HEALTHY BEGINNINGS
Healthy Beginnings focuses on early intervention, alongside the monitoring and assessment of young children’s health and development during the critical early years of life. This aligns closely with priority areas identified by South Western Sydney Local Health District, NSW Health, and the Australian Government’s National Action Plan for the Health of Children and Young People 2020–2030. The program centres on three key domains: child development, social and emotional wellbeing, and early educational outcomes.
Every 9 minutes a child is born who is at risk of developing a Development and Mental health Disorder. One in every five Australian children starts school “developmentally vulnerable”, resulting in a deficit in one or more areas of child development (e.g. motor, language, socio-emotional, cognitive and behavioural. Clear inequities exist in the prevalence of developmental vulnerability in Australia with up to half of children from disadvantaged communities, such as South Western Sydney. Early childhood is a critical time of brain development and a period that sets the foundations for behaviours that track into adulthood. Early identification and early intervention, more monitoring and better responsiveness across the first 1000 days will provide the best outcomes for a child to have the best start in life, and a focus on the early years can provide a 13% return on investment.
The BestSTART-SW brings together expertise from Infant Child and Adolescent Mental Health Service (ICAMHS, SWSLHD), Child and Family Health, Oral Health services, Karitane, Allied Health and the SWSLHD Department of Community Paediatrics to consider child health outcomes including: child development, social and emotional wellbeing and early educational outcomes in keeping with the SWSLHD, state and national policy priorities.
Listed below are some of our projects under this initiative:
1) Strengths-based, tiered, accessible resources and supports (STARS) for Kids Centre of Research Excellence Program: The STARS for kids program aims to identify, link, and navigate families to the right services at the right place and time. This program will be co-designed with consumers and the community and developed by our team. This program consists of Universal Service via a ‘digital front door’ using the Watch Me Grow-Electronic (WMG-E) Platform, an innovative technology that provides unique opportunities to reach vulnerable families in their homes (critical during the current pandemic), or via opportunistic service contacts (such as GP clinic waiting rooms during vaccination or routine health contacts), early childhood education services such as supported play groups, or via multicultural, refugee or Aboriginal services etc. and enable an integrated approach to identify and then support the child’s developmental, parental mental health, and wellbeing needs. WMG-E has been tested for child development and we propose to expand this to screen and address parents’ mental health and psychosocial needs – optimising the family’s wellbeing. Further, the program will provide tiered service based on individual needs, ranging from anticipatory guidance and health literacy (Tier 1); b) targeted services as per need and risk level (Tier 2); c) specialised supports (Tier 3) including family life skills and complex psychosocial supports via service navigation at Integrated, place-based Child and Family Hubs.
Funder: 2021 MRFF Chronic Neurological Conditions Grant Opportunity funding of $1,964,141.99.
2) The Integrated Kids Hubs – Ensuring Equity of Access for Children: The Integrated Kids Hubs – Ensuring Equity of Access for Children project aims to determine if integrated Hubs are effective in increasing access to child and family services for disadvantaged urban and regional families with children aged 3 years and under, thus improving early identification of developmental vulnerability, parental wellbeing and capacity, and addressing unmet psychosocial needs. If these issues are not identified and addressed early, these children will go on to struggle in school and life. We will use a pragmatic trial design (meaning the research is embedded in our usual practice), determine the social return on investment, and establish what is needed to scale up the Hubs across NSW and Australia.
Funder: ARC Linkage grant (ARC funding of $917,285 & Partners $641,158 = $1,558,443)
3) “Watch Me Grow”: Changing practice to improve Universal Child Health and Developmental Surveillance in the primary care setting: A cluster Randomised Controlled Trial (RCT) to develop a ‘universal’ surveillance of developmental problems in young children (18-24m). The trial of the WMG webapp in the GP practice setting has practice and policy implications for developmental surveillance to be done by the GP using the opportunistic contact during immunisation visits.
