1. B4 School Check Workshop
Dr Pat Tuohy, Chief Advisor, Child and Youth Health
Karl Le Quesne, Group Manager, Early Childhood Education

2. “We want our children…to grow up competent and confident, healthy in mind, body, and spirit, secure in their sense of belonging and in the knowledge that they make a valued contribution to society”
From Te Whaariki

3. Background
2005 Government announcement as a commitment to child health
Delivery of the B4SC started in 4 DHBs (Waikato, Nelson Marlborough, MidCentral and Lakes) in June 2008
The remaining DHBs across the country started delivery from September 2008

4. What is the B4SC? Eighth and final Well Child check
Comprehensive health, behavioural and developmental check
Aims to identify and address any health, behavioural, social or developmental concerns which could affect a child’s ability to get the most benefit from school
Has nationally defined protocols and referral pathways

5. When Where Who How As soon after the child turns 4 as possible
Well Child clinics, Plunket rooms, general practices, early childhood education centres, community centres, homes and others
Public health nurses, Plunket and Well Child nurses, practice nurses, Vision and Hearing Technicians
Takes about minutes
A dedicated national information system collects results

6. Evidence-based content
Child health questionnaire, including an immunisation check
Vision and hearing assessment through sweep audiometry, tympanometry and distance visual acuity
Measurement of height and weight
Oral health assessment using Lift the Lip
Behavioural and developmental questions using the Strengths and Difficulties Questionnaire (SDQ) and Parental Evaluation of Developmental Status (PEDS) tools
Health promotion and education

7. B4SC pilot
Piloted in the Whanganui and Counties Manukau DHBs from August to November 2007
An evaluation of the pilot found that:
Nearly all parents who participated (98%) indicated that they would recommend the programme to others
92% reported high levels of satisfaction
Most parents (86%) reported high levels of confidence in the programme
99% felt that their child’s check was completed in a culturally appropriate manner

9. How do B4SCs fit with ECE
ECE approach children’s learning differently from compulsory school sector
But ECE is part of the overall education system that provides opportunities for life-long learning
Going from ECE to school is an important transition in the continuum of life-long learning
Ensuring that children have best possible health, development and behaviour before starting school is an important way to support life-long learning
Difficulties in any of those areas predict difficulties with learning later on

10. Te Whaariki – the early childhood curriculum
The B4School check supports implementation of the early childhood curriculum
The principles in Te Whaariki encourage us to make families and communities an integral part of the curriculum – assisting parents with B4School check is part of this
The Goals are also relevant, e.g. Goal 4 focuses on children knowing the limits and boundaries of acceptable behaviour
Focusing on development and behaviour helps children to access all of the strands of the curriculum: well-being, belonging, contribution, communication and exploration
There is more than one way to support children’s learning and development – different approaches can help us.

11. B4 School check and Te Whaariki Principles
Empowerment
The early childhood curriculum empowers the child to learn and grow.
The B4 School check provides the opportunity to identify and remove barriers learning and growth, therefore adding value to ECE
Holistic Development
The early childhood curriculum reflects the holistic way children learn and grow.
The B4 School check takes a holistic approach to screening of the child’s development.

12. B4S check and Te Whaariki – the principles
Family and Community
The wider world of family and community is an integral part of the early childhood curriculum.
The B4 school check places the child at the centre of a caring family/whanau and community. It actively supports healthy family functioning
Relationships
Children learn through responsive and reciprocal relationships with people, places, and things.
The various screens and interventions are designed to involve the child and family as much as possible. e.g.hearing screening process

13. Te Whaariki strands and B4SC
Strand 1 Wellbeing - Mana Atua
The health and well-being of the child are protected and nurtured
Children experience an environment where:
their health is promoted;
their emotional well-being is nurtured;
they are kept safe from harm.
The B4School check’s focus on the promotion of health, development and behaviour helps children to access the strands of the curriculum.
The general health questionnaire enables parents to ensure that their child is getting the medical support they need in order to learn well.

