PhD thesis by Anita D'Aprano – Menzies School of Health Research
Child health experts recognise internationally that developmental care is vital to improve long-term health and wellbeing outcomes. A key challenge to the provision of quality developmental care in remote Australian Aboriginal communities has been the absence of culturally appropriate, structured developmental screening tools. Also, Aboriginal health workers (AHWs), recognised as key staff in this context, and a high proportion of other remote health practitioners, do not have adequate training in the area of early childhood development (ECD).
The TRAK study aimed to design, implement and evaluate a capacity building program in developmental practice for AHWs. This included: a) the cultural adaptation of the Ages and Stages Questionnaire (ASQ-3) for use in remote Aboriginal communities; b) the design and trialing of an ECD training program; and c) the implementation of the culturally adapted ASQ-3 into standard health service practice in remote Aboriginal health services.
A case study evaluation framework was adopted, utilising mixed methods, including interviews, observations and medical record audits. Two case study sites in the Northern Territory were selected. Purposive samples of AHWs, key community informants, Aboriginal parents from the two sites and ECD experts were included in the study. All reschildren under 5 years of age resident in the study communities were included in medical record audits to determine baseline developmental practice of remote health staff.
The study findings demonstrated that the cross cultural adaptation of the ASQ-3 developmental screening tool was considered highly acceptable and relevant to parents, AHWs and ECD experts. The customised training program was delivered successfully and valued by all participants with demonstrated improvements in practitioner skills, knowledge, competence and confidence to identify and manage developmental difficulties and promote child development.
Despite the acceptability and value of the developmental screening tool and the ECD training, the integration of the adapted ASQ-3 into routine health service did not occur as intended. Challenges to the uptake and ongoing use of the adapted tool were identified in three broad themes: leadership and governance, workforce support, and health centre structures.
This study sought to advance understanding of some of the critical factors needed to build the capacity of AHWs and other remote health practitioners in providing quality developmental care to remote-dwelling Aboriginal children. The findings identified key barriers and potential solutions to improving developmental practice in this challenging service context. These include effective and culturally appropriate practitioner training in ECD, the availability of a culturally appropriate developmental screening tool, and service requirements for its routine use. These findings have implications for policy, practice and further research to improve the developmental outcomes of Australian Aboriginal children.
Anita is a developmental paediatrician who trained in Melbourne and moved to Darwin in 2008 to work at the Menzies School of Health Research and the Royal Darwin Hospital. Her research interests lie in developmental monitoring and in the emotional wellbeing of Australian Aboriginal children.
Following on from this study, Anita commenced a post-doctoral fellowship at the University of Melbourne to explore the psychometric properties further. She will undertake a validation study of the ASQ-TRAK instrument alongside the team of early childhood education researchers from the Melbourne Graduate School of Education. As a result of the knowledge exchange project, Anita plans to conduct this research in collaboration with Central Australian Aboriginal Congress Corporation in Alice Springs. She will also collaborate with the authors of the original ASQ-3 to ensure the accuracy of the instrument is maintained. My post-doctoral research aims to contribute to the developmental outcomes for Australian Aboriginal and Torres Strait Islander children.
- D'Aprano A., Silburn S., Johnston V., Bailie R., Mensah F., Oberklaid F., Robinson G., 2016, Challenges in monitoring the development of young children in remote Aboriginal health services: clinical audit findings and recommendations for improving practice, Rural and Remote Health 2016; 16: 3852
- D'Aprano, A., Silburn, S., Johnston, V., Oberklaid, F., Tayler, C., 2015, Culturally Appropriate Training for Remote Australian Aboriginal Health Workers: Evaluation of an Early Child Development Training Intervention, Journal of Developmental and Behavioral Paediatrics, vol. 36(7): 503–11.
- D’Aprano, A, Silburn, S, Johnston, V, Oberklaid, F & Robinson, G 2014, The design, implementation and evaluation of a program to improve developmental practices in remote Aboriginal communities: Identifying barriers and facilitators, presented at Lowitja Institute 2nd National Conference on Continuous Quality Improvement (CQI) in Aboriginal and Torres Strait Islander Primary Health Care, 18 March 2014, Melbourne.
- D’Aprano, A, Silburn, S, Johnston, V, Oberklaid, F & Robinson, G 2014, The cross-cultural adaptation of the ASQ-3 for use with remote dwelling Australian Aboriginal children: Ensuring culturally competent care (poster), presented at Lowitja Institute 2nd National Conference on Continuous Quality Improvement (CQI) in Aboriginal and Torres Strait Islander Primary Health Care, 17–18 March 2014, Melbourne.
- D'Aprano A., Silburn S., Johnston V., Robinson G., Oberklaid, F. & Squires J. 2014, Adaptation of the Ages and Stages Questionnaire for Remote Aboriginal Australia, Qualitative Health Research, vol. 26(5): 613–251
- Simpson, S., D’Aprano, A., Tayler, C., Khoo, ST. & Highfold, R. 2016, Validation of a culturally adapted developmental screening tool for Australian Aboriginal children: Early findings and next steps, Early Human Development, 103, December, 91–5.
- ASQ-TRAK website
- D’Aprano, A. 2013, Improving developmental monitoring practices of remote Australian Aboriginal health workers - The TRAK study, PhD Thesis, Charles Darwin University