Promoting child mental health in primary health care

Episode 165 June 09, 2024 00:33:45
Promoting child mental health in primary health care
Emerging Minds Podcast
Promoting child mental health in primary health care

Jun 09 2024 | 00:33:45


Show Notes

In this episode, we’re joined by three guests: Margaret Dempsey (registered nurse), Dr Shereena Sinnayah (general practitioner) and Jacinta Goldenberg (practice nurse). They share their experience of responding to child mental health concerns with families in the primary health care sector and the considerations for practitioners, from systems level to daily practice.
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Episode Transcript

[00:00:00] Speaker A: Approximately 80% of the population visit a general practice in one year, and often more than once. So that's a large portion of the population that are accessing primary healthcare services, and that means a lot of opportunistic conversations. Nurses working in general practice settings have many opportunities to start conversations and ask open questions in a non judgmental, safe environment. [00:00:26] Speaker B: Welcome to the Emerging Minds podcast. [00:00:32] Speaker C: Hi, you're with Nicole Rolbush. This episode was recorded on the traditional lands of the Kaurna people, the lands of the Wurundjeri people of the Kulin nation, and the lands of the Gadigal people of the Eora nation. We pay respect to all Aboriginal and Torres Strait Islander peoples, their ancestors and elders, past, present and emerging from the different First nations across Australia. On today's episode, we're talking about child mental health in the context of primary health care in particular, the important role that practice nurses can play and how nurses and general practitioners can work together to address the child mental health concerns of families that present to their practices today. We've structured the conversation a little differently to cover the broad scope of this topic. In the first part of the episode, I'll be speaking with Margaret Dempsey, registered nurse and program solutions officer with the Australian Primary Healthcare Nurses association, or APNA. And Margaret joins us to really set the scene and provide context and share with us some systems level considerations. For the second half of the episode, I'm joined by doctor Shereena Sanaya, general practitioner, and Jacinta Goldenberg, practice nurse, to extend the conversation to include on the ground practice and examples of how gps and nurses can work together. But first up, we're joined by Margaret. Margaret has been a registered nurse for over 40 years, with 25 years experience in working in the mental health care sector. Margaret has worked as a nurse in general practice for ten years before moving into roles which enabled her to share her knowledge and experience to support other primary healthcare nurses. Margaret currently works with APnA using her wealth of experience in program solutions. Welcome Margaret. Thanks very much for coming along today. [00:02:17] Speaker A: Thanks for having me. It was lovely to have a chat with you. [00:02:19] Speaker C: I wanted to start off by asking you, what role do primary care clinicians play in the prevention and early intervention of child mental health difficulties? [00:02:29] Speaker A: Well, clinicians working in primary healthcare settings play an important role in prevention and early intervention strategies across the breadth of disease or illness, and child mental health care is no different to that. There are over 450,000 nurses registered to practice in Australia and over 96,000 of those work in primary healthcare settings. So that's over 20% of Australia's nursing workforce that are working in primary healthcare settings. And in any one year, approximately 80% of the population visit a general practice or primary healthcare setting and often they visit multiple times in a year. So primary healthcare nurses get to know patients, they get to know children, they get to know families and they build a strong, trusting relationship. And I think because of this regular contact that they have with children and with their parents or carers, nurses may be able to recognise changes in a child's behaviour at early points in care. [00:03:27] Speaker C: Yeah, it's such a significant reach. How does this fit in with the nursing scope of practice? [00:03:34] Speaker A: I'd like to actually start with the key message that nurses don't have to hold specific mental health qualifications or training to play a meaningful role in child mental health care. And I think that's something that's really important to keep as the key message, because people do get a bit scared with the term mental health care and especially if they're thinking about children, the nurses must always work within their scope of practice so that which they are authorised, educated, competent and confident to perform. As guided by the Nursing and Midwifery Board of Australia. I've mentioned that primary healthcare nurses have regular contact with children and their families. So nurses are observant and they're well placed to identify changes in a child's behaviour or be intuitive if a parent is undergoing a period of stress. Nurses have good listening