From the Program Manager Sharing stories, supporting mums Volume 1, Issue 2 APRIL 2010 Inside this issue: Program outcomes 2 News from the Sites 3 Staff Profile 4 Education Update 5 Resource development Role of the FPW 7 6 I would like to begin 2010 by thanking everyone for their great contribution to the establishment of the ANFPP in 2009. The year saw the heart of the program established and embedded and this is a significant achievement. I had the privilege of visiting some of the sites last year and saw first-hand the efforts of the program staff, including a renewed emphasis on engaging local Aboriginal and Torres Strait Islander Elders and community organisations in the formation of local reference groups. These groups will undoubtedly further strengthen the local implementation of the ANFPP. The implementing sites have also put significant effort into developing relationships with other local service providers in the health and human service sector with a particular emphasis being placed on those services engaged in strengthening the social and emotional wellbeing needs of families. Visiting the implementing sites, there is a general buzz of activity as the teams engage with referral providers, and continue the day-to-day work of arranging the ANFPP materials for clients and staff into local folders, packages or manuals, and establishing local policies and procedures. Moving forward, the ANFPP Support Service Team is very conscious of the opportunities for all of us in 2010 and we are keen to foster positive working relationships within and across sites. The project team have shared with me their pleasure at having the opportunity to collaborate with the sites on the production of these resources. The Education Team now have a range of contemporary and culturally appropriate training resources that will help with ongoing professional development for both current and future staff of the ANFPP. In the first edition of the newsletter for 2010, we include some updates from the existing services and we welcome two new services, in Wellington and Brisbane, to the program. We hope to share in this and future newsletters some of the stories and achievements of the sites implementing the program. In 2010, the newsletter will continue to provide updates on the progress of the ANFPP as we continue the journey. Wishing everyone a great year, Claire Runciman claire.runciman@anfppss.com.au At the end of 2009, the key activities undertaken by the Support Service Team included the development of a number of educational and program resources.
Program outcomes for the ANFPP Sites Nurse Supervisors have been very generous during the last few months in sharing a number of successes for the program thus far: The ANFPP teams have worked hard at implementing Reflective Practice. Many team members embraced the new supervision approach, seeing it as a wonderful opportunity to develop their skills and provide quality service to the community. "[It's] what we've always wanted to do but were never resourced adequately to do in other jobs," said one ANFPP staff member. The services say many mothers, even those with limited resources, have found the written materials provided in the program to be very helpful. There have been examples of participants returning to education (school and nursing training). In one instance, a pregnant mother prepared a presentation on the Nurse Home Visiting program for her assessment at TAFE. Meanwhile, another young pregnant mother set and achieved a goal of controlling persistent tremors and shaking so she "would not drop her baby". As team members have worked through all of the program domains, Nurse Home Visitors (NHVs) and mothers have increasingly recognised the value of the program s approach. As a result, a number of NHVs have become stronger advocates for ensuring the fidelity of the program model. Team members have become excited as they begin to witness how the program has helped individual mothers to achieve their goals. In the early stages, there have been many examples of these achievements within the program. Young pregnant teenagers, who have experienced significantly challenging environments, are preparing their folders, doing their homework and waiting expectantly for their Nurse Home Visits. A Nurse Home Visitor provides information to a first-time mother and her supportive partner on how to nurture their child. The program encourages fathers participation in the program ANFPP team members have also reported positive outcomes for family members. An increasing number of fathers have been engaging in the program. For example, when one participating woman was late home, the father used the opportunity to ask the NHV questions he said he would not have been comfortable asking in the presence of his partner. In another case, a husband requested to be referred for domestic violence counseling. These successes and others like them line up with the program goals of improved pregnancy outcomes; improved child health and development and improved maternal life course development. Home Visiting Teams help young women through provision of health information to have a healthier pregnancy and healthier babies. 2
