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Nurse KM, Parkin PC, Keown-Stoneman CDG, Bayoumi I, Birken CS, Maguire JL, Macarthur C, Borkhoff CM. Association Between Family Income and Positive Developmental Screening Using the Infant Toddler Checklist at the 18-Month Health Supervision Visit. J Pediatr 2024; 264:113769. [PMID: 37821023 DOI: 10.1016/j.jpeds.2023.113769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/28/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To examine the associations between several potential predictors (child biologic, social, and family factors) and a positive screen for developmental delay using the Infant Toddler Checklist (ITC) at the 18-month health supervision visit in primary care. METHODS This was a cross-sectional study of healthy children attending an 18-month health supervision visit in primary care. Parents completed a standardized questionnaire, addressing child, social, and family characteristics, and the ITC. Logistic regression analyses were used to assess the associations between predictors and a positive ITC. RESULTS Among 2188 participants (45.5% female; mean age, 18.2 months), 285 (13%) had a positive ITC and 1903 (87%) had a negative ITC. The aOR for a positive ITC for male compared with female sex was 2.15 (95% CI, 1.63-2.83; P < .001). The aOR for birthweight was 0.65 per 1 kg increase (95% CI, 0.53-0.80; P < .001). The aOR for a family income of <$40,000 compared with ≥$150,000 was 3.50 (95% CI, 2.22-5.53; P < .001), and the aOR for family income between $40,000-$79,999 compared with ≥$150,000 was 1.88 (95% CI, 1.26-2.80; P = .002). CONCLUSIONS Screening positive on the ITC may identify children at risk for the double jeopardy of developmental delay and social disadvantage and allow clinicians to intervene through monitoring, referral, and resource navigation for both child development and social needs. TRIAL REGISTRATION Clinicaltrials.gov (NCT01869530).
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Affiliation(s)
- Kimberly M Nurse
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Charles D G Keown-Stoneman
- Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Imaan Bayoumi
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Catherine S Birken
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada; Department of Pediatrics, Unity Health Toronto, Toronto, Ontario, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Colin Macarthur
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
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Alexander K, Mazza D. Routine developmental screening in Australian general practice: a pilot study. BMC PRIMARY CARE 2023; 24:143. [PMID: 37430184 DOI: 10.1186/s12875-023-02093-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Parents' Evaluation of Developmental Status, (PEDS), is a validated screening tool designed for primary health care clinicians to assess child development. Despite widespread use by local government child-nurse services, PEDS has not been tested in Australian general practice. We examined the effect of an intervention that aimed to use PEDS to improve documented assessment of child developmental status during routine general practice consultations. METHODS The study took place in a single general practice in Melbourne, Australia. The intervention included training of all general practice staff regarding PEDS processes and provision of PEDS questionnaires, scoring and interpretation forms. Mixed methods incorporated audits of clinical records of young children (1 to ≤ 5 years) before and after the intervention, and written questionnaires and a focus group (informed by the Theoretical Domains Framework and COM-B model) with receptionists, practice nurses and general practitioners. RESULTS Documented developmental status more than doubled after the intervention with almost one in three (30.4%) records documenting the PEDS tool. Overall, staff responses to questionnaires indicated that PEDS processes had been successfully implemented, half of the staff felt PEDS had developed their professional skills and clinicians expressed confidence using the tool (71%). Thematic analysis of the focus group transcript revealed divided reactions to PEDS screening with most barriers arising from general practitioners' motivation to use PEDS tools and perceptions of environmental constraints. CONCLUSIONS A team-practice intervention that applied PEDS training and implementation, more than doubled documented rates of child developmental status during routine visits. Solutions to underlying barriers could be incorporated into a revised training module. Future studies need to test the tool in more methodologically robust studies that include analysis of the outcomes of developmental surveillance and long-term sustainability of PEDS use in practices.
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Affiliation(s)
- Karyn Alexander
- Department of General Practice, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Danielle Mazza
- Department of General Practice, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Eapen V, Winata T, Gilbert M, Nair R, Khan F, Lucien A, Islam R, Masi A, Lam-Cassettari C, Mendoza Diaz A, Dissanayake C, Karlov L, Descallar J, Eastwood J, Hasan I, Jalaludin B, Kohlhoff J, Liaw ST, Lingam R, Ong N, Tam CWM, Woolfenden S, Barbaro J. Parental experience of an early developmental surveillance programme for autism within Australian general practice: a qualitative study. BMJ Open 2022; 12:e064375. [PMID: 36442896 PMCID: PMC9710335 DOI: 10.1136/bmjopen-2022-064375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Implementing support and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental conditions including autism. This study examined parents'/caregivers' experiences and perceptions about a digital developmental surveillance pathway for autism, the autism surveillance pathway (ASP), and usual care, the surveillance as usual (SaU) pathway, in the primary healthcare general practice setting. DESIGN This qualitative study involves using a convenience selection process of the full sample of parents/caregivers that participated in the main programme, 'General Practice Surveillance for Autism', a cluster-randomised controlled trial study. All interviews were audio-recorded, transcribed and coded using NVivo V.12 software. An inductive thematic interpretive approach was adopted and data were analysed thematically. PARTICIPANTS Twelve parents/caregivers of children with or without a developmental condition/autism (who participated in the main programme) in South Western Sydney and Melbourne were interviewed. SETTINGS All interviews were completed over the phone. RESULTS There were seven major themes and 20 subthemes that included positive experiences, such as pre-existing patient-doctor relationships and their perceptions on the importance of knowing and accessing early support/services. Barriers or challenges experienced while using the SaU pathway included long waiting periods, poor communication and lack of action plans, complexity associated with navigating the healthcare system and lack of understanding by general practitioners (GPs). Common suggestions for improvement included greater awareness/education for parents/carers and the availability of accessible resources on child development for parents/caregivers. CONCLUSION The findings support the use of digital screening tools for developmental surveillance, including for autism, using opportunistic contacts in the general practice setting. TRIAL REGISTRATION NUMBER ANZCTR (ACTRN12619001200178).
