This annual report - Taranaki District Health Board

WELL CHILD/TAMARIKI ORA SERVICESIntroductionThe Well Child/Tamariki Ora (WC/TO) Framework was introduced in 2002 with the aim ofreducing fragmentation and inconsistencies in the delivery of the WC/TO programme [84].The programme provides a universal health assessment, and a health promotion andsupport service for children and their families from birth to five years. WC/TO services areprovided by Plunket, DHB-funded providers, primary health organisations and Māori andPacific non-government organisations [85]. A review of the 2002 framework, commencingin 2006, led to the phasing in of a new framework from July 2010.The current WC/TO Framework consists of a series of initial contacts carried out by thelead maternity carer (LMC), a six-week check carried out by the baby’s general practice,and eight core contacts, from four to six weeks to five years (see Methods box below)carried out by a WC/TO provider [86,87]. Contacts consist of health and development/clinical assessments, interventions and support, and promotion of health and development/health education. Health and development/clinical assessments include a review ofmaternal, family and child health and wellbeing, child growth and development, vision andhearing, developmental assessments (Parental Evaluation of Developmental StatusPEDS), oral health (Lift the Lip), and a behavioural assessment at the B4 School Check.Interventions and support includes clinical evaluations, immunisations, ABC smokingcessation, family violence screening, response to assessments and additional contacts asrequired. Promotion of health and development/health education includes breastfeedingand nutrition, sudden unexpected death in infancy (SUDI) prevention, parenting support,injury prevention and childhood illness and child development education.The recent review of the WC/TO Framework sought to determine which types of activitiescan help improve child health outcomes and reduce inequalities among children aged 0 to5 years, based on evidence and best practice [85]. There is good evidence to support arange of health promotions activities in early childhood, including prevention of infectiousdiseases by vaccination and other means, reducing the risk of SUDI, supportingbreastfeeding, encouraging better dental care, and informing and advising parents aboutthe risk of accidents [88]. The evidence base for universal screening programmes is morelimited [88,89]. However, several evidence-based screening tests, such as newbornhearing screening, are including in the Framework, and the recent review has led to thephasing out of those screening tests that do not appear to be effective, such as routinetympanometry for glue ear at three years [85].With these issues in mind, the following section reviews the proportion of Plunket clientsreceiving each of their Core 1–7 Well Child contacts, as well as the proportion of four yearold children receiving their B4 School Check.Plunket Children Receiving Core Well Child ContactsIn New Zealand, Well Child/Tamariki Ora services are provided by a range of providersincluding Plunket, Māori and Pacific health providers and public health services. Of these,Plunket is the largest provider of Well Child Services. It sees over 91% of New Zealand’snewborn babies during their first six weeks of life, with contacts including home visits, clinicbased contacts, and visits at other locations such as marae, family centres, Kōhanga Reoand mobile buses [90]. In addition to its wide coverage, Plunket has a central databasewhich allows it to assess the proportion of active clients receiving their core WC/TOcontacts. The following section thus uses Plunket data to assess the proportion of Plunketchildren receiving their core WC/TO contacts during 2007–2012.Well Child/Tamariki Ora Services - 170