Check-ups before school: accessible, collaborative and integrated health and education in early childhood for families experiencing economic disadvantage in Australia

Children in families experiencing socioeconomic disadvantage are more likely to start school with unaddressed developmental needs than children who do not experience disadvantage. Participation in well-child checks and developmental screening programs is low in Australian disadvantaged communities. This research explores an integrated approach to addressing this challenge by embedding place-based child and family nurses in early childhood education settings and community centres to facilitate easy access for families to health services. We conducted a mixed methods study, employing focus group, survey, interview and data linkage methods to evaluate a trial of the 'Check-Ups Before School' (CUBS) program. Our participants included health and community service providers, early childhood educators, primary school teachers, parents and carers. We found that a child health check, conducted in a safe and familiar environment for the child and their family, can act as a catalyst for wrap-around care and service integration. Such an approach should be place-based, listen to families and provide them with tools and information for agency, where relationships are fundamental to good care and supported by information flow through the family's ecological environment, particularly in the transition to school. These findings can inform agencies in the design and implementation of integrated health and school readiness initiatives for children in the early years. Also discussed in the paper are policy implications for realising the potential of early childhood services as 'community hubs' and sites for integrated health and education, as well as implications for the role of educators as 'brokers' in relationships between parents/family members and health professionals.