Transcript Document

HEARING PARENTS’ VOICES:
LINKING PARENTS,
COMMUNITIES AND CHILD
CARE POLICY
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Hearing Parents’ Voices: Linking Parents,
Communities and Child Care Policy
Dr Nonie Harris and Ms Beth Tinning
James Cook University
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Research Aim

The intention of this research project is to contribute to the
early childhood education and care policy dialogue at this
time of policy opportunity.

The objective of this research project is to qualitatively
explore, from the perspective of parents and carers who are
searching for and using long day care, the impact of the
rapidly expanding and changing for-profit child care sector
on their opportunities to choose quality child care.
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Research Methodology

Feminist perspective
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Qualitative methodology
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In-depth interviews
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Grounded theory analysis
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50 respondents in Cairns, Darwin and Mackay
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20 respondents from Townsville 2007 pilot study
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+ Beggars Can’t be Choosers - Locating Child
Care in a Large Regional City
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In the end I was in a position where you had to use the strategy of putting
her name down in several places to see what came up, and keep my
bloody fingers crossed that I got somewhere that was good (Cairns parent)

We moved to Darwin and I just rang around to see where we could fit in …
beggars can’t be choosers … we are fortunate to get a place. (Darwin
parent)

In Cairns, you have to take what you can get really. I imagine in a bigger
city there would be more options. For me, I’m thinking there would be
more chance of finding services that aren’t so white, although at least up
here, because of the population groups, there is more chance that there
will be Indigenous workers. (Cairns parent)
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Compromising on Quality

When we arrived in Darwin … I started to think OK I will need
to find care in Darwin, I did not really know anyone up here … I
only really found one centre that had any positions … so I had
to take what ever was available at the time because we both
worked and we really didn’t have any other options. It (the
centre) was OK – it probably would not have been my first
choice, it was not ideal … so if I had had other options available
I probably would have chosen a different alternative. (Darwin
parent)
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A Matter of ‘Luck’

It was a fluke … I got my name down at a lot of centres and
found the waiting list was usually six, 12 or even 18 months at
that time, and then they opened a brand new centre. So it was
really lucky that I got in there before it was even built… I got
my name on the list and I was one of the first in the door, so it
was really lucky. (Cairns parent)

I have been lucky I think, in the sense that I did get a place for
Billy and that was probably - they said that a few people had
left because of the uncertainty of the ABC… (Darwin parent).
+ Looking for Happiness - The Link Between
Child Care Choice and Quality

Low ratio of staff to children
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A balance of play and learning activities
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Culturally appropriate and sensitive environment
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Quality staff child relationship
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Enthusiastic and energetic staff
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A warm friendly environment that was well resourced
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A safe environment
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Emphasis on children’s happiness to attend
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Positive relationship between the parent and the centre director
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Outdoor play area – touching the trees and the grass
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Welcoming and interested staff
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Some were Happy and Some were
not
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The first child care centre, I was very happy with it. They had some fabulous
workers in there that, you know their enthusiasm, their energy was right there.
I mean I’m wanting child care to add on to what I don’t provide, given that I’m
putting a kid in care for a long time. Um, so that was, it was fairly important that
I felt there you know, there was a lot of happiness. (Mackay parent)

I’m not real comfortable there and I’m sure part of it is that we are the only
black family. I’m hoping we won’t stay there for much longer, but at the moment
the boys have to wait. They’re not so unhappy, they seem OK, you know kids,
they’re adaptable … But you don’t want your kids to have to adapt … I hate the
thought that they are going somewhere second rate, but what I want doesn’t
exist and the closest thing to it has a six month waiting list. (Cairns parent)
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… looking back the first one that you know she was only at for couple of months
um probably met my expectations by about 70% … The second one, everyday I
said to myself get her out of here, get her out of here now. (Mackay parent)
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Child Care Quality and Market
Forces
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I think it only works if the women have a choice – if you have
got a couple of different child care centres to choose from then
of course you would pick the best one and that one would
prosper and the other one would not… But in reality there is
not a market, so women have to choose whatever they can up
here … there is not a choice. (Darwin parent)
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A Sign of the Times - The Current Child
Care Landscape
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… but the rise in the number of profit, yeah I just, I’m just trying
to be realistic, that’s just a sign of the times. I mean look at ABC,
who didn’t think to themselves I should snatch one of them up,
they’ll be going cheap, we could make a real, you know, killing
here. Um, you forget that your customers are newborn you
know, um but I guess that’s just being realistic … So you’d have
to be an idiot not to step up and say well I’ll open a child care
centre and I’ll charge whatever I want and people will pay it.
Especially in a town like Mackay, maybe not so much at the
moment, but I mean it is a boomtown and people will literally
pay what it takes… (Mackay parent)
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Dollar Signs and Cowboys
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I just think big dollar signs written all over them… It’s actually
something that I expected in that they were running a business
and it wasn’t charity. You opt to go back to work or you opt to use
child care for whatever reason, well this is the world you live in.
These people are here to make money, they have staff to support,
they’ve got a centre to run, that’s life you know, and any other
business would do it … I guess that’s just reality. (Mackay parent)

