Sharon Goldfeld

• FRACP FAFPHM PhD
• Professor (Full) at The Royal Children's Hospital

Evidence-based parenting programs (PPs) benefit children and families (e.g., enhanced parenting, reduced child problems). However, equitable delivery of PPs is challenging. Use of local and timely lead indicator data (assessing program quantity, quality, and participation) can show whether enough high-quality services reach families in need. This s...

BACKGROUND Child mental health disorders are a significant Australian public health issue with high prevalence rates compounded by inequitably higher rates for those living in families with lower income, lower levels of parental education and higher levels of unemployment. Prevention and early intervention approaches are critical to address problem...

Children living in adversity are disproportionately affected by inequities in early childhood health and education service delivery, leading to differential outcomes that track into adulthood. Previous research has demonstrated the inconsistency, lack of effectiveness, and harm that human services can cause across the social sector when service del...

Background In a world confronted with new and connected challenges, novel strategies are needed to help children and adults achieve their full potential, to predict, prevent and treat disease, and to achieve equity in services and outcomes. Australia’s Generation Victoria (GenV) cohorts are designed for multi-pronged discovery (what could improve o...

Aims While COVID‐19 no longer presents a global health emergency, the indirect (non‐infection) impacts of the pandemic may exacerbate health inequalities in years to come. We examined the socio‐economic distribution of the impacts of the pandemic on the psychosocial and economic well‐being of children, young people and their families. Methods The...

Household income and caregiver mental health are important drivers of children’s health and development. The COVID-19 pandemic created huge economic and mental health disruptions. This study examines financial hardship and its relationship with caregiver and child mental health using Australia’s only representative data spanning three years of the...

Introduction: Childhood adversity is associated with poor physical and mental health outcomes across the lifespan. Integration of health and social care may provide a solution to childhood adversity through practices of better detection and response. There is growing interest in the creation of child and family hubs that integrate health and social...

Purpose In this paper, we aim to test the usefulness and contribute to the further development of analytical frameworks that guide research into integrated health and social care initiatives. Design/methodology/approach This study uses case studies based in decentralised administrative areas within the New South Wales state health system using (1)...

Introduction Strong oral language and reading skills are important for child development. The response to intervention (RTI) framework supports schools to apply evidence-based practices and interventions to proactively meet the learning needs of all students and identify and support students at risk of learning difficulties. Getting it Right from t...

Longitudinal cohort studies, which follow a group of individuals over time, provide the opportunity to examine causal effects of complex exposures on long-term health outcomes. Utilizing data from multiple cohorts has the potential to add further benefit by improving precision of estimates through data pooling and by allowing examination of effect...

Purpose “Positive epidemiology” emphasizes strengths and assets that protect the health of populations. Positive mental health refers to a range of social and emotional capabilities that may support adaptation to challenging circumstances. We examine the role of positive mental health in promoting adolescent health during the crisis phase of the CO...

Background In a world confronted with new and connected challenges, novel strategies are needed to help children and adults achieve their full potential, to predict, prevent and treat disease, and to achieve equity in services and outcomes. Australia’s Generation Victoria (GenV) cohorts are designed for multi-pronged discovery (what could improve o...

This study investigated barriers and enablers to collecting, reporting, and using data and evidence-based lead indicators in decision-making. Four Australian place-based initiatives (PBI) focused on improving child health and reducing inequities participated. Eight interviews with PBI leaders revealed barriers and enablers aligned with all three Ca...

Designed to help solve complex problems facing children and adults, Generation Victoria is Australia’s largest-ever birth cohort, and the only such cohort mounted internationally during the COVID-19 pandemic. Here, we describe progress in bringing together this ‘cell-to-society’ consented cohort with diverse existing data and biosamples assets. Gen...

Background Childhood adversities worsen physical and mental health across the lifespan. Health and social care practitioners play a key role in identifying and responding to childhood adversity, however, may be reluctant to do so due to a perceived lack of services to refer to, time pressures and a deficit of training and confidence. We aimed to (1...

Background Adverse childhood experiences can impact physical and mental health throughout the lifespan. To support families experiencing adversity and improve child health and developmental equity, an integrated, multi-sector response is required. Child and Family Hubs (Hubs) are a feasible and acceptable approach to providing such a response. In t...

