Happy, Healthy, Ready – working with early childhood non-government organisations for developmental surveillance for vulnerable children

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Karen Edwards
Ritin Fernandez
Tania Rimes
Lisa Stephenson
Rebecca Smith
Jane Son
Vanessa Sarkozy
Deborah Perkins
Valsamma Eapan
Sue Woolfenden


Developmental screening, child development, Child and Family Health Nurse (CAFHN), culturally and linguistically diverse (CALD), migrant, refugee, interagency, multi-agency, detection


Objective: This study sought to improve: (1) knowledge of child development among non-health child and family workers; and (2) identification and referral of children from culturally and linguistically diverse (CALD) backgrounds at developmental risk, by partnering child health services with nongovernment early childhood education and family support services in two suburbs with high numbers of families from CALD backgrounds. Background: Children from CALD backgrounds have increased risk of developmental problems going undetected prior to school entry, thereby missing early intervention. Study design and methods: This was a quality improvement project. The model comprised: (1) co-locating a child and family health nurse CAFHN in a non-health setting or visits by early childhood health staff to undertake developmental surveillance and (2) training non-health staff on child development and New South Wales (NSW) developmental surveillance tools. Evaluation used a mixed methods design analysing qualitative data from parents, early childhood workers, CAFHNs, and paediatricians and de-identified activity data from CAFHNs, and other early childhood health services. Results: Non-health workers increased their referrals of children at developmental risk to CAFHN or other child health providers. In Rockdale, 44% (n=62) and Botany 41% (n=98) of children screened had one or more significant developmental vulnerabilities. CAFHN reported developmental surveillance for families who were not accessing traditional clinic-based services. Discussion: This study tested a model of developmental surveillance and entry into the child and family health system in a non-health setting, thus providing a ‘soft’ entry for parents who might not otherwise engage with these services. Conclusion: The project demonstrated a new way of working for CAFHNs and facilitated identification of developmental risk in children from CALD backgrounds, who would otherwise have been missed.

Implications for research, policy, and practice:

This relatively small-scale model of practice change has resulted in improved access for a marginalised population, but further research is needed to refine the model and test it for scalability and replicability.

What is already known about this topic?

Our team undertook a systematic review of outreach developmental surveillance occurring in non-health settings. Eight studies across high, middle and low income countries have been identified with a total of 150,047 children aged 18 months to five years, the majority from low socioeconomic backgrounds. Only one study has been based in Australia10 in a regional area in Victoria which showed increased detection of  children who were developmentally vulnerable. No studies have had a specific focus on CALD populations in Australia or have been based in the context of the NSW health and developmental surveillance system.

What this paper adds:

This paper describes the outcomes of a quality improvement project implemented in Rockdale and Botany – two disadvantaged areas of South Eastern Sydney – to increase access to developmental surveillance and early intervention for children from culturally and linguistically diverse (CALD) backgrounds attending supported playgroups and early childhood education services.

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