Given the myriad of factors (other services, community and social determinants) that influence child and family health outcomes outlined, it is important to measure service performance directly.
This Framework (the National Framework for Universal Child and Family Health Services) is a national service framework (rather than a system-wide framework) and service-oriented outcomes and measures are required to enable national performance monitoring.
Service-oriented outcomes and indicators for universal child and family health services will allow service performance to be measured, by first establishing benchmarks of current performance. Benchmarks will also assist in developing an understanding of the level of change required in each jurisdiction to achieve a truly universal service for all children in line with the vision of this national framework.
Performance indicators can be defined as ‘statistics or other units of information which reflect, directly or indirectly, the extent to which an anticipated outcome is achieved or the quality of the processes leading to that outcome’ . Outcomes and quality of processes can be difficult to measure, so indicators are not necessarily accurate measures of them. Nevertheless, performance indicators can provide useful information to guide decision making.
Reporting on the short- to medium-term outcomes will provide some information about how effective the service is. In addition, proposed service performance indicators have been developed based on a number of criteria outlined in the National Health Performance Framework (see Program Logic, Figure 5). These criteria include determining that services are accessible, appropriate and responsive. For example, through the use of a robust parent satisfaction survey it may be possible to determine the relevance of the service for children
and families and whether this service is provided in a way that is safe (does no harm) and takes account of individual needs, maintains dignity, is timely and facilitates access to social support networks . The parent satisfaction measure is intended for use by local services to inform quality improvement activities. It is not intended that these data would be collected nationally and aggregated. Further it is important to determine the capacity of the workforce to provide the service based on skills and knowledge, the ability to provide coordinated care or service across programs, practitioners, organisations and levels over time . Finally, services must be sustainable and innovative and respond to emerging needs. Table 11 outlines proposed service performance indicators for universal child and family health services:
Proposed service performance indicators
Proportion of children participating in UCFHS consultations at key contact points who:
- receive the initial contact within two weeks of the birth
- receive a health check from UCFHS at 6-8 months of age
- receive a health check prior to school entry (3-4 years)
- receive a vision screen between the ages of 3.5-4.5 years.
Parent satisfaction measure*
Proportion of parents who report:
- feeling engaged with the service
- feeling that providers listened carefully to their needs/concerns and their needs and those of their child are met
- feel supported as competent parents
- feeling that advice was explained in a way that was understood
- Proportion of first-time parents who are offered a new parents’ group and/or are linked to other community support services for parents
- Their child’s needs for referral to services have been attended to by UCFHS
- they received information as appropriate/needed on:
- establishing warm and nurturing relationships
- postnatal depression
- reading with child
- child-led play,
- teeth cleaning,
- nutrition and healthy eating
- smoking cessation (if required).
Notes : * Parent satisfaction measure may be undertaken at local level to inform quality service improvements.
Universal Child and Family Health Services – Program Logic
- Accessible facilities
- Information and data systems
- Materials and Tools
- Universal child and family health services
- Primary / secondary & targeted support services
- Qualified and competent health professionals
- Ongoing education and support
- Adequate supply of health professionals
Process1. UCFHS make contact with each family (phone HV clinic).
2. UCFHS build relationships with parents.
3. Parents not receiving service receive follow-up.
4. Parents who don’t attend are followed up. (Parents are engaged with a UCFHS).
5. Parent strengths and needs elicited
6. UCFHS provide appropriate age & stage consultations
7. Information/advice provided
8. Linked to support services
9. Practice-based intervention provided
10. Identify / recommend additional services
- Self Referral
- Incase of Assisted Referral, the Referral is followed up and Primary/Secondary community service need will be identified.
OutputsDevelopmental surveillance & health monitoring
- Physical health (Vision & hearing, Oral health, Growth monitoring)
- Physical, social emotional & cognitive development
- Identification of parental health needs
- Prevention of disease, illness & injury
- Health education, anticipatory guidance
- Provision of parenting information & advice
- Support for parents
- Community capacity-building
Identification of family support needs Responding to identified need Referral or provision of service information
Performance MeasuresProportion of children participating in UCFHS consults at key contacts points
- the initial contact within two weeks of the birth
- at 6-8 months of age
- the 4- yr- old health check prior to school entry
- vision screen
Parent satisfaction measure
Incl. % of parents who report:
Feeling engaged with the service
Feeling that providers listened carefully to their needs/concerns
Feeling their needs and those of their child are met
Offered a new parents’ group/linked to community supports
Received information on health promotion topics as appropriate
Then go to Medium term Outcomes
Increase in the proportion of children exclusively breastfed to four months
Increase (or no reduction) in the % of children who are fully immunised at age two
Increase in healthy weight of preschool aged children
Increase in children who have no dental caries (dmft/DMFT)
Early identification and attention to child health needs
Positive transition to primary school (children with developmental needs identified and addressed early are more likely to experience a positive transition)
Then go to Longer term Outcomes
Reduction in infant mortality
Reduction in death from avoidable injuries
Increase in the proportion who attend early childhood education in the 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