Maternal and Child Health Services Guideline



Canberra Hospital and Health ServicesClinical Guideline Maternal and Child Health Services in the ACTContents TOC \o "3-3" \h \z \t "Heading 1,1,Heading 2,2" Contents PAGEREF _Toc507152596 \h 1Guideline Statement PAGEREF _Toc507152597 \h 3Scope PAGEREF _Toc507152598 \h 3Section 1 – Three tiered approach to MACH Services PAGEREF _Toc507152599 \h 3Universal MACH services PAGEREF _Toc507152600 \h 4Levels of Vulnerability for MACH Service Provision PAGEREF _Toc507152601 \h 4MACH Plus PAGEREF _Toc507152602 \h 5Parenting Enhancement Program (PEP) PAGEREF _Toc507152603 \h 6IMPACT (The Integrated Multi-agencies for Parents and Children Together) Program PAGEREF _Toc507152604 \h 6Section 2 – Core service elements of MACH practice PAGEREF _Toc507152605 \h 6Principles PAGEREF _Toc507152606 \h 7Developmental surveillance and health monitoring PAGEREF _Toc507152607 \h 7Personal Health Record (PHR) Schedule PAGEREF _Toc507152608 \h 7Infant / Child Mental Health PAGEREF _Toc507152609 \h 9Infant /child behaviours PAGEREF _Toc507152610 \h 9Identification of family need and risk PAGEREF _Toc507152611 \h 10Child protection and mandatory reporting PAGEREF _Toc507152612 \h 10Health promotion PAGEREF _Toc507152613 \h 10Nutrition PAGEREF _Toc507152614 \h 10Breastfeeding PAGEREF _Toc507152615 \h 11Immunisation PAGEREF _Toc507152616 \h 11New Parent Group (NPG) PAGEREF _Toc507152617 \h 11Early Days Group (EDG) PAGEREF _Toc507152618 \h 12Sleep Group PAGEREF _Toc507152619 \h 12Section 3 – Family health and social wellbeing PAGEREF _Toc507152620 \h 14Maternal Wellbeing PAGEREF _Toc507152621 \h 14Implementation PAGEREF _Toc507152622 \h 15Related Policies, Procedures, Guidelines and Legislation PAGEREF _Toc507152623 \h 15References PAGEREF _Toc507152624 \h 16Definition of Terms PAGEREF _Toc507152625 \h 17Search Terms PAGEREF _Toc507152626 \h 18Attachments PAGEREF _Toc507152627 \h 18Appendix 1: MACH Child Health Checks Schedule, intervention and Health Promotion PAGEREF _Toc507152628 \h 20Appendix 2: MACH - Promotion of Health and Development Resources PAGEREF _Toc507152629 \h 22Appendix 3: Assessment Tools PAGEREF _Toc507152630 \h 24Appendix 4: Family Partnership PAGEREF _Toc507152631 \h 26Appendix 5: Circles of Security and Circles of Repair PAGEREF _Toc507152632 \h 27Guideline StatementThis guideline outlines the provision of client care by Maternal and Child Health (MACH) nurses in the Women Youth & Children Community Health Programs (WYCCHP) to achieve optimal health outcomes for families with children under 6 years of age.BackgroundMACH nurses are guided by The National Framework for Universal Child and Family Health Services (2011) whose vision is that, “all Australian children benefit from quality universal child and family health services that support their optimal health, development and wellbeing”. The framework is designed to meet the needs of all Australian children within a system of universal, targeted, secondary and specialist services and has been informed by emergent research, policy and service development. Supporting families, parents and carers to build skills and confidence in their parenting role is a core element of the ACT Children and Young People Plan 2015-2025. The WYCCHP seeks to contribute to this objective by providing MACH support for families with a primary health care approach, recognising the importance of optimal health and physical and mental wellbeing of parents and other primary carers. Universal child and family health services also contribute to the health of the general population through health promotion and preventive health initiatives such as breastfeeding promotion immunisation programs, child safety and parenting support.Back to Table of ContentsScopeThis document applies to all nurses and midwives working in Maternal and Child Health within the ACT Health, Women Youth and Children’s Community Health Programs (WYCCHP).Back to Table of ContentsSection 1 – Three tiered approach to MACH ServicesThree Tiered Approach to MACH Services (2017)Universal MACH services Universal MACH services are offered to all families who reside in the ACT, and are free of charge to Medicare and Asylum Seeker card holders. ACT hospital referrals are received within 1 -2 days of discharge. All parents and carers are contacted by telephone, assessed and triaged for level of vulnerability, and offered an initial MACH home visit within 1-2 weeks. MACH offers universal child & family services utilising the Family Partnership model and the principles of Circle of Security (Attachment 4 & 5), to practice in collaboration with families to assist them in actively engaging in the monitoring of their children’s health and wellbeing. MACH undertakes comprehensive assessments of parent/carer physical and emotional wellbeing, observes family interactions and provides guidance on the importance of a safe and nurturing environment for children. In addition, anticipatory guidance provided by MACH through assessment of child development, growth and behaviour, at a time when a family/parent/carer is receptive, optimally supports parent/carer individual knowledge and skills. Parents/carers requiring further support are provided with additional MACH services via MACH Plus, Parenting Enhancement Program (PEPs) and the Integrated Multi-agencies for Parents And Children Together (IMPACT).Levels of Vulnerability for MACH Service ProvisionThe following framework identifies the levels of vulnerability associated with children especially the newborn. At the initial contact with MACH services the level of vulnerability is assessed and this contact together with early postnatal support is viewed as a high priority for MACH service provision and forms the basis of service provision management strategies (Adapted from the NSW Health Maternal and Child Health Supporting Families Early (2010) and is intended for demonstrating a continuum of vulnerability framework).Level 1Clinical assessment and professional judgement identifies child as vulnerableFor example: prematurity, newborn, early discharge, mother received late antenatal care, complicated birth, postnatal