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Affiliation(s)
- Valsamma Eapen
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Teresa Winata
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Melissa Gilbert
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Radhika Nair
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Feroza Khan
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Abbie Lucien
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Raisa Islam
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Anne Masi
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Christa Lam-Cassettari
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Antonio Mendoza Diaz
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Saint Lucia, Queensland, Australia
| | - Lisa Karlov
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Joseph Descallar
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - John Eastwood
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Faculty of Medicine and Health, School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Iqbal Hasan
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Bin Jalaludin
- Centre for Research, Evidence Management and Surveillance, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Faculty of Medicine, School of Population Health, UNSW, Sydney, New South Wales, Australia
| | - Jane Kohlhoff
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Siaw-Teng Liaw
- School of Public Health and Community Medicine, UNSW, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Natalie Ong
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Chun Wah Michael Tam
- Faculty of Medicine, School of Population Health, UNSW, Sydney, New South Wales, Australia
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Susan Woolfenden
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism, The University of Queensland, Saint Lucia, Queensland, Australia
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Bater ML, Stark MJ, Gould JF, Anderson PJ, Collins CT. Parent concerns for child development following admission to neonatal intensive or special care: From birth to adolescence. J Paediatr Child Health 2022; 58:1539-1547. [PMID: 35661453 PMCID: PMC9540761 DOI: 10.1111/jpc.16030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/10/2021] [Accepted: 05/01/2022] [Indexed: 11/28/2022]
Abstract
AIM To describe the presence and nature of parent concerns regarding the development of their children admitted to Australian neonatal units (NNUs), comprising neonatal intensive care or special care. METHODS In a cross-sectional survey, mothers and fathers provided information regarding concerns for their child's development. The self-administered survey was completed by two separate cohorts; (i) parents of child graduates from Australian NNUs (n = 381); (ii) parents of infant's inpatient in two South Australian NNUs (n = 209). Data were analysed using thematic analysis and descriptive statistics. RESULTS Information was provided for 730 children. Developmental concern was reported for 39% of NNU graduates and 35% of inpatients. Children born very preterm (< 32 weeks' gestation) elicited greater parent concern than those born more mature (Cohort 1: 41% vs 36%; Cohort 2: 49% vs 22%), including in multiple developmental domains (Cohort 1: 17% vs 15%; Cohort 2: 28% vs 4%). Parents with inpatient infants were predominantly concerned about general development-milestones (19.1%) and the potential impact of medical or CNS issues (13.7%). Graduate parents commonly focused on specific domains, such as their child's speech-language (13.7%) and motor (12.9%) development. CONCLUSION Neurodevelopment is a substantial source of concern for mothers and fathers during NNU admission and childhood, particularly for children born very preterm. However, in the first year of life, developmental concerns are poorly defined. This highlights the need for clinical education resources detailing infant developmental expectations and supportive strategies for parents of these high-risk infants.
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Affiliation(s)
- Megan L Bater
- SAHMRI Women and KidsSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia,Discipline of PaediatricsAdelaide Medical School, the University of AdelaideAdelaideSouth AustraliaAustralia,Neonatal UnitWomen's and Children's HospitalAdelaideSouth AustraliaAustralia,Early Origins of HealthRobinson Research Institute, University of AdelaideAdelaideSouth AustraliaAustralia
| | - Michael J Stark
- SAHMRI Women and KidsSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia,Discipline of PaediatricsAdelaide Medical School, the University of AdelaideAdelaideSouth AustraliaAustralia,Neonatal UnitWomen's and Children's HospitalAdelaideSouth AustraliaAustralia,Early Origins of HealthRobinson Research Institute, University of AdelaideAdelaideSouth AustraliaAustralia
| | - Jacqueline F Gould
- SAHMRI Women and KidsSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia,Discipline of PaediatricsAdelaide Medical School, the University of AdelaideAdelaideSouth AustraliaAustralia,School of PsychologyUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Peter J Anderson
- Neurodevelopment ProgramTurner Institute for Brain and Mental Health & School of Psychological Sciences, Monash UniversityMelbourneVictoriaAustralia,Centre of Research Excellence in Newborn MedicineMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Carmel T Collins
- SAHMRI Women and KidsSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia,Discipline of PaediatricsAdelaide Medical School, the University of AdelaideAdelaideSouth AustraliaAustralia
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5
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Çelen Yoldaş T, Şenkon OG, Karakaya J, Özmert EN. Elucidating the level of developmental risk in a busy paediatric practice clinic from a middle-income country. Child Care Health Dev 2022; 48:781-787. [PMID: 35179245 DOI: 10.1111/cch.12987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Identifying young children with serious developmental concerns is a common challenge in paediatric settings around the world. Elucidating parental concerns about their children's development is a useful predictor of developmental status. The aim of this study is to elucidate the level of developmental risk in a busy outpatient paediatric clinic using the Parents' Evaluation of Developmental Status (PEDS) and observe the associated factors in a middle-income country. METHODS Parents attending a medical appointment for their children in a paediatric outpatient clinic were asked to complete the PEDS and a questionnaire pertaining to sociodemographic details. A total of 151 parents were eligible to participate in the study. Parents also rated the ease of completion of the test with the response options being 'difficult, a little difficult, easy, very easy'. RESULTS In our total sample, 9.3% (n = 14) were at high risk, 16.6% (n = 25) were at moderate risk and the remainder were at low/no risk. Being at high or moderate risk (25.8%, n = 39) was higher in male gender (p = 0.046) and older age children (p = 0.004). Hospitalization in a neonatal intensive care unit longer than 3 days, maternal employment status/housewife, long duration of screen viewing were independent risk factors significantly associated with high or moderate risk in multivariable analyses. Among the participants, 98.7% of parents reported that the PEDS was easy or very easy to complete in the clinical setting. CONCLUSION In this study, in a cosmopolitan city of a middle-income country, a quarter of children were observed to be at high or moderate risk. The findings highlight the importance of elucidating the prevalence of developmental concerns among the population to enable families to access universal high-quality early childhood services.
