Early identification and services – The role of developmental pediatrics. From 4th Child Protection Forum in Tajikistan, 2013.

2. Health status of women/children in Georgia
Indicator Statistical data
2009 2011
Maternal mortality rate 52,1 27,6
Antenatal visits 99,2 99,8
Skilled attendant at delivery 97,4 98,4
Under 5 mortality rate 16 13,8
Infant mortality rate 14,9 12,1
Underweight 1,7
Stunting 11,1
Sub-optimal breastfeeding 45

3. Children with disabilities or developmental difficultiesChildren with disabilities or developmental difficulties
Legislative basement
Approximately 8000 children with special need
Community Based Services
Funded by the State
Early intervention services ( 0-7
years)
Day care centers ( 6-18 years)
Inclusive Schools
Inclusive kindergartens (limited)
Project based
• Home care services
Residential and Alternative
Services
Specialized foster care for children
with special needs (0-18 years)
Boarding schools
Two Residential Institutions (6-18
years)
One Infant Home (0-6 years) with
increasing rate of children with
disabilities (about 70%)
Residential Institutions of child care (unit)

4. Maternal and Child Health Care Services in GeorgiaMaternal and Child Health Care Services in Georgia
Women’s
consultation
Family center
Doctor
Maternity
houses
Referral
(transportation)
services
Outpatient
clinics
ambulance
Diagnostic
Centers
Clinics/ Hospitals
Child
development
centers
Rehabilitation/
intervention
programs

5. Health care
services
Preschool
Counseling parent
education
Early identification,
intervention in case
of problems

6. Feasible: ~30 Contacts with Health System during
pregnancy and first 2 years
3
2
Conceptual Overview:
MCH Contacts during 1000 day Period

7. Developmental Evaluation
Developmental
surveillance
Developmental
screening
Developmental
assessment and
intervention
Primary
health
care
ECD
Center
Mental
Health
Center
• EARLY IDENTIFICATION
• ADEQUATE MANAGEMENT /
REFERRAL

9. Primary
health
care
State Program on Child Health and Developmental Surveillance for
Primary Health Care Facilities
• Antenatal care - 4 visits of pregnant women in Women
Consultation/Maternity Units (prevention, assessment, identification of
high risk, diagnostics, counseling, referral)
• Delivery – based on risk, in different level maternity units (I,II,III), and
established referral system for transportation
• Healthy child visits – in outpatient clinic ( patronage visits)
• Ambulance services

10. Primary
health
care
Development of national guidelines and protocols for primary health
care services (simple, easy to use, based on milestones and red flags
of development)
Development of referral criteria for referral from Primary Health Care
level to the National ECD Center
Development and implementation of mother–baby book (includes
doctor’s record; mother notes; and main recommendations on
breastfeeding, complementary feeding, child developmental
milestones, and stimulation)
Development and revision (by international experts) of training
modules on child development
Development of guidelines on child abuse and neglect
Training of primary health care staff on child development
Activities conducted by ECD center staff

11. ECD
Center
Clinical direction Educational
Direction
Research
Direction

12. ECD
Center Clinical direction
• CHILD DEVELOPMENT IS HOLISTIC.
• Assessed by multidisciplinary team (pediatrician, neurologist, psychologist,
ophthalmologist…):
 Child physical growth, BMI based on WHO growth standards
 Risk factors of child development
 Child development using parent questionnaires and screening tools
(ASQ, PEDS, PEDS DM, Pediatric symptom check list, DENVER,
MCHAT, RAVEN, KAUFMAN, WECHSLER, PIK 17 …)
 Assessment of mother child interaction (BRIGANCE)
 Assessment of child behavior by psychologist
 Neurological assessment
 Visual screening
 Hearing screening
 Assessment of school readiness
• Counseling of parents
State Program on Child
Development Screening at
the ECD Center

13. ECD
Center Clinical direction
Some indices of developmental and behavioral problems
Over one year, 5’875 patients (0-6 years)

14. Case A
Preterm girl born at 32 weeks of gestation, with very low birth
weight 1240, length 40 cm, small for gestational age, RDS
2 years old practically healthy child, she catches up in growth and
her development is appropriate for her biological age
Maternity unit Children’s Hospital
(NICU)
ECD
• retinopathy
• nutritional problems
•motor developmental
problems
Specialized
ophthalmological
services
Physical
therapy

15. Case B
Boy 3 years and 6 month, with probable language development
delay
Now he is 5 years boy, with mild communication problems,
speech is understandable
Outpatient
clinic
ECD
• autistic spectrum disorder
• deprivation
ABA therapy Home
visiting
program
Inclusive
Kindergarten

16. Case C
Girl 3 year-old, with probable language developmental delay
Now she is 4 years, starting to speak
Outpatient
clinic
ECD
• hearing screening – hearing impairment
Full audio logic
assessment
Speech
therapist
Special Cochlear
Implants

17. ECD
Center
Educational
Direction
Development of
•Syllabus and Curriculum for 4th grade medical students on
CHILD DEVELOPMENT (materials for teachers and students,
lecture slides, case studies, tests)
•Materials on identification of child abuse and neglect for
students and teachers
•Two-month training program on CHILD DEVELOPMENT and
BEHAVIOR for residents
•Participation in Development and Validation of ELDS Standards
Development of training curriculum for medical staff
•Training activities

18. ECD
Center
Research
Direction
 Nutrition problems and child development
 Biological and social risk factors
 Heavy metals and child development

19. Future PlansFuture Plans
CLINICAL DIRECTIONCLINICAL DIRECTION
Implementation of high sensitive and specific developmental
assessment and screening tools and upgrading the skills of specialists
(speech therapist, occupational therapist, behavioral therapist)
Strengthening the referral system from the Primary Health Care
facility to National ECD center
Establishment of regional ECD centers

20. Future PlansFuture Plans
EDUCATIONAL DIRECTIONEDUCATIONAL DIRECTION
Development of practical textbook on child development and behavior
Training of medical staff from the primary level to regional centers
Society awareness campaign on importance of early years, supporting
child development and the benefit of early intervention
ALL DIRECTIONSALL DIRECTIONS
Establishing partnership between Georgian National ECD Center with
well functioning ECD centers in developed countries for ongoing
collaboration and consultations regarding patients, assessment tools,
teaching tools, research and etc.

21. ConclusionsConclusions
Vulnerable children have a right to health and wellbeing
services to achieve their potential
The window of opportunity for early identification and
intervention is short, but
The health sector in CEE/CIS
 Is in frequent contact with pregnant women, infants, and young children
 Has the opportunity to prevent disabilities and delays and support good
parenting
 Can identify risk and intervene early to improve outcomes for children
There are many effective and efficient opportunities to
improve the Continuum of Health Care and improve
collaboration with other sectors

22. “We are guilty of many errors and many
faults, but our worst crime is abandoning
the children, neglecting the fountain of life.
Many of the things we need can wait. The
child cannot. Right now is the time his
bones are being formed, his blood is
being made, and his senses are being
developed. To him we cannot answer
‘Tomorrow’, his name is today.”
- Gabriela Mistral
Thank you for your
attention