complications, feeding difficulties (including breastfeeding), poor/slow weight gain, first time parenting, difficulty adjusting to parenting (including mild to moderate anxiety), multiple birth, low birth weight, parent/family affected by grief and/or loss, postnatal depression (PND) or history of PND, sleep/settling concerns, developmental or health concernsLevel 2The child’s family may be part of a population group known to experience barriers in accessing servicesChildren from an Indigenous or culturally and linguistically diverse (CALD) background Children living in poverty, or where parenting is affected by unemployment or low levels of literacyChildren living with a parent who is socially isolated e.g. unsupported parent including fly-in fly-out arrangements Large families with significantly young children e.g. four children under the age of 4 Children living in families with additional communication needs e.g. hearing, sight or speech impairment; and/or low English proficiencyChildren of adolescent parentsChildren living in families affected by chronic illness e.g., mental illness Children affected by disability including parent/s with disabilityChildren living in families affected by substance abuse Children living in families where parent/s experienced abuse as child/renChildren living in out of home careChildren in families who are homeless or at risk of homelessnessChildren in families living in rural or remote areasLevel 3 Complex family needs and a high likelihood the child will be at riskChildren living in families experiencing acute problems with mental illness, substance abuse, child protection, family violence Children suspected to be victims of abuse or neglectMACH PlusMACH Plus provides the opportunity for MACH nurses to offer additional brief interventions to support and intercept the family’s vulnerability, allowing for continued interaction with universal services to be sufficient in meeting the social and health care needs of the family. This can be in the form of extra clinic visits, drop in clinics, home visits and / or phone contact as per MACH Business Rules, 2017. Those with identified vulnerabilities after MACH Plus have the potential for inclusion in the Parenting Enhancement Program (PEP), this can be explored with the Clinical Nurse Manager (CNM). Parenting Enhancement Program (PEP)The PEP provides support to families with infants who are identified as vulnerable and requiring support beyond general MACH services. The PEP aim is to support vulnerable clients in the program to become engaged and supported within the community.Inclusion in the PEP is based on the presence of criteria or risk factors as per levels of vulnerability framework, clinical observation and client consultation. MACH Plus -There may be up to four contacts to assess the situation and client suitability. Following identification of a potential PEP client, the referrer (Allied Health, Non-Government Organisations (NGO’s), MACH nurses, midwives, Child and Youth Protection Services (CYPS) will consult with the PEP/IMPACT CNM) to consider inclusion on the PEP. Families are encouraged to be committed and engaged with the PEP model. Discharge from PEP occurs once client goals are attained or when the youngest child is 12 months old, families are then encouraged to access mainstream universal MACH services or linked to ongoing support.IMPACT (The Integrated Multi-agencies for Parents and Children Together) Program The IMPACT Program is not a standalone service, but a system wide approach, which facilitates agencies and services to work collaboratively, within a set of agreed principles, to better meet the needs of vulnerable families.Any agency, a client, or their family, may initiate a referral to the program. The IMPACT Co-ordination and Liaison Service can assist all of the agencies to complete a referral. Referral to the program is voluntary and requires the consent of the client. The IMPACT Program is a long-term approach for services working with the client during a pregnancy or until the youngest child turns 2 years of age. The program targets improved service coordination and response in order to achieve the outcomes that have been developed in collaboration with the client. Eligibility CriteriaThe IMPACT Program provides the coordination of care to clients who are active clients of Mental Health within the ACT Health Directorate - Division of Mental Health, Justice Health and Alcohol & Drug Service and/or clients who receive Opioid Replacement Treatment, who are pregnant or have children less than two years and who:Have a constellation of risk factors that increase the likelihood of reducing their child’s safety and wellbeingRequire additional assistance to access, negotiate, mobilise and maintain involvement with services Further information can be obtained from The Integrated Multi-agencies for parents and Children Together program Guidelines 2012.Back to Table of Contents Section 2 – Core service elements of MACH practicePrinciplesMACH nurses recognise the key function of universal child and family health services is to monitor child health, development and wellbeing, identify early disability and delay, or health issues (both physical and socio-emotional) and support the developing parent and infant (young child) relationship.There are four core service elements:health and developmental surveillance;health promotion;early identification of family need and risk; andresponding to identified need.The MACH nurse engages with families using a relationship- based approach designed to transition nursing care from a task orientated focus to a child-centred, family focused model of care (Maddox, Higgins Lee, Redgrave, Ridgway and, Hunter, 2017).This is supported by the principles of Family Partnership and Circle of Security (Appendix 4 & 5).Developmental surveillance and health monitoring Surveillance of child development allows for the early identification of children with developmental delay, and referral to early intervention services. Early intervention can significantly improve developmental outcomes. In high risk groups it may be possible to prevent