National Framework for Universal Child and Family Health Services

Executive Summary

Page last updated: 20 May 2013

The National Framework for Universal Child and Family Health Services (the Framework) articulates a vision, objectives and principles for universal child and family health services for all Australian children aged zero to eight years and their families.

The Framework provides a structure to strengthen (and in some cases build) effective services to ensure all Australian children and their families benefit from free, quality universal child and family health services. It is intended that a national Framework will deliver a number of
benefits including:

  • promoting the availability and the role of universal child and family health services to parents, the community as well as health, education and welfare professionals;
  • promoting consistency of service across jurisdictions;
  • providing a contemporary evidence base for service improvement; and
  • progress towards national performance monitoring and the compilation of national population health data for the purposes of comparison across jurisdictions and subpopulations.
The Framework does not seek to prescribe service delivery or restrict flexibility in delivering innovative services to meet the needs of communities. Rather, it provides suggestions and support for evidence-based practice. Evidence-based practice is described through ‘core service elements’ to guide a consistent approach applicable to all jurisdictions.

Universal child and family health services, together with high quality antenatal services, provide the first stage of the universal service system to support human development in Australia. Along with early childhood education and schooling, universal child and family health services aspire to support optimal health and development to give children the best opportunity to succeed in life and learning.

The focus of this document is on the universal health service platform that delivers a set of services to all children and families. This population health approach facilitates the systematic identification of children and families who require further assessment, intervention, referral and/or support. Universal child and family health services work alongside targeted or specialist and intensive services for vulnerable families or for those children where a health or development need is identified.

In recognition of the importance of the early years of life in influencing the health and development of children, the services outlined in the Framework monitor progress and promote health, development and wellbeing during critical periods in a child’s life. This includes recognising the importance of optimal health and wellbeing of parents and other primary carers and ensuring optimal maternal physical and mental health as well as a focus on developing father-inclusive services. Universal child and family health services also contribute to the health of the population through health promotion and preventive health initiatives such as immunisation programs, breastfeeding promotion, child safety and parenting support.

Development of the Framework has been informed by a review of relevant national and international child and family health service frameworks, the research evidence for universal service provision, and a two staged consultation process with approximately 400 stakeholders across all Australian jurisdictions.

The following text under heading "National Framework for Universal Child and Family Health Services" provides a summary of the Framework and outlines the vision, objectives, principles, core service elements and outcomes of the Framework for Universal Child and Family Health Services. This is expanded upon in detail in Section 3 of this document. Section 2 provides the background and context to the development of the Framework. Section 4 provides an overview of the elements of an effective child and family health service system required to underpin universal child and family health services. Sections 5 and 6 discuss the outcome measures, performance monitoring and considers implementation issues for the Framework.

National Framework for Universal Child and Family Health Services

Vision

All Australian children benefit from quality universal child and family health services that support their optimal health, development and wellbeing

Objectives

1. To promote health, wellbeing and development in children and families.
2. To enhance the confidence and capabilities of parents, families and carers in the parenting role, and promote the relationship between the parent/carer and the child.
3. To engage with parents and carers in the early identification of their children’s physical, developmental, social and emotional needs and enable access to timely and appropriate interventions and supports.
4. To support parents and carers in meeting their own and their children’s needs during key transition times especially at birth and the transition to school.
5. To provide early support to families with identified needs.
6. To promote population health through preventing avoidable illness, injury and disease.
7. To enhance community capacity to provide support to parents, carers and families.
8. To work collaboratively with other services to support children, parents, carers and communities.

Principles

Access

  • Services are universally available, free, appropriate, and accessible for all children and families and articulated where possible with other children’s services.
  • Services are delivered flexibly how and where the family needs it. Some families will need help to access services.

Equity

  • Services seek to improve the health of the whole population as well as reducing inequalities between population groups.
  • Universal services work with appropriate targeted responses directed to the families that need them most.
  • Service design and delivery is innovative and is informed by and is responsive to the social determinants of health, paying particular attention to the needs of Aboriginal and Torres Strait Islander children, families and communities.
  • Services actively ameliorate the poorer health and wellbeing of Aboriginal and Torres Strait Islander children, families and communities.
A focus on promotion and prevention
  • The primacy of health promotion, prevention and early intervention is recognised in service delivery.