If you open a child care centre, you can do whatever the hell you
want… they are for profit, they’re on their own, they make their
own rules… I just thought to myself you’re just a bunch of cowboys,
you just do what you want when you want, um and yeah no-one
sort of pulls anybody into line on a lot of it… (Mackay parent)
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
I think child care is a problem all over the country and
especially for families that need something different from the
norm. Because they have to offer whatever the most people
want, so they can get lots of kids to make their money… It
doesn’t make it fair though for those of us who aren’t in the
majority. (Cairns parent)
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Ask the Community What they
Want
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that finding quality child care will be difficult and
complicated
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the quality of care will be less than ideal
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where you live impacts your access to quality care
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getting a quality child care environment is a matter of luck
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that child care will be culturally inappropriate
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that child care is a business
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running a business means prioritising profits
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there is a lack of information about child care options such as
community-based and for-profit child care services
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there is a lack of clarity about who is monitoring quality after all anyone can open a child care centre
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for-profit centres make their own rules
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the ownership of centres can change and that there will be
constant change of this nature
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the for-profit delivery model is legitimate, because
government funds and supports this model of delivery
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flexible responsive services will not be provided unless they
make money – i.e. the profitable model of provision is what
we have and parents have to accept it
“Well I’d be saying ‘till I’m blue in the face - to ask the
community what they want … find out what is important.”
(Cairns parent)
PSYCHOSOCIAL SCREENING
IN A GYNAECOLOGICAL
ONCOLOGY SERVICE IN
ADELAIDE
Psychosocial screening in a
gynaecological oncology
service in Adelaide
Catherine M Burns, PhD
Senior Research Fellow, School of Medicine, Flinders University, South Australia
Cecily Dollman BSW,
Team Leader, Cancer Services, Social Work Department, Royal Adelaide Hospital
Kylie Smith BSW
Local Social Worker, Cancer Services, Social Work Department, Royal Adelaide
Hospital
Social Justice & Health
• A Healthier Future for all Australians
– Report of the National Health & Hospitals Reform
Commission. June 2009
• Key Points of Governance
–
–
–
–
–
–
People and family-centred
Equity
Shared responsibility
Promoting wellness & Strengthening prevention
Comprehensiveness
Value for Money
Population Growth & Social Justice
Australia’s Population – 1951 - 2030
Australian Population 1951-2001 & Projections to 2030
450000
400000
300000
Series1
250000
Series2
200000
Series3
150000
100000
50000
0
Ju
n_
1
Ju 95
n_ 1
Ju 1 95
n_ 6
Ju 1 96
n_ 1
1
Ju 96
n_ 6
Ju 1 97
n_ 1
1
Ju 97
n_ 6
Ju 1 98
n_ 1
1
Ju 98
n_ 6
Ju 1 99
n_ 1
Ju 1 99
n_ 6
2
Ju 001
n2
Ju 00
n- 6
2
Ju 011
n2
Ju 01
n- 6
2
Ju 02
n- 1
2
Ju 026
n20
30
Total Population
350000
Date of Census
Australian Population Distribution
1967-2027
Australia's Population X Age 1967-2027
80
70
% Total Population
60
50
1967
2007
40
2017
2027
30
20
10
0
0-14
15-64
65-84
Age Groups
85+
Social Justice and Cancer Care
WHO 2003 Report Cancer trends to 2010
–
–
31% increase Northern Europe
51% in North America
Australia AIHW Report 2008
• INCIDENCE 100,000 new cases of cancer in 2005, projected to
grow by over 3,000 each year.
– QLD 18,483 new cases in 2008.
• PREVALENCE x 8 = close to one million living with cancer.
• Around 150,00 people living with cancer in QLD
• 38,000 deaths from cancer in Australia in 2005.
•
Place of Death
Aged trends (Gomes & Higginson 06) absolute increase in deaths will commence in 2012
and last until 2050
• AIHW (09) first national linkage of hospital and residential aged data found
25% of people died within 4 months of entering a RACF
Place of Care (Agar M et al 08)
• Two conversations – “place of care is not a euphemism for death”
Barriers to Treatment:
Role of
Screening
• Social Justice
– Place of care and place of death
• Threat of increased barriers to treatment & care
– Ageing population and increases in absolute numbers of deaths
“expansion should occur in terms of home-based services and
improvements at the interface between inpatient and