News from the Sites Wellington Aboriginal Corporation Health Service The WACHS ANFPP Home Visiting Team came on board 18 January 2010. We are now busy working through the orientation and training packages in preparation for the first women who will join the Wellington program. The WACHS ANFPP will be run across two communities; Dubbo and Wellington. We have started promoting the program in the community and have already had a very positive response. New Recruits join the program As well as welcoming staff from the Wellington Aboriginal Corporation Health Service (WACHS) to the ANFPP community, Wuchopperen Health Service and the Victorian Aboriginal Health Service (VAHS) have also recruited new staff to the program. Unit 2 training, held in March was an opportunity for all new staff to meet, share ideas and create networks across the implementing sites. The team have been introducing themselves to referral agents and other community services. We have organised a community information day for both Dubbo and Wellington and we are looking forward to completing the Unit 2 training modules so we can begin taking on expecting mothers. The enthusiasm and feedback from the community and referral agents have inspired us and given us confidence that the program will be well received. We are excited about what the WACHS ANFPP will have to offer the community. Family Partnership Workers: (L to R) Sharon Hughes (VAHS) and Kerry Mundine (WACHS) The WACHS ANFPP Team: (L to R) Natalie Riley (FPW), Pam Toomey (Admin), Judy Townsend (Nurse Supervisor), Kerry Mundine (FPW), Kath Richards (Project officer) and Leanne Morris (NHV) Nurse Home Visitors: (L to R) Jessica Pearson (VAHS), Lucinda Russell (Wuchopperen), Janice Robinson (VAHS) and Catherine Coller (Wuchopperen). 3
Staff profile Janice Finlayson, the Nurse Educator in the ANFPP Support Service, shares her story and interest in Indigenous health. My story... I made the decision to become a nurse during fifth form, the equivalent of today s Year 11. At the time I only wanted to be a midwife but was told I had to become a Registered Nurse first, in order to do this. I didn t want to nurse adults so I was able to compromise by training as a General Nurse at a paediatric hospital. Thus I started my nursing career at Royal Alexandra Hospital for Children or 'Camperdown Kids' as it was affectionately known (now The Children's Hospital at Westmead). After graduating in 1980, I moved back to Canberra to be near my family. I started preparations to go to Scotland where I dreamed of training to become a midwife. But, like all the best-laid plans, that s not quite how it turned out! While completing some of the UK registration requirements, I met a man, got married and moved to Melbourne. Not to be swayed, my long-awaited plans to become a midwife were realised when I graduated from the Royal Women s Hospital in 1984. During my years in Melbourne I completed a Graduate Diploma in Community Health Nursing in 1994. Then, in 1997, I completed a Graduate Diploma in Maternal and Child Health. Following my return to Canberra in 1997, my career shifted direction when I was appointed Manager of the Nurses Centre at Australia s Parliament House. For the next nine years my focus was occupational health and safety. By 2005, I felt I needed new challenges. As geography has never Janice with Paul Healthy Start Clinic, Ivanhoe been either a draw or deterrent for me, later that year I applied for and was offered a position with Maari Ma Health Aboriginal Corporation in Broken Hill as the Healthy Start Program Coordinator. I worked in that position from January 2006 until March 2009. Across my entire career, it is this position in Broken Hill that gave me the most profound and deepest sense of accomplishment, pride and humility. It was through Maari Ma that my passion for child advocacy was rekindled and supported. I became involved with building community capacity through primary health care. I am humbled and feel very privileged to have had the opportunity to work with such accepting and motivated families and communities, through this dynamic organisation and its exceptional staff. It was also through Maari Ma that I first became aware of the Australian Nurse-Family Partnership Program. As detailed information was so sketchy, I investigated the possibility of moving overseas to join a team in either the UK or the USA. However, through networks, I discovered that JTA International was recruiting. This resulted in emails, phone calls, coffee with Claire two days before Christmas, an invitation to attend an interview and, much to my surprise, an offer to join the team. I have had the great fortune to become part of a dynamic team of professionals who also nurture and care with passion; not only about the work we do, but about each other. Like any role, there are successes and challenges but it s never dull. 4