Background Social disadvantage leads to dental caries during childhood. Aim This study investigated whether dental caries occur earlier in children from households experiencing social disadvantage than those not experiencing social disadvantage. Design The overall risk of, and relative time to, early childhood caries (ECC) according to sociodemog...

IntroductionNurse home visiting (NHV) is designed to redress child and maternal health inequities, but long-term evaluation is hampered by sample attrition. Evaluation using administrative data has the potential to overcome attrition through provision of a more complete outcome profile. Australia's “right@home” trial is the only long-running evalua...

BACKGROUND AND OBJECTIVES Coronavirus disease 2019 (COVID-19) lockdowns (stay-at-home orders) had significant mental health consequences in 2020 to 2021 for caregivers and children. Little is known about “postlockdown” periods in 2022 to 2023. We investigated the mental health experiences of Australian families throughout the 3 years of the COVID-1...

Australian Governments are increasingly understanding the impacts of early adversity, evidenced by ongoing policy and investment in two of the most widely implemented early interventions: nurse home visiting (NHV) and early childhood education and care (ECEC). Neither intervention fully redresses the developmental inequities engendered by early adv...

To better understand the specific influences of early life on the long-term health and well-being of local Aboriginal children in Alice Springs, high-quality local longitudinal data is required. The Central Australian Aboriginal Congress and the Murdoch Children's Research Institute are exploring the feasibility of establishing a cohort study to fi...

Objectives ‘Healthier Wealthier Families’ (HWF) seeks to reduce financial hardship in the early years by embedding a referral pathway between Australia’s universal child and family health (CFH) services and financial counselling. This pilot study investigated the feasibility and short-term impacts of HWF, adapted from a successful Scottish initiati...

There is a need for quality longitudinal data on the health and well-being of young Aboriginal and Torres Strait Islander children (hereafter Aboriginal) in Alice Springs that can be used for research, planning and evaluation. The primary aim of this descriptive qualitative study was to determine whether or not a proposed cohort study would be acce...

Background Early childhood interventions have the potential to reduce children's developmental inequities. We aimed to estimate the extent to which household income supplements for lower-income families in early childhood can close the gap in children's developmental outcomes and parental mental health. Methods Data were drawn from a nationally re...

Background Unaddressed family adversity has potentially modifiable, negative biopsychosocial impacts across the life course. Little is known about how Australian health and social practitioners identify and respond to family adversity in community and primary health settings. Objective To describe, in two Australian community health services: (1)...

Background Lower maternal education is associated with higher body mass index (BMI) and higher chronic inflammation in offspring. Childhood adversity potentially mediates these associations. We examined the extent to which addressing childhood adversity could reduce socioeconomic inequities in these outcomes. Methods We analysed data from two earl...

The COVID-19 pandemic has profoundly affected children’s care and education worldwide. This article reports on patterns of participation in early childhood education and care (ECEC) across Australia as influenced by the COVID-19 pandemic and national policies. Using ECEC data from Xplor – a software platform used across Australian childcare centres...

Objective Nurse home visiting (NHV) is designed to redress child and maternal health inequities. Of the previous trials to investigate NHV benefits beyond preschool, none were designed for populations with universal healthcare. To address this evidence gap, we investigated whether the Australian ‘right@home’ NHV programme improved child and materna...

Aim To identify the barriers associated with inadequate antenatal attendance by disadvantaged women in Australia and to further explore how these barriers are experienced by this population group. Design A qualitative descriptive study utilizing semi‐structured interviews and thematic analysis. Methods Interviews were conducted with 11 pregnant w...

Objective To explore caregivers’ experiences and challenges of accessing help for adversity across both health and social care sectors. Design Qualitative study design using semistructured interviews to explore how caregivers accessed services across health and social care. Interviews were audio recorded, transcribed verbatim and analysed using re...

Aim: Functional bowel (constipation and faecal incontinence) and bladder (urinary incontinence and enuresis) problems in children are often treated by paediatricians yet should mostly be managed by general practitioners (GPs). To understand whether the necessary skills and knowledge are being built in general practice, this study aimed to establis...

Background: Prevention is key to reducing socioeconomic inequities in children's mental health problems, especially given limited availability and accessibility of services. We investigated the potential to reduce inequities for disadvantaged children by improving parental mental health and preschool attendance in early childhood. Methods: Data...

