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