Maternal & Child Health Primary Health Care Policy

Transcription

1 Policy Directive Miistry of Health, NSW 73 Miller Street North Sydey NSW 2060 Locked Mail Bag 961 North Sydey NSW 2059 Telephoe (02) Fax (02) Materal & Child Health Primary Health Care Policy Documet Number PD2010_017 Publicatio date 04-Mar-2010 Fuctioal Sub group Cliical/ Patiet Services - Baby ad child Cliical/ Patiet Services - Materity Cliical/ Patiet Services - Nursig ad Midwifery space space space Summary The Materal ad Child Health Policy is oe part of the NSW Health/Families NSW Supportig Families Early package. The package cotais policies ad guidelies for the idetificatio of vulerable families from a uiversal platform of primary health care services. This is through the comprehesive primary care assessmet model, SAFE START, ad the provisio of materal ad child primary health care services icludig Uiversal Health Home Visitig. The package is uderpied by the Families NSW strategy, equity ad cliical practice priciples that iclude workig i partership with the family ad facilitatig the developmet of the paret-ifat relatioship. Author Brach NSW Kids ad Families Brach cotact NSW Kids & Families Applies to Area Health Services/Chief Executive Govered Statutory Health Corporatio, Board Govered Statutory Health Corporatios, Affiliated Health Orgaisatios, Affiliated Health Orgaisatios - Declared, Public Health Uits, Public Hospitals Audiece Materity, child & family health, early childhood, allied health, paediatric ipatiet, ED's Distributed to Public Health System, Divisios of Geeral Practice, Govermet Medical Officers, Health Associatios Uios, NSW Ambulace Service, Miistry of Health, Private Hospitals ad Day Procedure Cetres, Tertiary Educatio Istitutes Review date 31-Dec-2015 Policy Maual Patiet Matters File No. 02/ Status Active Director-Geeral space This Policy Directive may be varied, withdraw or replaced at ay time. Compliace with this directive is madatory for NSW Health ad is a coditio of subsidy for public health orgaisatios.

2 Policy Directive Miistry of Health, NSW 73 Miller Street North Sydey NSW 2060 Locked Mail Bag 961 North Sydey NSW 2059 Telephoe (02) Fax (02) Materal & Child Health Primary Health Care Policy Documet Number PD2010_017 Publicatio date 04-Mar-2010 Fuctioal Sub group Cliical/ Patiet Services - Baby ad child Cliical/ Patiet Services - Materity Cliical/ Patiet Services - Nursig ad Midwifery space space space Summary The Materal ad Child Health Policy is oe part of the NSW Health/Families NSW Supportig Families Early package. The package cotais policies ad guidelies for the idetificatio of vulerable families from a uiversal platform of primary health care services. This is through the comprehesive primary care assessmet model, SAFE START, ad the provisio of materal ad child primary health care services icludig Uiversal Health Home Visitig. The package is uderpied by the Families NSW strategy, equity ad cliical practice priciples that iclude workig i partership with the family ad facilitatig the developmet of the paret-ifat relatioship. Author Brach NSW Kids ad Families Brach cotact NSW Kids & Families Applies to Area Health Services/Chief Executive Govered Statutory Health Corporatio, Board Govered Statutory Health Corporatios, Affiliated Health Orgaisatios, Affiliated Health Orgaisatios - Declared, Public Health Uits, Public Hospitals Audiece Materity, child & family health, early childhood, allied health, paediatric ipatiet, ED's Distributed to Public Health System, Divisios of Geeral Practice, Govermet Medical Officers, Health Associatios Uios, NSW Ambulace Service, Miistry of Health, Private Hospitals ad Day Procedure Cetres, Tertiary Educatio Istitutes Review date 04-Mar-2015 Policy Maual Patiet Matters File No. 02/ Status Active Director-Geeral space This Policy Directive may be varied, withdraw or replaced at ay time. Compliace with this directive is madatory for NSW Health ad is a coditio of subsidy for public health orgaisatios.

3 POLICY STATEMENT MATERNAL AND CHILD HEALTH PRIMARY HEALTH CARE POLICY (A compoet of the NSW Health / Families NSW Supportig Families Early Package) PURPOSE This policy is to esure a cosistet statewide approach to the provisio of primary health care ad health home visitig to parets expectig or carig for a ew baby is implemeted throughout NSW. The policy idetifies a primary health model of care for the provisio of uiversal assessmet, coordiated care, ad home visitig, by NSW Health s materity ad commuity health services, for all parets expectig or carig for a ew baby. MANDATORY REQUIREMENTS All Area Health Services (AHS) are to esure that: a comprehesive assessmet process, cosistet with the SAFE START model, is implemeted i both materity ad early childhood health services (Referece: Policy Sectio 3) risk factors ad vulerabilities are determied usig a team-maagemet approach to case discussio ad care plaig (Referece: Policy Sectio 3) the cotiuity-of-care model is implemeted i accordace with this policy (Referece: Policy Sectio 3) effective commuicatio systems from materity services to early childhood health services are established (Referece: Policy Sectio 3) Uiversal Health Home Visitig (UHHV) is implemeted ad that every family i NSW is offered a home visit by a child ad family health urse withi two weeks of the baby s birth (Referece: Policy Sectio 4) Sustaied Health Home Visitig (SHHV) is implemeted i accordace with this policy (Referece: Policy Sectio 4) NB: SHHV is ot provided i all AHS ad is ot madatory IMPLEMENTATION Chief Executives are to esure this policy is implemeted i accordace with the Implemetatio Requiremets (Referece: Policy Sectio 5) ad persoel, resources ad the assigmet of resposibly is adequate to effectively implemet the policy. AHS are to provide to NSW Departmet of Health data as requested o UHHV ad SHHV (from those AHS fuded to implemet SHHV). This policy must be read i cojuctio with the followig documets that comprise the NSW Supportig Families Early Package. PD2010_016 SAFE START Strategic Policy available at: GL 2010_004 SAFE START Guidelies: Improvig metal health outcomes for parets ad ifats available at: PD2010_017 Issue date: March 2010 Page 1 of 2

4 REVISION HISTORY POLICY STATEMENT Versio Approved by Amedmet otes March 2010 (PD2010_017) Deputy Director-Geeral Strategic Developmet New policy as a compoet of the NSW Health/Families NSW Supportig Families Early Package ATTACHMENT 1. Materal ad Child Health Primary Health Care Policy PD2010_017 Issue date: March 2010 Page 2 of 2

5 FAMILIES NSW SUPPORTING FAMILIES EARLY PACKAGE Materal ad Child Health Primary Health Care Policy

6 NSW DEPARTMENT OF HEALTH 73 Miller Street NORTH SYDNEY NSW 2060 Tel. (02) Fax. (02) TTY. (02) This work is copyright. It may be reproduced i whole or i part for study traiig purposes subject to the iclusio of a ackowledgemet of the source. It may ot be reproduced for commercial usage or sale. Reproductio for purposes other tha those idicated above requires writte permissio from the NSW Departmet of Health. Suggested referece: NSW Departmet of Health, 2009, NSW Health/Families NSW Supportig Families Early Package materal ad child health primary health care policy, NSW Departmet of Health NSW Departmet of Health 2009 SHPN (AIDB) ISBN Further copies of this documet ca be dowloaded from the NSW Health website Jue 2009

7 NSW Health / Families NSW Supportig Families Early package The NSW Health / Families NSW Supportig Families Early package brigs together iitiatives from NSW Health s Primary Health ad Commuity Parterships Brach ad Metal Health ad Drug & Alcohol Office. It promotes a itegrated approach to the care of wome, their ifats ad families i the periatal period. Three compaio documets form the Families NSW Supportig Families Early package. Supportig families early materal ad child health primary health care policy The first part of the package is the Supportig Families Early Materal ad Child Health Primary Health Care Policy. It idetifies a model for the provisio of uiversal assessmet, coordiated care, ad home visitig, by NSW Health s materity ad commuity health services, for all parets expectig or carig for a ew baby. This model is described withi the cotext of curret materity ad child ad family health service systems. SAFE START strategic policy The secod part of the package, the SAFE START Strategic Policy, provides directio for the provisio of coordiated ad plaed metal health resposes to primary health workers ivolved i the idetificatio of families at risk of developig, or with, metal health problems, durig the critical periatal period. It outlies the core structure ad compoets required by NSW metal health services to develop ad implemet the SAFE START model. SAFE START guidelies: improvig metal health outcomes for parets ad ifats The third part of the package, the SAFE START Guidelies: Improvig Metal Health Outcomes for Parets ad Ifats, outlies the ratioale for psychosocial assessmet, risk prevetio ad early itervetio. It proposes a spectrum of coordiated cliical resposes to the various cofiguratios of risk factors ad metal health issues idetified through psychosocial assessmet ad depressio screeig i the periatal period. It also outlies the importace of the broader specialist role of metal health services i addressig the eeds of parets at risk of developig, or with, metal health problems. NSW Health Materal ad child health supportig families early PAGE i

8 PAGE ii NSW Health Materal ad child health supportig families early

9 Message from the Director-Geeral Pregacy ad becomig a paret is usually a excitig time, full of aticipatio, joy ad hope. It ca also be a time of ucertaity or axiety for parets ad families. To support families fully durig what ca be a stressful period, it is importat to address the rage of physical, psychological ad social issues affectig the ifat ad family. This rage of issues ad parets uderstadig of the tasks ad roles of parethood are recogised as sigificat iflueces o the capacity of parets to provide a positive eviromet that ecourages optimum developmet of the ifat. Providig support for ifats, childre ad parets, begiig i pregacy, icludig their physical ad metal health, is a key priority of the NSW Govermet. This is clearly articulated i the NSW Actio Pla for Early Childhood ad Child Care which is part of the Coucil of Australia Govermet s Natioal Reform Ageda, the NSW State Pla, ad the NSW State Health Pla. The NSW whole-of-govermet Families NSW iitiative is a overarchig strategy to ehace the health ad wellbeig of childre up to 8 years ad their families. Oe way it does this is by improvig the way agecies work together, so that parets get the services, support ad iformatio they eed. NSW Health is a key parter with other huma service agecies i developig prevetio ad early itervetio services that assist parets ad commuities to sustai childre s health ad wellbeig i the log term. Health services are the uiversal poit of cotact for these families eterig the Families NSW service system. NSW Health s visio is for a comprehesive ad itegrated health respose for families. This respose will ecompass all stages of pregacy ad early childhood developmet ad lik hospital, commuity ad specialist health services. The aim is to assist families i the trasitio to parethood, build o their stregths, ad ameliorate ay idetified risks that ca cotribute to the developmet of problems i ifats ad later o i life. The NSW Health / Families NSW Supportig Families Early package itegrates three NSW Health iitiatives that are uderpied by a commo uderstadig of the challeges that parethood ca ivolve, the importace of the early years of a child s developmet, ad the beefits of appropriate early itervetio programs. The iitiatives cotaied withi Supportig Families Early are a importat cotributio to the provisio of services that ehace the health of parets ad their ifats, help to protect agaist child abuse ad eglect, ad ehace the wellbeig of the whole commuity. Professor Debora Picoe AM Director-Geeral NSW Health NSW Health Materal ad child health supportig families early PAGE iii

10 Ackowledgemets The NSW Health / Families NSW Supportig Families Early, Materal ad Child Health Primary Health Care Policy is the culmiatio of may people s work over may years. Area Health Services (AHSs) have developed over time a rage of local programs, both uiversal ad targeted, to support families with youg childre, begiig i pregacy. The developmet of this Policy has draw o the expertise of materity ad child ad family health services across NSW ad the experiece of AHSs that are implemetig health home visitig as part of the Families NSW strategy. The staff of the Metal Health ad Drug ad Alcohol Office, NSW Health, ad the Cetre for Health Equity, Traiig, Research ad Evaluatio (CHETRE), collaborated i the developmet of this policy. PAGE iv NSW Health Materal ad child health supportig families early

11 Cotets Families NSW Supportig Families Early package... i Message from the Director-Geeral... iii Ackowledgemets... iv Sectio 1. Itroductio... 3 Sectio 2. Policy statemet... 5 Sectio 3. The primary health care model of periatal ad ifat care Comprehesive primary health care assessmet The timig of assessmets Process Scope of the assessmet Determiatio of vulerability ad stregths A team-maagemet approach to case discussio ad care plaig Determiatio of level of care Review ad follow-o coordiated care Effective programs ad itervetios Coordiated care Sectio 4. Health home visitig Uiversal health home visitig Aim ad objectives Orgaisig the iitial cotact visit What happes at the iitial postatal cotact visit? Outcomes of uiversal health home visitig Specific populatios Culturally ad liguistically diverse families Aborigial families Rural ad remote families Sustaied health home visitig Aim ad objectives Outcomes of sustaied health home visitig Implemetig sustaied health home visitig Sectio 5. Implemetatio requiremets Plaig Staffig Ratio for sustaied health home visitig Child ad family ursig staff Traiig Family partership traiig SAFE START psychosocial assessmet traiig Cliical supervisio Service systems to support cliical practice Service etworks Occupatioal health ad safety Cofidetiality Resource requiremets Fudig Evaluatio Reportig Targeted home visitig programs...23 NSW Health Materal ad child health supportig families early PAGE

12 Appedices 1 Health care services for mothers, babies ad families Priciples uderpiig the policy SAFE START psychosocial assessmet questios A 4B 4C Ediburgh Postatal Depressio Scale...42 Ediburgh Postatal Depressio Scale scorig guide Ediburgh Depressio Scale (Ateatal) Practice checklist for cliicias Area Health Service practice checklist: plaig for implemetatio Figures Figure 1. Primary care pathways for SAFE START... 9 Figure 2. Levels of care...16 Figure 3. Effectiveess of sustaied health home visitig programs...26 Tables Table 1. Areas of resposibility... 6 Table 2. Levels of care...17 Table 3. Geeric model of uiversal health home visitig...23 Refereces Glossary of terms PAGE 2 NSW Health Materal ad child health supportig families early

13 Sectio 1 Itroductio All families eed support to raise their childre ad some families eed additioal support for their particular eeds. Providig this support effectively ad promptly ca help prevet problems developig ad becomig etreched. The NSW Health / Families NSW Supportig Families Early package itegrates three NSW Health iitiatives that are uderpied by a commo uderstadig of the challeges that parethood ca ivolve, the importace of the early years of a child s developmet ad the beefits of appropriate early itervetio programs. The three iitiatives are: 1. Supportig Families Early Materal ad Child Health Primary Health Care Policy 2. SAFE START Strategic Policy 3. SAFE START Guidelies: Improvig Metal Health Outcomes for Parets ad Ifats The iitiatives are a importat cotributio to the provisio of services that ehace the health of parets ad their ifats, help to protect agaist child abuse ad eglect, ad ehace the wellbeig of the whole commuity. The Primary Health ad Commuity Parterships Brach has developed the Supportig Families Early Materal ad Child Health Primary Health Care Policy. The Metal Health ad Drug ad Alcohol Office has developed the SAFE START Strategic Policy ad the SAFE START Guidelies: Improvig Metal Health Outcomes for Parets ad Ifats. The Supportig Families Early Materal ad Child Health Primary Health Care Policy icludes madatory as well as recommeded practices. Sectio 2. Policy statemet The Policy Statemet, clarifies what is expected both from the NSW Departmet of Health ad Area Health Services (AHSs). The policy is uderpied by a atioal ad state commitmet to early itervetio ad prevetio. I particular the policy addresses targets i the followig: Coucil of Australia Govermets Natioal Reform Ageda, NSW Actio Pla for Early Childhood ad Child Care. State pla priorities: F4 embeddig prevetio ad early itervetio ito govermet service delivery F6 icreased proportio of childre with skills for life ad learig at school etry F7 reduced rates of child abuse ad eglect. State Health Pla Strategic Directio 1: Make prevetio everybody's busiess State Health Pla Strategic Directio 3: Stregthe primary health ad cotiuig care i the commuity. The Policy is uderpied by the Families NSW strategy, particularly the equity ad cliical practice priciples that iclude workig i partership with the family ad facilitatig the developmet of the paret-ifat relatioship. Sectio 3. The primary health care model of periatal ad ifat care This sectio details the primary health care model of periatal ad ifat care ad outlies the pathways for primary health staff to determie vulerability ad the level of service delivery/care required to provide for ogoig coordiated care. Sectio 4. Health home visitig The requiremet of health home visitig, which icludes Uiversal Health Home Visitig (UHHV) ad Sustaied Health Home Visitig (SHHV), is explaied i this sectio. Sectio 5. Implemetatio requiremets The fial sectio provides iformatio o what is required to implemet the Policy. This sectio icludes iformatio o a umber of implemetatio issues such as plaig, staffig, traiig, cliical supervisio, cofidetiality ad evaluatio. NSW Health Materal ad child health supportig families early PAGE 3

14 PAGE 4 NSW Health Materal ad child health supportig families early

15 Sectio 2 Policy statemet As NSW Health provides uiversal services to families who are expectig or carig for a baby, it is well placed to be the etry poit for families ito the broader Families NSW service etwork. The purpose of the NSW Health / Families NSW Supportig Families Early Materal ad Child Health Primary Health Care Policy is to esure that NSW Health implemets a cosistet statewide approach to the provisio of primary health care ad health home visitig to parets expectig or carig for a ew baby. NSW Health s materity ad commuity health services are the primary providers of these services, although the policy applies more broadly. The policy is applicable to: 5. review ad coordiated follow-o care. This is supported by, ad delivered i partership with, other health staff that provide care to ifats ad their families through a team approach. The itegrated approach to periatal ad ifat care aims to achieve the followig key results: 1. improved child health ad wellbeig 2. ehaced family ad social fuctioig 3. provisio of services that meet the eeds of childre ad families 4. improved cotiuity of care. Materity services Child ad family health services Early childhood health services Paediatric allied health services Paediatric ipatiet services Emergecy departmets Family care cetres Residetial family care cetres Child protectio services Aborigial health services Multicultural health services Health home visitig Health home visitig is ot delivered i isolatio but forms part of the cotiuum of care ad etwork of services for families with youg childre, begiig i pregacy. Comprehesive assessmet ad coordiated care provide the platform for health home visitig. There are a umber of models of health home visitig. It is madatory for AHSs to provide Uiversal Health Home Visitig (UHHV). This is the offer ad the provisio of a home visit by a child ad family health urse to families with a ew baby withi two weeks of the birth of the baby. Metal health services Drug & alcohol services Youth health services Wome s health services. Primary health care pathways for itegrated periatal ad ifat care The primary health model of care i the periatal period cosists of the followig elemets: 1. comprehesive primary health care assessmet 2. determiatio of vulerabilities ad stregths 3. team maagemet approach to case maagemet ad care plaig 4. determiatio of level of care required NSW Health provides some isolated targeted home visitig programs to support wome who are pregat or carig for a ew baby. Various staff, icludig midwives, urses ad social workers curretly offer targeted home visitig programs. As part of a comprehesive approach to service delivery, families that require additioal support may be offered Sustaied Health Home Visitig (SHHV). SHHV is a structured program of health home visitig over a sustaied period of time, begiig i pregacy ad cotiuig util the ifat is two years old. If implemeted i the AHS, SHHV is to follow the model that is described i sectio 4.4 of the Policy. The NSW Departmet of Health ad AHSs have resposibility to esure that primary health care ad health home visitig is effectively implemeted i the commuity. NSW Health Materal ad child health supportig families early PAGE 5