skills. They know how to listen to hear and not just listen to respond. And this all feeds into a nurse's scope of practice without formal mental health training or qualifications. [00:04:38] Speaker C: Yeah, and this is something we actually say a lot to practitioners. There's so many transferable skills that primary healthcare practitioners, nurses included using their day to day work. What would you say to nurses who don't feel very confident about discussing mental health or wellbeing as a topic? [00:04:56] Speaker A: Well, as you say, there's a lot of transferable skills and nurses are well placed to start opportunistic conversations with children, with their parents or carers during the course of the routine work or their routine appointments. So nurses, when they're speaking with children, nurses can inquire about school life, friendships, hobbies, when they're talking with the children. And they can also acknowledge that when speaking with adults, that sometimes life can bring challenges and sometimes those challenges facing the parent may actually have a flow on impact to the child. So I said before about nurses listening skills. Nurses listening and having respectful conversations during routine care, that's what they do. So it's not hard. It's what nurses do and it's what they do really well. [00:05:44] Speaker C: Yeah, absolutely. Can you tell us a bit more about that side of their work and how it helps patients and the relationship? [00:05:52] Speaker A: Well, we all know that nursing is a trusted profession and it's very often voted the most trusted profession. We also know that people may not share their concerns with health professionals unless they're invited to do so. So unless the health professional starts the conversation, start asking some questions. So over the course of my personal nursing journey, patients have often shared information with me as the nurse that they haven't shared with the doctor. And it's that old analogy, oh, the doctor's so busy, I didn't want to disturb the doctor. But knowing that the nurse is interested in them and interested in their situation, perhaps beyond the scope of the reason for the visit that day, knowing that can help elicit trust and provide a foundation for future open conversations. So it's not always about what happens or the conversation held on that day, but it's planting the seed and providing trust that you are interested in that person and that that might actually open up further conversations at another time. [00:06:56] Speaker C: Yeah, building that trust is so important and there are actually some exciting changes in the pipeline at the Commonwealth level for primary care. Can you tell us a bit about these changes and what opportunities do you think they present for primary care nurses as well as the future of primary healthcare in general? [00:07:13] Speaker A: Well, current government primary health care reform initiatives include increased funding to provide to general practice, to give them more resources to implement innovative programs. And we know that nurse clinics, or we call them nurse coordinated, team based models of care, are a model of care where nurses can work to their full scope of practice to deliver better health outcomes for people receiving care. So nurses are excellent coordinators of care. We see that in the role of developing care plans, along with gps nurses gathering that information to develop the plan and then assisting with future care and perhaps referrals to external providers. APNA supports many nurse clinic models and I'd actually like to share an example with you of a teen mental health nurse clinic that was established in a secondary school. So staff at this school identified that teenage mental health had been really significantly impacted during the pandemic as students experienced social isolation and disconnectedness and they noticed the after effects of increased anxiety and depression among the students. So the school nurse at this organisation set up a wellness clinic and the first step in this was to remove negative or sickness related terminology. So the named medical centre was renamed to become the wellness hub to better reflect its purpose. And then they removed the stark clinical furniture and it was replaced with comfortable casual seating, so far more appealing to the students at that secondary school. This space enabled students to reset and regulate their current mindset and with the aim to return the student back to the classroom in a better mindset, rather than being sent home, or rather remaining in the old named sickbay for many hours. The teaching staff also were more intuitive to the students needs and recognised that a student may need to take a break from that classroom structure to reset their focus and reset their mindset. So this is just one example where primary healthcare nurses are making a positive impact on child or adolescent mental health care. And it's a great example of a nurse clinic and I really wanted to share it with you today. [00:09:31] Speaker C: Thank you. Yeah, that's a fantastic example of that team approach to care where, you know, teachers, gps and nurses are all working together to support children and families. And just on that, what advice would you give to all