the formation of, or decrease the extent of, the delay or disability [National Framework for Universal Child and Family Health Services (2011) p 19].Developmental surveillance is tracked using the Personal Health Record (PHR or Blue book) as per the schedule below. Child Health Checks are offered at specific times to monitor growth and developmental milestones as well as provide an opportunity for nurses to give anticipatory guidance, health education / health promotion and support to parents. These include:Monitoring physical, social and emotional and cognitive development;Physical health, growth monitoring, oral health;Vision and hearing assessment; andAssessment of family psychosocial risk and protective factors.Personal Health Record (PHR) ScheduleHealth Check0 - 4 weeks6 - 8 weeks4 months6 months12 months18 months2 yrs3 yrs4 yrsFamily HistoryRisk FactorsQuestionsOther toolsYesGeneralRisk FactorsYesGeneralYesGeneralYesGeneral Parents’ Evaluation of Developmental Status (PEDS)Ages and Stages Questionnaire (ASQ)YesGeneral PEDSASQ if neededYesGeneral PEDSASQ if neededYesGeneral PEDSASQ if neededYesGeneral PEDSASQ if neededYesGeneral PEDSASQ if neededDevelopmentalAssessmentYesYesYesYesYesYesYesYesYesGrowth YesYesYesYesYesYesYesYesBMIYesBMIReflexes / BehaviourYesYesYesYesYesYesYesYesYesMotor SkillsYesYesYesYesYesYesYesYesYesVision CheckAge specificAge specificAge specificAge specificAge specificAge specificAge specificAge specificAge specificCDHYesYesYesYesYes(gait)(gait)ImmunisationBirthCheckCheckCheckCheckCheckCheckCheckCheckAnticipatory InformationYesYesYesYesYesYesYesYesYesAlert: After 4 years children are welcome to attend MACH Services for parental concerns and review, however the PHR developmental checks are completed at 4 years of age. Kindergarten checks will be available when a child commences the first year at school.The Child Health Check offers an opportunity for the MACH nurse to engage in partnership with parents/carers, to discuss their concerns about their infant/child. A comprehensive assessment includes emotional, social and cognitive development incorporating general and age appropriate surveillance. The MACH nurse will respond to parental/carer concerns, explain the results of the assessment, provide anticipatory guidance and health information to normalise infant/child behaviour and promote optimal development. If a secondary assessment is required an Ages and Stages Questionnaire (ASQ) will be provided to parents/carers to complete for further ongoing assessment and appropriate referral pathway. ASQ-3 Age appropriate activity sheets will be discussed and provided to carers This may include:AudiometrySpeech pathology General PractitionerOrthoptistsACT Child Development Service Behavioural management support ( Child and family centres)Community Paediatric and Child Health serviceQueen Elizabeth 11 Family centre Child at Risk Health Unit ( CAHRU)Referrals:Refer according to appropriate internal and external processes outlined in WYCCHP Service Guideline and Referral Criteria April 2017 foundQ:\CH\CY&W\CY&W_General\ALL STAFF\Referral BookletDiscuss any urgent, complex or ongoing concerns with Clinical Nurse Manager (CNM)Refer to:Canberra Hospital and Health Services Clinical Guidelines for Jaundice in the Newborn (2017)Canberra Hospital and Health Services Clinical Guidelines for Developmental Dysplasia of the Hip (2017)Canberra Hospital and Health Services Clinical Guideline - Safe Sleeping Guidelines: Neonates and Infants up to 12 months of age 2017Tools:Parents’ Evaluation of Developmental Status (PEDS) Tool (Appendix 3. Assessment Tools)Ages and Stages Questionnaire if required (Appendix 3. Assessment Tools)Infant / Child Mental HealthMACH nurses recognise the importance of the wellbeing of the primary caregiver in the attachment relationship and educates mothers, fathers and caregivers to recognise relationship-based attachment behaviours of each unique infant. The wellbeing of an infant is profoundly dependant on the wellbeing of their parent or carer.Refer to: Canberra Hospital and Health Services Clinical Guideline: Perinatal Emotional Wellbeing Circles of Security and Circles of Repair (Appendix 5)Australian Infant Mental Health Association /child behavioursYoung children may exhibit a broad range of behaviours which can cause concern to their parents or caregivers. Appropriate support for behavioural issues may avert ongoing behavioural and mental health issues through later childhood and adolescence. Parental characteristics and parenting styles influence child behaviour. MACH nurses use a strength-based approach based on family partnership principles to work collaboratively with families to plan strategies that parents / carers can implement to address their concerns. The Circle of Security model is used to encourage secure, warm parenting styles that aim to enhance family relationships and optimise child development. Interventions and information given must be evidence based and endorsed by WYCCHP. All consultation offers the MACH nurse an opportunity to engage with parents/carers, who are the experts on their child, to discuss their behavioural concerns about their infant/child. Information is gathered using validated tools.Refer to: Parents’ Evaluation of Developmental Status (PEDS) Tool (Appendix 3. Assessment Tools)Ages and Stages Questionnaire if required (Appendix 3. Assessment Tools). Circle of Security and Circle of Repair (Attachment 4, 5)WYCCHP Referral bookletResources: ParentlinkIdentification of family need and riskMACH Nurses identify health needs as early as possible in order to provide support to families. The complex risks and protective factors influence the child’s health and wellbeing and development. MACH nurses acknowledge the impact of the social determinants of health on families (Australian Institute of Health and Welfare 2016, pg 132)MACH nurses will respond to identified needs with practiced based interventions and implement appropriate care plans/pathways. Referrals for further assessment outside the universal MACH service may be appropriate. These could include targeted and brief interventions (Circle