Supporting the health,education and wellbeing of children and families: A priority-setting study with the service system in Logan,Queensland

Abstract

Priority-setting is a collective responsibility centred around inclusive engagement and alignment with the needs and desired outcomes of the community. In this study, we leveraged the collective expertise of stakeholders from the child and family service system, to identify priorities for supporting the health, education and wellbeing of children and families living in Logan, Queensland. A pragmatic approach combining a modified nominal group technique and consensus methodology was undertaken. Key system factors were identified and consolidated into 10 priority areas, which were ranked via an online questionnaire. The top three priority areas were identified by the service system as (i) early family and child support programs, (ii) support and resourcing of existing services, and (iii) recognition and support of a diverse community. These results present an opportunity to leverage the local knowledge and expertise of the service system to design solutions that address the greatest challenges for children and families in place.

Keywords

priority-setting child family service system health education wellbeing surveys and questionnaires

Background

Impact of disadvantage on early childhood development

The geographical, spatial, and social context in which one lives is integral in enabling access to services, resources, and opportunities. In Australia, while most people are faring well, there are areas of growing concern where persistent inequitable conditions mean a subset of children and families experience profound deprivation that can deeply affect their outcomes in life (Noble et al., 2021; Tanton et al., 2021). Disadvantage affects a family’s ability to afford essential goods and services for themselves and their children, and to take part in society in the ways that many families take for granted (Committee for Economic Development of Australia, 2023; Productivity Commission, 2018). Consequently, these families are less able to access and engage with social, health and educational services, thus potentially widening the inequity gap (Renalds et al., 2010; Schule & Bolte, 2015).

Considerable research demonstrates the important links between early childhood experiences and long-term outcomes, with the formative years being one of the most sensitive periods of development and critical in setting a foundation for physical and mental health, as well as emotional and social development (Adamson, 2012; Nicholson et al., 2012; Victorino & Gauthier, 2009). By the time children begin school, they are already distributed along a social gradient and the window of opportunity to ameliorate these gaps has narrowed. As such, children who experience disadvantage, which manifests as the circumstances in which they live, learn, and develop, have poorer health and developmental outcomes than their more advantaged counterparts. Environments, where there is a geographical concentration of disadvantage, are often referred to as locationally disadvantaged; areas that may have overlapping and complex vulnerabilities such as limited access to services and facilities, poor employment, training and educational opportunities, and poor physical and social infrastructures (Crimeen et al., 2017). Failure to account for how disadvantage occurs and accumulates over time within specific geographic regions constitutes a significant and ongoing public health problem and can undermine well-intended public health and public policy interventions. Inconsistencies, gaps and lower resourcing in the services and support that families receive within these contexts further embed inequality, with strong associations between the characteristics of place and the quality of life and health of individuals, families, and whole communities (Centre for Policy Development, 2021).

Place-based approach

Place-based approaches are long-term, collaborative efforts to guide systemic change, and contribute to a cycle of learning, predominantly within areas facing locational disadvantage (Amobi et al., 2019; Dupre et al., 2016). They focus on driving cross-sector collaboration to integrate service delivery in pursuit of long-term outcomes; shared accountability, decision-making, funding and service delivery to the local level to facilitate strategically targeted solutions tailored to community needs; building community capacity and social infrastructure; and, promoting community engagement and participation (Kamener et al., 2019). This can vary from bringing the community voice into the government prioritisation process to local coordination of centrally funded programmes. Some argue there is a strong evidence base for place-based initiatives, showing that connecting and integrating services that are planned and delivered in defined socio-geographical areas improves outcomes for high-risk families (Moore & Fry, 2011). Others have questioned this notion pointing out that a major challenge is in the setting of realistic and achievable outcomes and goals and not overestimating what place-based approaches can achieve; the latter being a fundamental principle (Bynner, 2016). One of the ways that we can ensure the efficacy of place-based approaches is by engaging in priority-setting processes to assess what are the most important places where resources can be allocated to have the highest likelihood of making long-lasting change.

