Victoria's early parenting centres, including Tweddle, have urged the Protection Victoria's Vulnerable Children Inquiry Panel to recommend strengthening support to families in the critical early years and to invest in therapeutic early intervention and prevention programs for families of infants and children up to the age of 4.
For more information about the inquiry and its terms of reference see here - http://bit.ly/jEJ5dn
Learning Disabilities: Share and Learn Webinar for Transforming Care Partners...NHS England
This webinar is relevant to all Transforming Care Partnerships, with a focus on a whole system approach to shaping the market. The session was commissioned by Jane Alltimes of the LGA and led by Sarah Broadhurst from the Institute of Public Care on behalf of the Local Government Association. The session:
• Explores market shaping activities that take a whole system, lifespan approach to commissioning for people with a learning disability and/or autism, enabling them to live good lives in the community;
• Considers research undertaken by IPC on market shaping and the development of learning disability market position statements;
• Works through some of the key challenges to shaping the market and identify solutions and approaches to overcoming these;
• Looks at the quality of the market and provision as part of the development of market position statements;
• Sign-post to useful resources and tools on market shaping activity
Learning Disabilities: Share and Learn Webinar – 25 August 2016NHS England
Topic 1: Co production – a long term relationship and different Conversations
Guest Speakers: Samantha Clark, Chief Executive, Inclusion North
In health & social care we are constantly grappling with how we can work differently and think differently about people who come to our services (willingly and otherwise) needing support. With so many new ways of thinking & working around – co production, person centred approaches, asset based community development, strengths based approaches, community capacity - sometimes it's hard for people who work in services, as well as the people and families they support, to work out what it those mean to their practice. This webinar will focus on the practical values driven implementation of co production – the long term relationship, shifting power but building on all contributions.
Topic 2: Transforming Care and Building the Right Support – the CQC approach to registering services for adults with learning disabilities
Guest Speakers: Theresa Joyce and Sue Mitchell, Care Quality Commission
This webinar will be an opportunity for commissioners to consider the CQC policy on registering providers who apply to deliver services for adults with learning disabilities. The policy is called ‘Registering the Right Support’ and outlines the factors we will consider in both approving and refusing applications for either new services or changes in existing services. We will consider specific issues, such as applications to change the registration of a hospital ward or unit, to register large or congregate services or to increase the size of an existing location. These factors are all important when commissioners are developing their plans under the Transforming Care program, and the webinar will enable discussion and questions about the registration approach and process.
Research published in February 2014 shows a growing number of local authorities across England are failing in their legal duties to families to provide outreach and childcare brokerage services.
Learning Disabilities: Share and Learn Webinar for Transforming Care Partners...NHS England
This webinar is relevant to all Transforming Care Partnerships, with a focus on a whole system approach to shaping the market. The session was commissioned by Jane Alltimes of the LGA and led by Sarah Broadhurst from the Institute of Public Care on behalf of the Local Government Association. The session:
• Explores market shaping activities that take a whole system, lifespan approach to commissioning for people with a learning disability and/or autism, enabling them to live good lives in the community;
• Considers research undertaken by IPC on market shaping and the development of learning disability market position statements;
• Works through some of the key challenges to shaping the market and identify solutions and approaches to overcoming these;
• Looks at the quality of the market and provision as part of the development of market position statements;
• Sign-post to useful resources and tools on market shaping activity
Learning Disabilities: Share and Learn Webinar – 25 August 2016NHS England
Topic 1: Co production – a long term relationship and different Conversations
Guest Speakers: Samantha Clark, Chief Executive, Inclusion North
In health & social care we are constantly grappling with how we can work differently and think differently about people who come to our services (willingly and otherwise) needing support. With so many new ways of thinking & working around – co production, person centred approaches, asset based community development, strengths based approaches, community capacity - sometimes it's hard for people who work in services, as well as the people and families they support, to work out what it those mean to their practice. This webinar will focus on the practical values driven implementation of co production – the long term relationship, shifting power but building on all contributions.
Topic 2: Transforming Care and Building the Right Support – the CQC approach to registering services for adults with learning disabilities
Guest Speakers: Theresa Joyce and Sue Mitchell, Care Quality Commission
This webinar will be an opportunity for commissioners to consider the CQC policy on registering providers who apply to deliver services for adults with learning disabilities. The policy is called ‘Registering the Right Support’ and outlines the factors we will consider in both approving and refusing applications for either new services or changes in existing services. We will consider specific issues, such as applications to change the registration of a hospital ward or unit, to register large or congregate services or to increase the size of an existing location. These factors are all important when commissioners are developing their plans under the Transforming Care program, and the webinar will enable discussion and questions about the registration approach and process.
Research published in February 2014 shows a growing number of local authorities across England are failing in their legal duties to families to provide outreach and childcare brokerage services.
Partnerships Working in Health and Social CareLiz Louw
The College of Social Work on the implications of the NHS Care Act for 'integration, cooperation and partnerships".
Read more: http://www.bridgesupport.org/bridge-blog/Introduction-to-Partnership-Working-in-Health-and-Social-Care
John Wilderspin: Early implementers update: making the best use of combined r...The King's Fund
John Wilderspin, National Director, Health and Wellbeing Board Implementation, Department of Health, discusses health and wellbeing boards and the progress of early adopters.
Our recently launched ‘Prevention Agenda’ for 2011 has the support of many influential health professionals, Government officials and organisations including the RCM, RCOG, FIGO, Sands and Bliss. Our recent focus has been to treat the effect of losing a baby, now we are looking to tackle the issues surrounding preventing stillbirth. We realise this is a particularly challenging task, but we feel the time is right to take action and move this up the health agenda. We also met with Anne Milton MP, Under Secretary of State for Health to move our agenda forward.
Workshop D Work-care reconciliation in different welfare systems - Liberal De...Care Connect
Policies for carers in the Australian liberal welfare state
Prof Sue Yeandle, Director, CIRCLE (Centre for International Research on Care, Labour and Equalities), University of Leeds
Carers and Work-Care Reconciliation International Conference
University of Leeds, 13th August 2013
o The China Analyst is a quarterly knowledge tool by The Beijing Axis. This March 2011 edition peers into the future that likely lies ahead for China and the changing opportunity landscape for foreign firms. For more on The Beijing Axis, and to see more publications by The Beijing Axis, please go to www.thebeijingaxis.com
Tweddle Child and Family Health Service is a statewide early intervention and prevention health service. Our purpose is to provide parenting support to families during pregnancy and with children from birth to school age. Our highest priority is to provide assistance to families that are facing multiple challenges and are in urgent need of therapeutic support.
The ‘Empowering Somali Mums’ research project explores and documents the challenges faced by Somali Mothers and their 0-4 year old children so that Early Parenting professionals can provide culturally respectful and appropriate care for Somali families. Somali mothers from North Melbourne and Flemington were recruited for research groups attended by 28 mums, 27 phone interviews with Somali health and welfare professionals were conducted and we held a Somali Health workers forum with ten senior community workers. We wanted to understand the challenges which prevent Somali mums from accessing parenting assistance and how we can understand parenting from a Somali mum’s perspective.