community care, to facilitate a move towards home”….
• Role of screening
– Identification of the vulnerable.
• A scientific methodology needed
• clinical audits to undertaken over time
• GUARANTEE commitment to equity is achieved.
• Where to start?
– Cancer Psychosocial Care
– social work practice model for extension to other areas of health
QIP Initiative at RAH
Screening for Distress
• Oncology Day Centre – 2007
– Funding Provided by Prof Dorothy Keefe
– Convenience sample only used 60% scored high
• This successful preliminary work provided a platform, to
implement a systematic screening approach
• Then sought to respond to highly vulnerable population
– women with gynaecological cancers
Method of Recruitment
• Obtained ethics approval
• Project undertaken over 5 weeks 7 October – 7
November 2008
• The were no exclusions defined in the population
• Recruitment procedure
– Nursing staff integral to the initiative
– Women asked to complete a survey form twice –
before and after their medical appointment
– This sought to control for pre-consult distress
• Women with high distress scores were referred same
day to clinic social worker for follow-up and assessment
Extreme
Distress
Please circle the number
(0-10) that best describes
how much distress
(mental or physical pain
or suffering) you have
been experiencing in the
past week, including today.
No
Distress
Characteristics Gynaecology Clinic Population
Marital status
•
•
•
•
Single
Married
Divorced/separate
Widowed
Religion
18.9
52.8
17.3
8.7
Employment status (n=107)
•
•
•
•
Employed
Home duties
Retired/pension
Unemployed/student
Place of Residence
• Metropolitan
• Rural
30.8
18.7
45.8
4.7
66.9
33.1
•
•
•
•
•
None
Anglican
Catholic
Uniting
Other
Income support
Occupation
•
•
•
•
•
•
•
Professional
Semi-prof/adv clerical
Clerical
Home duties
Retired
Pensioner
Unemployed/student
44.1
15.7
11.8
7.1
21.3
30.7
10.3
8.4
12.1
18.7
10.3
35.5
4.7
Characteristics Gynaecology Clinic Population
Major Diagnoses x Age
%
Gynaecology Clinic-Diagnoses x Age
45
40
35
30
25
20
15
10
5
0
Ovarian
Endometrial
Cervical
Benign/pre-ca
<45
45-54
55-64
Age groups
65-74
74+
Treatment - modalities
• Surgery
• Chemotherapy
• Radiotherapy
94.5
35.4
21.3
• Currently on treatment
37.0
• Recurrence
• Palliative
15.7
2.4
FINDINGS: Global Distress Score 0- 10
Pre and post appointment
Scale
Pre-Test N= 107
%
Post-test N= 101
%
0
20.6
36.6
1
15.9
13.9
2
8.4
12.9
3
16.8
6.9
4
3.7
5.9
5
7.5
7.9
6
7.5
3.0
7
7.5
5.9
8
7.5
4.0
9
6.5
1.0
10
1.9
2.0
DT Distress Scores
Pre & Post Scores P=<0.001
DT
Pre-Test
%
Post-test
%
60
50
40
0 -1
36.8
50.5
30
2-4
29.2
25.7
20
5-7
18.9
16.8
10
8-10
15.1
6.9
0
DT 0-1
DT 2 -4
DT 5 -7
DT 8-10
Pre-test
Post-Test
DT Scores
Time 1 & 2
x
Clinical Features
60
50
40
DT1 0-4
DT1 5-10
DT2 0-4
DT2 5-10
30
20
10
0
Currently on treatment Have recurrent disease
DT Scores Time 1 & 2 X Age
60
50
40
DT_1
DT_1
DT_2
DT_2
30
20
10
0
<55 yrs
55-65 yrs
>65 yrs
0-4
5 -10
0-4
5 -10
Summary of Global findings
• 24 % of patients report distress scores above the cut-off
level after their medical consultation
• Cross-tabulation of pre and post test scores confirms a
dynamic factor operating
• Those currently on treatment more likely to be
distressed
• Interestingly those with recurrent disease reported lower
levels
• Age is an important association in patients’ levels of
distress
– Younger women are likely to be much more distressed
– Older women are more likely to have no distress at all
Specific Areas of Concern
Practical
Housing
Insurance
8.41
%
.93
%
Work/school
12.15 %
Transport
10.28 %
Childcare
1.87 %
Specific Areas of Concern
Family
Dealing with partner
12.15
%
Dealing with children
11.21
%
Specific Areas of Concern
Emotional
Worry
46.73 %
Fears
27.70 %
Sadness
26.17 %
Depression
16.82 %
Nervousness
28.04 %
Loss of interest and activities
23.36 %
Specific Areas of Concern
Spiritual/Religious & Physical
Spiritual/Religious
%
1.8
PHYSICAL
Pain
Nausea
Fatigue
38.32
22.43
44.86
Sleep difficulties
Getting around
39.25
21.50
Bathing/dressing
Breathing
Mouth sores
10.28
9.35
6.54
Specific Areas of Concerns
Eating
Indigestion
Constipation
Diarrhea
Changes in urination
Physical (cont’d)
%
16.82
13.08
14.02
48.60
8.41
Fever
Dry Skin
Nose dry/congested
7.48
33.64
17.76
Tingling hands/feet
Feeling swollen
24.30
19.63
Sexual
Appearance
Memory/concentration
9.35
14.95
25.23
In Summary
• Case ascertainment has essentially remained unchanged in most
Australian hospitals for over 50 years
– Drs & nurses identify people whom they think could do with a social
work referral.
• Simple screening is a first step towards professional responsibility
for psychosocial care
• Implemented as QI measure
– Developing multidisciplinary responses appropriate to individual health
setting
– Clinical audit trail
• Most importantly of all, it is a real attempt to guarantee that the
most vulnerable people do not fall through the cracks
• Finally, it provides important irrefutable data for energetic, strategic
Directors of Social Work services to argue for increased service
provision which will be needed within the next few years