of security and sustained home visiting).Discussion with CNM for referral to PEPS if required. Child protection and mandatory reportingMACH Nurses are required to recognise, respond and mandated by law to report cases of suspected child abuse and neglect and/ or the presence of domestic violence.Refer to: ACT Health Child Protection 2013Child Protection SOP Canberra Hospital and Health Services Operational Guideline: ACT Health Staff working with Child & Youth Protection Services 2017Keeping Children and Young People Safe – A shared community responsibility October 2008 dhcs..auHealth promotionMaternal and Child Health services have the opportunity to conduct a range of evidence-based health promotion strategies that aim to encourage families to create attitudes, behaviours and environments to promote optimal health for children. (National Framework for Universal Child and Family Health Services (2011) p 24).These core service elements related to health promotion include:prevention of disease, injury and illness;health education, anticipatory guidance and parenting skill development;support that builds confidence and is reassuring for mothers, fathers and carers; andcommunity capacity building.Nutrition MACH nurses are well placed to promote healthy family eating, from early feeding, the appropriate introduction of solids, and progression to full family diet.Refer to:Eat for Health: Infant feeding Guideline - information for workers, NHMRC (2012) to provide evidence based nutritional advice to families.Canberra Hospital and Health Services Clinical Guideline: Breastfeeding 2016Tools: ACT Health Nutritional resources- Tuckatalk; Milk to More; Joining the Dots (Capital Health Network)Breastfeeding MACH Nurses are committed to providing an environment that protects, promotes and supports breastfeeding as the optimal way for a woman to feed her baby. MACH nurses will provide clear and consistent information across the care continuum supporting the Baby Friendly Health Initiative (BFHI) principles.Refer to:Canberra Hospital and Health Services Clinical Guideline: Breastfeeding 2016Eat for Health: Infant feeding Guideline - information for workers, NHMRC (2012) to provide evidence based nutritional advice to familiesImmunisationPrevention of disease is a core component of child and family health service provision. Vaccination has been demonstrated to be one of the most effective and cost-effective public health interventions. The MACH service provides a childhood immunisation service as per the National Immunisation Program (NIP) for children aged 0 - 5 years, with catch up available to the child’s 6th birthday.Refer to:Canberra Hospital and Health Services Operational Procedure: Immunisation Service Delivery in Schools and Child Health 2016 The Australian immunisation handbook 10th ed (2017 update). Canberra: Australian Government Department of Health, 2017Immunisation Standing Orders as per Chief Health Officer ( annual approval required)New Parent Group (NPG)The aim of NPG is to build relationships, provide support, and ensure evidence based information is provided within a friendly and safe environment. MACH Nurses will facilitate the groups using adult learning principles working collaboratively in partnership with parents/carers to enable the group needs to be met. The group will determine the topics to be covered and discussed thereby empowering the parents to engage early on in the session. Some sessions may have invited guest speakers from endorsed external agencies. To facilitate these groups the nurse will require a knowledge of facilitator challenges.Each MACH nurse will access ACT Health endorsed resources for group facilitation, session planning and evidenced based information for parents/carers within the NPG environment. Toolbox topics may include: Play, maternal/infant attachment, development, family wellbeing-relationships, looking after yourself, and common childhood illness topics (specifically for infants). The NPG are designed for first time parents with an infant younger than 4 months to obtain accurate parenting information, create informal networks and social supports.Alert: Attendance at the group can be negotiated with the Regional Clinical Nurse Manager for parents who do not fit the eligibility criteria.Early Days Group (EDG)The EDGs are designed for families who are requiring support and information around feeding and settling their infants up to 3 months of age. This drop-in-group offers access to early intervention to identify infant feeding and sleep / settling issues. Peer and MACH support within the group enables discussion often normalising infant behaviour and empowers parents in the early months of parenting. Continuity of care from this group will include management plans and review either on site or home visit. Group facilitation is provided by two MACH Nurses (preferably one with IBCLC qualifications) using adult learning principlesThe core themes of sleep, settling, feeding and maternal well-being underpin session content. The session will generally be divided into two parts:Part 1: informal assessment and individual discussion of presenting issues.Part 2: facilitated group discussion to address common identified issuesFollow ups occur in the afternoons providing continuity of care and more intensive parenting support.Sleep GroupInfants are more likely to develop secure attachments when their distress is responded to promptly, consistently and appropriately. Secure attachments in infancy are the foundation for good adult mental health. (AAIMH, 2013)The Sleep groups are designed for parents or carers with an infant or child who requires assistance with sleep management. The facilitators focus on circle of security principles and secure attachment theory enabling parents and care givers to feel more confident and able to achieve sustainable outcomes in responding and managing their infant’s or child’s sleep and settling behaviour. Sleep Groups are a single session by appointment only and facilitated by one MACH Nurse.Sessions are offered in three different age groupings including: 3 months - 8 months 9 months - 18 months and 