16 Areas of resposibility Followig are the areas of resposibility for the NSW Departmet of Health ad AHSs uder this Policy. Table 1. Areas of resposibility NSW Departmet of Health Orgaisatioal support for implemetatio Oversee the statewide implemetatio of the policy Review the impact of the policy ad respod to ay recommedatios that arise. Area Health Service Oversee policy implemetatio ad provisio of Area Health Service leadership ad directio i the provisio of primary health care ad health home visitig to parets expectig or carig for a ew baby by materity ad commuity health services (refer to Madatory Requiremets). Nomiate a Seior Executive Sposor with resposibility for Families NSW ad policy implemetatio of Supportig Families Early. Fudig, ad data collectio Support, maage ad moitor: Families NSW fudig to Area Health Services Area Health Service data collectio for Families NSW. Esure Families NSW data requiremets are cosidered i the desig ad implemetatio of cetrally developed data collectio systems. Refer to madatory requiremets (see over). Esure that data collectio systems have the capacity to collect ad aalyse Families NSW data so that staff ca collect data easily ad o time. Esure that the Families NSW data collected is i accordace with Departmetal requiremets. Workforce developmet ad support Support, maage ad moitor statewide Families NSW projects auspiced by NSW Health to support the implemetatio of Families NSW. Support cotiued research ito best-practice models for materity ad child ad family health services. Moitor Area Health Service plas to ehace ad support the materity ad child ad family health workforce ad improve cotiuity. Collaborate with traiig orgaisatios to esure that traiig programs are available statewide. Support Area Health Service Families NSW coordiators through the Families NSW Network. The Network provides: a effective two way commuicatio lik betwee the Departmet ad Area Health Services advice o policy developmet ad review educatio o curret issues relatig to Families NSW programs. Refer to madatory requiremets (see over). Itersectoral collaboratio with orgaisatios outside the NSW Health system Participate i itergovermetal forums established to promote the effective implemetatio of the Families NSW strategy, for example, the Families NSW Seior Officers Group. Esure participatio i regioal forums/etworks established to promote effective goverace of the Families NSW iitiative. Moitorig ad reportig of policy implemetatio Prepare statewide aual Families NSW reports for the NSW Departmet of Commuity Services. Esure compliace with the practices ad procedures outlied i this policy ad evaluate o a regular basis that this is occurrig. Prepare a aual report for submissio to the NSW Departmet of Health. PAGE NSW Health Materal ad child health supportig families early

17 Madatory requiremets Followig are the madatory requiremets of the Policy. The primary health care model of periatal ad ifat care Esure there is a comprehesive assessmet process i place, which is cosistet with the SAFE START (formerly the Itegrated Periatal ad ifat Care IPC) model, i both materity services ad early childhood health services. Determie risk factors ad vulerability usig a team-maagemet approach to case discussio ad care plaig. Esure that the cotiuity-of-care model is implemeted i accordace with the Policy ad that effective commuicatio systems from materity services to early childhood health services are established. Referece: Policy Sectio 3 Health home visitig Implemet UHHV. Esure every family i NSW is offered a home visit by a child ad family health urse withi two weeks of birth. Implemetatio of SHHV, whe provided i AHSs, is to comply with the Policy. Note SHHV is ot madatory. Referece: Policy Sectio 4 Implemetatio Plaig Plaig ad coordiatig health services that work with childre, parets ad families is the first step i effective implemetatio of primary health ad home visitig services for families expectig a ew baby or carig for youg childre. Families ad commuities are to be ivolved i these plaig processes. Staffig Each AHS is to esure that there are sufficiet staffig levels to provide UHHV for the Area s populatio ad characteristics. Traiig It is the resposibility of each AHS to esure that staff who deliver child ad family health services have appropriate qualificatios, skills ad traiig, icludig Family Partership Traiig ad SAFE START psychosocial assessmet traiig. Cliical supervisio Each AHS is to esure that staff receive cliical supervisio o a regular basis. Service systems to support cliical practice Uiversal child ad family health services are to be uderpied by support from a Tier 2 multidiscipliary team that has four fuctios: participatio i multidiscipliary case discussio to determie level of care cosultatio, support ad educatio for Tier 1 primary workers direct service provisio to families as required i collaboratio with Tier 1 staff facilitatio of referral to Tier 3 ad Tier 4 services whe required. [Tier 2 icludes a combiatio of direct service provisio ad cosultatio, support ad traiig to Tier 1, delivered by staff with more specialised skills. Defiitios of Tiers 1 4 ca be foud at Policy Sectio 5.5]. Service etworks Each AHS is to develop a directory of services ad referral protocols both withi NSW Health ad with other service etwork parters, to facilitate optimal trasitio of care betwee services for families. Occupatioal health ad safety Each AHS is to establish protocols ad procedures that address the occupatioal health ad safety cosideratios discussed i this policy, whe implemetig health home visitig. Cofidetiality The sharig ad trasfer of iformatio is to be coducted with regard to Iformatio Privacy provisios. Refer to the NSW Health Policy Directive PD2005_593. Resource requiremets The implemetatio of a home visitig service requires staff to be mobile ad therefore they are to have access to the followig equipmet: motor vehicle mobile phoe lockable briefcase cliical equipmet. Access to computers for data collectio ad to assist i cliical practice is required. NSW Health Materal ad child health supportig families early PAGE

18 Fudig Each AHS is to esure that adequate fudig is provided for implemetatio of primary health care ad health home visitig services for families expectig a baby or carig for youg childre. Evaluatio Each AHS is required to cotribute to statewide ad NSW Health evaluatios of the Families NSW strategy. Compliace with the practices ad procedures outlied i this policy is to be evaluated by each AHS o a regular basis. Reportig Each AHS is to provide a aual report to the NSW Departmet of Health. Each AHS is to provide data o UHHV performace as requested by NSW Departmet of Health. Referece: Policy Sectio 5. PAGE 8 NSW Health Materal ad child health supportig families early

19 Sectio 3 The primary health care model of periatal ad ifat care Withi the NSW Health / Families NSW Supportig Families Early strategy, the importace of psychosocial assessmet ad itegrated care i order to improve outcomes for wome, their ifats ad families, is clearly defied. This sectio outlies the model for providig primary health care for families expectig or carig for a baby. It is cosistet with the Metal Health ad Drug ad Alcohol Office s SAFE START model. Primary health care pathways for SAFE START The primary health model of care i the periatal period cosists of the followig elemets: 1. comprehesive primary health care assessmets 2. determiatio of vulerability ad stregths 3. team maagemet approach to case maagemet ad care plaig 4. determiatio of the level of care required 5. review ad coordiated follow-o care. Figure 1 outlies this model ad the pathways for primary health staff to determie vulerability, the level of service delivery/care required, ad to provide for ogoig coordiated care. This is supported by, ad delivered i partership with, other health staff who provide care to ifats ad their families withi a team approach. Figure 1. Primary care pathways for SAFE START Uiversal services Ateatal assessmet Idetified vulerability Yes No Level 1 Uiversal respose Level 2 Risk factors As per Table 2 Level 3 Risk factors As per Table 2 Birth Uiversal health home visit/iitial cotact/ Assessmet Multidiscipliary case discussio to determie level of care Idetified vulerability No Yes Level 1 Care Uiversal service Level 2 Care Ogoig support ad active follow up Level 3 Care Coordiated team maagemet ad review Level 1 Uiversal respose Assessmet at 6 8 weeks Idetified vulerability No Yes Level 2 Risk factors As per Table 2 Level 3 Risk factors As per Table 2 Level 1 Uiversal respose Assessmet at 6 8 moths Idetified vulerability No Level 1 Uiversal respose Yes Level 1 Care Uiversal service Multidiscipliary case discussio to determie level of care Level 2 Care Ogoig support ad active follow up Level 3 Care Coordiated team maagemet ad review NSW Health Materal ad child health supportig families early PAGE

20 3.1 Comprehesive primary health care assessmet The aim of assessig all wome/families durig the ateatal ad postatal periods is to idetify ad provide care to those parets ad their ifats who are most at risk for adverse physical, social ad metal health outcomes. The assessmet process should take ito cosideratio that: recommeded i the child Persoal Health Record (blue book) are completed Process The assessmet is to be coducted i a o-itrusive maer to ecourage the family to egage with the midwife/urse ad the health service. The woma ad her parter (if preset) are to be give iformatio about: the perso experiecig the issue has the right to defie the issue ad idetify his or her ow eeds the assessmet that will be coducted a comprehesive assessmet of physical, emotioal, all people have stregths ad are geerally capable psychological ad social factors of determiig their ow eeds, fidig their ow aswers ad solvig their ow problems the purpose of the assessmet to idetify the idividual care eeds for each family every perso is shaped by his or her uique history ad the cotext i which he or she lives cofidetiality issues the limits of cofidetiality ad advice as to who i the health service will have families should be ivolved actively i the process ad i decisios about their care. access to the iformatio from the assessmet (for iformatio privacy issues Refer to Sectio 5.8). Refer to Appedix 2 for priciples uderlyig the policy The timig of assessmets A comprehesive primary health care assessmet is to be coducted at the followig times durig pregacy ad the first 12 moths postpartum: 1. Ateatally at the first poit of cotact with NSW Health durig pregacy. This will occur at the first presetatio for ateatal care or as early as possible i the ateatal period before 20 weeks of pregacy. This will iclude the admiistratio of a Ediburgh Depressio Scale. 2. Postatally at the first health home visit services. The ateatal comprehesive primary care assessmet will be reviewed, or where oe has bee previously atteded, a comprehesive primary health care assessmet will be coducted. 3. Six to eight week check coducted by the child ad family health service. The previous assessmets will be reviewed ad ay ew or emergig issues idetified. If o previous assessmet has bee udertake, a comprehesive primary health care assessmet will be coducted. The Ediburgh Postatal Depressio Scale is to be admiistered at this visit or earlier i the postatal care where there are cliical idicatios or cocer that the family may ot re-preset at the six to eight week check. 4. It is recommeded that a further assessmet be coducted at six to eight moths postatally as part of the schedule of visits to the early childhood health service whe the child health assessmets Rapport should be established so as to egage the mother prior to askig sesitive questios. The iterview is to oly be coducted whe privacy ca be assured. Questios that are sesitive for the mother, such as those asked about domestic violece ad questios about past pregacies/ termiatios, must be asked with the mother aloe. I circumstaces where a child is preset, the questios should be asked oly if the child is aged uder three years. It is recommeded that sesitive questios be asked at the begiig of the iterview ad the the family ca be ivited ito the iterview with the urse ad mother. It is suggested that the requiremet to see the mother aloe iitially be icluded i the letter cofirmig the ateatal bookig, to provide a expectatio that this will happe. Iterviews eed to be coducted i a maer that facilitates the parets idetifyig issues ad cocers, ad participatig i makig choices about the type ad level of care ad support they require. If the paret does ot speak or uderstad Eglish, the use of a iterpreter will be ecessary. Services are to esure that they have the capacity to idetify those parets who speak little or o Eglish ad provide appropriate access to iterpreters Scope of the assessmet The assessmet process detailed i this Policy is compatible ad cosistet with the SAFE START model ad adopts the SAFE START variables for assessmet of psychosocial risk. AHSs are to esure that there is a comprehesive assessmet process i place i both materity services ad early childhood health services. Comprehesive primary health care assessmet PAGE 10 NSW Health Materal ad child health supportig families early

21 should assess all aspects of health ad should iclude systematic exploratio of the followig domais: physical health medical history psychosocial issues (see below) family structure relatioships support etworks employmet icome/fiaces are preset ad ca take less time ad be easier for staff ew to the process of psychosocial assessmet. Where there are literacy problems, or there is a lack of familiarity with the Eglish laguage, writte questioaires are ot recommeded. The decisio about which mode of admiistratio to implemet will deped o several factors, as described above however, the domestic violece questios should always be asked as required by the NSW Policy Directive PD2006_084 Domestic Violece Idetifyig ad Respodig. accommodatio recet major stressors family stregths curret or history of metal illess, substace use, child protectio issues, domestic violece, physical, sexual or emotioal abuse. The SAFE START model recommeds that the followig miimum core set of psychosocial variables be assessed ateatally ad postatally (refer to Appedix 3): lack of social or emotioal support availability of practical ad emotioal support All available iformatio regardig parets, baby ad family is sought i order to iform the comprehesive primary health care assessmet. Psychosocial issues recet major stressors recet (i the last 12 moths) chages or losses, eg fiacial problems, migratio issues, someoe close dyig low self-esteem icludig self-cofidece, high axiety ad perfectioistic traits Assessmet of psychosocial issues is to be icorporated ito the comprehesive primary health care assessmet to esure that psychological ad social aspects of health, as well as physical health, are addressed. Icorporatig psychosocial issues as part of a comprehesive assessmet has implicatios for the skills ad kowledge required by midwives/urses, the settig i which the assessmet takes place ad the availability of, ad access to, a etwork of appropriate referral services. Additioal iformatio about the psychosocial assessmet ca be foud i the SAFE START documets, which are part of the Supportig Families Early package. Questios to assess psychosocial health may be admiistered either as part of a iterview coducted by the cliicia or i a questioaire format completed by the woma, geerally durig the appoitmet. There are advatages ad disadvatages to each approach. Admiisterig psychosocial questios as part of the iterview may ehace the egagemet betwee the cliicia, the woma ad her family ad eable immediate discussio of issues i order to seek clarity. Coversely, admiisterig the questios i the questioaire format ca esure privacy for the respodet, particularly whe other family members history of axiety, depressio or other metal health problems, substace couple s relatioship problems or dysfuctio (if applicable) adverse childhood experieces domestic violece. Use of the Ediburgh Postatal Depressio Scale The Ediburgh Postatal Depressio Scale (EPDS) is a simple ad reliable self-report questioaire that is easy to admiister ad score. It is a useful tool to help professioals idetify ad assist wome who are experiecig curret distress or depressio durig the periatal period, ad are therefore potetially at risk of developig more complex health problems. Usig the EPDS usually ecourages wome to start to talk about their feeligs. Whe used to scree for depressio i the ateatal period ad beyod, beyod the immediate postatal period, the scale is referred to as the Ediburgh Depressio Scale (EDS) as a geeric term for depressio screeig durig the periatal period (Cox, Chapma, Murray ad Joes, 1996; Murray, Cox, Chapma ad Joes, 1995; Murray ad Cox, NSW Health Materal ad child health supportig families early PAGE 11

22 1990). Whe admiistered durig the ateatal period the ateatal versio of the EDS is recommeded as this has a appropriate preamble ackowledgig 'as you are about to have a baby' (Appedix 5). Where there are ay cliical cocers or if the cliicia suspects that the family may ot accept further cotact after the UHHV, the EPDS should be admiistered at the iitial uiversal postatal cotact, either at home or i the cliic. Iformatio o periatal depressio, axiety, the EPDS ad the importace of screeig will be provided to the woma ad her family at the iitial home visit. Wome will be ecouraged to make a appoitmet for the six to eight week check, whe the EPDS will also be admiistered. Early idetificatio of vulerable wome will allow early itervetio ad support to be arraged. Refer to Appedix 4 for a copy of the EDS/EPDS ad scorig scale. For Eglish speakig wome: the ateatal score for probable major depressio is 15 or more at least probable mior depressio is 13 or more the postatal score for probable major depressio 13 or more for at least probable mior depressio is 10 or more (Matthey, et al p.313). The EDS/EPDS has bee traslated ito a umber of laguages which are available o the NSW Health website Matthey et al. also recommeds that for wome from culturally ad liguistically diverse backgrouds, referece should be made to studies usig the EDS/EPDS from the particular culture/ethic backgroud for a cut off score. Research (Cox & Holde, 2003 p.61) has idicated that for may wome immediate itervetio may be uecessary for wome scorig 15 ad above ateatally ad 13 ad above postatally with the absolute exceptio beig ay woma who scores above 0 (zero) o questio 10 of the EDS/EDPS. It is therefore recommeded for these wome (ie those scorig 15 ad above ateatally ad 13 ad above postatally, ad 0 (zero) o questio 10) that a secod EDS/EPDS be admiistered two weeks after the iitial scree before ay itervetio is plaed or agreed. However, immediate itervetio should occur where cliical judgemet idetifies the eed. For ay score above 0 (zero) o questio 10 it is imperative that the cliicia udertakes further sesitive questioig. The safety of the mother, ifat ad family is a priority. Prior to ay midwife or child ad family health urse udertakig admiistratio of a EDS/EDPS it is importat that she/he receive traiig i admiistratio ad scorig of the EDS/EDPS ad is familiar with AHS policy for assessmet ad respose to cosumers with possible suicidal behaviour (based o NSW Health s PD2005_121). Midwives ad child ad family health urses must have appropriate traiig i prelimiary suicide risk assessmet ad maagemet ad uderstad the requiremets of the Framework for Suicide Risk Assessmet ad Maagemet protocols for Geeral Commuity Health Services (2004). Assessmet of people at risk of suicide is complex ad demadig. Wherever possible, all assessmets of suicide should be discussed with a colleague or seior cliicia at some stage of the assessmet process. Support from the Area Metal Health Service may also be sought by the cliicia ad local protocols followed as per NSW Health's PD2005_121. Cosideratio should also be give to makig a report to the Departmet of Commuity Services (DoCs) where the cliicia suspects risk of harm to the ifat. AHSs will esure that protocols are i place to support wome i the postatal/ateatal period who may be experiecig metal health issues icludig periatal depressio ad/or axiety. Pathways to care should be developed that assist cliicias to determie appropriate itervetio for the mother, ifat ad family. NSW Health has issued guidelies o the use of the EDS/ EPDS, The Ediburgh Postatal Depressio Scale Guidelies for Use i Primary Health Care (NSW Health 1994). I additio, the SAFE START O-lie Assessmet ad Traiig (2009) cotais guidelies for the admiistratio, scorig of the EDS/EPDS. The NSW Health Postatal Depressio Educatio Package (NSW Health 2001) a trai-the-traier package also cotais iformatio o the use of the EDS/ EPDS. Ateatal assessmet A comprehesive assessmet icorporatig psychosocial issues is to be coducted with all wome as early as possible i the ateatal period. This will occur at bookig-i or first visit to the materity service. The timig of psychosocial assessmet for idividual wome will vary, depedig o their first cotact with the materity service, the preferred time is withi the first 10 to 14 weeks of pregacy. PAGE 12 NSW Health Materal ad child health supportig families early

