Evaluation of an islandwide screening, assessment and treatment program

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AbstractThis article reports on the effectiveness of the Islandwide Screening, Assessment, and Treatment Program of the Child Development Project in Bermuda. From 1982 to 1984, approximately 1100 families with 2‐year‐old children were screened for children's cognitive and language delay, for behaviour management problems and for other home characteristics that put children at risk for later school failure. Children who failed the screening and subsequent assessment procedures (of whom random samples received treatment) and samples of others who passed screening and assessment were evaluated from 1984 to 1986 at 4 years of age. This article focuses on the results of the cognitive and language programs; the more problematic behaviour management analyses were reported elsewhere (Miller and Scarr, 1988). The screening procedures and assessment measures developed for this project were themselves evaluated and adjusted to maximize efficiency and costeffectiveness. The screening and assessment procedures proved effective in bringing to the attention of the Child Development Project those families and children who need developmental services, and in not overidentifying normal children as potentially delayed in development. Two kinds of treatment services were compared: The Mother‐Child Home Program (MCHP), administered by paraprofessional toy demonstrators, and other interventions tailored by professionals to the language and cognitive problems of the child (called ‘tailored programs’). Children who were not extremely delayed or disturbed were randomly assigned either to the MCHP or to a tailored program. Neither intervention program was preferable to the other. Even though improved, the 4‐year‐olds identified as developmentally delayed at 24 months still lagged behind children who passed all parts of screening and those who failed screening but passed assessment 2 years earlier. The screening and assessment procedures were very effective in the early identification of children with developmental problems, but the treatment programs failed to bring most children to normal levels of cognitive and language functioning.