Estimating hepatitis A immunity and outbreak risk among MSM in New South Wales, Australia, 2017-2018.

Families of young children in the United States are struggling. Parents face numerous challenges, including rising childcare costs, increases in mental health disorders, and growing social isolation and loneliness (Herbst, ; Khadka et al., ; Nowland et al., ). These challenges impact parents’ ability to provide safe, stable, and nurturing environments needed for optimal child development (Frosch et al., ). One in five mothers experience a mental health problem during pregnancy or the postnatal period (Fawcett et al., ), which, in turn, increases the risk of child maltreatment (Ayers et al., ). Almost 3 million children are investigated annually for experiencing abuse or neglect (US DHHS, ), and over one third of all children born in America will have been investigated by Child Protective Services for the experience of child maltreatment before age 18 (Kim et al., ). Child outcomes in the USA are poor compared to other industrialized nations and were exacerbated by the COVID-19 pandemic. Despite spending more than three times more per capita on healthcare than other developed nations, the USA ranks 33 out of the 38 nations in the Organisation of Economic Co-operation and Development (OECD) in the birth-to-five mortality rate (Gumas et al., ). Nearly 15% of 9–24-month-olds have a developmental concern that qualifies them for early intervention service, yet only 40% of those who qualify receive services (Boyle et al., ). Fewer than half of 5-year-olds are ready for kindergarten (Ghandour et al., ). Moreover, disparities in these child outcomes exist across race and income groups, which are worsening rather than improving (Reardon & Portilla, ; US DHHS, ). To improve the health and well-being of young children and their families, the federal government through the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program awards roughly $500 million annually to US states and territories to provide evidence-based home visiting services to families of young children (HRSA, ). Although the exact curriculum differs across home visiting models, all target improving the home and family environment for children during their first years of life (Edwards & Lutzker, ; Gershater-Molko et al., ; Olds, ; Wagner & Clayton, ). Most home visiting programs take a long-term, intensive approach by serving volunteer families selected based on demographic risk, such as first-time, low-income mothers. One limitation of this approach is that risk is defined narrowly and, therefore, some families in need of such services may not be eligible while other high-functioning families may receive services unnecessarily. Moreover, despite federal funding to all 50 states, the District of Columbia, and five US territories, the MIECHV Program annually serves only roughly 75,000 of the 20 million families with children aged 0 to 5 (HRSA,). As such, the sum of these programs has not yet achieved population impact on child and family outcomes. Programs are needed that reach universally and aspire to have population impact. A promising approach to population impact is universal home visiting, such as Family Connects. Family Connects (FC) was created to reduce population rates of child maltreatment and to promote child and family health and well-being in the early postpartum period, a time when almost all families report some need for support (Dodge & Goodman, ). Grounded in a developmental science understanding of how risk for adverse child outcomes accrues and a public health understanding of integrated systems of care, FC combines a “top-down” approach of engaging and aligning services supporting families of infants with a “bottom-up” approach of engaging every birthing family through nurse home visiting to assess family-specific needs. Families with needs are connected to tailored community services for ongoing support. Randomized trials indicate FC can be implemented with high penetration and fidelity and brings positive impact on improving mothers’ mental health while also reducing emergency medical care costs and child abuse investigations (Dodge et al., , ; Goodman et al., ). A population-level implementation in four rural counties yielded a 32% reduction in the total number of child emergency department visits by age 24 months (Goodman et al., ).