"Watch Me Grow Integrated approach - WMG- I”: A web-based developmental surveillance approach for uptake of childhood screening and intervention

This study aims to assess the effectiveness of integrating a web-based developmental surveillance (screening, referral and follow-up) approach in primary health care settings to improve uptake of childhood screening and intervention, parental education, school readiness, child behaviour and resource costs when children attend General Practice visits. This is a cluster randomised controlled trial. Forty General Practices (GPs) (20 each in Brisbane, Queensland and Sydney, New South Wales) who routinely see children for immunisation or other health concerns will be randomised to use the web based surveillance tool "Watch Me Grow-Integrated" (WMG-I) or receive Surveillance as Usual (SaU) in their practice. The study will recruit 2000 children (1000 WMG-I and 1000 SaU) across practices. Intervention: WMG-I Group, a web-based integrated-service approach to child developmental screening and surveillance will be provided when children (aged 18-months of age; age range 16 to 35-months) attend a GP appointment. Parents/caregivers of children will: (1a) complete; consent, trial entry questions (socio-demographics, birth/health information) and standardised developmental screens using the WMG-I weblink on a device of their choice (mobile phone/tablet) whilst in the GP waiting room at Time 1. The developmental screens include: Parent Evaluation of Developmental Status (PEDS), Quantitative Checklist for Autism in Toddlers – 10-item (Q-CHAT-10), Learn the Signs Act Early (LTSAE), and for those children with failed primary screens, parents will complete the Ages and Stages Questionnaire-Third Edition (ASQ-3) online. Parents will also complete the Kessler Psychological Distress Scale – 6 (K6). These questionnaires will take approximately 15 minutes to complete. Automated scoring according to screening manuals will be emailed to the parent and sent via secure message to the GP prior to consultation to facilitate point-of-care consultation. (1b) Time 1 surveys are reviewed by a Child and Family Health Nurse (CFHN) and/or ‘Triage and Review Team’. Those who are identified to be at risk of developmental concerns following Time 1 screening are invited to complete a standardised psychometric assessment to recommend, implement and follow-up referral pathways with GPs and parents. (1c) automated email prompts will commence once the child reaches the appropriate age, to advise participants to complete ongoing WMG-I screens (aligned to the Personal Health Record schedule, aged 3, and 4). Step 1b above is repeated annually until the child reaches 4 years of age. Uptake of referrals will be logged by the GPs on a standard template and audited fortnightly by the research team. Online survey analytics will be used to ensure questionnaires are complete and send follow up emails for incomplete surveys. (2) At 2 years of age: all children who screen positive and a 10% random sample of screen negative cases identified from the initial screening process will be diagnostically assessed for developmental and behavioural outcomes by blinded assessors; in a face-to-face appointment at a local university site, or approved health care site such as a community health centre. Measures include Mullen Scale of Early Learning (MSEL), Vineland Adaptive Behavior Scales Third Edition (Vineland-3), and the Autism Diagnostic Observation Schedule Toddler Module (ADOS-2). The assessments will take 2-3 hours to complete. (3) At 3 years of age: all parents will receive an email alert to complete an online surveillance questionnaire about ongoing developmental surveillance, uptake on recommendations, service utilisation and parent satisfaction with services. This will take approximately 5 minutes to complete. (4) At 4 years of age: Step 3 will be repeated. All children will be assessed for Anxiety, Mood, and Disruptive Disorders via an email notification to complete the Strengths and Difficulties Questionnaire (SDQ) online, which takes approximately 10 minutes. In addition, parents of children who screened positive, as well as 10% of children who screened negative, in step 2 will receive an email alert to complete additional online questionnaires including the: Health Literacy Questionnaire (HLQ), K6, EQ5D5L and the Institute for Medical Technology Productivity Cost Questionnaire (iPCQ). Questionnaire completion will take approximately 30 minutes. The trial will take 5 years, with recruitment in the General Practice occurring during the first 12 months of the trial.