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Burgeoning numbers of child abuse and neglect reports throughout the developed world has prompted calls for preventive and early intervention measures to support and prepare families for parenting. Nurse home visiting is one form of service delivery gaining acceptance as an appropriate strategy. Although home visiting is not a new concept in service delivery, enthusiasm for home-visitation programmes has re-emerged not only in Australia in recent years, but in many other developed countries with initiatives being launched or recommended at state, national and international levels. This thesis presents a review of the tenets of home visiting and examines a home visiting intervention programme targeting children born into families with child abuse or neglect risk factors. A randomised controlled trial using a cohort of 181 families was undertaken to evaluate the impact of this home visiting programme. Mothers were recruited in the immediate postnatal period and allocated either into the home visiting programme or into a comparison group. The research design required self-identification into the study by providing positive responses to a range of risk factors. This procedure was shown to have utility in the context of recruitment to a research trial, in that respondents were willing to disclose sensitive personal issues using this form of screening as the basis for targeted intervention. The home visiting programme examined by this study was also shown to have social validity, with mothers willing to accept this form of intervention from the immediate postnatal period. High retention and satisfaction rates strengthened this conclusion. The ability of this study to evaluate the effectiveness of the home visiting intervention programme may have been compromised by a range of contextual factors influencing programme outcomes detailed in this thesis. Nonetheless, the study found that, for a group of families reporting risk factors for child abuse and neglect potential, provision of an intensive home visiting intervention using nurses, social workers, and parent aides was not effective in producing more favourable adjustment to the parenting role over time compared with nonintervention or clinic based service provision. The intervention programme group participants gained knowledge of child development and child management skills during the early postnatal weeks while the comparison group participants developed knowledge and skills later in the first year of their infant's lift. Early adaptation to the parenting role, parenting knowledge, and skill acquisition bodes well for parent-infant attachment and the children's long-term health and developmental outcomes. However, a 12-month assessment of maternal, family, and child development variables did not demonstrate maintenance of a positive intervention impact on parenting stress, parenting competence, or quality of the home environment. Finally, predictive analysis of fictors measured in the immediate postnatal period revealed an absence of any predictive value to demographic characteristics, which secondary prevention efforts typically target. These results not only demonstrate that there is a relationship between maternal, family and enviromnental factors identified in the immediate postnatal period, and adjustment to the parenting role, but also challenge demographic targeting for child abuse and neglect risk. Findings are discussed and placed within the context of previous research and reference is made to implications for future child health practice, development, and research. Recommendations arising from this discussion relate to both future research and community child health practice.

There has been considerable debate among cognitive psychologists and epidemiologists regarding which determinants of children’s intelligence are most important. Factors such as children’s diet, maternal stress and social support are important for general health and wellbeing, but have received little research attention in longitudinal studies involving cognitive outcomes. Few studies have examined the determinants of intelligence in children born small-for-gestational age (SGA) at term even though these children may be particularly vulnerable to poorer postnatal environments. The aim of this study was to identify factors associated with cognitive ability in middle childhood in New Zealand (NZ) European children and children born SGA. The present research was conducted as part of the Auckland Birthweight Collaborative (ABC) study. Approximately half of the children in this study were born SGA (birthweight<10th percentile) and half were born appropriate-for-gestational age (AGA=birthweight>10th percentile). Information was collected from mothers and children on pregnancy, obstetric, socio-demographic, postnatal and dietary factors when the children were born (n=871), at one year (n=744), 3.5 years (n=550), and 7 years of age (n=591). Cognitive ability was assessed at 7 years using the Wechsler Intelligence Scale for Children – Third Edition. For the total sample, the analyses utilised weighting to allow for the disproportionate sampling of children born SGA. Results showed that SGA and AGA children did not differ in intelligence at 7 years. Factors associated with intelligence included maternal pregnancy factors (e.g. hypertension), socio-demographic factors (e.g. paternal education), and postnatal factors (e.g. maternal social support). In general, the effects of environmental factors did not differ significantly for SGA children compared with AGA children. A number of dietary factors were also found to be significantly and positively associated with intelligence measures including higher intakes of breads and cereals and weekly fish consumption. In contrast, daily margarine consumption was associated with significantly lower intelligence scores, particularly in SGA children, and this is the first study to report this association. iii Dietary and “environmental” factors were stronger predictors of children’s intelligence in middle childhood than “biological” factors, such as infant’s birthweight. Importantly, most of the factors associated with intelligence that were identified in this study are potentially modifiable. Further research is needed to examine whether these factors continue to be associated with cognitive ability in later childhood.