Tweddle staff are undergoing cross-cultural training and building knowledge and resources that will help strengthen relationships between the Somali community, and other migrant communities. Tweddle provide Halal food, have private prayer space and families can bring up to three children to Tweddle. Thanks to the Victorian Women’s Trust (Con Irwin Sub Fund) for providing the grant that enabled this learning.
Partnerships Working in Health and Social CareLiz Louw
The College of Social Work on the implications of the NHS Care Act for 'integration, cooperation and partnerships".
Read more: http://www.bridgesupport.org/bridge-blog/Introduction-to-Partnership-Working-in-Health-and-Social-Care
John Wilderspin: Early implementers update: making the best use of combined r...The King's Fund
John Wilderspin, National Director, Health and Wellbeing Board Implementation, Department of Health, discusses health and wellbeing boards and the progress of early adopters.
Our recently launched ‘Prevention Agenda’ for 2011 has the support of many influential health professionals, Government officials and organisations including the RCM, RCOG, FIGO, Sands and Bliss. Our recent focus has been to treat the effect of losing a baby, now we are looking to tackle the issues surrounding preventing stillbirth. We realise this is a particularly challenging task, but we feel the time is right to take action and move this up the health agenda. We also met with Anne Milton MP, Under Secretary of State for Health to move our agenda forward.
Workshop D Work-care reconciliation in different welfare systems - Liberal De...Care Connect
Policies for carers in the Australian liberal welfare state
Prof Sue Yeandle, Director, CIRCLE (Centre for International Research on Care, Labour and Equalities), University of Leeds
Carers and Work-Care Reconciliation International Conference
University of Leeds, 13th August 2013
o The China Analyst is a quarterly knowledge tool by The Beijing Axis. This March 2011 edition peers into the future that likely lies ahead for China and the changing opportunity landscape for foreign firms. For more on The Beijing Axis, and to see more publications by The Beijing Axis, please go to www.thebeijingaxis.com
Tweddle Child and Family Health Service is a statewide early intervention and prevention health service. Our purpose is to provide parenting support to families during pregnancy and with children from birth to school age. Our highest priority is to provide assistance to families that are facing multiple challenges and are in urgent need of therapeutic support.
The ‘Empowering Somali Mums’ research project explores and documents the challenges faced by Somali Mothers and their 0-4 year old children so that Early Parenting professionals can provide culturally respectful and appropriate care for Somali families. Somali mothers from North Melbourne and Flemington were recruited for research groups attended by 28 mums, 27 phone interviews with Somali health and welfare professionals were conducted and we held a Somali Health workers forum with ten senior community workers. We wanted to understand the challenges which prevent Somali mums from accessing parenting assistance and how we can understand parenting from a Somali mum’s perspective.
Tweddle staff are undergoing cross-cultural training and building knowledge and resources that will help strengthen relationships between the Somali community, and other migrant communities. Tweddle provide Halal food, have private prayer space and families can bring up to three children to Tweddle. Thanks to the Victorian Women’s Trust (Con Irwin Sub Fund) for providing the grant that enabled this learning.
Day Stay Program - Research and Evaluation - Tweddle Child and Family Health ...Tweddle Australia
A recent Monash University Jean Hailes Research Unit study into the Tweddle Day Stay Program examined the health, social circumstances and presenting needs of 115 clients attending the Tweddle Day stay Program. The study looked at parents with infants under 12 months old and assessed the parent mental health and infant behaviour outcomes and factors associated with program success. Results revealed that Day Stay participants’ mental health and their infants’ behaviours were significantly improved after their admission.
Recent Victorian State Government policy and legislative changes are intended to promote earlier intervention for vulnerable families and children. Tweddle’s Day Stay programs, which operate across 5 western locations across Victoria, have a focus on infant health and development and the promotion of parent-infant emotional attachment. The study, conducted by Heather Rowe, Sonia Mccallum, Minh Thi H Le and Renzo Vittorino concluded that the Day Stay Program offered important benefits for the prevention of more serious family problems and consequent health care cost savings
This invited presentation for the Institute of Health Visiting Leadership Conference gives a DPH view on the future of Child Public Health and the need for a systems approach
A list of all 'Innovation, Excellence and Strategic Development Fund' successful projects from financial year 2014-15, followed by a summary of each project supplied by the organisations.
The Changing Nature of Managementin Child Care Centres in Qu.docxmamanda2
The Changing Nature of Management
in Child Care Centres in Queensland:
A Review of Directors’ Perspectives
Hannele Nupponen
The aim of this paper is to produce an understanding of directors’ work; perceptions of
their role as managers in the centre; their experiences; and the nature of management
within the context of the child care field in a complex social, legislative and economic
climate. In the current context of the delivery of child care services in a market-driven
climate, the language of business and organisational theory has entered the lexicon of the
early childhood field. The findings indicate that the director of a child care centre needs
to have knowledge, skills and experience in business management to enhance their
competencies for management of centres in today’s competitive environment.
Introduction
Centre-based child care services in Queensland, Australia are regulated under the
Child Care Act 2002 (Qld) and Child Care (Child Care Centres) Regulations 2003.
Child care centres in Australia are required to participate in the National Childcare
Accreditation Quality Improvement System to be eligible for Childcare Benefit, which
is a fee subsidy to offset fees paid by the parents. This accreditation system has been
operational since 1994, and is the first of its kind in the world, where funding is
linked to centre performance.
Practitioners and researchers alike in the early childhood field are probably aware
that management issues in child care services have received increasing attention in the
past two decades because of the demand for, and the expansion of, service provision
in formal child care settings, such as long-day care centres. The Australian
Government, Department of Family and Community Services (2002) Census of
Child Care Services showed that in Queensland alone 14,576 children younger than
12 years old attended community-based long-day care services (total number of
children younger than 12 years of age in community-based long-day care services in
Hannele Nupponen is at Queensland University of Technology. Correspondence to: Dr Hannele Nupponen, 258
Miller Road, Logan Village Qld 4207, Australia. Tel: 61 7 55 468843; Email: [email protected]
ISSN 1357-5279 print/1476-489X online/06/040347-17 # 2006 The Child Care in Practice Group
DOI: 10.1080/13575270600863259
Child Care in Practice
Vol. 12, No. 4, October 2006, pp. 347 �363
Australia was 107,317) and 65,108 children younger than 12 years of age attended
private long-day care services (total number of children younger than 12 years of age
in private long-day care services in Australia was 200,815). Consequently interest in
the management of child care services has increased, evidenced by the range of
professional child care publications in the 1990s (for example, see Farmer, 1995;
Hayden, 1999; Rodd, 1998).
Many developments have occurred in the provision and delivery of child care
services for young children and their fami.