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Affiliation(s)
- Tuba Çelen Yoldaş
- Department of Pediatrics, Division of Developmental Pediatrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Jale Karakaya
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Elif Nursel Özmert
- Department of Pediatrics, Division of Developmental Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Hodgins M, Ostojic K, Hu N, Lawson KD, Samir N, Webster A, Rogers H, Henry A, Murphy E, Lingam R, Raman S, Mendoza Diaz A, Dadich A, Eapen V, Rimes T, Woolfenden S. Study protocol for a real-world evaluation of an integrated child and family health hub for migrant and refugee women. BMJ Open 2022; 12:e061002. [PMID: 36041760 PMCID: PMC10439340 DOI: 10.1136/bmjopen-2022-061002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Continuity of child and family healthcare is vital for optimal child health and development for developmentally vulnerable children. Migrant and refugee communities are often at-risk of poor health outcomes, facing barriers to health service attendance including cultural, language, limited health literacy, discrimination and unmet psychosocial needs. 'Integrated health-social care hubs' are physical hubs where health and social services are co-located, with shared referral pathways and care navigation. AIM Our study will evaluate the impact, implementation and cost-benefit of the First 2000 Days Care Connect (FDCC) integrated hub model for pregnant migrant and refugee women and their infants. MATERIALS AND METHODS This study has three components. Component 1 is a non-randomised controlled trial to compare the FDCC model of care with usual care. This trial will allocate eligible women to intervention and control groups based on their proximity to the Hub sites. Outcome measures include: the proportion of children attending child and family health (CFH) nurse services and completing their CFH checks to 12 months of age; improved surveillance of growth and development in children up to 12 months, post partum; improved breastfeeding rates; reduced emergency department presentations; and improved maternal well-being. These will be measured using linked medical record data and surveys. Component 2 will involve a mixed-method implementation evaluation to clarify how and why FDCC was implemented within the sites to inform future roll-out. Component 3 is a within-trial economic evaluation from a healthcare perspective to assess the cost-effectiveness of the Hubs relative to usual care and the implementation costs if Hubs were scaled and replicated. ETHICS AND DISSEMINATION Ethical approval was granted by the South Eastern Sydney Local Health District Human Research Ethics Committee in July 2021 (Project ID: 020/ETH03295). Results will be submitted for publication in peer-reviewed journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER ACTRN12621001088831.
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Affiliation(s)
| | | | - Nan Hu
- UNSW, Sydney, New South Wales, Australia
| | - K D Lawson
- Western Sydney University, Sydney, New South Wales, Australia
| | - Nora Samir
- UNSW, Sydney, New South Wales, Australia
| | - Amanda Webster
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Helen Rogers
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | | | - Elisabeth Murphy
- UNSW, Sydney, New South Wales, Australia
- North Sydney Local Health District, Sydney, New South Wales, Australia
| | - Raghu Lingam
- UNSW, Sydney, New South Wales, Australia
- Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Shanti Raman
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | | | - Ann Dadich
- Western Sydney University, Sydney, New South Wales, Australia
| | - Valsamma Eapen
- UNSW, Sydney, New South Wales, Australia
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Tania Rimes
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Susan Woolfenden
- UNSW, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
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Solomonian L. Scope of Practice and Principles of Care of Naturopathic Medicine in North America: A Commentary. CHILDREN (BASEL, SWITZERLAND) 2021; 9:8. [PMID: 35053632 PMCID: PMC8773912 DOI: 10.3390/children9010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/05/2021] [Accepted: 12/18/2021] [Indexed: 11/17/2022]
Abstract
Naturopathic medicine is a growing profession in North America that provides expertise in complementary and alternative, or integrative care to pediatric patients. It is imperative that healthcare providers have an understanding of the training and scope of other health professionals in order to effectively make decisions regarding research, collaborative clinical care, and policy. Given the prevalence of use of complementary and alternative medicine by children and families in North America, and the growing interest in "integrative" medicine, we aim to offer an overview of naturopathic care for children. This document describes the principles, training, and scope of naturopathic medicine, including health promotion, disease prevention, and illness management. It describes the process by which naturopathic doctors create an integrative healthcare plan for children, evaluate and apply evidence, and integrate ethical issues in practice management, and speaks to the role naturopathic doctors have regarding advocacy for community and planetary health as it relates to pediatrics.
