the immediate service implementation to service sustainability, integration and community capacity building.

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