Education Update Core Curriculum Coordinator Sally Clark and Janice Finlayson are part of the Education Team. As the implementers of the program s core curriculum and professional development, they believe it is important the ANFPP is delivered with a high level of fidelity and integrity to ensure the goals and objectives of the program are met. One strategy is the provision of a high quality core education program. This program explains the principles and the importance of adhering to the program as well as Education Team Janice Finlayson and Sally Clark providing opportunities to practice the skills required by providers of the ANFPP. The core training consists of both self-directed and face-to-face modules, called units. While Unit 1 introduces the theory and elements of the program, it is in Units 2 and 3 that the program comes alive for the participants, as the 'how' of the program. Developing online resources for training In September 2009 work began in earnest to develop stage one of the proposed online learning strategy. The Support Service engaged the expertise of the elearn Australia team to develop the NHV Unit 1 module in a more interactive online learning medium. NCAST Keys to CareGiving - Pam Stilling Pam Stilling, RN, RM, MCHN, and certified NCAST trainer has recently completed Keys to CareGiving and Teaching Scale Workshops for all home visiting staff at the Wave 1 ANFPP sites. Recognising and responding to infant engagement and disengagement behavior (cues) are important steps in being able to relate to babies and provide sensitive care. When Nurse Home Visitors know about these concepts and communicate them to parents, parents are empowered in their relationships with their infants. The Keys to CareGiving workshop has been designed to give service providers, parents and caregivers this knowledge. The NCAST Parent-Child Interaction Teaching Scale is a reliable and valid means of observing and rating interactions between caregivers and their children. Scores from interactions with children as young as three months of age show a significant association with subsequent measures of attachment, resilience and cognitive abilities. NHVs who demonstrate an 85 per cent reliability in rating parent-child interactive patterns at the workshops are able to use the scales to observe caregiver and child interaction. Through these observations the NHV is able to identify strengths as well as identifying learning opportunities that can be facilitated through future home visits. A testbed for the online learning system known as Moodle was created and the interface for the welcome page was designed. This was shared with ANFPP sites via the virtual classroom and web conferencing tool, Elluminate. Feedback from staff indicated they would accept photos of people more readily than the original animated avatars. Staff also suggested audio clips would be more beneficial than text-heavy pop-ups and this was included. One of the most exciting outcomes of the project has been the increased acceptability and use of Elluminate. We have also been able to use still photos from the DVD training resources which provide information on Motivational Interviewing, Reflective Practice and Early Infant Communication which ties the learning materials together nicely and has brought the Unit 1 materials to life. Photo: Pam and class at Congress Pam, who was recently awarded the Anita Spietz Teaching Excellence Award by NCAST, provided well facilitated interactive sessions, with all teams showing high levels of engagement. The NHV Unit 1 online module went live for Wave 2 sites to access from January 27 2010. 5
Tropic Productions: Developing the Training DVDs The ANFPP Support Service Education Team, in collaboration with Tropic Productions, have produced training DVDs on Motivational Interviewing, Reflective Practice and Early Infant Communication. Jan Cattoni, the director of Tropic Productions who has previously had a career in paediatric nursing before becoming a film maker, said she was able to use her combined experiences in the project. "The ANFPP project helped combine my background in health care with a strong interest in working with Indigenous people in previous projects and it was a great opportunity to collaborate with the ANFPP Home Visiting Teams," Ms Cattoni said. A number of infant communication scenarios were filmed in Alice Springs and the surrounding areas, using children from one month to two years old, with parents and extended family members. Ms Cattoni identified a number of challenges associated with filming in such remote settings. "On first meeting our families, the purpose of the footage was discussed and families were genuinely interested that the footage was to be used for mothers, nurses and Family Partnership Workers," she said. She said the communities were very welcoming as some of the filming participants were already aware of the good work of ANFPP. This made the filming context easier for them to understand. "As a result, we now have some very good footage of baby and toddler communication in both town and community settings," Ms Cattoni said. Fathers can play an important role in a child s development. A photo still from the training DVD on infant communication in Alice Springs Working with small babies and cameras brings unique challenges. "Because we were shooting on verandas and outdoors it was hard to hide the camera and ourselves from the baby s view," Ms Cattoni said. "Many of