Children consistently exposed to positive, stimulating environments, including their spatial neighbourhood, experience foundations for ongoing optimal development. Recognition of the neighbourhood as a mechanism to enhance wellbeing is reflected in the United Nation's New Urban Agenda. Through a series of innovations and advancements, this paper ai...

Aim: Schools are a key platform for health promotion and a point of connection to local health-care services, with an almost universal reach across the child and adolescent population. This study sought to determine whether validated psychosocial assessment tools exist for a school-based nursing program that would assist in providing an initial he...

Linking very large, consented birth cohorts to birthing hospitals clinical data could elucidate the lifecourse outcomes of health care and exposures during the pregnancy, birth and newborn periods. Unfortunately, cohort personally identifiable information (PII) often does not include unique identifier numbers, presenting matching challenges. To dev...

Objective We examined associations between neighbourhood built environment features and early childhood development (ECD), and tested the contribution of the built environment to associations between neighbourhood disadvantage and ECD. Methods Spatial neighbourhood built environment measures were linked to participant addresses in the 2015 Austral...

In 2020, Australia's successful COVID‐19 public health restrictions comprised a national “initial lockdown” (March–May) and “ongoing lockdown” (July–November) for metropolitan Victorian residents only. We evaluated associations between ongoing lockdown and family finances and mental health. In the June and September 2020 Royal Children's Hospital N...

Objectives Nurse home visiting (NHV) is widely implemented to address inequities in child and maternal health. However, few studies have examined longer-term effectiveness or delivery within universal healthcare systems. We evaluated the benefits of an Australian NHV program (“right@home”) in promoting children’s language and learning, general and...

Background Sweden is often held up as an example of a country with low child deprivation; yet, rates of relative deprivation are rising. Every municipality in Sweden is required to provide free, timely and accessible budget and debt counselling under the Social Services Act. The services have been encouraged to perform preventative practice with fa...

Children need rich language learning experiences in school to build language and reading skills. Research suggests that various effective ways to support teacher provision of these experiences. The Classroom Promotion of Oral Language cluster randomized controlled trial ( n = 1,360 students; 687 intervention, 673 control) examined whether a teacher...

Background The relationship between childhood adversity and inflammation is well-established. Examination of positive experiences can provide a more complete understanding of intervention opportunities. We investigated associations of adverse and positive experiences, and their intersection, with inflammation in children and adolescents. Methods Da...

Issue addressed: To determine if Australian policies support a primary health care system to identify family adversity and subsequently support these families. Methods: Two methodological approaches were used: 1) a scoping review of Australian federal and two states (Victoria, NSW) policies related to family adversity (e.g., childhood maltreatme...

Issue addressed: Accurate data on the health of Australia's First Nations peoples is critical in determining appropriate public health programs and establishing a baseline against which to measure progress. The effective translation of evidence into practice continues to be a challenge for Australian health departments and policymakers. The object...

Background Little is known about the efficacy of pregnancy screening tools using non-sensitive sociodemographic questions to identify the possible presence of as yet undiagnosed disease in individuals and later adverse childhood events disclosure. Objectives The study aims were to: 1) record the prevalence of risk disclosed by families during rece...

Students with additional health and developmental needs are at risk of poor psychosocial and academic outcomes as they enter and move through school. Early identification and supports to promote participation and learning can be highly effective in meeting the needs of these students helping them thrive academically, socially, and emotionally. This...

Objectives: Explore the feasibility of an integrated Child and Family Hub within Victorian Community Health Services (CHS) to identify and respond to family adversities as preventable determinants of child mental health problems. Methods: Thirteen Victorian CHS staff and government policy makers (PMs), recruited via snowball sampling, participat...

Child dental caries (i.e., cavities) are a major preventable health problem in most high-income countries. The aim of this study was to compare the extent of inequalities in child dental caries across four high-income countries alongside their child oral health policies. Coordinated analyses of data were conducted across four prospective population...

Background There are calls for research into the mental health consequences of living through the COVID-19 pandemic. Australia’s initial, effective suppression of COVID-19 offers insights into these indirect impacts in the relative absence of the disease. We aimed to describe the mental health experiences of Australian caregivers and children over...

Background/objectives: This study analysed the relationship between early childhood socioeconomic status (SES) measured by maternal education and household income and the subsequent development of childhood overweight and obesity. Subjects/methods: Data from seven population-representative prospective child cohorts in six high-income countries:...