Funder: NHMRC partnership grant
Key findings: The qualitative findings from the GP practices involved in the study has provided evidence base for a GP and Practice Nurse CPD module for developmental surveillance in collaboration with Royal Australian College of General Practitioners (RACGP) and Australian Primary Health Care Nurses Association (APNA). Further, the pilot work completed at Myhealth Oran Park was instrumental in obtaining leveraged funding from NSW Health for a Covid-19 grant to extend the use of the WMG weblink for parental mental health and social care needs.
4) Ashcroft Wellbeing Mirrung Hub Project: This project evaluates a place-based wellbeing hub designed to support children and families within the Ashcroft community through integrated and co-designed services. The initiative combines digital developmental screening, psychosocial supports, and community engagement to improve child development, parental mental health, and family wellbeing. The evaluation also explores the acceptability, feasibility, and cost-effectiveness of the hub model through interviews and stakeholder workshops.
5) Brighter Beginnings Preschool Checks: This statewide initiative aims to increase the proportion of children receiving health and developmental checks before starting school. The program brings together NSW Health and the Department of Education to support early identification of developmental vulnerabilities and improve school readiness. By strengthening early intervention pathways, the project seeks to improve long-term health, education, and social outcomes for children across NSW.
6) Keeping the Infant in Mind: This longitudinal study investigates how early relational trauma and parenting processes influence children’s emotional and behavioural development. The project examines factors such as parental sensitivity, emotion processing, mentalisation, and child temperament across early childhood. Findings are expected to improve understanding of early risk and protective factors associated with socioemotional development.
7) PCIT-T as Prevention: Pilot Study: This study evaluates Parent-Child Interaction Therapy for Toddlers (PCIT-T) as an early prevention program delivered online to families experiencing social or psychological challenges. The project aims to strengthen parent-child relationships and improve behavioural and emotional outcomes in toddlers. The study also explores the feasibility and effectiveness of delivering early parenting interventions through accessible digital platforms.
8) The Neurobiology of Disruptive Behaviour Disorder Subtypes in Early Childhood and Parenting Sensitivity: This project examines the biological and environmental contributors to disruptive behaviour disorders in young children. The study investigates associations between genetic factors, parenting sensitivity, child characteristics, and environmental influences. The findings aim to improve understanding of early pathways to disruptive behaviour and inform more targeted intervention strategies.
9) Evaluating the promotive and protective effects of positive childhood experiences on adult outcomes: This project explores how positive childhood experiences contribute to improved adult mental health and wellbeing outcomes. The study examines the extent to which supportive early experiences can buffer against adversity and promote resilience across the lifespan. The findings aim to strengthen evidence around prevention and early intervention approaches in child mental health.
10) Physiological and Neural Synchrony in Father-Child Rough and Tumble Play: This study investigates physiological and neural synchrony between fathers and children during rough-and-tumble play interactions. The project aims to better understand the role of father-child play in child socioemotional and neurodevelopmental outcomes. Findings may contribute to improved understanding of positive parent-child interactions and their influence on child development.
11) Nurturing Connections: This project evaluates an attachment-based intervention designed to support vulnerable caregivers and strengthen caregiver-infant relationships. Implemented across multiple Local Health Districts, the evaluation examines program effectiveness, acceptability, and service delivery processes. Findings will contribute to evidence regarding attachment-focused interventions within community and perinatal services.
12) Bubs Quit Project: An NHMRC-funded smoking cessation project focused on improving maternal and infant health outcomes among pregnant women. The project aims to support behaviour change during pregnancy through evidence-based cessation strategies and targeted support for high-risk populations. It also seeks to reduce inequities in perinatal health outcomes associated with tobacco exposure.
HEALTH SYSTEMS RESEARCH, POPULATION CHILD HEALTH, AND HEALTH EQUITY
Health Systems Research aims to evaluate new integrated models of care, making sure that families can access the right level of care (e.g., GPs, specialists) when they need it. Our work targets health systems delivery for children with complex health needs and those with chronic health conditions, which is a priority area for SWSLHD.
