Modelling Collaboration within Autonomous Community Development Practice: An Interview with Karen Hoare

By Denise Wilson, RN, PhD, FCNA(NZ)

Karen Hoare is no stranger to working with communities and families to establish the necessary supports so that their children are able to have a positive start in life. She is a lecturer at Massey University and a Public Health Nurse, and has recently been admitted to the College of Nurses as a Fellow. In her work as a Public Health Nurse in Wellsford, Karen identified a sector of children within the community that were beginning school without being able to hold a book and lacking the necessary skills for success at school. Educational success is one of the determinants of a child’s health status, especially as an adult. Using her background as a Community Practitioner and Health Visitor in the United Kingdom (UK), and her work in developing African countries, she has been instrumental in mobilising the Wellsford community to establish a Children’s Centre, and raising awareness of the need to establish supports at a Ministry level.

A long time advocate for children and their families, Karen’s nursing career in the UK epitomises a blend of autonomous and collaborative practice within the Primary Health Care sector. As a Community Practitioner and Health Visitor (CP&HV), she was responsible for patients enrolled with a General Practitioner, who included children from 0 to 5 years and their families, children over 5 years with special needs and those over 65 years. She provides numerous examples of how collaboration in her practice aimed to achieve optimal outcomes for those she worked with. For example, working with pregnant women and their Midwives initially at the antenatal clinic, and then more substantially in their last trimester, where detailed information was gathered, support that the family may require once the baby is born negotiated, and handing the parent held record to the mother so that the birth details could be recorded. As the CP&HV, she also worked collaboratively with Midwives to provide antenatal education. If all was well with the mother and baby one to two weeks after the birth of the baby, the Midwife would sign care over to the CP&HV. The CP&HV provided ongoing support and guidance with parenting and relationship development, breastfeeding, maternal mental health, screening for domestic violence, and child health surveillance. If a mother showed signs of mental health problems a process was then implemented that involved assessment using the Edinburgh Postnatal Depression Scale, involving referral to, and working collaboratively with the General Practitioner (GP), when the scores were high.

Karen also facilitated Postnatal Support Groups that were linked to the antenatal groups and eventually aimed to have these groups self-supporting. These were run on a weekly basis, focusing on a mixture of core topics (such as immunisation and baby massage as an attachment activity) and the needs of the women attending. At the end of these sessions nurse clinics were held that mothers could access if they wanted, and where GPs were available if needed. Karen cited the evidence that was used to inform and develop these groups, such as attachment theories, peer support, and literature about parental mental health. The success of these groups was evident in a number of ways, but particularly notable was the 95% immunisation rate (excluding MMR) in the area that Karen was working.

Karen maintains that such collaborative practice was aimed at ensuring that the multidisciplinary care provided was seamless, with all health professionals working together to achieve positive health outcomes for patients. As a health visitor, Karen was also a nurse prescriber independently providing treatment for eczema, simple skin conditions, oral candidiasis, fever, worms, head lice and vomiting and diarrhoea. This independent prescribing practice, however, was recorded using a shared computerised patient record with the GP to ensure that the prescribing practices of the GP and the nurse were a safe and collaborative exercise.

While Karen was able to work autonomously as a nurse who had prescribing rights, she is resolute that successful delivery of health services requires a commitment to work collaboratively with a range of relevant health professionals and related services. This model of collaborative practice provides overlaps that result in a continuity of care, which minimises anyone ‘falling through the cracks’ of service provision. Karen maintains that such an approach to primary health care services facilitates the development of positive family relationships, parenting and support, and enables a preventive approach to child protection. Positive outcomes include improved immunisation rates and a reduction in child maltreatment and abuse. Eventuating of this type of approach to primary health care services is a form of ‘mandatory’ surveillance of children and their families that is about providing support when it is needed. Those who choose to ‘opt out’ undergo a thorough follow-up process with Social Services.

Karen has been in New Zealand for 18 months and is currently involved in establishing the Timata Pai (Start Well) project in Wellsford - the name endorsed by local Kaumatua and Kuia. The aim of Timata Pai is to establish a Children’s Centre using her experience with Sure Start in the UK (which was modelled on the Head Start programme in the United States), to enable all children within the community to start school on a similar level. Karen claims that the underlying premise is that those children who are born in circumstances of disadvantage are most likely to be disadvantaged throughout their life. Indeed, reducing child poverty involves improving their health, social and emotional development, and their ability to learn through community development.

Establishing a Children’s Centre in Wellsford, for example, will involve developing the community supports, enabling subsidised childcare, and importantly provide training courses with crèches to support parental development. It aims to empower and support parents to make positive changes for their children. But this is not solely a parental responsibility, it is one shared with professionals and the community with a mutual goal to improve children’s lifestyles within the Wellsford community. The building of a Children’s Centre will involve people, parents and organisations working together to develop a plan. While Karen maintains a building is not essential, it does provide a place for people to come together to work for the benefit of children. Planning also acknowledges the bicultural nature of the community, and the cultural diversity that exists in order to provide culturally appropriate services of both Maori and Pakeha children. Thus, the Children’s Centre will provide a Maori resource centre that will be inclusive of all children.

Karen’s familiarity with community development work extends to the developing world, which acknowledges culture and celebrating difference. Not only has Karen worked within West African communities, she has taken her experiences and knowledge to develop children in the UK as responsible global citizens. This has been achieved through activities such as linking a school in the UK with a school in a developing country (for example, Zambia, Peru, Tanzania or Kenya) as a health project. The health project, such as hand washing to prevent diarrhoea, requires the children from both schools to undertake an action research project, share information about their communities and their research. This work is briefly outlined on the Development Direct website (www.developmentdirect.org.uk), which Karen set up and remains a trustee of the Board.

Karen’s practice is truly collaborative, yet autonomous. She brings to New Zealand a wealth of community development experience that involves local, national and global activities. Her commitment to child and family wellbeing drives her to be an advocate who is unafraid to speak up for children who are disadvantaged, and to mobilise communities to develop strategies so that families can be supported and children can have a positive start to their lives.