Priority-setting for decision-making

Priority-setting is a decision making tool that in recent years, has become the foundation for determining strategic directions or guiding practice and policy as well as a key part of the allocation of limited financial resources (Viergever et al., 2010). The process of priority-setting encompasses any activity that involves identifying, prioritising, and reaching a consensus on areas, topics, or questions that reflect a joint value or vision (Tan et al., 2022; Tong et al., 2019). They are especially useful in the early stages of priority-setting when the generation of ideas in a short amount of time and input from multiple stakeholders is necessary. The nominal group technique (NGT), selected for this study, is a consensus method which is a structured, multistep, facilitated, group meeting technique used to generate and prioritise responses to a specific question by a group of people who have expert insight into a particular area of interest (Cowan, 2010; Harb et al., 2021; McMillan et al., 2014). Traditionally, NGT comprises of four key stages: generating ideas, recording ideas, evaluating ideas, and prioritising ideas; with the potential for an additional re-ranking step or an interpretation and extension of ranking to be included (McMillan et al., 2014; McMillan et al., 2014). A key strength of NGT is that it allows balanced participation from group members, meaning that bias raised by dominant personalities or vested interests is minimised. NGT has demonstrated validity across studies with highly complex issues and can be used flexibly to enable problem identification, generation of research questions, development of solutions, and establishing priorities for action (Campbell, 2002). The technique also allows comparisons of priorities between different groups which can identify areas of divergence and convergence (McMillan et al., 2014).

Historically, priority-setting has been led by discipline experts and researchers and is not typically informed by the views and/or experiences of non-research stakeholders. Leading international bodies, like the European Commission, the Organisation for Economic Co-Operation and Development, and the World Health Organisation provide guidance to actively involve non-research stakeholders in setting their research agendas, acknowledging that better alignment is needed between the allocation of limited resources and the priorities of those in a position to implement findings (Mazzucato, 2019; OECD, 2017; WHO, 2013). This is shown to foster ownership of the established priorities among those involved in the priority-setting approach, meaning that priorities are more relevant, more likely to be accepted and efficacious (Alqahtani et al., 2021; Hanney et al., 2020; Roche et al., 2021). Pratt (2019) argues that where research projects and services do not give voice to non-research stakeholders in setting priorities, they are less relevant and are likely to be less informed by evidence-based research, make smaller contributions to improving community health, and/or have less impact on reducing health disparities - which is a key issue of concern, particularly for place-based programs.

Theoretical foundation

The overarching approach to this study focuses on strengthening the formal and informal supports within the system that serves children and their families. This includes the programs, services, activities, networks, coordination efforts and other non-tangible assets that exist to bolster these elements. To achieve this, we apply a co-design approach that actively empowers and enables communities to shape the activities and outcomes. Co-design involves a collaborative partnership between the researchers and community stakeholders (defined as the people, groups, and organisations that comprise the system that serve children and their families) that prioritises meaningful participation in identifying objectives and building cooperative relationships to develop and address relevant problems (Voorberg et al., 2015). To authentically engage in co-design, we have undertaken research that centralises narrative and discourse with community stakeholders to exchange ideas and develop mutual understanding, as well as identify the shared objectives for research and future action (Coghlan & Brydon-Miller, 2014). There was a commitment to engagement with the community that is inclusive, equitable, clear in roles and responsibilities, accountable, and respectful, as well as to building and maintaining relationships based on trust. To provide a structured mechanism through which co-design can be operationalised in our studies, we adhered to a set of foundational principles (Table 1).

Table 1.

Five core principles foundational to our theoretical foundation.

Principle	Description
Collaborating for inclusive participation	This principle underscores the capacity of community stakeholders to identify and tackle challenges within their communities, emphasising their knowledge and skill, and the valuable resources and expertise that can be effectively utilised through collaborative initiatives
Maintaining and building trusting and respectful relationships	For successful co-design, establishing trust in engagements with and among community stakeholders is paramount. This trust is fundamental to achieving a thorough understanding of the pathways for children and young people, enabling the collaborative creation of local solutions to challenges
Prevention and promotion	This principle highlights the importance of a focus on positive development and early prevention efforts rather than reactionary actions. This will be achieved by orienting towards a strengths-based approach, positive development, and sustainable solutions rather than reactive remedies to problems
Accountability	We aim to define the roles of all individuals in the co-design process, ensuring transparency, establishing mutually agreed-upon expectations, and serving as facilitators of dialogue. Recognising the research team’s role in guiding action, we emphasise our accountability in delivering outcomes that reflect diverse voices and are culturally safe, respectful, and responsive
Evidence-informed practice	We are committed to empowering community stakeholders to actively engage with various forms of evidence as we explore together. We will integrate diverse knowledge sources, including lived experience, practical insights, and scientific evidence, to shape actionable initiatives. Our approach involves incorporating iterative learning cycles that provide structured opportunities to reassess goals, priorities, and assumptions

In this study, health and wellbeing are broadly understood as the dynamic relationships between children and their environments that produce positive outcomes across physical, mental, and social domains. We aimed to leverage the collective expertise of stakeholders from various sectors within the child and family service system, to identify top priorities to support the health, education and wellbeing of children and families living in Logan, Queensland.

