Healthy Kids Check Research Articles

Scrapping the Healthy Kids Check: a lost opportunity.

The HKC was introduced into general practice in 2008, policy that reflected advances in neuroscience (eg, the evolution of brain architecture, critical time points for development and the benefits of early intervention) and significant health shifts towards prevention. Uptake of the health assessment was slow (16% of eligible children in its first year) and beset by argument about a lack of evidence for some of its mandatory components and by scaremongering about labelling 3-year-olds with mental health diagnoses. In the ensuing negative debate, it was easy to forget major barriers to preventive health care before the HKC: sick child consultations, poor remuneration, lack of time, resources and training, and the ever-increasing demands of chronic disease management in an ageing population. Nevertheless, over the next 7 years, uptake of the HKC climbed to 50%, as practice nurses were upskilled and parents were incentivised by tax benefits. Our research with practitioners, 3 years after its introduction, indicated that in some circumstances, the HKC had acted as a catalyst for general practitioner and practice nurse (PN) role development, and in some cases promoted an entire practice shift towards preventive health care for young children. The important contribution made by PNs, in particular, has been overlooked by the government in its statement that GPs can continue to provide health assessments as part of Medicare-funded general GP attendance items, because PNs are excluded from those services.

The challenges of trying to increase preventive healthcare for children in general practice: results of a feasibility study.

BackgroundIn Australia, general practice, the linchpin for delivery of preventive health care to large segments of the population, provides child-immunisation and preventive health alongside government services. Despite this, less than half of eligible children complete a Healthy Kids Check (HKC), a preschool preventative health assessment available since 2008. Using a rigorous theoretical process, the barriers that affected delivery and reduced general practitioner and practice nurse motivation to provide HKCs, were addressed. The resulting multifaceted intervention, aimed at increasing the proportion of children receiving evidence informed HKCs from general practice, was piloted to inform a future randomised controlled trial.MethodsThe intervention was piloted in a before and after study at three sites located southeast of Melbourne, between February and October 2014. The HKC-intervention involved: 1) Delivery of training modules that motivated reception and clinical staff by delivering key messages about local prevalence rates and the “Core Story of Child Development” 2) Practical advice to prepare clinics for specific HKC-examinations 3) Workflow advice regarding systems that included all staff in the HKC process, and 4) Provision of a “Community Resources Folder” that enabled decision making and referrals. A major component of the intervention incorporated the promotion of structured developmental screening by the practice team using Parents’ Evaluation of Developmental Status.ResultsTwenty of 22 practitioners and practice managers agreed to join the study. Post-training questionnaires showed participants had developed their skills working with young children as a result of the training and all respondents believed they had successfully implemented standardised HKC services. Post intervention proportions of children completing HKCs significantly increased in two of the practices and quality improvements in HKC-processes were recorded across all three sites.ConclusionThis pilot study confirmed the feasibility of delivering a multi-faceted intervention to increase HKCs from general practice and demonstrated that significant quality improvements could be made. Future studies need to extend the intervention to other states and research the health outcomes of HKCs.

Identified health concerns and changes in management resulting from the Healthy Kids Check in two Queensland practices.

To determine how many children had health problems identified by the Healthy Kids Check (HKC) and whether this resulted in changes to clinical management. A medical records audit from two Queensland general practices, identifying 557 files of children who undertook an HKC between January 2010 and May 2013. Child health problems identified in the medical records before, during and after the HKC. Most children in our sample had no problems detected in their medical record (56%), 21% had problems detected during the HKC assessment, 19% had problems detected before, and 4% after. Most frequent health concerns detected during the HKC were speech and language (20%), toileting, hearing and vision (15% each), and behavioural problems (9%). Of the 116 children with problems detected during the HKC, 19 (3% of the total sample) had these confirmed, which resulted in a change of management. No further action was recorded for 9% of children. Missing data from reviews or referral outcomes for 8% precluded analyses of these outcomes. We estimated that the change in clinical management to children with health concerns directly relating to the HKC ranged between 3% and 11%. Overall, data suggest that general practitioners are diligent in detecting and managing child health problems. Some of these problems were detected only during the HKC appointment, resulting in change of management for some children. Further studies are required to estimate the full benefits and harms, and particularly the false negatives and true positives, of the HKC.

