Sharing stories, supporting mums

A day in the life of a NHV

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Wellington goes green for Sorry Day

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Congratulations Deslie, Nancy and Neari

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ANFPP Stage 1 Evaluation Report

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Connecting with colleagues in Canberra

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Partners in Parenting Education Training

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Inside this issue:

Twelfth Edition July 2013

Message from the Team Leader

This issue of the newsletter hopes to share some insight into the everyday tasks of the Australian Nurse-Family Partnership Program (ANFPP). “A day in the life of a Nurse Home Visitor (NHV)” provides some insight into a “typical” single working day for a member of the ANFPP, giving us a small glimpse of the activities involved in home visiting. In this article, Jane Boulton, a NHV at Central Australian Aboriginal Congress gives us a glimpse into her experiences visiting clients in a remote community near Alice Springs in the Northern Territory.

It is a great account of the personal determination and resourcefulness required of program staff. The flexibility demonstrated by Jane and Jasmine Campbell, Aboriginal Community Worker (ACW), show a true commitment to their clients. On 26 May, Australia recognised National Sorry Day, which commemorates, remembers and honours the Stolen Generations and acknowledges those who were affected by the removal of generations of Aboriginal children as a result of the forced removal policies. The team at the Wellington Aboriginal Corporation Health Services recognised this day by creating a wall garden with their clients and babies, which was a well-received, thoughtful and unique gesture of acknowledgement and appreciation. The Stage 1 Formative Evaluation of the ANFPP is now publicly accessible on the ANFPP website. This is a significant development for the program as it examines how appropriate and effective the program has been to date and its contribution to the health and wellbeing of Indigenous mothers and their babies. The report provides key findings and recommendations around the program implementation against this initial evaluation phase. It is always appreciated when we are provided with the opportunity to recognise and acknowledge the great aspects and achievements of

ANFPP. This was made possible during the biennial national conference of the Australian Association of Maternal, Child and Family Health Nurses in May, where three program staff had the opportunity to connect with colleagues in Canberra and showcase the role of Family Partnership Workers (FPWs)/ACWs in the ANFPP. The core training and ongoing professional development of our staff remains a key aspect of the program’s ability to maintain fidelity to its program model and effectiveness for its clients. As part of this ongoing professional development we have seen three of the FPWs at Wuchopperen Health Service gain recognition of prior learning towards a Diploma of Community Services. New staff also took part in the Partner in Parenting Education (PIPE) training with the support of a highly-respected international trainer, Christine Russell. Her knowledge and breadth of the program is a valuable asset to the ANFPP. As the program looks to the second half of 2013, we look forward to sharing more of the ANFPP activities and achievements. Claire Runciman ANFPP Support Service Team Leader

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Reflections: A Day in the Life of a Nurse Home Visitor

Jane Boulton, Nurse Home Visitor (NHV) from Central Aus-tralia Aboriginal Congress (CACC) recently shared her expe-riences working with the ANFPP. Each Wednesday, two teams, consisting of one NHV and one Aboriginal Community Worker (ACW) make the trip out to Santa Teresa, an Aboriginal community located approxi-mately 85km south-east of Alice Springs. It’s a long and tir-ing day; however it’s incredibly rewarding and exciting to take such a beneficial program out to community.

The Family Partnership Program (as the ANFPP is known at Congress) is well accepted in Santa Teresa, everyone seems to know someone or is related to someone who is currently on the program or who has graduated from the pro-gram. Jasmine Campbell (ACW) and I are currently visiting five women in Santa Teresa, all of whom are currently re-ceiving pregnancy home visits. Anissa Thompson (NHV) and Tinky Watson (ACW) see the other clients who are also on the program in Santa Teresa. Prior to traveling to Santa Te-resa, I try to plan my day out, but not once have my visits turned out the way I had planned! Here is a little overview on how my day can pan out. My first visit takes place with a woman who is expecting her third child; she works at the Child Care centre which is locat-ed at the Women’s Centre. Our visits usually take place in the activities room while the older children are outside play-ing and she rocks a baby to sleep in a pram. Jasmine doesn’t sit with us throughout our visits as Jasmine is family to my client’s partner and she would prefer if Jasmine wasn’t involved in her visits. This is generally my only client at San-ta Teresa who I know I can always find. As for the other