Working in partnership with families

  • Services work in partnership with families, developing an ongoing relationship with parents/carers focusing on strengths and building capacity.
  • The central role and expertise of families in influencing and supporting the health, wellbeing and development of children is recognised and parents are enabled in this role.
  • Families and communities participate in service design and delivery.

Diversity

  • The diversity of Australian families and communities is valued and services are sensitive and responsive to family, cultural, ethnic and socioeconomic diversity.

Collaboration and continuity

  • Universal child and family health services work in partnership with primary, secondary and tertiary health services and the education, welfare and disability sectors to provide coordinated, multidisciplinary care and integrated service delivery.
  • Continuity of care at transition points is ‘seamless.’
  • Services maximise opportunities for families to develop sustained relationships with health, education, welfare and disability service providers.

Evidence based

  • Services reflect the best evidence or harness practice wisdom where evidence is not available.
  • Continuous improvement and evaluation of services promotes better outcomes for children and families.
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The Role of Universal Child and Family Health Services

Universal child and family health services work in partnership with families and in collaboration with other services to:
  • Promote the parent/child relationship.
  • Promote parental social and emotional wellbeing with detection of social and emotional distress and mental health problems known to impact on parenting (e.g. Post Natal Depression).
  • Conduct developmental surveillance and health monitoring of children from birth to eight years of age.
  • Deliver health promotion activities including primary prevention strategies (e.g. immunisation), health education (e.g. SIDS prevention), anticipatory guidance (infant’s tired signs), parenting skill development (toddler behaviour) and provide support for parents (reassurance, normalisation of child behaviour).
  • Respond to identified needs by providing short or long-term interventions appropriate to the service context, and/or timely and appropriate referral to other services.
  • Participate in community capacity building activities in response to local needs such as parenting groups or local projects focused on child and family-friendly communities.
  • Work collaboratively with other professionals and services to ensure children transition to school with the basic skills for life and learning

Core Service Elements

Developmental surveillance and health monitoring

  • Monitoring physical, social and emotional and cognitive development.
  • Physical health, growth monitoring, oral health.
  • Vision and hearing assessment.
  • Assessment of family psychosocial risk and protective factors.

Health Promotion

  • Prevention of disease, illness and injury.
  • Health education and anticipatory guidance.
  • Support for mothers, fathers and carers.
  • Community capacity building.

Early identification of family need

  • Identify the factors known to increase the likelihood of a child experiencing poorer health, development and wellbeing outcomes.
  • Work with parents, families and communities to build strengths and address needs.
  • Facilitate and coordinate where appropriate, support across multiple services.

Responding to Identified need

  • Information, advice and assistance.
  • Brief practice-based interventions.
  • Referral for further assessment and diagnosis.
  • Referral or invitation for further support within universal health services.
  • Referral for additional or enhanced targeted services.
  • Respond appropriately to child protection concerns.

Performance Indicators

Proportion of children participating in UCFHS consultations at key contact points who receive:
  • initial contact within 2 weeks of the birth
  • contact at 6-8 months of age
  • health check prior to school entry (3 to 4 years)
  • a vision screen between the ages of 3.5 to 4.5 years
Proportion of families who receive follow-up care from UCFHS 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;
  • their child’s needs for referral to services were attended to;
  • they were offered a new parents’ group or linked to support; and
  • they received information on: breastfeeding, reading with child, safe sleeping, teeth cleaning, nutrition and healthy eating, smoking cessation (if required), child-led play, establishing warm and nurturing relationships parent/carer/ child (if needed).

Medium-Term Outcomes**

  • 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 primary school children who have no dental caries (decayed, missing and filled teeth dmft/DMFT).
  • Increase in proportion of children who are identified early and receive attention to child health and developmental needs.
  • Increase in proportion of children experiencing a positive transition to primary school.
  • Increase in families with identified needs who are receiving social support.

Long-Term Outcomes**

  • Reduction in infant mortality.
  • Reduction in death from avoidable injuries.
  • Increase in the proportion of children 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.

Footnotes
* Parent satisfaction measure may be undertaken at local level to inform quality service improvements.
** The medium- and long-term indicators are linked to the current (December 2010) National Headline Indicators for Children’s Health, Development and Wellbeing[1].
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