Development of a Multi-professional and multi-agency Model, PLUSS (mental health, learning, development, collaboration around pre-school children), to Facilitate Early Detection and Support of Pre-School Children with Neurodevelopmental Difficulties in the Swedish Child Health Care – A Description of the Model and Initial Results

Abstract

Background: Neurodevelopmental difficulties are frequent in preschoolers and constitute a risk for later negative consequences. This article describes the development of a multi-professional and multi-agency model, PLUSS, to facilitate care and interventions for preschoolers with neurodevelopmental difficulties. Methods: The PLUSS-model was developed for children aged 1.5-5 years with a need for a further assessment of neurodevelopmental symptoms. The model is evaluated using a quasi-experimental study design along with qualitative interviews. Outcomes of interest are a) implementation, b) effectiveness related to processes and multi-agency collaboration, c) capacity building among professionals, d) child-related outcomes with a longitudinal follow-up as well as d) parental wellbeing and satisfaction. Results: The model was launched in 2019 and so far, approximately 130 children have been assessed. Results from a pilot study with 62 children (27-72 months; boys: girls 2.65:1) show, using the strengths and difficulties questionnaire (SDQ), that the included children have clinically significant problems. The total mean SDQ score in parental rating was 15 +/- 6 and in preschool teacher ratings 14 +/- 7, exceeding the Swedish cut-off of 12. 54 parents have participated in parental training and rate high levels of satisfaction (mean score 4.5, max 5.0). In addition, 74 pre-school professionals have been trained in early signs of neurodevelopmental difficulties to facilitate early detection. Feedback from these educational activities is encouraging (mean score 4.2, max 5.0). Conclusions: The PLUSS-model enables early detection and interventions for preschool children and their families, without a set diagnosis. The pilot study shows that the screening procedure can detect children with clinically significant problems. In addition, encouraging results have been obtained from both parent- and preschool teacher training. The longitudinal study approach enables both child follow-up and evaluation of interventions provided by the working model. Trial registration: Clinical Trials 2021, PLUSS identifier, NCT04815889. First registration 25/03/2021.