Background. Despite on-going efforts to reduce bullying among adolescents, this phenomena remains a persistent public health problem (Espelage & Colbert, 2015). Positive youth development (PYD)-physical activity based programs have the potential to target health risk behaviors by focusing on positive psychological assets and promoting personal growth (Fraser-Thomas, Côté, & Deakin, 2005). Similarly, physical activity has been associated with physical and psychosocial benefits as it enhances the process of development, promote life skills, and foster personal and interpersonal skills through peers and non-parental adult interactions (Fraser-Thomas et al., 2005; Weiss, Smith, & Stuntz, 2008). While we know quite a bit about PYD programs and understand the importance of physical activity related to its influence on bullying behaviors, we know far less about the effectiveness of anti-bullying programs that combine both PYD with physical activity components. However, addressing this gap in the literature could inform prevention science research efforts as it would enhance understanding on how such interventions might decrease bullying in youth. This study aimed to evaluate the effectiveness of positive youth development (PYD) physical activity based interventions on bullying behaviors among pre- and young adolescents (8 - 14 years old). Methods. A systematic review was conducted and included a search of five databases (PsycINFO, PubMed, Cochrane Library, ERIC and CINAHL), and reference lists of included studies and reviews from 2003 to 2017. Additional information was requested from study authors. The study inclusion criteria included interventions that used both PYD and physical activity components, recruited participants who ranged in age from 8 to 14, and that targeted bullying behaviors (bullying, victimization, and bystander). Two independent reviewers assessed studies, and extracted data, and one reviewer evaluated risk of bias using the Cochrane risk of bias tool (Higgins, Sterne, Savović, Page, & Hróbjartsson, 2016). Studies were placed into two groups based on type of study (quasi-experimental and experimental). To determine effect sizes for the quasi-experimental designs and experimental designs, Pearson’s correlation coefficient (r) and standardized mean differences (SMD) were used, respectively. Results. Seven studies met the inclusion criteria, of which three were quasi-experimental and four were experimental studies. For bullying outcome, the quasi-experimental studies were found to have a small effect size (r = -.24 to -.22) while experimental designs had small, medium, and large effect size (SMD = -.68 to -.27). For victimization, a medium effect size was found in one study (SMD = -.53), and for bystander involvement, a medium effect size was found for unadjusted model (r = .37), and a small/negligent effect size was found for the adjusted model (r = -.05). Reductions in bullying and victimization, and increase in prosocial bystander behavior were found across the physical activity-based, PYD interventions, which utilized a combined approach of PYD components (e.g., caring, empathy, respect), and physical activity context, as well as the use of an interactive and supportive approach to deliver the program’s PYD component between the participants and staff. Selection bias, lack of blinding bias, attrition to follow-up bias, and failure to control for confounding were found across the studies, with experimental study designs reporting generally better quality than quasi-experimental. Conclusion. PYD-based, anti-bullying interventions with a physical activity component are promising in reducing bullying among adolescents. Findings revealed that the further interventions should be structured into a physical activity-based PYD setting that foster youth’s psychosocial development and provide them with opportunities to develop these PYD components in a mastery-oriented climate, which in turn may reduce problem behaviors The small number of studies identified strongly suggests that there remains a critical need for PYD-physical activity based interventions that target bullying behaviors.

