Figure 1
Flow Diagram of included studies.
Table 1
The CIMO configuration of Universal and Targeted Well Child Care*.
| Context | Interventions | Mechanisms | Outcomes |
|---|---|---|---|
| Universal Well-child Care | Various programs, e.g. Families NSW in NSW, Best start in Victoria, Australian Medicare Healthy Kids Check (July 2008 to July 2016) | Evidence for effectiveness | Variability in delivery-based on context and activated mechanism |
| Well-child Care is important as early childhood period is critical | North American Bright Futures program | Training and role of the staff (GPs, paediatrician, nurse, changing workforce) | Delays in identification of children with DD |
| There is either a national consensus on Well-child Care or no consensus | New Zealand Well-child Care program | Funding mechanisms | Improvement in parents knowledge |
| Personal Health Records (PHRs)-contents | Best approach -Screening, surveillance or health promotion | Reduction in avoidable hospitalisations | |
| Guidelines for Well-child Care | Parenting skills (health literacy of parents) | Identification of parental vulnerabilities | |
| Screening programs (oral screening, STEPS, hearing screen) | Population characteristics | Unmet parenting needs | |
| How do parents and providers use PHRs | Parents satisfaction with the programs | ||
| Communication style- reassurance and partnership | Little information sharing between Well-child Care providers | ||
| Children in vulnerable populations are at risk for poor outcomes and neglect, and access less health visits | Specific programs for vulnerable populations | Social determinants –isolation, poverty, unemployment, mental health issues | Success in maintaining safety and well-being of children |
| Sustained nurse visiting program | Feeling disempowered | Inconsistent engagement of vulnerable families | |
| Tiered approach for identification of vulnerable families | Perception of families regarding first contact with health provider | Missed opportunities at immunisation visits | |
| Partnership-non-judgmental style | Integration between services remain limited | ||
| Provider-task-oriented |
[i] * CIMO–Context-Intervention-Mechanism-Outcomes, NSW – New South Wales (Australia), STEPS–State-wide Eyesight Pre-schooler Screening, DD–Developmental Disability.
Figure 2
The components for Well Child Care using the WHO Integrated Care Models framework.
Table 2
Components of Integrated Model of Well child Care.*
| Component | Sectors | Type of Integration | Common outcomes measures |
|---|---|---|---|
| Pregnancy Early identification of psychosocial stressors-domestic violence, depression | Social sector – reporting systems for family vulnerabilities, interventions Health sector – nursing and medical teams, private and public sectors Non-governmental organisations Programs for pregnant women Local Level Government Educational programs, parenting groups | Organisation – formal memorandum of understandings, development of information sharing platforms with respect to personal privacy Service Integration – joint programs for vulnerable population groups, multidisciplinary teams from various organisations Clinical Integration – shared guidelines and protocols | Proportion of babies’ breast fed up to 6 months exclusive (%) Proportion of mothers identified with postpartum depression Proportion of boys (<20 yrs.) identified overweight + and obese Proportion of children with developmental vulnerabilities in at least one domain at school entry |
| Postnatal, Infancy, toddlerhood and early childhood Age appropriate anticipatory guidance on sleep, feeding, discipline, safety, developmental milestones-improving health literacy of families Screening and Surveillance for developmental-behavioural problems for early identification, referral and linkage to intervention programs Screening for hearing and vision Monitoring of Physical growth Psychosocial assessment for parental issues-jobs/illnesses in the family Care-coordination | Community and Social services Health services – primary and secondary levels of care, specific risk groups such as preterm follow up programs, community health, nursing and family and general practice teams, format of well child care checks Early childhood education Developmental surveillance and screening for early identification of developmental problems Local Level Government – councils, educational, and health promotion activities at libraries, and other community programs | Organisation – formal memorandum of understandings, development of information sharing platforms with respect to personal privacy Service Integration – joint programs for vulnerable population groups multidisciplinary teams from various organisations Clinical Integration – shared guidelines and protocols | Proportion of babies immunized fully 12 to 23 months Continuity of provider for well child care (usual source primary care provider) Proportion of children with ASD (2–17 years), most recent estimates Proportion watching TV more than 1 hr and less than 4 hrs (1–17 years) Developmental screening completed (10 months-5years) Family involved in home visitation program Proportion of children <5 yrs visiting dental worker Proportion of 4 year old children enrolled in an early childhood program Annual number of deaths and injuries 1–14 yrs. per 100000(1991–1995). Child maltreatment deaths per 100000 children (up to 15 yrs) |
[i] * As highlighted in table above, both horizontal and vertical integration, at micro-level for individuals, meso-level for specific populations, and macro level for whole populations will be needed.