Guest Editorial

Child and Family Health Nursing and Early Intervention

Gay Edgecombe
Community Child Health Nursing, RMIT University, VIC

PP: 143 - 144

Article Text

Child and family health nurses around Australia provide a universal service (free to families at the point of access) to most families with infants and young children. School nurses work with families and their school-aged children and adolescents. Services may vary from state to state and territory but the goals are similar: to provide infants, children and adolescents and their families with a range of professional services that have a strong emphasis on prevention, early intervention, support and referral to other services.

Early Intervention

What does early intervention mean and why is it so important? Early intervention can mean intervening early through working with parent(s) during pregnancy and infancy or it can mean intervening early during a key transition point or pathway in an individual's life. Transition points and pathways have been described in Pathways to Prevention (1999) and by the Department of Human Services, Victoria (2002: 25):

...early intervention is characterised by an emphasis on pathways and transition points. Pathways are the 'road through life' that fork out in different directions at critical points that mark new relationships or experiences. At each of these transition points, there is a possibility of more than one outcome. One crucial consequence of a focus on pathways is that 'early intervention' means intervention early in the pathway. This may not mean early in life. This approach does not deny the importance of intervening early in life. However it does propose that early intervention may also occur at key transition points, in order to divert people from harmful pathways before maladaptive patterns of behaviour are well entrenched.

The literature on causal pathways provides insight into other aspects of early intervention. Stanley (2002) described causal pathways as:

• complex
• start early in life
• arise in social and environmental adversity
• inadequately researched
• research is fragmented and undertaken in silos an does not inform solution.

Further, she (2002) pointed out that causal pathways open up opportunities for intervention. Stanley stated that designing an intervention for a single risk factor cause is not effective because human development is shaped by many factors leading to vulnerability. The best way to intervene in her view was:

• at key developmental transition points, and
• at early and later intervention points.

In providing an example of causal pathways she explained that causal pathways for adolescents may have all or some of the following elements:

• no sense of belonging/connectedness
• no sense of control/chronic stress
• no social support/social skills/social networks
• limited participation with family/school/community
• no significant adults about
• no experience of success.

Stanley, Sanson & McMichael (2002: 11-12) are of the view that 'Causal pathways thinking opens up concepts of multiple outcomes from single pathways (multifinality) and multiple pathways to single outcomes (equifinality).'

There has been a renewed interest in early intervention early in life as a result of new research on brain development, particularly during the first three years of life that has 'clearly shown that a child's brain development is intimately linked to, and influenced by, the child's environment - a complex interaction between genetic inheritance and experience.' (Department of Human Services 2001: 1).

Implications

Child and family nurses have understood for many decades about the need for early intervention. They now have stronger evidence to support their professional practice and a growing literature on differing interpretations of early intervention and how such approaches can be viewed and improved. Parents need to be provided with the support they need when they need it. Yet we know that many parents do not receive early intervention services in a timely manner, particularly during the first weeks following the birth of their child.

How well are universal child and family nursing early intervention services linked into services such as acute midwifery services, school health and general practice? There appears to be confusion between some midwifery services about what day post delivery families should be linked into universal child and family nursing programs. Likewise, some universal child and family services appear unclear about when their services are available post delivery to families.

Universal child and family nursing programs must be well integrated and flexible to ensure that parents do receive the early intervention support they need for their infants, children and adolescents.

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