19 months - 3 yearsThese age groupings enable similar developmental stages and concerns to be discussed and addressed. MACH nurses will access ACT Health endorsed resources for group facilitation, session planning and evidenced based information for parents/carers within the sleep group environment.Participants in the group will be asked to share and discuss what is happening for them in a safe and secure environment. This will direct the group discussion facilitated by the MACH Nurse.Group discussion may include: Infant mental health,Circle of security principlesTired signs/sleep needsSafe sleep recommendationsSleep cycles/circadian rhythmsResponsive settlingUnderstanding of infant developmentMaternal and family health and wellbeing Alert: The attendance of an age appropriate sleep group is a pre- requisite for families prior to referral to Queen Elizabeth II Family Centre (QE11), the tertiary inpatient model. Variation to this process for families with vulnerabilities can be negotiated with the Regional Clinical Manager Nursing and Midwifery at QE II.Post group attendance, families are offered a phone contact 2-4 weeks later from a MACH Nurse to provide follow up support and appropriate follow on referral if sleep issues are not resolved. Health promotion within MACH supports capacity building within communities. This occurs through networking and collaboration with government and non-government organisations, for example: provision of some groups occur within Community Health Centres, Child and family Health Centres and ACT education sites. This further supports empowering the community by social connections and relationship building and responsive service delivery.Refer to:Canberra Hospital and Health Services Clinical Guideline - Safe Sleeping Guidelines: Neonates and Infants up to 12 months of age 2017Resource: Rednose Australian Competition & Consumer Commission: Find Out More: Keeping baby safe, a guide to infant and nursery products, 2013.Back to Table of Contents Section 3 – Family health and social wellbeingMaternal WellbeingThe wellbeing of an infant is profoundly dependant on the wellbeing of their parent or carer. The MACH nurse collaborates with families to identify their individual needs and offers support by providing appropriate, accessible and acceptable MACH services in line with primary health care principles.On assessment at the universal home visit, or initial clinic visit the MACH nurse will assess maternal wellbeing and safety through a preliminary discussion related to the mothers birth experience, general health and psychological health. The Perinatal Psychosocial Assessment Tool (PPSA) will also inform on family support and domestic situation.A psychosocial assessment is routine at 6-8 weeks using the Edinburgh Postnatal Depression Scale (EPDS) and forms an ongoing assessment of maternal mood and needs (see Appendix 3: Assessment tools) Referral flow chart for: PERINATAL MENTAL HEALTH INTEGRATED CARE PATHWAY GUIDELINE hereRefer to: Canberra Hospital and Health Services Clinical Guideline: Perinatal Emotional WellbeingCentre of Perinatal Excellence COPE: Mental Health Care in the Perinatal period: Australia Clinical Practice Guidelines: October 2017. HereBack to Table of Contents Implementation An all staff email will be sent to all relevant teams via the Clinical Nurse Manager. MACH nurses will be informed of the guideline and receive education during orientation.Education of all CHHS staff to access the Clinical Policy and Guidelines via the Intranet.Back to Table of ContentsRelated Policies, Procedures, Guidelines and LegislationFrameworkAustralian Health Ministers Advisory Council (2011) National Framework for Universal Child and Family Health Services – Vision, objectives and principles for universal child and family health services for all Australian children aged zero to eight yearsPolicies, Procedures & GuidelinesACT Health Child Protection PolicyCanberra Hospital and Health Services Clinical Guideline: BreastfeedingCanberra Hospital and Health Services Clinical Guidelines for Developmental Dysplasia of the Hip Canberra Hospital and Health Services Clinical Guideline: Perinatal Emotional WellbeingCanberra Hospital and Health Services Clinical Guideline: Safe Sleeping Guidelines: Neonates and Infants up to 12 months of ageCanberra Hospital and Health Services Operational Guideline: ACT Health Staff working with Child & Youth Protection Services 2017Assessment and Management of Perinatal Mental HealthCanberra Hospital and Health Services Operational Guideline Home Visiting Canberra Hospital and Health Services Operational Guideline Initial Management, Assessment and Intervention for People Vulnerable to Suicide Canberra Hospital and Health Services Clinical Procedure: Jaundice in the Newborn Canberra Hospital and Health Services Clinical Procedure: Tongue Tie Assessment, Management and DivisionClinical Record Management PolicyClinical Record Documentation procedureConsent and treatment policyPerinatal Emotional Wellbeing Work Health and Safety PolicyLegislationChild & Young People Act 2008 Freedom of Information Act 1989 Health Record (Privacy and Access Act) 1997Back to Table of ContentsReferencesACT Government (2011) Parentlink Parenting Guides retrieved 03 November 2017 from )Australian Association for Infant Mental Health (2006, reviewed May 2016) Positions Paper 2: Responding to baby’s cues. Retrieved 26 October 2017 from (2016)-Responding-to-infant-cues-(1).pdf(2016)-Responding-to-infant-cues-(1).pdfAustralian Association for Infant Mental Health (2013) Positions Paper 1: Controlled Crying viewed 26 June 2017 Institute of Health and Welfare 2016. Australia’s health 2016. Australia’s health series no. 15. Cat. no. AUS 199. Canberra: AIHW Institute of Health and Welfare 2016. Australia’s health 2016. Australia’s health series no. 15. Cat. no. AUS 199. Canberra: AIHW.CDC Growth charts (2001) are accessed at Cooper,G., Hoffman, K., Powell, B., Marvin, R. (1998). Circle of Security. Retrieved Nov 3 , 2017, from Circle of Security early intervention program for parents and children: Circle of security International: Resources for