Addressing health equity by screening for neurodevelopmental concerns in primary healthcare

The Tracking Cube is a 6 tiered process. It is considered to be the intervention for this project. The six tiers are: Informed consent (Tier 1), history (Tier 2), the Rapid Neurodevelopmental Assessment (RNDA; Tier 3); collaborative information from carers and teachers (Tier 4); feedback and support (Tier 5), and comprehensive assessment (Tier 6). Tiers are woven into usual care medical components. This project evaluates the implementation of the first 4 tiers. Tiers 5 and 6 are completed at the discretion of the health service. The occasions of service for Tiers 5 and 6 will be documented as ‘follow-up’, but outcomes from these occasions of service will not be evaluated, as this is not the research question. Tier 1 takes around 10 minutes. Tier 2 takes around 30 minutes. Tier 3 takes around 30 minutes. Tier 4 takes around 30 minutes. However, the Health Care Providers (HCP), carer and child work together through each Tier of the Tracking Cube - there is no time limit. Children and carers can take breaks as needed. Therefore, eligible participants will progress with the Tracking Cube at their own pace. For example, in Tier 1 the HCP discusses participation with carers and patients. Participation can be discussed over multiple appointments as needed. The health service determines the most appropriate time to start the Tracking Cube. For example, at child well-health checks or at any appointment with the HCP. HCPs enter information into a digital platform, allowing site-based data control. Each primary healthcare site has a license to use this platform. This previously developed digital infrastructure was co-designed for research purposes. Examples of factors/data that will be entered into the digital platform are: historical factors (e.g. family history, maternal birth complications if known, developmental milestones); neurodevelopmental assessment results (e.g., cognitive, speech, attention, vision and hearing) and caregiver concerns about the child (e.g. behavioural and sleep patterns). The digital platform is hosted securely and meets all national compliance and security standards. Providing an intuitive user experience, aggregated data is presented in dashboards, which summarise risk and protective factors, screening results and carer concerns for HCPs to view at a glance. This helps practitioners augment real-time clinical decisions. This is a point of difference with usual care. Built-in e-consent has the potential for data exchange with other organisations involved in the child's care. An editable summary, recommendations and referral can be generated as needed for HCP review. Using a stepped-wedge randomised design, each site will commence 3 months after each other. Each site will progress through 4 phases: exploration (3 months), preparation (3 months), intervention (2 years), and sustainability (6 months). Exploration is about understanding the workflow at each site to ensure the Tracking Cube can fit into existing workflows, and co-designing the localisation of the Tracking Cube where needed. Each HCP is trained to a standard during the preparation phase. The training protocol involves online modules (6 hours) that include video examples, follow-up tele-mentoring (Microsoft Teams) by the research team, and an online competency assessment at the end of training. During this time, the research team also works with the health service to integrate the Tracking Cube into usual care workflows. Weekly online tele-mentoring occurs to adjust organisational flow, and address barriers to incorporating the Tracking Cube. The intervention phase continues tele-mentoring from project staff with allied health backgrounds as needed to ensure fidelity with the protocol. Monthly audits of the digital platform will highlight drift from protocol and feedback will be provided to HCPs. Fidelity checklists will be collected every 6 months to support HCPs in identifying where they may have drifted from protocol. This will provide insights about adherence to the Tiers. In the sustainability phase, clinicians will continue to use the Tracking Cube, but without support from the research team.