Well Child

Background

Review of the Well Child Framework

Resources

Questions and Answers

Well Child
Questions and Answers

What are Well Child services?
Well Child Tamariki Ora services are a screening, education and support service offered to all New Zealand children and their families or whanau from birth to 5 years. The services assist and support families and whanau to improve and protect their children’s health.

Well Child services are provided by registered nurses and community health workers /kaiawhina) with specific training in child health. The current Well Child Schedule includes 12 health checks (contacts) with 8 of these offered to children aged from 6 weeks to 5 years. At present not all children receive all 12 contacts.

First time parents and families requiring extra support are offered additional contacts. Some contacts are carried out in the home and others in clinics or community facilities.

In the 2006 budget the Government announced funding for new initiatives including newborn hearing screening and a "transition to school'' health check for four year olds. Additional funding was also pledged to ensure all pre-school children received their full entitlement.

What is the Well Child Framework?
The Well Child Tamariki Ora Framework and the associated Well Child/Tamariki Ora National Schedule Handbook were agreed in 2002-2003. The aim of the Framework is to support families/whanau to maximise their children’s health status and developmental potential from birth to five years, establishing a strong foundation for ongoing healthy development.

The Framework consists of a service delivery framework and a pricing framework. The schedule incorporates the key public health concepts of supportive environments, disease prevention, and health promotion.

How much is spent on Well Child services?
Currently the Government spends around $45 million dollars per year on Well Child Tamariki Ora services. The services are delivered by a variety of providers including Maori and Pacific providers. Some additional Well Child services are funded through dental, maternity and primary care budgets.

Details of the 2006 funding package are as follows;

$40.8 million over four years for a strengthened child and adolescent oral health service to include the rebuilding and re-equipping of the School Dental Service, with additional capital expenditure,
$23.6 million over four years to create a '’Transition to school' health check for four year olds and ensure that pre-school children receive all their Well Child checks,
$16 million over four years for the creation of a universal newborn hearing screening programme.

What is the Well Child Framework Review and how did it come about?
The Government requested that the Ministry of Health undertake a review of the Well Child Framework. This request reflects Government’s ongoing commitment to child health and the need to ensure that Well Child services effectively meet the needs of children and their families. The review also responds to the Government's request that the final Well Child check becomes more focused on the adequate preparation of children for school entry.

The Well Child Framework review will include;

whether the services are reaching children and families
whether the services are reaching those families who need extra support
the content of the contacts and whether this can be improved
what the appropriate number of contacts is
how best to provide the ‘transition to school’ check
the effectiveness, efficiency and quality of the services
the linkages between Well Child and other early childhood services
the linkages between Well Child and primary health care services
the linkages between Well Child services and other government initiatives.

What is a ‘transition to school’ check?
A ‘transition to school’ check has been proposed to ensure that children are adequately prepared for school entry. Work is underway looking at how, when and where this final Well Child check might best be delivered, by whom and what this should include.

It is likely that vision, hearing, growth and development will be part of the service as well as assessment of personal and social issues. The child’s ability to learn and communicate will also be included.

How many Well Child checks are currently carried out?
The Ministry does not currently have a national register of Well Child contacts; however KidsLink in Counties Manukau District Health Board maintains a local register of Well Child events.

It is possible that the review of the Well Child Framework will make recommendations about a national Well Child information system to record Well Child service provision. A National Immunisation Register is already in place to record immunisation events.

It is also possible that the review may recommend changing the way in which some Well Child contacts are offered, recognising that some families may need more support and others less.

What is the Ministry of Health doing about children who are not accessing Well Child services or falling through the gaps?
Well Child services are available to all New Zealand families but the services are not compulsory.

The review of the Well Child Framework will focus on reducing inequalities and examine options for children who are not currently being reached by these services. Recommendations from the review may include alternative delivery options, the establishment of a national Well Child register and improved linkages with other providers and agencies.

What are the time frames for the Well Child Framework Review?

July 2006 Review of Well Child Framework begins
August 2006 Literature reviews completed, communications strategy launched
August September 2006 Steering, Reference and Advisory groups set up, initial consultation with the sector/providers
October – March 2007 Options/Discussion paper drafted
April/May 2007 Discussion paper released and consultation with sector/providers
June/July 2007 Analysis of submissions
August – October 2007 Recommendations paper developed
November 2007 Changes/amendments announced
December 2007 Implementation of recommendations begins

What is happening with newborn hearing screening?
Each year between 135 and 170 babies are born in New Zealand with a mild to profound permanent congenital hearing loss. The average age of detecting moderate to profound hearing loss in New Zealand is nearly 4 years of age, and the effects of late diagnosis are considerable. Lack of exposure to language early in a child’s life can lead to serious, on-going problems with a child’s development, communication skills, educational and career achievement.

Early detection is crucial. It enables early interventions to be made that can result in improved outcomes for children and their families. Interventions are a joint responsibility between the Ministries of Health and Education. These can include resource materials and support groups for parents, the introduction of communication strategies such as sign language to a child’s early learning and access to assistive technologies such as hearing aids and cochlear implants.

Currently there is no formal hearing screening until children start school; however as part of the Well Child programme, parents are asked about indicators of hearing in their children.

An expert advisory group has recommended setting up a universal newborn hearing screening programme. Officials are considering a range of information, including an independent evaluation of the Waikato pilot programme, an economic evaluation and a literature review of best practice. A range of options will be presented to the Ministers of Education and Health as soon as possible. Feedback and advice will be sought from a range of key stakeholders to aid the development of a universal newborn hearing screening programme.

Page updated: September 2006