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Affiliation(s)
- Leslie Solomonian
- Canadian College of Naturopathic Medicine, Toronto Campus, Toronto, ON M2K 1E2, Canada
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8
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Jain K, Solomon J, Ramachandran S. Knowledge, attitude and practices on developmental surveillance and screening among health professionals in Indian health care settings: An exploratory sequential mixed methods study. J Pediatr Rehabil Med 2021; 14:55-63. [PMID: 33492251 DOI: 10.3233/prm-190649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study was to assess the knowledge, attitude and practices of health care professionals in pediatric settings on developmental surveillance and screening programs and also to identify the barriers and facilitators during its implementation. METHODS The data were collected from health professionals involved in pediatric developmental care, practicing in various hospitals, clinics and nursing homes in a suburban city on west coast of Southern India. The study involved cross-sectional exploratory sequential mixed method design which included a quantitative questionnaire survey on health professionals (n= 52) followed by qualitative face-to-face interviews with chosen respondents who participated in the survey (n= 8). The survey data are reported with descriptive statistics, and interview data are subjected to inductive content analysis for deriving codes, categories and themes. RESULTS The study results indicate that health professionals involved in pediatric developmental care in Indian health care settings have fair knowledge and a favorable attitude towards the use of developmental surveillance and screening. Furthermore, the facilitators and barriers of implementation have been reported. The strategies outlined by interview respondents to improve adherence to implementation have been discussed. CONCLUSIONS The practice of developmental surveillance and screening is limited despite favorable knowledge and attitude among health professionals in pediatric developmental care and is dependent on health care organizational setup.
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Barbaro J, Masi A, Gilbert M, Nair R, Abdullahi I, Descallar J, Dissanayake C, Eastwood J, Hasan I, Jalaludin B, Karlov L, Khan F, Kohlhoff J, Liaw ST, Lingam R, Mendoza Diaz A, Ong N, Tam CWM, Unwin K, Woolfenden S, Eapen V. A Multistate Trial of an Early Surveillance Program for Autism Within General Practices in Australia. Front Pediatr 2021; 9:640359. [PMID: 33968847 PMCID: PMC8102783 DOI: 10.3389/fped.2021.640359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The early detection of developmental conditions such as autism is vital to ensure children can access appropriate and timely evidence-based supports, services, and interventions. Children who have undetected developmental conditions early in life are more likely to develop later health, developmental, learning, and behavioral issues, which in turn can have a cumulative effect over the life course. Methods: The current protocol describes a multi-site, cluster randomized control trial comparing a developmental surveillance pathway for autism to usual care, using opportunistic visits to general practitioners (GPs). Units of randomization are GP clinics across two Australian states (New South Wales and Victoria), with thirty clinics within each state, each of which will aim to recruit approximately forty children aged between ~18- and 24-months, for a total of ~2,400 participants. Children will be randomized to two clusters; namely, an autism surveillance pathway (ASP) or surveillance as usual (SaU). The screening process for the ASP arm involves primary and secondary screenings for developmental concerns for autism, using both parent and GP reports and observations. Children in both arms who show signs of developmental concerns for autism will be offered a full developmental assessment by the research team at 24 months of age to determine the efficacy of developmental surveillance in successfully identifying children with autism. Trial Registration: The trial is registered with ANZCTR (ACTRN12619001200178) and reporting of the trial results will be according to recommendations in the CONSORT Statement.