professionals. Retrieved 3 Nov 2017 , H & Day, C 2010, Working in partnership with parents, 2nd edn, Pearson, LondonDepartment of Education and Early Childhood Development (Victoria) (2011). Maternal and child health service guidelines. Maternal and child health, office for children and portfolio coordinationHarris, L & Day, C 2013, ‘The Family Partnership Model: bringing theory, practice and implementation closer together, CPCS, LondonHockenberry, M & Wilson, D. (eds)(2015) Wong’s nursing care of infants and children, 10th ed Mosby: MissouriKliegman, Robert (2016) Nelson textbook of pediatrics (1-4557-7566-5, 978-1-4557-7566-8),?Edition 20.?Accessed online 31/05/2016 ACT Health LibraryMaddox, J., Higgins, H., Lee, S., Redgrave, K., Ridgway, M. Hunter, V. (2017). Supervision Framework for Child and Family Health Nurses: Promoting Reflective Practice. Child and Family Nurses Association NSW inc. Carramar.National Health and Medical Research Council (2002), Child Health Screening and Surveillance: a critical review of the evidence. National Health and Medical Research Council: Canberra.National Health and Medical Research Council (2012). Eat for Health Infant feeding Guideline: information for workers. National Health and Medical Research Council: CanberraNSW Health (2009). Supporting Families early SAFE START strategic policy. health..auNSW Health (2010) Maternal and Child Health Supporting Families Early Raising Children Network (2006-2017) accessed 30/12/2016RedNose (2015) : keep baby smoke free before birth and after articleRednose: Safe Sleeping brochureRednose: Safe Wrapping brochureRednose: Tummy Time BrochureRednose: sharing a sleep surface with a babyRoyal Children’s Hospital Melbourne, Centre for Community Child Health (2009) Parents’ Evaluation of Developmental Status (PEDS) Sharma, A. & Cockerill, H. (2014). From Birth to Five Years: Practical Developmental Examination. Routledge, Taylor & Francis Ltd. London, UK Sheridan, M., Sharma, A. & Cockerill, H. (2014). Mary Sheridan’s From Birth to Five Years: Children’s Developmental Progress. (4th Ed) Routledge, Taylor & Francis Ltd. London, UKWorld Health Organization (WHO). (1978). Declaration of Alma Ata , International conference on PHC, Alma-Ata, USSR, 6–12 September. (accessed September 3 November 2017 (1986) Ottawa Charter for Health Promotion. 1st International Conference on Health Promotion accessed 29/9/2016The WHO Child Growth Standards (1999) accessed at to Table of ContentsDefinition of Terms Primary Health Care is:‘Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process’ (WHO 1978).Child development is a ‘dynamic process of growth and transformation through which children achieve new physical, cognitive and psychological abilities’ (Sharma & Cockerill, 2014. P 14).Developmental Surveillance is defined by the NHMRC as the process of: 'eliciting and attending to parents' concerns, making accurate and informative longitudinal observations on children, obtaining a relevant?developmental?history and promoting?development' (NHMRC, 2002 p. 22).Developmental Milestone is defined as a developmental ability that is achieved by most children at a certain age (Sharma & Cockerill, 4th Edit. 2014. P 125 ).Health Education is ‘consciously constructed opportunities for learning, involving some form of communication designed to improve health literacy, including improving knowledge, and developing life skills which are conductive to individual and community health’ (WHO 1998).Health Promotion is ‘the process of enabling people to increase control over and improve their health’ (WHO Ottawa Charter for Health Promotion).Social determinants of health is ‘the circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness. The conditions in which people live and die are, in turn, shaped by political, social, and economic forces’ (CSDH 2008). Back to Table of ContentsSearch Terms Children, Maternal and Child Health (MACH)Back to Table of ContentsAttachmentsAppendix 1. MACH Child Health Checks Schedule, Intervention and Health Promotion Appendix 2. Promotion of Health and Development ResourcesAppendix 3. Assessment ToolsAppendix 4. Family PartnershipAppendix 5. Circle of Security/Circles of RepairDisclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.Policy Team ONLY to complete the following:Date AmendedSection AmendedDivisional ApprovalFinal Approval 21/02/2018Complete ReviewLiz Chatham, ED WY&CCHHS Policy CommitteeThis document supersedes the following: Document NumberDocument Name2.2.6MACH - Behaviour - Guide to Managing Challenging Behaviours in Children under 5 years.doc2.0.1MACH - Early Days Services.doc2.6.1MACH - New Parent Group Facilitation.docx2.2.8MACH - Nursing assessment of infants and young children up to 5 years.doc2.8.4MACH - Parenting Enhancement Program (PEP) - Case conferencing and documentation.doc2.8.1MACH - Parenting Enhancement Program (PEP)- Assessment process and criteria for inclusion.docCHHS13/604MACH - Role of MACH Liaison Nurse.docx2.9.3MACH - Self Weigh Stations.docx2.2.7MACH - Sleep and settling management for infants and children from birth to 3 years of age.docx2.1.4 MACH - Staff mobile phone usage.docx2.0MACH - Support for Families.doc2.2.15 MACH - Vision Screening Procedure for Maternal and Child Health Nurses.docAppendix 1: MACH Child Health Checks Schedule, intervention and Health Promotion Child Health CheckHealth and Developmental MonitoringInterventionPromoting Health and Wellbeing1-4 WeeksInitial clinic or home visitDevelopment Family wellbeingFull physical AssessmentHistory of Pregnancy, Birth, Family SmokingHearing QuestionsFamily history and risk factorsMaternal PPSABreastfeeding, ImmunisationCrying, SIDS / Safe SleepingAppropriate car seat / SafetyHealth6-8 weeksDevelopmentFamily wellbeingFull physical AssessmentRespond to Assessments SmokingMaternal EPDSFeeding, ImmunisationCrying, SIDS / Safe SleepingSun Smart / safetyParents emotional healthContraception, Health 4 monthsDevelopmentFamily WellbeingFull physical AssessmentRespond to AssessmentsSmokingFeeding, ImmunisationCommunication, language and playTeething and dental care Health Crying, SIDS / Safe SleepingSun