PCG Human Services White Paper - Cross-System Approaches That Promote Child W...Public Consulting Group
Child welfare agencies can successfully partner with Medicaid and managed care organizations to address the complex health and behavioral needs of children who experience maltreatment. If prevention and intervention efforts are applied early and effectively, these high-risk children and youth may avoid costly health conditions and experience improved health and psychological outcomes.
Child abuse and neglect is an important concern that negatively affects the physical and psychological well-being of a population that is already vulnerable. Increased preventive services to children in high-risk households can help states minimize the cost of health/medical services to deep-end youth, reduce the number of children with chronic medical conditions and can improve general well-being outcomes. Providing targeted prevention programs and interventions to these children of at-risk families have been shown to reduce the cost of providing intensive services to children with poor health outcomes later on.
Children who are investigated for maltreatment or enter the child welfare system have greater health needs. Children investigated by the welfare system have been found to have 1.5 times more chronic health conditions than the general population. After controlling for other risk factors, children with maltreatment reports have a 74-100% higher risk of hospital treatment. Over 28% of children involved with maltreatment investigations are diagnosed with chronic health conditions during the three years following the investigation.
The slides cover the AHSN's response to the Covid-19 pandemic, and provides a review of 2019-20.
There are also case studies where AHSN staff returned to the frontline NHS, to support our colleagues with the response to Covid-19. All documents can be viewed or downloaded below.
Bill Gillespie, Chief Executive of Wessex AHSN, said: "Thanks to the trusted relationships we have built with regional and national partners over the past eight years, we have been in a strong position to provide a solid, adaptive response to the crisis.
"Along the way, we have discovered that staff at every level of our partner organisations have enormous depths of creativity and commitment; and that the public are more willing than we ever imagined to welcome technology and innovation into their care.
"Our own AHSN staff have also shown a huge willingness to take on new roles, to work almost entirely virtually; and, for some, to step back into frontline roles or play a part in key national Covid projects. We’d like to thank them for their amazing commitment over the past few months."
Transforming the workforce: funding, education and skillsLisa Bayliss-Pratt
In this presentation, given at a national conference on February 16, 2017, "Safer Maternity Care: Next Steps Towards the National Maternity Ambition" I cover key issues on achieving the goals of Better Birth and the Maternity Transformation Programme, including HEE's work on ensuring that training supports a culture of continuous learning and improvement in safe services.
Stocktake of Prevention, Education and Frontline responses to Child Abuse in ...WERDS_NZ
This stocktake report was commissioned by the Every Day Communities unit of Child Youth and Family and the Waitakere Anti-Violence Essential Services. The report identifies trends, issues and gaps in child abuse prevention and response services across the Waitakere area., and makes recommendations for improvemen
We've produced an annual report for the West of England Academic Health Science Network to showcase how the organisation is helping to enhance healthcare delivery.
Improve Outcomes for Children in Foster Care by Reforming Congregate Care Pay...Public Consulting Group
In child welfare, there is growing emphasis on keeping children at home, and when that isn’t possible, placing them with relatives or in other family-like settings. Secure attachments to consistent caregivers are critical for the healthy development of children and youth, especially for very young children.Congregate care placements are also significantly costlier than traditional foster care or kinship care placements.
Similar to Tweddle's joint submission to 'Victoria's Vulnerable Children Inquiry' (20)
Barbara cosson swinburne tweddle fathers stories of exclusion 2012 (id 1930)Tweddle Australia
This research reports on the perceptions of 27 fathers involved in fi ve focus groups which were conducted in late 2009 on behalf of Tweddle Child and Family Health Service in Melbourne. The fathers in this research highlight their encounters with services that frequently presume they are secondary or part-time parents.
Tweddle’s programs are underpinned by four key themes also known as our four Ts. Our priority is to help parents learn about their child by teaching them about secure attachment and attunement, as a result a child builds trust and a sense of security. This is done in a timely manner that acknowledges that the peak period of development for a child is the first 1000 days. We do this together with families, staff, community organisations and universal services.
In Partnership with Western Health, Tweddle offers a comprehensive range of education classes in a relaxed informal atmosphere. Classes are conducted by our dedicated childbirth educators who are skilled in providing the best care for you before and after the birth of your baby. They will discuss your choices for childbirth and the facilities available to you.
You can choose from classes that run across three Thursday evenings, or full day classes on either a Saturday or a Sunday.
Bookings should be made at the 20 - 30 week gestation period.
Tweddle Childbirth Education Classes for 2015
Thur 6.00pm to 9.30pm 3wks $80 per couple or $60 with Health Care Card
Sat 10am to 4pm 1 day $120 per couple or $100 with Health Care Card
Sun 10am to 4pm 1 day $120 per couple or $100 with Health Care Card
As positions are limited, please allow for eight weeks notice to book in for your classes. For more information call Tweddle on (03) 9689 1577 between 1pm and 5pm Monday to Friday.
Your stay with us will provide
an opportunity for you and your family to explore any
parenting issues you are currently facing.
Parenting issues involve the whole family and we invite
you, your partner or a support person to attend.
The program is designed to assist you to achieve your
goals. The program has 4 phases:
• Exploration
• Confidence building
• Skill consolidation
• Preparation for home
Tweddle recognises that each family is unique. We
respond to your individual needs working with you to
achieve your goals and we will be on hand day and night.
In a typical day, we will work with you to develop confidence
in your skills. This will be achieved by observing
you do the task and providing you with feedback and
encouragement. Information groups are run everyday and
you are invited to attend them.
At Tweddle, we assist parents with young children who need support and strategies to confidently manage the challenges of early parenting. Families with children and babies up to the age of four years old are welcome.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
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2. CONTENTS
Summary of solutions ............................................................................. 3
Background and current services .............................................................. 4
Breaking the cycle of intergenerational disadvantage .................................. 6
Focus on funding therapeutic interventions ................................................ 6
Service issues for young children and families ............................................ 7
Focus on secondary service – early intervention and prevention ................... 7
The value of early parenting – the return on the investment ........................ 9
Accessing vulnerable families – health and community service links ............ 10
EPCs and child protection families ........................................................... 11
Mental health services........................................................................... 12
Regional and rural services .................................................................... 13
What else can we do ............................................................................. 14
The way forward .................................................................................. 14
Building workforce and sector capacity .................................................... 15
Collaboration ....................................................................................... 17
EPCs as health services ......................................................................... 18
Child protection .................................................................................... 19
Managing growth and demand ............................................................... 20
Appendix 1 .......................................................................................... 22
A new approach to early intervention - Tummies-to-Toddlers: pilot program
overview ............................................................................................. 22
Appendix 2 .......................................................................................... 24
Western Health And Tweddle – a partnership to strengthen family support .. 24
Appendix 3 .......................................................................................... 25
Background on Victoria‟s three early parenting centres ............................. 25
O‟Connell Family Centre ........................................................................ 25
The Queen Elizabeth Centre ................................................................... 26
Tweddle Child + Family Health Service .................................................... 26
2
3. SUMMARY OF SOLUTIONS
1. Increase investment and service capacity (recurrent and capital
investment) of Victoria‟s early parenting services to enable earlier
intervention/therapeutic support to young families.
