ࡱ> _b^ RIbjbjUU 8N??! //8L,4EEEEE "B N3333333$694E  4/.]$EEc4T!!!EE3!3!!P2|3EWX234<42U:pU:$3U:3@V0"!VVV44TVVV4U:VVVVVVVVV :  New Zealand Paediatric Society B4 School Check Position Statement The B4 School Check is a free health and wellbeing assessment for children aged four years old, and is the final check of the New Zealand Well Child/Tamariki Ora Programme. The primary purpose of the check is to ensure that every child has the best start to school. There are two components of the check: Firstly to support parents to prepare their preschooler for school through the provision of health and education promotion information and anticipatory guidance, and secondly to identify and address any health, behavioural, developmental or social issues and intervene before a child begins school. Background There is compelling evidence that the early years of life are critical periods in the development of healthy mind and body, self-confidence, pro-social skills, and cognitive abilities. Proactive and population-focused early intervention programmes have been shown to support childrens health and development. Some of these programmes also protect children from child abuse and childhood injury. In many countries, including New Zealand, early years services have been provided through a range of health, education and social agencies. Well child/ Tamariki ora services in the first three years of life also provide the opportunity to encourage enrolment in Early childhood education. Over the last three to four decades the emergence of the new morbidity of developmental and behavioural problems and chronic disease has challenged the relevance of existing Well-child programmes. Although the Well child/Tamariki ora programme adopted new service delivery models to meet the changing needs of their client base, the system within which the programme was located had not adapted to support this change in emphasis. This led to insufficient emphasis on the pathways of care for children with behavioural and developmental difficulties, continued provision of clinical activities which lacked an evidence base, and a lack of information about whether the programmes were achieving the desired outcomes, In 2005 a review of Well Child services was conducted with a focus on improving health outcomes for children, and creating more efficient and consistent well child programme. One component of the existing programme was the 5 year old New Entrant check. Although it was supposed to be a nationally consistent and comprehensive well child check, the components of the 5 year old New Entrant check varied significantly across and within District Health Boards. Clarification of the requirements for the 5 year old check and bringing all the information relating to this check together in one place was clearly necessary. The review also highlighted the lack of a national child health database, which could be used to monitor programme uptake and quality, and support provision of Well child checks and support to families the service did not reach. The 5 year old New Entrant check took place some time after school entry, and any issues identified would not be addressed until the child was nearing the end of their first year at school. The review identified the lack of suitable referral services in some DHBs and long waiting times for children who were referred for further assessment or intervention. This meant that for many children early school failure or behavioural issues impaired the childs functioning and adversely coloured their perception of and participation in education. The Ministry of Health Well Child 2007 review recommended a national school readiness check be implemented at age 4. This would address the regional and local inconsistencies in the provision of the school entry check, and bring the content of the check up to date with recent international literature on the early years. The B4 School Check content was informed by the growing evidence that health and wellbeing from infancy and childhood has a significant impact on children that has long term implications into adulthood. It is also of interest to note that most children who received the 3-5year old check from their WC provider were children with younger siblings who were also enrolled with the programme, reflecting the significance of family centred care / relationship - spanning a number of years. Philosophy of B4 School Check The first years of a childs compulsory schooling are important for creating a positive attitude to learning and supporting socialisation. Starting school well builds a childs confidence as a learner, and assists them to develop positive peer relationships. Parents have a key role in preparing a child for starting school, and the B4School check supports parents in this role through its educative and health promoting aspects. Review of the B4school as it has been implemented shows that parents value reassurance about normal behaviours, and anticipatory guidance about how to support children in the transition to school. The benefits of the check therefore extended beyond the identification of children in need of formal follow-up services. A childs health is a