Apunipima Baby Baskets Program
Knowledge Circle Practice Profiles

Overview

Practice focus

Child and maternal health services; health education; health promotion and community engagement

Delivered by

The Baby Baskets program was developed and delivered by the Apunipima Cape York Health Council (Apunipima), a community controlled Aboriginal health organisation based in Cairns that provides comprehensive primary health care to 11 remote Cape York communities. More information about Apunipima can be found at: http://www.apunipima.org.au/

Location(s)

The Baby Baskets program was implemented in 11 Indigenous communities throughout the Cape York Peninsula.

Issue being addressed

The program aimed to address the Cape York region's (the northernmost region of Queensland with a large Indigenous population) poor maternal and child health. For maternal and child health, regular visits to health professionals reduces the risk of disease or complication due to early identification and treatment, as well as providing opportunities for education about healthy parenting behaviours such as good nutrition, alcohol and smoking cessation and the benefits of breast feeding.

Service type

Child and maternal health services; health education; health promotion and community engagement

Target population

The target population for the program were Indigenous women living in Cape York communities who are expecting a baby or have recently given birth.

Aims and objectives

Started in 2009, the Baby Baskets program aimed to engage Indigenous women with the health system by encouraging early and frequent attendance at antenatal clinics and regular postnatal check-ups. The program aimed to achieve better maternal health, reduce complications during and after pregnancy and increase the proportion of normal weight babies and thriving infants.

Program basis

The program is based on knowledge that a healthy start to life should help reduce the gap in life expectancy between Indigenous and non-Indigenous Australians. The baskets provided an opportunity to encourage women to present for ante-natal appointments earlier and more frequently. This, it is hoped, will lead to better antenatal care, improved mother and family education on pregnancy and better maternal and child health outcomes.

The program consisted of the delivery of three Baby Baskets, which included practical gifts for pregnancy, health education material and food vouchers to purchase fruit and vegetables. The baskets were delivered in the first trimester, immediately prior to birth and six months post birth. While delivering the baskets, health workers had the opportunity to engage with women, their partners and families about issues that affect the growing baby (eg. healthy choices around smoking, alcohol and diet). This engagement, is meant to help mothers feel comfortable and motivated to continue to attend maternal and child health services after birth.

The program was led by Apunipima in partnership with Queensland Health and Royal Flying Doctor Service staff. The program included home visits that involved extended family members. The advantages of home visits included: allowing more personal care, women not having to worry about transport to the clinic, enabling healthcare workers to better assess living conditions and protecting the anonymity and confidentiality of women and their families.
The baskets contained :

  • Basket 1: Included a travel cot for babies, health education information, booklet on pregnancy written by Indigenous health workers, fresh food vouchers.
  • Basket 2: Delivered prior to the birth of the baby, when the mother arrived in Cairns at 36 weeks for birth. It included nappies, baby clothes, personal hygiene items for the mother.
  • Basket 3: Delivered in the community six months after the birth of the baby and included postnatal information, toys, a toothbrush and toothpaste.

Cultural relevance

Local community context

In Cape York, Indigenous maternal and child health is particularly poor with high rates of maternal and neonatal morbidity and mortality in comparison to the rest of Australia. According to the Baby Baskets evaluation report, in 2005/06, 70 percent of pregnant women in Cape York were reported to have smoked at some time during their pregnancy; there were high rates of gestational diabetes and more than double the number of low birth weight babies in comparison to the rest of Queensland.

Involvement of Aboriginal and Torres Strait Islanders

While the initial idea for the Baby Basket program was developed by non-Indigenous health workers, Apunipima were quick to support and then lead the design and delivery of program. Apunipima were involved in the design of the program and convened meetings with maternal and child health staff from the Royal Flying Doctor Service, Queensland Health and the specialist hostel in Cairns that many Indigenous Cape York mothers use when they arrive in Cairns at 36 weeks pregnancy.
Apunipima staff ordered and packed the contents of the Baby Baskets. Indigenous health workers also delivered the baskets to women in their homes, which allowed them to educate and engage women about pre and post natal health care services.

Cultural practices and materials

The Baby Baskets contained some merchandise that was decorated with Indigenous art. Some specific products that had positive feedback included:

  • Information booklet: this was written by Apunipima for local mothers about the stages of pregnancy and health care services. It contained photos of mothers in the community and was used by Apunipima staff as a tool to engage with mothers.

  • Bags decorated with Indigenous art: there was anecdotal evidence that the bags were both useful (many mothers didn't have or couldn't afford a bag) and that it made them feel connected to a health service that was looking after them, particularly when they were transferred to the hospital in Cairns for the birth.