2. Take advantage of early parenting centres already positioned to provide
services to young families in the secondary and tertiary space - significant
risk will be created if there is a shift of focus to the child protection/tertiary
service sphere alone.
3. Strengthen and invest more in the referral pathways between universal and
secondary service systems so the system works more effectively.
4. Strengthen the secondary service sector to prevent progression to the
tertiary level.
5. Encourage ChildFirst to access and use the early parenting services more
often and more effectively.
6. Enhance referrals from community service organisations to early parenting
services.
7. Government to extend its vision to include the importance of parenting in
the health and wellbeing of children and family.
8. Encourage Government, health and community agencies to discuss how to
maximise the existing links that early parenting centres, as public hospitals,
have with maternity services.
9. Formally engage EPCs to work with antenatal services.
10. The Parenting Assessment and Skills Development Service should be
expanded, together with the development of a more consistent practice and
legal reporting framework for all PASDS providers.
11. Formally use early parenting centres to identify parents with or at risk of
mental health difficulties.
12. Strengthen and invest more in regional and rural services: services are
currently limited and those that do exist are not well funded.
13. Career pathways in early parenting services should be established to
supplement the aging workforce and to develop the professional skills and
opportunities for child care workers.
14. Re-establish early parenting centres as training facilitators.
15. Encourage more collaboration by funding partnerships.
16. Trial, evaluate and only fund successful alternate models of practice.
17. Set up a conciliation system for placement prevention rather than continue
with the current adversarial approach.
18. Establish a collaborative „go to‟ Internet site for parents.
3
4. BACKGROUND AND CURRENT SERVICES
Australia is unique in the world in having established early parenting centres
(EPC) with a component of intensive residential support. Victoria has three
Early Parenting Centres: O‟Connell Family Centre, Queen Elizabeth Centre and
Tweddle Child + Family Health Service.
While the history of each of the three publicly funded centres in Victoria is
different, each has evolved to today having a shared focus and vision for their
services. These are specialist early intervention and prevention health and
therapeutic services that have been designed to support vulnerable families.
The three public EPCs have strong relationships with both the health and
community sectors. They also work together collaboratively and in recent years
have joined forces in research and evaluation to build and enhance evidence
informed clinical practice.
4
5. Services
EPCs provide outreach and home based programs, centre based services and all
deliver some services regionally. The programs are evidence informed and focus
on attachment and strengthening family relationships, especially parent-child
relationships. The EPC workforce is multidisciplinary, with a public health
emphasis which includes mental health, social welfare and nursing expertise.
Services are also, like many agencies, undergoing significant organisational
development and practice change. For example, recently piloted group
therapeutic programs, such as PlaySteps and Tummies to Toddlers, have
achieved outstanding success. This new practice direction is supported by all
three agencies. Skill development and other practice development priorities to
adopt these new directions are well underway.
Services are always at 100% capacity and are well known to have long waiting
lists. Priority is therefore given to families at risk – intensive early intervention
and preventions support. Services are also provided to child protection families –
assessment and skill development programs.
Service capacity to support child protection clients was established more than
ten years ago and there has been limited growth in capacity to support these
families over that time. Triage processes have been established to ensure
admission priority is given to families and children at risk.
5
6. BREAKING THE CYCLE OF INTERGENERATIONAL
DISADVANTAGE
FOCUS ON FUNDING THERAPEUTIC INTERVENTIONS
Situation:
The current investment in EPCs (2009/10) is $12 million. In that period, 7500
families were supported by publicly funded EPCs – approximately 10% of the
number of babies born in Victoria
In the work of Nobel Laureate and economist James Heckman every dollar
invested in the early years saves $17 in later years - a potential saving to the
public purse of $204.1 million.
Based on the June 2010 Australian Institute of Family Studies report “The
Economic costs of Child Abuse and Neglect” (Bromfield, Holzer and Lamont) the
estimate of total lifetime costs associated with outcomes for young people
leaving care is $738,741 (2004-05 dollars) per care leaver.
To extend this analysis, if only 5% of families in current EPC targeted services
were successfully supported to care for their children within the family, this
would represent a saving of $81,261,510.
Solutions:
Invest and grow the service capacity of Victoria‟s early parenting centres.
Victoria‟s three specialist early parenting centres have established intervention
and prevention health and therapeutic services specifically designed to support
vulnerable families. EPCs have existing capacity to directly intervene to improve
the parent – child relationship and thus improve the capacity to protect and
promote resilience. Furthermore, the three centres have strong relationships
with both the health and community sectors.
EPCs are already positioned to provide services to young families in the
secondary and tertiary space. Significant risk would be created if we saw a
shift of EPCs to be focused in child protection/tertiary service sphere alone.
We strongly encourage the Government through its health and education
services to increase the investment and service capacity of Victoria‟s early
parenting services to enable earlier intervention and therapeutic support to
young families. This investment must be recurrent and capital investment to
build flexible infrastructure that will enable the services to grow and to adapt its
programs over time.
Strengthen referral pathways. We also strongly urge strengthening of the
referral pathways between service systems so the system works more
effectively.
6
7. SERVICE ISSUES FOR YOUNG CHILDREN AND FAMILIES
FOCUS ON SECONDARY SERVICE – EARLY INTERVENTION AND
PREVENTION
Situation:
The lack of investment in secondary early parenting intervention services is a
serious service gap. Secondary early parenting intervention services are
essential if Victoria is to support vulnerable families as early as possible to
prevent progression to tertiary services.
Recent service enhancements have largely been focused on the universal
platform or positioned within the tertiary sector. Family access to, and sustained
engagement in, universal services is of course critical to achieve increased family
independence.
Maternal and child health, childcare and kindergartens are fundamental to this.
Lack of investment in the secondary space creates the risk of primary sector
professionals having no clear pathway of support other than rapid escalation to
the tertiary sector to ensure child and family safety.
Solution:
Strengthen secondary services. While it is considered very important to
strengthen primary level services to identify risk Victoria needs a strong
secondary service sector for referral to prevent progression to the tertiary level.
In the early years a number of community service programs are well placed and
can be further developed to address this current service gap.
Earlier intervention at its best is pre birth with the building of trusted
relationships supporting families through key stages of a child‟s and family
development. “Wrap around” services to support families engaging with and
accessing universal services, to build independence.
Successful secondary services will necessarily combine therapeutic responses as
well as general living support and skill development.
Situation:
There have been many place-based initiatives, such as family hubs and
centralised intakes developed. Many of these service hubs are located in high
needs communities and have proved helpful in assisting families to access
support when and where they need it.
Family Coaches, a Government initiative, is an integrated service delivery model
targeted at child protection. ChildFirst, also a Government initiative, was
developed as a secondary level platform for families at risk of entering the child
protection system.
