National Framework for Universal Child and Family Health Services

3.7.1 Core contact recommendations

Page last updated: 20 May 2013

Antenatal contact

Contact with the child and family health service during the antenatal period provides the opportunity to inform families about the services available after birth. The purpose of antenatal contact by CFHN is not to replace or duplicate services provided by maternity providers such as midwives but to increase early engagement by developing a rapport with families and providing health information [46]. Antenatal contact also improves transition of care between maternity services and child and family health nursing [47] and has been shown to improve service participation for children and families living in disadvantaged communities [46]. It has also been reported that contact between maternity service providers and child and family health services in the antenatal period helps to improve communication, build collaboration and reduce gaps in services [47].

The National Indigenous Health Equality Council has identified in its 2010 publication of Child Mortality Targets: Analysis and Recommendations, that Aboriginal and Torres Strait Islander mothers are accessing antenatal services later in pregnancy and less frequently. Increased access to antenatal care by Aboriginal and Torres Strait Islander women is important as they are at higher risk of giving birth to low birth weight babies. It is also important that universal health service providers such as CFHN work closely with Aboriginal Controlled Health Organisations and with specific Aboriginal and Torres Strait Islander mother and baby programs to increase engagement in universal child and family health services.

Initial universal contact

The initial contact with universal child and family health services occurs ideally within 1-2 weeks following birth. This should be, where possible and desired by the family, offered as a home visit by the CFHN [48]. Home visiting in this context is part of a universal approach to outreach and ensures that the service is able to contact all families of newborn children and connect them with the service. Families who choose not to accept a home visit should be offered other options for support such as, an appointment at a community health centre or review by a GP. It is also acknowledged that home visiting services are not always available or appropriate, particularly in remote Aboriginal and Torres Strait Islander communities.
The home visit has a number of intuitive and anecdotal benefits:
  • It provides a familiar environment for the parent, enhancing their participation and control of the interaction with the health service.
  • It is convenient for parents with a newborn infant, which may be more acceptable to parents.
  • It provides an opportunity for the CFHN to undertake a more comprehensive assessment by observing family interactions and to support parents in providing a nurturing and safe home environment. This also assists in the provision of information to parents that is tailored to their individual needs and may identify issues that require follow-up or referral.
Contact with families in the first 1-2 weeks of their infant’s life provides an opportunity to support parents as they develop a relationship with their infant emphasising infant capacities for learning and communication. This contact also facilitates support for and promotion of breastfeeding, response to any parental concerns for example, feeding and settling, physical examination of the newborn, and orientates the family to relevant support services in their local community.

Health and development monitoring contacts

The ongoing scheduled visits should subscribe to the principles of universal child and family health services and provide opportunities to assess the growing child as evidenced by the sequential achievement of developmental milestones and early identification of children who require further monitoring and/or referral. These scheduled visits also provide the opportunity for anticipatory guidance for expected changes in development over the next few months, and identification of maternal physical health issues and assessment of maternal (or paternal) psychosocial issues including mental health. Detection of problems and ongoing engagement with the service is enhanced if the care is provided by a known professional in a ‘continuity of carer’ model.

Health and developmental opportunities.

Up to the age of 6 months neuro-developmental pathways that influence social and emotional development are being laid down, particularly in response to maternal-infant attachment. Together with support for breastfeeding, the promotion of children’s social and emotional development and parental physical, emotional and mental health are core to this stage of development. Opportunities to promote a healthy home environment (e.g. smoke-free, child safe) that promotes language and communication are also central elements of assessment and health promotion at this time.

Between six and 18 months of age there is rapid development of the infant’s motor, language and cognitive skills, (including social and non-verbal skills). Delays in communication and language development are often evident by 18 months and mild motor delays that were undetected earlier may be more apparent at 18 months of age. In addition, symptoms of autism are often first identified at the 18-month assessment [49].

Ongoing contacts between two years and five years enable continued surveillance of the child’s growth and development over the period of development that many parental concerns are likely to emerge [50]. Early detection of physical, social and emotional developmental concerns and intervention allows a smoother transition to school and minimises the impact of health issues on learning.