A novel digital application which helps to identify children with developmental difficulties is being successfully implemented in multicultural and Indigenous communities in NSW, thanks to a project partly supported by Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE).
The Watch Me Grow project exploits the high uptake of child vaccination in the preschool period to engage parents in completing a developmental checklist – accessed via a QR code while in the GP waiting room. In 2020, following the closure of some clinics due to the COVID-19pandemic, the project pivoted to sending weblinks directly to families at home.
If a parent’s responses to the checklist raises any concerns, an algorithm in the application automatically flags developmental issues and suggests further assessment by a qualified health professional.
“The Australian Early Development Census indicated that one-in-five Australian children have difficulties in one or more aspects of their development at the start of school,” says project chief investigator Professor Valsamma Eapen from the University of NSW and South Western Sydney Local Health District.
“Interventions are often too little and too late, and the consequences of inaction are costing Australia’s health system an estimated $15.2 billion a year.”
Once parents are engaged, the Watch Me Grow system provides anticipatory guidance about normal development relevant to the child’s age, and automatically sends parents reminders for further developmental checks at intervals up to 5 years old.
One Aboriginal parent commented that “as a first-time mum I’m looking forward to more emails to remind me that it is time to check how he is going, and we have now started talking in our yarning group about how important it is”.
The results and recommendations are also transmitted to the family’s GP or other health professionals, providing key developmental information to busy clinicians at the child’s point-of-care.
Professor Eapen says her research shows that the greatest obstacle to early identification is an “inverse care law.”
“Children from the most culturally, linguistically, geographically, and economically disadvantaged backgrounds, who have the greatest developmental risk, are the ones least engaging with health services,” says Professor Eapen. “They actually tend not to use services until it is too late”.
To help overcome the cultural and linguistic barriers, Watch Me Grow has been translated into multiple languages.
An Arabic speaking mother of an 18-month-old baby girl from south western Sydney says receiving the information in her first language has been vital.
“I was worried my daughter was late in talking but I didn’t know what to do. I don’t like going to doctors as my English is not good but this time when I went for my daughter’s vaccination, I was able to answer the questions in the waiting room in Arabic and for the first time I was able to understand what was going on and my GP then helped me with a referral”.
Watch Me Grow aims to systematically reach as many children as possible. As well as GP clinics, further research, funded by NSW Office of Health and Medical Research, is focussing on people from disadvantaged and CALD backgrounds in Sydney’s Fairfield local government area and Aboriginal communities in the Murrumbidgee region.
A National Health and Medical Research Council grant – in collaboration with NSW Health, Queensland Health and the Primary Health Network – is funding the scale-up the program in Sydney and in Brisbane.
And funding from Autism Co-operative Research Centre has engaged 60 GP practices in South West Sydney and Melbourne for a cluster randomised control trial.
The mother of 12-year-old boy Ollie, who was eventually diagnosed with autism and ADHD, says “I wish he’d gotten help earlier.”
“I took him to the hospital last month because he was cutting himself. The doctor asked me questions that made me wonder why something hadn’t been done to help Ollie before.”
Professor Eapen says the case is typical of the unmet need for early engagement and identification, and Watch Me Grow will address this.
“Children need to access support during critical windows in time when their brain’s plasticity is at its peak,” says Professor Eapen. “Otherwise, we have to wait all the way until they start school and teachers notice a child is not speaking, or worse, cases like Ollie’s where diagnoses are so late that interventions are more expensive and less effective as complexities and comorbidities have set in.”
The program has provided the evidence base for the recent changes to the NSW Health Blue Book Personal Health Record program.
Professor Eapen says there is good evidence that early childhood interventions can improve educational, social and employment outcomes.
“Our research found that only 1 in 3 families are engaging with developmental monitoring when their children are 12 to 18 months. This rate of participation declines thereafter, generating a ‘silent period’ in which problems such as language delays or autism emerge but are missed.”
“Our work shows this program is feasible and acceptable to families, including those from multicultural backgrounds, as well as to service providers.”More News