7
8. The early parenting sector has sought to support and participate in ChildFirst
alliances, allocating capacity for referral from this platform. However ChildFirst
has not accessed the early parenting sector significantly. Given the large
numbers of at risk families with young children, it is unclear why this is the case.
Referral pathways from universal services to early parenting services, especially
universal health services, are strong.
Solution:
Enhance referral pathways from community service organisations and ChildFirst.
We strongly recommend that referrals from community service organisations
and ChildFirst to early parenting services should be enhanced.
Challenge ahead:
The challenge remains as to how to integrate specialist secondary services
consistently across such platform models and how to sustain the engagement of
vulnerable families.
8
9. THE VALUE OF EARLY PARENTING – THE RETURN ON THE
INVESTMENT
Situation:
In 2010, a policy framework for early parenting services in Victoria was released.
It was a pleasing step to have a clear description of how early parenting centres,
in particular, sit in the continuum of care for young families in both the health
and community sectors. The document is not however a strategy or vision for
the future of our services. It describes well the current service framework and
a number of actions such as consistent referral pathways flow from it.
We also welcome the fact that the Baillieu-Ryan Government places a strong
emphasis on children and families and the Premier is congratulated on the recent
release of a statement on families.
Challenge:
We know that most of the families we see are overwhelmed by circumstances
that impact on their ability to provide basic parenting skills and respond to the
social and emotional needs of their children.
It is now time to enable the early parenting sector‟s real vision to become
reality.
That vision is to support vulnerable families in ways that are empowering and
energising. Making the vision a reality entails improving Government and
community understanding of the importance of the therapeutic work the centres
do and can develop further.
Solutions:
Include parenting. EPCs urge government to extend its vision to include the
importance of parenting in the health and wellbeing of children and the family.
Access to housing and vocational training, and other supports as needed.
Stable housing and vocational training are critical aspects for families to achieve
independence and resilience. Many families accessing early parenting centres
face other fundamental challenges of managing family relationships in addition
to the needs of employment and shelter. These factors need to be recognised
in policy and vision statements.
9
10. ACCESSING VULNERABLE FAMILIES – HEALTH AND COMMUNITY
SERVICE LINKS
Situation:
Research findings are very clear on the importance of “getting in” early with
families, including antenatally. Evidence is well established and expanding on
the importance to long-term wellbeing of sound attachment and a healthy
parent-child relationship.
EPCs can and are providing these types of services. EPCs are a strong
established bridge between health and community sectors and bridge to
universal early years health and education services.
Established formal referral pathways exist with most of the major maternity
hospitals - Southern Health (Monash and Casey), Royal Women‟s Hospital, Mercy
Hospital for Women and Western Health (Sunshine).
Relationships include neonatal units and paediatric services. In addition referral
pathways from and to ChildFirst platforms and general family services are
strengthening, although more work needs to be done.
Solution:
EPCs are public hospitals: encourage better links with maternity services.
Because of the historic context of EPCs and our status as hospitals we provide a
valuable existing link to the health sector, particularly maternity hospitals,
mental health services, mother baby units and to some extent general medical
practice.
We believe we can do more with our links to maternity services and encourage
further discussion with Government, health and community agencies about how
this can be achieved. PASDS clients are referred as a result of child protection
intervention/investigation and that the child is more often than not under 12
months old. This suggests opportunity exists to undertake antenatal work in
order to prevent entry into the child protection system and EPCs are perfectly
positioned to do/ assist in this.
The current Commonwealth reforms in the public sector, particularly Medicare
Locals, provide opportunities for the EPCs to extend existing links within the
universal sector especially GP Divisions within their regions.
10
11. EPCs AND CHILD PROTECTION FAMILIES
Situation:
Taking an all of community responsibility approach to protecting children
requires a child protection workforce that is community based and co-located
with service providers. Working as local teams that are accessible to families and
the community is widely regarded as a more effective service response as well
as enabling communities to share the responsibility and support of the most
vulnerable.
There is potential to do much more work with child protection clients and
collaboratively with other Parenting Assessment and Skills Development Service
(PASDS) providers. The service provides an assessment of parenting capability,
in some cases directed by the court, and a skills development element.
The Family Coaches model of service, currently being piloted, provides an
opportunity to engage prior to birth and extend the period of support for families
for a 12 month period. This integrated service brings together family support
services, specialist early parenting providers and therapeutic elements. The
outcomes from these pilots should provide essential learnings for any systems
reform undertaken.
Solutions:
More consistent practice required. There is a need to develop consistent practice
and legal reporting framework for all PASDS providers. Growth in capacity for
this service together with clear criteria for access to programs are needed for
child protection workers, service providers and officers of the court to ensure
highest priority families are admitted and to minimise risk to infant safety where
an admission to a program may not be possible immediately. Service capacity in
this essential intensive care service that supports timely decision making for
infants needs to more adequately reflect the increase in workloads across the
system.
Family coaching - a major opportunity. Family Coaching has been positioned as
a placement prevention strategy but it is imperative that we consider how
similar pre birth and longer term support programs can be implemented as a
preventative strategy to relieve some of the pressure on the child protection
system. Engaging at an earlier stage with families from a universal platform
strengthens the partnership approach with families and increases the
opportunity to motivate change.
Work more effectively with Early Parenting Centres: EPCs are already positioned
to provide services to young families in the secondary and tertiary space.
Significant risk would be created if we saw a shift of EPCs to be focused in child
protection/tertiary service sphere alone. Without the EPC capacity for early
targeted intervention and prevention in the early years, the increase in child
protection case load in the short and long term would inevitably grow.
11
12. MENTAL HEALTH SERVICES
Situation:
Several studies have shown that women attending Australia‟s residential early
parenting programs for children‟s sleep and settling issues have poor mental
health, with at least 40 per cent scoring in the clinical range on the Edinburgh
Postnatal Depression Scale (EPDS) indicating probable depression (Barnett,
Lochart, Bernard, Manicavasgar & Dudley, 1993; Fisher, Feekery, Rowe Murray,
2002; Fisher, Feekery, Amir, & Sneddon, 2002; Fisher, Feekery & Rowe, 2003;
Fisher & Rowe, 2004; McMahon, Barnett, Kowalenko, Tennant & Don, 2001).
Maternal depression is well-known to have short and long-term adverse effects on
maternal morbidity, parenting, and children‟s emotional, behavioural and cognitive
development (Beardslee & Wheelock, 1994).
A systematic follow-up of women admitted to a public (n=79) and a private
(n=81) early parenting service found that only six percent had consulted a
specialist mental health professional, and very few believed that seeing a mental
health professional would be helpful (Fisher, Feekery, & Rowe, 2003; Fisher &
Rowe, 2004).
The Australian Government funded National Perinatal Depression Initiative
(NPDI) has enhanced mental health support available for parents perinatally,
however access to services, navigation of service systems and coordination
between services often create additional complexities for women experiencing
mental health problems.