Methods

Research setting

As one of Australia’s largest Local Government Areas, the City of Logan in South-East Queensland is made up of over 60 suburbs or 13 electoral divisions with varying concentrations of disadvantage (.idcommunity, 2021). Home to more than 360,000 people (estimated resident population 30 June 2022), Logan is fast growing (3.53% since the previous year) in comparison to South-East Queensland, Queensland, and Australia (2.23%, 2.01% and 1.25% respectively) (Australia Bureau of Statistics [ABS], (2022)). Logan is one of the most culturally diverse cities in the country, with 27.6% of people born overseas, 18.1% speak a language other than English in the home, and 3.3% of people with Maori ancestry live in Logan (3.3%), compared to South-East (1.5%), Queensland (1.3%) and Australia (0.7%). Aboriginal and Torres Strait Islander people represent 4.2% of the population, a substantial difference when compared to South-East Queensland (2.8%) and Australia (3.2%) (ABS, 2022). In 2021, Logan had a higher proportion of children (under 18) and a lower proportion of persons aged 60 or older than Australia (26.6% and 18.3% vs. 23% and 21.7%). The median age of residents is 34 years, which is 4 years younger than the national average. Notably, there is a higher concentration of children under 15, and a greater proportion of these children reside in single-parent households compared to the broader state demographics (ABS, 2022).

Research design

This study employed a multistep priority-setting approach based on the NGT (Figure 1). First, a series of workshops (structured and non-hierarchical) to understand core areas of concern within the service system were hosted by the research team. This stage corresponds to the NGT stages of generating and recording ideas and is detailed in (Stuart et al., 2023). Next, key system factors were evaluated and refined through expert review and consolidated into a list. This step corresponds to the NGT stages of evaluating and refining ideas. Finally, these system factors were redistributed for ranking via an online priority-setting questionnaire, resulting in a ranked list (corresponding to the NGT stage of prioritisation) by the service system. This approach was both practical and maximised participation to ensure balanced input while using each participant’s experience and expertise to reach a consensus on the complex topic under investigation. Ethics approval for this study was granted by Griffith University Human Research Ethics Committee (2021/505).

Figure 1.

Three stages of the priority-setting process used in this study and how they align to the four stages of NGT.

Research team

The study described herein was designed and implemented by researchers with complementary expertise in community research methodologies, community development, guiding collaboration and community facilitation. Additionally, a Community Advisory Group (CAG) comprised of individuals with knowledge and experience in key segments of the community and service system, including a First Nations advisor and frontline practitioners and leaders from local government and community-led organisations, were involved. These individuals were also residents of the community and as such also represented potential end-users of the service system.

Identification of stakeholders

A multistep approach was used to identify stakeholders who were experts in the service system that supports the health, education and wellbeing of children and families living in Logan, Queensland. The service system included agencies and providers of current activities within the community, such as programs, services, organisations, and the networks, coordination efforts and other non-tangible community assets, that together exist to achieve shared outcomes for this community. We recognise that these individuals have deep extant knowledge about the system in this place that should be specifically drawn upon to assist in setting priorities. We used three strategies to identify and recruit stakeholders, with a focus on including members of typically under-represented groups who have deep and diverse knowledge. First, a comprehensive online review of all community services, assets and resources for children and families in Logan, Queensland was conducted. Information about the community infrastructure (i.e., places, spaces, resources, and physical assets) and service system assets and resources were compiled into an online database (Aicken et al., 2010). From this review, unique service system programs, groups, and organisations were defined, and a stakeholder register was created. This was complemented by submissions from the project’s Steering Committee and CAG. Throughout this process, we aimed to recruit at least one individual from each service provider or agency who had specific experience working in place. Specifically, we invited leaders from government and non-governmental organisations who advocate support for the health, education and wellbeing of children and families living in Logan, Queensland.