healthcare professionals, including gps, about what nurses can do to improve child mental health? Perhaps there are some examples of some opportunities where nurses and gps can work together. [00:09:56] Speaker A: So, as mentioned previously, approximately 80% of the population visit a general practice in one year and often more than once. So that's a large portion of the population that are accessing primary healthcare services, and that means a lot of opportunistic conversations and the perfect opportunity for team collaboration. And I'm glad you mentioned about team collaboration, because it is so important. Nurses working in general practice settings have many opportunities to start conversations and ask open questions in a non judgmental, safe environment. And if you think about the different opportunities, people attending for immunisations is a perfect one. Children coming in with their parent or carer coming from vaccination, adults coming in for vaccinations as well, perhaps coming in for pathology tests or procedure, where the nurse is assisting the GP in a procedure. So these are all opportunities for nurses to check in with people and can often be the catalyst to starting a conversation with the child or the parent, which may lead to recognising changes in behaviour. So concerns can then be raised with the GP and further exploration can occur with a referral to specialist services if required. And just back onto your comment about the team involvement. They say it takes a village to raise a child and the primary healthcare team, including the nurse, are part of that village. [00:11:24] Speaker C: Absolutely. And going back to your earlier point that primary healthcare nurses don't have to hold specific mental health qualifications to actually play a role in prevention and early intervention, I think that's such an important message. And we have some resources, including a conversation guide and some practice positions that we're going to put in the podcast notes that we've developed to support practitioners to feel confident in this work. And just a final message, Margaret, we sometimes hear people say that someone is just a nurse. What would you say about that statement? [00:11:58] Speaker A: I'd like to challenge anyone who makes the comment I'm just a nurse. To actually rethink that statement. Nurses are scientific, evidence based health professionals. They're educated, nurturing and trusted professionals. And I personally feel extremely privileged to work as a nurse, especially when people invite me into their world. It's a privilege that only few people experience, and I especially feel extremely privileged. So I would just like to reiterate that key message of primary healthcare nurses don't have to hold specific mental health qualifications to play a role and an important role in prevention and early intervention of child mental health care. And I would like to say to the nurses listening, please don't underestimate what you do and the impact you have on other people's lives and health outcomes. And certainly in the realm of child mental health care, absolutely. [00:12:55] Speaker C: There's such a significant positive impact that nurses can make on children's lives and on their mental health and wellbeing. Thanks so much for joining us today, Margaret, and sharing your wealth of experience in this area. [00:13:06] Speaker A: Thanks for having me. I've enjoyed chatting with you. [00:13:09] Speaker C: I think this beautifully sets the scene for our next guests. Joining me for the second half of this episode is doctor Sherina Sinaya, GP, and Jacinta Goldenberg, registered nurse. Shereena and Jacinta work together within a group practice where the whole team, whether medical or administrative, work together to provide care for families. With Margaret's comments in mind, I was curious to hear from a practice nurse and GP living and breathing this practice each day. So, Jacinta and Shereena, thanks for joining me. I wanted to invite you to start by introducing yourselves and perhaps speaking a little bit about group practice. [00:13:45] Speaker D: I'm Sharina, I'm a GP. We work as a group practice and this means that everyone is a part of that team that really builds that patient and families experience, whether it be administrative or medical. The reception staff make sure that we've got adequate time to cater to a family's needs and also have a role in making sure that they're able to prompt families when it comes to things like a postnatal check for mum and checking in on her mental health, or booking future immunisation appointments. In order to keep families on schedule, the administrative staff also have the potential to give families questionnaires like Edinburgh postnatal depression scales in order to speed up the time in the consultation with the nurse or the GP. Our practice nurses are crucial in making family medicine work. They are often that first point of contact for families and provide a more relaxed, more approachable environment to explore a family's dynamic and their concerns. Our practice nurses often initiate discussions about growth, about feeding sleep, discussions about immunisation and development, and that information is then captured as a little snapshot to really enhance the