B4 School Check Workshop Dr Pat Tuohy, Chief Advisor, Child and Youth Health Karl Le Quesne, Group Manager, Early Childhood Education

“We want our children…to grow up competent and confident, healthy in mind, body, and spirit, secure in their sense of belonging and in the knowledge that they make a valued contribution to society” From Te Whaariki

Background 2005 Government announcement as a commitment to child health Delivery of the B4SC started in 4 DHBs (Waikato, Nelson Marlborough, MidCentral and Lakes) in June 2008 The remaining DHBs across the country started delivery from September 2008

What is the B4SC? Eighth and final Well Child check Comprehensive health, behavioural and developmental check Aims to identify and address any health, behavioural, social or developmental concerns which could affect a child’s ability to get the most benefit from school Has nationally defined protocols and referral pathways

When Where Who How As soon after the child turns 4 as possible Well Child clinics, Plunket rooms, general practices, early childhood education centres, community centres, homes and others Public health nurses, Plunket and Well Child nurses, practice nurses, Vision and Hearing Technicians Takes about 45-60 minutes A dedicated national information system collects results

Evidence-based content Child health questionnaire, including an immunisation check Vision and hearing assessment through sweep audiometry, tympanometry and distance visual acuity Measurement of height and weight Oral health assessment using Lift the Lip Behavioural and developmental questions using the Strengths and Difficulties Questionnaire (SDQ) and Parental Evaluation of Developmental Status (PEDS) tools Health promotion and education

B4SC pilot Piloted in the Whanganui and Counties Manukau DHBs from August to November 2007 An evaluation of the pilot found that: Nearly all parents who participated (98%) indicated that they would recommend the programme to others 92% reported high levels of satisfaction Most parents (86%) reported high levels of confidence in the programme 99% felt that their child’s check was completed in a culturally appropriate manner

How do B4SCs fit with ECE ECE approach children’s learning differently from compulsory school sector But ECE is part of the overall education system that provides opportunities for life-long learning Going from ECE to school is an important transition in the continuum of life-long learning Ensuring that children have best possible health, development and behaviour before starting school is an important way to support life-long learning Difficulties in any of those areas predict difficulties with learning later on

Te Whaariki – the early childhood curriculum The B4School check supports implementation of the early childhood curriculum The principles in Te Whaariki encourage us to make families and communities an integral part of the curriculum – assisting parents with B4School check is part of this The Goals are also relevant, e.g. Goal 4 focuses on children knowing the limits and boundaries of acceptable behaviour Focusing on development and behaviour helps children to access all of the strands of the curriculum: well-being, belonging, contribution, communication and exploration There is more than one way to support children’s learning and development – different approaches can help us.

B4 School check and Te Whaariki Principles Empowerment The early childhood curriculum empowers the child to learn and grow. The B4 School check provides the opportunity to identify and remove barriers learning and growth, therefore adding value to ECE Holistic Development The early childhood curriculum reflects the holistic way children learn and grow. The B4 School check takes a holistic approach to screening of the child’s development.

B4S check and Te Whaariki – the principles Family and Community The wider world of family and community is an integral part of the early childhood curriculum. The B4 school check places the child at the centre of a caring family/whanau and community. It actively supports healthy family functioning Relationships Children learn through responsive and reciprocal relationships with people, places, and things. The various screens and interventions are designed to involve the child and family as much as possible. e.g.hearing screening process

Te Whaariki strands and B4SC Strand 1 Wellbeing - Mana Atua The health and well-being of the child are protected and nurtured Children experience an environment where: their health is promoted; their emotional well-being is nurtured; they are kept safe from harm. The B4School check’s focus on the promotion of health, development and behaviour helps children to access the strands of the curriculum. The general health questionnaire enables parents to ensure that their child is getting the medical support they need in order to learn well.

