Developmental vulnerability – don't investigate without a model in mind

Woolfenden, Susan; Williams, Katrina; Eapen, Valsamma; Mensah, Fiona; Hayen, Andrew; Siddiqi, Arjumand; Kemp, Lynn

doi:10.1111/cch.12181

Cited by 14 publications

(11 citation statements)

References 61 publications

(110 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the current setting, the inverse care law suggests that children who are developmentally vulnerable and socioeconomically disadvantaged (highest need) would have lower service use than those who are not developmentally vulnerable and not disadvantaged (lowest need). This aligns with the theoretical frameworks of cumulative risk and intersectionality of risk factors in relation to early childhood development 18–20. Yet, while health service patterns according to socioeconomic disadvantage and developmental vulnerability have been described separately,2 3 12 the combined effect on the use of health services by a preschool-aged child of being developmentally vulnerable and socioeconomic disadvantaged has not been examined.…”

Section: Introductionsupporting

confidence: 56%

Use of health services by preschool-aged children who are developmentally vulnerable and socioeconomically disadvantaged: testing the inverse care law

Woolfenden

Galea

Badland

et al. 2020

J Epidemiol Community Health

View full text Add to dashboard Cite

AimThe inverse care law suggests that those with the greatest need for services are least likely to receive them. Our aim of this study was to test the inverse care law in relation to the use of health services by children aged 4–5 years in Australia who were developmentally vulnerable and socioeconomically disadvantaged.MethodCross-sectional data were collected from the Longitudinal Study of Australian Children birth cohort when the children were aged 4–5 years. Children were grouped according to the combination of developmental vulnerability (yes, no) and socioeconomic disadvantage (lower, higher), resulting in four groups (reference group: developmentally vulnerable and disadvantaged). Multivariate regression was used to examine the impact of the combination of developmental vulnerability and disadvantage on health service use, adjusting for other sociodemographic characteristics.Results3967 (90%) of children had data on developmental vulnerability at 4–5 years. A third of children (32.6%) were classified as developmentally vulnerable, and 10%–25% of these children had used health services. Non-disadvantaged children who were developmentally vulnerable (middle need) had 1.4–2.0 times greater odds of using primary healthcare, specialist and hospital services; and non-disadvantaged children who were not developmentally vulnerable (lowest need) had 1.6–1.8 times greater odds of using primary healthcare services, compared with children who were developmentally vulnerable and disadvantaged (highest need).ConclusionWe found some evidence of the inverse care law. Equity in service delivery remains a challenge that is critically important to tackle in ensuring a healthy start for children.

show abstract

Section: Introductionsupporting

confidence: 56%

Use of health services by preschool-aged children who are developmentally vulnerable and socioeconomically disadvantaged: testing the inverse care law

Woolfenden

Galea

Badland

et al. 2020

J Epidemiol Community Health

View full text Add to dashboard Cite

show abstract

“…This finding is in keeping with the bioecological model of ECD with a cumulative burden of multiple risk factors on developmental outcomes. 9 11 21 24 26–30 What was somewhat surprising was that this cumulative effect was evident as early as infancy, a time of enormous neurobiological and neuroanatomical adaptation and vulnerability. Studies examining the dose response relationship between the number of risk factors and developmental vulnerability as indicated by the PEDS have included young children in their sample, but none have solely focused on children under 2 years of age.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and factors associated with parental concerns about development detected by theParents’ Evaluation of Developmental Status (PEDS)at 6-month, 12-month and 18-month well-child checks in a birth cohort

