A public health approach aims to prevent or reduce a particular illness or social problem in a population by identifying risk indicators. It is an approach that aims to prevent problems occurring in the first place, quickly respond to problems if they do occur, and minimise any long-term effects – and prevent reoccurrence.

The public health approach

All families play a vital role in providing children with a safe and supportive environment. As problematic family circumstances and environments could arise in any family at any time, supports and appropriate interventions should be widely available to all, with targeted back-ups for those requiring more intense support.

In Australia, the public health model is recognised as the appropriate platform for ensuring the safety and wellbeing of children (e.g., the National Framework for Protecting Australia’s Children 2009-2020). It comprises three platforms: primary, secondary and tertiary services.

The greatest investment should be in primary prevention services, as they reach the largest numberof families. If successfully implemented, primary prevention services will shift the “risk profile” positively for the entire community, meaning that fewer children and families will need more intensive secondary or tertiary services.

Primary or universal services are delivered to the whole community in order to provide support before problems occur. They may focus on changing cultural and societal norms, such as beliefs about the use of corporal punishment, information and supports for all families about positive parenting practices, policy and legal reforms, and alleviating social inequalities. Social marketing campaigns often accompany primary approaches, but their effectiveness is limited unless they are linked to discrete actions and sources of support for implementing the targeted beliefs, attitudes and behaviours. They are best implemented using universal service delivery platforms that all families already access – such as health services, early childhood education and care, schools, and other community services including transport, housing, disability, and local child, youth, and family services provided by councils and community organisations.

Secondary services target families where there is a higher risk of child maltreatment. Risk indicators for maltreatment can include poverty, parental mental health problems, parental relationship conflict and/or breakdown, family violence, and parental drug and alcohol misuse. The presence of a risk indicator/s does not mean that a child will experience maltreatment; however, the likelihood of maltreatment occurring increases when a child or family experiences greater vulnerability due to financial strain, family violence, substance misuse, etc.

Secondary interventions also need to be based on solid evidence of their efficacy so that funders can be confident that the “investment” will pay off (for some examples, see these evidence-based programme profiles). Secondary interventions usually involve early screening to identify children who are most at risk or targeting families in circumstances that are indicative of vulnerability, followed by a combination of interventions to address risk indicators for child maltreatment. An example of a secondary intervention is the Communities for Children program, which supports organisations to deliver programs and activities targeted to meet the needs of children and families living in disadvantaged areas.

Tertiary services target families where child abuse or neglect has already occurred or is believed to have occurred. Primarily, these are statutory child protection services that aim to meet the ongoing safety needs of children unable to remain safely in the care of their parents (i.e., out-of-home care systems), as well as therapeutic services to address trauma. Tertiary interventions aim to reduce the long-term implications of maltreatment and to prevent maltreatment reoccurring. Central to a public health approach is a focus on prevention, which means prioritising services, information, and supports through primary prevention (universal) platforms, linked to a comprehensive suite of secondary services to assist families (“progressive universalism”).

Limitations of a public health approach

• There is evidence to support the efficacy of a public health approach; however, the evidence base is still limited.
• While governments still focus efforts on secondary and tertiary services (which communities typically expect), it is difficult to find resources to appropriately prioritise universal services and public health-style campaigns and interventions to reach the most families.
• Important gains have been achieved in the last 30 years with certain programs, such as home visitation programs for young parents experiencing vulnerable circumstances, which have been shown to be effective in reducing child maltreatment. Further evaluations of existing public health interventions are now required to ensure programs are effective.
• A public health approach attempts to categorise programs and services as primary, secondary or tertiary; however, there is a need for some programs to be both primary and secondary, or secondary and tertiary due to the complexity of issues surrounding child protection. Referred to as “progressive universalism”, this means having the capacity within a universal service delivery platform (such as a school) to ramp up the intensity or nature of services to meet the needs of those for whom a standard service is not enough (e.g., a school-based hub where family support workers and other professionals using evidence-based programs to equip parents with better parenting skills, or address their vulnerabilities, such as substance misuse or mental illness).

Conclusion

According to a public health model, primary, secondary and tertiary services are all critical elements in the child welfare and protection system. However, a well-balanced system has primary services as the largest component of the service system, with secondary and tertiary services comprising progressively smaller components of the service system. Investment in primary prevention programs has the greatest likelihood of preventing progression along the service continuum and sparing children and families from the harmful consequences of abuse and neglect.

Further reading

• A public health approach to enhancing safe and supportive family environments for children: An article on Australia's public health approach to child protection.
• Defining the public health model for the child welfare services context: An overview of the public health model and how it applies to the Australian child welfare and child protection system.
• Families, policy and the law: Selected essays on contemporary issues for Australia
• Positioning a public health framework at the intersection of child maltreatment and intimate partner violence: An article discussing the public health model of prevention for child maltreatment and family violence.
• Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities: A select group of strategies based on the best available evidence to help prevent child abuse and neglect.
• Protecting children: Evolving systems: An article that highlights the rapid expansion of child protection systems in Australia since the 1980 and examines the National Framework for Protecting Australia's Children.
• Safe and Supportive Family Environments: An article summarising a report about safe and supportive family environments for children.
• Supporting Parents the Biggest Priority: An article discussing the importance of providing parents with support and resources.
• The Triple P-Positive Parenting Program: An example of a public health approach to evidence-based parenting support: An article that discusses how to design and disseminate a system of parenting support within a public health framework in Australia.
• Are social marketing campaigns effective in preventing child abuse and neglect?: An overview of the evidence for the impact of media-based social marketing campaigns related to child protection, parenting and child abuse prevention.

The feature image is by Tania Caruso, CC BY-NC-ND 2.0.