time in the GP consultation. [00:15:03] Speaker E: My name is Jacinta and I'm a registered nurse, and I look at same practice as Shereena. I mean, Shereena, she said it all, we do work very closely together, so I've been pretty fortunate and that we do do all those developmental health checks together. So right from the beginning, just making sure they've got the appropriate appointments booked, you know, because that can be another stressor, like, and making sure the timing works well for gps, that I'm giving the adequate time as well. And just so I do get to see them first and I get those longer appointments, it's just really helpful for me, like, to gather information, as Shereena says, later, and then just have those conversations about what's really important for them at that time. So they get the 15 minutes, I get the 30 minutes. I think I'm like, in the best position anyone could be to sort of utilize that time and my skills, as much as possible really help contribute to a good care find that works well for everybody involved. [00:15:56] Speaker C: Yeah. Thank you both. What are some of the benefits for families that you've seen through working as a team in a group practice? [00:16:02] Speaker E: I would definitely say that the benefit is that, you know, you get that continuity of care. So you see me, you see your regular GP as well, and that there's follow ups, then there may be that not every GP works at a single practice every day of the week. And knowing that there's somebody else who's aware of that person's situation or any stressors and actually just having someone to be able to make that phone call or follow up for them, you know, really makes such a huge difference, because sometimes, yeah, again, I'm in a good position to be able to do that. I can make appointments, I can book a page, like, put the client in to see me, and I can just book in a phone call if that's all it takes as well. And sometimes that's all what people need. So I think working as a team really makes such a huge difference to outcomes and just how we manage it, and that it's really central to, like, what they're expecting and what they would like, and you're meeting those needs as well. So. And I don't know everything. You know, I'm a registered nurse, but we do very little in terms of child mental health. So I really lean on a lot of the GPs as well to, like, help support me, give them the right information, as well as do my own training. But there's huge benefit working with gps who, you know, have a lot of child and mental health experience or just developmental experience. So that's a big benefit, I think, for everybody involved. [00:17:17] Speaker D: I think the GP time is also quite time pressured. So for families, there's often this sense that when you go to see the GP, the time is very short and often there's a long wait to see the GP as well. Having the nurse there provides another touch point, another contact point with which to discuss their concerns. And I think it gives families that sense for a holistic team that builds their sense of confidence in their care and that they have an environment where they can be very open and disclose some of those issues that may arise in the home environment. [00:17:50] Speaker C: Yeah, fantastic. And Margaret spoke about prevention and early intervention in child mental health earlier in the episode, and I wanted to ask you both about this as well. How do you see your roles in this space? [00:18:02] Speaker D: Gps are well placed for the prevention and identification of child mental health issues. They have a very unique relationship with the families that they care for, and often these relationships will begin, you know, well before a child enters that family. It means that through pregnancy and the transition to parenthood, gps have the capacity to really support and educate those families. And patients that are better supported or parents that are better supported will have more capacity, I think, to really identify and address the needs of their child. [00:18:36] Speaker E: There's a tricky one because, as I said, part of it is that, you know, I don't have a lot of that information or training, but I do know I can, you know, see when someone is struggling. And I sort of have a great position where people are willing to have those conversations with me. You know, I guess one, as I can refer to as the childhood development book, is that, you know, does your child change behavior based on their setting? And parents might put expectations on their children to act a certain behavior in front of their gps, but generally, you know, that themselves are their usual behavior and they're happy to have those conversations regarding concerns and it may be that it is their own mental health that could be impacting on their child's mental health. So I think me having that 30 minutes to really dig down and find out about everything, you know, as well as social, emotional, down to physical, like this, can really have an impact on their child's mental health and their mental health. So I may not, you know, be doing a diagnosis, but I can talk about places that can provide that assistance, give that information to the GP and, like, make those suggestions about where I think that we could support