Concerns over preschool checks
Screening could be widening country’s rich-poor divide
One of the country’s biggest health initiatives isn’t picking up serious problems and could actually widen the rich-poor divide. Every child is offered a “before school check” (B4SC) on turning 4.
The programme helps identify health, behavioural, social or developmental issues, such as a hearing problem, which could affect learning. The aim is to help those children access health and learning support.
About 55,000 children will be covered this year at a cost of more than $10 million.
However, the Herald can reveal serious concern about the programme, including the possibility it could actually worsen inequality.
The Auckland, Counties Manukau and Waitemata District Health Boards have jointly written to the ministry’s chief adviser on child health, Dr Pat Tuohy, urging a review.
“Local data identifies the B4SC may be increasing inequities,” states the October 2017 letter, released under the Official Information Act.
“The children at the highest risk of poor health outcomes are less likely to be identified and referred, and if they are referred, the families are less able to navigate the system to receive timely appropriate follow-up.
“Eligibility for publicly funded health services . . . [is] a barrier for some families and a national solution to this issue should be sought.”
The timing of screening should be reviewed, the DHBs suggested, because currently there wasn’t time to help children with some conditions before they start school.
The ministry has acknowledged the concerns, some of which were already identified, and says they will be fed into an upcoming review.
No screening can identify all issues, it says, and checks run alongside regular nurse and GP visits.
The problems were discovered during research involving 126 children attending mostly decile 1A
schools in Auckland’s Glen Innes, Pt England and Panmure.
Study co-author Russell Burt said the most disadvantaged families — often Ma¯ ori and Pasifika, — were more likely to say their child was okay, because their development was typical for the community.
“Middle classes and above tend to be far more in-advocacy for their children’s needs — taking note of when other children walk, how early they are toilet trained, how well they speak — this view of developmental things being a competition.”
The Welcome To School study involved the Manaiakalani Ka¯ hui Ako group of local schools, the Cure Kids research foundation and Starship community services. Specialists and nurses checked new entrants.
The number of problems not picked up by before-school checks was “very significant”, said Burt, the principal at Pt England School and Manaiakalani convener.
There had been a misunderstanding about what checks covered, Burt said. For example, schools assumed eye testing was more comprehensive.
“But what in effect was being checked on was what lay people would call a lazy eye.
“If a parent doesn’t notice there’s something inhibiting their child . . . you’ve got a kid who might struggle to interact with text, when their brains are perfectly all right but their eyes aren’t doing what they ought to.”
He said the challenge facing lowdecile schools was bigger than suspected. Many children were starting at a language development age of 3-4 years. More than 30 per cent had a language proficiency in the bottom 2.5 per cent of the population.
The study, sent to Ministers of Health and Education, concludes that “our current model of delivering health, education and social services equally is increasing inequity”.
A ministry spokesman said the concerns would feed into a planned review of the suite of Well Child Tamariki Ora services, offered from birth to 5. He said B4SC coverage was consistently above 90 per cent.