Study procedure

Stage 1: Workshops with service system experts

Stakeholders from the child and family service system were invited to attend one four-hour workshop; two were hosted on the university campus and one at a community centre. All three workshops were conducted in person (October and November 2021) and moderated by two members of the research team (SB & MG) with experience in group facilitation and community engagement, as well as one observer (JS) who collected field notes. In addition, members of the CAG assisted with the facilitation of group activities that included mind-mapping and semi-structured discussions. Each workshop employed a participatory system mapping methodology and used consensus-building and shared decision-making strategies to identify emergent factors related to the experience and knowledge of service system experts (Barbrook-Johnson & Penn, 2021). The workshop methodology and system mapping are extensively detailed in (Stuart et al., 2023). In summary, participants were asked to independently brainstorm factors (positive or negative) related to the question: “According to your experience and knowledge, what do you consider the most important factors in the system, to support the health, education and wellbeing of children and families living [in place]?” This was followed by small group consolidation, and an activity that enabled participants to share their ideas and discuss: (i) why it is important, (ii) whether are there any connections between factors, and (iii) what is working well/not working well (within the service system). Groups then selected two to four system factors and using the round-robin technique, the facilitator solicited one factor from each group. These were listed on a whiteboard for the whole group to view and were further refined through facilitated discussion seeking clarification, elaboration and/or removal of duplication. The explicit purpose of this activity was to elicit the diverse viewpoints of participants and to develop a deeper understanding of key system factors. This method was chosen as it has the advantage of preventing certain individuals from dominating the conversation or influencing the voting. A total of 52 factors and 179 ideas were generated across the three workshops.

Stage 2: Refining and verifying system factors

The research team reviewed the list of system factors. Using thematic analyses, similar concerns/areas were grouped and/or articulated by framing concepts identified through analysis of field notes, observations in situ, and expertise in the subject matter. This resulted in a condensed list of 36 system factors (see full list at Stuart et al., 2023). An inductive approach to identifying and grouping was applied, generating a list of 10 priority areas (Table 2). Prominent themes centred around children, families and parenting, services, access, and utilisation (of services), funding, and hubs (inclusive collaborative spaces that are community-driven, trusting(ed), meet community needs and are positive).

Table 2.

10 priority areas identified by the service system that influence the health, education, and wellbeing of children, and families living in Logan, Queensland.

Priority area^a	Description
Champion community and children’s voice	Empowering individuals, communities, and children themselves to actively participate in decision-making processes, advocacy efforts, and initiatives that directly affect their wellbeing and quality of life
Collaboration within the service system	Essential to ensuring a holistic and coordinated approach, collaboration involves various agencies, organisations, professionals, and stakeholders working together to provide comprehensive services and support
Connection with community	Building connections with the community creates a supportive ecosystem that enhances the overall wellbeing, resilience, and opportunities and fosters a sense of belonging - contributing to a thriving community environment
Early family and child support programs	Initiatives designed to provide assistance, guidance, and resources to children, young people, and their families during the critical early years of development. These programs aim to enhance child wellbeing, support positive parenting practices, and promote healthy family dynamics
Evidence to support the service system	Evidence-based decision-making and continuous monitoring and evaluation of services are essential for ensuring that the service system effectively supports children, and their families to make informed choices
Professional development within the service system	Equipping professionals with the knowledge, skills, and expertise necessary to provide high-quality and culturally sensitive support, such that they can adapt to the evolving needs of the communities they serve
Recognition and support of a diverse community	Ensuring that all members of the community receive equitable and inclusive services, recognising that diversity involves acknowledging and celebrating the differences in cultures, backgrounds, identities, and needs among the community’s residents
Spaces and places for children and families	Creating spaces and places that support and foster community wellbeing, provide growth opportunities, and strengthen family bonds. These spaces would offer a range of resources, activities, and services that contribute to the overall wellbeing, development, and social cohesion of the community
Support and resourcing of existing services	Adequate support and resources help services address the diverse needs of their community and provide high-quality care. This requires ongoing commitment, and collaboration among governments, organisations, communities, and individuals
Tools and technologies for service system navigation	Tools designed to streamline the process of finding and accessing appropriate support services, such as online directories and databases, telehealth platforms, and connected service portals will ultimately contribute to better outcomes for children and families

^alisted in alphabetical order.