Evaluation

Evaluation status

An external evaluation of the program was published in 2014 (http://www.lowitja.org.au/baby-basket)

The aims of the evaluation were to:

  • Assess what had been achieved, whether it is making a difference and why
  • Understand the contextual factors which impacted the implementation of the program in the community
  • Provide feedback to service providers to improve service delivery
  • Identify elements of best practice in maternal and child health service delivery
  • Identify what is required to replicate and expand the program across other settings.
Evaluation details

Qualitative and quantitative methods were used to evaluate the Baby Basket program. The qualitative methods were based on interviews and focus groups with women who received the Baby Baskets and their family members, and healthcare workers who delivered the program.
The quantitative evaluation was a based on three sub-studies that involved:

  • (1) analysis of surveys of women who had received a Baby Basket (this data was collected by Apunipima);
  • (2) a cost analysis to estimate the resources required to deliver the Baby Basket to a cohort of 170 participants, and
  • (3) an analysis of indicators related to the aims of the Baby Basket program (this was based on data from One21Seventy - an online database for Aboriginal health care providers to assist with audit, assessment and analysis of their service).

The evaluation was designed and implemented collaboratively with Apunipima and other Indigenous researchers. An evaluation steering commitee regularly reported to and sought feedback from Apunipima on the evaluation and its progress. In particular, Apunipima assisted with engaging mothers in the qualitative part of the evaluation. The evaluation research team also included a female Indigenous researcher who helped design and conduct the interviews with mothers.

Effectiveness

Most effective aspect

The evaluation highlighted the importance of relationship building between health workers and mothers and found that the baskets were essential part building trust. Such was the success of the Baby Basket program at building relationships and engaging mothers in health services, that it was used as the model for Apunipima's successor Baby One Program (BoP).

BoP is the next phase of the Baby Basket program and aims to be a holistic, family centred model of care, led by health workers, families and the community. The program continues as a home visiting program that begins by providing baby baskets in pregnancy and services extend up to the first 1000 days of the child’s life.

Demonstrated outcomes

Key findings from the qualitative evaluation included:

  • Health care workers and women viewed the central purpose of Baby Basket program to be working towards empowering families
  • Women appreciated the items in the Baby Baskets and found them to be highly useful. The baskets also paved the way for women to learn what to expect through pregnancy, birth and motherhood, how to prevent ill-health, and to better care for themselves and their children. They also passed on their learnings to other pregnant women.
  • Healthcare workers also reflected on their practice, including the consistency of education messages, and applied their learnings to improve their practices.

Key outcomes from the quantitative evaluation included:
The survey of women who received a Baby Basket showed positive results. Highlights were:

  • A high proportion (78.8 percent) of women rated the baskets as ‘very useful’ and the majority of recipients said all of the contents were useful.
  • The survey results suggested that in 2013, over 98 percent of basket handovers were reported to have been accompanied with advice on smoking, alcohol, nutrition and SIDS. This result fulfilled one of the aims of the Baby Basket program.

The cost study showed that delivering the Baby Basket program to 170 participants in Cape York cost about $147,000, or approximately $874 per participant.

The evaluation report cautioned against drawing any conclusions from the One21Seventy data analysis, but did outline the following findings:

  • Compared with mothers in control sites (without the program), Apunipima mothers had a higher number of antenatal visits before the 13 weeks pregnancy. A substantial improvement in this indicator occurred for Apunipima mothers between 2008 and 2009 (when the Baby Basket program was introduced). This result is in keeping with a key aim of the Baby Basket program: to encourage women to have earlier and more frequent antenatal visits to the clinic.
  • For frequency of postnatal visits, Apunipima mothers also has a more favourable result than the control sites.

The evaluation report acknowledged the limitations with the quantitative data (particularly the One21Seventy data) and reported it is not possible to specifically attribute the improvements in many of the indicators examined in the evaluation exclusively to the Baby Basket program. The report suggests that it is likely that a combination of factors (including routine maternal health service) have played a role in improving outcomes for mothers and children. However, given the activities of the Baby Basket program and its specific focus on improving attendance at antenatal and postnatal clinics, the report maintains it is both feasible and likely that the Baby Basket program contributed to the improvements in these measures since 2009.
However, the evaluation was not able to identify the extent to which the Baby Basket program contributed to this outcome.

One key point is that the findings of the evaluation have been incorporated into the Baby One Program, in particular the implementation of more robust evaluation frameworks.

Other evidence

There has also been positive anecdotal feedback including:

  • Some women were pleased the baskets contained products that were not available or too expensive at the local community stores.
  • The fruit and vegetable vouchers in the baskets allowed the community stores to plan more effectively and order fruit and vegetables so that they had enough fresh supplies for the mothers and families.
Resourcing

The program was resourced through funding from the Queensland Government.

Evidence base and opportunities

As part of the evaluation a literature review was conducted to identify maternal and child health programs for Indigenous Australians that could usefully inform the Baby Basket Program and contextualise the evaluation findings. The evaluation report concluded that there has been a substantial increase in publications documenting Indigenous child and maternal health programs and services over the past decade. These publications outline responses to a range of health and wellbeing issues relevant to Indigenous mothers, infants and children, with the majority of studies documenting programs targeting mothers and their babies through antenatal and postnatal care. However the literature review noted that new research is needed that focuses on developing good quality longitudinal data to assess the impact of Indigenous child and maternal health programs and services over several decades.

Other sources of information about parenting and early years health intervention programs for Indigenous people can be viewed here:
Community embedded maternal and infant health programs: http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Our_publications/2014/ctgc-ip08.pdf

Parenting support programs:
http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2012/ctgc-rs16.pdf

 

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