women, they are often busy or in town; that is one of the challenges visiting Santa Teresa. After my first visit at the Women’s Centre and a quick chat to the others who work there, it’s off to try and find the other women, who are often at a different house each week. We call the women to see if they are in town; if the women an-swer their phones or it’s not being used by someone else it can make locating them easier. After a few phone calls and stops at different houses we find my next client; she doesn’t like having her visits at the house because of all the family around, so we are off to the clinic to have our visit. Jasmine sits with us during these visits, as does her older son. Once we have completed our visit and dropped her home the same process takes place to find my next client, who is expecting her first baby. Today she is at her partner’s aunt’s house; our visit takes places under the veranda of the house sitting on a picnic rug. Our visit is frequently interrupted by family walking by, dogs annoying us or even the occasional pony just popping in to see what we are up to, all providing some light entertainment throughout the visit. We also cele-brate her 20th birthday today with some of the family from inside the house who came out to sing happy birthday and enjoy some cake. It felt very special to be part of her birthday celebration. From here, it’s off to find another client; she is not at her usu-al house, her family tell us she is staying with her boyfriend. We go to his home but no one is there. Some young boys walking home from school tell us that the woman we are looking for has gone to town for the day. I quickly write out a note to her saying I will be back next week, if she has any worries to please call or to let her know if she is going to town again to pop into our office in Alice Springs. The young

Jane Boulton (NHV) and Jasmine Campbell (ACW) on their way to a home visit in Santa Teresa.

The road to Santa Teresa

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Simone and Jane (NHV) on a home visit

boys assure me they will pass on the note. These are the only women we planned to visit today; if I do happen to see my other client around town or at the store, Women’s Centre or I drive past her house I stop to say a quick hello and remind her we will be back next week for a visit. Our final stop for the day is back up to the clinic to check in with the midwife or nurse to see if they are aware of any other pregnant women and touch base with them about the ANFPP clients. After this, it’s time to head back to town, hoping that we don’t get a flat tyre or have an encounter with the cows, horses or other animals hanging out on the side of the road and enjoy some lunch along the way. My weekly visit to Santa Teresa is something I look forward to and thoroughly enjoy. I feel so privileged to be part of these women’s lives in some small way, and enjoy greatly what each woman teaches me, their generosity in sharing with me insights about their lives, family and culture.

Reflections: A Day in the Life of a Nurse Home Visitor (continued)

Flat tyre on the way to Santa Theresa

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Congratulations Deslie, Nancy and Neari!

Wellington goes green for Sorry Day

Recently, to mark Sorry Day with the clients at Wellington Aboriginal Corporation Health Service (WACHS), the ANFPP team participated in the creation of a wall garden made from recycled shipping pallets at Buninyong School as Communi-ty Centre. The team at WACHS has an enthusiastic relationship with the Buninyong Art Buddies (BABS) program, which operates from the Buninyong School and features a range of art-based activities that ANFPP clients participate in. The BABS program has been running since last June and BABS mem-bers considered a range of ideas to mark Sorry Day, which led to the idea of building a small garden that could be launched on the day with a barbeque breakfast for everyone. The ANFPP clients who are a part of the BABS program loved the experience of building the garden. The garden was a community event and was built by Indigenous and non-Indigenous members of the community and the Buninyong School. The garden, which is built from recycled materials, has a range of natives, flowers, shrubs and water resistant plants. Growing a garden was considered significant to Sorry Day as it reflects growing, healing and changing life. It was erect-ed on a wall at the Buninyong School for visitors to see and enjoy. The children learnt about Sorry Day as a part of the activity and the garden is a reminder of what the day repre-sents. Next year, these plants will be planted in the gardens

around the school and more plants will be planted in the wall garden in a process of continuous growth symbolic of the way that healing our past is a process of continual growth

and renewal.

Three of the Family Partnership Workers (FPWs) from Wu-chopperen Health Service recently completed a process to gain recognition of prior learning (RPL) for the Diploma of Community Services. FPWs undertake a range of activities as a part of the ANFPP, including working with communities and clients as a part of the home-visiting team. In the course of this work, FPWs develop a range of communication, community devel-opment and program-specific skills and competencies. To recognise this bank of knowledge and experience, three members of the ANFPP team at Wuchopperen, Neari van Hooren, Deslie Dempsey and Nancy Mosby-Kirk worked with a registered training provider and the ANFPP to develop a portfolio of documentation that would support their applica-tion to the diploma. The decision to pursue this external qualification was made as a team, although as individuals several members were already aware that they had a strong background of work-place training and on-the-job experiences that may be suita-ble for the diploma. Although it was an extensive process to provide documentation of current and past work experienc-es, skills and knowledge against the modules, all three

FPWs found that the experience was worthwhile to have their accumulated skill sets formally recognised. As Deslie reflected:

Deslie’s comments were echoed by Neari, who said that “it felt good that we were able to reflect on our knowledge and skills and be recognised that we do have a good under-standing and knowledge base around working with families and communities”. Neari now has an appetite for further training, perhaps in Promotion and Marketing following this experience. Congratulations from the whole ANFPP team on this won-derful achievement and recognition!

