Healthy beginnings, changing the life trajectory of Australian children: a pilot feasibility trial

This study is a 6-month pilot feasibility cluster randomised controlled trial evaluating the Healthy Beginnings Model, a multi-component early intervention delivered within early childhood education and care (ECEC) centres. The Healthy Beginnings Model is not a novel or experimental clinical intervention. Rather, it is an integrated model of care that combines and coordinates existing, evidence-based, and routinely available child health services, developmental screening, and referral practices into a structured, centre-based delivery framework. Healthy Beginnings Model arm (HBM): A 6-month, centre-based intervention delivered in participating ECEC centres by a care coordinator (a Child and Family Health Nurse), supported by a healthcare multidisciplinary team and the research team. Parents/caregivers of children aged 0–4 years who provide consent will complete the Ages & Stages Questionnaire (ASQ) in either online or paper format at the beginning of the pilot. Children in the monitor or refer category, or for whom educators have concerns, will be invited to a second-stage, one-to-one interview conducted by the care coordinator to further explore these concerns. Following completion of the two-stage assessment, the care coordinator will undertake a structured triage involving a standardised review of assessment findings and relevant family circumstances. Where appropriate, multidisciplinary team input will be sought to determine the nature, severity and urgency of identified concerns and to develop an individualised care plan. Care may include family feedback and shared decision-making, referral coordination, navigation of health and community services, and ongoing monitoring. The multidisciplinary team may include general practitioners (GPs), paediatricians, child psychiatrists and allied health professionals, depending on the child's needs. The timing of triage will depend on completion of the two-stage assessment process. Children remaining in the monitor category following the second-stage assessment will receive readily available, age-appropriate ASQ learning activities and family guidance targeting identified developmental domains, with repeat assessment 2 to 3 months after initial screening. Structured triage is generally conducted once per child following identification of concerns but may be repeated after reassessment if concerns persist or increase. Capacity-building sessions will be delivered across participating ECEC centres over six months, comprising approximately six 1.5-hour sessions per centre (three for educators and three for parents), delivered either online or in person by a member of the multidisciplinary team. Focus areas include early childhood development and wellbeing, recognising developmental and behavioural concerns, service navigation and referral pathways, and strengthening shared understanding between families, educators and health professionals. Adherence will be monitored through screening records, care coordinator logbooks, referral and activity logs, attendance at capacity-building sessions, engagement with the multidisciplinary team, and completion of surveys and participation in qualitative interviews. The model is delivered within ECEC settings to facilitate earlier identification of developmental and health needs, and to improve timely access to existing support services. This study evaluates the feasibility, acceptability, and implementation of embedding this integrated model within routine practice, as well as its potential to improve early identification, care coordination, and access to support.