Listed below are some of our projects under these initiatives:
1) Psychosocial adversities in childhood and access to intervention and support in South Western Sydney – Pathways for amelioration: Early identification and intervention are key to reducing potential negative health impacts amongst vulnerable children and youth. SWSLHD Community Paediatric clinics already have an adverse childhood experiences (ACE) checklist in routine use. As part of a service improvement initiative, we aimed to assess the relationship between children’s exposure to early adversities, clinicians’ ability to respond to these, and children’s access to recommended interventions to optimise their development.
2) Electronic Practice Based Research Network/MedicineInsight: We are working with MedicineInsight, a data repository of data from 600+ general practices nationally, to determine its data quality and fitness for purpose for primary care research and development. By also harmonising MedicineInsight with a common data model that we have applied in the electronic Practice Based Research Network (ePBRN) work (this linked SWSLHD and GP data), we have a potential pathway to include GP data in the data observatory. In addition to this first step to large scale data linkage that includes BestSTART’s footprint, we have also established a secure research environment for digital health (SREDH) research that is compliant to UNSW and NPS standards for cybersecurity. This is a more flexible alternative to ERICA in terms of accommodating our library of open-source tools.
3) Aboriginal Health Service Mapping Exercise: Equity focussed pathways – Collaboration with Aboriginal Health mapping and addressing service gaps. An initial report of Aboriginal early intervention services was created in collaboration with Community paediatrics, Aboriginal Health, and Western Sydney University. This report is the foundation for further research into the quantitative analysis of services and the qualitative mapping of client experiences.
4) Improving the child and family health service system for Aboriginal Children and Young People in South West Sydney through culturally responsive, integrated pathways: This is a mixed-methods evaluation, involving an audit of clinical encounters, development of a Cultural Audit tool and qualitative interviews of staff via yarning circles.
5) Exploring Inequity for Children with Neurodevelopmental Disabilities in South Western Sydney: SWS is a culturally and linguistically diverse region with marked social disadvantage. Using the best available data sources, we aimed to explore the prevalence of children with developmental disability and their access to disability support services through the National Disability Insurance Scheme and Department of Education.
6) Economic Evaluations for People on the Autism Spectrum and/or with Intellectual Disability: This project examines how economic evaluations can better incorporate the lived experiences of young people with developmental disabilities and their families. The study aims to move beyond narrow cost-saving perspectives and capture broader societal and individual value. Findings are expected to improve the relevance and inclusivity of future disability-related economic evaluations and policy decisions.
MENTAL HEALTH
This theme is focussed on understanding child, family, and institutional processes that lead to mental health concerns. This includes working closely with the district’s ICAMHS unit, children, and young people, to co-design research projects aimed at improving mental health outcomes.
Listed below are some of our projects under these initiatives:
1) BestSTART-SWS Youth Advisory Council: This initiative engages young people in identifying research priorities related to their health and wellbeing and supports co-design of future research that reflects their needs and perspectives. It also strengthens youth participation in health system planning and decision-making. Although “mental health” was not initially a BestSTART theme, consultations with children and young people in South Western Sydney highlighted it as a key priority. In response, it was incorporated into the program’s research focus, reflecting broader concerns such as rising self-harm rates, stress, discrimination, and self-esteem challenges. The initiative builds on strong partnerships across researchers, services, and the community to support grassroots collaboration and the co-development of mental health research and interventions.
2) Evaluation of the Safeguards Child and Adolescent Acute Response Teams (CAARTs): The Safeguards Teams Program: This evaluation examines the implementation, impact, and economic outcomes of a rapid-response mental health service for children and adolescents experiencing acute mental health crises. The program aims to provide trauma-informed assessment, brief intervention, and improved navigation across fragmented CAMHS pathways. The project also evaluates whether the model reduces unnecessary emergency department presentations and hospital admissions.
3) Evaluation of the National Perinatal & Infant Mental Health – ForWhen Program: This national evaluation examines the implementation and effectiveness of the ForWhen navigation service supporting perinatal and infant mental health. The study evaluates service reach, utilisation, clinical outcomes, and stakeholder experiences across Australia. Findings will inform future approaches to navigation and service coordination within perinatal mental health care systems.