the babies were naturally curious and immensely interested in the camera, so you couldn t always be a fly on the wall. "We shot the Reflective Practice scenes in Cairns and it was great to have the involvement of the Wuchopperen ANFPP staff in the A Nurse Supervisor demonstrates some of the micro-skills in good communication with a Nurse Home Visitor: photo still from the training DVD on Reflective Practice in Cairns. filming process." Ms Cattoni also shared some of the production experiences during the script development of the Reflective Practice scenario. "Once we had the script developed by the content experts, we then moved to a process of script rehearsal," she said. "This gives those involved in the acting an opportunity to rehearse in an atmosphere that allows people to get to know each other and share ideas that make the content of the script a lot more natural." This script rehearsal process allowed time for participants to explore the script and generate possible suggestions to simulate a more natural and real process. During the filming the cast reflected on their own performances and refined them with each take. The cast quickly adjusted to the filming cues and had a good understanding of the filming process by the end of the shoot. The Cairns shoot was very successful with good cohesion between the cast and the crew and the working process which was flexible and responsive to the needs of all. The Support Service Education Team were very excited to participate and contribute to the development and production of such contemporary and culturally appropriate resources for use in the program. Ms Cattoni said that "the community's knowledge of the program really helped build trust in the relationships and allowed us access to a number of community people to participate in the filming." 6
Strengthening the role of the Family Partnership Worker: outcomes from the Workshop in Cairns A workshop, held in Cairns on May 5 2009, provided a unique opportunity for Family Partnership Workers (FPWs) from the first wave of implementing sites to come together and share learnings in their new roles. This workshop was facilitated by Professor Yvonne Cadet-James and Mary Whiteside from James Cook University. There was a general excitement as the FPWs shared some of the local resources they were using that have contributed to the adaptation of the program by Home Visiting Teams. In addition, the FPWs were able to provide many examples from practice of their developing roles and the unique collaborative partnerships that are forming within Home Visiting Teams, which are contributing to strong intercultural partnerships with the nurses. They discussed how their role contributes to the recruitment of women into the program - through regular information sessions with other service providers and community members - and follow-up referrals by meeting with clients, discussing the ANFPP, and obtaining consent to participate. There was wide-spread agreement that this required knowledge and the development of links with community agencies that are likely to encounter women early in their pregnancies, and should include opportunities to liaise with such agencies as antenatal clinics and school nurses. These agencies will become common referrals sources to the ANFPP. The workshop allowed the FPWs to listen to their colleagues and reflect on experiences regarding their knowledge of the cultural issues and community conditions specific to their implementing sites and how this can help ensure that ANFPP home visiting is provided in a culturally sensitive and contextually informed manner. In identifying the social and emotional wellbeing needs of mothers in the program, one of the FPWs indicated how important it was to keep up to date with the local community resources and to facilitate other family members (non-anfpp clients) use of other needed services. The FPWs shared some of their experiences and roles with their colleagues at the workshop. Sometimes there is a language barrier some [women] speak Creole we have to break it down as they don t understand the [Nurse Home Visitor]. On the first Home Visit with the [NHV] we make the introduction to the Elder of the household, as sometimes the clients are single young mums and it [is] not their home we [are] visiting. We ve been talking about being involved in other groups such as the Cairns Base [Hospital] for the Indigenous antenatal class. We don t want people to be dependent this is what the program is about. [But] there are situations you have to judge. I took one girl to Centrelink [because] she had no money, no ID, didn t feel she could speak English. 7
The Australian Nurse-Family Partnership Program is delivered by the following organisations: Aboriginal & Torres Strait Islander Community Health Service Brisbane, Queensland Central Australian Aboriginal Congress Alice Springs, Northern Territory Victorian Aboriginal Health Service Melbourne, Victoria Wellington Aboriginal Corporation Health Service Wellington, New South Wales Wuchopperen Health Service Cairns, Queensland The Editorial Team invites submissions of stories and articles. These can be sent to: newsletter@anfpp.com.au 8