Stage 3: Ranking of priority areas

Ranking of the 10 priority areas was completed via an online survey (LimeSurvey GmbH v.2.59.1), created by the lead researchers who had expertise in questionnaire design; members of the CAG reviewed the survey for comprehension and refinement. A link was distributed via email to individuals identified on our stakeholder register, regardless of whether they participated in a workshop (survey was active from 13 December 2021 to 21 January 2022). Two reminder emails were sent three and six weeks after the initial invitation. The average time to completion was 22.5 ± 16.7 minutes. Participant demographics, community work experience, and service sector practice were collected, followed by selecting their top three priority areas (from the list of 10 presented in random order to omit selection bias). Additionally, feedback on the priority-setting process was sought using a five-point Likert scale (strongly disagree to strongly agree).

Data analysis

Data were assessed using descriptive statistics expressed as counts and frequencies, in aggregate form. The main outcome measure was the ranked priority list, using weighted rank order analysis. Values were summed and ordered consecutively, where a higher score indicated greater priority. Analyses were performed using the SPSS statistical software package (IBM, version 25). Questions rated on a five-point Likert scale are presented as diverging stacked bar charts with weighted mean ± standard deviation (SD).

Results

Of the 62 organisations invited to attend a workshop, 21 were represented (response rate of 33.8%), by 32 participants. Twenty-one survey responses were received. Most participants were aged between 41 and 50 years old, were female, White Australian or New Zealand European, were university educated, and in paid employment (Table 3). A large majority of participants represented the community services, and the not-for-profit sector, with an average of 17.9 ± 12.7 years (range 2–45 years) of experience employed in the child services sector. Participants had the most experience working in services that focused on the early years, preschool and early primary, as well as parents and careers of young children.

Table 3.

Characteristics of study participants.

Characteristics	Workshop N (%)	Survey N (%)
Total, N	32	21
Age range (years)
21 to 30	7 (21.9%)	4 (19.0%)
31 to 40	7 (21.9%)	3 (14.3%)
41 to 50	11 (34.4%)	6 (28.6%)
51 to 60	7 (21.9%)	5 (23.8%)
61 or over	0 (0.0%)	3 (14.3%)
Gender
Male	7 (21.9%)	1 (4.7%)
Female	25 (78.1%)	20 (95.2%)
Ethnicity or cultural group
First nations^a	2 (6.2%)	1 (4.7%)
Māori/Pacifika^b	6 (18.7%)	3 (14.3%)
White Australian/New Zealand European	21 (65.6%)	16 (76.1%)
Other ethnicities	0 (0.0%)	1 (4.7%)
Not disclosed	3 (9.3%)	0 (0.0%)
Immigrant to Australia
Yes	4 (12.9%)	2 (8.6%)
No	27 (84.3%)	19 (90.4%)
Highest educational qualification
Secondary school	1 (3.1%)	1 (4.8%)
High school graduate, diploma or equivalent	2 (6.3%)	1 (4.8%)
TAFE or college certificate	7 (21.9%)	1 (4.8%)
Bachelor’s degree	13 (40.6%)	11 (52.3%)
Postgraduate studies (MD or PhD)	9 (28.1%)	7 (33.3%)
Current employment status^c
Paid	27 (84.3%)	20 (95.2%)
Voluntary	8 (25.0%)	1 (4.8%)
Service sector(s) employer^c
Community services	17 (53.1%)	7 (33.3%)
Cultural/Faith-based organisation	3 (9.4%)	2 (9.5%)
Education	3 (9.4%)	5 (23.8%)
Government	3 (9.4%)	6 (28.6%)
Health	2 (6.3%)	2 (9.5%)
Local business	1 (3.1%)	0 (0.0%)
Local council	2 (6.3%)	1 (4.8%)
Not-for-profit	14 (43.8%)	7 (33.3%)
Years working in community settings
Mean ± SD	18.8 ± 27.3	17.4 ± 12.2
Range	2–33	2–45
Experience across different life stages^c
Perinatal	7 (21.9%)	5 (23.8%)
Early years (0 – 3 years)	13 (40.6%)	13 (61.9%)
Preschool and early primary (4 – 8 years)	17 (53.1%)	11 (52.4%)
Middle years (9 – 12 years)	10 (31.3%)	4 (19.0%)
Adolescence (13 – 16 years)	12 (37.5%)	7 (33.3%)
Youth (17 – 25 years)	10 (31.3%)	7 (33.3%)
Parenting/careers	14 (43.8%)	12 (57.1%)

^aIndividuals who identify as Aboriginal and/or Torres Strait Islander persons.