them better and how. And this is how they would like to be supported as well, because those are the discussions they may have with me. [00:19:44] Speaker C: Yeah. And that really links back to those transferable skills Margaret was talking about earlier. I wanted to ask you about parents and what are some of the key things that you're doing to engage parents in these preventative or early conversations about their children's wellbeing? [00:19:59] Speaker D: It's about understanding the family dynamics and how they are coping at home. It's giving them the opportunity and the space and that level of comfort to talk very openly about these family dynamics and some of those interpersonal relationships within the household. I do think, again, it comes down to time and it comes down to those longer term relationships that we build with clients that allow us that ease of conversation. And I think the time with the nurse is definitely not an unstructured time, but I guess a more informal environment with which families will discuss, you know, often with. With some humour about how things are coping at home. I think the nurse appointments also, because of the nature of them in that, you know, there's often a bit of movement, there's measurements, there's, you know, it is that sort of sense of, I guess, a bit more casual, it's a bit more dynamic and gives different opportunities for parents to. Into that conversation about mental health difficulties and concerns they might have about how their child is coping. [00:21:01] Speaker E: Yeah, I guess it's that, again, sense of curiosity and just checking in with parents, you know, like the first thing I would do is, as they come into the room is like, how are you? And how have things been? You know, especially they've just had a new child added to the family and maybe their first one or maybe their second one. I think that's really key and important for me because it actually gives me an understanding of how the mother's coping and how that can impact the child. And we talk about those things of social adversity all the time and, you know, their mood and how that can affect their care for their child and how they respond as well. So, you know, identifying their early on struggles, whether it be sleep, whether it be feeding, you know, because a lot of the time they can really undermine their concerns as well. But I think when it comes to having that conversation with me or a nurse, they may say, oh, this seems silly, but they're happy to bring that up with me. And that's because they know, I guess they have that time as well. And they, it's not that gps write a judgmental like environment to be in, but it's definitely a lot more formalized and that's what they, I guess, have experienced before or have the expectations to be like that. And it's another thing of how do I manage their expectations. So when they come in, what do you know, what would they expect parenting to be like as well? And just bringing that back to a reality where every child is different. So that could be part of my assessment of like, you know, looking at preventative healthcare, what's happening for them at the moment and how that's affecting them because the child to the addition, another child not maybe coping and they may respond in a way that they wouldn't generally and understanding how that's impacting them and why their child is crying, why they can't settle them, you know, and just having those important conversations because all the time they'll say this is just what it is and I have to deal with it, but it's not. And then they come to a point where they're, you know, they're breaking because they haven't slept, you know, and then the child isn't in a great sleeping pattern. And, you know, developing routines is so crucial for like, again, preventing like, further challenges as well that they might experience which might be employments or being ill all the time. So I think just having those conversations, being re casual. How are things going? Have you done your postnatal check? How are you managing six weeks after your cesarean? I guess those types of things in a less form way. Is your pain manageable? Because all those things are going to directly impact how they're parenting their child. And, you know, environmental and home based things can all have an impact on like, you know, mental health just to be all known. [00:23:24] Speaker D: So how you structure those appointments can be quite useful as well. We have the nurse appointment first followed by the GP appointment. And families are coming in. You know, having raced there in the car, they're running a bit late. It was hard getting out of the house. Bub is screened the whole way to the appointment and the parents can get there quite flustered and overwhelmed. Allowing that time with the nurse first, I guess, gives them the time to decompress and deescalate so that they actually are more able to open up about some of their stresses. And then by the time they get to the GP, they're feeling very at ease and very comfortable and are ready to take on some of the information and preventative advice that we give them. [00:24:03] Speaker C: Sometimes these can be really tricky conversations to have depending on what's going on for the family. How do you