WACHS wall garden in Dubbo, New South Wales

“Over the years, I had done studies and worked in many departments, which I believed I could get RPL. It does make you realise when you help or assist clients that your role plays a big part in all walks of life, no matter what type of work you are employed in.”

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ANFPP Stage 1 Evaluation Report

The ANFPP is pleased to announce that the Stage 1 Forma-tive Evaluation of the program has been released on the ANFPP website (www.anfpp.com.au) and is available for download and distribution. The evaluation, which was developed under the ANFPP Evaluation Framework, was based on an analysis of qualita-tive and quantitative data from the program, its stakeholders and clients. Both the evaluation team and participating stakeholders were pleased to receive the report, which will be used to inform and improve the program’s delivery, and subsequent program monitoring and evaluation. It was timely that the evaluation was able to take into con-sideration recent literature from the Nurse-Family Partner-ship program in the United States and the United Kingdom. For a copy of the report, please go to: www.anfpp.com.au/evaluation

In May, Neari van Hooren (Wuchopperen Health Service), Jasmin Cockatoo-Collins (Wuchopperen Health Service) and Janice Finlayson (ANFPP Support Service) attended the “Connections” conference to share information about the development of the Family Partnership (FPW) training curric-ulum in the ANFPP. Connections, which is the biennial national conference of the Australian Association of the Maternal, Child and Family Health Nurses, was held this year in Canberra and focused on:

Connecting and working in partnership with families

Connecting and engaging with communities

Connecting professionally with colleagues.

The ANFPP group presented on the theme of “connecting professionally with colleagues” and showcased how a focus on strengths has helped find solutions in the area of collabo-rative practices and workforce development. While the ANFPP is based on the Nurse-Family Partnership (NFP) Program from the United States - an extensively re-searched (including three randomised controlled trials) and evidence based program, however, the introduction of the Family Partnership Worker role was a significant Australian adaptation of the NFP program. The main aim of the FPW role is to promote trust and re-spect between the clients and their family, the local Aborigi-nal and Torres Strait Islander community, the wider commu-

nity, the ANFPP team, and other health providers. However, as there had never been an Indigenous-specific role includ-ed in any national or international NFP replication site be-fore, systems need to be developed to support the FPW role to achieve its intended aim. The goal was simple and clear: to develop and support a new role in the program. While everyone was committed to the goal, there were considerable challenges in determining how best it might be achieved. The presentation described the processes that brought about the development; design and implementation of the role and the associated training. Jasmin and Neari introduced the presentation at the confer-ence using a case study of a client whom they had support-ed to illustrate the breadth and importance of the role. Then Janice, Neari and Jasmin shared their perceptions and frus-trations of the process through which the role emerged, was documented, and subsequently distilled into a training pack-age. The case study demonstrates the importance of providing extensive opportunities for pioneers in new roles to discuss and develop their ideas about their roles. Our experience is that it is not reasonable to expect new workers in a program to be able to document what they do, develop procedures and protocols for themselves, build a platform for training and to mentor new staff. External support is required to do this. Further, it is likely that many “different avenues” will be explored before a way forward is agreed and documented for learning by the next generation of workers in the role.

Connecting with colleagues in Canberra

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Partners in Parenting Education Training

Recently, new members of ANFPP teams from all imple-menting sites undertook training in Partners in Parenting Education (PIPE) with international trainer, Christine Rus-sell. PIPE is an interactive parent and child education model that focuses on supporting mothers to emotionally connect with their infants, whilst also giving them important information and knowledge about infant cues and healthy behaviours. PIPE is an interactive and relationship-based curriculum and instructional model that is designed to increase the emotional availability and relationship building skills of par-ents/caregivers with young children. PIPE is incorporated into the ANFPP to increase awareness of attachment behaviours between mothers and their in-fants. PIPE emphasises how listening, learning and playing can enable healthy and fulfilling relationship between moth-ers and their infants. As the participants described:

“[PIPE] is a curriculum that has been developed to help young parents to connect with their infants and under-stand that attachment process…it’s about managing your emotions and we all know how important it is for the development of our brain to actually form at least one strong attachment with one known care giver. So the idea behind PIPE is for [Nurse Home Visitors] to help young parents form those attachments with their babies” - Tiffany Lohs, Nurse Home Visitor (NHV) (Central Australian Aboriginal Congress).