^bIndividuals who identify as Māori or Samoan.

^cMore than one response possible. Abbreviations: TAFE, Technical and Further Education; MD, Medical Degree; LGA, Local Government Area.

The proportional ranking of the 10 priority areas is presented in Figure 2. Of these, six were ranked as the top priority, eight as the second priority, and nine as the third priority. The top three priority areas ranked as the most important for supporting the health, education and wellbeing of children and families by the service system were (i) early family and child support programs (weighted rank 26.2%), (ii) support and resourcing of existing services (weighted rank 14.3%), and (iii) recognition and support of a diverse community (weighted rank 12.7%). Despite ‘spaces and places for children and families’ receiving 43% of the total votes, once weighted for first, second and third priority, it was ranked fifth. Similarly, the priority areas of champion community and children’s voice, evidence to support the services system and connection with community were equally placed sixth at 6.3% weighted rank. Table 4 lists ideas related to the top three priority areas that were generated by the service system experts across the three workshops.

Figure 2.

Ranking of top 10 priority areas, as distributed by proportion ranked as the first, second and third priority and in order from most important to least important priority.

Table 4.

A selection of ideas generated from service system experts, to address the top three priority areas for improving the health, education and wellbeing of children and families living in Logan, Queensland.

Priority 1: Early family and child support programs
Holistic family assessments	Implement a comprehensive family assessment tool to identify the specific needs and strengths of each family. Use this information to tailor support services accordingly
Early intervention programs	Develop early intervention programs that target specific developmental milestones, such as speech and language development, motor skills, or social skills, to address potential delays
Mobile health clinics	Establish mobile healthcare clinics that visit underserved communities, providing convenient access to check-ups, immunisations, and health education for children and parents
Community-based preschools	Collaborate with local communities to establish affordable or free community-based preschools, ensuring that children receive quality early education regardless of their family’s income
Community engagement events	Host regular community events, such as family picnics, storytelling sessions, or art workshops, to foster social connections and a sense of belonging among families
Home visiting teams	Create home visiting teams consisting of trained professionals who visit families in need, offering guidance, support, and referrals to appropriate services
Priority 2: Support and resourcing of existing services
Diversify funding sources	Actively seek out diverse funding sources, including government grants, corporate sponsorships, and community fundraising initiatives. Create a dedicated team or hire a grant writer to pursue funding opportunities
Professional development fund	Establish a fund dedicated to ongoing staff training and development. This could include workshops, certifications, and continuing education to enhance the skills of your team
Technical upgrade initiative	Allocate funds for upgrading technology infrastructure. Invest in new software, hardware, and communication tools to streamline operations and improve client services
Partnership development	Actively seek out partnerships with local organisations, schools, and businesses. Collaborate on projects, share resources, and leverage each other’s networks for mutual benefit
Data-driven decision-making	Invest in data collection and analysis tools to assess program effectiveness. Use this data to make informed decisions about resource allocation and program improvements
Advocacy and awareness	Launch an advocacy campaign to raise awareness of existing services among policymakers, and the community
Priority 3: Recognition and support of a diverse community
Cultural liaison officers	Employ cultural liaison officers or community ambassadors who are familiar with the customs and languages of different cultural groups. These individuals can serve as intermediaries to enhance communication and trust
Culturally tailored health initiatives	Implement culturally tailored health and wellness initiatives, including clinics, workshops, and educational materials, that address specific health concerns and practices within different communities
Integration in schools	Collaborate closely with local schools to ensure that culturally diverse families are actively engaged. Offer culturally sensitive parenting workshops and support services that respect the cultural values of each family
Resource directory	Create a cultural resource directory that provides information about culturally specific services, community organisations, places of worship, and support networks for various groups
Community navigator program	Establish a community navigator program with trained individuals who can guide families through the process of accessing services, benefits, and resources
Local media campaign	Develop a localised media campaign to promote your services and community events. Use community newspapers, social media, and local radio stations to reach a wider audience