23 The ateatal psychosocial assessmet is i additio to the physical assessmet of the mother s wellbeig ad the progress of the pregacy that is coducted by the midwife or doctor as part of a ateatal visit. The ateatal psychosocial assessmet is to iclude the: core psychosocial risk questios either as questios asked durig the iterview process or as a self-report questioaire (ote that domestic violece questios should be asked, ot self-admiistered) Ediburgh Depressio Scale (EDS) (see Appedix 4). A care pla for pregacy ad birth that is iformed by all of the above assessmets ad cosultatio with the cliet will the be developed. Where the family is idetified as requirig additioal support the care pla should iclude postatal care ad be developed i cojuctio with the child ad family health service. The UHHV will be icluded as part of the care pla. I additio to the assessmet of the baby that is coducted by the child ad family health service as part of the 6 to 8 week schedule of visits i the Persoal Health Record, it is also recommeded that the followig be icluded: review the core psychosocial risk questios to determie whether there have bee ay chages that have occurred i the family circumstaces that may result i a chage to the level of care for the family (refer sectio 3.4 Determiatio of level of care) admiister the EPDS. Assessmet betwee 6 ad 8 moths The third assessmet should occur whe the baby is betwee 6 ad 8 moths, either at the 6 moth child health check or wheever the family presets to the early childhood health service durig this period. Issues for cosideratio at all postatal assessmets I additio, the followig issues should be cosidered at the above assessmets: Postatal assessmet Materity staff are to idetify ay emergig psychosocial issues ad esure that plaig for a smooth trasitio from oe service to aother icorporates the maagemet of pre-existig ad emergig issues. Iitial assessmet It is importat that child ad family health cliicias be itroduced early i the postatal period to maximise egagemet with the service ad cotiue to optimise support. This is particularly importat for families with idetified vulerabilities. The ateatal care pla is to be reviewed ad a care pla for the postatal period developed that is iformed by the above assessmets ad i cosultatio with the cliet ad family. It should be oted that materity ad child ad family health staff may be providig care durig the same period, each with their ow uique focus. Assessmet betwee 6 ad 8 weeks If a comprehesive health assessmet icludig psychosocial assessmet has ot occurred previously the this should be udertake at this time. the birth experiece psychological ad social adjustmet to parethood, such as: expectatios of parethood mood feeligs about, ad resposiveess to, the baby ability to cope with the practical ad emotioal demads of carig for a ew ifat/s ability to cope with the practical ad emotioal demads of carig for a family self-care relatioship with parter resumig social activities child safety, icludig history of, or curret, child protectio cocers materal physical adjustmet, such as: level of fatigue eergy levels physical health icludig breastfeedig family adjustmets to the ew baby, such as: paretal cocers about child s developmet, temperamet ad progress paretal cocers about the care of the baby, NSW Health Materal ad child health supportig families early PAGE 13

24 eg physical health, feedig ad settlig sibligs acceptace of the ew baby family eviromet housig uemploymet curret fiacial stress isolatio level of social support, icludig: adequacy of available support feeligs of isolatio relatioships with others, eg mother. cosideratio of risk ad resiliece factors. Risk factors are cosidered across several domais: the child, paret ifat relatioship, materal, parter, family, eviromet ad life evets ad are categorised i the followig way: Level 1 o specific vulerabilities detected Level 2 factors that may impact o ability to paret that usually require a level 2 service respose icludig; usupported paret, ifat care cocers, multiple birth, housig, depressio ad axiety (see Table 2, Level 2) The care pla is to be reviewed ad updated at each assessmet/review based o the above assessmets ad cosultatio with the cliet/family. Outcome of the assessmet Psychosocial risk factors impact sigificatly o a family s ability to paret, ad subsequetly the baby s developmet. The assessmet process is desiged to: idicate whether risk is preset or potetial idetify the stregths ad resources of the family. Therefore, the purpose of the comprehesive primary health care assessmet is to idetify the broad rage of issues that ca affect paretig ad the healthy developmet of the baby that may require further assessmet or case discussio with the broader multidiscipliary team ad likig to relevat resources. At the completio of the assessmet process, vulerabilities ad stregths eed to be cosidered. 3.2 Determiatio of vulerabilities ad stregths Vulerability ad resiliece are dyamic ad chagig pheomea. Families are either strog or vulerable by default, but go through stages of stregth ad istability. The relatioship betwee vulerability ad resiliece, risk ad protective factors is complex. Risk factors for adverse outcomes ofte co-occur ad may have cumulative effects over time. Risk ad protective factors may chage over time, ad the saliece of risk ad protective factors will vary with idividual ad family characteristics ad the sociocultural cotext i which the family lives. I geeral, families will be more vulerable if exposed to more risk factors ad less protective factors ad resiliet whe more protective factors are able to be put i place, reducig exposure to risk factors. A professioal assessmet of a family s eeds iclude Level 3 complex risk factors that usually require a level 3 service respose icludig; metal illess, drug ad alcohol misuse, domestic violece, curret/history of child protectio issues (see Table 2, Level 3). The level of care required by a family must be ascertaied i the cotext of a holistic professioal assessmet (refer to sectio 3.4 for iformatio o the determiatio of the level of care). It should be oted that as the umber of risk factors icreases so does the potetial impact ad effect of the risks. There ca also be cosiderable variatio betwee idividuals i vulerability ad resiliece to these risk factors. Cosequetly, a family with Level 2 risk factors preset may actually require a service respose similar to that of Level 3. Therefore, it is recommeded that ay cliet with Level 3 or multiple Level 2 vulerabilities be discussed utilisig a team-maagemet-case-discussio approach, i order to cosider the most appropriate level of care service respose required. It is recommeded that where families are idetified as multiple Level 2 ad level 3, uiversal materity/child ad family health services should be provided however case maagemet ad care should be trasferred to a more appropriate service, such as Brighter Futures, metal health ad drug & alcohol services ad relevat o-govermet orgaisatios. Child protectio Assessmets may also idetify child protectio cocers for either the baby or other childre. The NSW Health Frotlie Procedures for the Protectio of Childre ad Youg People (NSW Health 2000) directs health workers to coduct comprehesive ateatal assessmet ad care plaig for wome, icludig a thorough psychosocial assessmet. A thorough assessmet of a woma s family, risk factors ad stregths both durig pregacy ad the postatal period will help idetify the eed for ay supports. If child protectio issues are idetified the the relevat procedures as outlied i the PAGE 14 NSW Health Materal ad child health supportig families early

25 NSW Health PD2005_299 ad NSW Health PD2006_104 must be followed. Drug ad alcohol Social work Materity staff should be aware that domestic violece ofte begis or escalates durig pregacy. Whe respodig to wome where domestic violece is suspected or occurrig, the NSW Health PD2006_084 should be cosulted. Sectio 25 of the Childre ad Youg Persos (Care ad Protectio) Act 1998 allows preatal reports to be made to DoCS if there may be a risk of harm to the child after birth. Preatal reportig may be particularly helpful for pregat wome i domestic violece situatios, or with metal health or substace misuse i pregacy issues, as it may be a catalyst for assistace. Preatal reportig is ot iteded as a puitive measure, ad should oly be used where there are reasoable grouds to suspect that a ifat or other childre may be at risk of harm. If a preatal report has bee made, ay cotiuig or escalatig risk of harm must be assessed followig the child's birth. Iformatio regardig a child who is the subject of a preatal report or their family may be exchaged with DoCS where the iformatio relates to the safety, welfare ad wellbeig of the child. For more iformatio refer to NSW Health PD2007_023. These provisios aim to esure that appropriate support ad itervetios are provided where there is a risk of harm to a child, icludig a ubor child. 3.3 Multi-discipliary case discussio ad team maagemet approach I situatios where a woma or family has bee idetified through the assessmet process as vulerable to risk ad i eed of additioal support, the AHS is to develop a process to support ad assist the midwife or urse to determie the best maagemet strategy ad to assist i likig the family to the most appropriate services. This is to be through the establishmet of a multi-discilpiary approach to care plaig ad determiatio of the level of care service respose required. The multidiscipliary team should iclude, whe appropriate, cliicias from the followig health services: Materity Early childhood health Metal health/psychiatry Psychology Child protectio. Case maagemet meetigs provide all team members with the opportuity to discuss complex families, seek support ad advice ad develop coordiated care plas. This approach may be istituted through the use of existig itake or case cosultatio meetigs or the establishmet of ew meetigs. The team are to determie a care pla that addresses the presetig issues ad areas of risk, ad builds o the stregths of the parets ad family. The care pla is to be developed i cosultatio with the family ad is to address the priority issues idetified with the family. The care pla may iclude: specialist assessmet ad itervetio ogoig support urse health home visitig referral to appropriate services referral for sustaied health home visitig where a fuded service is available. As part of the care plaig process, the followig are to be established: determiatio of level of care service delivery required for each cliet clarificatio of the roles ad resposibilities of team members idetificatio of a key worker to coordiate care a process for team review of progress. A team-maagemet approach to care plaig is particularly importat i complex cases where the woma or family presets with multiple issues ad areas of risk. A team-maagemet approach is essetial where Level 3 risk factors are preset such as moderate to severe (or sigificat ) drug ad alcohol, metal health ad/or child protectio issues. A teammaagemet approach to care plaig should also be cosidered whe there is idetified social disadvatage ad/or multiple Level 2 risk factors are preset. The establishmet of a team-maagemet approach to care plaig as part of both ateatal ad postatal services is critical to providig comprehesive care to wome or families idetified as vulerable to NSW Health Materal ad child health supportig families early PAGE 15

26 psychosocial risk. Whe vulerabilities are idetified ateatally, it is importat to ivolve child ad family services i care plaig to facilitate the relevat commuity-based services that are to be put i place ad a seamless trasitio of care i the postatal period. Systems are to be established to eable services exteral to AHSs to participate i the team-maagemet approach to care plaig whe appropriate. It is importat that alog with the provisio of uiversal child ad family health services there are appropriate referral pathways to services such as Brighter Futures, particularly for complex Level 2 ad Level 3 cases. 3.4 Determiatio of level of care The level of care service respose is determied by cosiderig the risk factors i the cotext of the stregths of the woma ad her family ad local resources available. Risk factors are divided ito levels (see table 2) that may or may ot correspod with level of service respose determied by the team. The levels of care service respose are, as idicated i figure 2, categorised i the followig way: Level 1 uiversal services, eg midwifery, early childhood health cliics, paretig groups, commuity supports, ad paret support telephoe or web liks. Level 2 early itervetio ad prevetio services. Ogoig ad active follow-up/review is required, eg day stay cliics, family care cetres, specialist support groups ad services, geeral practitioer, paediatricia or psychiatrist referral to 12 sessios of Allied Health assessmet ad care through Better Access Medicare Agreemets. Level 3 complex paretig eeds a coordiated team-maagemet approach is required ad referral to relevat eeds-specific services such as Brighter Futures. These levels of care are ot idepedet or distict categories, but rather form a cotiuum of service delivery. The level of support offered is to meet the idetified eeds of the idividual family. It is evisaged that families may move ito, ad out of, the differet levels of support as their circumstaces chage. Families may also require differet itesity of itervetios withi the differet levels of care i respose to their idividual circumstaces. This requires the service etwork to be flexible eough to meet the chagig eeds of idividuals ad families. Whe decidig the most appropriate level of care, the health worker is to develop the care pla i cosultatio with their multidiscipliary team ad the family, ad address the priority issues that have bee idetified with the family. Health s respose should be formulated i the cotext of, ad with cosideratio to, all materity ad family services available, icludig those available i the exteral child ad family service etwork as well as local commuity supports. Whe idicated, parterships are to be formed with other service providers to provide the most appropriate care ad level of service to the family. Figure 2. Levels of care 3 Complex eeds Service respose: Coordiated team maagemet 2 Early itervetio ad prevetio Service respose: Ogoig ad active follow up 1 Uiversal all families Service respose: Uiversal health services Commuity etworks ad services Child ad family service etwork Commuity activities ad resources eg libraries, sports facilities, childcare Iformal support etworks eg cultural, family, peers, eighbours PAGE 16 NSW Health Materal ad child health supportig families early

27 Table 2. Levels of care Geeral service respose Risk factors Needs-specific services Level 1. All (Uiversal support) Routie health services are offered. Local systems are i place to ecourage families to: utilise uiversally available services utilise early childhood health services at key trasitio poits i the child s developmet lik with other services available for families with youg childre withi their local commuity. Services are delivered i a health promotig, early itervetio framework. No specific risk factors are idetified. Families are ecouraged to utilise a rage of services ad commuity level supports, depedig o their idividual eeds. These supports ca iclude: Materity services Early childhood health services, icludig UHHV, paretig ad breastfeedig groups Geeral practitioers Paretig ad child developmet iformatio Paret help lies Commuity activities, eg playgroups, breastfeedig peer support groups, libraries Childcare, preschools Iformal support etwork, eg family, peers, eighbours Etho-specific ad multicultural support etworks Level 2. Prevetio ad early itervetio Ogoig support ad active follow-up. Families idetified as vulerable should be: actively followed up ad supported with progress reviewed at key trasitio poits liked with ad referred to other services as eeded ecouraged ad supported to utilise uiversally available services. A key worker may eed to be idetified to coordiate care across services. Youg (uder 20 years) Usupported paret Late ateatal care Multiple birth Premature birth Complicated birth Child or paret with disability/ chroic illess Adjustmet to paretig issues Mild-to-moderate axiety Mild-to-moderate depressio History of metal health problem or disorder eg eatig disorder Grief ad loss associated with the death of a child or other sigificat family member Uresolved relatioship issues, icludig with ow parets Fiacial stress Ustable housig Parter uemployed Isolated, eg geographic, o telephoe, lack of support Refugee status, recet migrat, poor Eglish skills. A rage of services ca be accessed for cosultatio or referral to support families idetified as vulerable, depedig o their idividual eeds ad priorities. Services to be cosidered iclude Level 1 services ad may iclude ay of the followig: Materity services active follow-up Early childhood health services priority ad active follow-up UHHV priority ad active follow-up, ad may require a umber of home visits over the short-term Sustaied health home visitig Family care services cetre-based ad outreach Breastfeedig cliics/uits Adolescet pregacy ad paretig support services Child ad family cousellig services Iterpreter services Disability services Early itervetio services Supported playgroups Residetial family care services Cousellig Social work Allied Health/Cousellig via geeral practitioer, paediatricia or psychiatrist referral through Better Metal Health Access Medicare Agreemets Metal health Drug ad alcohol Other Govermet ad NGO programs, eg Family Support Services, Disability Services, voluteer home visitig services, housig Etho-specific ad multicultural support etworks. NSW Health Materal ad child health supportig families early PAGE 17

28 Geeral service respose Risk factors Needs-specific services Level 3. Complex eeds Coordiated team maagemet. Families idetified as havig complex eeds will require a coordiated team maagemet approach to care. This may also iclude some families with level 2 vulerabilities. The pla is developed i cosultatio with the family. Roles ad resposibilities of members of the team will eed to be clarified. A key worker will be idetified for the coordiatio role. The family will receive: coordiated care review of progress referral to specialist services. problematic substace use or paret/carer o the opiate treatmet program diagosed metal illess, eg schizophreia, bipolar disorder curret or history of domestic violece kow to Departmet of Commuity Services curret or history of child protectio issues. A rage of health ad other services will work together to support families with complex issues ad will iclude some or all of the followig: Level 1 services Level 2 services Families may also eed referral to all or some of the followig: Specialist health services drug ad alcohol metal health icludig residetial ad ipatiet services Physical Abuse ad Neglect of Childre (PANOC) child protectio cousellig services via DoCS Helplie Drugs i Pregacy Programs Other Govermet ad NGO programs eg Departmet of Commuity Services, Family Support Services, Brighter Futures Domestic Violece Services. 3.5 Review ad follow-o coordiated care The success of primary health care, icludig health home visitig, i the periatal period depeds o regular review ad coordiated ad appropriate follow-o care Effective programs ad itervetios It is clear from the research that early itervetio with vulerable families will improve outcomes across a rage of physical, psychological ad social idicators. Itervetios ad specific programs durig the ateatal ad early ifacy period should aim to ehace the resiliece of parets, promote optimal child developmet, facilitate secure attachmet relatioships ad prevet developmetal ad emotioal disorders. To be effective, these programs should address prevetio of risks ad the ehacemet of protective factors that will stregthe paretig. They should icorporate a focus o the emotioal ad social developmet of the ifat, ad the prevetio of adverse metal health outcomes (Mrazek & Haggerty 1994). The provisio of services that are uiversal, volutary ad o-stigmatisig is advocated. Programs should have multiple goals, be flexible i itesity ad duratio, be sesitive to the uique characteristics ad circumstaces of families, ad be provided by well-traied ad supported staff Coordiated care There is a eed for plaig across the cotiuum of early child developmet. This is especially so for those families with greater challeges to maage due to their idividual, family ad/or commuity circumstaces. Families carig for a ew baby require holistic care for the mother, child ad family across the trasitio from materity services to commuity-based services. It is ackowledged that the materity ad child ad family health service system withi each AHS is differet. Service plaig across the trasitio from pregacy to birth to parethood should be coducted withi the cotext of the services ad models that are curretly i place i each AHS. The key elemets of coordiatig care are: itegratig ad coordiatig service developmet across materity, child ad family health ad specialist services withi a AHS esurig liks to the service etwork across Health, other govermet, o-govermet ad commuity PAGE 18 NSW Health Materal ad child health supportig families early

29 services available to parets expectig or carig for a ew baby. The processes for review ad coordiated follow-o care are to be established ad cosistetly implemeted. The role of the midwife or child ad family health urse The maagemet of families who require additioal support is to be cosistet with the cliical skills ad abilities of the staff ad the local supports ad resources that are available. The role of the midwife or child ad family health urse (C&FHN) is to: idetify the risks idetify the stregths ad supports that the cliet/family may already have idetify the eed for ogoig support ad where appropriate facilitate cliet access to eeds-specific services develop a maagemet pla with the cliet/family whe appropriate, support the family as the key primary health care worker ad cosult with specialist staff or geeral practitioer as ecessary provide ogoig midwifery ad child ad family ursig care to cliets. Trasitio of care from materity services to early childhood health services Esurig trasitio of care betwee materity services ad early childhood health services is importat i improvig health outcomes for childre ad providig support to parets. All parets are to receive iformatio prior to discharge from hospital to home o: the services available through the early childhood health service a cotact for their local early childhood health service should issues arise betwee discharge from hospital ad the Uiversal Health Home Visit the offer of their first early childhood health service withi their ow home withi the first two weeks of their baby s birth relevat commuity peer support groups, eg Australia Breastfeedig Associatio. AHSs are ecouraged to explore additioal strategies to facilitate stroger liks betwee materity services, early childhood health services, other commuity health services ad geeral practitioers. It should be oted that materity ad child ad family health staff may be providig care durig the same period, each with their ow uique focus. Materity ad eoatal itesive care discharge services With the itroductio of UHHV, it is importat that materity, eoatal itesive care ad paediatric discharge services, family care cottages, day stay uits ad child ad family health services work together, complemet each other ad esure a cotiuum of care across this trasitio. Systems are to be established to esure that there is effective trasfer from the hospital to commuity health services. It may be appropriate i such circumstaces for the child ad family health service to visit the family with the materity or eoatal home visitig service i order to achieve a seamless trasitio. The provisio of home visitig by a materity discharge service does ot meet the requiremet for the offer of a Uiversal Health Home Visit. It should be oted that a pricipal objective of the Uiversal Health Home Visit is to esure a early itroductio to, ad coectio with, commuity-based early childhood health services followig the birth of a baby, i order for these services to be accessed by the family throughout the early childhood years. Families idetified as vulerable ateatally The ogoig care of these families followig the birth of the baby is to be determied as part of the team maagemet approach to care plaig (refer to sectio 3.3). A coordiated support pla is to be developed prior to discharge from hospital that addresses the eeds of the parets ad ifat i the early postatal period. The local early childhood health service is to be ivolved i plaig for the care of these families. Plaig is to ivolve local materity, social work ad child ad family health services. The Uiversal Health Home Visit is part of this ogoig care. Trasfer of iformatio I order to promote this trasitio of care, AHSs will develop systems to esure the effective flow of iformatio from the materity service to the early childhood health service. Such a trasfer of iformatio will eable support commeced ateatally to be reiforced ad stregtheed. NSW Health Materal ad child health supportig families early PAGE 19

