The second in a series of forums for representatives of community child health services around Australia was held in Adelaide in May. The Child and Family Health Services of South Australia (CAFHS) initiated the forums as an opportunity to exchange information about policies and practices across the states, with health surveillance and immunisation identified as issues of mutual concern.

The first forum discussed the Personal Health Record booklet issued to the mother of each newborn infant in most states. These booklets are designed to be a lifelong record of development, immunisation, health and screening results. They also contain information for parents on child development and health.

South Australia, which has used Personal Health Records the longest (since 1982), has found they are well used by parents and CAFHS but not by general practitioners. There was general agreement that it would be useful to have a national version of the Personal Health Record.

A highlight of the second forum was a presentation by each state on successful child and maternal health projects.

• Western Australia reported on its high school nurses. The scheme, piloted in 1974, was a success from the start. Nurses are located in high schools with a health centre/consulting room and sick bay. They counsel on health-related issues, and crises such as child abuse, pregnancy, suicide and substance abuse. They take part in pastoral care with teachers and also work in feeder primary schools so that they will keep in contact with the same children as they reach high school.

Nurses are assuming a broader role with programs such as the Suicide Prevention Package, which was developed by the Ministry of Education and the Health Department after a working party was set up to look at teenage suicide. The package was developed to assist school staff to deal with a suicide attempt or a suicide, and looks at the role of the school in suicide prevention.

• Victoria reported on how it has managed to achieve the highest rate of immunisation in Australia. Under the Health Act, children must have a School Entry Immunisation Certificate or they may not be enrolled in school. This certificate, which is issued by local council health departments, indicates that the child has been immunised or that there is a good reason why not. Immunisation in most local government areas is recorded on a data base.
• South Australia reported on two aspects of its service: the flying nurse and parent education. The nurse, who has a pilot's licence, flies to outlying towns, avoiding the need to station nurses there permanently who then must spent a great deal of time on the road driving to service surrounding areas. The flying nurse service has proved very successful.

With regard to parent education, South Australia wants to eradicate the idea that a 'good' mother frequently attends the child care clinic. Going too often to a clinic can undermine a mother's self esteem and feelings of competence in caring for her child, thus health checks are recommended at two weeks, six--eight weeks, four months, seven months, 15 months, two-and-a- half years and four-and-a-half years. Professionals are to give advice but not encourage dependency. Nurses also run parent education courses for parents of children in different age groups, building on parents' existing knowledge and fostering ongoing support groups that continue without professional guidance.

Twenty per cent of nurses' time should be allocated to parent education. Telephone counselling and additional individual health checks are still available to parents if they want them.

Nurses are being trained to adjust to this change in their roles. They are given three days in-service training on group dynamics, one day on the new baby package, and two days for the toddler and school age child packages. An adolescent package has just been completed and 80 staff trained on this.

There are manuals available for each of the age groups. As nurses become more confident, they become more flexible and less reliant on prepared material. Packages will eventually be developed for special groups. It is, however, too early to evaluate this program.

CAFHS also discussed research into what influences the compliance rate of parents whose children are referred on from screening for health problems at school entry. It is estimated that 30 per cent of children who are referred on with some problem are not taken for follow-up evaluation and treatment.

• Queensland now has a 008 free telephone number for 24-hour counselling for mothers with difficulties. There are also several research projects looking at aspects of child health and related issues. The first project reported had followed up 60 children who had been treated for sleeping difficulties to evaluate the success of the treatment; another project is examining breastfeeding trends in Queensland with a sample of 500 mothers. A third project is evaluating whether existing services are meeting parents' needs.
• The Australian Capital Territory reported on its Neighbours program, which is a parenting group for low income mothers in temporary housing. This group, which began in the carport of a block of flats, promotes awareness of health care for women and children. Child health nurses first had to be accepted by the mothers before dealing with issues such as low self esteem, limited communication skills, isolation, poor nutrition, low income, and drug and tobacco dependency.

The group recently had its second birthday and now has its own board of management although the nurses are still involved because of the transient population in the area. Achievements include: 100 per cent immunisation, an increased number of women using contraception, increased awareness of exposure to sun, fitness classes, awareness of cervical cancer and pap smears, reduction in smoking, awareness of nutrition, new mothers attending the infant welfare clinic through the Neighbours program and mothers supporting each other and overcoming their personal isolation.

The next forum, to be held in Victoria in November, will be jointly hosted by the state's Maternal and Child Health Unit and the Family Health services.