Karen Block

Expanding Children's Food Experiences: The Impact of a School-Based Kitchen Garden Program

OBJECTIVE Evaluate achievement of the Stephanie Alexander Kitchen Garden Program in increasing child appreciation of diverse, healthy foods. DESIGN Comparative 2-year study. SETTING Six program and 6 comparison primary schools in rural and metropolitan Victoria, Australia, matched for socioeconomic status and size. PARTICIPANTS A total of 764 children in grades 3 to 6 (8-12 years of age) and 562 parents recruited. Retention rates at follow-up included 85% children and 75% parents. INTERVENTION Each week of the school year, children spent 45 to 60 minutes in a garden class and 90 minutes in a kitchen class. PHENOMENON OF INTEREST Program impact on childrens willingness to try new foods, capacity to describe foods, and healthy eating. ANALYSIS Qualitative data analyzed using inductive thematic analysis. Quantitative data analyzed using random-effects linear regressions adjusted for school clustering. RESULTS Child and parent qualitative and quantitative measures (if never tried before, odds ratio 2.0; confidence interval, 1.06-3.58) showed increases in childrens reported willingness to try new foods. No differences in articulation of food descriptions (program vs comparison groups). Qualitative evidence showed that the program extended its influence to healthy eating, but this was not reflected in the quantitative evidence. CONCLUSIONS AND IMPLICATIONS Findings indicate program success in achieving its primary objective, meriting further program research.

Accessing maternal and child health services in Melbourne, Australia: Reflections from refugee families and service providers

BackgroundOften new arrivals from refugee backgrounds have experienced poor health and limited access to healthcare services. The maternal and child health (MCH) service in Victoria, Australia, is a joint local and state government operated, cost-free service available to all mothers of children aged 0–6 years. Although well-child healthcare visits are useful in identifying health issues early, there has been limited investigation in the use of these services for families from refugee backgrounds. This study aims to explore experiences of using MCH services, from the perspective of families from refugee backgrounds and service providers.MethodsWe used a qualitative study design informed by the socioecological model of health and a cultural competence approach. Two geographical areas of Melbourne were selected to invite participants. Seven focus groups were conducted with 87 mothers from Karen, Iraqi, Assyrian Chaldean, Lebanese, South Sudanese and Bhutanese backgrounds, who had lived an average of 4.7 years in Australia (range one month-18 years). Participants had a total of 249 children, of these 150 were born in Australia. Four focus groups and five interviews were conducted with MCH nurses, other healthcare providers and bicultural workers.ResultsFour themes were identified: facilitating access to MCH services; promoting continued engagement with the MCH service; language challenges; and what is working well and could be done better. Several processes were identified that facilitated initial access to the MCH service but there were implications for continued use of the service. The MCH service was not formally notified of new parents arriving with young children. Pre-arranged group appointments by MCH nurses for parents who attended playgroups worked well to increase ongoing service engagement. Barriers for parents in using MCH services included access to transportation, lack of confidence in speaking English and making phone bookings. Service users and providers reported that continuity of nurse and interpreter is preferred for increasing client-provider trust and ongoing engagement.ConclusionsAlthough participants who had children born in Melbourne had good initial access to, and experience of, using MCH services, significant barriers remain. A systems-oriented, culturally competent approach to service provision would improve the service utilisation experience for parents and providers, including formalising links and notifications between settlement services and MCH services.

Growing Community: The Impact of the Stephanie Alexander Kitchen Garden Program on the Social and Learning Environment in Primary Schools

This article presents results from a mixed-method evaluation of a structured cooking and gardening program in Australian primary schools, focusing on program impacts on the social and learning environment of the school. In particular, we address the Stephanie Alexander Kitchen Garden Program objective of providing a pleasurable experience that has a positive impact on student engagement, social connections, and confidence within and beyond the school gates. Primary evidence for the research question came from qualitative data collected from students, parents, teachers, volunteers, school principals, and specialist staff through interviews, focus groups, and participant observations. This was supported by analyses of quantitative data on child quality of life, cooperative behaviors, teacher perceptions of the school environment, and school-level educational outcome and absenteeism data. Results showed that some of the program attributes valued most highly by study participants included increased student engagement and confidence, opportunities for experiential and integrated learning, teamwork, building social skills, and connections and links between schools and their communities. In this analysis, quantitative findings failed to support findings from the primary analysis. Limitations as well as benefits of a mixed-methods approach to evaluation of complex community interventions are discussed.

