A ground-breaking initiative targeting Hawke’s Bay’s four-year-olds is picking up and addressing health, developmental and behavioural problems to ensure the region’s youngsters get the best start at school.
In its first six months, the Before-School Check (B4SC) has resulted in referrals for 31 percent of 1400 preschoolers assessed. The early intervention identifies issues likely to impact on the children’s education so they can be remedied before they start school.
Researchers from EIT Hawke’s Bay and the Hawke’s Bay District Health Board are tracking the health outcomes of the scheme for the Hawke’s Bay Children’s Holding Trust. The trust is philanthropic in nature and is guardian of assets previously owned by three local community organisations – the Hawke’s Bay Children’s Home, Birthright Napier and Family Care Hawke’s Bay.
The B4SC includes a child health questionnaire, vision and hearing screening, height and weight checks, an assessment of behaviour and development, an oral health screen, health promotion and education and referrals as indicated to specialists. The screening is carried out in Hawke’s Bay by 84 fully trained practice nurses, Tamariki Ora nurses and independent practitioners.
Children identified as requiring further attention are channelled through a clinical nurse leader to a group of specialists for further assessment.
The commonest groups of referrals have been children with two or more issues (29%), children with dental decay or unenrolled (19%), vision issues (13%), concerns about development (12%) and children with incomplete immunisation (11%).
The B4SC scheme was evaluated after 2007 pilots undertaken by the Counties Manukau and Whanganui District Health Boards. The Hawke’s Bay programme was implemented in light of findings from both areas.
The region’s major health groups are committed to the scheme, which is led by the Hawke’s Bay Primary Health Organisation under contract to the Hawke’s Bay District Health Board.
Critical to the success of the Hawke’s Bay programme so far has been the collaboration between those in the health, education and social services sectors. All are represented on a Clinical Advisory Board chaired by Dr Russell Wills, Clinical Director of Paediatrics at the Hawke’s Bay District Health Board.
A major concern of those working with children in the region is that the pre-school population is more deprived than the rest of New Zealand. That is, of the babies delivered in the region in 2005, 47.1 percent were born into families within the two lowest social-economic indexes compared to 26.8 percent nationally.
Reporting on the tracking of the Before School Check programme in Hawke’s Bay, EIT Research Professor Kay Morris Matthews says: “Optimising a child’s readiness for school can make a great different to early achievement. For example, if a child has hearing loss or behavioural issues that are detected at age four then there is every chance that these can be addressed by the time the child starts school. Conversely, if the child starts school with such issues undetected then it is highly likely these will impact negatively on learning.
“Importantly, interventions in later childhood or adulthood produce mixed results and are labour and resource intensive. In contrast, there is a growing evidence base of effective interventions for younger children with development and behavioural difficulties – including in New Zealand.”
“In 2006, the proportion of young people 15 years and over with little or no formal attainment on leaving school was 31 percent compared with a national average of 40 percent,” says Professor Morris Matthews.