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Affiliation(s)
- Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia.,Cooperative Research Centre for Living With Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
| | - Anne Masi
- Cooperative Research Centre for Living With Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia.,Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Melissa Gilbert
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Radhika Nair
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Ifrah Abdullahi
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia.,Cooperative Research Centre for Living With Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
| | - John Eastwood
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Faculty of Medicine and Health, School of Medicine, University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine, School of Women and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Iqbal Hasan
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Bin Jalaludin
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Karlov
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Academic Unit of Psychiatry, Infant Child and Adolescent Mental Health Services, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Feroza Khan
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Jane Kohlhoff
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - S T Liaw
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Raghu Lingam
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Antonio Mendoza Diaz
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Academic Unit of Psychiatry, Infant Child and Adolescent Mental Health Services, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Natalie Ong
- Children's Hospital Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Chun Wah Michael Tam
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW, Australia.,Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Katy Unwin
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Sue Woolfenden
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Valsamma Eapen
- Cooperative Research Centre for Living With Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia.,Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Academic Unit of Psychiatry, Infant Child and Adolescent Mental Health Services, South Western Sydney Local Health District, Sydney, NSW, Australia
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10
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Alexander KE, Mazza D. Improving assessment of child development: Results of a quality improvement intervention in general practice. J Paediatr Child Health 2020; 56:1053-1059. [PMID: 32073191 DOI: 10.1111/jpc.14813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/20/2019] [Accepted: 01/19/2020] [Indexed: 11/28/2022]
Abstract
AIMS Parents' Evaluation of Developmental Status (PEDS) is a validated tool used to assess child development that has not previously been tested in Australian general practice. We examined the effect of a Quality-Improvement intervention in a single general practice in Melbourne, Australia, that aimed to use this tool to improve the documented assessment of child developmental surveillance during vaccination visits. METHODS Mixed methods incorporated audits of clinical records of children aged 1-5 years, before and after intervention, written questionnaires and a focus group (informed by the theoretical domains framework and Capability, Opportunity, Motivation-Behaviour (COM-B model)) with clinical and non-clinical staff. RESULTS After 6 months, developmental surveillance more than doubled and was documented in more than one in three visits (34.1%). Almost one in five (18.6%) vaccination visits included the PEDS tool. Overall, the tool was positively received with staff expressing high levels of comfort asking parents to complete it (92.8%), increasing development of professional skills (71.4% staff) and confidence (55% clinicians) detecting developmental delays. Thematic analysis of the focus group transcript revealed underlying barriers arising from the practice environment, staff capabilities and motivation. CONCLUSIONS In a whole of practice Quality-Improvement intervention that applied PEDS training and implementation, including the receptionist in the medical team more than doubled documented rates of child developmental surveillance during vaccination visits. Solutions to underlying barriers could be incorporated into a revised training module. Future studies need to test the tool in more methodologically robust studies that include analysis of the outcomes of developmental surveillance.
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Affiliation(s)
- Karyn E Alexander
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Danielle Mazza
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
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11
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Baker J, Kohlhoff J, Onobrakpor SI, Woolfenden S, Smith R, Knebel C, Eapen V. The Acceptability and Effectiveness of Web-Based Developmental Surveillance Programs: Rapid Review. JMIR Mhealth Uhealth 2020; 8:e16085. [PMID: 32324149 PMCID: PMC7206511 DOI: 10.2196/16085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/05/2020] [Accepted: 02/10/2020] [Indexed: 12/05/2022] Open
Abstract
Background Web-based developmental surveillance programs may be an innovative solution to improving the early detection of childhood developmental difficulties, especially within disadvantaged populations. Objective This review aimed to identify the acceptability and effectiveness of web-based developmental surveillance programs for children aged 0 to 6 years. Methods A total of 6 databases and gray literature were searched using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses–informed protocol. Data extraction included variables related to health equity. Results In total, 20 studies were identified. Most papers implemented web-based versions of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up screener for autism spectrum disorder or Parent Evaluation of Developmental Status screeners for broad developmental delay. Caregivers and practitioners indicated a preference for web-based screeners, primarily for user-friendliness, improved follow-up accuracy, time, and training efficiencies. Conclusions Although evidence is limited as to the necessity of web- versus face-to-face–based developmental screening, there are clear efficiencies in its use. Trial Registration PROSPERO CRD42019127894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=127894
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Affiliation(s)
- Jess Baker
- The University of New South Wales, Liverpool, Australia
| | - Jane Kohlhoff
- The University of New South Wales, Carramarr, Australia
| | | | | | - Rebecca Smith
- South Eastern Sydney Local Health District, Sydney, Australia
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12
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Chando S, Craig JC, Burgess L, Sherriff S, Purcell A, Gunasekera H, Banks S, Smith N, Banks E, Woolfenden S. Developmental risk among Aboriginal children living in urban areas in Australia: the Study of Environment on Aboriginal Resilience and Child Health (SEARCH). BMC Pediatr 2020; 20:13. [PMID: 31931753 PMCID: PMC6956483 DOI: 10.1186/s12887-019-1902-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/23/2019] [Indexed: 12/05/2022] Open
Abstract
Background Most Australian Aboriginal children are on track with their development, however, the prevalence of children at risk of or with a developmental or behavioural problem is higher than in other children. Aboriginal child development data mostly comes from remote communities, whereas most Aboriginal children live in urban settings. We quantified the proportion of participating children at moderate and high developmental risk as identified by caregivers’ concerns, and determined the factors associated with developmental risk among urban Aboriginal communities. Methods Study methods were co-designed and implemented with four participating urban Aboriginal Community Controlled Health Services in New South Wales, Australia, between 2008 and 2012. Caregiver-reported data on children < 8 years old enrolled in a longitudinal cohort study (Study of Environment on Aboriginal Resilience and Child Health: SEARCH) were collected by interview. The Parents’ Evaluation of Developmental Status (PEDS) was used to assess developmental risk through report of caregiver concerns. Odds ratios (OR) were calculated using multinomial logistic regression to investigate risk factors and develop a risk prediction model. Results Of 725 children in SEARCH with PEDS data (69% of eligible), 405 (56%) were male, and 336 (46%) were aged between 4.5 and 8 years. Using PEDS, 32% were at high, 28% moderate, and 40% low/no developmental risk. Compared with low/no risk, factors associated with high developmental risk in a mutually-adjusted model, with additional adjustment for study site, were male sex (OR 2.42, 95% confidence intervals 1.62–3.61), being older (4.5 to < 8 years versus < 3 years old, 3.80, 2.21–6.54), prior history of ear infection (1.95, 1.21–3.15), having lived in 4 or more houses versus one house (4.13, 2.04–8.35), foster care versus living with a parent (5.45, 2.32–12.78), and having a caregiver with psychological distress (2.40, 1.37–4.20). Conclusion In SEARCH, 40% of urban Aboriginal children younger than 8 years were at no or low developmental risk. Several factors associated with higher developmental risk were modifiable. Aboriginal community-driven programs to improve detection of developmental problems and facilitate early intervention are needed.