30 Advice regardig the sharig of this iformatio with the commuity-based child ad family health service is to be made available to parets as part of the routie iformatio provided by the hospital o bookig-i ad agai prior to discharge. To esure a smooth trasitio of care from hospital to commuity-based health services, the followig iformatio is to be trasferred from the materity service to the early childhood health service withi 48 hours of discharge from hospital: MR 44/PR16 or Obstetric discharge summary outcomes of the ateatal psychosocial assessmet ad ay follow-up services provided to address the idetified issues other iformatio about the parets ad ifat that is required to esure appropriate care ad follow-up idetificatio of those families requirig priority follow-up. It is also importat to establish cross-border protocols betwee health services for trasfer of iformatio ad discharge plaig, as well as protocols with private hospitals. Likig to the service etwork All families require social support ad coectedess at the eighbourhood ad commuity level. Various health ad other services are workig to provide supportive etworks uder Families NSW. Health services are to establish systems of liaiso, referral, ad service agreemets where appropriate, with the local service etwork available for families with youg childre. Local mechaisms are to be put i place withi each AHS to facilitate ad support the likig of families from specialist services back to uiversal support services, such as early childhood health services ad geeral practitioers. Priority follow-up The early childhood health service is to be iformed by materity services of the families who require priority follow-up. AHSs are to develop local protocols to esure these families are referred to the child ad family health service for priority follow-up. Idicators for priority follow-up may iclude but ot be limited to risk factors idetified i Table 2, Levels 2 ad 3. PAGE 20 NSW Health Materal ad child health supportig families early

31 Sectio 4 Health home visitig Health home visitig is ot delivered i isolatio but forms part of the cotiuum of care ad etwork of services for families with youg childre. Comprehesive assessmet ad coordiated care provide the platform for health home visitig. The literature idicates that home visitig programs that provide support to parets should be offered to all parets with ewbors o a volutary basis. Through the provisio of volutary ad o-stigmatisig home visitig, those families idetified as vulerable or at risk ca be targeted to receive additioal support services (Vimpai 2000). 4.1 Uiversal health home visitig Uiversal Health Home Visitig (UHHV) withi the cotext of NSW Health s child ad family health service system icludes the offer ad provisio of at least oe uiversal cotact i the cliet s home withi two weeks of birth ad may also iclude further home visitig. The child ad family health urse from the early childhood health service coducts the UHHV Aim ad objectives The aim of UHHV is to egage all families with ewbors ad to provide support to parets with youg childre. UHHV is based o uiversality of access, assessmet ad itervetio i the cotext of the cliet s ow eviromet ad the developmet of parterships. The objectives of UHHV are to: improve access to services by cotactig ad offerig a home visit to all families with ewbors better determie families eeds for ogoig care by addig depth ad cotext to the assessmet by coductig it i the family home ad i partership with the family esure a itroductio to, ad coectio with, commuity-based child ad family services withi Health ad across other govermet ad commuity orgaisatios, for families that may ot have readily accessed these services Orgaisig the iitial cotact visit Whe iformatio is received from the materity service, the early childhood health service is to establish cotact with the family ad offer a home visit. Whe the offer of a health home visit is accepted, the visit is to be provided withi the first two weeks of birth. If the family has bee idetified as vulerable ateatally, the UHHV is icluded i the care pla ad orgaised i advace. This costitutes a offer of a UHHV. Whe the offer of the home visit is accepted, the parets are to be advised of the purpose of the home visit, the ame of the child ad family health urse who will be visitig ad a mutually agreed time for the visit. The child ad family health urse is to esure there are o threats posed to their safety i udertakig the home visit. A risk assessmet is to be completed by the child ad family health urse for each family, prior to the first home visit. This risk assessmet is to idetify ay potetially dagerous coditios ad/or situatios that may compromise worker safety. Local ad NSW Health Occupatioal Health ad Safety (OH&S) policy should be followed for all home visitig (refer to sectio 5.7). itroduce families to the cocept of health home visitig i a o-stigmatisig maer actively egage those families that do ot traditioally access materity ad early childhood health services ad that eed extra support egage families with the child ad family service system ad to provide support early, withi two weeks of birth NSW Health Materal ad child health supportig families early PAGE 21

32 4.1.3 What happes at the iitial postatal cotact visit? The iitial postatal cotact visit is to be drive by the family s eeds ad coducted at a pace ad i a maer suitable for the idividual family. It is reasoable to expect that the cotact would take a miimum of oe hour i order to cover the poits set out below. Preferably, this cotact will occur i the home ad may take more tha oe visit to complete. Whether it occurs i the cliic or the home, at the iitial cotact the urse will: establish a trustig relatioship based o priciples of the Family Partership model review the ateatal comprehesive primary care assessmet, or coduct a comprehesive primary health assessmet with the parets if there is cliical or access cocers (refer to sectio 3.1 Assessmet) provide positive support, affirm ad ormalise early paretig experieces whilst recogisig deviatios from the orm respod to issues or cocers that the parets may have regardig the health ad developmet of the baby, ad coduct the 1-4 week check as per the NSW child Persoal Health Record. moitor the baby s growth ad geeral progress, ad provide iformatio ad resources as required determie ad respod to issues regardig breastfeedig for both the mother ad her ifat, eg breast care ad maagemet, adequate milk itake to meet optimal growth, (refer to NSW Health PD2006_012) or respod to issues associated with other methods of ifat feedig determie the eed for further home visitig it is ackowledged that for some families more tha oe home visit may be eeded ad that additioal home visits may be eeded over the short term to support parets experiecig early adjustmet issues, for example, settlig ad breastfeedig Outcomes of uiversal health home visitig Health home visitig, withi the cotext of uiversal Child ad Family health services, should cotribute to the followig outcomes: icreased appropriate use of services ad programs improved family relatioships ability to demostrate paret craft ad child developmet kowledge ad skills improved quality of the paret child iteractio icreased positive health behaviours reduced axiety icreased cofidece icreased resourcefuless, that is, the ability to idetify ad garer resources eeded for positive health ad wellbeig. The outcomes achieved from the UHHV are depedet o the itervetio delivered, the capacity of the cliet to respod to the itervetio ad the capacity of the urse ad service to deliver the itervetio as illustrated i table 3. promote paret ifat bodig ad attachmet idetify with parets the coditios ad experieces that will promote their baby s health ad wellbeig provide health educatio o key issues such as safe sleepig, o smokig, breastfeedig, ifat utritio, ifat safety ad immuisatio establish with parets their support eeds ad idetify how these eeds ca be met lik parets with other appropriate services ad supports, icludig cetre-based early childhood health services ad the broader child ad family service system. The recommeded miimum early childhood health schedule is described withi the NSW child Persoal Health Record. PAGE 22 NSW Health Materal ad child health supportig families early

33 Table 3. Geeric model of Uiversal health home visitig (Source: Aslam ad Kemp 2005) Co-depedet aspects of itervetio Create the coditios Cotext trust relatioship Respose Itegrated ito ormal activities Itegrated i eviromet Predictable Opportuistically idetifyig eeds Flexible Istitutioal Reliable No-authoritaria Back-up safety et Agreed boudaries/ expectatios Support Psychosocial Affirmatio Normalisig Empowermet Reflectig behaviour Goal settig Istrumetal Iformatio made accessible Resources Likig Educatio Adaptive paretig/ attachmet skills Paret craft skills Child developmet Health Promotio Accessible Capacity to deliver/respod to itervetio (mediatig layer) Cliet (mother/family) Resiliece Skills Support persoal Stage of chage Persoal ad family stregths Nurse Traiig Experiece Support/supervisio Skills ad qualities Health service Staffig Fudig Resources Networks Reputatio Goals ad values Number, legth ad duratio of visits Correlated outcomes Geeralised ad istitutioal trust Demostrated Social resources Social well-beig kowledge emotioal well-beig Adaptability Icreased appropriate use of services ad programs. Improved family relatioships. Paret craft. Adaptive paretig. Appropriate developmetal expectatios. Reduced axiety/stress Icreased cofidece. Resourcefuless. Health behaviours. 4.2 Targeted home visitig programs NSW Health provides some isolated targeted programs to support wome who are pregat or carig for a ew baby. A rage of staff, icludig midwives, urses ad social workers curretly offer targeted home visitig programs. AHSs are to review their existig service models ad esure they reflect this policy ad operate i partership with home visitig services delivered by child ad family health urses. Some models of targeted home visitig developed i some AHSs iclude: materity home visitig programs early childhood health service home visitig programs locally developed home visitig services for culturally ad liguistically diverse families adolescet pregacy ad paretig support services drugs-i-pregacy services metal health services supportig families. 4.3 Specific populatios The implemetatio of health home visitig programs should be flexible ad be coducted i a maer that allows for the eeds of specific populatios i the commuity to be met. AHSs are ecouraged to work with local commuities to develop culturally sesitive ad appropriate resposes. NSW Health Materal ad child health supportig families early PAGE 23

34 4.3.1 Aborigial families The health disadvatage of the majority of Aborigial ad Torres Strait Islader people begis early i life ad cotiues throughout their lives. May Aborigial people have had egative experieces with maistream services, ad may carry a lot of mistrust ad fear ad may ot readily ope their homes to health workers they do ot kow. Service providers eed to be sesitive to the eeds of Aborigial families. By utilisig a primary health care approach which simultaeously addresses health service delivery ad the broad social factors affectig Aborigial commuities, it is possible to achieve sigificat log term improvemets i Aborigial materal ad ifat health (NSW Aborigial Periatal Health Report 2003). I order to deliver effective uiversal child ad family health services icludig home visitig, it is essetial that health staff egage with Aborigial commuities ad Aborigial health care providers i their Area. A excellet example of a effective primary health care model for the delivery of Aborigial services is the Aborigial Materal ad Ifat Health Strategy (AMIHS). More iformatio o the strategy is provided i Appedix 1, 1.1 Materity Services Rural ad remote families It is recogised that providig health home visitig i rural ad remote locatios requires additioal time ad resources to accommodate the issue of distace ad access to other services. It is also recogised that some of these families may have a heighteed eed for home visitig support as a result of their geographic isolatio. AHSs may eed to explore additioal methods of maitaiig cotact with these families, for example through the use of telephoe ad services or group programs that ivolve several families livig i proximity to each other Culturally ad liguistically diverse families Services are to be aware ad respectful of diverse cultural beliefs ad practices. Kowledge of cultural beliefs ad issues is essetial to iform cliical practice. It is importat ot to make assumptios about what parets from a particular cultural backgroud require, but rather work i partership to establish each family s specific eeds. Whe plaig ad providig services, icludig health home visitig, staff are to be aware of the specific issues for parets from culturally ad liguistically diverse backgrouds. The followig issues may be ecoutered. Isolatio ad lack of exteded family ad social etworks. Isolatio ca be a sigificat issue affectig the metal health of parets from culturally ad liguistically diverse backgrouds, ad a major factor cotributig to axiety ad depressio. Staff require kowledge of multiligual ad etho-specific support groups ad etworks. Settlemet problems ad socio-ecoomic factors. Settlemet problems ad socio-ecoomic factors may also affect the copig ability of parets from culturally ad liguistically diverse backgrouds. Refugee backgrouds. Parets from refugee backgrouds have additioal issues related to their experiece of trauma, possible sexual assault or torture, or years of deprivatio. Cultural sesitivity of maistream services ad cross-cultural competecies of health professioals. Ateatal, materity ad child ad family health staff require a uderstadig of differet cultural birthig ad child rearig practices. Laguage. A family s eed for a iterpreter service is to be established whe a woma is bookig i at her first ateatal visit, or at the family s first cotact with the health service. Services are to be coducted i the appropriate laguage. NSW Health fuds the Health Care Iterpreter Service, which provides both face-to-face ad telephoe iterpretig services. For further iformatio o the use of health care iterpreters, please refer to (PD2006_053 Iterpreters Stadard Procedures for Workig with HealthCare Iterpreters). Subject to resource availability, the same iterpreter should be utilised for a family to facilitate cotiuity of care ad relatioship with the cliet. Writte iformatio should be provided i the appropriate laguage. The NSW Multicultural Health Commuicatio Service has publicatios related to pregacy ad child ad family health i several laguages. These publicatios are available o the NSW Health website mhcs/idex.html. The use of biligual workers is ecouraged. Cosultatios with specific commuities are to be udertake as part of each AHS s service developmet processes. PAGE 24 NSW Health Materal ad child health supportig families early

35 4.4 Sustaied health home visitig As part of a comprehesive approach to service delivery, families that require additioal support may be offered support i their ow homes over a two-year time frame, this is kow as Sustaied Health Home Visitig (SHHV). Where fudig has bee idetified specifically for this purpose, SHHV is itegrated ito the service etwork for families with youg childre. Health home visitig programs comprisig itesive ad sustaied visits by professioals (usually urses) over the first two years of life show promise i promotig child health ad family fuctioig, ad amelioratig disadvatage Aim ad objectives The objectives of SHHV are to: actively egage those families who eed additioal support ad may ot otherwise access materity ad early childhood health services build o existig kowledge ad experiece of parets establish ad develop a trustig relatioship betwee the family ad urse foster the developmet of paretal self-efficacy, the early attachmet relatioship ad awareess of the developmetal eeds of the ifat i order to ehace the social ad emotioal developmet of childre ehace health, safety ad wellbeig of childre ad families through commuity-based ivolvemet ad family support Outcomes of sustaied health home visitig Whe supported by SHHV, a review of trials (Aslam H & Kemp L 2005) has show that families with risk factors for adverse child outcomes have: Systematic reviews have show that SHHV itervetios that iclude the followig elemets have greater success: a uiversal populatio approach to erolmet, rather tha referral-based erolmet services which target populatios or families that are vulerable to poor materal ad/or child outcomes ( at-risk ) with the aim of iterveig proactively to prevet ad miimise risk, eg mothers with, or at risk of, postatal depressio; mothers of lower socio-ecoomic status or teeage mothers commece ateatally comprehesive itervetios icludig a combiatio of cousellig, problem solvig, child growth ad developmet, social support, paretig skills, paret-child iteractio ad provisio of resources, icludig iformatio ad likig to relevat services itervetios based o respectful paret-urse parterships proactive itervetios based o aticipatory guidace. Furthermore, these reviews have show that SHHV itervetios with the followig characteristics are ulikely to result i successful outcomes for families: those that are focussed o relatioship buildig ad social support i the absece of other elemets of a comprehesive itervetio services targetig populatios or families with multiple, kow sigificat problems (the at risk ), requirig a proactive approach to existig problems, eg families experiecig domestic violece, drug ad alcohol misuse or egagemet with the child protectio system. These families require a specialist ad cotiuig support respose. Figure 4 illustrates where the best evidece exists for SHHV as a effective itervetio, ad the best-practice respose i light of this evidece. sigificatly improved quality of the home eviromet, paret child iteractio, child developmet ad family fuctioig higher immuisatio rates reductios i the umbers of subsequet pregacies, reliace o welfare support, crimial behaviour ad child abuse ad eglect. NSW Health Materal ad child health supportig families early PAGE 25

36 Figure 3. Effectiveess of sustaied health home visitig programs Is there curret evidece that sustaied health home visitig works as a itervetio? Risk factors Best practice-respose No Sigificatly atteuated Previous child abuse Domestic violece Other high risks (metal illess, drug addictio) Complex eeds Team approach/ case maagemet Strogest evidece Teeaged mothers Social disadvatage (first time, poor, usupported) Other level 2 risk factors Nurse sustaied home visitig Implemetig sustaied health home visitig Target group Families who require additioal support do ot ecessarily use uiversal services or seek help whe problems arise. Where there is specified fudig available, a SHHV program ca be cosidered as a possible service respose followig comprehesive assessmet for those families idetified with level 2 vulerabilities. Where a SHHV program exists it is to be provided i the cotext of uiversal services, coordiated care ad a teammaagemet approach to care plaig. Comprehesive assessmet ad cliical judgemet are to be used to determie who will be offered a service i the cotext of the curret service structure, the commuity profile ad the outcome evidece. Approach to implemetig There are two possible approaches to implemetig SHHV as part of the early childhood health service: 1. delivered by the child ad family health urses deliverig UHHV ad cliic-based services, or 2. delivered as a separate ad distict service i which child ad family health urses are specifically employed to udertake SHHV. There are beefits ad disadvatages to both approaches. For example, there may be beefits i a mixed case load for urses deliverig UHHV, cliic-based ad SHHV services, but the urse is likely to be more easily available to the family i a separate ad distict SHHV service. The approach adopted will also have implicatios for how the service is structured, skills ad kowledge required by urses, ad the provisio of cliical supervisio ad access to multidiscipliary services. Sustaied health home visitig service model Sustaied health home visitig cosists of the provisio of approximately 20 home visits (actual umber of visits determied by eed) primarily by the same child ad family health urse durig the pregacy ad the first two years post birth. The home visits are to be stadardised as follows: Ateatal home visits, at least oe joit visit with the midwife should be udertake. A postatal visit withi oe week of birth, ad the visits weekly util six weeks; secod weekly till 12 weeks; mothly to 15 moths; bi-mothly util two years. Idividually tailored cotet of each home visit based o the mother s eeds, skills, stregths ad capacity. Guided by a stregths-based approach, the urse will: support ad eable the mother ad the family to ehace their copig skills, problem solvig skills ad ability to mobilise resources foster the emotioal well-beig of the mother foster positive paretig skills PAGE 26 NSW Health Materal ad child health supportig families early

