Universal child and family health services are delivered through a schedule of periodic contacts with children between birth and school entry in most jurisdictions in Australia and also in many countries around the world. The timing of these key visits have been designed to coincide with critical periods in development, to maximise the opportunity for parental guidance, and to support developmental surveillance and health monitoring. In addition to the scheduled periodic contact times, universal child and family health services offer brief or targeted interventions to children and families with identified needs in order to address issues early and often prevent further referrals. It is well understood that the efficacy of targeting families with greater need (i.e. closing the disadvantage gap) will be reliant on the strength of the universal service base .
These schedules of contact exist internationally (Bright Futures, USA; National Service Framework for Children, Young People and Maternity Services, UK; Well Child Framework, New Zealand) for monitoring of the ‘well child’. Although there is no clear evidence as to a particular minimum or maximum number of contacts (or the exact timing of contacts), all frameworks include regular and relatively frequent assessment in the early years in order to provide the opportunity for parents to discuss any concerns leading to the early identification of issues that can either be addressed or further referred . All Australian states and territories recognise the benefits of regular scheduled contact with families. This is in line with medical associations and governments internationally who consistently recommend that all children receive periodic universal developmental surveillance, particularly in the years before children start school .
Principles for the delivery of well child careCore contact times are therefore based on a series of principles including:
- critical periods of child development – recognising development is rapid during the early years, particularly the first 12 months, and therefore early interventions during this period are more economical and effective
- alignment to immunisation schedules to encourage participation in both programs
- opportunities to identify families at risk and offer timely family support services
- opportunities for targeted anticipatory guidance, provision of age-specific health information and relevant health promotion activities and
- aligning contacts with memorable events such as the child’s birthday (particularly over 18 months of age).
- Facilitates the development of a relationship between the family and services. A relationship based on trust and continuity of care is important to engage parents in services, to respond appropriately to parental concerns and to work together towards a common goal (will add refs here to Davis et al and Olds also Kemp).
- Facilitates timely support for parents as they learn to recognise and accommodate the frequent transitions in infant development (can add ref to Wonder Weeks)
- Promotes parental peer support and community networking either on an individual or group basis (can ref to Scott & others).
- Links parents with both formal and informal community-based services and supports.
Flexible optionsOpportunistic contact with children and families will also occur at immunisation and general practitioner visits when episodic illness and other concerns arise. Families, who are confident in their parenting ability because they have gained experience caring for other children, may choose to access child and family health services solely for immunisation. It is therefore important for immunisation service providers (CFHNs, GPs and others) to opportunistically discuss any other relevant information at this contact or encourage participation in the universal service where this is beyond their scope of practice (e.g. Practice Nurse).
Flexibility is central to providing universal child and family health services which are responsive to the needs of families. While families are encouraged to access services at key ages and developmental stages, this should not preclude access to services for assessment and support at any other time. Although somewhat challenging, it is in fact this flexibility that will ensure that universal services are able to more effectively target families who may have greater needs.