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Affiliation(s)
| | - Jonathan C Craig
- University of Sydney, Sydney, Australia.,Flinders University, Adelaide, Australia
| | - Leonie Burgess
- Sax Institute, Sydney, Australia.,Australian National University, Canberra, Australia
| | - Simone Sherriff
- University of Sydney, Sydney, Australia.,Sax Institute, Sydney, Australia
| | | | - Hasantha Gunasekera
- University of Sydney, Sydney, Australia.,Sydney Children's Hospitals Network, Sydney, Australia
| | - Sandra Banks
- Tharawal Aboriginal Medical Service, Campbelltown, Australia
| | - Natalie Smith
- Riverina Medical and Dental Corporation, Wagga Wagga, Australia
| | - Emily Banks
- Australian National University, Canberra, Australia
| | - Sue Woolfenden
- Sydney Children's Hospitals Network, Sydney, Australia. .,University of New South Wales, School of Women and Children's Health, Sydney, Australia.
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13
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Garg P, Eastwood J, Liaw ST, Jalaludin B, Grace R. A case study of well child care visits at general practices in a region of disadvantage in Sydney. PLoS One 2018; 13:e0205235. [PMID: 30307993 PMCID: PMC6181326 DOI: 10.1371/journal.pone.0205235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 09/22/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Well-Child Care (WCC) is the provision of preventive health care services for children and their families. Prior research has highlighted that several barriers exist for the provision of WCC services. OBJECTIVES To study "real life" visits of parents and children with health professionals in order to enhance the theoretical understanding of factors affecting WCC. METHODS Participant observations of a cross-sectional sample of 71 visits at three general practices were analysed using a mixed-methods approach. RESULTS The median age of the children was 18 months (IQR, 6-36 months), and the duration of visits was 13 mins (IQR, 9-18 mins). The reasons for the visits were immunisation in 13 (18.5%), general check-up in 10 (13.8%), viral illness in 33 (49.2%) and miscellaneous reasons in 15 (18.5%). Two clusters with low and high WCC emerged; WCC was associated with higher GP patient-centeredness scores, younger age of the child, fewer previous visits, immunisation and general check-up visits, and the solo general practitioner setting. Mothers born overseas received less WCC advice, while longer duration of visit increased WCC. GPs often made observations on physical growth and development and negotiated mothers concerns to provide reassurance to them. The working style of the GP which encouraged informal conversations with the parents enhanced WCC. There was a lack of systematic use of developmental screening measures. CONCLUSIONS GPs and practice nurses are providing parent/child centered WCC in many visits, particularly when parents present for immunisation and general check-ups. Providing funding and practice nurse support to GPs, and aligning WCC activities with all immunisation visits, rather than just a one-off screening approach, appears to be the best way forward. A cluster randomised trial for doing structured WCC activities with immunisation visits would provide further evidence for cost-effectiveness studies to inform policy change.
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Affiliation(s)
- Pankaj Garg
- Department of Community Paediatrics, Liverpool Hospital, Liverpool, New South Wales, Australia
- Specialist Disability Health Team, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- South Western Sydney Local Health District, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Women’s and Children’s Health, UNSW, Sydney, Australia
| | - John Eastwood
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Women’s and Children’s Health, UNSW, Sydney, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, Griffith University, Gold Coast, Queensland, Australia
- Department of Community Paediatrics, Sydney Local Health District, Croydon, New South Wales, Australia
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
| | - Siaw-Teng Liaw
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
- Academic General Practice Unit, Fairfield Hospital, Fairfield, New South Wales, Australia
| | - Bin Jalaludin
- South Western Sydney Local Health District, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
| | - Rebekah Grace
- Faculty of Human Sciences Department: Department of Educational Studies, Macquarie University, Sydney, Australia
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14
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Garg P, Ha MT, Eastwood J, Harvey S, Woolfenden S, Murphy E, Dissanayake C, Williams K, Jalaludin B, McKenzie A, Einfeld S, Silove N, Short K, Eapen V. Health professional perceptions regarding screening tools for developmental surveillance for children in a multicultural part of Sydney, Australia. BMC FAMILY PRACTICE 2018; 19:42. [PMID: 29609547 PMCID: PMC5879732 DOI: 10.1186/s12875-018-0728-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/19/2018] [Indexed: 11/13/2022]
Abstract
Background Encouraging early child development and the early identification of developmental difficulties is a priority. The Ministry of Health in the Australian State of New South Wales (NSW), has recommended a program of developmental surveillance using validated screening questionnaires, namely, the Parents’ Evaluation of Development Status (PEDS) and Ages and Stages Questionnaire (ASQs), however, the use of these tools has remained sub-optimal. A longitudinal prospective birth cohort “Watch Me grow” study was carried out in the South Western Sydney (SW) region of NSW to ascertain the uptake as well as the strategies and the resources required to maximise engagement in the surveillance program. This paper reports on a qualitative component of the study examining the attitudes, enablers and barriers to the current developmental surveillance practices, with reference to screening tools, amongst health professionals. Methods Qualitative data from 37 primary health care providers in a region of relative disadvantage in Sydney was analysed. Results The major themes that emerged from the data were the “difficulties/problems” and “positives/benefits” of surveillance in general, and “specificity” of the tools which were employed. Barriers of time, tool awareness, knowledge and access of referral pathways, and services were important for the physician providers, while the choice of screening tools and access to these tools in other languages were raised as important issues by Child and Family Health Nurses (CFHN). The use of these tools by health professionals was also influenced by what the professionals perceived as the parents’ understanding of their child’s development. While the PEDS and ASQs was utilised by CFHNs, both General Practitioners (GPs) and paediatricians commented that they lacked awareness of developmental screening tools and highlighted further training needs. Conclusions The results highlight the practical challenges to, and limited knowledge and uptake of, the use of recommended screening tools as part of developmental surveillance. There is a need for further research regarding the most effective integrated models of care which will allow for a better collaboration between parents and service providers and improve information sharing between different professionals such as CFHNs GPs, Practices nurses and Paediatricians involved in screening and surveillance programs.
