Presentation by Ms. Maia Kherkheulidze, State Medical University, Child Developmental Center, Georgia


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

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  • Health sector is the only public sector with direct access and greatest reach to children and there families during pregnancy, birth and early childhood (especially 0-3 years) through clinical services and home visitation.
  • (i.e.: cognition, communication, behavior, social interaction, motor and sensory abilities, and adaptive skill s)
  • Center is in close collaboration with Central Children’s Hospital’s different divisions such as genetics, diagnostic, endocrinology and etc.
  • Could you make the program more alive by providing two fictional, but typical cases (how newborn A is identified in the maternity and then assessed and services provided, and infant B referred by the parent or pediatrician…), maybe one slide each for each case.
  • Could you make the program more alive by providing two fictional, but typical cases (how newborn A is identified in the maternity and then assessed and services provided, and infant B referred by the parent or pediatrician…), maybe one slide each for each case.
  • This slide should probably be two
  • This slide should probably be two
  • Presentation by Ms. Maia Kherkheulidze, State Medical University, Child Developmental Center, Georgia

    1. 1. 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
    2. 2. 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)
    3. 3. 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
    4. 4. Health care services Preschool Counseling parent education Early identification, intervention in case of problems
    5. 5. Feasible: ~30 Contacts with Health System during pregnancy and first 2 years 3 2 Conceptual Overview: MCH Contacts during 1000 day Period
    6. 6. Developmental Evaluation Developmental surveillance Developmental screening Developmental assessment and intervention Primary health care ECD Center Mental Health Center • EARLY IDENTIFICATION • ADEQUATE MANAGEMENT / REFERRAL
    7. 7. 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
    8. 8. 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
    9. 9. ECD Center Clinical direction Educational Direction Research Direction
    10. 10. 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
    11. 11. ECD Center Clinical direction Some indices of developmental and behavioral problems Over one year, 5’875 patients (0-6 years)
    12. 12. 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
    13. 13. 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
    14. 14. 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
    15. 15. 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
    16. 16. ECD Center Research Direction  Nutrition problems and child development  Biological and social risk factors  Heavy metals and child development
    17. 17. 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
    18. 18. 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.
    19. 19. 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
    20. 20. “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