4) Mind Link project: Mind Link is a consultation and workforce development model that strengthens collaboration between paediatrics and child and adolescent mental health services. The project aims to build mental health capability within paediatric settings and improve integrated care for children and young people. It also seeks to enhance cross-disciplinary knowledge sharing and service coordination.
5) Co-designing an implementation strategy for a youth suicide prevention digital health intervention in hospitals – A scoping study: This project aims to co-design implementation strategies for youth suicide prevention digital health interventions within hospital emergency departments. The study focuses on improving feasibility, integration, and acceptability of digital supports for young people presenting in crisis. The findings will help inform future implementation of digital mental health interventions within acute care settings.
6) Joining the Dots: A new model of continuity of perinatal mental health care for the “missing middle”: This project evaluates a new continuity-of-care model designed to support women experiencing mild-to-moderate perinatal psychological distress. The initiative aims to address service gaps for women whose needs may not meet thresholds for specialist mental health services but still require structured support. The study will assess implementation, acceptability, and impacts on maternal mental health outcomes.
7) IAR-DST quality improvement project: This project examines how the Initial Assessment and Referral Decision Support Tool is used in routine practice to support clinical decision-making and improve coordination of care for children and young people across services. It aims to understand whether the tool helps better match young people’s needs with appropriate levels of support and strengthens consistency across the service system.
The project involves a clinical audit of de-identified cases, clinician interviews on real-world use of the tool, and a knowledge translation phase to share findings and support service improvement. Conducted across health, NGO, and education settings in South Western Sydney Local Health District, it is designed to inform system-level improvements rather than evaluate individual service performance.
8) Improving the outcomes for children with Tourette Syndrome and comorbid mental health conditions: A program focused on improving early identification and integrated care for children with Tourette Syndrome and co-occurring mental health conditions. It aims to strengthen clinical pathways and workforce capability across multidisciplinary settings. The project also seeks to improve long-term psychosocial and functional outcomes.
9) Intellectual and Developmental Disability Training for Healthcare Providers (Vietnam Project): This project develops a structured training framework to strengthen healthcare provider capability in the assessment and rehabilitation of intellectual and developmental disabilities. It focuses on improving clinical knowledge, diagnostic accuracy, and service delivery in low-resource or capacity-limited settings. The program is designed to support sustainable workforce development and improved patient outcomes.
10) Lifestyle Interventions for Adverse Effects of Anti-psychotics (Growing Minds Australia): A trial evaluating lifestyle-based interventions designed to mitigate metabolic and physical health side effects associated with antipsychotic medication use in children. It focuses on improving diet, physical activity, and overall health behaviours within paediatric mental health care. The study also examines feasibility and clinical effectiveness in routine service settings.
11) Neurodevelopmental Assessment Scale (NAS): Development of a cross-domain neurodevelopmental assessment tool designed to identify functional impairments across a range of neurodevelopmental presentations. The scale integrates cognitive, behavioural, and adaptive functioning domains into a unified assessment framework. It aims to improve early identification and support planning for children with complex needs.
12) Links between previous trauma, emotional information processing, and parenting sensitivity & mentalising: This project examines how prior trauma exposure influences emotional information processing and subsequent parenting behaviours. It explores associations with parenting sensitivity and mentalising capacity to better understand intergenerational pathways of risk. Findings aim to inform interventions that support caregiver–child relationships.
13) The Feasibility and Perceived Effectiveness of Psychological Interventions for Tics: This study evaluates the feasibility and perceived effectiveness of cognitive behavioural interventions for children and adolescents with tic disorders. It examines acceptability from both clinician and participant perspectives alongside preliminary clinical outcomes. The findings will inform scalable intervention models for tic management in youth mental health services.
DATA OBSERVATORY PLATFORM
The BestSTART-SWS Data Observatory Platform includes the district’s routinely collected data as well as information gathered throughout the studies families take part in. The data observatory aims to link available health data for all children born in South Western Sydney Local Health District (SWSLHD) so we can untangle the complex relationships leading to resilience and ill-health, map the trajectory of the district, and ensuring the district is at the cutting edge of big data, using it to inform services and solutions.