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Affiliation(s)
- Pankaj Garg
- Department of Community Paediatrics, Liverpool Hospital, Liverpool, NSW, Australia.,School of Women's and Children's Health, UNSW, Sydney, Australia.,School of Medicine, University of Sydney, Sydney, Australia.,Specialist Disability Health Team, Fairfield, Australia.,Ingham Institute of Applied Medicine, Liverpool, Australia
| | - My Trinh Ha
- ICAMHS, South Western Sydney Local Health District, Sydney, NSW, Australia.,University of Western Sydney, Sydney, Australia
| | - John Eastwood
- School of Women's and Children's Health, UNSW, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, NSW, Australia.,Ingham Institute of Applied Medicine, Liverpool, NSW, Australia.,School of Medicine, Griffith University, Gold Coast, QLD, Australia.,Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, Croydon, Sydney, Australia
| | - Susan Harvey
- School of Nursing and Midwifery, Griffiths University, Brisbane, QLD, Australia
| | - Sue Woolfenden
- Sydney Children's Hospital Network (Randwick), Randwick, Australia.,UNSW, Sydney, Australia
| | | | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Katrina Williams
- Royal Children's Hospital, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia
| | - Bin Jalaludin
- NSW Ministry of Health, Sydney, Australia.,South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Anne McKenzie
- Child and Family Health Nursing, Primary and Community Health, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Stewart Einfeld
- Centre for Disability Research and Policy and Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Natalie Silove
- The Children's Hospital at Westmead, Westmead, NSW, Australia.,University of Sydney, Sydney, Australia
| | - Kate Short
- University of Sydney, Sydney, Australia.,Liverpool Hospital, South Western Sydney LHD, Liverpool, NSW, Australia
| | - Valsamma Eapen
- School of Medicine, Griffith University, Gold Coast, QLD, Australia. .,UNSW, ICAMHS, South Western Sydney LHD, Sydney, NSW, Australia. .,Chair, Infant Child and Adolescent Psychiatry, University of New South Wales, Head, Academic Unit of Child Psychiatry, South West Sydney (AUCS), ICAMHS, Mental Health Centre, L1, Liverpool Hospital, Elizabeth Street, Liverpool, Sydney, NSW, 2170, Australia.
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15
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Eapen V, Walter A, Guan J, Descallar J, Axelsson E, Einfeld S, Eastwood J, Murphy E, Beasley D, Silove N, Dissanayake C, Woolfenden S, Williams K, Jalaludin B, The 'Watch Me Grow' Study Group. Maternal help-seeking for child developmental concerns: Associations with socio-demographic factors. J Paediatr Child Health 2017; 53:963-969. [PMID: 28661061 DOI: 10.1111/jpc.13607] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 03/27/2017] [Accepted: 04/17/2017] [Indexed: 11/28/2022]
Abstract
AIM To examine socio-demographic factors associated with maternal help-seeking for child developmental concerns in a longitudinal birth cohort study. An understanding of these factors is critical to improving uptake of services to maximise early identification and intervention for developmental concerns. METHODS A birth cohort was recruited from the post-natal wards of two teaching hospitals and through community nurses in South Western Sydney, Australia, between November 2011 and April 2013. Of the 4047 mothers approached, 2025 consented to participate (response rate = 50%). Socio-demographic and service use information was collected after the child's birth and when the child was 18 months of age. Sources of help were divided into three categories (formal health services, other formal services and informal supports) and compound variables were created by summing the number of different sources identified by mothers. RESULTS Significantly more sources of help were intended to be used and/or actually accessed by mothers born in Australia, whose primary language was English, with higher levels of education and annual household income, and among mothers of first-born children. CONCLUSIONS Developmental concerns are known to increase with increased psychosocial adversity. Our findings of reduced intent to access and use of services by socio-economically disadvantaged families and those from culturally and linguistically diverse backgrounds suggests that an inverse care effect is in operation whereby those children with the greatest health needs may have the least access to services. Possible explanations for this, and recommendations for improving service accessibility for these populations through targeted and culturally appropriate services, are discussed.
