The B4 school check behaviour measures: findings from the Hawke's Bay evaluation.

BackgroundThe B4 School Check is a free health and development check delivered to four year old children throughout New Zealand (Ministry of Health, 2008). It aims to identify and address any health, behavioural, social or developmental concerns that could affect a child's ability to get the most benefit from school. It is the eighth core contact of the Well Child/Tamariki Ora Schedule of services and replaced the New Entrant Check that was offered in some areas of the country.Delivery of the B4 School Check started in four District Health Board (DHB) regions (Waikato, Nelson Marlborough, Mid-Central and Lakes) in June 2008. The remaining regions, including Hawke's Bay, commenced delivery in September 2008. A year later the B4 School Check programme in Hawke's Bay was recognised as one of the more successful in terms of the numbers and efficacy, with 1,848 checks completed, representing 84% of all eligible 4 your olds and 75% of those from the most deprived areas (Wills, Morris Matthews, Hedley, Morris & Freer, 2010).The B4 School Check includes height and weight measurements, vision and hearing checks, an oral health assessment, immunisations, and general health, development and behaviour questionnaires. Nurses who conduct the checks are required to have completed the compulsory, locally provided B4 School Check training programme. B4 School Check nurses provide advice and support for parents in relation to their child's health and development and make referrals to specialist services if concerns are identified that require further attention. The checks usually occur within general practices and health centres. On rare occasions they may take place with parents in attendance in early childhood centres, community centres, marae and in mobile vans. Some primary health providers, particularly Maori health service providers, contract nurses to reach underserved populations by visiting them in their homes (Cameron, 2011; Petkovich, 2011). Results of Wills et al.'s (2010) evaluation showed that ten months after the first nurse training, the B4 School Check in Hawke's Bay was beginning to demonstrate some of the desired outcomes, such as high rates of completed checks and a stable high rate of referrals. Increased confidence in the use of the measures for child development and behaviour was also noted (Wills et al., 2010).Reported here are the results of the second phase of evaluation funded by the Hawke's Bay Children's Holdings Trust to assess the outcomes of the B4 School Check programme in Hawke's Bay. This evaluation focused specifically on children assessed at a B4 School Check with behaviour issues as determined by the Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1999). Children who are identified through this instrument as exhibiting problematic behaviour are referred by the B4 School Check Triage team for appropriate intervention which could be, for example, to Children and Adolescent Mental Health Services, Ministry of Education Early Intervention Service, nongovernmental organisation (NGO) for parenting skills programmes or other social services. The evaluation aimed to track some of these children in the Hawke's Bay region over two years to help determine the outcomes of the B4 School Check for child behaviour and what differences the checks have made (Thompson, Morris Matthews, Stockdale Frost, Pentecost & Wive 11, 2011).Review of literatureChild behaviour in New ZealandResearch published from the longitudinal child development study of the Dunedin Multidisciplinary Health and Development Unit reported that behavioural difficulties identified in children at the age of three had escalated by the age of nine (Silva & Stanton, 1996). A similar study conducted by the Christchurch School of Medicine and Health Services found that conduct problems identified in children at age five were highly predictive of poor educational outcomes at school leaving, and that 70% of the adults in the study with significant mental health issues had conduct problems in early childhood (Polland & Legge, 2005). …