Smart / SafetyCommunity Supports / groups6 monthsDevelopmentFamily WellbeingFull physical Assessment6/12 Parents Evaluation of Development Status (PEDS) Respond to AssessmentsSmokingStarting Solids, ImmunisationHealth, Sleeping, Dental careCrying, Safety / SIDS / Safe Siblings / Positive ParentingCommunication, language and play12 monthsDevelopmentFamily wellbeingFull physical Assessment12/12 Parents Evaluation of Development Status (PEDS)Respond to AssessmentsSmokingHealthy Eating, Family mealsDental care /Dental checkChild Behaviour, Immunisation Childcare, Health / Safety18 monthsDevelopmentFamily WellbeingFull physical Assessment18/12 Parents Evaluation of Development Status (PEDS) Respond to AssessmentsHealthy families eating ImmunisationChild Behaviour, SleepDental care / Dental CheckSun Smart / SafetyStarting Toilet training 2 yearsDevelopmentFamily WellbeingFull physical Assessment2 year Parents Evaluation of Development Status (PEDS)Respond to AssessmentsSmokingCommunication, language and playHealthy Eating for families HealthDental care / Dental CheckSun Smart / Safety Health, Childcare Child’s Independent BehaviourPositive parenting Toilet training3 years DevelopmentFamily WellbeingFull physical Assessment3 year Parents Evaluation of Development Status (PEDS)Respond to AssessmentsSmokingBMIHealthy Family EatingImmunisationCommunication relating to othersLiteracy – story reading SleepChild Behaviour / siblingsHealth Dental care / Dental CheckSun Smart / Safety Toilet training4 yearsDevelopmentFamily WellbeingFull physical Assessment4 year Parents Evaluation of Development Status (PEDS)Respond to AssessmentsSmokingCommunication + relating to othersHealthy Eating for familiesChild feelings and behavioursSleep Sun Smart / SafetyGoing to preschool or schoolPositive parenting, Health Appendix 2: MACH - Promotion of Health and Development Resources Evidenced based written health resources as listed may be distributed at each key age and stage consultation. This information supports a facilitated discussion with parents about key health promotion messages and ensures consistency of practice. Some of these brochures may be used at other ages and stages too.Key VisitHealth PromotionBrochure1-4 Week Healthcare RightsMACH Services BreastfeedingAustralian Charter of Healthcare RightsEarly Days, Drop InGood Nutrition while BreastfeedingWhat to Expect from My BabyACT Health Breastfeeding Brochures as requiredExpressed Breast MilkPoison InfoFirst Aid for Poisoning MagnetImmunisationNational Immunisation Program Schedule (Magnet)Pathway to Wellness: PANDSIPost natal DepressionBlokes Business: When Your Partner has had a difficult childbirth ExperienceSIDS Safe Sleeping SIDS & Kids Safe SleepingDevelopmentASQ: Activities for Infants 1-4 Months old6-8 WeeksPost natal DepressionBeyond Blue/PANDSI resources as required 4 MonthsDentalLift the lipDevelopmentASQ: Activities for Infants 4-8 Months old6 MonthsNutritionBottle or Cup TuckatalkFirst Foods TuckatalkMilk to More (ACT Health website)DevelopmentASQ: Activities for Infants 8-12 Months old12 MonthsNutritionFood for your Toddler 1-3 years TuckatalkDevelopmentASQ: Activities for Infants 12-16 Months old18 MonthsNutritionSnacks to get your teeth into TuckatalkDevelopmentASQ: Activities for Toddlers 16-20 Months oldASQ: Activities for Toddlers 20-24 Months old2 YearsDevelopmentASQ: Activities for Children 24-28 Months old3-4 YearsHealthy WeightConnecting the dots for healthy kids MagnetHealthy Eating for ChildrenFood for your 4-6 year old TuckatalkASQ: Activities for Children 36-48 Months oldAppendix 3: Assessment ToolsInfant / Child Assessment Tool’s General InformationThe MACH nurse uses two validated tools to elicit parental concerns about a child’s development and behaviour. The tools used are the Parents Evaluation of Developmental Status (PEDS) tool for initial screening and if further assessment is required an Ages and Stages Questionnaire (ASQ) (see Attachment 3). These tools require practitioners to undertake associated training in the use and scoring of the tool. Each tool used is interpreted or scored acting as a baseline for subsequent assessment and offers referral paths. Parents Evaluation of Developmental Status (PEDS)The PEDS tool is a primary assessment. It is a 10 item, parent completed questionnaire that has been demonstrated to be a reliable, valid and cost effective method for eliciting parents’ concerns about their child’s development and behaviour. The PEDS tools are utilised at key developmental age checks starting at 6 months then at 12 months, 18 months, 2 years, 3 years and 4 year old checks. Parents are advised to complete the questionnaire prior to their child’s clinic appointment or it can be completed with assistance in the clinic. The PEDS tool is printed in the Personal Health Record or available in pads.Ages and Stages Questionnaire (ASQ)The ASQ questionnaire is a secondary assessment to a PEDS. It is a series of questionnaires for children aged 1 month to 5yrs 6 months. It is a brief assessment procedure designed to identify children who should receive more intensive early intervention.Each questionnaire has 3 parts: a family information sheetseveral pages of items/questions to be answered by parent or primary caregiveran ASQ Information Summary sheet.There are 21 questionnaires are available for use at different ages, referred to as “intervals”. Selecting the correct interval for the child is critical to accurate use of the ASQ (see Quick Start Guide).Each interval of the ASQ has 30 questions about a child’s abilities, organized into 5 areas: Communication, Gross Motor, Fine Motor, Problem Solving and Personal-SocialThe ASQ Questionnaire is given to a parent or caregiver to take home following use of the PEDS tool if further clarification of the parent’s concerns is required. Parents are advised to complete the questionnaire prior to their child’s clinic appointment or it can be completed with the nurse’s assistance in the clinic or at a home visit. The ASQ is scored and results are discussed with the parent at the next appointment or visit.Maternal Assessment ToolsValidated assessment