A Health Promoting School (HPS) approach is now widely accepted internationally, with a focus on children’s health, the school curriculum, and whole school environment. In Thailand, the health and well-being of children is a fundamental value. HPS programmes have been implemented in schools as a strategy to focus on young people’s health. A number of barriers to successful HPS have been identified. While there is international evidence to show the steps and the key factors in creating successful HPS, little is known about successful HPS in the Thai context, in particular, in Northeastern Thailand which has been classified the poorest region. Ethnographic methods were used to examine what understanding of the meaning of HPS is necessary for a successful school, and how all those involved acted from the adoption of the HPS programmes by the local school until it achieved HPS status. A rural school which was successful in a HPS programme was selected, in Mahasarakham province, Northeastern Thailand. The data were obtained through participant observation, ethnographic interviews, and ethnographic records, and data analysis took place simultaneously with data collection. In this study, Lofland’s strategy for the analysis of the structure of human interaction was used. A variety of techniques for improving and documenting the credibility of the study such as prolonged engagement, persistent observation, and triangulation were used. This research revealed that the informants’ views reflected diverse understandings of the meaning of HPS. Those views were based on their experiences of HPS which differed according to the degree of participation, different levels of knowledge about HPS, and in the roles they played in the implementation of HPS in the school. Thai culture and school ethos influenced the success of HPS. Community participation was also crucial in supporting the school’s achievement. Key factors that underpinned success are identified. Implications of the findings for the HPS programme, health professionals, the school and community are discussed.

A Health Promoting School (HPS) approach is now widely accepted internationally, with a focus on children’s health, the school curriculum, and whole school environment. In Thailand, the health and well-being of children is a fundamental value. HPS programmes have been implemented in schools as a strategy to focus on young people’s health. A number of barriers to successful HPS have been identified. While there is international evidence to show the steps and the key factors in creating successful HPS, little is known about successful HPS in the Thai context, in particular, in Northeastern Thailand which has been classified the poorest region. Ethnographic methods were used to examine what understanding of the meaning of HPS is necessary for a successful school, and how all those involved acted from the adoption of the HPS programmes by the local school until it achieved HPS status. A rural school which was successful in a HPS programme was selected, in Mahasarakham province, Northeastern Thailand. The data were obtained through participant observation, ethnographic interviews, and ethnographic records, and data analysis took place simultaneously with data collection. In this study, Lofland’s strategy for the analysis of the structure of human interaction was used. A variety of techniques for improving and documenting the credibility of the study such as prolonged engagement, persistent observation, and triangulation were used. This research revealed that the informants’ views reflected diverse understandings of the meaning of HPS. Those views were based on their experiences of HPS which differed according to the degree of participation, different levels of knowledge about HPS, and in the roles they played in the implementation of HPS in the school. Thai culture and school ethos influenced the success of HPS. Community participation was also crucial in supporting the school’s achievement. Key factors that underpinned success are identified. Implications of the findings for the HPS programme, health professionals, the school and community are discussed.

A Health Promoting School (HPS) approach is now widely accepted internationally, with a focus on children’s health, the school curriculum, and whole school environment. In Thailand, the health and well-being of children is a fundamental value. HPS programmes have been implemented in schools as a strategy to focus on young people’s health. A number of barriers to successful HPS have been identified. While there is international evidence to show the steps and the key factors in creating successful HPS, little is known about successful HPS in the Thai context, in particular, in Northeastern Thailand which has been classified the poorest region. Ethnographic methods were used to examine what understanding of the meaning of HPS is necessary for a successful school, and how all those involved acted from the adoption of the HPS programmes by the local school until it achieved HPS status. A rural school which was successful in a HPS programme was selected, in Mahasarakham province, Northeastern Thailand. The data were obtained through participant observation, ethnographic interviews, and ethnographic records, and data analysis took place simultaneously with data collection. In this study, Lofland’s strategy for the analysis of the structure of human interaction was used. A variety of techniques for improving and documenting the credibility of the study such as prolonged engagement, persistent observation, and triangulation were used. This research revealed that the informants’ views reflected diverse understandings of the meaning of HPS. Those views were based on their experiences of HPS which differed according to the degree of participation, different levels of knowledge about HPS, and in the roles they played in the implementation of HPS in the school. Thai culture and school ethos influenced the success of HPS. Community participation was also crucial in supporting the school’s achievement. Key factors that underpinned success are identified. Implications of the findings for the HPS programme, health professionals, the school and community are discussed.

