Translating 'proportionate universal healthcare' into meaningful system design to optimize equity in child and family services.
Lynn Kemp, Kathy Donohoe, Prue Matthews and 1 others
PMID 38922956WHAT IT FOUND
Child and family health nursing contacts before redesign did not vary by family risk.
In the pilot, nurses reported less faking but no burnout improvement, while MECSH home-visiting families showed increased good ability to adapt and self-manage.
Key findings
01Before redesign, child and family health nursing contact patterns were very similar across low, moderate and high psychosocial risk groups, with only slight evidence of extended or intensive provision for higher risk groups.
02In the nurse pre-post survey, deep acting increased and surface acting and faking decreased, but emotional exhaustion and depersonalization increased and personal accomplishment decreased; these burnout changes were small and not statistically significant.
03Among families in the MECSH sustained home-visiting programme, the proportion assessed as having good ability to adapt and self-manage increased from 61.4 per cent on enrolment to 72.1 per cent on exit, and poor ability reduced from 13.1 to 4.5 per cent.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single pilot region in one health district, so scalability to other services is not established. Small nurse samples: 13 completed the pre-redesign survey and 13 completed the post-redesign survey, and anonymous responses mean paired changes were unknown. No post-redesign administrative data were available to assess whether service use became proportional to risk. The pilot delivered new service pathways, assessment tools, training, MECSH home visiting and change-management support together, so the contribution of any single component cannot be separated. COVID-19 redeployment, bushfires and pandemic service changes disrupted caseload build, timing and client help-seeking. Transition groups and pathways to treatment or child protection were not assessed. Child health and development outcomes were not measured after redesign, so impact on children was not shown.
Declared interests
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The authors have no conflicts of interest.
The easy way to misread this
Do not conclude that the redesigned service system alone improved family outcomes or nurse wellbeing. The pilot delivered new service pathways, assessment tools, training, MECSH sustained home visiting and change-management support together, and nurse burnout did not improve.