Barriers and enablers to delivery of the Healthy Kids Check: an analysis informed by the Theoretical Domains Framework and COM-B model.

BackgroundMore than a fifth of Australian children arrive at school developmentally vulnerable. To counteract this, the Healthy Kids Check (HKC), a one-off health assessment aimed at preschool children, was introduced in 2008 into Australian general practice. Delivery of services has, however, remained low. The Theoretical Domains Framework, which provides a method to understand behaviours theoretically, can be condensed into three core components: capability, opportunity and motivation, and the COM-B model. Utilising this system, this study aimed to determine the barriers and enablers to delivery of the HKC, to inform the design of an intervention to promote provision of HKC services in Australian general practice.MethodsData from 6 focus group discussions with 40 practitioners from general practices in socio-culturally diverse areas of Melbourne, Victoria, were analysed using thematic analysis.ResultsMany practitioners expressed uncertainty regarding their capabilities and the practicalities of delivering HKCs, but in some cases HKCs had acted as a catalyst for professional development. Key connections between immunisation services and delivery of HKCs prompted practices to have systems of recall and reminder in place. Standardisation of methods for developmental assessment and streamlined referral pathways affected practitioners’ confidence and motivation to perform HKCs.ConclusionApplication of a systematic framework effectively demonstrated how a number of behaviours could be targeted to increase delivery of HKCs. Interventions need to target practice systems, the support of office staff and referral options, as well as practitioners’ training. Many behavioural changes could be applied through a single intervention programme delivered by the primary healthcare organisations charged with local healthcare needs (Medicare Locals) providing vital links between general practice, community and the health of young children.

Encouraging general practitioners to complete the four-year-old Healthy Kids Check and provide healthy eating and physical activity messages.

To describe the impact of a training and support intervention to encourage completion of the Healthy Kids Check (HKC) by general practitioners (GP) or practice nurses (PN) and provision of brief advice on diet and physical activity. The intervention (June 2008 to July 2010) was delivered by Divisions of General Practice (DGP) in the Hunter New England (HNE) region of NSW, Australia, to members in 300 practices. Intervention impact was evaluated using Medicare data on the number of HKCs completed and a post-intervention telephone survey of randomly selected parents in HNE and rest of NSW. Training reached 31% of GPs (n∼ 216/700) and 71% of PNs (n∼320/450); 31% of four-year-olds received a HKC in HNE compared to 15% in NSW; 27% of HNE parents (n=162) reported a GP or PN had provided advice during their child's vaccinations visit compared to 15% of parents (n=154) in NSW (p=0.002). There was no significant difference in proportion of children who had weight or height assessed (55.6% in HNE and 54.6% in NSW). Boosting HKC claims and healthy eating and physical activity messages in general practice is feasible. More intensive strategies are required if obesity prevention and management benefits are to be achieved. General practice is an important but under-utilised source of advice for parents and data for policy makers on childhood obesity in Australia.

Changes to the Healthy Kids Check: will we get it right?

Medical Journal of AustraliaVolume 198, Issue 9 p. 475-477 Perspective Changes to the Healthy Kids Check: will we get it right? Michael F Daubney MB BS, FRANZCP, Corresponding Author Michael F Daubney MB BS, FRANZCP Child Psychiatrist [email protected] School of Medicine, Griffith University – Logan Campus, Brisbane, QLD.Correspondence: [email protected]Search for more papers by this authorCate M Cameron PhD, MPH, BSocWork(Hons), Cate M Cameron PhD, MPH, BSocWork(Hons) Senior Research Fellow School of Medicine, Griffith University – Logan Campus, Brisbane, QLD.Search for more papers by this authorPaul A Scuffham PhD, BA, Paul A Scuffham PhD, BA Chair in Health Economics, Griffith Health Institute School of Medicine, Griffith University – Logan Campus, Brisbane, QLD.Search for more papers by this author Michael F Daubney MB BS, FRANZCP, Corresponding Author Michael F Daubney MB BS, FRANZCP Child Psychiatrist [email protected] School of Medicine, Griffith University – Logan Campus, Brisbane, QLD.Correspondence: [email protected]Search for more papers by this authorCate M Cameron PhD, MPH, BSocWork(Hons), Cate M Cameron PhD, MPH, BSocWork(Hons) Senior Research Fellow School of Medicine, Griffith University – Logan Campus, Brisbane, QLD.Search for more papers by this authorPaul A Scuffham PhD, BA, Paul A Scuffham PhD, BA Chair in Health Economics, Griffith Health Institute School of Medicine, Griffith University – Logan Campus, Brisbane, QLD.Search for more papers by this author First published: 20 May 2013 https://doi.org/10.5694/mja12.11455Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume198, Issue9Mental health issueMay 2013Pages 475-477 RelatedInformation