14. Te Whaariki strands and B4SC
Strand 2: Belonging – Mana Whenua
Children and their families feel a sense of belonging.
Children and their families experience an environment where:
connecting links with the family and the wider world are affirmed and extended;
they know that they have a place;
they feel comfortable with the routines,customs, and regular events;
they know the limits and boundaries of acceptable behaviour.
The B4SC is a joint initiative between parents, teachers and child health nurses and places the child at the centre of a caring community.
Referral services linked to B4 School checks support teachers to set limits and boundaries of behaviour.

15. Te Whaariki strands and B4SC
Strand 3: Contribution – Mana Tangata
Opportunities for learning are equitable, and each child’s contribution is valued.
Children experience an environment where:
there are equitable opportunities for learning, irrespective of gender, ability, age, ethnicity, or background;
they are affirmed as individuals;
they are encouraged to learn with and alongside others.
The B4School check identifies children who experience barriers to learning, and ensures that they are able to make a contribution.

16. Te Whaariki strands and B4SC
Strand 4: Communication – Mana Reo
The languages and symbols of their own and other cultures are promoted and protected.
Children experience an environment where:
they develop non-verbal communication skills for a range of purposes;
they develop verbal communication skills for a range of purposes;
they experience the stories and symbols of their own and other cultures;
they discover and develop different ways to be creative and expressive.
The hearing screening and the PEDS ensure that speech and language problems are not impairing communication skills

17. Te Whaariki strands and B4SC
Strand 5: Exploration – Mana Aotūroa
The child learns through active exploration of the environment
Children experience an environment where:
their play is valued as meaningful learning and the importance of spontaneous play is recognised
they gain confidence in and control of their bodies;they learn strategies for active exploration, thinking, and reasoning
they develop working theories for making sense of the natural, social, physical, and material worlds.
The PEDS screening tool gives parents an opportunity to raise any concerns about a child’s fine or gross motor development or cognitive skills. Teachers need to be aware of a child’s movement or cognitive difficulties in order to tailor the curriculum to their special needs

18. Children learn in many contexts
The family and community is the most important context for children’s learning and development
ECE is another important context for children’s learning
We need to support their learning and wellbeing in all of their contexts
That means we need to work and collaborate with parents and other professionals
ECE services have a long history of working with parents and others and the B4SCs support this
Most children will be just fine with good quality ECE experiences, but some do need extra help

19. The SDQ forms

20. The Strengths and Difficulties Questionnaires
Used to screen a child’s social and emotional development
2 versions:
One for parent to complete based on their observations of their child’s interactions at home (the SDQ-P); and
One for teachers to complete based on their observations of the child’s interactions in the social learning environment (the SDQ-T)

21. Why use the SDQ?
There is no perfect tool for identifying a child’s social and emotional needs, but the SDQ was considered by both the Ministries of Health and Education to be the most appropriate for use in the B4SC
The SDQ is an internationally validated tool used to identify needs requiring further discussion and assessment
The SDQ is not used to diagnose or label children, rather it is a tool designed to get an overall picture of the child’s strengths and difficulties using parental and teacher perceptions of the child
The SDQ is well respected by specialists and researchers and is used by several countries

22. The SDQ-T
When parents give consent for the B4SC they give consent for an SDQ-T to be requested from their child’s early childhood education teacher or centre (if they have one).
A child’s overall SDQ score is significantly more sensitive (ie. it will be better at identifying strengths and difficulties) if both a parent and a teacher complete the questionnaire.

23. Communication with ECE
The Ministries of Health and Education jointly developed the pamphlet ‘B4 School Check: Information for the education sector’.
Copies of this pamphlet were sent to over 3,500 early childhood education centres around the country in February 2009, accompanied by a joint letter and a list of Frequently-Asked-Questions.
DHBs’ B4SC Coordinators have been meeting and engaging locally with ECEs about the B4SC and the SDQ-T.

25. Results so far?
Approximately 10,000 children have received, or are in the process of receiving, their full B4SC
Only 1.6% of parents have declined a B4SC for their child
17% of children have been referred for services or further assessment following their B4SC
The B4SC components with the highest percentages of referrals are:
immunisation (5.7%)
vision (5.6%)
oral health (5.4%)
hearing (4.6%).
SDQ (1.4%).

26. Questions?