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

The Before (B4) School Check is a free health and development check delivered by specifically trained nurses to four year old children throughout New Zealand, aimed 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. Reported here are the results of an evaluation of the B4 School Checks in Hawke's Bay, focusing specifically on children assessed at the 84 School Check with behaviour issues as determined by the Strengths and Difficulties Questionnaire (SDQ). Health Hawke's Bay (HHB) records were reviewed to understand the number and demographics of the children assessed with behaviour issues at the B4 School Checks up to 31 August 2011, and the interventions to which they were referred. Telephone Interviews were conducted with 36 parents/caregivers of these children to address the questions, what difference did the B4 School Check make to children assessed with behaviour issues and what aspects of the B4 School Check delivery contributed to successful outcomes for these children? Results showed that child behaviour issues in Hawke's Bay were identified in more boys than girls and concentrated in more deprived families. Maori children were represented in numbers disproportional to the regional population. The majority of referrals for child behaviour directed parents/caregivers to non-governmental organisations for family support and parenting programmes. Thematic analysis was applied to the qualitative data derived from the interviews with parents/caregivers and results indicated high levels of satisfaction with the B4 School Check for behaviour and the referred outcomes. Implications for nursing practice arise from these findings in that they identify factors which contribute to what does and does not work well for achieving successful outcomes from the B4 School Check for behaviour.

Improving school readiness with the Before School Check: early experience in Hawke's Bay.

AIM: The New Zealand Ministry of Health's Before-School Check (B4SC) aims to identify those 4-year-old children with health, developmental or behavioural problems likely to impact on their education so these can be remediated before school entry. This evaluation aims to demonstrate the outcomes of the first 10 months of the B4SC programme in Hawke's Bay and the lessons learnt. METHODS: The B4SC was implemented in Hawke's Bay using an intersectoral, collaborative approach including all major stakeholders, led by the Hawke's Bay Primary Health Organisation (HBPHO). Local clinical practice and referral processes were established by a Clinical Advisory Group. Eighty-four practice nurses, Well Child/Tamariki Ora nurses and independent practitioners have been trained in group and individual settings. All referrals come through a clinical nurse leader to an intersectoral triage group. RESULTS: In the 10 months since the first training the nurses have assessed 1848 out of 2180 or 84% of the cohort, including 75% of children in quintile 5. Referrals average 55% and have been of high quality with 74% accepted, 14% already known, and only 8% declined at triage. CONCLUSION: The intersectoral Clinical Advisory Group has been critical to the success of the programme, as it has achieved engagement and commitment from all stakeholders to the clinical processes and referral pathways. Training nurses with existing community health skills, relationships with families and strong community networks has led to high rates of children seen from the most deprived quintile. The training and the referral pathway, via the Clinical Nurse Leader to an intersectoral triage group, have led to high quality referrals and a low rate of referrals declined.