Improving healthcare access for vulnerable children The First 2000 Days Care Connect Project (FDCC)

By Linda Music

Early childhood (0-5 years) is a critical period for interventions to shape the long-term health and wellbeing of children. During this period, establishing a continuum of care, which includes regular growth and development checks plays a significant role in fostering optimal child health outcomes. However, for migrant and refugee populations, accessing and engaging with health services can be challenging.

Recognising this, the First 2000 Days Care Connect (FDCC) project emerged as a response, aiming to address these issues and improve the health trajectories of children from migrant and refugee populations. Funded by the NSW Health Translational Research Grants Scheme, FDCC has leveraged research to pioneer a holistic model of care, focusing on transition from maternity service to community child and family health (CFH) services, engaging families in child growth and development checks with a CFHN Nurse and service navigation support to both health and social care services.

The problem

The statistics paint a concerning picture: one-quarter of NSW preschool-aged children from nonEnglish speaking families are at risk of delayed development. This risk stems from various factors, including undiagnosed maternal postnatal depression, premature cessation of breastfeeding, and unaddressed psychosocial needs. Consequently, these children are doubly vulnerable to academic underachievement, compromised health, and escalated healthcare costs compared to their peers.

However, by 12 months of age, only a third of these children have their growth and development checks completed, meaning that developmental issues are often not picked up until they start school. Ensuring these families become engaged with CFH Nursing Services where concerns can be identified and early intervention offered, provides a significant way to prevent this from happening. However, as Tania Rimes, Chief Investigator of the FDCC project explains, accessing and engaging with CFH services can be challenging due to various barriers including cultural disparities, language barriers, and limited health literacy.

The Solution: First 2000 Days Care Connect (FDCC) Intervention Model

The FDCC hub model, supported by care navigation, aims to bridge the gap between migrant and refugee families and essential healthcare services The model is an innovative approach which involves co-locating CFH services within or close to NonGovernment Organisations (NGOs) such as playgroups and childcare centres, and providing access to psychosocial support services, general practitioners, paediatricians, domestic violence support, and more.

“Essentially, the project brings CFH services to where the families are rather than making them come to the service,” explains Tania.

The FDCC model was built upon the achievements of the “Happy Healthy Ready” pilot model implemented in Rockdale. This pilot demonstrated notable success, with 63% of families attending the Rockdale Hub re-engaging with CFH services during the period from 2014 to 2018, involving a total of 160 families.

From 2021-2023, the FDCC model was trialled across South Eastern Sydney Local Health District (SESLHD) and South Western Sydney Local Health District (SWSLHD). To participate in this trial, expectant mothers needed to be beyond 20 weeks’ gestation, aged 16 or older at enrolment, and either newly arrived migrants or self-identified refugees from non-English speaking backgrounds within the past decade. Participants also needed to reside in the geographical catchment and attend antenatal clinics in specific hospitals such as St George, Liverpool, or Fairfield Hospitals.

The first six months –(Rockdale)

The impact evaluation of the FDCC project looked at the influence of the Hub model on attendance and completion rates of child health and development checks (primary outcome). Data about attendance was collected at 1-4 weeks, 6-8 weeks, six months and 12 months.

Although the finalisation of the 12-month electronic medical records (eMR) and survey data is not expected until June 2024, preliminary data collected up to the six-month mark indicates a notable disparity in attendance rates between families accessing services within the hub area and those outside (control group).

Within the first 1-4 weeks, the intervention group displayed full attendance (100%), while the control group followed closely at 94.34%. By the 6-8 week mark, the intervention group maintained a high attendance rate of 86.54%, whereas the control group exhibited a lower attendance rate of 68.3%. At the six-month milestone, the intervention group maintained a robust attendance rate of 86%, demonstrating sustained engagement with CFH Nurse checks, whereas the control group’s attendance dropped to 50%.

“These findings demonstrate the tangible impact of the FDCC project in increasing attendance for growth and developmental checks and the length of time families engage with the Rockdale Hub,” said Tania.

Miller – small gains can lead to improve service delivery

At the Miller site, the distinctions between the control group and the intervention group remain noteworthy. At the six-month mark only 7.84% of families in the control group showed up for the child and family health check, compared to a significantly higher attendance rate of 33.33% in the intervention group. This suggests that the intervention is indeed making strides in boosting attendance rates. Acknowledging the differences in health seeking behaviour, socio-economic backgrounds and educational levels of families in this area, is key to enhancing services for families in South West Sydney.

Through their integrated care model, the FDCC project has proven to improve access to vital healthcare services and fosters healthier futures for children by catering to the unique needs of migrant and refugee families. The project’s ongoing evolution looks to ensure that children from these families receive the necessary support to thrive during their crucial early years.