37 foster paretal skills i supportig optimal child developmet support the family to establish supportive relatioships i their commuity metor materal-ifat bodig ad attachmet provide primary health care ad health educatio, icludig but ot limited to immuisatio, Sudde Ifat Death Sydrome (SIDS) risk reductio, ifat utritio icludig breastfeedig, ad child safety. Facilitated access to other appropriate early childhood ad specialist services. Where other childhood, commuity or specialist services are ivolved i supportig the family, it may be appropriate for the health home visitor to arrage joit visits. The SHHV program is to be supported by a systematic program of assessmet, moitorig ad evaluatio of goals ad outcomes of the itervetio, for each family. provide a secod tier of support for the family. Idividuals providig this level of support udertake two roles i supportig the work of the primary child ad family health urse: traiig, cosultatio, cliical advice ad educatio for the primary child ad family health urse direct provisio to the family of more specialised services i cojuctio with the primary child ad family health urse. Whe several workers ad services are ivolved i supportig a family, there is to be regular commuicatio ad care plaig betwee these workers. The family is to be iformed that services are workig together to support them ad that iformatio is beig exchaged. Whe iformatio is to be exchaged with other govermet ad commuity services, the permissio of paret/carer is to be obtaied. Coset to exchage iformatio is ot required i circumstaces such as: A team approach to supportig vulerable families I order for SHHV to be most effective, the home visitig urse is to be part of a multidiscipliary team. This team will iclude other health services or teams ad idetified service parters withi the service etwork. Members of the team are idetified to whe makig a risk of harm report to DoCS, or a respose to a Sectio 248 request whe there is a serious ad immiet threat to the life, health or safety of the idividual or other perso (refer NSW Iteragecy Guidelies for Child Protectio Itervetio 2006, NSW Health Privacy Maual V2, 2005). NSW Health Materal ad child health supportig families early PAGE 27

38 Sectio 5 Implemetatio requiremets 5.1 Plaig Plaig ad coordiatig health services that work with childre, parets ad families is the first step i effective implemetatio of primary health ad home visitig services for families expectig a ew baby or carig for youg childre. AHSs are to collect iformatio regularly o the: populatio of childre, icludig the umber of births, the characteristics of families (icludig the idetificatio of Aborigial families ad culturally ad liguistically diverse families) ad the local commuities i which they live Ratio for sustaied health home visitig A ratio of oe urse full time equivalet (FTE) positio to every 25 families is a guide to the recommeded staffig level for sustaied health home visitig, where this is specifically fuded ad delivered as a distict ad separate service by child ad family health urses specifically employed to deliver the service. The guide of oe urse FTE to 25 families is the maximum caseload, assumig circumstaces are optimum. The model has ot bee trialled i rural NSW, however, the ratio for rural areas is less ad recommeded at oe urse FTE to every 20 families. rage of health services available to parets ad families durig the pregacy ad first years of the child s life rage of health services that support vulerable families services available i the broader child ad family service etwork staffig ad fudig for child ad family health services liguistic/cultural skills of staff ivolved i the delivery of materity ad child ad family health services Child ad family health staff Qualificatios The recommeded miimum qualificatios for UHHV staff employed i the early childhood health service to udertake UHHV are registered urse or midwife with qualificatios i child ad family health. Other desirable qualificatios iclude Graduate Certificate i Lactatio/ Iteratioal Board Certified Lactatio Cosultat, Graduate Diploma of Midwifery/Midwifery Certificate, Graduate Diploma i Ifat Metal Health, or advaced cousellig skills. This iformatio is to be used to iform the quality of service provisio ad to develop a plaig framework to idetify the mix of cliical, uiversal ad targeted service models eeded to support families. Families ad commuities are to be ivolved i these plaig processes. 5.2 Staffig AHSs are to esure that there are appropriate staffig levels to provide UHHV for the Area s populatio ad characteristics. It is ackowledged that characteristics such as rurality ad culturally diverse populatios will impact o the staffig levels required. It is ackowledged that some AHSs employ registered geeralist commuity urses to provide early childhood health services ad provide traiig ad educatio through Area i-service programs, icludig o-the-job metorig ad supervisio. AHSs are ecouraged to adopt recruitmet policies to employ registered urses or midwives with qualificatios i child ad family health. The quality ad efficiecy of care provided to childre ad families is depedat o the level of competecy of the cliicia. For this reaso, specialist qualificatios i child ad family health are cosidered to be the ideal. PAGE 28 NSW Health Materal ad child health supportig families early

39 Scope of practice The Child ad Family Health Nurses Associatio (CAFHNA) idetifies the scope of practice for urses workig i the child ad family health area as: child health ad developmet materal health ad welfare family health ad welfare paretig support cousellig health surveillace of ifats ad childre commuity health ursig commuity developmet ad parterships. The Competecy Stadards for Child ad Family Health Nurses (Child ad Family Health Nurses Associatio (NSW) Ic., 2000) are based o curret best-practice priciples for child ad family health ursig ad provide a guide to determie competecies i this area of ursig practice. 5.3 Traiig It is the resposibility of the AHS to esure that staff deliverig materity, child ad family services have adequate qualificatios, skills ad traiig. Traiig ad developmet systems for all staff are to support a multidiscipliary ad iteragecy approach to workig with families. Each AHS is to implemet the NSW Health Families NSW traiig that will be developed ad delivered as part of a Statewide traiig project. This traiig package is desiged to support all staff with the implemetatio of Families NSW, this Policy ad the Family Partership Model. The traiig icorporates two primary compoets: 1. The Family Partership Traiig. 2. SAFE START psychosocial assessmet ad depressio screeig traiig Family partership traiig Family Partership Traiig is desiged to provide basic traiig i the Family Partership Model (refer to Appedix B sectio 1.4.2). The model has bee evaluated i several research projects ad is beig implemeted i a variety of settigs, both atioally ad iteratioally (Davis et al. 2002). Family Partership Traiig was first itroduced i NSW to uderpi the Families NSW strategy of UHHV, ad particularly SHHV by child ad family health urses. However, it also has relevace for all health professioals who have cotact with cliets as well as their maagers. Family Partership Traiig eables primary health staff, icludig midwives ad child ad family health urses, to feel prepared to deal with paretal cocers at a early stage, although referral to a more specialised service may be ecessary at a later stage. By idetifyig ad dealig with issues early it is possible to prevet more severe, etreched problems developig. To do this effectively, staff eed maagerial support to work i this way, ad ogoig supervisio, to support them ad maitai ad ehace their skills. Family Partership Traiig focuses o the importace of developig a relatioship, listeig effectively to ehace the assessmet of the cliet s eeds ad developig strategies to assist parets to solve their problems. It helps staff to idetify ad develop the skills ad qualities required to egage with families ad develop a basic uderstadig of Persoal Costruct Theory, icludig the awareess that every perso is shaped by his or her uique history which iflueces their costructios or view of the world ad evets. The basic course cosists of 10 half-day sessios. There are two facilitators ad a maximum of 12 participats, ad the sessios are best delivered weekly. The course is delivered i a adult learig style that builds the kowledge, skills, stregths ad experiece of the participats. As the course progresses, a partership betwee facilitators ad the participats develops that mirrors the partership that develops betwee a helper ad a cliet. Learig occurs through reflectio, exploratio ad participatio, particularly i skills practice sessios. NSW Health Materal ad child health supportig families early PAGE 29

40 5.3.2 SAFE START psychosocial assessmet ad depressio screeig traiig With a more psychosocial focus to their work, primary health care staff, icludig child ad family health urses ad midwives, require further traiig ad support i psychosocial assessmets ad dealig with the outcome of these assessmets. This traiig aims to support the Statewide implemetatio of psychosocial assessmet ad depressio screeig by drawig together several compoets that are essetial ad complemetary for workig with families durig the periatal period. Importat areas covered i this traiig iclude: the cocept of a itegrated approach for workig with families i the periatal period the evidece base icludig the importace of the early years, ratioale for Families NSW, the SAFE START model ad early itervetio ad prevetio i geeral comprehesive psychosocial assessmet processes ad the key depressio screeig tools the importace of cliical pathways ad commuity etworks for families workig i partership with the family to promote stregths ad idetify vulerabilities assessmet of safety of paret ad ifat. I additio, attedace at the followig existig traiig opportuities is ecouraged: Area drug ad alcohol courses; updates o child ad family health issues; cultural awareess traiig; aual educatio programs; cofereces ad semiars; ad specific courses such as breastfeedig/lactatio ad ifat metal health. Attedace at madatory traiig such as suicide risk assessmet ad maagemet, child protectio ad domestic violece screeig are to be arraged as a priority ad before staff coduct psychosocial assessmets ad depressio screeig. 5.4 Cliical supervisio Staff workig with families are required to exercise professioal judgemet ad make decisios o optios for care that have sigificat cosequeces for families. Cliical supervisio is vital to support the practitioer ad maitai a professioal service that focuses o the cliet s eeds. AHSs are to esure that staff receive regular cliical supervisio. Cliical supervisio focuses o the health professioal, his or her cliical practice ad the cliet. The key fuctio of a cliical supervisor is to provide a eviromet where the health professioal ca feel safe to discuss, reflect upo ad explore cliical experieces ad issues. The supervisor is usually a health professioal who is able to provide additioal expertise, kowledge ad skill. This supervisor should ot have direct maagerial resposibility for the perso whom they are supervisig. Approaches to cliical supervisio iclude: Idividual the health professioal ad the supervisor meet o a regular basis to discuss cliical cases ad experieces. This approach will be most appropriate for staff ivolved i home visitig more complex/vulerable cliet groups. Group the supervisor meets several health professioals o a regular basis to discuss cliical cases ad experieces. This method of supervisio has the added advatage of group members learig from their colleagues experieces ad will be most appropriate for all staff workig with families. Peer support ca be used to provide additioal opportuities for discussio about cliical practice issues ad/or the opportuity to review literature. No formal supervisor is icluded i this group discussio. 5.5 Service systems to support cliical practice As part of the Family Partership Model (Davis et al 2002), primary ad commuity health care services ad staff withi these services ca be categorised accordig to the type ad complexity of service delivered, which ca be grouped uder geeralist ad specialist tiers. Withi both the geeralist ad specialist tiers there are two further tiers that reflect the complexity of services provided withi these tiers. This results i a four-tier model i which each tier requires its ow level of expertise ad set of skills ad depeds o good workig relatioships ad liks with the other tiers to ehace the quality of care delivered. These tiers relate to the primary, secodary, tertiary ad quaterary levels of service. Tier 1 (Primary level service) ivolves direct service provisio for cliets with low-level ad commo eeds delivered by staff with highly developed geeralist skills. For example, withi the broad child ad family health service system, child ad family health urses ca be cosidered to be Tier 1 staff, deliverig Tier 1 service to all childre ad their families. PAGE 30 NSW Health Materal ad child health supportig families early

41 Tier 2 (Secodary level service) ivolves a mixture of direct service provisio ad cosultatio, support ad traiig to Tier 1, delivered by staff with more specialised skills. For example, the multidiscipliary team, as described i Sectios 3.2 ad 3.3, provides elemets of Tier 2 service withi this team, by providig support ad cosultatio for the Tier 1 staff deliverig the primary care. Tier 3 (Tertiary level service) ivolves the direct provisio of care to cliets with specific coditios that require specialised care ad support by staff that have specialised, coditio-related cliical skills. Access is geerally by referral from the geeralist tier. Tier 3 services also provide support ad cosultatio to the geeralist tiers. Metal Health ad Drug & alcohol services are examples of Tier 3 services. Tier 4 (Quaterary level service) ivolves itesive short-term care for cliets with the most severe, complex ad least frequet coditios. It is importat for health services to develop effective parterships betwee the tiers, to allow geeralist health services to maage ogoig care of cliets with specific health problems ad be able to access specialised support ad effective referral pathways for cliets with more acute ad complex problems. Uiversal materity, child ad family health services are to be uderpied by support from a Tier 2 multidiscipliary team that has four fuctios: participatio i multidiscipliary case discussio to determie level of care cosultatio, support ad educatio for Tier 1 primary care workers direct service provisio to families, as required, i collaboratio with Tier 1 staff facilitatio of referral to Tier 3 ad Tier 4 services whe required. The provisio of Tier 2 support is essetial because it provides a importat level of service to people with extra eeds that caot be met adequately by Tier 1 services. Tier 2 support acts as a buffer or filter to the more specialised Tier 3 ad Tier 4 services (therefore limitig premature referrals ad escalatio of cost) ad collaborates with Tier 1 staff to provide ogoig care for people with higher level eeds. AHSs eed to cosider the availability ad accessibility of all tiers. 5.6 Service etworks Health home visitig may lead to the idetificatio ad egagemet of more families with a rage of problems ad issues that will require itervetios by several professioal groups ad services. AHSs are to esure there is a directory of services available that outlies what services the AHS ad broader child ad family service etworks provide for families, ad the eligibility criteria to access these services. AHSs are to develop referral protocols both withi NSW Health ad with other service etwork parters to facilitate optimal trasitio betwee services. The developmet of protocols to effect the timely ad smooth referral of childre ad families is essetial for the effective operatio of health home visitig. Whe appropriate, AHSs should cosider developig service agreemets or memorada of uderstadig. 5.7 Occupatioal health ad safety Health professioals coductig home visitig are to be aware of the practices ad approaches that will reduce the risks to their persoal safety ad the safety of the family they are visitig. Workers should ot place themselves at risk. The NSW Health Policy directive PD2005_339 should be used as the basis for developig AHS occupatioal health ad safety procedures relatig to health home visitig. AHSs are to establish protocols ad procedures that address the followig occupatioal health ad safety cosideratios whe implemetig health home visitig: Risk assessmets to be completed for each family prior to the first home visit to idetify ay potetially dagerous coditios ad/or evirometal hazards that may compromise worker safety. Precautios situatios i which urses should ot home visit ad/or visit aloe should be idetified. Whe aggressio or violece has bee assessed as a potetial cocer, a home visit should ot be coducted ad alterative arragemets should be made, for example, cotact i a health facility or public place NSW Health Materal ad child health supportig families early PAGE 31

42 Itierary systems are i place to moitor staff movemets, safety ad retur, icludig procedures for late retur. Procedures to maximise safety durig the home visit ad actio to be take whe a worker feels at risk durig a home visit. Commuicatio equipmet all health professioals ivolved i home visitig are to carry a mobile telephoe that is capable of fuctioig i the geographical area of use, switched o durig home visits ad carried o the health professioal s body (ot left i brief case/bag). Car breakdows access to a mobile phoe ad clear guidelies o what to do i the evet of a breakdow or accidet. be obtaied from the paret prior to the trasfer of that iformatio. Parets are to be iformed of the purpose for sharig iformatio, what iformatio will be shared ad with whom, ad the beefits of sharig iformatio. AHSs will develop local policies ad protocols that support sharig iformatio ad case coordiatio across the service etwork i the cotext of Iformatio Privacy provisios. 5.9 Resource requiremets The implemetatio of a home visitig service will require urses to be mobile ad have access to the followig equipmet. Motor vehicle 5.8 Cofidetiality The sharig ad trasfer of iformatio are to be coducted with regard to Iformatio Privacy provisios. The NSW Health Policy Directive PD2005_593 is to be referred to. I geeral the followig should be oted: patiets/cliets are to be advised that access to their health record will be available to the patiet s/cliet s treatig health care providers withi the public health system patiets/cliets are to be provided with iformatio o how their persoal health iformatio will be used withi the public health system a paret ca give iformed coset i relatio to their child but they caot give coset o behalf of a parter or other family member persoal health iformatio is ot to be disclosed to third parties without the iformed coset of the perso to whom it relates uless there is a legal obligatio to do so uder the Childre ad Youg Persos (Care ad Protectio) Act 1998 the Departmet of Commuity Services ca direct agecies icludig NSW Health to provide iformatio that relates to the safety, welfare ad wellbeig of a child or youg perso (refer to NSW Iteragecy Guidelies for Child Protectio Itervetio 2006 ad NSW Health PD2005_299). Health services are to respect cofidetiality ad obtai coset whe sharig iformatio with services other tha those provided by the AHS. Before a referral is made to aother agecy, writte permissio is to Access to a motor vehicle is essetial to the success of health home visitig. Ideally a vehicle should be allocated to each cliicia providig home visitig or there should be ready access to a pool vehicle. Staff coductig home visitig eed to have access to a motor vehicle that allows opportuistic visits ad iteractios with families. It is ot appropriate for staff to be dropped off whe visitig i the home ad picked up at a later time as this potetially compromises staff safety. Mobile telephoes Access to a mobile telephoe with appropriate etwork coverage for the area beig serviced is also required for all staff coductig home visits. Lockable brief case All staff require a lockable bag to securely trasport cliet records. The locked bag is to be trasported i the boot of the car ad take i whe visitig a cliet. Cliet records are ot to be left uatteded i a car. Cliical equipmet Equipmet for moitorig the growth ad developmet of the ifat is required for home visitig, for example scales, age-appropriate toys. The availability of this equipmet will esure that urses may udertake opportuistic child health screeig ad surveillace whe required. Iformatio techology Access to computers for the provisio of data ad for access to iformatio ecessary to support cliical practice ad commuicate with the service etwork is required. PAGE 32 NSW Health Materal ad child health supportig families early

43 5.10 Fudig AHSs are to esure that adequate fudig is provided for implemetatio of primary health care ad health home visitig services for families expectig a baby or carig for youg childre. AHSs have bee provided with ehacemet fuds as part of the Statewide implemetatio of Families NSW. These ehacemet fuds are to be used i the developmet of systems to support the implemetatio of Families NSW ad health home visitig. AHSs may eed to redirect existig resources ad re-oriet their services to implemet health home visitig Reportig A aual report that provides iformatio o AHS Families NSW activity icludig SAFE START, progress o UHHV, fiacial reportig ad major achievemets, is to be provided to the NSW Departmet of Health, at the ed of each fiacial year. Specific data o UHHV performace is requested by NSW Departmet of Health o a quarterly basis. AHSs are required to report aually to the NSW Health Departmet o the expediture of the ehacemet fuds made available for implemetig Families NSW Evaluatio The implemetatio of the Families NSW strategy across the State will ehace NSW Health s ability to cotribute to improvig outcomes for the childre of NSW. The Families NSW Headlie Idicators ad Outcomes Framework sets out the expected log term outcomes from the strategy, ad is oe aspect of the overall evaluatio strategy for Families NSW. These broad, high level outcomes are coceptualised at a populatio level. Whe measured ad moitored over time they will iform us about the health ad wellbeig outcomes for childre, families ad commuities i NSW ad whether these outcomes are improvig. Curretly, several NSW Health Statewide data sets ad systems are i use, or beig developed that may cotribute to the provisio of data for moitorig ad evaluatio. These iclude the Midwives Data Collectio, the Statistical Ipatiet Collectio (Health Outcomes Iformatio Statistical Toolkit), ad the NSW Health Survey Program. AHSs are to evaluate their compliace with the practices ad procedures outlied i this policy regularly. NSW Health Materal ad child health supportig families early PAGE 33

