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Developmental monitoring: benefits of a preventive health care system
Meinou H C Theunissen1, Janine Bezem2,3, Sijmen A Reijneveld2,4
1TNO Child Health, P. O. Box 3005, 2301 DA, Leiden, Netherlands. Meinou.Theunissen@tno.nl.
Insights
Preventive child healthcare systems identify emotional, behavioral, and developmental problems in children, facilitating early support. Referral rates to specialized services remain low, highlighting the system
Area of Science:
- Child Health Monitoring
- Developmental Pediatrics
- Public Health Systems
Background:
- Well-child care necessitates continuous monitoring for early problem identification and intervention.
- The Dutch Preventive Child Healthcare (PCH) system exemplifies a developmental monitoring system focused solely on preventive tasks.
Purpose of the Study:
- To evaluate the identification rates of emotional, behavioral (EB), cognitive developmental, and family problems in children within a PCH system.
- To assess the system's contribution to referrals for specialized mental health and social care services.
Main Methods:
- Data were collected over six months from 1370 children (aged 0-18 years) within two Dutch PCH organizations.
- PCH professionals' identification of child problems and referral practices were assessed.
- Prevalence rates of identified problems and follow-up actions were analyzed by child age group.
Main Results:
- Among preschool children, 22% exhibited EB, cognitive developmental, and/or family problems (primarily EB and family issues).
- School-aged children showed problem identification rates between 10-14% (mainly EB problems).
- PCH follow-up assessments were offered to 3-10% of children, with external referrals made for 0-4%.
Conclusions:
- Developmental monitoring systems focused on prevention can effectively identify children with EB, cognitive developmental, and family problems.
- These systems facilitate early support for most identified children, with minimal referrals to specialized care.
- Findings suggest the need for validation in diverse settings and international contexts.
Abstract:
This study aims to assess the identification rates in a developmental monitoring system (i.e., preventive child healthcare, PCH system) regarding identification of emotional, behavioral (EB) problems, cognitive developmental and family problems in children, and the contribution of such a system to referral to (specialized) mental health and social care services. Over a predetermined period of 6 months, we retrieved data from a random sample of 1370 children aged 0 to 18 years from the registries of two PCH organizations in the Netherlands. We assessed the degree to which PCH professionals identify EB and cognitive developmental and family problems and invite children with these problems for follow-up PCH assessments or refer them to (specialized) mental health and social care services. Among preschool-aged children, we identified 22% with EB problems, cognitive developmental and/or family problems (mainly EB and family problems). Among school-aged children, numbers varied from 10 to 14% (mainly EB). PCH invited 3 to 10%, varying in proportions of child age, for a follow-up assessment, and referred 0 to 4% of the children to external services.
Conclusion:
A developmental monitoring system with only preventive tasks may help to identify children with EB, cognitive developmental, and/or family problems. This can lead to early support for most of these children, with low referral rates to (more specialized) mental health and social care services. Our findings deserve validation in comparable settings and in other countries.
What Is Known:
• Well-child care requires monitoring of the health and development of children for timely identification of problems and subsequent intervention. • The Dutch Preventive Child Healthcare system is an example of a developmental monitoring system with only preventive tasks.
What Is New:
• A developmental monitoring system with only preventive tasks may help to identify children with problems, resulting in early support for the majority. • This may reduce referral rates to (more specialized) mental/social health services.
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