Solutions:
Use EPCs to identify parents with or at risk of mental health difficulties. Early
Parenting Centres provide support to parents with early parenting difficulties such
as children‟s sleep and settling issues. They are well placed to normalise and de-
stigmatise health and wellbeing difficulties during the early parenting years.
They are in an ideal position to identify parents at risk of, or currently
experiencing mental health difficulties, and facilitate appropriate and timely
access to information and professional support to promote and enhance their
health and wellbeing.
Use EPCS to deliver mental health support. EPCs provide a non-stigmatised and
effective platform for delivering additional mental health support for parents and
linkages with area mental health services.
Better resource infant mental health support. Infant mental health support is an
important field that is not currently well resourced. EPCs are in the process of
enhancing skills in therapeutic support of infant mental health. Our practice
approaches are informed by attachment and trauma theory. Evidence is now
clear that if we are not continuously mindful of the infant‟s emotional care
environment as well as physical care, brain architecture can be seriously
impacted and the life trajectory altered dramatically.
12
13. REGIONAL AND RURAL SERVICES
Situation:
EPCs all provide some regionally based services. The services do not provide
equity of access for all Victorians to specialist early parenting support and there
are significant service gaps such as in the Wimmera and Mallee and in East
Gippsland. While many families will travel to the closest regional centre that
provides a service, there are no doubt a similar number cannot access services
because the travel is too hard.
A number of rural municipalities have approached EPCs to establish local
community based early parenting services because they have identified a
demand. Often facilities are available for such services or offices for outreach
workers. The recurrent funding is not available.
Solution:
Invest in regional and rural services. While it is understood that it would not be
cost effective to invest in residential services across the state, the other service
options that have been described can be readily and quickly established if
funding were available.
13
14. WHAT ELSE CAN WE DO
THE WAY FORWARD
Situation:
There are a number of tiers of support that families need. Every family
engages in the non-stigmatised and trusted universal health pathway of
maternity services. Most women birth in a hospital and health professionals in
the maternity services can and do identify babies at risk. This identification
often occurs antenatally. EPCs have formal partnerships and well established
referral pathways from hospitals to its services. EPCs can and do tap directly
into these services antenatally to identify and engage with families and infants at
risk.
We believe it is important to introduce and use non-stigmatised pathways in
order to develop secure attachment between parent and child in the very early
formative years of a child‟s life.
No one area of government should feel the need to take on the responsibility;
rather the approach could be across government departments.
By drawing on expertise from outside and inside government, the coming
together of the collective ensures informed responses to the immediate
problems and helps take the pressure off the overwhelmed Child Protection
System.
Evidence collected both locally and overseas indicates that providing longer-term
interventions and connecting with families prior to birth will improve outcomes
for children. Long-term home visiting by child health nurses that incorporates a
relationship-focused and strengths-based family-centred approach has been
shown to be a cost-effective strategy for improving maternal and child health
and life outcomes for first-time, single, disadvantaged teenage mothers and
their children in a variety of settings (Olds et al, 2002).
The Children and Young Persons Act 2005 extended protection to the unborn
child. Reports to protective services for unborn children are occurring, but there
has been a limited service response available to support families entering the
protective system antenatally.
Solution:
Formally engage EPCs to work with antenatal services. Use EPCs formally to
identify vulnerable families and refer to evidence based therapeutic programs
such as Tummies to Toddlers.
Use these services to strengthen connections with social work departments of
major hospitals – identifying families that are below the threshold for statutory
intervention but whose children are at high risk of poor psycho social outcomes.
14
15. BUILDING WORKFORCE AND SECTOR CAPACITY
Situation:
EPCs specialise in enhancing whole of family functioning – initially through
identifying and supporting emotional and social well being of mothers and then
supporting the development of healthy relationships with the infant and other
family members. In parallel, health assessments of family members are
undertaken and appropriate referrals to other specialists are made as needed.
Historically EPCs were training facilities. With the wisdom of hindsight,
discontinuing their training function might have been a mistake.
EPCs with their expertise in identifying and engaging with families at risk are
very well placed to help build the capacity of the universal sector to identify and
engage with these families and achieve improved early intervention – especially
services such as child care centres, kindergartens etc.
EPCs have established risk criteria to assist in identification of and engagement
with families and consistent decision making to prioritise access and referrals for
those most at risk.
EPCs already provide guest lecturers and deliver undergraduate subjects/units in
early parenting at relevant tertiary institutes.
Solutions:
Create an early parenting career pathway and a new professional category –
early parenting professional. There is a need to create career pathways in early
parenting services in order to supplement the aging workforce and to further
develop the professional skills and opportunities for child care workers. Work has
commenced on the establishment of an accredited qualification in early
parenting and EPCs are seeking formal partnerships with relevant institutes to
achieve this.
Government support for strengthened professional development and capacity
building programs is critical to success.
Re-establish funding for EPCs as training facilities. Opportunities for EPCs as
training facilities include:
Why and how early parenting is a means to reduce incidence and negative
impact of child abuse and neglect
Knowledge of early childhood health and development and therapeutic
interventions – community sector workers
Shared learning models such as the work of Tweddle supporting a
therapeutic approach to families in supervised access (Department of
Human Services and Tweddle partnership at the Arbour Centre in Sunshine
is a good example of this approach).
15
16. Training in internationally accredited and assessed early parenting tools
such as QEC expertise and accreditation to deliver NCast. The NCAST
parent child interaction scales offer a thorough assessment of interaction,
assessing both caregiver and child behaviours. The NCAST scales are used
as they provide an indication of strengths and potential difficulties in the
way in which the parent and child interact. The scales are reliable indicators
of successes, or potential barriers, to a child‟s future development.
EPC collaboration and grant submission to establish a graduate certificate
course in early parenting
Provision of course subjects, workshops and training courses at Swinburne,
Centre for Excellence and others
Building knowledge in general practice of mental health and other health
presentations of families admitted to EPCs (some programs are under
development with National Perinatal Depression Initiative funding to
establish programs of this kind).
16
17. COLLABORATION
Situation:
Everyone knows resources are scarce. An exciting opportunity to be cost
effective through collaboration exists. Much work to encourage collaboration is
already being done nationally and at state level including co-location,
partnerships, and integrated service models.
Examples of good collaboration in the EPC space include:
Adopt an aunty – This progam is designed to provide enhanced support to
aboriginal women and families when they go home with their babies and to
prevent babies and young children being placed in out of home care. With a
collaboration between Mercy Hospital for Women, Child Protection,
Aboriginal Elder volunteers and EPCs, “Adopt an Auntie”, is being developed
as a model of care whereby Aboriginal Aunties will form lasting and
nurturing relationships with vulnerable Aboriginal parents and their babies.
Playsteps – is an innovative, highly monitored, supervised and outcome
driven eight (8) week program applying early intervention and prevention
practices. It places emphasis on relationship building through play and has
proved highly acceptable to fathers and Aboriginal families.
