Bridging the Gap: Partnerships for change in refugee child and family health
Research area: Population Health > Intergenerational Health | Status: Active

Refugee background families are at greater risk of poor health outcomes given their experience of trauma, torture and the challenges of settling into a new country.
We are a partnership program that brings together health service clinicians and managers, policy makers and researchers to bring about sustainable improvements in the quality of maternity and early childhood health care to improve health and health care outcomes for families of refugee background.
We are a partnership program that brings together health service clinicians and managers, policy makers and researchers to bring about sustainable improvements in the quality of maternity and early childhood health care to improve health and health...
We are a partnership program that brings together health service clinicians and managers, policy makers and researchers to bring about sustainable improvements in the quality of maternity and early childhood health care to improve health and health care outcomes for families of refugee background.
Overview
The Bridging the Gap partnership formed in recognition that refugee background families are at greater risk of poor health outcomes given their experience of trauma and torture and the challenges in settling in a new country. Universal health systems face difficulties in ensuring their services are accessible and responsive to the needs of refugee background families.
Our vision
The Bridging the Gap partners have developed a vision for what they would like to achieve to improve health and health care for families.
Women & families who feel:
- Respected and treated with dignity
- Engaged and confident
- Safe
- Their experience & needs are understood & valued
- They can communicate and be heard
Services that are:
- Welcoming
- Responsive
- Connected and well integrated
- Seamless
- Flexible
- Family centred
- Multidisciplinary
Workers who are:
- Knowledgeable
- Sensitive
- Culturally aware
- Well supported
The program includes multiple quality improvement projects that are being implemented in four maternity hospitals (Western Health and Monash Health) and two local government maternal and child health services (Cities of Wyndham and Greater Dandenong) with an evaluation of process and outcomes occurring concurrently.
Together, the partnership has been developing projects that will lead to:
- earlier and better identification of families of refugee background
- opportunities for clinicians and front-line staff to build their understanding of the refugee experience through training and professional development
- building system capacity to support families in accessing care, including the provision of language services
- greater continuity of care for families of refugee background
- alternative ways of providing clinical care and health education that engage bicultural workers and interpreters
- enhanced health literacy
- improved linkages and referral systems between health and local support service providers
- community engagement in service planning
- more seamless, integrated care across maternity and early childhood health services.
Program profile
Bridging the Gap quality improvement initiatives are many and varied and run simultaneously. Projects are co-designed by the partners using evidence to inform planning, with quality improvement activity implemented using the Plan-Do-Study-Act (PDSA) framework.
PDSA is a pragmatic method for implementing and testing iterative changes through small rapid cycles of improvement with flexibility to adapt change according to feedback.
Bridging the Gap has developed on the premise that individual care providers are best enabled to provide quality care with knowledge, skills and systems in place that support them to do so. We highlight several demonstration and quality improvement projects below.
Building workforce capacity in caring for refugee background families
Bridging the Gap has seen significant training and professional development activity across the health sectors and regions. Partners identified that building workforce capacity to “do things differently” in caring for families of refugee background was a fundamental component of Bridging the Gap.
In Melbourne’s west, we made training available to partners on the day of the launch of Bridging the Gap in 2014. In the morning, launch attendees took part in Foundation House’s refugee experience training tailored to the context of motherhood and young families.
In the afternoon, maternity clinicians and maternal and child health nurses took part in a professional development activity with a focus on responding to trauma using Foundation House’s recovery framework.
Booking clerks and front of house staff came together for a training session “First impressions” and worked together on better ways to identify and support refugee background women at the point of entry into the health system.
The Bridging the Gap partnership joined forces for a full day training program in Melbourne’s south east in May 2015 and again in October 2016. These days were a culmination of a collaborative effort of a working group spanning different departments within Monash Health, City of Greater Dandenong staff, Foundation House and MCRI.
Over 100 participants have taken part in refugee experience training and attended co-facilitated sessions, including incidental counselling, safety planning, case management, working with interpreters and identification of families of refugee background. The working group has ensured that we position the training modules for sustainability.
Professional development supports clinicians working on specific Bridging the Gap projects, for example, the Healthy Happy Beginnings program and in-services sessions at Monash Health to support staff in improving women’s access to interpreters in labour.
Recently, maternal and child health nurses in Wyndham and midwives from Mercy Werribee met together for an afternoon of professional development, including the refugee experience with a focus on life in a refugee camp on the Thai/Burma border and working well with interpreters.
At Sunshine Hospital, obstetric registrars and midwives attended two afternoons exploring some of the issues that may explain poorer outcomes for people of refugee background and ways to enable trauma informed maternity care.
Attendees have been overwhelmingly positive about the professional development offered, commenting"
"It gave me insight in the client's lived experience. The insight will enable me to provide more compassion in my care."
