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B4School check: Securing children's futures

B4School check: Securing children's futures

What is a B4 School Check?

The B4 School Check is a free health and development check for your 4-year-old. It’s the last Well Child Tamariki Ora check by both a Plunket nurse and a vision and hearing technician, and helps give a child the best start at school.

A Plunket nurse will check a child’s:

  • height and weight
  • teeth
  • immunisation status
  • current learning and development, including strengths and difficulties
  • overall health and wellbeing

And will provide advice and support about a child’s health and development.

A vision and hearing technician will check that the child can see and hear well.

Why is the B4 School Check important?

  • We want to allow children to have the best chance of addressing their health needs by encouraging families to have their child’s B4 school check soon after their 4th birthday
  • We need to ensure that we are supporting our culturally diverse population who have a range of specific needs – language and cultural practices

Our goals are to:

  • improve access to B4 school check services for families with diverse needs
  • reduce health disparities by developing a trusting open partnership with families
  • engage with Maori, Pacific and families with low socioeconomic status to ensure services meet their children’s needs

What did we find?

We consulted with GP practices to understand how to support them more effectively. We learned that:

    There was a lack of public awareness that the B4 school check includes both a Plunket nurse and vision and hearing assessment which meant that the check was not often completed,
  • Access to both components was often difficult for transient families
  • The national database did not list phone numbers or connect with other agencies, so information could not be shared to provide specific support for families

What have we done?

  1. Introduced a text message programme to provide brief advice to patients via their mobile phones – 30% of recipients asked for help to quit
  2. We have created a ‘One Stop Shop’ – our Plunket and Vision and Hearing Testing (VHT) teams worked together to combine home visiting and clinics for B4 school checks
  3. We now provide choices for families to attend clinics, including Saturday clinics for working parents, or to have home visits
  4. We target children who do not attend an Early Childhood Education (ECE) facility to receive checks (children are offered VHT assessments at ECE facilities)
  5. Our B4SC teams attend health promotion days for communities with diverse needs
  6. Our Plunket and VHT teams have improved communication through the sharing of information and establishing a monthly meeting to ensure a seamless delivery of B4 school service
  7. We now regularly audit our clinics and home visits, making changes as necessary to ensure we are meeting the needs of the community and providing a flexible service

B4 School Check - 'One Stop Shop'
B4 School Check - 'One Stop Shop' clinic

B4 School Check - Home Visits
B4 School Check - Home Visit

Did we make a difference?


Increased overall coverage by 25%

Increased coverage of Maori by 44%, Pacific by 38%, and high needs families by 22%

Strong relationships established across teams

  • Better public awareness of what the B4 school check is through attending Health Promotion Days and networking with other agencies in the community
  • Improved access for Maori, Pacific and high needs families with an increase in completed checks each year
  • Timeliness has improved with most children seen just after their 4th birthday – this allows for early intervention and a better start at school
  • Improved outcomes for children means better learning when they start school. Increased referrals to agencies such as Ministry of Education, Auckland Regional Dental Service, Family Doctors, Marinoto (child and adolescent mental health), Parenting Programmes eg "Incredible Years"
  • Supporting families with limited or no transport by taking the service to them


"It’s a really thorough check and it’s great, we can have it all done at the same time" – feedback from a family

"Not only are we better supporting families by working together, we are also supporting each other. We feel like we are making a difference" – feedback from staff