<p dir="ltr">Families experiencing homelessness and housing instability (FEH/HI) face myriad challenges, placing their children at risk for adverse outcomes. Research typically adopts a deficit-based approach to meet immediate needs, but this may limit understanding of the children’s experiences. Recognizing children’s strengths is important for improving their health, development, and support. Resilience and family resilience are concepts that draw on a strengths-based approach. However, there is a need for more research to identify the strengths, such as resilience, among families and their children who are not stably housed. The present research seeks to address the gaps in the literature by examining the resilience perceptions and experiences of adolescents in FEH/HI, as much of the existing research focuses on the adult perspectives, within a family resilience framework through multiple studies. Study 1 (Chapter 2) systematically reviewed existing research on resilience and family resilience within FEH/HI. An analysis of 27 studies identified resilience-related factors across individual, interpersonal, and community domains. Study 2 (Chapter 3) integrated a strengths- and deficit-based approach to explore the challenges and strengths of children in FEH/HI from the perspectives of parents/caregivers and service providers. Semi-structured interviews with 17 parents/caregivers and 15 service providers identified challenges and strengths at the individual, interpersonal, and system levels. Study 3 (Chapter 4) investigated how adolescents within FEH/HI experience and make meaning of family resilience in their day-to-day lives using photo-elicitation (PE) and Froma Walsh’s family resilience framework. Four adolescents participated and took photographs depicting family resilience within their families. Together, findings from these studies provide insights into the strengths and resilience within FEH/HI. Moreover, they emphasize the need for strengths-based approaches in research and practice to support the health, development, and wellbeing of children and adolescents in FEH/HI.</p>

Children are often referred to as the 'hidden' generation, a powerless group who in infancy and childhood depend on their parents and families/whanau to ensure they receive everything in life required to enable them to grow into healthy young people and adults. Some are more disadvantaged than others due to the socioeconomic circumstances they grow up in. This can have lasting effects on their health in childhood with associated impacts later in life. In New Zealand the populations of children most disadvantaged are those from Maori, Pacific and other low income families/whanau. The disparities that exist between children from these populations and other groups whilst lessening, is still significant. The purpose of this study was to explore with Maori, Pacific and low income parents and caregivers why they choose to 'seek' health services for their children, or not as the case may be. Patterns of use are established early in life therefore it is important to understand children's health care use. The literature suggests that children's access to health care is influenced by predisposing factors such as their socioeconomic status, ethnicity, the availability of services, choice of providers, availability of school–based health services, outreach services, relationships between the community and health service providers and having a regular source of primary health care. A qualitative exploratory design was the methodology chosen for this research. A modified 'community as partner' model (Anderson, 2008) formed the conceptual framework for the research. Sixteen Maori, Pacific and Pakeha parents and caregivers participated in three focus groups to discuss their perceptions of children's access to health care. Thematic analysis was used to identify codes, categories, themes and sub themes from the data. The New Zealand Child Health Strategy (Ministry of Health, 1998) was used as a model to inform the discussion. The main themes were: reality of life, visibility, knowing you, knowing me and kids come first. The findings suggest that relationships with primary health care providers, the cost of health care for children over five years, awareness of services and a need to prioritise children's needs, enable or prevent children's access to health care. Decisions made regarding further service provision for children will be enhanced by health providers and practitioners having a clearer understanding of the enablers and barriers to access and the factors that influence parental choice of services.