Overall, participants were highly satisfied with their experience of the priority-setting process (4.13 ± 0.26). For those who attended a workshop, most ‘agreed’ or ‘strongly agreed’ that it achieved its aims (4.00 ± 0.25) and were very satisfied with the priority-setting experience (4.17 ± 0.31). One participant advised ‘I think you did brilliantly, and I walked away feeling inspired and hopeful’ and ‘[It] will be really great if something actually comes of it and there is change made in area for children’. All participants responded positively when asked if they were given the opportunity to contribute at the workshops (4.33 ± 0.26), whether they felt that their contributions were valued (4.33 ± 0.26) and were represented in the final research and action areas (4.17 ± 0.27). Five of the eight attributes received 100% positive feedback, with respect (i.e., the priority-setting process treated workshop participants in a positive and supportive manner) being the highest-ranked attribute (4.50 ± 0.25) (Figure 3). The lowest ranked attribute, albeit still high, was whether the process was inclusive (i.e., of services, people and organisations required and others who might otherwise be excluded or marginalised) (3.83 ± 0.19).

Figure 3.

Evaluation of attributes related to the priority-setting process.

Discussion

This priority-setting study makes several important contributions and provides valuable guidance to the service system and researchers in this field. Using a rigorous multistep process, we identify 10 priority areas and articulate the top three from the perspective of the child and family service system for supporting the health, education and wellbeing of children and families living in Logan, Queensland.

Our results indicate a clear set of priorities, as well as a high degree of consensus among participants of where efforts should be focused. Specifically, early intervention and prevention efforts were highlighted as critical importance, which is well-aligned with the extant research demonstrating that investing in the early years of children and families who are at risk of poor outcomes can build a strong foundation for long-term positive physical, social/emotional, behavioural and cognitive health outcomes (Adamson, 2012; Homel et al., 2015; Membride, 2016; Nicholson et al., 2012; Victorino & Gauthier, 2009). This supports previous reports that an absence of effective early intervention options contributes to widening disparities in outcomes. Furthermore, supporting the functioning of existing services, creating spaces and places for community and service collaboration, and supporting a diverse community were also found to be activities to support better outcomes for children and families.

This study follows a modified NGT methodology which offers a unique and highly validated approach to setting research priorities through an equal partnership between researchers and service system experts. In this study, we sought to build consensus concerning the areas where limited investments and scarce resources could be mobilised to be the most beneficial.

Our findings share some similarities with recent research conducted by Brockway and colleagues (Brockway et al., 2021) where families in Canada similarly identified issues of early child development as two of their top eleven priorities. However, our study is novel in that the focus for consensus building was on research and action priorities within a specific, disadvantaged region among service providers with ongoing experience in supporting families within complex systems and institutional knowledge of the strategies programs previously trialled in this community context. While involving service users has been argued to be a critical issue in making the most impactful choices for research in many previous priority-setting studies (Jacobson et al., 2003), the inclusion of user voices will tend to elicit individually relevant issues as compared to issues relevant at a system level. Therefore, by focusing on service providers who report considerable lived experience in navigating the system, we were able to identify unique areas of need that are highly likely to initiate service system reform which, in turn, will benefit end-users of the service system.

Priorities identified by the child and family service system

Priority 1: Early family and child support programs

In Logan, Queensland the commitment to early family and child support programs reflects a dedication to nurturing the foundation of future generations, fostering positive development and equitable opportunities for all. Such programs play a pivotal role in fostering the wellbeing and development of children and families. Specifically, stakeholders in our study wanted investment in programs that are evidence-based, effective, evaluated, are community designed, and most importantly, are ‘needed by the community’.

Priority 2: Support and resourcing of existing services

The support and resourcing of existing services was a fundamental priority to child and family support services. Adequate support and building capacity, ensure the sustainability and effectiveness of these services, allowing them to meet the diverse needs of the community. Stakeholders were in support of ‘tailored spaces’ that were unstructured, welcoming and could be a safe space to reside. Resourcing existing services would involve continuous evaluation and adaptation, since properly supported services contribute to long-term positive outcomes.

Priority 3: Recognition and support of a diverse community

Recognition and support of a diverse community are essential components of effective child and family support services. Acknowledging and celebrating the diversity within a community is paramount in tailoring services to meet the unique needs of every family. Stakeholders wanted to see inclusive and culturally sensitive approaches, to create an environment where families from diverse backgrounds feel understood, respected, and empowered.