“[PIPE provides] a positive way for the NHVs to interact with the Indigenous mothers in the program…it’s an easy way to learn” - Joy Malam, Nurse Supervisor (Wuchopperen Health Service)

This year’s PIPE training was delivered by Chris Russell a public health nurse with over 35 years of experience. Chris

has been involved with the United States Nurse-Family Partnership (NFP) Program since 1994, when she was se-lected to be one of the 10 NHVs to take part in the NFP ran-domised control trial in Denver in 1994. During her time in the program she has held a variety of roles, including NHV, Nurse Supervisor and Nurse Educator. With over 30 years of experience Chris brings an extraordinary wealth of knowledge, combined with and balanced by clinical and program specific experiences. She presented valuable, pro-gram specific training methods that were beneficial in theory and in practice. As one trainee said:

“[it’s] good to learn from the best” Chloe Cassar, NHV (Wuchoperren Health Service)

While for Tiffany Lohs, NHV (Central Australian Aboriginal Congress):

“[the most useful aspect of PIPE was] Chris telling her stories. Just hearing how it works with different clients, how [Chris] chooses topics for different clients, what her thinking process is and why she chooses specific topics for different things… I like hearing an expert’s process, it’s really beneficial to get that and understanding how someone else is processing something.”

As part of the ANFPP core training activities, PIPE was de-livered to new NHVs and one Nurse Supervisor from two implementing sites. The training focused on providing the program’s nurses with key strategies and tools that can be used to educate mothers on their own wellbeing and their child’s needs. It also gave the nurses key skills to delivery these messages effectively and appropriately. Like any new approach, having not heard of or partaken in PIPE before, it can be difficult for some NHVs to understand the depth and importance of PIPE to the ANFPP and to fully appreciate its advantages.

Tiffany Lohs (NHV CAAC) and Chloe Cassar (NHV WHS) during an interactive role play

Chris Russell (PIPE Facilitator), and Tiffany Lohs (NHV Congress)

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The PIPE training provides a twofold approach to care that involves understanding infant behaviours and the mother’s physically and psychological capacity to care for her baby. Whilst acknowledging the importance of infant cues and good health behaviours, it also looks at promoting maternal mental health and providing nurses with the right tools to adequately engage and build the confidence and capacity of mothers in the program. By addressing this holistic approach to parenting, PIPE en-courages a cycle of care that acknowledges the importance that self-efficacy, working in partnership and family orientat-ed models of care can have on an infant’s wellbeing.

“Promoting maternal mental health [is especially useful] towards the end of that pregnancy stage… good way to brighten up [the pregnancy] and make it a bit more inter-active and fun… anything to increase the communication between mum and baby while it’s still in the uterus is fantastic” Jane Boulton, NHV (Congress).

For the nurses attending the training it was clear to see the importance and value of PIPE. Each received valuable knowledge on how to enable their clients to build a connec-tive and positive relationship with their children both emo-tionally and physical. Interesting to note, was the practical value that PIPE provided to the nurses, and how the training enhanced their capacity to educate and transfer key con-cepts and practices to their clients. As Chloe Cassar, NHV from Wuchopperen said:

“PIPE is a fantastic way to deliver the program, each topic teaches something different and a new concept to a parent [which] for a lot of our mums, they are things that they have never thought to do with their baby [and are] quite foreign things. So by teaching them different concepts it allows them to broaden their parenting scope”.

Congratulations to the team for a successful training!

Partners in Parenting Education Training (continued)

L-R: Chris Russell (PIPE Facilitator), Tiffany Lohs (NHV CAAC) Jane Boulton (NHV CAAC) and Chloe Cassar (NHV WHS)

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The Australian Nurse-Family Partnership Program is delivered by the following organisations:

Central Australian Aboriginal Congress Alice Springs, Northern Territory

Ground Floor, Jock Nelson Centre

Suite 1, 16 Hartley St, Alice Springs NT 0870 Ph: (08) 8958 4850

www.caac.org.au

Wellington Aboriginal Corporation Health Service Wellington, New South Wales

68 Maughan Street, Wellington NSW 2820

Ph: (02) 6845 2565

www.wachs.net.au

Wuchopperen Health Service Cairns, Queensland

13 Moignard St, Manoora QLD 4870

Ph: (07) 4080 1000

www.wuchopperen.com

The Editorial Team invites submissions of stories and articles. These can be sent to: newsletter@anfpp.com.au