A population approachInternationally there is strong support for a population approach to child health and development. The landmark Canadian Early Years Study states that:
Societies and governments have an obligation to the future to devise systems that ensure effective parenting, support good early child development .
The expectation underpinning this statement is that all children have equal opportunity for optimal growth and development in the early years accessed through a universal platform of services . In Australia for example, universal services include health services (antenatal care, child and family health services), school education and in some jurisdictions, early childhood education and care. The World Health Organization (WHO)  also argues that:
Health-care systems contribute most to improving health and health equity where the institutions and services are organised around the principle of universal coverage ... and where the system as a whole is organised around Primary Health Care (p.96).
A population approach seeks community mobilisation directed towards achieving population-wide change in social norms and structures that directly benefit health and wellbeing. It seeks to influence individual behaviours and lifestyles indirectly by changing social norms and social support . Universal population approaches also seek to direct services appropriately to families in response to their needs, and has been most recently articulated in the concept of ‘progressive universalism’  which is premised upon support for all, with more support for those who need it most.
When health services are available to all children and families in the population (that is, are universal) the range of developmental outcomes narrows and more children approximate the average, that is, more children attain normal development. In contrast, the targeting of additional services and supports for children at or below the vulnerability threshold for normal development leads to a decrease in the number of children not attaining normal development. Figures 1 and 2 illustrate the benefits gained from a population approach to services supporting child health and development .
Source: adapted by the AEDI National Support Centre
A system of universal, targeted, secondary and specialist servicesAustralia has a well-accepted system of free, universal health services based on the principles of primary health care3 to meet the needs of pregnant women, children and families at multiple contact points. Midwives provide care at no cost across pregnancy, birth and the postnatal period for up to six weeks after birth in some models of care. Child and family health nurses4 (CFHN) provide services for families and
children from birth to school entry and in some jurisdictions will provide services in the antenatal period and beyond school entry to the age of 12. General practitioners (GPs) also provide significant primary care services for children and families however, these are often at a financial cost to families (see Figure 4) . Universal child and family health services focus on increasing protective factors and reducing risks that impact on children’s health and wellbeing and provide early identification and referral for children and families who may require targeted, secondary or tertiary specialist services. It is expected that 100% of families are able to access universal services.
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Targeted services focus on children and families or communities who have additional needs or increased likelihood of poor health or developmental outcomes limiting opportunities to reach their full potential. Such children and families may include: refugee and culturally and linguistically diverse families, families where drug and alcohol use is a problem and children in out-of-home care. Importantly, targeted services and supports work to reduce inequalities in outcomes between groups of children. Such services are often
provided from within the universal service platform and aim to minimise the effect of risk factors for children and to build protective factors and resilience. Proactive outreach by universal health service professionals to encourage engagement with universal services is one form of targeted support. Other forms include: extended home visiting programs, outreach programs in disadvantaged communities, day stay services and supported playgroup programs.
Secondary level services: Secondary level health services also form part of targeted services and usually fall outside the scope of practice of the universal health providers. Examples of secondary level services include allied health intervention programs, developmental disability and inclusion support services and parenting or family relationships programs. General practitioners play a significant role in both accepting and making appropriate referrals. Approximately, 30% of families are expected to require secondary level services (see Figure 3).
Specialist or intensive tertiary services and supports are individually tailored responses to a particular child and family situation that often requires high levels of expertise. For example, specialist allied health and medical services, paediatric care, mental health, drug and alcohol treatment services or child protection support including adoption and fostering (Adapted from [23, p.19]). Only 20% of families will require tertiary level care, as demonstrated in Figure 3.
The relationship between universal, targeted and specialist services is outlined in Figure 3.
Figure 3: Levels of intervention for child health and development .
Toward an integrated approach to service deliveryAustralia currently has a complex and multi-layered system of funding, service provision regulation and policy development involving a range of government and non-government stakeholders supporting children and their families. While there are examples of high-quality, innovative service provision; inconsistency across jurisdictions and fragmentation of services across professional groups and service sectors means many children and families, particularly those who are most disadvantaged, do not receive the services they need [38, 39].
Better coordinated and integrated approaches to service models and collaborative ways of working are increasingly being recognised both nationally and internationally as the optimal way of meeting the needs of children and families. Partnership and collaboration across professions and traditional service boundaries and coordination of service delivery results in: enhanced access to services; improved health outcomes; a wider choice for consumers; and, a reduction in the use of inappropriate or unnecessary services [40-42].
Universal child and family health services play a critical role in articulating with all elements of a coordinated child and family service system. This integrated approach to looking at how the service system can best meet the needs of children and families is illustrated in Figure 4. The intersections with community services, education and the rest of the healthcare system are critical elements if the service system is to deliver better outcomes for children.
Figure 4: Child and family service system: an integrated approach
3 In theory, the principles of primary health care underpin the work of universal child and family health services although in practice, primary health care strategies are not always well articulated or visible and are often confused with primary care.
4 Known as Maternal and Child Health Nurses in Victoria.
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