Abstract
BackgroundUniversal child health services (UCHS) provide an important pragmatic platform for the delivery of universal and targeted interventions to support families and optimize child health outcomes. We aimed to identify brief, evidence-based interventions for common health and developmental problems that could be potentially implemented in UCHS.MethodsA restricted evidence assessment (REA) of electronic databases and grey literature was undertaken covering January 2006 to August 2019. Studies were eligible if (i) outcomes related to one or more of four areas: child social and emotional wellbeing (SEWB), infant sleep, home learning environment or parent mental health, (ii) a comparison group was used, (iii) universal or targeted intervention were delivered in non-tertiary settings, (iv) interventions did not last more than 4 sessions, and (v) children were aged between 2 weeks postpartum and 5 years at baseline.ResultsSeventeen studies met the eligibility criteria. Of these, three interventions could possibly be implemented at scale within UCHS platforms: (1) a universal child behavioural intervention which did not affect its primary outcome of infant sleep but improved parental mental health, (2) a universal screening programme which improved maternal mental health, and (3) a targeted child behavioural intervention which improved parent-reported infant sleep problems and parental mental health. Key lessons learnt include: (1) Interventions should impart the maximal amount of information within an initial session with future sessions reinforcing key messages, (2) Interventions should see the family as a holistic unit by considering the needs of parents with an emphasis on identification, triage and referral, and (3) Brief interventions may be more acceptable for stigmatized topics, but still entail considerable barriers that deter the most vulnerable.ConclusionsDelivery and evaluation of brief evidence-based interventions from a UCHS could lead to improved maternal and child health outcomes through a more responsive and equitable service. We recommend three interventions that meet our criteria of “best bet” interventions.
Highlights
Universal child health services (UCHS) provide an important pragmatic platform for the delivery of universal and targeted interventions to support families and optimize child health outcomes
Four studies primarily focused on infant sleep outcomes [44,45,46,47]: of which, two assessed parental mental health and child social and emotional wellbeing (SEWB) [44, 45] and one assessed parental mental health [47]
Four studies focused on parental mental health and reported on no other outcome areas [53,54,55,56,57]
Summary
Universal child health services (UCHS) provide an important pragmatic platform for the delivery of universal and targeted interventions to support families and optimize child health outcomes. The high prevalence of common health and developmental problems in families is associated with increasing social disadvantage [7]. Prevention of these problems, known as ‘millennial morbidities’, is increasingly seen as critical to addressing inequity and the future human capital of countries [8, 9]. Inequity is commonly seen as the presence of systematic and potentially remediable differences among population groups [10] and, as intervening in early life is the most costeffective time to influence the health of an individual across the life course [11], it makes sense that universal child health services (UCHS) around the world are best placed to provide equitable and effective care. Most services consistently provide a platform for early identification and referral for health and developmental problems, support for at-risk families, and health and developmental promotion
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