Te Whaariki strands and B4SC Strand 2: Belonging – Mana Whenua Children and their families feel a sense of belonging. Children and their families experience an environment where: connecting links with the family and the wider world are affirmed and extended; they know that they have a place; they feel comfortable with the routines,customs, and regular events; they know the limits and boundaries of acceptable behaviour. The B4SC is a joint initiative between parents, teachers and child health nurses and places the child at the centre of a caring community. Referral services linked to B4 School checks support teachers to set limits and boundaries of behaviour.

Te Whaariki strands and B4SC Strand 3: Contribution – Mana Tangata Opportunities for learning are equitable, and each child’s contribution is valued. Children experience an environment where: there are equitable opportunities for learning, irrespective of gender, ability, age, ethnicity, or background; they are affirmed as individuals; they are encouraged to learn with and alongside others. The B4School check identifies children who experience barriers to learning, and ensures that they are able to make a contribution.

Te Whaariki strands and B4SC Strand 4: Communication – Mana Reo The languages and symbols of their own and other cultures are promoted and protected. Children experience an environment where: they develop non-verbal communication skills for a range of purposes; they develop verbal communication skills for a range of purposes; they experience the stories and symbols of their own and other cultures; they discover and develop different ways to be creative and expressive. The hearing screening and the PEDS ensure that speech and language problems are not impairing communication skills

Te Whaariki strands and B4SC Strand 5: Exploration – Mana Aotūroa The child learns through active exploration of the environment Children experience an environment where: their play is valued as meaningful learning and the importance of spontaneous play is recognised they gain confidence in and control of their bodies;they learn strategies for active exploration, thinking, and reasoning they develop working theories for making sense of the natural, social, physical, and material worlds. The PEDS screening tool gives parents an opportunity to raise any concerns about a child’s fine or gross motor development or cognitive skills. Teachers need to be aware of a child’s movement or cognitive difficulties in order to tailor the curriculum to their special needs

Children learn in many contexts The family and community is the most important context for children’s learning and development ECE is another important context for children’s learning We need to support their learning and wellbeing in all of their contexts That means we need to work and collaborate with parents and other professionals ECE services have a long history of working with parents and others and the B4SCs support this Most children will be just fine with good quality ECE experiences, but some do need extra help

The SDQ forms

The Strengths and Difficulties Questionnaires Used to screen a child’s social and emotional development 2 versions: One for parent to complete based on their observations of their child’s interactions at home (the SDQ-P); and One for teachers to complete based on their observations of the child’s interactions in the social learning environment (the SDQ-T)

Why use the SDQ? There is no perfect tool for identifying a child’s social and emotional needs, but the SDQ was considered by both the Ministries of Health and Education to be the most appropriate for use in the B4SC The SDQ is an internationally validated tool used to identify needs requiring further discussion and assessment The SDQ is not used to diagnose or label children, rather it is a tool designed to get an overall picture of the child’s strengths and difficulties using parental and teacher perceptions of the child The SDQ is well respected by specialists and researchers and is used by several countries

The SDQ-T When parents give consent for the B4SC they give consent for an SDQ-T to be requested from their child’s early childhood education teacher or centre (if they have one). A child’s overall SDQ score is significantly more sensitive (ie. it will be better at identifying strengths and difficulties) if both a parent and a teacher complete the questionnaire.

Communication with ECE The Ministries of Health and Education jointly developed the pamphlet ‘B4 School Check: Information for the education sector’. Copies of this pamphlet were sent to over 3,500 early childhood education centres around the country in February 2009, accompanied by a joint letter and a list of Frequently-Asked-Questions. DHBs’ B4SC Coordinators have been meeting and engaging locally with ECEs about the B4SC and the SDQ-T.

Results so far? Approximately 10,000 children have received, or are in the process of receiving, their full B4SC Only 1.6% of parents have declined a B4SC for their child 17% of children have been referred for services or further assessment following their B4SC The B4SC components with the highest percentages of referrals are: immunisation (5.7%) vision (5.6%) oral health (5.4%) hearing (4.6%). SDQ (1.4%).

Questions?