Supporting schools to create an inclusive environment for refugee students

In a context of increasing numbers of refugees and asylum seekers globally, recognition of the importance of the school environment for promoting successful settlement outcomes and inclusion for refugee-background young people is growing. Yet schools may be poorly equipped to recognise and respond to the multiple challenges faced by children and young people who must learn a new language while grappling with unfamiliar educational and social systems. Refugee-background students often have minimal or significantly disrupted formal education prior to arrival in their new country. Young people, and sometimes their families, may lack literacy in first languages and many are coping with the impacts of trauma associated with forced displacement. Evidence for effective interventions in schools that promote an inclusive learning environment is scarce. This paper presents the results of an evaluation of the School Support Programme operating in schools in Victoria, Australia. The programme is provided to networks of schools in a region and facilitates partnerships between schools and agencies and provides a holistic model for a whole-school approach focused on the learning, social and emotional needs of refugee-background students. The evaluation concluded that the programme provides an appropriate and feasible model that supports the capacity of schools to provide an inclusive education for this group.

Psychological outcomes following the Victorian Black Saturday bushfires

Objective: We aimed to map the prevalence and predictors of psychological outcomes in affected communities 3–4 years after the Black Saturday bushfires in the state of Victoria, Australia. Methods: Baseline assessment of a longitudinal cohort study in high-, medium-, and low-affected communities in Victoria. Participants included 1017 residents of high-, medium-, and low-affected fire communities. Participants were surveyed by means of a telephone and web-based interview between December 2011 and January 2013. The survey included measures of fire-related post-traumatic stress disorder (PTSD) and general PTSD from other traumatic events, major depressive episode, alcohol use, and general psychological distress. Results: The majority of respondents in the high- (77.3%), medium- (81.3%), and low-affected (84.9%) communities reported no psychological distress on the K6 screening scale. More participants in the high-affected communities (15.6%) reported probable PTSD linked to the bushfires than medium- (7.2%) and low-affected (1.0%) communities (odds ratio (OR): 4.57, 95% confidence interval (CI): 2.61–8.00, p = 0.000). Similar patterns were observed for depression (12.9%, 8.8%, 6.3%, respectively) (OR: 1.83, 95% CI: 1.17–2.85, p = 0.008) and severe psychological distress (9.8%, 5.0%, 4.9%, respectively) (OR: 2.08, 95% CI: 1.23–3.55, p = 0.007). All communities reported elevated rates of heavy drinking (24.7%, 18.7%, 19.6%, respectively); however, these were higher in the high-affected communities (OR: 1.39, 95% CI: 1.01–1.89, p = 0.04). Severe psychological distress was predicted by fear for one’s life in the bushfires, death of someone close to them in the bushfires, and subsequent stressors. One-third of those with severe psychological distress did not receive mental health assistance in the previous month. Conclusions: Several years following the Black Saturday bushfires the majority of affected people demonstrated resilience without indications of psychological distress. A significant minority of people in the high-affected communities reported persistent PTSD, depression, and psychological distress, indicating the need for promotion of the use of health and complementary services, community-based initiatives, and family and other informal supports, to target these persistent problems.

Beyond Bushfires: Community, Resilience and Recovery - a longitudinal mixed method study of the medium to long term impacts of bushfires on mental health and social connectedness.

BackgroundNatural disasters represent an increasing threat both in terms of incidence and severity as a result of climate change. Although much is known about individual responses to disasters, much less is known about the social and contextual response and how this interacts with individual trajectories in terms of mental health, wellbeing and social connectedness. The 2009 bushfires in Victoria, Australia caused much loss of life, property destruction, and community disturbance. In order to progress future preparedness, response and recovery, it is crucial to measure and understand the impact of disasters at both individual and community levels.Methods/designThis study aims to profile the range of mental health, wellbeing and social impacts of the Victorian 2009 bushfires over time using multiple methodologies and involving multiple community partners. A diversity of communities including bushfire affected and unaffected will be involved in the study and will include current and former residents (at the time of the Feb 2009 fires). Participants will be surveyed in 2012, 2014 and, funding permitting, in 2016 to map the predictors and outcomes of mental health, wellbeing and social functioning. Ongoing community visits, as well as interviews and focus group discussions in 2013 and 2014, will provide both contextual information and evidence of changing individual and community experiences in the medium to long term post disaster. The study will include adults, adolescents and children over the age of 5.DiscussionConducting the study over five years and focussing on the role of social networks will provide new insights into the interplay between individual and community factors and their influence on recovery from natural disaster over time. The study findings will thereby expand understanding of long term disaster recovery needs for individuals and communities.

The role of anger and ongoing stressors in mental health following a natural disaster.