create a safe environment for families for these conversations to happen in? [00:24:14] Speaker D: Depends what kind of tricky topics we need to talk about. The nurse appointment followed by the GP appointment, I guess, gives quite a breadth of time. This is, you know, 30 to 45 minutes in our practice and any issues that might be raised in that nurse appointment. Again, there's time to decompress. There's time for parents to reflect on some of the things that are said. And so when they are getting to the GP appointment, they're always expecting that next level discussion. So they're almost coming in a little bit more prepared to hear some of those hard things, the way we run our practice and I think having that much more, you know, I guess relaxed sort of attitude and atmosphere means that sometimes when there are difficult things to discuss, the parents feel more confident because they are, they feel so cared for. So, you know, the reality in medicine is there's always going to be hard discussions that need to be had. And I think if it's delivered well and with patience and kindness, that information is often well received and appreciated. [00:25:17] Speaker E: Well, you know, this tricky questions, I guess opening up the conversation immediately, as I've said before, and building the relationship from there. And, you know, I see. How often do we see kids that six weeks, four months, six months, twelve months? Like, there's so many opportunities, plus maybe additional vaccines in between for us to build a really good relationship with these parents over, you know, that first year of life even. And one of the things that I'd noticed when I started working at the general practice I'm at, Sharina, is that a really important part of me being able to be involved and building that relationship and being able to ask those tricky questions because I've built a rapport is being introduced to the family as a whole. I might not have ever messaged any of these clients before, but they may go into a GPS office, they'll bring them through and say, hey, at some point these guys may. Can't come in to see you. And I just want them to have a face and someone to recognize. I think that's where I continue to build the relationship. I introduce myself, they know my point of contact again and just being like, look, I'm here four days a week, you can call me with, you know, any questions, like, I think it's always that informal conversation for me, just being like, I'm just. I'm just here to listen and look, you can just call me. It doesn't have to be for any advice. You can just call me to talk about how things are going. And I think that people do utilize that service quite a lot and it's just to have a general check in and discuss or further discuss those concerns. They may not be able to come in for an appointment. So for me, asking the tricky questions is like building it from the beginning and making sure that everybody, like, is aware, I guess, of the family as well. So not just introducing mum and bup, but siblings might come in and there again you start to build a relationship where it allows you to sort of delve a bit deeper into, like, what might be happening for them and they feel more comfortable to share that information with me. [00:27:03] Speaker D: Early childhood is also filled with uncertainty and illness and our practice nurses triage phone calls from parents if they are concerned about their child and wondering whether they should come in, see a GP and provide another point of contact, another source of, you know, clinical information, which, again, builds that sense of confidence in the care that they're providing, but also the confidence that they have in the practice nurse and their very important role in general practice. [00:27:33] Speaker C: Yeah, absolutely. And when you're providing care across a team like you do, how do you exchange the information you're hearing from families with one another? [00:27:42] Speaker D: It's a constant dynamic. [00:27:44] Speaker C: Yeah. [00:27:45] Speaker E: I mean, sometimes it may be that, you know, I have these conversations and I make people aware that, you know, I work with their GP and that, like, the information is going to be read by them and, like, making sure they're comfortable with, you know, me collecting that information and consenting to it as well, because I think that's very important. And it couldn't be as informal as me walking out the room with them, bringing them into the GP's office and being like, measurements are perfectly fine developmentally. We've managed, you know, ticked all the boxes. Bong has these concerns outside of this and that's how informal can be. I say, you know, struggling with a bit of eczema. It doesn't have to be, you know, a systematic handover of head head to toe, particularly if it's there developmental, it's been met. We've cleared the book together just about having in front of the family as well, because I want them to know that what I'm sharing is the correct information, which is really important for me because sometimes when I'm gathering it, it may be that their recollection of, like, events might have, you know, been different or I'd gathered the wrong information or misinterpreted that. And I think it's really important for