44 Appedix 1 Health care services for mothers, babies ad families NSW Health has a log ad successful history of providig health services to mothers, babies ad families. Materity ad Child ad Family Health Services have demostrated cosiderable iovatio i deliverig flexible ad resposive services with a capacity to respod to chagig social circumstaces. Cetral to this has bee the ogoig commitmet ad dedicatio of the health professioals deliverig these services. Uiversal primary health care services The platform for the provisio of itegrated periatal ad ifat services is the uiversal primary health care system. NSW Health curretly provides uiversal services to families who are expectig or carig for a baby. Materity ad child ad family health services are well placed to be the etry poit for families ito the broader Families NSW service etwork. NSW Health has the capacity to egage with all families followig the birth of a baby, ad may families prior to birth, ad has a key role i providig support for all families expectig or carig for a ew baby. Midwives ad child ad family health urses adopt a holistic model of care which ecompasses medical, physical, psychological, emotioal ad social aspects ad are therefore able to idetify the eeds of families ad facilitate access to the required supports. This sectio outlies the rage of materity ad early childhood health services curretly provided by NSW Health. This is icluded to esure that itegrated periatal care, icludig UHHV, is viewed ad implemeted as part of the uiversal service system provided by NSW Health to parets expectig or carig for a baby. 1.1 Materity Services Materity services are the first poit of etry to the Families NSW service system for most parets expectig a baby i NSW. NSW Health provides a rage of materity services to the commuity through metropolita ad rural AHSs. The ature ad scope of materity services available to local populatios varies cosiderably withi ad betwee AHSs. The NSW Framework for Materity Services (NSW Health 2000) idetifies the followig services ad systems of care that costitute the materity services of NSW: Core services iclude ateatal, itrapartum, birth ad postpartum care. Cliicias iclude obstetricias, paediatricias, midwives ad urses for both outpatiets ad ipatiets with access to aaesthetic ad allied health services. Systems ad processes withi ad betwee primary, secodary ad tertiary models of care that are etworked to facilitate trasfer of care betwee AHS facilities ad the commuity settig by ecouragig effective commuicatio ad cosumer participatio. Specific services ad programs that provide direct care, iformatio ad/or specific educatio programs that target margialised or disadvataged groups of wome ad their families. No-specific services ad programs that provide iformatio ad/or educatio programs for wome ad their families i the ateatal ad postatal period, ie preparatio for parethood, ateatal ad postatal educatio classes or group sessios. Area Health Services are expected to provide cotiuity of care for all wome throughout the ateatal, itrapartum ad postatal periods. Cotiuity-of-care models Cotiuity-of-care utilises a primary health care philosophy that eables wome to develop a meaigful relatioship with the same caregiver(s) throughout pregacy, birth ad the postatal period. Each woma receives care from a primary carer(s) who takes resposibility for esurig that the care provided to the woma is appropriate, safe ad effective, based o her idetified eeds ad idividual circumstaces. Materity home visitig programs Most AHSs have developed materity home visitig programs to support wome durig pregacy ad i the trasitio from hospital to home. PAGE 34 NSW Health Materal ad child health supportig families early

45 Across NSW there is wide variatio with regard to access, availability, etry criteria ad scope of service provisio, icludig duratio ad timig of visits, for these programs. The aims of postatal services are to provide early postatal materity care ad assessmet of the woma ad baby, with a focus o physical aspects, psychosocial ad evirometal eeds that relate to the trasitio to home, icludig the establishmet of ifat feedig. Additioal services have bee developed i some metropolita tertiary hospitals for the provisio of eoatal home visitig services for babies who have bee discharged from eoatal itesive care uits. These services are restricted to those babies whose coditios meet specific criteria ad who reside withi set geographical areas. I some AHSs, additioal services are provided for wome ad their babies with idetified problems, to promote effective discharge from hospital ad seamless uptake ito the commuity-based child ad family health services. Materity care for Aborigial wome The NSW Aborigial Materal ad Ifat Health Service (AMIHS) features a primary health care model of ateatal ad postatal care for Aborigial wome util their baby is 8 weeks old. Withi this model, teams of midwives ad Aborigial health workers work with geeral practitioers ad other specialists to provide comprehesive care for Aborigial wome durig the ateatal ad postatal period. The key elemets of this model are: Cotiuity of materity care, providig ateatal ad postatal care a partership betwee a midwife ad Aborigial health worker/educatio officer a partership approach betwee Area Health Services ad the Aborigial commuity-cotrolled sector commuity-based, culturally appropriate services, icludig home visitig ad outreach the provisio of trasport a traiig compoet for midwives ad Aborigial health workers a explicit focus o commuity peer educatio ad commuity developmet (i additio to health service delivery) participatio of Aborigial families i program implemetatio ad evaluatio. AMIHS icludes programs fuded by the Australia Govermet kow as Alterative Birthig Services Program (ABSP), ad Area Health Services fuded programs with the same philosophy ad service delivery model. 1.2 Early childhood health services Early childhood health services form part of the comprehesive etwork of primary health care services for families ad childre across NSW. Early childhood health services are provided for childre aged zero to five years ad their parets/carers. The staff of these services are primarily registered urses who predomiatly have postgraduate qualificatios ad experiece i child ad family health ursig ad other relevat qualificatios, for example midwifery. NSW Health provides a rage of health care services to childre ad their families. Health services specifically provided for childre ad their families iclude: Early childhood health services Family care cetres Residetial family care cetres Paret help telephoe lies Child ad family teams i commuity health services Child protectio services Child ad adolescet metal health services Childre s wards i geeral hospitals Specialist childre s hospitals. Geeral practitioers are major providers of care withi the primary health care system. They are key parters i the provisio of health services for childre ad their families. The health system must maitai strog liks with other relevat govermet departmets, local govermet, o-govermet orgaisatios, health professioals ad families to create the best opportuities for improvig childre s health. Early Childhood Health Cetres are staffed by health professioals (icludig registered urses) who specialise i child ad family health. The child ad family health urse gives assistace with carig for babies ad youg childre, icludig iformatio o: breastfeedig copig with sleepig ad cryig NSW Health Materal ad child health supportig families early PAGE 35

46 childre s growth ad developmet immuisatio safety playig with babies or toddlers to stimulate developmet paretal wellbeig. The rage of early childhood health services ecompasses areas of activity delivered i two mai settigs at cetres ad i the cliet s home. Cetre based activities Group programs programs are coducted for a rage of issues icludig postatal depressio, breastfeedig, sleep ad settlig ad child behaviour. These groups also ecourage social iteractio amogst parets so that they may develop ad utilise their ow supportive etwork of frieds. Group programs ca also be used at appropriate well child health checks. Various other services provided from cetres are desiged to maximise the opportuities for families to etwork, for example ewsletters, pram-walkig activities, ad coffee morigs. Early childhood health cliics services are provided o a appoitmet or drop i basis withi a cliic settig. Home visitig AHSs have developed specific early childhood health home visitig programs to address local eeds. Home visitig is sometimes provided over the short term to address specific health issues, such as breastfeedig, settlig or postatal depressio. I some istaces, these programs have bee available uiversally ad i others they have bee targeted to particular groups. The uiversal postatal home visit outlied i the Policy is oe compoet of home visitig that is delivered by child ad family health urses as part of the uiversal primary health care services provided withi the NSW Health system. PAGE 36 NSW Health Materal ad child health supportig families early

47 APPENDIX 2 Priciples uderpiig the policy The itegrated approach to periatal ad ifat care, as part of the Supportig Families Early iitiative, aims to achieve the followig key results: 1. improved child health ad wellbeig 2. ehaced family ad social fuctioig 3. provisio of services that meet the eeds of childre ad families 4. improved cotiuity of care. Achievemet of these results ecessitates workig withi a service framework guided by: lik families to the services best able to meet their eeds have a holistic view of each family seek ad take ito accout feedback from families about the service they have received provide flexible services i coveiet settigs work with families as a team at two levels, withi the service itself ad across the service etwork have access to opportuities for ogoig traiig ad developmet. Families NSW ivestmet i the early years: NSW Actio Pla Early Childhood ad Child Care, State Pla ad State Health Pla equity cliical practice priciples that iclude workig i partership with the family ad facilitatig the developmet of the paret ifat relatioship. Service plaig Services will be more effective i helpig families if they: form part of a etwork of services which is multidiscipliary ad multifaceted are built o practices that have proved to be effective ecourage feedback from commuities ad families 1.1 Families NSW Families NSW is based o research that demostrates that the way i which families are supported i the early years of their childre s lives has lastig effects o childre s developmet ad later educatio, health ad ecoomic outcomes. The two uderpiig priciples of the Families NSW strategy are: a stregths-based approach to workig with families, iclusive of all cultures ad family types a plaed, coordiated service system that is resposive to the eeds of families. Workig with families Staff ca make their iteractios with families as valuable as possible if they: empower parets to be active i the decisios which affect their lives view parets as experts who kow what is best for their family are developed locally by families, voluteers ad staff are appropriate to the eeds of differet commuities (eg culturally ad liguistically diverse ad Aborigial commuities ad commuities at differet levels of fuctioig) are flexible ad accessible to families i coveiet settigs collect ad share iformatio ad participate i evaluatio. 1.2 Ivestmet i the early years The NSW Govermet is committed to supportig childre ad families. It recogises the importace of providig childre with a good start i life, to esure their optimal growth ad developmet. This commitmet is a priority i the NSW Actio Pla Early Childhood ad Child Care, uder the Coucil of Australia Govermets, Natioal Reform Ageda, the State Pla (i particular, NSW Health Materal ad child health supportig families early PAGE 37

48 F4 embeddig prevetio ad early itervetio ito Govermet service delivery i NSW, F6 Icreased proportio of childre with skills for life ad learig, ad F7 reduced rates of child abuse ad eglect) ad the State Health Pla (Strategic Directio 3 Stregthe primary health ad cotiuig care i the commuity). The ratioale for this ivestmet is supported by ecoomic evidece that ivestmet i the early years is cost effective. Professor James Heckma, a leadig US ecoomist ad Nobel laureate, promotes ivestmet i the early years as a meas to icreasig productivity i the ecoomy ad society more broadly. Early itervetios for disadvataged childre provide the greatest retur. Itervetios have bee show to promote schoolig, improve the quality of the workforce, ehace the productivity of schools ad reduce crime, teeage pregacy ad welfare depedecy. The itervetios evaluated were show to raise earigs i adulthood ad promote social attachmet. The retur from the dollars ivested is as high as per cet. Further more, the cost of iterveig icreases with age (Heckma 2006), makig early childhood itervetio cheaper ad more effective i the log term. 1.3 Equity The Policy focuses o two key cocepts for equity: a uiversal populatio approach workig i cotext to address the social determiats of health. Uiversal populatio approach A uiversal populatio approach aims to improve the health ad wellbeig of the whole populatio. It seeks to ifluece idividual behaviours ad lifestyles idirectly by chagig social orms ad social support (Nutbeam & Harris 1999). Home visitig is most effective whe a uiversal populatio approach to erolmet is used (Guterma 1999). Workig i cotext to address the social determiats of health Materal ad child health is, iextricably liked with social factors i our commuities (Tiedje 2000). Primary child ad family health care addresses the broader cotext of family, social system ad eviromet, particularly the social ad psychological aspects. This is best achieved by workig i the cotext of the family home, where the oe-to-oe relatioship i that private domai, appears to provide the foudatio for very idividualized care (Carr 2001). 1.4 Cliical practice priciples Cliical practice priciples iclude workig i partership with the family, the Family Partership model ad the commo core of skills ad kowledge Workig i partership with the family Workig i partership with the family is supported by a stregths-based model of service delivery. Professioals who work from a stregths-based perspective focus o what is workig i the family rather tha what is ot. While family issues are ot igored, they are ot viewed as pathologies or labelled. The focus is o the qualities that a family may already have that ca be draw o to help them maage the problem. The family is supported to idetify the available resources ad skills withi the family ad commuity so they ca become empowered to use those assets. Family resiliece is viewed as a iheret property of families that ca be urtured ad mobilised. Practitioers focus o helpig families to recogise their stregths i order to icrease their resiliece. If oe studies oly family problems, oe fids oly family problems. Whe stregths are idetified they ca become the foudatio for cotiued growth ad positive chage i a family ad a society. (DeFrai 1999) The family partership model The Family Partership Model (Davis et al. 2002) is a framework that ca be applied withi a orgaisatio ad withi cliical practice to support cliicias to work from a stregths-based perspective, i partership with their cliets. This model was developed to eable all potetial helpers egagig with parets to provide a more effective service ad work together to eable a more complete system of care. The itetio is to eable them (the cliicias) to uderstad the processes ad skills of helpig, so that they ca use their ow techical expertise more effectively by takig ito accout the iterpersoal processes, yet also deal with the psychological ad social issues that are ivariably preset whe people have a problem. (Davis et al. 2002). The model focuses o skilled practitioers egagig cliets i a partership-based process to eable them to work together o idetifyig, clarifyig ad maagig problems. The partership icludes the followig elemets: PAGE 38 NSW Health Materal ad child health supportig families early

49 mutual respect ad trust the developmet of a mutual trustig relatioship betwee the urse ad the family is eeded to facilitate chage effective commuicatio of both. Workig withi a partership relatioship, the professioal seeks to help the paret to recogise the aspiratios they hold for themselves ad their childre ad the support them to realise these. workig closely together sharig power but led by parets operatig with hoesty ad flexibility idetifyig ad respectig each other s complemetary expertise establishig paret-directed goals presetig ideas as suggestios for cosideratio ad egotiatio. The approach is primarily cocered with fosterig the paret professioal relatioship ad paret-ifat relatioship so that parets ad families are supported to build o their stregths to rectify ay health, lifestyle or paretig issues. The service system a coordiated, tiered approach There are high levels of psychosocial problems i some families ad the resources available to assist them are limited (Davis et al. 2002). Therefore, to address this eed most effectively withi the curret service system, it is importat that there be a iteractive ad resposive system that relies o all the compoets of uiversal ad specialised services. The Family Partership framework idetifies a model to explai the relatioship betwee both uiversal ad specialist services. The model cosists of coordiated tiers of service ragig from Tier 1 services that deal with all childre, to Tier 4 services that are the most specialist level dealig with the comparatively few childre ad families that have the most complex eeds. I this model, services are structured to eable skilled Tier 1 workers to cosult with, ad be supported by, more specialised Tier 2 staff. This facilitates the provisio of effective ad efficiet support to families, by improvig the quality of help available to all families ad decreasig the eed for referral to specialist services (refer to Sectio 5.5). The paret-helper relatioship I the Family Partership Model the ature of the relatioship betwee the professioal ad paret is oe that regards the paret as the expert i his or her ow life. It ivites a paradigm shift away from the professioal as expert to oe of professioal ad paret i partership, recogisig the complemetary expertise Such a relatioship is assumed to be the vehicle by which parets may be able to explore difficulties they face, to clarify their situatio ad to develop the most helpful ad effective strategies for optimisig the psychosocial developmet of their childre (Davis et al. 2002). The ature of the relatioship betwee the professioal ad the paret ca be used to model the attachmet relatioship betwee the paret ad the baby. Parets are ecouraged to mirror the ature of this relatioship with their ifats by followig ad respodig to their ifat s cues ad providig the ifat with the support they eed whilst they are learig to master ew skills. I both circumstaces, the relatioship is desiged to provide support, rather tha ecourage depedecy. I the Family Partership Model, there is a focus o ehacig the paret s ability to: effectively deal with circumstaces ad problems that may iterfere with paretig relate to ad iteract with their childre appropriately. The paret-ifat relatioship Huma developmet occurs withi a relatioship cotext (Doley 1993). It is well recogised that, from birth, urturig relatioships with carig adults are essetial to a child s healthy developmet. From coceptio, the ifat is totally depedet o the eviromet for survival ad is embedded i relatioships with caregivers who provide the igrediets to support both physical ad psychological growth (Sameroff & Fiesse 2000). Attachmet theory highlights the importace of the relatioship betwee the primary care-giver ad ifat i the first three years of life i establishig edurig emotioal patters that affect emotioal regulatio, copig capacities, self-cofidece ad social iteractios throughout the lifespa (Egelad & Erickso 1999). Paretig is a iteractive process ad the attachmet relatioship that develops is affected primarily by the paret s iteractios with the ifat, sesitivity to idetifyig a ifat s eeds, ad cosistecy i respose to a ifat s behaviour. To provide effective help for parets ad their childre, cliicias eed to uderstad: the ature of the paret ifat iteractio NSW Health Materal ad child health supportig families early PAGE 39

50 that a child s behaviour ad developmet is the result of the cotiuous dyamic iteractio betwee the child ad the experieces provided by that child s family. The Family Partership Model icludes a model of paret child iteractio that mirrors the model of paret helper iteractio. This model has direct implicatios for helpig families with youg childre, as it will assist cliicias with: uderstadig the basis of paretig coductig psychosocial assessmets promotio, prevetio ad early itervetio assistig parets with their uderstadig of paret-ifat iteractios ad the importace of the early paret-ifat relatioship for their baby s future health ad wellbeig. The quality ad stability of relatioships i the first few years form the basis for may later developmetal outcomes such as soud metal health, school achievemet, ad capacity to develop ad sustai relatioships The commo core of skills ad kowledge The Commo Core of Skills ad Kowledge for the Childre s Workforce sets out the basic skills ad kowledge eeded by people whose work brigs them ito regular cotact with childre, youg people ad families. It eables multi-discipliary teams to work together more effectively i the iterests of the child. The skills ad kowledge are described uder six mai headigs: effective commuicatio ad egagemet with childre, youg people ad families child ad youg perso developmet safeguardig ad promotig the welfare of the child supportig trasitios multi-agecy workig sharig iformatio. More iformatio o the above ca be foud at services/ commocore/ Youg childre experiece their world as a eviromet of relatioships, ad these relatioships affect virtually all aspects of their developmet itellectual, social, emotioal, physical, behavioural (Shokoff 2004). PAGE 40 NSW Health Materal ad child health supportig families early

51 APPENDIX 3 SAFE START psychosocial assessmet questios Example of preamble: I this health service we ask all wome the same persoal questios about a umber of thigs, icludig violece at home. We ask about these thigs because we kow that there are some issues for wome or their parters that ca affect paretig. The aswers to these questios ca help us to help you ad your family to care for your baby. You do't have to aswer the questios if you do't wat to. What you say will remai cofidetial to the Health Service, except where we are seriously cocered for you or your childre's safety. Recommeded core psychosocial risk questios Variables I Lack of support Psychosocial questios 1. Will you be able to get practical support with your baby? 2. Do you have someoe you are able to talk to about your feeligs or worries? II Recet major stressors i the last 12 moths III low self-esteem (icludig self-cofidece, high axiety ad perfectioistic traits) IV History of axiety, depressio or other metal health problems V Couple s relatioship problems or dysfuctio (if applicable) VI adverse childhood experieces VII Domestic violece Questios must be asked oly whe the woma ca be iterviewed away from parter or family member over the age of three. Staff must udergo traiig i screeig for domestic violece before admiisterig questios. 3. Have you had ay major stressors, chages or losses recetly (ie i the last 12 moths) such as fiacial problems, someoe close to you dyig, or ay other serious worries? 4. Geerally do you cosider yourself a cofidet perso? 5. Does it worry you a lot if thigs get messy or out of place? 6. Have you ever felt axious, miserable, worried or depressed for more tha a couple of weeks? a) If so, did it seriously iterfere with your work ad your relatioships with frieds ad family? 7 Are you curretly or have you i the past, received treatmet for ay emotioal problems? 8. How would you describe your relatioship with your parter? 9. a) Ateatal: What do you thik your relatioship will be like after the birth? b) Postatal (i a commuity settig): Do you have cocers about how your relatioship has chaged sice havig the baby? 10. Now that you are havig/have a child of your ow, you may thik more about your ow childhood ad what it was like. As a child were you hurt or abused i ay way (physically, emotioally, sexually)? 11. Withi the last year have you bee hit, slapped, or hurt i other ways by your parter or ex-parter? 12. Are you frighteed of your parter or ex-parter? (If the respose to questios 11 ad 12 is No the offer the DV iformatio card ad omit questios 13 18) 13. Are you safe: here at home?/to go home whe you leave here? 14. Has your child/childre bee hurt or witessed violece? 15. Who is/are your childre with ow? 16. Are they safe? 17. Are you worried about your child/childre s safety 18. Would you like assistace with this? Opportuity to disclose further 19. Are there ay other issues or cocers you would like to metio? NSW Health Materal ad child health supportig families early PAGE 41