powerful determinant of physical and mental health and wellbeing later in life. The B4 School Check includes: vision and hearing screening, behaviour and developmental screening using the Strengths and Difficulties (SDQ) and Parental Evaluation Developmental Status (PEDS) questionnaires, measurement of height and weight, recording the Body Mass Index (BMI) as a population level indicator, Lift the Lip assessment of oral health a general health assessment that includes follow up on 4 year old immunisations. The check aims to identify and address any health, behavioural, developmental or social issues and address these prior to a child beginning school. The B4 School Check promotes a holistic approach to child health identified in the research Monitoring the Health of New Zealand Children and Young People: Literature Review and Framework Development. It is a joint Ministry of Health and Education initiative that links into the Ministry of Education Te Whriki; Early Childhood Education Curriculum by taking into account the child s wider social context with their learning and development. Outcomes from the Check There are multiple outcomes expected from the B4 School Check which are: Identification of a child and familys needs to ensure appropriate resources and support are available from health and education professionals. Detecting health, behavioural, developmental or social issues and providing interventions and support to a child and family prior to starting school Long term health, education and social benefits to the child. Position Statement: The New Zealand Paediatric Society: recognises the importance of the early years as a critical period of development, and strongly supports a universal well child programme for New Zealand children that is continuous from prior to birth through to school entry supports the early identification of health, developmental, behavioural or social issues, and the provision of appropriate and timely interventions in the context of a childs family/whanau to ensure children experience healthy life trajectories. notes that successful implementation of the check must ensure that children identified through Well child service as needing an assessment or intervention have timely access to adequate and effective referral services recommends that all health professionals work within their community to promote B4 School Checks across the sector. recommends that the B4School check should be fully integrated into the preceeding Well child checks, and link seamlessly with the diverse health information systems at local, regional and national levels Strongly supports that the B4School check programme is sufficiently funded and resourced to be universal with an emphasis on ensuring the majority of at risk children are seen (those from higher deciles, higher socioeconomic deprivation). The current funding model is punitive and therefore prohibitive to ensuring this happens and needs to be reviewed. notes that effective Well child/Tamariki Ora programmes must have good linkages to follow-up evaluation and to education and social service provision, This requires adequate resourcing and an appropriate skill base, including acceptability to whanau recommends ongoing evaluation and refinement of the programme to ensure the objectives are met, and ensure that the programmes adapts to the changing needs of children and families/whaanau      Ben-Schlomo Y., Kuh D. A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. International Journal of Epidemiology 2002; 31: 285-93  Olds D.L., Robinson J.R., OBrien R., et al. 2002. Home visiting by paraprofessionals and by nurses: a randomised controlled trial. Pediatrics, 110(3), 486-96  Kendrick D, Coupland C, Mulvaney C, et al. 2007. Home safety education and provision of safety equipment for injury prevention. Cochrane Database of Systematic Reviews. Issue 1. Art No CD00514. DOI: 10.1002/14651858.pub2.  Supporting evidence for Changes to the Content of the WellChild/Tamariki Ora Framework A Background paper, 2007. Ministry of Health Wellington.  Craig E., Jackson C., Han D.Y., NZCYES Steering Committee. Monitoring the Health of New Zealand Children and Young People: Literature Review and Framework Development. 2007. Auckland: Paediatric Society of New Zealand, New Zealand Child and Youth Epidemiology Service.  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BNew Zealand Paediatric Society B4 School Check Position Statement TitleP <D_NewReviewCycle  !"#$%&')*+,-./123456789:;<=>?@ABCDEFGHIJKLMOPQRSTUWXYZ[\]`adRoot Entry F@WcData (1Table0y:WordDocument 8NSummaryInformation(NDocumentSummaryInformation8VMsoDataStore@eWWZ4E0WUXBOVXQ==2@eWWItem  PropertiesUCompObj y   F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q Paediatric Society of New Zealand: Position Statements
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Position Statements

From time to time the Society will produce a Position Statement - a statement that presents the Society's opinion about a particular child health issue in the form of a detailed report which explains and/or recommends a particular course of action.  

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