et al. 2016

View full text Add to dashboard Cite

ObjectivesEarly identification of developmental vulnerability is vital. This study aimed to estimate the prevalence of moderate or high developmental risk on the Parents' Evaluation of Developmental Status (PEDS) at 6-month, 12-month and 18-month well-child checks; identify associated risk factors; and examine documentation of the PEDS at well-child checks.Design, participantsA prospective birth cohort of 2025 children with 50% of those approached agreeing to participate. Demographic data were obtained via questionnaires and linked electronic medical records. Telephone interviews were conducted with parents to collect PEDS data.Primary and secondary outcomesMultiple logistic regression analyses identified risk factors for moderate or high developmental risk on the PEDS. A Cumulative Risk Index examined the impact of multiple risk factors on developmental risk and documentation of the PEDS at the well-child checks.ResultsOf the original cohort, 792 (39%) had 6-month, 649 (32%) had 12-month and 565 (28%) had 18-month PEDS data. Parental concerns indicating moderate or high developmental risk on the PEDS were 27% (95% CI 24 to 30) at 6 months, 27% (95% CI 24 to 30) at 12 months and 33% (95% CI 29 to 37) at 18 months. Factors associated with moderate or high developmental risk were perinatal risk (OR 12 months: 1.7 (95% CI 1.1 to 2.7)); maternal Middle Eastern or Asian nationality (OR 6 months: 1.6 (95% CI 1.1 to 2.4)), (OR 12 months: 1.7 (95% CI 1.1 to 2.7)); and household disadvantage (OR 6 months: 1.5 (95% CI 1.0 to 2.2). As the number of risk factors increased the odds increased for high or moderate developmental risk and no documentation of the PEDS at well-child checks.ConclusionsChildren with multiple risk factors are more likely to have parental concerns indicating developmental vulnerability using the PEDS and for these concerns to not be documented.

show abstract

“…Theoretical models can help us to understand how different factors interact on the path to behaviours and health outcomes [26]. An ecological model suggested by Bronfenbrenner, where the ecological environment is conceptualised as a set of nested structures, provided a framework for the investigation of parental experiences and factors that may impact their decision making in relation accessing health services for developmental surveillance and anticipatory guidance [27, 28].…”

Section: Methodsmentioning

confidence: 99%

Explaining culturally and linguistically diverse (CALD) parents’ access of healthcare services for developmental surveillance and anticipatory guidance: qualitative findings from the ‘Watch Me Grow’ study

Garg

Eastwood

et al. 2017

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundRegular health visits for parents with young children provide an opportunity for developmental surveillance and anticipatory guidance regarding common childhood problems and help to achieve optimal developmental progress prior to school entry. However, there are few published reports from Australian culturally and linguistically diverse (CALD) communities exploring parents’ experiences for accessing child health surveillance programs. This paper aims to describe and explain parental experiences for accessing developmental surveillance and anticipatory guidance for children.MethodsQualitative data was obtained from 6 focus groups (33 parents) and seven in-depth interviews of CALD parents recruited from an area of relative disadvantage in Sydney. Thematic analysis of data was conducted using an ecological framework.ResultsAn overarching theme of “awareness-beliefs-choices” was found to explain parents’ experiences of accessing primary health care services for children. “Awareness” situated within the meso-and macro-systems explained parents knowledge of where and what primary health services were available to access for their children. Opportunities for families to obtain this information existed at the time of birth in Australian hospitals, but for newly arrived immigrants with young children, community linkages with family and friends, and general practitioner (GPs) were most important. “Beliefs” situated within the microsystems included parents’ understanding of their children’s development, in particular what they considered to be “normal” or “abnormal”. Parental “choices”, situated within meso-systems and chronosystems, related to their choices of service providers, which were based on the proximity, continuity, purpose of visit, language spoken by the provider and past experience of a service.ConclusionsCALD parents have diverse experiences with primary health care providers which are influenced by their awareness of available services in the context of their duration of stay in Australia. The role of the general practitioner, with language concordance, suggests the importance of diversity within the primary care health workforce in this region. There is a need for ongoing cultural competence training of health professionals and provisions need to be made to support frequent use of interpreters at general practices in Australia.

show abstract

Developmental vulnerability – don't investigate without a model in mind

Cited by 14 publications

References 61 publications

Use of health services by preschool-aged children who are developmentally vulnerable and socioeconomically disadvantaged: testing the inverse care law

Use of health services by preschool-aged children who are developmentally vulnerable and socioeconomically disadvantaged: testing the inverse care law

Prevalence and factors associated with parental concerns about development detected by theParents’ Evaluation of Developmental Status (PEDS)at 6-month, 12-month and 18-month well-child checks in a birth cohort

Explaining culturally and linguistically diverse (CALD) parents’ access of healthcare services for developmental surveillance and anticipatory guidance: qualitative findings from the ‘Watch Me Grow’ study

Contact Info

Product

Resources

About