52 Appedix 4A Ediburgh Postatal Depressio Scale The Ediburgh Postatal Depressio Scale (EPDS) is a well validated uiversal screeig measure origially used to scree commuity samples of wome for depressive symptoms followig childbirth. The EPDS has also bee foud to be useful for screeig o-postpartum wome ad ca be reliably used from coceptio up to 18 moths postpartum (Kowaleko et al. 2000). As with all assessmet tools, the EDS should be used to complemet cliical judgemet. The scale helps professioals to idetify ad assist wome who are experiecig distress or depressio durig the periatal period ad, therefore, who are at sigificat risk of developig more complex health problems. The EPDS is a self-report questioaire that ca be completed i two or three miutes. Scorig the Ediburgh Postatal Depressio Scale The respose categories are scored 0, 1, 2 or 3, accordig to the order of severity of the symptoms. Some items are scored i reverse order (that is 3, 2, 1 or 0). Addig the scores for the 10 items yields a total score betwee zero ad 30. Scores are graded as follows (the validated cut off scores that are provided are take from Variability i use of cut-off scores ad formats o the Ediburgh Postatal Depressio Scale implicatios for cliical ad research practice, Matthey et al 2006): Ateatal period 15 or more: probable major depressio 13 or more at least probable mior depressio Postatal period 13 or more: probable major depressio 10 or more at least probable mior depressio Thigs to check: icosistecy betwee low ad high scores ad the cliical presetatio ad verbal resposes of the woma the woma s literacy level ad comprehesio of the items (this is particularly importat if the woma is from a o-eglish-speakig backgroud) cut off scores for wome from o-eglish speakig backgrouds. It is recommeded that a thorough search of the literature is udertake for studies usig the EDS/EPDS from the particular culture/ ethic backgroud beig reportig o. If o studies have bee coducted, it is recommeded that this is metioed ad the ratioale is explaied for whatever score issued (Matthey et al 2006) differet cut-off scores are appropriate for differet cultural groups idividual items that received a high score a score of 10 or more suggests the eed for further assessmet. All wome expressig a positive respose to questio 10 require further assessmet to determie risk of harm to self or others. Assessmet of suicidality also requires a assessmet of family safety, particularly the safety of ay childre or ubor babies. Assessmets are based o a combiatio of the backgroud coditios ad the curret factors i a perso's life ad the way i which they are iteractig. Further iformatio is available i NSW Health Framework for Suicide Risk Assessmet ad Maagemet for NSW Health Staff September extremely high ad low scores, as cliical experiece suggests that extremely high scores are achieved by those with severe persoality disorders (who may also have a major depressive disorder). A score of zero should also evoke suspicio. Importat ote Remember the Ediburgh Postatal Depressio Scale is a screeig tool ad scores aloe do ot represet a diagosis or a assessmet. A appropriate maagemet pla relevat to the cliet s eeds ca oly be developed after a full assessmet. Refereces Bamett B, Fowler C. 1995, Carig for the family s future: A practical workbook o recogisig ad maagig postatal depressio. Haymarket, NSW: Norma Swa Medical Commuicatios. PAGE 42 NSW Health Materal ad child health supportig families early

53 Kowaleko N, Barett B, Fowler C, Matthey S. 2000, The periatal period: Early itervetio for metal health. Adelaide: AusEiet. Natioal Health ad Medical Research Coucil (NHMRC). 2000, Postatal depressio: A systematic review of published scietific literature to Caberra: Commowealth of Australia. Matthey S, Heshaw C, Elliot S, Barett B. 2006, Variability i use of cut off scores ad formats o the Ediburgh Postatal Depressio Scale implicatios for cliical ad research practice. Archives of Wome s Metal Health, vol 9,pp Ediburgh Postatal Depressio Scale Cox JL, Holde JM, Sagovsky R. (1987). Date Mother s ame Age Baby s ame Date of birth Sex As you have recetly had a baby we would like to kow how you are feelig. Please UNDERLINE the aswer which comes closest to how you have felt IN THE PAST 7 DAYS, ot just how you feel today. Here is a example, already completed. I have felt happy: Yes, all the time Yes, most of the time No, ot very ofte No, ot at all This would mea: I have felt happy most of the time durig the past week. Complete the other questios i the same way. 1. I have bee able to laugh ad see the fuy side of thigs: As much as I always could Not quite so much ow Defiitely ot so much ow Not at all 2. I have looked forward with ejoymet to thigs: As much as I ever did Rather less tha I used to Defiitely less tha I used to Hardly at all 3. I have blamed myself uecessarily whe thigs wet wrog: Yes, most of the time Yes, some of the time Not very ofte No, ever 4. I have bee axious or worried for o good reaso: No, ot at all Hardly ever Yes, sometimes Yes, very ofte 5. I have felt scared or paicky for o very good reaso: Yes, quite a lot Yes, sometimes No, ot much No, ot at all 6. Thigs have bee gettig o top of me: Yes, most of the time I have t bee able to cope at all Yes, sometimes I have t bee copig as well as usual No, most of the time I have coped quite well No, I have bee copig as well as ever 7. I have bee so uhappy that I have had difficulty sleepig: Yes, most of the time Yes, sometimes Not very ofte No, ot at all 8. I have felt sad or miserable: Yes, most of the time Yes, quite ofte Not very ofte No, ot at all 9. I have bee so uhappy that I have bee cryig: Yes, most of the time Yes, quite ofte Oly occasioally No, ever 10. The thought of harmig myself has occurred to me: Yes, quite ofte Sometimes Hardly ever NSW Health Materal ad child health supportig families early PAGE 43

54 Appedix 4B Ediburgh Postatal Depressio Scale scorig guide Score for each questio has bee iserted o the left-had side of each possible respose. Add the scores for each questio to calculate a total score out of a possible I have bee able to laugh ad see the fuy side of thigs: 0 As much as I always could 1 Not quite so much ow 2 Defiitely ot so much ow 3 Not at all 2. I have looked forward with ejoymet to thigs: 0 As much as I ever did 1 Rather less tha I used to 2 Defiitely less tha I used to 3 Hardly at all 3. I have blamed myself uecessarily whe thigs wet wrog: 3 Yes, most of the time 2 Yes, some of the time 1 Not very ofte 0 No, ever 4. I have bee axious or worried for o good reaso: 0 No, ot at all 1 Hardly ever 2 Yes, sometimes 3 Yes, very ofte 5. I have felt scared or paicky for o very good reaso: 3 Yes, quite a lot 2 Yes, sometimes 1 No, ot much 0 No, ot at all 6. Thigs have bee gettig o top of me: 3 Yes, most of the time I have t bee able to cope at all 2 Yes, sometimes I have t bee copig as well as usual 1 No, most of the time I have coped quite well 0 No, I have bee copig as well as ever 7. I have bee so uhappy that I have had difficulty sleepig: 3 Yes, most of the time 2 Yes, sometimes 1 Not very ofte 0 No, ot at all 8. I have felt sad or miserable: 3 Yes, most of the time 2 Yes, quite ofte 1 Not very ofte 0 No, ot at all 9. I have bee so uhappy that I have bee cryig: 3 Yes, most of the time 2 Yes, quite ofte 1 Oly occasioally 0 No, ever 10. The thought of harmig myself has occurred to me: 3 Yes, quite ofte 2 Sometimes 1 Hardly ever 0 Never PAGE 44 NSW Health Materal ad child health supportig families early

55 appedix 4c Ediburgh Depressio Scale (Ateatal) Cox JL, Holde JM, Sagovsky R. (1987). Cox JL, Holde, JM. (2003) As you are about to have a baby we would like to kow how you are feelig. Please UNDERLINE the aswer which comes closest to how you have felt IN THE PAST 7 DAYS, ot just how you feel today. Here is a example, already completed. I have felt happy: Yes, all the time Yes, most of the time No, ot very ofte No, ot at all This would mea: I have felt happy most of the time durig the past week. Complete the other questios i the same way. 1. I have bee able to laugh ad see the fuy side of thigs: As much as I always could Not quite so much ow Defiitely ot so much ow Not at all 2. I have looked forward with ejoymet to thigs: As much as I ever did Rather less tha I used to Defiitely less tha I used to Hardly at all 3. I have blamed myself uecessarily whe thigs wet wrog: Yes, most of the time Yes, some of the time Not very ofte No, ever 4. I have bee axious or worried for o good reaso: No, ot at all Hardly ever Yes, sometimes Yes, very ofte 5. I have felt scared or paicky for o very good reaso: Yes, quite a lot Yes, sometimes No, ot much No, ot at all 6. Thigs have bee gettig o top of me: Yes, most of the time I have t bee able to cope at all Yes, sometimes I have t bee copig as well as usual No, most of the time I have coped quite well No, I have bee copig as well as ever 7. I have bee so uhappy that I have had difficulty sleepig: Yes, most of the time Yes, sometimes Not very ofte No, ot at all 8. I have felt sad or miserable: Yes, most of the time Yes, quite ofte Not very ofte No, ot at all 9. I have bee so uhappy that I have bee cryig: Yes, most of the time Yes, quite ofte Oly occasioally No, ever 10. The thought of harmig myself has occurred to me: Yes, quite ofte Sometimes Hardly ever Never NSW Health Materal ad child health supportig families early PAGE 45

56 Appedix 5 Practice checklist for cliicias Ateatal assessmet ad coordiated materity care Review ateatal assessmets trasferred from materity services. Assessmet provided at the first ateatal visit or bookig i (before 20 weeks preferably). Uiversal assessmet offered to all pregat wome. Core psychosocial assessmet. Core psychosocial assessmet reviewed or where oe has bee previously atteded coduct a primary health care assessmet. Admiister Ediburgh Postatal Depressio Scale, if cliical or access cocers; record ad discuss score with the paret. Admiister Ediburgh Depressio Scale; record ad discuss score with paret. No vulerabilities detected care pla developed ad materity care util birth No vulerabilities detected, care pla developed, assessmet poits as per ifat s persoal health record ( Blue book ) ad provisio of uiversal health services. If ew vulerabilities detected. If ew vulerabilities detected. Idetify level of vulerability (refer to Idetify level of vulerability Table 2 ad Sectio 3.2 of the Policy). (refer to Table 2 ad Sectio 3.2 of the Policy). Refer for case discussio withi multidiscipliary Refer for case discussio withi multidiscipliary team maagemet approach. team maagemet approach. Level of care/service respose determied Level of care/service respose determied by team ad care pla developed i by team ad care pla developed cojuctio with mother i cojuctio with cliet (refer to Sectio 3.2 to 3.4 of the Policy). (refer to Sectios 3.3 ad 3.4 of the Policy). Case review as determied i care pla. Case review as determied i care pla. Followig birth, trasfer of cliet s iformatio to the early childhood health service withi two (2) days of discharge. 6 to 8 weeks assessmet I additio to the ifat check coducted at 6 8 weeks. Esure a smooth trasitio of care to early childhood health services. Postatal assessmet ad coordiated care by child ad family health Uiversal Health Home Visit/assessmet offered to all families with a ew baby ad will ideally be provided withi two (2) weeks of date of birth. Preferably assessmet will be provided i the home; however, there will be occasios whe assessmets will eed to be provided i the cliic settig. Provide paret with Ediburgh Postatal Depressio Scale, readmiister i two weeks if score is 13 or above ad 0 o questio 10. Review postatal assessmets ad cosider withi a team maagemet approach to care. No vulerabilities detected, assessmet poits as per ifat s Persoal Health Record ( Blue Book ) ad provisio of uiversal health services. If vulerabilities detected. Idetify level of vulerability (refer to Table 2 ad Sectio 3.2 of the Policy). PAGE 46 NSW Health Materal ad child health supportig families early

57 Refer for case discussio withi multidiscipliary team maagemet approach. Level of care/service respose determied by team ad care pla developed i cojuctio with cliet (refer to Sectio 3.3 ad 3.4 of the Policy). Case review as determied i care pla 6 moths assessmet I additio to the ifat check coducted at 6 moths. Provide paret with Ediburgh Postatal Depressio Scale, if a eed has bee idetified. Record ad discuss score with paret. Review postatal assessmets ad cosider withi a team maagemet approach to care, if a eed has bee idetified. No vulerabilities detected, assessmet poits as per ifat s Persoal Health Record ( Blue Book ) ad provisio of uiversal health services. If vulerabilities detected. Idetify level of vulerability (refer to Table 2 ad Sectio 3.2 of the Policy). Refer for case discussio withi multidiscipliary team maagemet approach. Level of care/service respose determied by team ad care pla developed i cojuctio with cliet (refer to Sectio 3.3 to 3.4 of the Policy). Case review as determied i care pla. NSW Health Materal ad child health supportig families early PAGE 47

58 Appedix 6 Area health service practice checklist Plaig for implemetatio Collect baselie iformatio o Cotiuum of care The populatio of childre ad their families, icludig Aborigial families ad culturally Review cliical pathways to care to esure cosistecy with the Policy. ad liguistically diverse families. Health services ad programs directed to childre ad their parets. Itegrate ad coordiate service developmet across materity, child ad family health ad specialist services. Staffig ad fudig provided to child ad family health services. Service etwork AHSs are to idetify the service etwork for families with youg childre ad establish methods of liaiso ad referral, ad service agreemets where appropriate, across the rage of govermet ad commuity orgaisatios i the area. Develop systems to esure the effective flow of iformatio from materity to early childhood health services followig the birth of a baby. Psychosocial assessmet Esure a assessmet process is i place i both materity ad early childhood health services that will facilitate uiversal, systematic exploratio of key areas of risk, as per the SAFE START model ad the Policy. Support for cliical practice Esure availability of Tier 2 multidiscipliary support staff for Tier 1 staff. Health home visitig Review services ad programs deliverig support to families to icorporate UHHV. Review existig home visitig programs that support families expectig or carig for a baby to esure that the services provided are cosistet with this Policy. Esure that all families are offered a uiversal health home visit (UHHV) by the child ad family health service ad that this is delivered withi the first two weeks of birth. Team maagemet Develop a team maagemet approach to collaboratively plaig care for families idetified as vulerable. Referral systems Develop a directory of services ad referral protocols withi the AHS ad with other service etwork parters, ad policies that support sharig of iformatio ad case coordiatio across the service etwork withi the cotext of iformatio privacy provisios. Evaluatio Esure evaluatio processes are i place. PAGE 48 NSW Health Materal ad child health supportig families early

59 Qualificatios Traiig Esure that staff have qualificatios ad skills appropriate to the role to work withi a multidiscipliary iteragecy approach supportig families ad to deliver primary health care i the periatal period as outlied i the Policy. Esure that staff have access to all ecessary traiig as described i the Policy. Resource requiremets Fudig Services Moitor demad for, ad esure timely access to, iterpreter services, specialist cosultatio ad therapeutic services eeded to support health home visitig. Equipmet Esure access to a motor vehicle, a mobile phoe ad cliical equipmet for health home visitig staff. Cliical supervisio ad support Esure staff receive cliical supervisio o a regular basis. Families NSW ehacemet fuds have bee provided to AHSs ad are to be used to employ additioal staff to develop systems to support Families NSW implemetatio. Occupatioal health ad safety Reportig requiremets Develop Occupatioal Health ad Safety procedures for home visitig based o the NSW AHSs are required to report aually to the NSW Departmet of Health Health Policy Directive PD2005_339. o the implemetatio of the Policy ad the use of Families NSW ehacemet fuds. Note: Area Health Services are to esure that families are provided with iformatio o the ratioale for chage i service provisio icludig health home visitig ad are ivolved i the ogoig plaig ad evaluatio of health home visitig services. NSW Health Materal ad child health supportig families early PAGE 49

60 PAGE 50 NSW Health Materal ad child health supportig families early

61 Refereces Australia Istitute of Health ad Welfare (AIHW). 2005, A picture of Australia s childre. AIHW cat. o. PHE 58. AIHW, Caberra. Alperstei G., Thomso J., Crawford J. 1997, Health Gai for Childre & Youth of Cetral Sydey: Strategic Pla. Health Services Plaig Uit & Divisio of Populatio Health, Cetral Sydey AHS, Camperdow, NSW. Armstrog K.L., Fraser J.A., Dadds M.R., Morris J. 1999, A radomized, cotrolled trial of urse home visitig to vulerable families with ewbors. Joural of Paediatrics ad Child Health, Vol. 35, pp Armstrog K.L., Fraser J.A., Dadds M.R., Morris J. 2000, Promotig secure attachmet, materal mood ad child health i a vulerable populatio: a radomised cotrolled trial. Joural of Paediatrics ad Child Health, Vol. 36, pp Aslam H., Kemp L. 2005, Home Visitig i South Wester Sydey a Itegrative Literature Review, Descriptio ad Developmet of a Geeric Model. Cetre for Health Equity Traiig, Research ad Evaluatio (CHETRE), Sydey. ort%20fial%20for%20pritig.pdf) Bamett B., Fowler C. 1995, Carig for the family s future: A practical workbook o recogisig ad maagig postatal depressio. Norma Swa Medical Commuicatios, Haymarket, NSW. Belli P., Bustreo F., Preker A. 2005, Ivestig i childre s health: what are the beefits? Bulleti of the World Health Orgaizatio, Vol. 83, pp Carr S.M., 2001, Nursig i the commuity impact of cotext o the practice ageda. Joural of Cliical Nursig, Vol. 10, pp Child ad Family Health Nurses Associatio. 2000, Competecy Stadards for Child ad Family Health Nurses, Child ad Family Health Nurses Associatio (NSW) Ic., North Ryde. Child ad Family Health Nurses Associatio. 2001, The Scope of Practice for Child ad Family Health Nurses. Child ad Family Health Nurses Associatio (NSW) Ic., North Ryde. Commowealth Departmet of Health ad Aged Care. 2000, Natioal Actio Pla for Promotio, Prevetio ad Early Itervetio for Metal Health. Metal Health ad Special Programs Brach, Commowealth Departmet of Health ad Aged Care, Caberra. Cox J., Chapma G., Murray D., & Joes B. 1996, Validatios of the Ediburgh Postatal Depressive Scale i o-postatal wome. Joural of Affective Disorders, Vol. 39, No. 3, pp Cox J., Holde J., Sagovsky R. 1987, Detectio of postatal depressio: developmet of the 10-item Ediburgh Postatal Depressio Scale. British Joural of Psychiatry Vol. 150, pp Cox, J., & Holde, J. 2003, Periatal metal health: a guide to the Ediburgh Postatal Depressio Scale (EPDS). The Royal College of Psychiatrists: Gaskell, Lodo. Davis H. 1993, Cousellig Parets of Childre with Chroic Illess or Disability. British Psychological Society Books, Leicester. Davis H., Day C., Bidmead C. 2002, Workig i partership with parets: the Paret Advisor model, The Psychological Corporatio, Lodo. DeFrai J. 1999, Strog families aroud the world, Family Matters, No. 53, Witer, pp Departmet of Commuity Services, Child Protectio - Iteragecy Guidelies for Child Protectio Itervetio. NSW Govermet, Sydey. Doley, M. 1993, Attachmet ad the emotioal uit, Family Process, Vol. 32, pp Eckerode J., Gazel B., Hederso C.R. Jr, Smith E., Olds D.L., Powers J., Cole R., Kitzma H., Sidora K. 2000, Prevetig child abuse ad eglect with a program of urse home visitatio: the limitig effects of domestic violece. JAMA, Vol. 284, pp Egelad B., & Erickso M.F. 1999, Attachmet theory ad research, zero to three. Natioal Cetre for Ifats, Toddlers ad Families, Vol. 20, p. 2. NSW Health Materal ad child health supportig families early PAGE 51