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Affiliation(s)
- Valsamma Eapen
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Academic Unit of Child Psychiatry South West Sydney (AUCS), South Western Sydney Local Health District, Liverpool Hospital, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Amelia Walter
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Academic Unit of Child Psychiatry South West Sydney (AUCS), South Western Sydney Local Health District, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Jane Guan
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Emma Axelsson
- Academic Unit of Child Psychiatry South West Sydney (AUCS), South Western Sydney Local Health District, Liverpool Hospital, Sydney, New South Wales, Australia.,Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Stewart Einfeld
- Centre for Disability Research and Policy, University of Sydney, Sydney, New South Wales, Australia
| | - John Eastwood
- Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Elisabeth Murphy
- Office of Kids and Families, NSW Ministry of Health, Child and Family Health, Sydney, New South Wales, Australia.,Child Health, School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Deborah Beasley
- Office of Kids and Families, NSW Ministry of Health, Child and Family Health, Sydney, New South Wales, Australia
| | - Natalie Silove
- Child Development Unit, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Cheryl Dissanayake
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Sue Woolfenden
- Community Child Health, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Katrina Williams
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Developmental Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, Sydney, New South Wales, Australia
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16
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Garg P, Ha MT, Eastwood J, Harvey S, Woolfenden S, Murphy E, Dissanayake C, Jalaludin B, Williams K, McKenzie A, Einfeld S, Silove N, Short K, Eapen V. Explaining culturally and linguistically diverse (CALD) parents' access of healthcare services for developmental surveillance and anticipatory guidance: qualitative findings from the 'Watch Me Grow' study. BMC Health Serv Res 2017; 17:228. [PMID: 28330490 PMCID: PMC5361826 DOI: 10.1186/s12913-017-2143-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 03/08/2017] [Indexed: 11/28/2022] Open
Abstract
Background Regular health visits for parents with young children provide an opportunity for developmental surveillance and anticipatory guidance regarding common childhood problems and help to achieve optimal developmental progress prior to school entry. However, there are few published reports from Australian culturally and linguistically diverse (CALD) communities exploring parents’ experiences for accessing child health surveillance programs. This paper aims to describe and explain parental experiences for accessing developmental surveillance and anticipatory guidance for children. Methods Qualitative data was obtained from 6 focus groups (33 parents) and seven in-depth interviews of CALD parents recruited from an area of relative disadvantage in Sydney. Thematic analysis of data was conducted using an ecological framework. Results An overarching theme of “awareness-beliefs-choices” was found to explain parents’ experiences of accessing primary health care services for children. “Awareness” situated within the meso-and macro-systems explained parents knowledge of where and what primary health services were available to access for their children. Opportunities for families to obtain this information existed at the time of birth in Australian hospitals, but for newly arrived immigrants with young children, community linkages with family and friends, and general practitioner (GPs) were most important. “Beliefs” situated within the microsystems included parents’ understanding of their children’s development, in particular what they considered to be “normal” or “abnormal”. Parental “choices”, situated within meso-systems and chronosystems, related to their choices of service providers, which were based on the proximity, continuity, purpose of visit, language spoken by the provider and past experience of a service. Conclusions CALD parents have diverse experiences with primary health care providers which are influenced by their awareness of available services in the context of their duration of stay in Australia. The role of the general practitioner, with language concordance, suggests the importance of diversity within the primary care health workforce in this region. There is a need for ongoing cultural competence training of health professionals and provisions need to be made to support frequent use of interpreters at general practices in Australia.
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Affiliation(s)
- Pankaj Garg
- Department of Community Paediatrics, Liverpool Hospital, Liverpool, Australia.,School of Women's and Children's Health, UNSW, Liverpool, Australia.,School of Medicine, University of Sydney, Westmead, Australia.,Ingham Institute of Applied Medicine, Liverpool, Australia
| | - My Trinh Ha
- University of Western Sydney, Penrith, NSW, Australia
| | - John Eastwood
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.,School of Public Health, University of Sydney, Sydney, NSW, Australia.,Ingham Institute of Applied Medicine, Liverpool, Australia.,School of Medicine, Griffith University, Gold Coast, QLD, Australia.,Syney Local Health District, Croydon, NSW, Australia
| | - Susan Harvey
- School of Nursing and Midwifery, Griffiths University, Queensland, Australia
| | - Sue Woolfenden
- Sydney Children's Hospital Network (Randwick), UNSW, Sydney, Australia
| | | | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Bin Jalaludin
- South Western Sydney Local Health District and UNSW, Sydney, Australia
| | - Katrina Williams
- Royal Children's Hospital, Melbourne and University of Melbourne, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Anne McKenzie
- Primary and Community Health, Child, Youth and Family, Child and Family Health Nursing, South Western Sydney Local Health District, Sydney, Australia
| | - Stewart Einfeld
- Centre for Disability Research and Policy and Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Natalie Silove
- The Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Kate Short
- Liverpool Hospital, South Western Sydney LHD, University of Sydney, Sydney, Australia
| | - Valsamma Eapen
- UNSW, South Western Sydney LHD, Ingham Institute of Applied Medicine, Liverpool, Australia. .,Infant Child and Adolescent Psychiatry, Academic Unit of Child Psychiatry, South West Sydney LHD, ICAMHS, Mental Health Centre, University of New South Wales, Liverpool Hospital, L1, Elizabeth Street, Liverpool, NSW, 2170, Sydney, Australia.
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