tools are used to assess Perinatal Emotional Wellbeing Perinatal Psycho Social Assessments (PPSA) Edinburgh Postnatal Depression Scale (EPDS)MACH nurses complete these assessments and manage clients according to the Canberra Hospital and Health Services Clinical Guideline: Perinatal Emotional Wellbeing Referral flow chart for: PERINATAL MENTAL HEALTH INTEGRATED CARE PATHWAY GUIDELINE hereAppendix 4: Family PartnershipFamily Partnership training is a highly acclaimed, evidence based model created by Hilton Davis (Davis, H., Day, C., & Bidmead, C. (2002)). The Family Partnership model has been widely implemented around the world and is the basis for many successful early intervention programs for families. It is an innovative approach based upon an explicit model of the helping process that demonstrates how specific practitioner’s qualities and skills, when used in partnership, enable parents and families to overcome their difficulties, build strengths and resilience and fulfil their goals more effectively.The model assists practitioners to develop highly respectful relationships with parents and?clients. The course is designed to take into account the skills and expertise of the participants. Training is interactive and requires the involvement of all participants in active discussion. Participants are encouraged to explore and reflect on their knowledge, skills and confidence in the process of engaging and relating to parents and supporting them effectively. The course is widely applicable across many professions. Any person who is involved in working closely with parents, families and youth will benefit from the skills gained in this training.? The Family Partnership Model has been developed to give a better understanding of the processes of helping. It draws together the important aspects of helping parents and shows how they relate to each other.The key components of the Family Partnership Model are:A clear, structured and flexible helping process.Explicit outcomes of the process.The nature of the partnership between practitioners, parents and children.The interpersonal skills and personal qualities required of practitioners to facilitate the helping process.The nature of parents and children, their strengths and resources, difficulties and challenges and involvement in the helping process.The community context for services to families and support for practitioners from managers and supervisors.An understanding of the processes of change and how these are affected by the ways in which practitioners and parents make sense of? themselves, each other, the tasks and purpose of helping and their wider context (constructions).Appendix 5: Circles of Security and Circles of RepairTravelling Around the Circle of Security (To be used in conjunction with the Circle of Security graphic)Looking at the top half of the circle- providing a Secure Base Use this as a starting point for taking a tour around the Circle of Security.(See ‘Support My Exploration “on the circle.) This is one of the two transition needs on the circle. Since children depend so much on their parents to protect them while they explore, young children also watch to see if their parent is paying attention to them for that protection. Young children don’t actually think about this- remember they are wired to do this automatically! With their parents support children head out for grand adventures.Even though what children need from their parent changes as they travel around the circle, it is important to remember that children need their parent all the way around the circle.(see Watch Over Me” on the Circle). When a child is exploring, it is usually the parents’ job to watch out for danger or be there in case something happens – if the parent becomes unavailable, the child’s exploration ends.(see “Help Me” on the circle) This requires the parent to provide the necessary help without taking over. Children just need enough help to do it themselves.(see “Enjoy with Me” on the circle) At times the child simply wants their caregiver to enjoy with them. These shared moments provide children with a sense that the caregiver is attentive, available and attuned. It also makes children feel they are worthy of such attention.(see ”Delight in Me”) At times, children need to know that no matter what they are doing, their parent finds delight in them, for no other reason than their simply being alive. During moments of exploration- moments that often to do with building autonomy and mastery- a child will look back just to make sure the parent is delighted. Moments like these build a well-engrained sense of self worth in the child.Looking at the bottom half the of the circle – Providing a Safe Haven“Welcome My Coming To You”. Unless the child is very frightened the first thing children need on the bottom half of the circle is a sign from their parent that they are welcome to come back to the parent. It is the second transition need of the circle. Like support for exploration, a child’s sense that they are welcome to come back is a combination of a history of support, as well as an immediate cue.(see “Protect Me ”on bottom circle) Providing protection from clear and immediate danger is a basic part of parenting that we clearly understand – however children are sometimes frightened and need to be soothed even when, to the adult, there is no clear danger. (see “ Comfort Me” on the Circle). Although most parents understand the idea of comfort, not all parents have experience of either comforting or being comforted and so they struggle giving comfort to their children.(see” Organised My Feelings” on the circle) Sometimes children need help organising an internal experience that is overwhelming. Most parents understand that their children need help organising their internal world. Whatever the cause, children need their parent’s help because they are still too young to do it alone. It is through the repeated process of parents helping their learn how to manage feelings both by themselves and in relationships. (Cooper,G., Hoffman, K., Powell, B., Marvin, R. (1998)) ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download