Inequity in developmental vulnerability, its determinants and the role of access to early identification and intervention

Abstract

ABSTRACT BACKGROUND AND AIMS Children who are developmentally vulnerable are those that have significant problems in at least one area of their development. Limited information is available on the prevalence of developmental vulnerability prior to the start of school, whether it has an inequitable distribution and how children are identified and referred to early intervention. This thesis aimed to: 1. Explore challenges in investigating inequity in developmental vulnerability. 2. Assess inequities in the prevalence of developmental vulnerability, associated risk factors and their interactions. 3. Explore factors that influence access to early identification and intervention. METHODS Methods included: a literature review; a theoretical critique; a systematic review of the prevalence of parental concerns on the Parents’ Evaluation of Developmental Status (PEDS) indicating developmental vulnerability and associated risk factors; a prospective birth cohort investigating developmental vulnerability and its early identification; a qualitative study of access to early identification and intervention; and a survey of primary health practitioners. RESULTS Between a quarter to a third of children were developmentally vulnerable as indicated by parental concerns on the PEDS in the systematic review and the original research of this thesis. There was evidence of inequities in developmental vulnerability associated with socioeconomic disadvantage, and culturally and linguistically diverse background (CALD). Children with multiple risk factors at the child, parent, family and neighbourhood level were more likely to be developmentally vulnerable but were less likely to have the PEDS documented at well child checks. Parents from CALD backgrounds, health and early childhood practitioners described barriers to access and quality in early identification and intervention services. CONCLUSION To reduce inequities in developmental vulnerability, differential risk needs to be addressed through early childhood policy that ensures cumulative buffering through universal early interventions with enhanced support for vulnerable populations. Differential knowledge needs to be addressed by ensuring that early childhood development is “everyone’s business”. Differential quality needs to be addressed through training and monitoring of primary health care systems to ensure consistency of practice. Differential access needs to be addressed through integrating primary health and early childhood services.