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This study investigated patterns of universal health and education service use from birth through Kindergarten (age 4 years) and estimated associations between cumulative risk and service use patterns, and between service use patterns and children's developmental vulnerability in the Preparatory Year (age 5 years). The study used population‐wide linkage of health and education administrative data records for 5168 children who had a 2018 AEDC instrument collected in Tasmania and were born in Tasmania (2011–2013). Latent class analysis (LCA) identified three service use patterns: Regular (72.2 per cent of children; reference group), Low (15.6 per cent of children) and High service use (12.2 per cent of children). The patterns of Regular, Low and High service use were consistent across health and education services used at different ages and stages of child development. Membership of the Low and High service use groups was associated with higher cumulative risk and increased odds of developmental vulnerability, relative to the Regular service use group. This population‐wide view of universal service use can be used by the health and education sectors to explore ways in which their specialist expertise, resources and referral processes can be further integrated within and across services to meet the developmental needs of children and families. [ABSTRACT FROM AUTHOR]

• Outreach was occurring in all early childhood services, but varied in practice. • Outreach activities were facilitating engagement with more vulnerable families. • Outreach was characterised by being purposeful and informed by principles of flexibility, consistency, responsiveness and persistence. • Policies and frameworks provided no guidance about outreach and what it entailed. Tasmanian early childhood services (ECS) are attempting to improve their engagement with vulnerable families and increase the uptake of universal health and education services in this population. This paper presents qualitative findings from the Tassie project, focusing on the scope and role of outreach in supporting family engagement in the Tasmanian ECS. Using an ethnographic study design, over 100 naturalistic observations were recorded in health and education ECS settings in Tasmanian communities between April 2017 and February 2018. In addition, 42 ECS providers and 32 parents/guardians with pre-school aged children participated in semi-structured interviews. Interview transcripts and observation field notes were analysed thematically, focusing on family engagement and the role of outreach across three key universal ECS. Outreach was undertaken by all services involved in this study, but varied in practice and scope. Outreach was not directed at specific population groups, but was instigated in response to an identified need with more vulnerable families to address issues of inequity in service access. Policies and strategic frameworks within services provided little or no guidance about outreach beyond procedures for conducting home visits. Attending specialised services alongside parents, a strategy adopted by one service, was particularly effective for facilitating connection to services for vulnerable families. The capacity of services to offer outreach was constrained by structured service systems, individual providers' skills and capability, resource limitations and lack of clarity with respect to policies and procedures. Outreach activities are occurring within the universal ECS system in Tasmania, facilitating engagement with vulnerable Tasmanian families and children. Flexible service systems, building the skills and capacities of service providers and clearer policies and procedures would enable services to more fully embed outreach practices within existing ECS. [ABSTRACT FROM AUTHOR]

Background: In Australia, the health and education sectors provide universal early childhood services for the same population of children. Therefore, there is a strong imperative to view service use and outcomes through a cross-sectoral lens to better understand and address the service needs of young children and their families., Objectives: To investigate patterns of health and education service use from birth through Kindergarten (age four years), the associations with cumulative risks, and developmental vulnerability in the first year of full-time school (age five years)., Methods: A retrospective cohort study that used population-wide linkage of health and education administrative data records for 5,440 children with a Tasmanian 2015 Australian Early Development Census (AEDC) record who were born in Tasmania (2008-2010)., Results: Four service use patterns were identified: Regular (46% of children), Declining (24%); Low (18%); and Selective service use (12%). Regular service use (aOR 0.8, 95% CI 0.7 to 0.9), adjusted for cumulative risks, was associated with decreased odds of developmental vulnerability, compared to the other service use groups. Low (OR 6.1, 95% CI 4.5 to 8.2) and Declining service use (OR 2.5 95% CI 1.9 to 3.4) were more likely for children with the highest levels of cumulative risks. Low and Declining service use, adjusted for cumulative risks were associated with increased odds of developmental vulnerability, compared to the Regular service use group., Conclusion: This study provides a whole population view of the differential use of universal services and the complex risk circumstances that influence service use. The association between patterns of multiple risk and service use points to barriers to service use, and the varying level of developmental vulnerability within each service use group draws attention to children who may benefit from higher sustained participation in core health and education services across the whole of early childhood., Competing Interests: Statement on conflicts of interest: The authors declare they have no conflicts of interest.