How do primary health-care practitioners identify and manage communication impairments in preschool children?

Abstract

Communication impairments (CIs) in preschool children are common and can have long-term adverse consequences if not detected and treated early. This study investigated the knowledge, training and practice of primary health-care practitioners in the identification and management of CIs in preschool-aged children. A cross-sectional survey of 277 primary health-care practitioners in the Inner West and South West Sydney was undertaken. The majority of practitioners surveyed understood the importance of early identification of CIs. Eight per cent of practitioners correctly identified all of the ‘red flags’ for verbal and non-verbal communication. The majority (80%) correctly described the management of a typical case presentation. Two-thirds of practitioners reported using a tool in their practice for developmental surveillance, but the quality of surveillance tools was variable. One-third felt their training in this area was poor and 90% indicated they would like further training. Barriers to referral included waiting times, availability and cost of services. We concluded that primary health-care practitioners are aware that CIs are significant and they need to be identified early. There are opportunities for further training and promoting high-quality developmental surveillance in primary care. In addition, there are broader health system issues that include promotion of an integrated response to the detection and management of CIs.

Equitable access to developmental surveillance and early intervention – understanding the barriers for children from culturally and linguistically diverse (CALD) backgrounds

“…There was a general consensus that despite these concerns, children were not being identified and accessing early intervention in a timely manner. The lack of professional use of standardized tools (except CFHNs) for DS in our study may result in the underdetection of developmental problems such as language delay in CALD communities . There were also many examples given of language delays and other significant developmental disorders in children from CALD backgrounds being missed due to professional and family belief that bilingualism, a child being exposed to more than one language, was responsible for late talking.…”

“…International and Australian data have demonstrated that the practice of DS in primary health‐care services is suboptimal in terms of the proportion of families who access these services and the quality of DS undertaken . Of concern, according to AEDC data, only a quarter of developmentally vulnerable children have their problems detected and receive any early intervention prior to starting school .…”

Predictors of developmental surveillance completion at six months of age in south western Sydney

“…PEDS completion may therefore be increased by improving parental awareness of the Child and Family Health Nurse's role, and increasing access to standardised training in DS administration by all primary health professionals. This is supported by the work of Woolfenden et al (2015) who found that one third of a sample of 277 NSW GPs and practice nurses felt that their training in childhood development was poor, and 90% desired further training.…”

A Multidisciplinary Approach to the Assessment and Management of Pre-school Age Neuro-developmental Disorders: A Local Experience

“…Multidisciplinary and inter-professional approach has been documented to be effective in the management of many childhood situations spanning from healthy child surveillance to inpatient mental health care [9,10]. The primary care provides a unique area of potential ample opportunities for training and promotion of high-quality developmental surveillance [11].…”

“…Many categories of professionals are often involved, including therapists (Speech and language, Occupational therapists), psychology and mental health professionals, Pediatricians, primary care professionals including nurses, social care professionals, allied healthcare professionals (e.g. Audiology/Vestibuloauditory), educational staff including Educational Psychologist, Early-years practitioners, and nursery nurses [15,11].…”