The identification and ranking of the 10 priority areas is not the end of the process and while these priorities represent a ‘snapshot in time’ of the areas that matter the most to the child and family service system they can be refreshed at a future date to reflect changes in the management or service system reform. They can also be explored with end-users or community members to ensure their voices are heard in identifying and planning actions within their community. In recent work undertaken by Finlay-Jones and colleagues (Finlay-Jones et al., 2020) priority-setting was followed up by rapid reviews of the evidence to better inform the subsequent research and action. It is also important to move beyond the high-level priority areas identified here to create a series of focused research questions and actions aligned to each of the themes that are disseminated broadly to enable planning and future research and application to be coordinated and directed to areas of the highest priority. Evidence-based approaches that engage stakeholders in decision-making are becoming more commonplace, and in situations where there are complex issues of vulnerability, it is crucial to undertake these methods to allocate limited resources in transparent and credible ways (Fadlallah et al., 2020; Viergever et al., 2010).

Strengths and limitations

This study represents a novel application of the priority-setting process adhering to best practice guidelines. Introducing complexity in the focus on a disadvantaged context and specificity in seeking consensus among service providers, the findings from this study should be considered in the context of its strengths and limitations. Of note, both a limitation and strength of this study was the focus on one defined region and while this is likely to limit the transferability of our findings to other geographical areas, it has produced an evidence base for which place-based programs, research and activities may be informed and strengthened within the region of focus. Furthermore, our results are likely to have high levels of external validity as diverse stakeholders from across the service sectors representing different cultural backgrounds, areas of expertise and roles were included, as well as the community advisors who were an integral part of our review and piloting process. Indeed, involving a diverse range of stakeholders in the priority-setting process has been suggested to increase the legitimacy and acceptability of the identified priorities, yet engaging authentically can be challenging in terms of resources, capacity, and feasibility (Fadlallah et al., 2020). To the best of our ability, we created a safe environment for participants to discuss their priorities within a group setting. There are, however, topics that people are likely to find uncomfortable to talk about, and perhaps authentic discussions about barriers related to relationships between different stakeholder organisations may be contentious. To overcome this barrier, we employed both workshop and individual surveys. While this study provides a good overview of priorities, not all topics that were suggested in the workshops could be included in the final list, and we recognise that the resulting list reflects the background and motivations of the service system that participated. We also acknowledge that ranking surveys are subject to a potential lack of reliability, and empirical results suggest that the stability of ranking information decreases with decreasing rank. To mitigate this potential limitation, we asked respondents to select their top three priorities. Further, the implications of COVID-19 during our study were mostly associated with the increased social distancing and mask-wearing requirements, which made it challenging for our workshops. As such, we did not achieve our target sample size, but we did achieve diversity of participation across our stakeholder group who we consider having sufficient expertise to achieve the objectives and reflected with our CAG on methodology, process, and interpretation. The results of this priority-setting study will enable funders to prioritise research and action within the child and family service system and hopefully will provide new, much-needed knowledge in this domain.

Future implications

We intend that the results of this study are the first step in the dialogue and co-design process with the child and family service system in Logan, Queensland. Further work to strengthen relationships and stimulate conversations with relevant stakeholders to ensure applicability at the local and system levels have since taken place. Interviews were held with community leaders overseeing organisations, services, or programs dedicated to supporting children and families in Logan. These interviews were crucial to the extant knowledge these individuals possess about the service system (unpublished manuscript). Together, with the findings from this study, we will consolidate the research and actions ideas, review these against existing research gaps and community need, to ultimately inform targeted actions and foster a more comprehensive and impactful approach to supporting children and families. In this respect, a systems approach to address complex multilevel evidence-based priorities will require multisector interagency collaboration.

Conclusion

This study provides the much-needed guidance to align future efforts and allocate limited resources to areas identified by the service system in efforts to improve the health, education and wellbeing of children and families living in Logan, Queensland. The service system called for early support programs for young children and their families, resourcing of existing services, and the recognition and support of diversity in the community.

Footnotes

Acknowledgements

The authors would like to thank members of the Community Advisory Group and all individuals who participated in the study. We acknowledge S. Zanus for conducting the community assets and resources review, and G. Leeming and E. Searle for helping to facilitate the small group workshops.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Paul Ramsay Foundation (grant number 681). Any opinions, findings, or conclusions expressed in this report are those of the author(s) and do not necessarily reflect the views of the Foundation.

ORCID iDs

Michelle A. Krahe

Mandy Gibson

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