Over the last decade it has been clearer that improvements in population health require different strategies, beyond the application of larger scale clinical interventions. Experience teaches that more focus needs to be given to the determinants of health and of health problems and to strategies that build systems to make a measurable difference in the outcomes for children. South Australia is in a relatively unique position, in Australia, of having a State wide child and family health service. This offers both opportunity and challenge to the development of a population based early intervention across metropolitan, regional and remote areas