Figure 1
Core Components of the co-designed Child and Family Hub. The family facing components are denoted in grey and practitioner components in blue.
Figure 2
Timeline of Child and Family Hub from development to implementation.
Table 1
Data Collection During Implementation.
| DATA TYPE | TIME POINT | COLLECTION METHOD | PURPOSE OF DATA | RESEARCHER |
|---|---|---|---|---|
| Observation | During clinical encounters at baseline and at 6 months | Notes detailing how practitioners asked about adversity and what types of adversity discussed during clinical encounters | To determine if there was any observable change in practitioners directly asking about adversity | SL |
| Observation | During initial practitioner training | Field notes from conversations with practitioners during training | To determine how comfortable practitioners were at baseline to address adversity | SL, NW, LC |
| Observation | During monthly learning collaboratives | Field notes from conversations with practitioners during monthly meetings | To identify barriers and facilitators of CFH implementation | SL, NW |
| Observation | Throughout implementation | Field notes from conversations and emails from practitioners | To identify barriers and facilitators of CFH implementation | SL, NW |
| Transcripts | Monthly learning collaboratives | Direct quotes from practitioners | To identify barriers and facilitators of CFH implementation | SL, NW |
| Process Data | Each month throughout implementation | Number of referrals received by each Hub service collected monthly | To show changes in referral patterns over the 12 months | NW |
Table 2
Topics and themes of monthly learning collaboratives.
| MONTH | TOPIC DISCUSSION AT LEARNING COLLABORATIVE | THEMES IDENTIFIED EACH MONTH WITH SUPPORTIVE QUOTES |
|---|---|---|
| Month 1 | Working together Reflection on training and establishing CFH | Theme: Uncertainty Uncertainty in how to approach adversity. Practitioners were unsure how to ask about adversity “Do I push further?” (P1) not wanting to duplicate asking about adversity “not overstepping our practice” (P6). Uncertainty in understanding the CFH. Seeing the Hub as an external service rather than integrated care “I have many families suitable for the Hub” (P1) |
| Month 2 | Legal Support How the lawyers can help to address adversity | Theme: Building relationships in the CFH. Starting to form relationships across practitioners “great to have communication across the team” (P3), to “know your face” (P14) Theme: Fear of damaging relationship. Afraid to talk to a family about family violence for fear of damaging relationship “so careful about that [asking about family violence] as there is already so much guilt for a mother who stays in a violent relationship” (P1) |
| Month 3 | Reframing parenting as a solution Introducing role of mental health expert in CFH | Theme: Permission to directly ask Practitioners finding it difficult to directly ask especially families they know well “I feel uncomfortable asking about financial questions because I don’t have this issue” (P1) “this is not relevant to what I am doing here so I leave it” (P12) “the box goes unchecked” (P4) |
| Month 4 | Permission Giving Lived experience researcher shared her thoughts on being asked about adversity | Theme: Barriers to engagement with parents Practitioners reflected on barriers to engagement with parents and the need to build trust. Families were seen as “hard to work with” (P12) but that “it doesn’t have to be as hard” (P5) Theme: What is the Hub? Practitioners were still confused about the CFH and saw this as a referral to the Wellbeing Coordinator “I referred to [WBC] as a starting point”(P2) |
| Month 5 | Micro-coaching parents Supporting practitioners to use all opportunities to provide coaching to parents | Theme: Parent engagement through building trust Practitioners had difficulties with engaging families, and it took time to find out about adversity “[legal issues] came out after a few conversations…found out different bits and pieces as they trust you” (P20) parents seen as “not willing to engage” (P9) |
| Month 6 | Reflective Practice Practitioners given exercise to help them reflect on their own practice change. | Theme: Importance of being in a team Practitioners discussed the best things about being in the CFH as being in a team “connecting with practitioners that we ordinarily wouldn’t connect with” (P7), “opportunity to network, to meet regularly, to get to know the team” (P8) Theme: Feeling ill-equipped Practitioners reflected on feeling “out of depth, out of my scope so I found it challenging” (17) and “if I had to do it again, I would ask questions differently.” (P13) Barriers in language used. |
| Month 7 | Family Violence Aim to improve practitioner comfort to directly ask about family violence | Theme: Opening a can of worms Fear of directly asking about family violence. “putting clients in further danger” (P13) “I’ve asked then what” (P12) “asking may affect the relationship I have with the person, they may be offended” (P17) “You might need to open a can of worms”(P16). Challenges in getting client alone to ask “how to deal and treat it with a child in the room” (P2) |
| Month 8 | Perinatal Mental Health Lived experience of getting help for mental health issues | Theme: Power of asking about adversity Practitioners recognising the value of asking about adversity “you don’t lose anything by asking and most people will be glad that you asked even if it is not true at that moment”(P1) Theme: Overcoming stigma of mental health Practitioners discussed the challenges to overcome stigma when asking about mental health “it can be difficult sometimes…it might affect future income protection” (P4) |
| Month 9 | Reflections on Learnings Practitioner reflection on what they had learnt so far in CFH | Theme: It’s Ok to ask about adversity Practitioners recognised that they did not have to solve all the problems when they asked about adversity, “I have changed the way I think about it to not trying to solve the problem…I feel more comfortable doing the holding now”(P1) Positive experiences were encouraging “So I feel that goes to what you have been saying all along is that people don’t mind being asked [about adversity] and people don’t mind being approached and it can be a relief” P20. |
| Month 10 | The words we use Improving confidence to directly ask with focus on the language used | Theme: Time poor Practitioners discussed that they found it difficult to identify adversity because they did not “have time” (P3) “so much adversity…hard to know where to start…we are completely rushed” (P2) Theme: Families disclose adversity Practitioners felt that families were disclosing so much adversity that they did not need to ask directly “they will burst into tears, and they will blurt out or vomit everything”(P21) |
| Month 11 | The next step in practice Practitioners planning the next step in their own practice change | Theme: Evolution of practice Practitioners recognised the changes they had made in their practice and how asking about adversity was beneficial. “Can I just say I love how to pose these questions has evolved from the beginning, because they’re so much more approachable” (P1) Practitioners were more comfortable to take the next step in practice “taking more initiative to ask questions” (P5) |
| Month 12 | Housing support Education about options for housing support | Theme: Overwhelmed/You are asking too much of me Practitioners discussed feeling “completely overwhelmed” (P21) and under “constant pressure” (P1) trying to address adversity while being time poor and knowing “how you do deal with it once they [families] tell you all of these things”(P21) |
Figure 3
Postcards to address permission giving.
Figure 4
Referral patterns by month.
*Financial counsellor left at 10 months.
Figure 5
Organisational Readiness for Change.