A Better Start E Tipu e Rea National Science Challenge has helped to inform the next steps for the country’s Well Child Tamariki Ora programme, which provides health and development screening for children from birth to five years.

A major review, commissioned by the Ministry of Health, has found the WCTO programme is outdated and inequitable, and is likely to change to become a whānau-led model.

A Better Start National Science Challenge researchers were commissioned to undertake a series of rapid reviews, providing expert analysis of 11 child wellbeing domains including parental mental health, excessive weight gain and poor growth, alcohol and drug use during pregnancy, and neurodevelopmental screening and surveillance.

Releasing the findings of the review this month, Associate Minister of Health Dr Ayesha Verrall said the WCTO programme was developed with good intent but needed more consistency in referring tamariki to specialist services.

“New Zealand’s population has changed significantly, and this programme has not kept pace with the needs of whānau including the impact of poverty, drug use, mental health challenges, housing and family situations. It needs better integration with other health, maternity, social and early learning services.

“That work must respond to the science around the first 1000 days of life, which shows strong evidence that investing in whanau during pregnancy and a baby’s early years can make the biggest difference to lifelong wellbeing.”

The Ministry of Health began a review of the Well Child programme, which is delivered by Whānau Āwhina Plunket and more than 60 other non-government organisations nationwide, two years ago to ensure it was delivering the best possible outcomes for tamariki and their whānau.

It commissioned A Better Start E Tipu e Rea National Science Challenge to undertake rapid evidence reviews of 11 child wellbeing domains, including:

  • Parental mental health problems during pregnancy and postnatal period
  • Social, emotional and behavioural mental health screening
  • Family violence screening and intervention
  • Neurodevelopmental screening and surveillance
  • Excessive weight gain and poor growth
  • Parent-child relationships, including caregiving and attachment
  • Vision screening in infancy and childhood
  • Hearing screening in childhood, excluding newborns
  • Parental alcohol, cannabis, methamphetamine and opioid use during pregnancy
  • Oral health promotion and early preventive interventions in a community setting
  • Adverse childhood experiences

Professor Wayne Cutfield, the Director of A Better Start, says the Challenge was in the best position to undertake the reviews because of its research expertise and diverse, multi-disciplinary science and health networks across New Zealand.

“A Better Start has a wide reach in the health sector and science networks, which allowed us to create great collaboration and deliver these 11 reviews in just three months for the Ministry of Health.

“One of A Better Start’s goals is to create and turn science and evidence into policy to effect positive real-world change. This is as close as you can get to creating large scale impact on a nationwide programme that monitors the health and wellbeing of our young tamariki,” says Professor Cutfield.

Review findings and next steps

The findings of the Well Child Tamariki Ora review identify that a whānau-led approach is needed to ensure equitable outcomes and to fully support tamariki who are Māori or Pacific, are living with disabilities, are in state care and/or have high needs, and to better integrate with other health, maternity, social and early learning services.

The report says the rapid evidence reviews undertaken by A Better Start identified some key areas where current approaches to screening, surveillance and assessment needs improvement, through either development and validation of new tools and processes or revision of existing ones.

These included:

  • Vision and hearing screening: “The current tool for vision screening is no longer supported by evidence, and new technologies are emerging that enable faster and more accurate vision screening. There is enough evidence to justify reconsideration of the recommended ages for hearing screening.”
  • Growth: “The rapid evidence review suggests there could be value in using body mass index (BMI) in contacts earlier than four years, because it can be used as a proxy measure of nutritional status. Before we make any changes to the way we measure growth, we must consider whānau perspectives and experiences, to ensure a positive, strengths-based approach to growth.”
  • Social, emotional, behavioural and communication development: “There is a significant risk that the current specified developmental surveillance tools are not well accepted by parents, and that they are not being administered consistently across the programme. Alternative developmental screening tools are available, in use and better accepted in other jurisdictions.”
  • Oral health: “There is not an evidence base for the current oral health risk assessment and examination activity undertaken within WCTO services and providers, Lift The Lip. We need a systems approach, to ensure community oral health services are available and accessible to support early intervention when oral health risk is identified. We need to provide workforce development for practitioners, to refresh the quality of the Lift The Lip intervention and ensure we assess oral health in the context of nutrition and parenting education.”

A Better Start E Tipu E Rea National Science Challenge documents commissioned to support the Well Child Tamariki Ora review:

A Better Start Evidence Reviews Well Child Tamariki Ora (PDF, 4.9MB)

WCTO Domain 1– Neurodevelopmental screening and surveillance (PDF, 1.6MB)

WCTO Domain 2 – Parent-child relationships, including caregiving and attachment (PDF, 1.2MB)

WCTO Domain 3 – Social, emotional and behavioural mental health screening (PDF, 1.2MB)

WCTO Domain 4 – Parental mental health problems during pregnancy and the postnatal period (PDF, 1.3MB)

WCTO Domain 5 – Parental alcohol, cannabis, methamphetamine and opioid use during pregnancy (PDF, 1.2MB)

WCTO Domain 6 – Excessive weight gain and poor growth (PDF, 1.4MB)

WCTO Domain 7 – Vision screening in infancy and childhood (PDF, 2.1MB)

WCTO Domain 8 – Oral health promotion and early preventive interventions in a community setting (PDF, 2.3MB)

WCTO Domain 9 – Adverse childhood experiences (PDF, 1.5MB)

WCTO Domain 10 – Hearing screening in childhood, excluding newborns (PDF, 1.2MB)

WCTO Domain 10 – Hearing screening in childhood, excluding newborns (PDF, 1.2MB)

WCTO Domain 11 – Family violence screening and intervention (PDF, 1.5MB)

The full Well Child Tamariki Ora Review report:

Well Child Tamariki Ora Review Report July 2021 Well Child Tamariki Ora Review Report July 2021 (PDF, 16.8MB)