‘Can they really identify mental health problems at the age of three?’ Parent and practitioner views about screening young children’s social and emotional development

To report the views of parents, general practitioners and practice nurses on the proposed changes to incorporate social and emotional health checks of three-year-olds into the Healthy Kids Check, a one-off pre-school health assessment delivered through general practice. Participants were recruited from three socio-culturally diverse urban areas of Melbourne for a qualitative study involving 28 parent interviews and six focus groups with a total of 40 practitioners. Participants discussed child social and emotional development, health-seeking and preventive health care for young children. Transcripts were thematically analysed. Common themes showed: (i) Although both parents and practitioners were receptive to the idea of social and emotional screening, parents had limited knowledge about mental health issues for young children and the need for early intervention. (ii) All groups questioned the current capabilities of practice staff to identify problems, and practitioners expressed a need for further training and tools. (iii) Parents and practitioners cautioned that screening may increase parental anxiety and lead to unnecessary referrals. Practitioners countered this with examples of cases not recognised by parents. (iv) Participants questioned the value of earlier identification of problems without effective and accessible therapeutic pathways. For programmes to be effective, parents need to be reminded of the benefits of early intervention and encouraged to attend preventive health appointments. Practitioners require further training and tools specific to the primary care setting. Further investment in specialist and allied health services is considered essential to assure better outcomes for young children's mental health following screening and referral. Practitioners welcome a more collaborative relationship with other professionals (e.g. early educators) in assessing children's social and emotional development. General practice has the capability but requires a more structured approach to assessing the social and emotional health of young children.

Healthy Kids Check: Lack of transparency and misplaced faith in the benefits of screening

Healthy Kids Check: Lack of transparency and misplaced faith in the benefits of screening

P85– The Australian Healthy Kids Check: Does it conform to evidence-based guidelines?

P85– The Australian Healthy Kids Check: Does it conform to evidence-based guidelines?

The Healthy Kids Check — is it evidence‐based?

To assess whether the components of the Healthy Kids Check (HKC), a preschool screening check recently added to the Australian Government's Enhanced Primary Care Program, are supported by evidence-based guidelines or reviews. Guideline and MEDLINE databases were searched for guidelines and systematic reviews published between 2000 and 2008 that were relevant to screening, prevention or well-child care in primary health care, and including children of preschool age. Search subjects reflected the HKC components: growth, weight, obesity, vision, hearing, oral health, enuresis, encopresis, allergic disease and food allergies. 34 relevant guidelines or reviews were retrieved. For each component of the HKC, guidelines addressing the presumed rationale for screening, or the test or tool required to implement it, were reviewed. Relevant evidence-based and consensus-based guideline recommendations were assessed as either supporting or opposing components of the HKC, or stating that the evidence was insufficient to recommend screening of preschool children. Guidelines were often inconsistent in their recommendations. Most of the components of the HKC (eg, screening for chronic otitis media and questioning about toilet habits) are not supported by evidence-based guidelines relevant to the primary care setting, though a number of consensus-based guidelines are supportive. There is currently a dearth of evidence relevant to child health surveillance in primary care. The components of the HKC could be refined to better reflect evidence-based guidelines that target health monitoring of preschool children.