PLAYSTEPS helps a parent/carer to develop secure attachment with their
infant or toddler (newborns to age 3) to improve life outcomes and
optimise their social, emotional, and educational pathways.
The program has been successfully implemented to enable 'reunification' of
a parent/carer whose child/ren has been removed at the direction of 'Child
Protection. EPC staff have been trained and mentored in implementing and
evaluating Playsteps as a collaborative project, funded by the NPDI.
Collaborative research and evaluation of programs and pilots - between
EPCs and leading research institutes
Shared IT system development between EPCs - current project
Adoption of group therapeutic programs across EPCs that are trialed and piloted
as effective models of service with strong long term outcomes – eg Playsteps
and Tummies to Toddlers.
Solution:
Encourage more collaboration by funding partnerships. Whilst open processes for
tendering are important and an equal playing field is necessary, competitive
tendering processes can work to undermine collaboration. Funding partnerships,
including partnerships with government and statutory services placed in the
community and working with the community is critical.
17
18. EPCs AS HEALTH SERVICES
Situation:
With health sector reforms it is timely to ensure that the positioning of EPCs as
hospitals and not primary health services is re-emphasised. The importance of
links and referral pathways between EPCs and primary health services, child care
and education services has already been stressed in this submission.
Solution:
Strengthen referral pathways. Further strengthening of the referral pathways
between maternity hospitals, paediatric units, mental health services and
mother/baby units is required. Strengthening ChildFirst and family service
referral pathways is also of critical importance to provide access for highly
vulnerable infants.
18
19. CHILD PROTECTION
Situation:
The major factor preventing EPCs doing more with families involved with child
protection services is capacity. Intensive therapeutic programs of support are
necessarily long term and the cost per family is high. Residential and home-
based services are expensive.
Solution:
Invest in evaluated alternative models of practice. Interventions like Tummies to
Toddlers where specialist early parenting staff work with families from about 26
weeks of pregnancy until a child is 2 years old have delivered great results and
are a cost effective option. Ongoing funding for this initiative, given it has
proven results, must be funded on a recurrent basis. Programs such as these
can be readily conducted regionally as well as using existing infrastructure.
Situation:
EPCs have developed considerable expertise in working collaboratively with child
protection services to deliver PASDS. Delivering these services over the past
decade has resulted in high level of skills in developing strong partnerships with
families, whilst maintaining a clear focus on the child.
Furthermore EPC PASDS services are highly valued in legal decision making.
Timely decisions during infancy are critical to support secure attachments and
act in the best interests of the child. Capacity in PASDS services has not kept
pace with the estimated 9% per annum increase in the work of the Children‟s
Court, resulting in a lack of access to the support and skills development aspects
of this intensive service model. As a result of the trusted expertise in this work
that EPCs have built up, we are well placed to also do work in a less adversarial
context.
Solutions:
Set up a conciliation system for placement prevention. The setting up of a
conciliation system using EPC expertise and the established matrix of risk
assessment may deliver better outcomes for families in terms of placement
prevention as well as building trust in engaging with universal services.
Encourage sharing of expertise. Collaborative and informed practice around
working with parents of highly at risk infants is an identified gap in sector
knowledge. EPCs have the potential to share this expertise across the child and
family service systems if funded to do so.
19
20. MANAGING GROWTH AND DEMAND
Situation:
Growth in service need and demand in early parenting, across the service
system is huge. Melbourne‟s west and southeast are known to be some of the
fastest growing regions in Australia. In Victoria, the birth rate and population
growth have both increased dramatically. At the same time, EPCs see more
babies discharged with health issues including issues relating to prematurity,
drug exposure in utero and complex medical needs. Demand on universal
services has increased accordingly and so too has demand in secondary for
secondary and tertiary services.
Solution:
Managing service demand. Managing this growth in service demand commands a
different approach that includes developing a sensitive approach to a broader
range of cultural and specialist need services. In our view, this approach must
commence from a universal perspective using technology as well as more
traditional services to exchange accurate and validated information.
Capacity of the sector must grow to meet the growing birth rate and demand.
This of course requires an increase in recurrent funding. It also requires
investment in infrastructure and a capital development program for early
parenting services, as important health services and public hospitals supported
by Government.
Situation:
Parenting information. Parenting information is today accessed in a range of
ways that may not include the advice of expert or specialist services. Online
include social networking and chat rooms are a major source of parenting tips.
Some of this advice can be confusing, conflicting or even false and risky for a
child or infant.
Solution:
Establish a collaborative „go to‟ internet site for parents. As a universal platform
we can cost effectively provide some parenting advice and service access
information using these media. While there are various very credible sites on
parenting (eg Raising Children‟s Network) families need to know they exist or
find them. More often it is through less formal means that information is
gleaned. Many parenting concerns can be “fixed” in this way, creating service
capacity for those needing more intensive support.
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21. Situation:
We already know what has to happen if Victoria is to engage with and support
more families and that is to grow early parenting service capacity.
We already know what does not work, and continuing to pilot different cost
effective models of service is not the answer.
EPCs have, with their own funding, trialed and evaluated cost effective service
models. Government has also piloted programs, such as Stargate, that have
been proven to have excellent longer term outcomes for children and their
families.
Currently there is no common data collection. Reporting is throughput rather
than outcome focused. In order to grow sector capacity this needs to change
with evidence based improvements being vital so that there is an in built
continuous improvement mode of operation within the sector.
Solution:
Trust the evidence. It is time now to stand by the power of investment and to
fund successfully trialed evidence based programs rather than continue to run
out different cost-effective models of service. It would be timely for
government to support research and evaluation in parenting programs to ensure
that services are continuously improved and based on current evidence and
research findings.
The government must start funding common data collection which is useful for
benchmarking and research to drive improvement.
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22. APPENDIX 1
A NEW APPROACH TO EARLY INTERVENTION -
TUMMIES-TO-TODDLERS: PILOT PROGRAM OVERVIEW
QEC conducted a pilot program for a target of fifteen (15) women in the Greater
Dandenong area of South East Melbourne. The pilot phase applied an „action
learning‟ approach over two years. The program model combined home visiting
and group sessions engaging at about 26 weeks of pregnancy and continuing
engagement until the child is 18 months old.
The pilot commenced with the referral process in August 2008, developed a full
project plan for delivery and engagement with stakeholders. It concluded in
January 2011.
Aims and Objectives, and Anticipated Community Benefits
The pilot project aimed to maximise the window of opportunity during pregnancy
when parents are highly motivated about their unborn child by incorporating a
childbirth preparation program that helps vulnerable parents prepare for the
future relationship with their child. Parents would learn infant cues and the
expected behaviour patterns of the unborn child and explore issues around being
a parent.
