National Framework for Universal Child and Family Health Services

5. Outcomes and Performance Monitoring

Page last updated: 20 May 2013

Effective universal child and family health services can influence a range of health, development and wellbeing outcomes of Australian children and their families. Determining the specific outcomes services impact upon is difficult, given the universal nature of service delivery and the range of other factors that affect outcomes.

Selected National Headline Indicators for Children’s Health, Development and Wellbeing that most closely relate to the outcomes sought by universal child and family health services have been adopted in the Framework as provisional outcome measures.

The Headline Indicators [1] are a set of national, jurisdictionally-agreed priority areas for children’s health development and wellbeing with accompanying indicators that are reported by the Australian Institute of Health and Welfare biannually and every four years in the publication. A Picture of Australia’s Children. These indicators and the associated Headline Indicator data collection system, provide a starting point to measure the impact of the Framework.

Table: Outcome measures for universal child and family health services

Priority areaHeadline Indicator
Infant mortalityMortality rate for infants less than one year of age
BreastfeedingProportion of infants exclusively breastfed at four months of age
ImmunisationProportion of children on the Australian Childhood Immunisation
Register who are fully immunised at two years of age
Overweight and obesityProportion of children whose BMI score is above the international cut-off
points for ‘overweight’ and ‘obese’ for their age and sex
Dental healthMean number of decayed, missing or filled teeth (dmft/DMFT) among
primary school children
Social and emotional wellbeingNo indicator identified
InjuriesAged-specific death rates from all injuries for children aged 0-4, 5-9 and
10-14 years
Attending early childhood
education and care programs
Proportion of children attending an early educational program in the
two years prior to beginning school
Transition to primary schoolProportion of children entering school with basic skills for life and
Child abuse and neglectRate of children aged 0-12 who were the subject of child protection
substantiation in a given year
Family social networkNo indicator identified

The selected outcome measures are high level outcomes and conceptualised at a population level. It is not suggested that there is a direct causal effect between services provided by universal child and family health services and the selected Headline Indicators. However, when measured and monitored over time these indicators will provide information about the health and wellbeing of Australian children and families and whether outcomes are improving over time. Increasing the availability of comparable outcome data at the population level has the potential to also inform service planning, coordination and delivery at the local level.

Some of the selected Headline Indicators in Table 10 are more closely or proximally related to the work of universal child and family health services. The following have been identified as medium term indicators of the Framework:
  • Increase in the proportion of children exclusively breastfed to four months.
  • Increase in the proportion of children who are fully immunised at age two years.
  • Increase in healthy weight of preschool-aged children.
  • Increase in children who have no dental caries (dmft/DMFT)
  • Increase in proportion of children who are identified early and receive attention to child health, developmental and wellbeing needs.
  • Increase in proportion of children experiencing a positive transition to primary school (that is if children with developmental needs are identified and addressed early they are more likely to experience a positive transition).
  • Increase in families with identified needs who are receiving social support.
Other selected Headline Indicators are related in a distal way that is, universal child and family health services are only one of many factors likely to influence these child and family outcomes in the long term. The following outcomes have been identified as long-term outcomes of the Framework:
  • Reduction in infant mortality.
  • Reduction in death from avoidable injuries.
  • Increase in the proportion of children who attend early childhood education for one to two years prior to school entry.
  • Reduction in the number of children who are the subject of substantiations of child abuse and neglect.
  • Improved social and emotional wellbeing of Australian children and families.
The program logic outlined in Figure 5 identifies the expected outcomes of the Framework for universal child and family health services and displays the relationship between services processes, outputs, performance and proximal and distal outcomes.