The First 2000 Days Framework
What are the implications of integrated approaches to maternal and child health for PHNs and LHDs?
In Australia, the responsibility for maternal and child health is shared by a number of key stakeholders and departments funded through the Federal and State government. In addition to health services, both level of government have a role in administering programs that reach mothers and children across the education, housing, employment and social services portfolios.
At a local level and within a health specific context, Primary Health Networks (PHNs) and Local Health Districts (LHDs) have responsibility for delivering coordinated and streamlined maternal and child health services. Many PHNs and LHDs are making headway on the development of joint maternal and child health strategies in an attempt to gain clarity around their investments and deliver accessible services to women and children.
The development of localised solutions between PHNs and LHDs are made possible and enhanced by progressive policy work at both the state and national level. In a NSW context, the NSW Ministry of Health published ‘The First 2000 Days Framework’ in February 2019.
“The First 2000 Days Framework is a strategic Policy Document which outlines the importance of the first 2000 days in a child's life (from conception to age 5) and what action people within the NSW Health System need to take to ensure that all children have the best possible start in life.”
Individual LHDs across New South Wales were directed by the Ministry to embed ‘The First 2000 Days Framework’ in their local plans by July 1 2019. This has given NSW based PHNs and LHDs a timely impetus to buddy up and flesh out what a ‘good’ maternal and child health system could look like. For PHNs and LHDs who haven’t seized this opportunity - don’t sweat it, it at least gives you a framework for future planning and you can take a look at what the others have done.
The Framework
The framework is divided over three strategic objectives, including:
Strategic Objective 1: All staff in the NSW health system understand and promote the importance of the first 2000 days and the best opportunities for action.
Strategic Objective 2: The NSW health system provides care to all and works in partnership to promote health, wellbeing, capacity and resilience during the first 2000 days.
Strategic Objective 3: The NSW health system provides additional services for those who need specialised help, when they need it.
Each of the strategic objectives above solidifies the rationale of developing a Child and Health Strategy that encompasses the role of primary care, community care and hospital care.
Figure 1: Underpinning the First 2000 Days Framework is the desire to provide services targeted to the needs of the individual and family at the right intensity (NSW Health)
Strategic objective 1: All staff in the NSW health system understand and promote the importance of the first 2000 days and the best opportunities for action.
The education of primary care practitioners and service provider organisations is critical to ensure that consistent information is delivered to community members across any region, irrespective of health setting. Likewise, it is important that information on the importance of the first 2000 days is publicly available for community members to access and consider taking steps to mitigating risk factors and improving child and maternal health.
“Families want what is best for their children, but it can be hard to sift through all the information available and know what the best thing is. The system needs to support families to access information about the first 2000 days and understand its significance when making important decisions that affect their child’s health and wellbeing. By working together, we can provide integrated services and supports so that families can have consistent and streamlined care. Having a system where everyone has access to the information, care and support they need will also help families to increase their resilience and reduce stressors and risks in their lives.”.
Strategic objective 2: The NSW health system provides care to all and works in partnership to promote health, wellbeing, capacity and resilience during the first 2000 days.
The First 2000 Days Framework reiterates that collaboration, coordination and integration of maternal and child health services is key for children and families who need ‘extra care’ through:
Identification of mothers and children who may need a little additional support through health and development assessments.
Early identification of needs and risk/screening and links to additions support and services.
Where possible promote continuity of care and focus on coordination between settings.
Investing in evidence-based parenting programs and interventions from pregnancy onwards.
Enhance surveillance measures and support through My Health Record or the ‘Blue and Red Book’.
Screening in pregnancy and early parenting for psychosocial risk factors.
Dedicated services responses for Aboriginal women and children
“The relationship with GPs is vital. NSW Health professionals should work closely with GPs in their districts, promoting awareness of the first 2000 days and strengthening partnerships to support families.”
Strategic objective 3: The NSW health system provides additional services for those who need specialised help, when they need it.
In parallel to the LHD, PHN funded services and primary care providers could support the objectives of the First 2000 Days Framework by:
having clear referral pathways established based on the needs of mother and child
having effective processes for identifying and responding to those with high needs
deliver trauma-informed care for people with moderate to complex needs
provide culturally appropriate services for Aboriginal, Torres Strait Islander and culturally and linguistically diverse communities.
“Additional and specialist services and support must be available when needed. Services should be provided as part of an integrated service system, where the service response is progressively ‘stepped up’ to meet the identified needs of the families.”
PHN and LHDs play a key role in identifying mothers and children who need specialised support and referring them onward to evidence based support programs. Strong and functional relationships between primary care, hospital and the non-government sector are fundamental to ensure women and children receive the supports they need to thrive.
So what?
When developing a joint Maternal and Child Health Strategy, it can be concluded that adopting a singular framework across the LHD and PHN environments would likely enable consistency and continuity of care for mothers and children. Specifically, this can be achieved through integrated models of care, coordination between primary and secondary care and ensuring that women and families are effectively screened and matched with appropriate service responses.
Key consideration should also be given to supporting Aboriginal and Torres Strait Islander services to continue to deliver culturally competent and appropriate services as well as equipping mainstream services to support Aboriginal and Torres Strait Islander people in accessing their services and perhaps adapt current service models to reflect community needs.
We recently supported Murrumbidgee PHN and Murrumbidgee LHD with the development of a Maternal and Child Health Strategy for their region. Click here to read the published strategy.