Longitudinal cohorts can provide timely and cost-efficient evidence about the best points of health service and preventive interventions over the life course. Working systematically across cohorts has the potential to further exploit these valuable data assets, such as by improving the precision of estimates, enhancing (or appropriately reducing) c...

BACKGROUND Digital health solutions have the potential to transform health delivery and health outcomes. However, the process of building acceptable and sustainable digital health interventions (DHIs) proves an ongoing challenge in a local landscape with complex and diffuse clinical informatics systems, siloed governance arrangements, and the safet...

Background: Care of young children with neurodevelopmental disorders (NDD) is a major component of paediatric outpatient practice. However, cross-country practice reviews to date have been limited, and available data demonstrate missed opportunities for early identification, particularly in vulnerable population subgroups. Methods: Multicountry...

Longitudinal cohort studies have the potential to examine causal effects of complex health exposures on longer-term outcomes. Utilizing data from multiple cohorts has the potential to add further benefit, by improving precision of estimates and allowing examination of effect heterogeneity and replicability. However, the interpretation of findings c...

This review assesses the effectiveness of integrated primary health and social care hubs on mental health outcomes for children experiencing adversity and describes common integration dimensions of effective hubs. PubMed, OVID Medline and PyschINFO databases were systematically searched for relevant articles between 2006–2020 that met the inclusion...

Financial counselling and income-maximisation services have the potential to reduce financial hardship and its associated burdens on health and wellbeing in High Income Countries. However, referrals to financial counselling services are not systematically integrated into existing health service platforms, thus limiting our ability to identify and l...

Introduction Integrated community healthcare Hubs may offer a ‘one stop shop’ for service users with complex health and social needs, and more efficiently use service resources. Various policy imperatives exist to implement Hub models of care, however, there is a dearth of research specifically evaluating Hubs targeted at families experiencing adve...

Healthy development in the early years lays the foundations for children’s ongoing physical, emotional, and social development. Children develop in multiple contexts, including their local neighbourhood. Neighbourhood-built environment characteristics, such as housing, walkability, traffic exposure, availability of services, facilities, and parks,...

Background We examine (1) the frequency of financial difficulties in Australian families with young children (0–8 years) in the early and later phases of the pandemic; (2) the extent to which parents' pre‐pandemic socio‐economic disadvantage (SED) predicted financial difficulties; and (3) whether grandparent intergenerational SED further amplified...

This paper explores neighborhood-built environment features related to ‘better than expected’ and ‘as expected’ early childhood development outcomes (ECD) in 14 Australian disadvantaged communities. This paper draws from mixed methods data collected in the Kids in Communities Study – an Australian investigation of community effects on ECD – in comm...

Attendance at high-quality early childhood education and care services can have positive impacts on children’s learning and development, particularly for disadvantaged children. Aboriginal children in the Northern Territory are among the most disadvantaged in Australia and stand to benefit in the short- and long-term from attending high-quality and...

Understanding of how socio-economic disadvantage experienced over the life course relates to mental health outcomes in young adulthood has been limited by a lack of long-term, prospective studies. Here we address this limitation by drawing on data from a large Australian population cohort study that has followed the development of more than 2,000 A...

Participation in high-quality early childhood education and care (ECEC) benefits children and society. Policy recognition of this manifests through government subsidy strategies to increase ECEC access in the years immediately preceding school. Yet despite this action, many children do not receive the recommended amount. This study utilizes a mixed...

Background The epidemiology of SARS-CoV-2 in children is an important consideration for control measures. To inform the safe re-opening of Victorian schools and early childhood education and care (ECEC) in late 2020, a detailed analysis of local data was undertaken. Methods Data on all Victorian SARS-CoV-2 confirmed cases, their close contacts, an...

In this narrative review, we summarise the vast and burgeoning research on the potential and established indirect impacts on children of the COVID-19 pandemic. We used a community child health lens to organise our findings and to consider how Australia might best respond to the needs of children (aged 0-12 years). ▪We synthesised the literature on...

CONTEXT Adverse childhood experiences (ACEs) are associated with increased risk of poor mental health outcomes. Although there is interest in screening for ACEs for early identification and intervention, it is not known whether screening improves outcomes for children. OBJECTIVE To systematically review whether screening for ACEs in children leads...