Objective: Research has established the mental health sequelae following disaster, with studies now focused on understanding factors that mediate these outcomes. This study focused on anger, alcohol, subsequent life stressors and traumatic events as mediators in the development of mental health disorders following the 2009 Black Saturday Bushfires, Australia’s worst natural disaster in over 100 years. Method: This study examined data from 1017 (M = 404, F = 613) adult residents across 25 communities differentially affected by the fires and participating in the Beyond Bushfires research study. Data included measures of fire exposure, posttraumatic stress disorder, depression, alcohol abuse, anger and subsequent major life stressors and traumatic events. Structural equation modeling assessed the influence of factors mediating the effects of fire exposure on mental health outcomes. Results: Three mediation models were tested. The final model recorded excellent fit and observed a direct relationship between disaster exposure and mental health outcomes (b = .192, p < .001) and mediating relationships via Anger (b = .102, p < .001) and Major Life Stressors (b = .128, p < .001). Each gender was compared with multiple group analyses and while the mediation relationships were still significant for both genders, the direct relationship between exposure and outcome was no longer significant for men (p = .069), but remained significant (b = .234, p < .001) for women. Conclusions: Importantly, anger and major life stressors mediate the relationship between disaster exposure and development of mental health problems. The findings have significant implications for the assessment of anger post disaster, the provision of targeted anger-focused interventions and delivery of government and community assistance and support in addressing ongoing stressors in the post-disaster context to minimize subsequent mental health consequences.

Working better together: new approaches for understanding the value and challenges of organizational partnerships

Inter-agency partnerships are critical for addressing the interrelated circumstances associated with the social and health determinants of health inequalities. However, there are many challenges in evaluating partnership processes and outcomes. We discuss a mixed methods study that explored partnership processes in an innovative program that aims to promote social and economic inclusion for young newly arrived refugees. A theoretically informed evaluation was designed and data collected in three ways: an organizational ethnographic approach; a partnership self-assessment tool and semi-structured interviews. Partnership assessments and interviews were collected at two points in time providing progressive process data. Analyses explore divergent levels of staff satisfaction with the partnerships operations, particularly between staff working in program development (strategic management) and program delivery (service provision) roles. Follow-up data collection indicated satisfaction with partnership processes had improved. The partnership did achieve its aim of increasing the level of cooperation between service providers to support young people from refugee backgrounds. This paper presents insights into how to evaluate inter-agency partnerships and reports both methodological and empirical findings. It provides an approach for a better understanding of the levels at which individuals operate within such partnerships, indicates areas where support and attention is needed.

Methodology for the evaluation of the Stephanie Alexander Kitchen Garden program

ISSUES ADDRESSED Community and school cooking and gardening programs have recently increased internationally. However, despite promising indications, there is limited evidence of their effectiveness. This paper presents the evaluation framework and methods negotiated and developed to meet the information needs of all stakeholders for the Stephanie Alexander Kitchen Garden (SAKG) program, a combined cooking and gardening program implemented in selectively funded primary schools across Australia. METHODS The evaluation used multiple aligned theoretical frameworks and models, including a public health ecological approach, principles of effective health promotion and models of experiential learning. The evaluation is a non-randomised comparison of six schools receiving the program (intervention) and six comparison schools (all government-funded primary schools) in urban and rural areas of Victoria, Australia. A mixed-methods approach was used, relying on qualitative measures to understand changes in school cultures and the experiential impacts on children, families, teachers, parents and volunteers, and quantitative measures at baseline and 1 year follow up to provide supporting information regarding patterns of change. RESULTS The evaluation study design addressed the limitations of many existing evaluation studies of cooking or garden programs. The multistrand approach to the mixed methodology maintained the rigour of the respective methods and provided an opportunity to explore complexity in the findings. Limited sensitivity of some of the quantitative measures was identified, as well as the potential for bias in the coding of the open-ended questions. CONCLUSION The SAKG evaluation methodology will address the need for appropriate evaluation approaches for school-based kitchen garden programs. It demonstrates the feasibility of a meaningful, comprehensive evaluation of school-based programs and also demonstrates the central role qualitative methods can have in a mixed-method evaluation. So what? This paper contributes to debate about appropriate evaluation approaches to meet the information needs of all stakeholders and will support the sharing of measures and potential comparisons between program outcomes for comparable population groups and settings.

Mental Health Following Separation in a Disaster: The Role of Attachment

Short-term separation from close family members during a disaster is a highly salient event for those involved. Yet, its subsequent impact on mental health has received little empirical attention. One relevant factor may be attachment style, which influences patterns of support-seeking under threatening conditions. Individuals (N = 914) affected by the 2009 Victorian bushfires in southeastern Australia were assessed for disaster experiences, depression, posttraumatic stress disorder (PTSD) symptoms, and attachment style 3-4 years after the fires. Using multigroup structural equation modelling, individuals who reported separation from close family members during the bushfires (n = 471) were compared to those who reported no separation (n = 443). Cross-sectional results indicated that separated individuals had higher levels of PTSD symptoms. Furthermore, attachment anxiety was more strongly positively associated with depression among separated (b = 0.62) versus not separated individuals (b = 0.32). Unexpectedly, among separated individuals, attachment avoidance had a statistically weaker association with depression (b = 0.17 vs. b = 0.35) and with PTSD symptoms (b = 0.06 vs. b = 0.22). These results suggest that attachment anxiety amplifies a negative reaction to separation; meanwhile, for avoidant individuals, separation in times of danger may facilitate defensive cognitive processes.