Healthy Beginnings

Healthy Beginnings serves first-time mothers of infants from socially and economically disadvantaged areas in Sydney, Australia. The model aims to prevent childhood obesity by improving children’s and families’ eating patterns, reducing sedentary activities such as television viewing, and increasing physical activity. In Healthy Beginnings, nurse home visitors address the following topics during each visit: infant nutrition and physical activity, family nutrition and physical activity, and family social support. The nurse home visitors offer referrals if the family has questions or concerns unrelated to the discussion topics. Telephone support is available between visits. Families receive eight home visits from the prenatal period through when the child is 24 months old. Each visit ranges in length from 45 to 90 minutes.

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Healthy Beginnings is designed to prevent children from becoming overweight and obese. The program draws on research demonstrating the link between being overweight and obese during childhood and immediate and long-term adverse health and social-emotional effects. Recognizing that a child’s environment influences nutrition and physical activity, the program uses a family-focused approach to address risk factors associated with childhood obesity.

The model emphasizes the following messages:

•    “Breast is best”
•    “No solids for me until six months”
•    “I eat a variety of fruit and vegetables every day”
•    “Only water in my cup”
•    “I am part of an active family”
•    “TV away, let’s go play”

The model has been adapted for virtual service delivery using telephone or text messaging. The text messaging delivery model has been adapted to support caregivers of infants from culturally and linguistically diverse communities.

Healthy Beginnings was designed by researchers from Sydney and South Western Sydney Local Health Districts Health Promotion Service and the University of Sydney, in Australia. The Healthy Beginnings team at the University of Sydney works with programs to ensure the model is being implemented with fidelity. The team also provides intervention materials and evaluation tools. 

The Healthy Beginnings team is available to support replication in the United States. 

Healthy Beginnings serves first-time mothers of infants from socially and economically disadvantaged areas of Sydney.

The model aims to prevent childhood obesity by improving child and family eating patterns, reducing sedentary activities such as television viewing, and increasing physical activity.

In Healthy Beginnings, nurse home visitors provide home visits to first-time mothers with newborns. During each visit, nurse home visitors address infant nutrition and physical activity, family nutrition and physical activity, and family social support. Using questions tailored to the child’s age, the nurse home visitors initiate discussions and provide information on topics listed in a visit checklist. The nurse home visitors offer referrals if the family has questions or concerns unrelated to the discussion topics. Telephone support is available between visits.

Families receive eight home visits at the following stages: the prenatal period and when the child is 1, 3, 5, 8, 12, 18, and 24 months old. Each visit ranges in length from 45 to 90 minutes. The visits are designed to coincide with early childhood developmental milestones related to feeding practices, nutrition and physical activity, and parent-child interactions.

No adaptations or enhancements that would be eligible for HomVEE review have been made to the model.

The Sydney and South Western Sydney Local Health District Health Promotion Service oversees program implementation. The Health Promotion Service develops, implements, and evaluates community-based programs designed to reduce health disparities.

The model developer outlines fidelity guidelines in Healthy Beginnings: A User’s Guide. Please contact the model developer for additional information about these guidelines.

Nurse home visitors are experienced child and family health nurses who receive basic training followed by minimal supervision. 

The model requires the nurse home visitors to participate in pre-service training. Before conducting home visits, the nurse home visitors receive training on the following topics:

• Developing respectful family partnerships
• Early brain development; attachment theory; infant states, cues, and state modulation
• Measuring a child’s weight and length     
• Nutrition, including infant feeding, introduction of solids, water as main other drink, cup feeding, serving sizes, fruit and vegetables, family food, reading labels, and healthy snacks
• Australian Breastfeeding Association guidelines
• Grief and loss in the perinatal period
• Play training
• Child protection
• Food security
• Pre- and postnatal exercises
• Physical activity training, including stages of change model and motivational training

The model also requires the nurse home visitors to participate in two hours of in-service training each month.

Please contact the model developer for additional information about the pre-service training and ongoing professional development requirements.

Li Ming Wen, M.D., M.Med., Ph.D.
Professor, Sydney School of Public Health, University of Sydney
Director, Population Health Research and Evaluation Hub, Sydney Local Health District Health Promotion Service

Phone: +61 2 9505 9055
Email: liming.wen@health.nsw.gov.au; liming.wen@sydney.edu.au
Website: http://www.healthybeginnings.net.au/