1. B4 School Checks Capital & Coast and Hutt Valley DHB Areas

2. Purpose of the B4 School Check “To promote health and well-being in preschool children and identify behavioural, developmental or other health concerns that may adversely affect the child’s ability to learn in the school environment” B4 school check – handbook for practitioners – Ministry of Health 2008

3. Te Whariki – Strand 1 Goals- “children experience an environment where: their health is promoted; their emotional well being is nurtured; they are kept safe from harm” Te Whariki – Early childhood Curriculum 1996

4. Background The b4 school check is a nationwide programme offering free health and development checks for 4 year olds It is the 8 th core contact of the Wellchild Tamariki Ora Schedule and replaces the 5 year old check Aims to identify and address any health, behavioural, social or developmental concerns, which could affect the child’s ability to learn

5. Background Cont. The check is holistic – no one part is taken in isolation We are now in our 6 th year We work in two teams in partnership with Regional Public Health and 3 Iwi providers

6. Background continued Plunket has the contract in Wellington and Hutt – differs around the country The check is funded by the Ministry of Health through DHBs in partnership with Ministry of Education

7. The Check Designed to support and empower families to enhance children’s ability to learn General questionnaire on health and development Assessment of teeth, gums, height, weight, vision and hearing Review of immunisation Questions re child’s development and behaviour

8. Check Continued Any concerns identified - family offered referral for further assessment and/or help from another service Carried out by experienced registered nurses in a variety of venues including Early Childhood Centres Plunket has a partnership with three iwi providers to check their own children Also have a partnership with Regional Public Health to carry out vision and hearing screening

9. Where we do the checks Clinics – Plunket rooms, community venues, churches Early childhood centres Home

10. What are the barriers? Lots of paperwork! English as second langauge Unfamiliar environment We try to be flexible in venues and times for families. Interpreters are available if required and nurses will assist with paperwork as required.

11. When are the checks done? We like to see children as soon as possible after they turn 4 because... If there is a concern requiring referral to another agency, this leaves enough time for this to happen before the child turns five. Some agencies the waiting list is up to 12 months.

12. What does the check consist of? Child health questionnaire Dental assessment Immunisation check Development assessment Height and weight Behavioural assessment Hearing and vision screen

13. Referrals 2011-2012

14. Strengths & Difficulties Questionnaire (behaviour) Consideration is given to the areas below; Emotional health Conduct – behaviour Hyperactivity – activity levels/age appropriate Peer relationships Pro-social skills – helping/sharing/comforting/rescuing

15. Important The SDQ is never considered in isolation. It is part of process of gathering information about a child with the best interests of the child central to the outcome It is an ‘indicator’ of strengths and difficulties and must be considered in the context of current stresses and strains that may be currently impacting on a family

16. Important cont. It may indicate an area for development to work on with a child – few have the need for a ‘specialist’ Home and early learning spaces will observe a child differently. Supports the direction for referral

17. Where does the information Go? All notes are held at our office in locked files All information is stored on the B4 school data base which is a secure one from the MoH – used for stats only Summary of check sent to GP No other information given out without parent’s permission Parent’s can have copies of entire check if they wish

18. Case Study John Early childhood teacher concerned about child – behaviour, speech, socialisation Referred for speech already but nothing else Mother resisting advice

19. John cont. Seen at check Behind sibling (under 2 years) in communication and social skills Concentration poor Responds to adults one to one only No understanding of consequences Could do all motor skills of check Appears to have own language

20. John continued Spoke with mother (present at check) about all concerns Recognised there was an issue Agreed to referral to Child Development Team being made

21. Moana’s story Moana – mother of 4 year old Tamati Violent home which child had witnessed Father in prison Severe speech problems Major behavioural issues at home and ECE centre Poor concentration Developmentally delayed (moderate)

22. Moana’s story cont. Seen at B4 school check (held at ECE centre) All issues discussed with Moana and the full assessment carried out. Multiple referrals made – speech therapy, Maori mental health services, early intervention team, Incredible years parenting course

23. Moana’s Story cont. Moana and Tamati have had a positive result with lots of support 18 months later – father back with the family and has also attended parenting course. He attended the B4 school check with younger sister who was happy and progressing well.

24. Geoff’s story Geoff’s mum came to the check with no concerns At the check the teacher’s SDQt revealed some potential problems at his preschool Through the B4 school check mother discussed with ECE centre and a Psychologist

25. Geoff contd Geoff one of only a few older children at the centre and was a little bored Mother and the staff at the centre, worked together to provide more stimulation for him and incentives for good behaviour with positive results.

26. What Do you think? Daisy 4yrs Recently moved with family from Christchurch Mother worried – Daisy unsettled, poor sleep, separation anxiety Relatively settled in new ECE centre but slight change in routine means tantrums etc. Physical health and motor skills normal

27. Daisy contd. Family unit the same with 2 parents and younger sibling What should we do for this family if anything?

28. Did you know? You can refer to: Your local Plunket or other Well Child nurse Plunketline or Healthline Have dental enrolment forms available for all families Encourage families to have a B4 school check Encourage parenting programmes where appropriate

29. In Summary Check is now established Has helped many children prior to starting school Working in partnership with other agencies, especially early childhood teachers, gives the best possible outcome for the child Great opportunity for health and education to work together

30. To Finish “the B4 school check is an opportunity for a stock take – to see exactly where a child is at, physically, emotionally and socially.” Minister of Health

31. Ring us Contact us : 04 2124558 Wellington/Porirua/Kapiti Or : 04 460-4670 – Hutt valley