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Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

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

Sue Woolfenden A F , Kate Short B , Roger Blackmore C , Rene Pennock D and Michael Moore E
+ Author Affiliations
- Author Affiliations

A Sydney Children’s Hospital Network – Community Child Health, corner Avoca and BarkerStreet, Randwick, Sydney, NSW 2031, Australia.

B South West Sydney Local Health District – Speech Pathology Department, corner Goulburn and Campbell Streets, Liverpool, Sydney, NSW 2170, Australia.

C South West Sydney Local Health District – Community Paediatric Department, Hugh Jardine Building, Elizabeth Street, Liverpool, Sydney, NSW 2170, Australia.

D South West Sydney Medicare Local, PO Box 5919, Minto DC, Sydney, NSW 2560, Australia.

E Inner West Sydney Medicare Local, Level 1, 158 Liverpool Road, Ashfield, Sydney, NSW 2131, Australia.

F Corresponding author. Email: susan.woolfenden@sesiahs.health.nsw.gov.au

Australian Journal of Primary Health 21(2) 176-181 https://doi.org/10.1071/PY12152
Submitted: 19 November 2012  Accepted: 11 October 2013   Published: 12 November 2013

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.


References

AAP (2006) Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening. Pediatrics 118, 405–420.
Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening.Crossref | GoogleScholarGoogle Scholar | 16818591PubMed |

Anderson LM, Shinn C, Fullilove MT, Scrimshaw SC, Fielding JE, Normand J, Carande-Kulis VG (2003) The effectiveness of early childhood development programs: A systematic review. American Journal of Preventive Medicine 24, 32–46.
The effectiveness of early childhood development programs: A systematic review.Crossref | GoogleScholarGoogle Scholar | 12668197PubMed |

Chung PJ, Lee TC, Morrison JL, Schuster MA (2006) Preventive care for children in the United States: quality and barriers. Annual Review of Public Health 27, 491–515.
Preventive care for children in the United States: quality and barriers.Crossref | GoogleScholarGoogle Scholar | 16533127PubMed |

COAG (2009) The early childhood development strategy. Available at http: //www.coag.gov.au/ coag_meeting_outcomes/2009–07–02/docs/national_ECD_strategy.pdf [Verified September 2012]

Dawson G, Rogers S, Munson J, Smith M, Winter J, Greenson J, Donaldson A, Varley J (2010) Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics 125, e17–e23.
Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model.Crossref | GoogleScholarGoogle Scholar | 19948568PubMed |

Department of Education and Early Childhood Development (2010) Victorian child health record review benchmarking report, August 2010. (Victorian Government: Melbourne) Available at http://www.education.vic.gov.au/Documents/about/research/childhealthrecordbenchmarking.pdf [Verified 30 October 2013]

Fiscella K, Kitzman H (2009) Disparities in academic achievement and health: the intersection of child education and health policy. Pediatrics 123, 1073–1080.
Disparities in academic achievement and health: the intersection of child education and health policy.Crossref | GoogleScholarGoogle Scholar | 19255042PubMed |

Glascoe FP (1999) Using parents’ concerns to detect and address developmental and behavioral problems. Journal of the Society of Pediatric Nursing 4, 24–35.
Using parents’ concerns to detect and address developmental and behavioral problems.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M3ms1Gmsw%3D%3D&md5=4ea68c0f9924cf562aa9929e980f6c91CAS |

Glascoe FP (2005) Screening for developmental and behavioral problems. Mental Retardation and Developmental Disabilities Research Reviews 11, 173–179.
Screening for developmental and behavioral problems.Crossref | GoogleScholarGoogle Scholar | 16161092PubMed |

Goldfeld S, O’Connor M, Sayers M, Moore T, Oberklaid F (2012) Prevalence and correlates of special health care needs in a population cohort of Australian children at school entry. Journal of Developmental and Behavioral Pediatrics 33, 319–327.
Prevalence and correlates of special health care needs in a population cohort of Australian children at school entry.Crossref | GoogleScholarGoogle Scholar | 22569337PubMed |

Hall DM, Michel JM (1995) Screening in infancy. Archives of Disease in Childhood 72, 93–96.
Screening in infancy.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2M3jtlyjsQ%3D%3D&md5=99021205ec4029a7a7a5b02328e336d9CAS | 7717751PubMed |