me to share it again and hear out loud. Yes, that's actually what happens. Or this was actually what happened, because it gets another point. People forget, yeah, 100 things to talk about when you get into a GP office these days, you know, and nurses. [00:29:01] Speaker D: Do document what they're going through. So having the nurse's appointment first means that when I'm opening up the patient file, I get a snapshot of what their discussion has been. Jacinta's wonderful and she actually highlights down the bottom what some of those concerns are. So I've already got a little bit of an inkling of what I need to explore in the consultation. And then I think that personal handover, you know, I might go to Jacinta's room and say, look, is bub ready now? Can I escort them down to my consultation room? Or Jacinta will bring them down to me. Creates that very, you know, that very personal handover. Families feel cared for. They're not being ushered from one room to another. They are our focus. They are what is important to us for that very small time that they are with us. [00:29:44] Speaker E: Their GP might join me in the room and we'll do the developmental health check together, which is, you know, another great means that they've got just as much time as I sort of do with that client, you know, if possible, and things will running well. [00:29:54] Speaker D: So muffle found loitering in Jacinta's office. [00:29:57] Speaker C: Actually, and I wanted to link back to something else that Margaret spoke about earlier in the episode, that there are so many transferable skills in primary healthcare and, you know, you don't have to be an expert on child mental health to talk about it with families. What are both of your thoughts about that? Do you have to be an expert? [00:30:16] Speaker D: You don't have to be an expert in child mental health to be approachable, to actively listen and elicit the concerns of that family. You just need to be present and available. [00:30:29] Speaker E: Yeah, I mean, it's just as easy as saying, are you okay? I guess. And no, you know, nobody needs to be a professional in that area of mental health to ask that question at all, and that would just facilitate discussion and garcia. Facilitate? Yeah, I don't think you need to be an expert at all. And I think that, you know, we're. People are aware of some challenges that people can face in any area and any social determinant. [00:30:55] Speaker A: Right. [00:30:55] Speaker E: So just being like, looking at those areas, you don't have to, again, do any formal training to really understand how that impacts on someone and what mental health is. [00:31:06] Speaker C: And just a final question for both of you before we wrap up today. Any last thoughts on working together as a GP and a practice nurse that you could share with our audience? [00:31:16] Speaker D: Earlier, Jacinta said that, you know, she doesn't know everything. I think as a GP, I often feel that too. And it is true. Practice nurses can be a wonderful resource for information about immunisations. They attend regular immunisation updates and I often feel that sometimes their knowledge will exceed my own. So I do think they're a wonderful resource in that way in organising, you know, catch up schedules or finding avenues through public health for patients to receive care. Again, it becomes a little bit about time that they might, in their day, possibly have a little bit more time to, you know, do referrals to early childhood services like Tresilian, or contact public health if we're unsure about a combination of immunisations. So really drawing on their expertise, drawing on their knowledge, and really appreciating the fact that their knowledge is a very unique resource to draw from. [00:32:11] Speaker E: You know, I've got the time to affirm and listen, and that's what's really important as well, is that sometimes people just want to up a conversation, and that's just easy for me to sit back for ten or 15 minutes and then go through everything that sort of formally needs to be done during those child health checks. But I can just casually sit for. [00:32:31] Speaker D: 15 patients, come in with a laundry list of things that they want to discuss in a consultation. And having that time with the practice nurse means that there may be some of those ones that they feel comfortable to discuss. They might start working on that laundry list, saving maybe a few special items for the GP, but it means that they go home feeling like, these are my concerns, I've aired my concerns, I've received validation that some of these actually need addressing, and they just have more of a framework to work from. [00:33:00] Speaker C: Well, that's all we have time for today. A big thank you again to Margaret, Sherina and Jacinta for joining us and for sharing your experience with us. And thank you to our audience for listening in. We hope you'll join us again soon. Bye. [00:33:13] Speaker B: For now, visit our website at dot au to access a range of resources to assist your practice brought to you by the National Workforce Centre for Child Mental Health led by emerging minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child or Youth Mental Health program.

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