People from culturally and linguistically diverse (CALD) backgrounds in Australia are known to experience multiple social disadvantages and face challenges in health and health care needs (1). Previous reviews on access to health services among CALD populations have focused on specific health issues (2–4). However, there is a dearth of evidence available on child and family health service-related problems in CALD populations. Recent research and government policies have increasingly focused on early intervention for child developmental delays in the general population (5–7). It is understood that children who do not access early developmental screening are at-risk for delays in early identification of developmental issues and delayed access to appropriate interventions, leading to future difficulties (8). For instance, one in five Australian children starting school do not have the developmental skills necessary to thrive (9). In Australia, each state and territory has its own processes around developmental surveillance; in most cases, this involves developmental screening completed by Child and Family Health Nurses at 6, 12, 24, 36, and 48 months. While there are state and federal developmental surveillance models (see Table 1), the uptake is variable, especially for children from CALD backgrounds. These children are at higher developmental risk, but the developmental concerns/delays go unidentified until the start of school in many instances. This impact was further increased by the COVID-19 pandemic effect (e.g. service closures and resource constraints), thereby missing out on early screening and intervention opportunities (10).
Table 1
Current Australian national and NSW state-based models of child development surveillance, screening and diagnosis (15).
Model feature | NSW | Australia |
Target population – universal | √ | √ |
Progressive or proportionate universalisma | √ | √ |
Ages for contact | Birth to 4 years | Birth to 5 years |
Number of contact points | 8 | Not specified |
Settings | Home visits & clinics | Home visits & clinics |
Primaryb Healthcare professionals involved Secondaryc | Child and family health nurses, midwives, GPs --- Paediatricians, social workers, psychologists, speech pathologist, and so forth | Child and family health nurses, midwives, GPs --- Paediatricians, social workers, psychologists, speech pathologist, and so forth |
Physical health monitoringd | √ | √ |
Hearing and vision screeninge | √ | √ |
Growth monitoringd | √ | √ |
Health promotion | √ | √ |
Developmental assessmentf | √ | √ |
Child developmental screening tool | Blue Book (Learn the Signs. Act Early [LTSAE]) | Based on jurisdiction |
Immunisation | √ | √ |
Anticipatory guidance | √ | √ |
Autism screening | × | × |
IT utilised in program | × | × |
Notes: a Each of the comprehensive models sought to include all children (universal reach) although most noted a need for targeted resources for disadvantaged children. Documents varied with respect to the amount of detail regarding the identification, engagement and management of such disadvantaged children, although sub-populations of indigenous/aboriginal families, teenage mothers and children living in poverty were frequently mentioned as being prioritised. |
b Primary health care is provided by General Practitioners who serve at the entry level to the health system and, as such, is usually a person’s first encounter with the health system. They provide a broad range of activities and services, from health promotion and prevention, to treatment and management of acute and chronic conditions.
c Secondary health care relates to a specialist medical practitioner (e.g. paediatricians) when patients are referred from a primary care service such as the General Practice to the next level in the service system, and this could be in a hospital or a community based specialist clinic.
d Monitoring enables ongoing tracking of health and developmental problems as well as linking children with services for further assessment or intervention when concerns are identified.e Developmental screening is a test (or a series of tests) performed on a population to systematically examine whether the child is meeting the developmental milestones, with a view of identifying any developmental delay/problems early.
f Developmental assessments are a comprehensive evaluation of a child’s physical, intellectual, language, social and emotional development. It is the process of mapping a child’s performance compared with children of similar age, and aims to highlight what normal developmental parameters are, when and how to assess a child, and when to refer for specialist assessment.
Children from CALD or socioeconomically disadvantaged communities have an increased risk of developmental challenges (11, 12). According to the ‘inverse care law,’ children from socio-economically disadvantaged and CALD backgrounds and who are most at-risk for developmental delays are less likely and less able to access preventative care services, such as developmental surveillance programs (13, 14). While such programs aim to promote child health and development, and to facilitate early detection and intervention, including growth monitoring, physical health, developmental surveillance, and health promotion, data have suggested that uptake of these programs has been low (15). In a study involving a 2000-strong cohort in South Western Sydney (16), for example, it was found that while up to 30% of children are at developmental risk by their 18-month ‘well-child’ check, only 30–50% of these children attending primary healthcare have their developmental surveillance record completed (17–19). Another study (20) highlighted the need for practice and policy changes including training of general practitioners in developmental surveillance, as well as allocation of time and financial remuneration for developmental checks in primary care (1). Qualitative findings from previous research have demonstrated enabling factors such as proximity, continuity of care, opportunistic contacts, integrated/connected engagement between services, as well as parental and service provider language and cultural concordance (22–24).
Accessing services might be particularly difficult for CALD families due to their cultural beliefs, language barriers, poor health literacy and awareness of services, and the complex nature of child and family health services (13, 22, 24, 25). The COVID-19 pandemic might have exacerbated difficulties with service access for CALD families (26). These accessibility challenges for families from CALD backgrounds extend to telehealth or online services due to few adaptations and translations (27). While the use of web-based applications can increase health screening uptake, more needs to be understood about real-world implementation (28).
Increasingly, family member perspectives are being included during the evaluation of health initiatives (22, 24, 29). Qualitative research that focuses on in-depth description and personal experience stories and gathers the perspectives of family members and service providers on developmental surveillance and service access is important to provide insights around what works and how developmental surveillance monitoring can be improved.
Research aims
As part of a whole evaluation, the aim of this study is therefore to evaluate engagement with developmental surveillance, services access to child and family health, and uptake of service recommendations by identifying the barriers and enablers of our digital developmental surveillance program, WMG-E, in a multicultural community, according to family members, service navigators and service providers. Specifically, we focused on perspectives regarding the developmental surveillance program and the service navigator role.