Heckman JJ (2008) Schools, skills, and synapses. Economic Inquiry 46, 289
Schools, skills, and synapses.Crossref | GoogleScholarGoogle Scholar | 20119503PubMed |

Johnson CP, Myers S (2007) American Academy of Pediatrics Council on Children With Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics 120, 1183–1215.
American Academy of Pediatrics Council on Children With Disabilities. Identification and evaluation of children with autism spectrum disorders.Crossref | GoogleScholarGoogle Scholar | 17967920PubMed |

Law J, Garrett Z, Nye C (2003) Speech and language therapy interventions for children with primary speech and language delay or disorder. Cochrane Database of Systematic Reviews CD004110

McLaughlin MR (2011) Speech and language delay in children. American Family Physician 83, 1183–1188.

Medicare (2011) Medicare healthy kids check. Available at http://www.medicareaustralia.gov.au/provider/budget-2011/NMHR-checks-for-3year-olds.jsp [Verified September 2012]

Naudeau S, Kataoka N, Valerio A, Neuman M, Elder L (2011) ‘Investing in young children: an early childhood development guide for policy dialogue and project preparation.’ (International Bank for Reconstruction and Development/World Bank: Washington, DC)

Nelson HD, Nygren P, Walker M, Panoscha R (2006) Screening for Speech and language delay in preschool children: systematic evidence review for the US Preventive Services Task Force. Pediatrics 117, e298–e319.
Screening for Speech and language delay in preschool children: systematic evidence review for the US Preventive Services Task Force.Crossref | GoogleScholarGoogle Scholar | 16452337PubMed |

National Health and Hospitals Reform Commission (2009) A healthier future for all Australians – final report of the National Health and Hospitals Reform Commission. Available at http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/nhhrc-report [Verified 30 October 2013]

National Health and Medical Research Council (2002) ‘Centre for Community Child Health. Child health screening and surveillance: a critical review of the literature.’ (National Health and Medical Research Council: Canberra)

Schmied V, Mills A, Kruske S, Kemp L, Fowler C, Homer C (2010) Understanding the needs and experiences of families. The nature and impact of collaboration and integrated service delivery for pregnant women, children and families. Journal of Clinical Nursing 19, 3516–3526.
Understanding the needs and experiences of families. The nature and impact of collaboration and integrated service delivery for pregnant women, children and families.Crossref | GoogleScholarGoogle Scholar | 20946442PubMed |

Shonkoff JP (2003) From neurons to neighborhoods: old and new challenges for developmental and behavioral pediatrics. Journal of Developmental Behavioral Pediatrics 24, 70–76.
From neurons to neighborhoods: old and new challenges for developmental and behavioral pediatrics.Crossref | GoogleScholarGoogle Scholar | 12584488PubMed |

Sices L (2007) Developmental screening in primary care: the effectiveness of current practice and recommendations for improvement. (The Commonwealth Fund: New York, NY) Available at http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007/Dec/Developmental-Screening-in-Primary-Care--The-Effectiveness-of-Current-Practice-and-Recommendations-f.aspx [Verified May 2013]

SISA (2012) Simple interactive statistical analysis. Available at http://www.quantitativeskills.com/sisa/statistics/twoby2.htm [Verified May 2013]

Skarzynski H, Piotrowska A (2012) Prevention of communication disorders–screening pre-school and school-age children for problems with hearing, vision and speech: European Consensus Statement. Medical Science Monitor 18, SR17–SR21.
Prevention of communication disorders–screening pre-school and school-age children for problems with hearing, vision and speech: European Consensus Statement.Crossref | GoogleScholarGoogle Scholar | 22460107PubMed |

Starfield B (2005) Equity, social determinants, and children’s rights: coming to grips with the challenges. Ambulatory Pediatrics 5, 134–137.
Equity, social determinants, and children’s rights: coming to grips with the challenges.Crossref | GoogleScholarGoogle Scholar | 15913405PubMed |

SurveyMonkey (2012) Survey monkey. Available at http://www.surveymonkey.com [Verified May 2013]

Templeton L, Deehan A, Taylor C, Drummond C, Strang J (1997) Surveying general practitioners: does a low response rate matter? British Journal of General Practice 47, 91–94.