Kendall, S;
Nash, A;
Braun, A;
Bastug, G;
Rougeaux, E;
Bedford, H;
(2014)
Evaluating the use of a population measure of child development in the Healthy Child Programme Two Year Review.
UCL Children's Policy Research Unit: London, UK.
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Abstract
INTRODUCTION AND BACKGROUND: In the policy statement ‘Supporting Families in the Foundation Years’, the Government set out its intention to commit to improving outcomes for young children and families through increased focus on preventive and early intervention services in pregnancy and the early years. Here, the intentions are laid out to develop an outcome measure of child development at 2-2½ years, through which the effects of interventions could be monitored, and to explore the options for bringing together the Healthy Child Programme (HCP) 2-2½ year health and development review and the Early Years progress check at 2 years into a single integrated review (IR). In November 2013, the Department of Health announced that, on the basis of work already conducted and interim results from other work, Ages & Stages Questionnaires®, Third Edition (ASQ-3™) would be used to collect data for the Child Development Indicator with Ages & Stages Questionnaires®: Social-Emotional (ASQ:SE) (6) to be incorporated at a later stage. ASQ-3 will therefore need to be included in Healthy Child Programme reviews for 2- 2½ year olds, or integrated reviews where these take place, in all areas by the end of 2015. AIMS AND OBJECTIVES: The overall aim of this study was to inform the use of ASQ-3™ and of ASQ:SE in the Healthy Child Programme two year review which in turn is intended to contribute to overall improved outcomes for children and their families. AIM: To explore the acceptability and understanding of the ASQ-3 and ASQ:SE as measures of child development as part of the Healthy Child Programme two year review among health professionals and parents. OBJECTIVES: 1. To determine the acceptability of ASQ-3 and ASQ:SE among parents of children who have had a HCP a two year review. 2. To investigate parents’ understanding of ASQ-3 and ASQ:SE used as part of the 2 year review. 3. To determine the acceptability of ASQ-3 and ASQ:SE among health professionals using the measures as part of the HCP two year review. 4. To investigate health professionals’ understanding of ASQ-3 and ASQ:SE as part of the two year review. METHODS: Four study sites known to be currently using ASQ-3 as part of the HCP two year review were selected to reflect differences in geography and in socio-demographic characteristics of the population. A mixed methods approach was taken and data were collected from 153 parents of children who were due their HCP two year review and 126 health professionals conducting two year reviews using survey questionnaires. Twelve focus groups involving 85 health professionals were conducted, 40 parents interviewed individually and 12 HCP two year reviews observed. FINDINGS: The key findings were: In general, most parents and HPs accepted the ASQ-3 as a measure that provides useful information about a child’s development at two years; Parents and HPs were less certain that ASQ:SE could provide an accurate assessment; of social and emotional development. Parents enjoyed and found it valuable to observe their own child and make their own observations prior to an assessment visit either in a clinic or at home; Parents and HPs were positive about the opportunity to work in partnership in relation to the child’s development; There was wide variation both across and within the areas studied as to how the ASQ-3 was used (home, clinic, with parents, put to one side, scored differently, health visitor or community nursery nurse, referrals and re-reviews etc.); There was considerable variation around the preparation and training for the ASQ-3 and ASQ:SE amongst HPs; There was some evidence of confusion about the purpose of the ASQ-3, namely whether it was for screening developmental delay or for use as an assessment tool; There was misunderstanding and criticism of some of the individual questions, especially where there was use of American vocabulary or activities that did not make sense to parents or HPs and also misunderstanding of the possible responses; There was evidence of misunderstanding of the scoring of the ASQ-3, potentially leading to over- or under- reporting of developmental delay; There were problems in the reporting of the scores and the assessment related to time availability, access to a suitable electronic record system such as RIO, access to computers and internet, over-reliance on hard copy and reporting scores in the Personal Child Health Record (PCHR); There was some evidence of variation in practice in making referrals for speech and language or paediatric assessment.
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