Brain development research over recent years has demonstrated:
The brain develops rapidly in the first three years of life
Neurons are present at birth and the neuronal pathways and synaptic
junctions are formed by repeated use of the pathway
Responsive reciprocal nurturing in the early years helps „wire‟ the brain
Lack of stimulation and stress in the early years reduces brain
development
Positive interactions in first years of life correlate strongly to intellectual
and language capabilities and ability to form secure attachments to major
caregivers
Maternal verbal and physical responsiveness correlated positively to
developmental status
Caregiver tendency to provide stimulating and positive interactive
experiences related to mental and linguistic abilities in children at 24 and
36 months.
It was hypothesised early interventions would hopefully result in a reduction in
the need for longer-term interventions and this would provide cost savings to
the health system and broader community.
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23. Tummies-to-Toddlers Program – Unique for Victoria (and Australia)
The introduction of the new Children, Youth and Families Act 2005 now allows
services to reach out further and consider the best interests of the unborn child.
Potential risks for children can be identified in parents before a child is born.
Currently there is an identified gap in the provision of services able to meet the
needs of vulnerable families. This raises the opportunity to be proactive and
provide future parents with services to prepare for life after birth. Current
antenatal services are limited in their capacity to incorporate attachment work
into their current service model.
The development of sustainable partnerships within this project between QEC
and the existing antenatal clinics facilitated the incorporation of relationship
based approaches to antenatal visits and assisted vulnerable families to make
more meaningful connections with their child in utero that strengthen the
relationship post birth and beyond and will hopefully be sustainable into the
future. There is a strong emphasis on health and early year partnerships.
QEC developed a non-stigmatised model of investing very early in order to offer
the child the best possible opportunity to help them grow into a healthy adult,
with a sense of social connectedness and desire for community participation.
QEC directly responded to the social isolation factor by incorporating group
interactions run by skilled clinical and nursing staff into the study.
This new way of working with non-communicative, untrusting, or anti-social
individuals suffering from mental health issues, violent or abusive relationships,
substance abuse or a lack of stable accommodation appeared to be one of the
primary reasons for the program‟s success.
Tummies-to-Toddlers transformed these vulnerable individuals. They gradually
began to display a change in their behaviour and showed more positive traits
and positive bonding with their newborn child. Their fellow group members
benefited from their more caring attitude and they developed a high level of
trust towards QEC staff. Their attitude towards the „system‟ became more
relaxed and they became amenable to utilise the services that would be
available to them once they concluded the program.
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24. APPENDIX 2
WESTERN HEALTH AND TWEDDLE – A PARTNERSHIP TO
STRENGTHEN FAMILY SUPPORT
Tweddle and Western Health have established a formal Memorandum of
Understanding and partnership to:
provide a range of community based perinatal support services
strengthen referral pathways between universal services, hospitals and
secondary early parenting services
make service access for young families easier
The first joint service established is the delivery at Tweddle, in the community of
ante natal classes. Tweddle commenced the program in March 2011. The
antenatal program includes an extra session that will cover transition to
parenting. Through this service Tweddle also works with hospital social work
and specialist services departments to identify families that might benefit from
more intensive support and referral to its programs. It has also created the
opportunity to work with vulnerable families before birth.
Other programs are also under development -
Direct referral from hospital to Tweddle mental health support services
Provision of a residential bed at Tweddle for priority access for families
and babies considered vulnerable within the maternity setting. This
service will link to relevant Child Protection, ChildFIRST and family
services to ensure longer term support of families as needed.
Paediatric screening of all infants admitted to Tweddle.
Should new innovative programs such as group interventions (eg Tummies to
Toddlers) be supported the formal partnership readily provides an existing
referral pathway.
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25. APPENDIX 3
BACKGROUND ON VICTORIA‟S THREE EARLY
PARENTING CENTRES
O‟CONNELL FAMILY CENTRE
Mercy Health O‟Connell Family Centre (OFC) was built at the current site in
Canterbury by the Family Care Sisters, affectionately known as the Grey Sisters,
in 1949. The Sisters‟ work in caring for families with a focus on the welfare of
mothers and children, commenced in 1930 in rural Victoria and in homes in
disadvantaged Melbourne suburbs. In 1935 the service began parenting and
mothercraft education, with Canterbury being a mothercraft training school from
1949-1978. The O‟Connell Family Centre now has strong links with universities
and training facilities and continues to support students.
The centre was registered as a public hospital in 1975 and OFC formally became
an Early Parenting Centre in 1993 while retaining public hospital status. In 2006
OFC was gifted to the Sisters of Mercy. Mercy Health O‟Connell Family Centre is
now an entity of Mercy Public Hospitals Incorporated. OFC has a natural synergy
with Mercy Hospital for Women and the mental health service and shares clients
from their specialist services. This enhances opportunity for care and smooth
transition into community.
OFC continues to provide residential and community based therapeutic programs
for vulnerable families, with focus on the safety and development of the child.
OFC admits families from across the state, in particular from the Eastern region.
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26. THE QUEEN ELIZABETH CENTRE
QEC derived from the Victorian Baby Health Centre Association (VBHCA). The
VBHCA was established in 1917 and opened the State‟s first Baby Health Centre
in Richmond in the same year to tackle Victoria‟s high infant mortality rate in
infants aged less than 12 months. From the 1920s the VBHCA mobilised infant
welfare services and parent education, delivering to rural communities. In 1951
VBHCA gained new premises in Carlton and was named the Queen Elizabeth
Hospital for Mothers and Babies. Services were provided to vulnerable young
pregnant women, abandoned and unwell babies and parents needing additional
support following birth. QEC also provided mothercraft and infant welfare nurse
training until 1979.
The organisation was renamed The Queen Elizabeth Centre in 1986 and in 1998
its operations moved to purpose built premises in Noble Park. QEC‟s current
specialist parenting interventions are delivered in residential, day, group and
outreach home visiting settings. Outreach staff deliver services across the
Southern and North and West metropolitan regions and the rural regions of
Upper Hume and Gippsland.
Access to all QEC services is prioritised for vulnerable families and QEC is the
largest provider of Parenting Assessment and Skills development services to the
State‟s High Risk Infant Child Protection units and a partner in Child First
alliances in City of Latrobe and Wodonga.
TWEDDLE CHILD + FAMILY HEALTH SERVICE
Tweddle was established in 1920 as a baby hospital. It provided services from
its current site in Footscray as well as having mobile services in the northern
suburbs of Melbourne. Services were provided to sick babies, foundlings and
children who were subjects of abuse and/or neglect. Until the 1980s it was
also an accredited training institute for mothercraft nursing and it provided a
component of maternal and child health nurse training. Adoption services were
also provided.
Today Tweddle provides a range of centre based and outreach programs to
support vulnerable families. The programs are evidence based and therapeutic
in nature. Services are provided in Melbourne‟s north and west, Geelong,
Werribee and Terang.
Tweddle also has a strong research focus and has for at least ten years
undertaken research that has led to real change and development of practice.
Research with the University of Melbourne led to the establishment of a
multidisciplinary approach and the introduction of mental health and social
support services.
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