"as a result, I will be more aware of supporting staff to support and care for women and families"
"I found most useful the discussion about what situations may trigger previous experiences - relevant to my work as a clinician"
Research team
Many people are involved in Bridging the Gap, including clinicians, managers, policy makers and researchers.
Program Steering Group and Study Investigators
Principal investigator
Jane Yelland
Murdoch Children's Research Institute
Investigators
Elisha Riggs
Murdoch Children's Research Institute
Stephanie Brown
Murdoch Children's Research Institute
Sue Casey
Victorian Foundation for Survivors of Torture
Fiona Mensah
Murdoch Children's Research Institute (Investigator)
Sharon Goldfeld
Murdoch Children's Research Institute
John Furler
University of Melbourne
Jo Szwarc
Victorian Foundation for Survivors of Torture
Sue Willey
Monash University
Rhonda Small
La Trobe University
I-Hao Cheng
Monash University
Mary Anne Biro
Monash University
Investigators & implementation site partners
Euan Wallace
Monash Health
Christine East
Monash Health
Glyn Teale
Sunshine Hospital
Bernie Harrison
City of Greater Dandenong
Pauline Petschel
City of Wyndham
Carol McIntyre
City of Wyndham
Catherine Mills
City of Greater Dandenong
Tina Pettigrew
Western Health
Project partners
Colleen Turner
VICSEG New Futures
Natalija Nesvadba
Mercy Public Hospitals
Program facilitator
Wendy Dawson
Murdoch Children's Research Institute
Senior Research Assistant
Dannielle Vanpraag
Murdoch Children's Research Institute
Collaborators
- Murdoch Children's Research Institute
- Victorian Foundation for Survivors of Torture
- Monash Health
- Western Health
- City of Wyndham
- City of Greater Dandenong
- Department of Health and Human Services
- Department of Education and Training
- Municipal Association of Victoria
- Mercy Hospitals Victoria (project partner)
- Victorian Cooperative on Children's Services for Ethnic Groups (project partner)
Funding
Bridging the Gap: addressing refugee inequalities through primary health care service reform is supported by contributions from the partner organisations and a partnership grant from the National Health and Medical Research Council (2013-2017).
Publications
Improving the ascertainment of refugee background people in health data sets and health services. Australian Health Review 2017
This paper reports how women of refugee background can be identified in maternity and early childhood health services using four routinely collected data items, and a set of questions as a guide for clinicians to use in consultations.
Cultural safety and belonging for refugee background women attending group pregnancy care: an Australian qualitative study. Birth 2017
Reports Karen women’s experiences of participating in the first year of Healthy Happy Beginnings, concluding that the inter-agency group pregnancy care model has potential to increase women’s access to pregnancy care, sense of belonging and cultural safety using services, preparation for birth and care of a newborn.
Bridging the language gap: a co-designed quality improvement project to engage professional interpreters for women duing labour. Australian Health Review 2016
Reports the learnings and achievements of the Language in Labour initiative, a co-designed multi-faceted project that resulted in a three-fold increase in the number of women who had a professional interpreter in labour.
Improving health literacy in refugee populations. MJA 2016; 204(1):9
A commentary on the importance of health literacy to ensure that people of refugee background have the confidence, support and resources to manage their health.
Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities. Implementation Science 2015; 10:62
This paper tells the story of the evidence behind Bridging the Gap, how the partnership was formed and the iterative, co-designed approach to quality improvement. The evaluation, including the time-series design and process measures, are also described.
Having a baby in a new country: the views and experience of Afghan families and stakeholders
The Bridging the Gap program builds on the findings of the Having a baby in a new country study undertaken by Murdoch Children's Research Institute and Victorian Foundation for Survivors of Torture.
Findings from the study:
Final report - Having a baby in a new country; The views and experiences of Afgan families and stakeholders459.23 KB
- Ectopic pregnancy and miscarriage: summary of NICE guidance - BMJ Rapid Response from the Afghan study
- How do Australian maternity and early childhood health services identify and respond to the settlement experience and social context of refugee background families? BMC Pregnancy & Childbirth 2014; 14:348.
- Promoting the inclusion of Afghan women and men in research: reflections from research and community partners involved in implementing a 'proof of concept' project. International Journal for Equity in Health 2015; 14:13
- Compromised communication: a qualitative study exploring Afghan families and health professionals experience of interpreting support in Australian maternity care. BMJ Quality & Safety 2015
- Fatherhood in a new country: a qualitative study exploring the experiences of Afghan men and implications for health services. Birth 2015
- Afghan families and health professionals' access to health information during and after pregnancy. Women and Birth 2019
Contact us
Bridging the Gap
Murdoch Childrens Research Institute
The Royal Children's Hospital
Flemington Road
Parkville VIC 3052
Australia
Phone: +61 3 9936 6673
Email:
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