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Transitioning to a Flexible, Tiered, Developmentally Informed Same-Day Screening Model for Preschoolers in

Robyn Smith1, Elizabeth M Jordaan2, Dorothy C Russell3

  • 1School of Health and Rehabilitation Sciences, University of the Free State, Bloemfontein, South Africa.

Child: Care, Health and Development
|February 6, 2026
PubMed

Insights

A new flexible screening model improves early detection of developmental delays and health risks in preschool children in low-resource settings. This adaptable approach enhances early identification and referral within early childhood care and education platforms.

Area of Science:

  • Child Development
  • Public Health
  • Global Health

Background:

  • Preschool years (ages 3-5) are crucial for development and health, yet many low-resource settings miss early detection opportunities.
  • Early childhood care and education (ECCE) platforms in low- and middle-income countries (LMICs) are underutilized for preventive services due to resource limitations and coordination challenges.
  • Barriers include logistical constraints and low caregiver engagement, hindering effective early intervention.

Purpose of the Study:

  • To iteratively refine an initial screening protocol into a flexible, tiered model for LMIC ECCE settings.
  • To address implementation barriers identified through stakeholder feedback.
  • To create a context-sensitive and scalable screening solution.

Main Methods:

  • An observational, descriptive study in South Africa collected baseline data on preschoolers' development, sensory function, nutrition, and health.
  • A Participatory Action Learning and Action Research (PALAR) approach was used to refine the initial multi-indicator protocol.
  • Feedback from caregivers, facilitators, interpreters, fieldworkers, and healthcare professionals guided protocol adaptations.

Main Results:

  • Key barriers identified: fragmented scheduling, long sessions, limited interpreters, caregiver disengagement, and challenges with children's behavior.
  • A proposed flexible, tiered model was developed to consolidate visits, shorten sessions, improve interpreter support, and streamline tools.
  • The model enhances feasibility, accuracy, and cultural responsiveness, supporting scalable application in low-resource ECCE contexts.

Conclusions:

  • The proposed screening model offers a context-sensitive, scalable approach for early identification and referral in LMIC ECCE settings.
  • Its adaptable structure facilitates broader implementation and better aligns with children's developmental needs.
  • This model can inform future policy and integrated service planning for early childhood development.
Abstract

Keywords:
ECCE in low‐resource settingsLMIC contextsdevelopmental and health screeningearly childhood developmenttiered screening model

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