Recent developments in low-cost screening and assessment of childhood disabilities in Jamaica. Part 2: Assessment

This paper summarise the requirements and criteria for assessment of childhood disabilities. It reviews recent research carried out in Jamaica and outlines procedures for medical and psychological assessment used in the International Epidemiological Study of Childhood and Disability as well as local experience in community-based rehabilitation. While the medical assessment procedures were considered to be validated, there is an urgent need for local research and development in psychological assessment. These approaches, while not perfect as yet, bring the possibility of local community capability closer. They will require changes in professional attitudes, training of health and educational personnel, and changes in the service systems, so that screening and assessment can be integrated into existing services. However, although this will obviate the need for new, specialised administrations, improved linkages and lines of referral will be necessary.

Recent developments in low-cost screening and assessment of childhood disabilities in Jamaica. Part 2: Assessment

This paper summarise the requirements and criteria for assessment of childhood disabilities. It reviews recent research carried out in Jamaica and outlines procedures for medical and psychological assessment used in the International Epidemiological Study of Childhood and Disability as well as local experience in community-based rehabilitation. While the medical assessment procedures were considered to be validated, there is an urgent need for local research and development in psychological assessment. These approaches, while not perfect as yet, bring the possibility of local community capability closer. They will require changes in professional attitudes, training of health and educational personnel, and changes in the service systems, so that screening and assessment can be integrated into existing services. However, although this will obviate the need for new, specialised administrations, improved linkages and lines of referral will be necessary. (AU)

Identification of childhood disability in Jamaica: the ten question screen

This is the first in a series of papers that report the testing of two instruments for the identification and assessment of childhood disability by community workers (CWs) in Third World countries. It is part of the International Epidemiological Study on Childhood Disability. The Ten Question Screen (TQ) was used as the main instrument to identify disability in a two stage population-based survey of 5478 children aged 2-9 years in Clarendon, Jamaica. In the second stage, TQ positive and 8 percent of the screen negative controls were professionally assessed by a doctor and a psychologist using standard criteria on the main classification system of the ICIDH. Sensitivity of the TQ as a whole varies in different strata of the group and amongst different disabilities, from perfect in girls under 6 years, fits and motor disabilities and for serious disability in all groups except boys over 5 years with a cognitive disability. Specificity was good but the false positive rate was unacceptably high at 74 percent. It was concluded, firstly, that the validation of a simple questionnaire of perceptions of behaviour against objective measurments of impairments was perhaps not fair to the TQ. In spite of this, the TQ would be a very useful instrument in collection disability data for identifying people in need of rehabilitation help, if a way of reducing false positive could be found. (AU)

Use of the key informant method and the community survey method in the rapid identification and assessment of childhood disability in Jamaica - abstract

An international collaborative study has as its main objective the development of a methodology for the rapid identification of children with disabilities in the age group 2-9 years. It focuses on a simple screening instrument, the ten question screen with probes (TQP), which will provide a tool for the measurement of this health problem. In addition to this objective, the project also compared the effectiveness of two screening approaches for the identification of disability; the use of "key informants" (persons with knowledge about the child population in their area) with the community survey method, in which a house-to-house survey was carried out by primary health care workers. In both cases, children identified as being disabled and a control group were referred to a doctor and psychologist for professional assessment of their disabilities and handicaps. Approximately 120 key informants were exposed to a two-day workshop designed to give them information about the project and distribute questionnaires for the referral of children in their communities. Six months later, they were reminded of the survey and further referrals were solicited. Eight community workers, completed a house-to-house survey of all families in two areas in Clarendon and administered the TQP on 5,400 2-9 year-olds during a one-year period in 1987 and 1988. Seventeen referrals were made by the key informants. Of these, two were seen by the professional team and found to be disabled. The community workers referred over 200 children who were TQP positive (i.e., disabled according to the criteria). It is concluded that, in Jamaica, considerable groundwork and preparation of key informants would have to be done if such persons were to be relied upon for referrals of disabled children (AU)