Background Children in out-of-home care (OOHC) have high rates of health needs; consequently, many countries (including Australia) have policies and/or statutory requirements for health assessment upon OOHC entry. However, Australia has no data on health service utilisation or timeliness. We aimed to describe timing and extent of health service uti...

This systematic review investigated small-group Tier 2 interventions to improve oral language or reading outcomes for children during preschool and early primary school years. Literature published from 2008 was searched and 152 papers selected for full-text review; 55 studies were included. Three strength of evidence assessment tools identified a s...

Teacher classroom instructional practice can be a powerful influence on student learning. The Classroom Promotion of Oral Language randomized controlled trial tested whether teacher professional learning focused on promoting oral language in classrooms could improve teacher knowledge and classroom instruction. This study focuses on evaluating the i...

Objectives: To investigate the additional programme cost and cost-effectiveness of 'right@home' Nurse Home Visiting (NHV) programme in relation to improving maternal and child outcomes at child age 3 years compared with usual care. Design: A cost-utility analysis from a government-as-payer perspective alongside a randomised trial of NHV over 3-y...

Introduction Poverty has far-reaching and detrimental effects on children’s physical and mental health, across all geographies. Financial advice and income-maximisation services can provide a promising opportunity for shifting the physical and mental health burdens that commonly occur with financial hardship, yet awareness of these services is limi...

Objective Positive childhood experiences (PCEs), that occur within secure and nurturing social environments, are fundamental to healthy physical, socio-emotional, and cognitive development. However, reliable measures of these experiences are not yet widely available. We used data from the Longitudinal Study of Australian Children (LSAC) to empirica...

Background Australia has maintained low rates of SARS-COV-2 (COVID-19) infection, due to geographic location and strict public health restrictions. However, the financial and social impacts of these restrictions can negatively affect parents’ and children’s mental health. In an existing cohort of mothers recruited for their experience of adversity,...

There is increasing international interest in place-based approaches to improve early childhood development (ECD) outcomes. The available data and evidence are limited and precludes well informed policy and practice change. Developing the evidence-base for community-level effects on ECD is one way to facilitate more informed and targeted community...

Background Inflammation is one of key mechanisms linking childhood experiences to later chronic disease risk. Childhood adversity is associated with inflammation, but little is known about positive experiences. We examine how adverse and positive experiences are associated with inflammatory markers in late childhood, and whether they have an intera...

Focus of Presentation Utilising data from multiple cohorts to address causal questions in health research has become increasingly widespread due to a number of advantages. These include improved precision of estimates, in particular to investigate effect heterogeneity as well as rare events and exposures, and the ability to examine the replicabilit...

Background There are calls for research into the mental health consequences of living through the COVID-19 pandemic. Australia’s initial, effective suppression of COVID-19 offers insights into these indirect impacts in the relative absence of the disease. We aimed to describe the mental health experiences of Australian caregivers and children over...

Objectives In 2020, Australia’s successful COVID-19 public health restrictions comprised a national ‘initial lockdown’ (March-May), and ‘ongoing lockdown’ (July-November) for metropolitan Victorian residents only. We evaluated the relationships between ongoing lockdown and family finances and mental health. Methods In the June and September 2020 R...

Background Mental health competence (MHC) involves psychosocial capabilities such as regulating emotions, interacting well with peers and caring for others, and predicts a range of health and social outcomes. This study examines the course of MHC from childhood to adolescence and patterning by gender and disadvantage, in Australian and UK contexts....

Objectives : We investigated whether nurse home visiting (NHV) affects the uptake and quality of formal early childhood education and care (ECEC) at child ages 2 and 3 years, and reasons for using ECEC at 3 years. Methods : Design: Secondary analysis of the “[email protected]” randomized trial of NHV. Participants: 722 pregnant Australian, English...

Objectives To demonstrate the challenges of interpreting cross-country comparisons of paediatric asthma hospital admission rates as an indicator of primary care quality. Methods We used hospital administrative data from >10 million children aged 6–15 years, resident in Austria, England, Finland, Iceland, Ontario (Canada), Sweden or Victoria (Austr...

Background This study describes trends in social inequities in first dose measles-mumps-rubella (MMR1) vaccination coverage in Western Australia (WA) and New South Wales (NSW). Using probabilistically-linked administrative data for 1.2 million children born between 2002 and 2011, we compared levels and trends in MMR1 vaccination coverage measured a...