62 Elka R., Kedrick D., Hewitt M., Robiso J., Tolley K., Blair M., Dewey M., Williams D., Brummell K. 2000, The effectiveess of domiciliary health visitig: a systematic review of iteratioal studies ad a selective review of British literature. Health Techology Assessmet, Vol. 4, No. 13. Geggie J., DeFrai J., Hitchcock S., Silberberg S. 2000, The Family Stregths Research Report, Family Actio Cetre, Uiversity of Newcastle, Newcastle, NSW. Gomby D.S., Culross P.L., Behrma R.E. 1999, Home visitig: Recet program evaluatios aalysis ad recommedatios. The future of childre: home visitig: recet program evaluatios, Vol 9 (Sprig/Summer). Griffiths R., Cruze L., Feradez R., Lagdo R., Getles L. 2001, Health Equity: A Draft Literature Review. South Wester Sydey AHS ad Uiversity of Wester Sydey. Guterma N.B. 1999, Erolmet strategies i early home visitatio to prevet physical child abuse ad eglect ad the uiversal versus targeted debate: a meta-aalysis of populatio-based ad screeig-based programs. Child Abuse & Neglect, Vol. 23, pp Hartwick G., Lidsay A., Hills M. 1994, Family ursig assessmet: meetig the challege of health promotio. Joural of Advaced Nursig, Vol. 20, pp Heckma J., The Ecoomics of Ivestig i Early Childhood, Presetatio to the NIFTeY coferece February ivest-unsw_all_ _12pm_mms.pdf Hertzma C., Mustard F. 1997, A Healthy Early Childhood A Healthy Adult Life. Fouders Network Report, Vol. 1, Issue 1. Karoly L., Greewood P.W., Everighams S.S., Hoube J., Kilbur M.R., Rydell C.P., Saders M., Chiesa J. 1998, ivestig i our childre: what we kow ad do t kow about the costs ad beefits of early childhood itervetios. Rad Corporatio, Sata Moica, Califoria. Karoly L.A., Kilbur M.R., Cao J.S. 2005, Early Childhood Itervetios Prove Results, Future Promise. Rad Corporatio, Sata Moica, Califoria. Keller L. 1997, Home Visitatio: Report of the Commuity Care Pilot Project. March 1994 March 1997, Faculty of Health, Uiversity of Wester Sydey, Macarthur Campus, Sydey. Kitzma H., Olds D.L., Hederso C.R., Haks C., Cole R., Tatelbaum M.D., McCoochie K.M., Sidora K., Luckey D.W., Shaver D., Egelhart K., James D., Barard K. 1997, Effects of preatal ad ifacy home visitatio by urses o pregacy outcomes, childhood ijuries ad repeated childrearig: a radomized cotrolled trial. JAMA, Vol. 278, pp Kitzma H., Olds D.L., Sidora K., Hederso C.R., Haks C., Cole R., Luckey D.W., Body J., Cole K., Glaser J. 2000, Edurig effects of urse home visitatio o materal life course: a 3 year follow-up of a radomised trial, JAMA, Vol. 283, pp Kowaleko N., Barett B., Fowler C., Matthey S. 2000, The periatal period: early itervetio for metal health. AusEiet, Adelaide, SA. Kapma J., Morriso T. 1998, Makig the most of supervisio, Pavilio Publishig, Brighto, East Sussex. Kudse E., Heckma J., Camero J., Shokoff J. 2006, Ecoomic, eurobiological, ad behavioural perspectives o buildig America s future workforce. PNAS, Vol. 103, Issue full/103/27/10155 MacLeod J., Nelso G. 2000, Programs for the promotio of family welless ad the prevetio of child maltreatmet: A meta-aalytic review. Child Abuse ad Neglect, Vol. 24, pp Matthey S., Barett B., Kavaagh D., Howie P. 2001, Validatio of the Ediburgh Postatal Depressio Scale for me ad compariso of item edorsemet with their parters. Joural of Affective Disorders, Vol. 64, pp Matthey S., Heshaw C., Elliot S., Barett B. 2006, Variability i use of cut off scores ad formats o the Ediburgh Postatal Depressio Scale implicatios for cliical ad research practice. Archives of Wome s Metal Health, Vol. 9, pp McCai M., Mustard J.F. 1999, Reversig the real brai drai: early years study fial report, The Caadia Istitute of Advaced Research, Toroto, Otario. McCai M., Mustard J.F. 2002, The early years study three years later, The Fouders Network, Toroto, Caada. McMaho C., Barett B., Kowaleko N., Teat C., Do N. Postatal depressio, axiety ad usettled ifat behaviour, Australia ad New Zealad Joural of Psychiatry, Vol. 35, pp PAGE 52 NSW Health Materal ad child health supportig families early

63 Mrazek P.J., Haggerty R.J. 1994, Reducig risks for metal disorders: frotiers for prevetive itervetio research, Natioal Academy Press, Washigto, DC. Murray D., Cox J., Chapma G., & Joes P. 1996, Childbirth: life evet or start of a log-term difficulty? further data from the Stoke-o-Tret cotrolled study of postatal depressio. British Joural of Psychiatry, Vol. 166, No. 5, pp Murray D., Cox J. 1990, Screeig for depressio durig pregacy with the Ediburgh Depressio Scale. Joural of Reproductive ad Ifat Psychology, Vol. 8, No. 2, pp Natioal Health ad Medical Research Coucil (NHMRC). 2000, Postatal depressio: A systematic review of published scietific literature to Caberra: Commowealth of Australia. Natioal Scietific Coucil o the Developig Child. 2004, Youg Childre Develop i a Eviromet of Relatioships. Workig Paper No. 1 (Shokoff J, chairma). NSW Govermet. 2000, Families First Resource Kit, The NSW Cabiet Office, Sydey. NSW Govermet. 2007, Coucil of Australia Govermets Natioal Reform Ageda Early Childhood ad Care Cetre NSW Actio Pla NSW Health. 1994, Ediburgh Postatal Depressio Scale Guidelies for Use i Primary Health Care, NSW Departmet of Health, North Sydey. NSW Health. NSW Health Public Health Bulleti, Series o Improvig the Health of Childre i NSW, Vol. 9: No. 5 (May), No. 6 (Jue), No. 7 (July), No. 10 (October), No. 11 (November) 1998; Vol. 11: No. 5 (May) backissues.html NSW Health. 1999, The Start of Good Health: Improvig the Health of Childre i NSW, NSW Departmet of Health, North Sydey. NSW Health. 2000, NSW Aborigial Materal ad Ifat Health Strategy. NSW Departmet of Health, North Sydey. NSW Health. 2000, The NSW Framework for Materity Services, NSW Departmet of Health, North Sydey. NSW Health. 2003, NSW Aborigial Periatal Health Report. NSW Departmet of Health, North Sydey. NSW Health. 2004, Framework for Suicide Risk Assessmet ad Maagemet for NSW Health Staff. NSW Health. 2004, Suicide Risk Assessmet ad Maagemet Protocols: Geeral Commuity Health Service. NSW Departmet of Health, North Sydey. NSW Health. 2004, NSW Health ad Equity Statemet, i all fairess, icreasig health i equity across NSW. NSW Departmet of Health, North Sydey. NSW Health. 2005, PD2005_121 Policy guidelies for the maagemet of patiets with possible suicidal behaviour for NSW health staff ad staff i private hospital facilities. NSW Departmet of Health, North Sydey. NSW Health. PD2005_299, Protectig Childre ad Youg People, NSW Departmet of Health, North Sydey. NSW Health PD2005_339 Protectig People/ Property: NSW Health Policy/Guidelies for Security Risk Maagemet i Health Facilities; NSW Departmet of Health, North Sydey. NSW Health. 2005, PD2005_543 Midwives Data Collectio Form MR441 PR16 - Early Childhood Health Services. NSW Departmet of Health, North Sydey. NSW Health. 2005, PD2005_593, Privacy Maual (Versio 2). NSW Departmet of Health, North Sydey. NSW Health. 2006, PD2006_012 Breastfeedig i NSW - Promotio, Protectio ad Support, NSW Departmet of Health, North Sydey. NSW Health. 2006, PD2006_104 Child Protectio Roles ad Resposibilities - Iteragecy, NSW Departmet of Health, North Sydey. NSW Health. 2006, PD2006_084, Domestic Violece - Idetifyig ad Respodig. NSW Departmet of Health, Norht Sydey. NSW Health. 2007, PD2007_023, Preatal Reports, NSW Departmet of Health, North Sydey. NSW Health. 2007, A New Directio for NSW. State Health Pla Towards ISBN Nutbeam D., Harris E. 1999, Theory i a Nutshell: A Guide to Health Promotio Theory. McGraw Hill, Sydey. Olds D.L., Eckerode J., Hederso C.R., Kitzma H., Powers J., Cole R., Sodira K., Morris P., Pettit L.M., Luckey D. 1997, Log term effects of home visitatio o materal life course ad child abuse ad eglect: fiftee-year follow-up of a radomized trial, JAMA, Vol. 278, pp NSW Health Materal ad child health supportig families early PAGE 53

64 Olds D.L., Hederso C.R., Phelps C., Kitzma H., Haks C. 1993, Effect of preatal ad ifacy urse home visitatio o govermet spedig. Medical Care, Vol. 31, pp Olds D., Kitzma H., Cole R., Robiso J., Sidora K., Luckey D., Hederso C.R., Haks C., Body J., Holmberg J. 2004, Effects of urse home-visitig o materal life course ad child developmet: age 6 follow-up results of a radomized trial. Paediatrics, Vol. 114, pp Perry B.D., Pollard R.A., Blakeley T.L., Baker W.L., Vigilate D. 1995, Childhood trauma, the eurobiology of adaptatio ad use-depedet developmet of the brai: how states become traits. Ifat Metal Health Joural, Vol. 16, pp Queeslad Health. 2000, The Family CARE Home Visitig Guide, Child ad Youth Health Uit, Queeslad. Roberts T., Kramer M.S., Suissa S. 1996, Does home visitig prevet childhood ijury? A systematic review of radomized cotrolled trials, BMJ, Vol. 312, pp Sameroff A., Fiese B. 2000, Models of developmet ad developmetal risk, i Zeaah C (ed), Hadbook of Ifat Metal Health, 2d ed., Guilford Press, New York, pp Scott D. 1997, Home Visitig: A Australia Perspective. Keyote address at the First Natioal Home Visitig Coferece, August, Caberra. Shokoff J.P., Phillips D.A. 2000, From euros to eighborhoods the sciece of early childhood developmet. Natioal Research Coucil Istitute of Medicie, Natioal Academy Press, Washigto DC. Vimpai G. 2000, Editorial commet: Home visitig vulerable ifats i Australia. Joural of Paediatrics ad Child Health, Vol. 36, pp Vimpai G., Frederico M., Barclay L., Davis C. 1996, Home Visitor Programs i Australia Report, A audit of Home Visitor Programs ad the developmet of a evaluatio framework. Commissioed uder the Auspices of the Natioal Child Protectio Coucil by the Commowealth Departmet of Health ad Family Services. AGPS, Caberra. Weiss, H.B. 1993, Home visits: Necessary but ot sufficiet. The future of childre: home visitig Vol. 3 (Witer), pp Wraith C., Kakakios M., Alperstei G., Nossar V., Wolfede S. 1998, Achievig health outcomes for childre i sw stregtheig families ad commuities. Draft discussio paper, upublished. NSW Departmet of Health, North Sydey. Zubrick S.R., Williams A., Silbur S., Vimpai G. 2000, Idicators of family ad social fuctioig, Departmet of Family ad Commuity Services, Commowealth of Australia, Caberra. Websites the Families NSW website ad liks to other sites relevat to supportig families. comprehesive list of research ad articles o prevetio ad early itervetio support for families. NSW Health s website Shokoff J.P. 2004, Youg childre develop i a eviromet of relatioship, Natioal Scietific Coucil o the Developig Child Workig Project No.1. Silberberg S. 2001, Searchig for family resiliece. Family Matters, No. 58, Autum, pp Tiedje L.B. 2000, Returig to our roots: 25 years of materal/child ursig i the commuity. The America Joural of Materal/Child Nursig, Vol. 25, pp Tremblay R. Developmetal origis of aggressio. Presetatio to the NIFTeY coferece February cofereceframe.htm Vagelista A. 1999, Good begiigs atioal paretig project: commowealth report. Primary Professioal Home Visitig Project, Good Begiigs Natioal Office, Surry Hills. PAGE 54 NSW Health Materal ad child health supportig families early

65 Glossary of terms Assessmet is a ogoig process begiig with first cotact ad cotiuig throughout all ivolvemet with the family. Assessmet is based o a rage of iformatio sources. It looks at physical, psychological, emotioal ad social aspects of health ad idetifies both vulerabilities ad stregths of the family. Child ad Family Health Services are those health services available to support childre ad their families ad iclude services such as metal health, drug ad alcohol, early childhood health ad allied health. Cliical supervisio is a support mechaism for health professioals withi which they ca share cliical, orgaisatioal, developmetal ad emotioal experieces with aother professioal i a secure, cofidetial eviromet i order to ehace kowledge, skills ad reflective practice. Drug misuse/abuse is a patter of drug use that has adverse physical, psychological ad/or legal cosequeces for a perso usig drugs ad/or those livig with or otherwise affected by the actios of the perso usig drugs. Early Childhood Health Service is the program of services offered by the child ad family health urses. The role of this service is to provide support to families with childre age 0 5 years. It is part of the comprehesive child ad family health service. Early itervetio strategies target people displayig the very early sigs ad symptoms of a illess. Early itervetio also ecompasses the early idetificatio of people sufferig from a first episode of a problem or disorder. Early itervetio may also refer to programs focused o the early years of life. Family stregths are characterised by those relatioship patters, iterpersoal skills ad competecies, ad social ad psychological characteristics which create a sese of positive family idetity, promote satisfyig ad fulfillig iteractio amog family members, ecourage developmet of the potetial of the family group ad idividual family members, ad cotribute to the family s ability to deal effectively with stress ad crisis. Health promotio is a actio to maximise health ad wellbeig amog populatios ad idividuals. Health Home Visitig is defied as the delivery of health services withi a cliet s home, to parets/carers who are expectig or carig for a baby, i order to ehace health ad social fuctioig by respodig to the specific eed of that family withi the family's ow eviromet. Key worker is the worker idetified by all persos ivolved i the care of a family as the pivotal support perso. The role of the key worker is to esure good commuicatio betwee all service providers ad the family ad to act as the advocate for the family. Metal health is the capacity of idividuals withi groups ad the eviromet to iteract with oe aother i ways that promote subjective wellbeig, optimal developmet ad use of cogitive, affective ad ratioal abilities. Metal health problem is defied as dimiished cogitive, emotioal or social abilities but ot to the extet that the criteria for metal illess or metal disorder are met. Paret is ay perso or persos with primary resposibility for the care ad welfare of the child. NSW Health Materal ad child health supportig families early PAGE 55

66 Periatal is defied withi the metal health cotext, as ecompassig pregacy ad the first year postpartum. Postatal period is defied by the World Health Orgaizatio (WHO) as the period that starts about a hour after the delivery of the placeta ad icludes the followig six weeks. WHO states that the postatal period represets a critical trasitio for a woma, her ewbor ad her family at a physiological, emotioal ad social level ad that postpartum care should respod to special eeds of the mother ad baby. Populatio-based itervetios target populatios rather tha idividuals. They iclude activities targetig the whole populatio as well as activities targetig populatio groups such as Aborigial peoples. Prevetio is a itervetio that occurs before the oset of the problem or disease ad ca be desiged as a uiversal (whole populatio), selective (groups at risk) or idicated (idividuals with early sigs or symptoms) itervetio. Primary Health Care NSW Health defies the meaig of Primary Health Care by adoptig the defiitio used by the Australia Health Miisters Coucil (1998): Sustaied Health Home Visitig is a structured program of health home visitig over a sustaied period of time, begiig i pregacy ad cotiuig util the ifat is two (2) years old. The aim of this program is to provide a rage of support aroud health ad other bio-psychosocial areas of risk ad vulerability. Targeted programs idetify childre ad/or groups for itervetio who are at higher risk of developig poor social or health outcomes. Uiversal Health Home Visitig (UHHV) icludes at least oe uiversal cotact i the cliet s home withi two weeks of birth ad may also iclude further home visitig. The child ad family health urse from the early childhood health service coducts the UHHV. A home visit ca be classified as a UHHV if it has occurred up to ad icludig four weeks ad six days from the birth of the baby. Uiversal programs are characteristically available to all. There are two types of uiversal itervetios those that focus o particular commuities or settigs, ad those with a whole populatio focus. Primary Health Care seeks to exted the first level of the health system from sick care to the developmet of health. It seeks to protect ad promote the health of defied commuities ad to address idividual ad populatio health problems at a early stage. Primary health care services ivolve cotiuity of care, health promotio ad educatio, itegratio of prevetio with sick care, a cocer for populatio as well as idividual health, commuity ivolvemet ad the use of appropriate techology. Service etwork is the group of services, teams or idividuals withi the local commuity that supports families. Stregths-based approach views a family as resourceful ad skilled, settig the ageda ad actively egaged i the process of addressig their issues ad solvig their ow problems. The focus is o the available resources ad skills withi the family ad commuity, ad empowerig the family ad commuity to use those assets i buildig resiliece. The aim is to facilitate families i the process of idetifyig their ow stregths. PAGE 56 NSW Health Materal ad child health supportig families early

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68 SHPN (AIDB)