Child Fluoride Varnish Programs Implementation: A Consensus Workshop and Actions to Increase Scale-Up in Australia

This paper presents the findings of the National Fluoride Varnish Workshop in 2018 along with subsequent actions to scale-up the use of fluoride varnish nationally in Australia. The use of fluoride varnish programs to prevent dental caries in high-risk child populations is an evidence-based population health approach used internationally. Such programs have not been implemented at scale nationally in Australia. A National Fluoride Varnish Consensus Workshop was held in Sydney in November 2018 with an aim of sharing the current work in this area being undertaken by various Australian jurisdictions and seeking consensus on key actions to improve the scale-up nationally. Forty-four people attended the Workshop with oral health representatives from all Australian state and territory health departments, as well as the Australian Dental Association (ADA) at both NSW branch and Federal levels. There was strong support for further scale-up of fluoride varnish programs nationally and to see the wider use of having non-dental professionals apply the varnish. This case study identifies key actions required to ensure scale-up of systematic fluoride varnish programs as part of a strategic population oral health approach to preventing dental caries among high-risk children who may not routinely access dental care.

Implementation of an Effective Decentralised Programme for Detection, Treatment and Prevention of Tuberculosis in Children

Childhood tuberculosis (TB) is consistently under-detected in most high-burden countries, including Uganda, especially in young children at high risk for severe disease and mortality. TB preventive treatment (TPT) for high-risk child contacts is also poorly implemented. The centralised concentration of services for child TB at the referral level is a major challenge in the prevention, detection and treatment of TB in children. In 2015, the DETECT Child TB Project was implemented in two districts of Uganda and involved decentralisation of healthcare services for child TB from tertiary to primary healthcare facilities, along with establishing linkages to support community-based household contact screening and management. The intervention resulted in improved case finding of child and adult TB cases, improved treatment outcomes for child TB and high uptake and completion of TPT for eligible child contacts. A detailed description of the development and implementation of this project is provided, along with findings from an external evaluation. The ongoing mentorship and practical support for health workers to deliver optimal services in this context were critical to complement the use of training and training tools. A summary of the project’s outcomes is provided along with the key challenges identified and the lessons learnt.

‘You Decide’: Relationship-Based Knowledge and Parents’ Participation in High-Risk Child Protection Crisis Interventions

In the scholarly writing on child protection, there is a broad consensus regarding the importance of parents’ participation in knowledge-production processes. However, there is limited research on the conditions required to make parental participation possible in high-risk crisis situations. In particular, there is a dearth of writing that takes into consideration the context of poverty that influences families’ lives and the power imbalances between social workers and parents that are evident in these processes. Through a case illustration of a high-risk crisis situation in the Israeli child protection system, this article examines the potential contribution of a developing critical paradigm—the Poverty-Aware Paradigm—to the promotion of parents’ participation in high-risk crisis situations. Specifically, it points to ‘relationship-based knowledge’ as an organizing axis for knowledge production, and to its derivative, ‘dialogue on power/knowledge’, as a useful practice in child protection interventions. The case analysis reveals three distinguishing features of this dialogue: (i) the social worker holds a dialectic stance regarding knowledge; (ii) the social worker and the parents negotiate their interpretations; and (iii) the social worker shares common hopes and worries with the parents.