Developing an Inuit Approach to Developmental Screening and Assessment
PROJECT OVERVIEW
International Meeting on Indigenous Child Health Presentations By: Anna Claire Ryan (ITK) Maryse Turcot, Jeannie Aragutak, Ariane Quirion(KRG) March 31, 2017 Presenters disclosure
Anna Claire Ryan, Jeannie Aragutak, Ariane Quirion, and Maryse Turcot have no relevant financial relationships with the manufacturer(s) of commercial services discussed in this CME activity.
The authors do not intend to discuss an unapproved/investigative use of a commercial product/device in this presentation Inuit Tapiriit Kanatami
• National voice / organization for Inuit in Canada
The majority of Inuit live in Inuit Nunangat
53 Inuit communities
Four Inuit Land Claim Regions ◦ Inuvialuit Settlement Region ◦ Nunavut ◦ Nunavik ◦ Nunatsiavut Inuit Early Childhood Development Working Group
• Regional Childcare Coordinators who have a keen interest in and work to promote Inuit Early Childhood Development • Forum to discuss Inuit ECD resources, priorities, policies, issues and concerns at a national level • Inuit ECD Strategy • Goal: Happy, healthy and safe Inuit children and families Project Overview
• Inuit have long identified the need for an Inuit‐specific approach to developmental screening and assessment for young children
• Goal is to foster national collaboration with Inuit in the area of developmental screening and assessment in Canada
• Overall vision: To support young Inuit children and their families Project Overview
Phase 1: Understanding the Developmental Screening and Assessment Tool Landscape
◦ Build Collaboration and Partnership
◦ Create an Inventory of Current Tools being used in Health, ECD and Education
◦ Do a Literature Review on Tools
◦ Develop a Final Report and Recommendations for Future work Inventory •“What developmental screening and assessment tools are being used with children aged 0‐6 years of age?”
• Interviews by phone + review of documents
• Systems‐level engagement
• Health, Education, Early Childhood Development
Inventory Findings
• 23 Different Tools being used across 4 Inuit regions • No two Regions are using the same complement of tools • No single sector (Health, Education, ECE) is using the same tools • For many partners, first time engaged in dialogue with Health, ECD and Education at the same time. • Different professional practices and language same goal • Integrated service delivery is essential Literature Review • Overview of Developmental Screening and Assessment • Lit Review Critiques of Commercial Tools (Inuit context) • Tools currently being used in Inuit Communities • Recommendations from Literature Developmental Screening
Used to determine if a child is meeting a broad range of milestones for typical development at their age
Used to identify children that may require some extra support or assessment
Ideally brief, cost effective, and easily administered without highly specialized training
Not a diagnostic tool! Developmental Assessment
Used to determine if a child shows patterns of development that are typical of children with known developmental difficulties or delays
More comprehensive and take longer than screening
Generally carried out by healthcare or education professionals Developmental Screening & Assessment Landscape LITERATURE REVIEW Common Critiques of Commercial Tools (Inuit Context)
• Culturally appropriateness of tool content ◦ E.g. deficit rather then strength based • Language delivery ◦ E.g. Misinterpretations of speech and language differences as evidence of deficits • Purpose / cultural value of testing ◦ E.g. Inconsistent with internally identified goals for child and family development •“Norm” group similarity ◦ E.g. validation of the tool, standardized processes etc. Inuit‐Specific “Norms” for Development
• “Norms” for most screening and assessment instruments have been established on large samples of white, middle class children
• There are differences in developmental norms between populations
◦ E.g. 90% of Inuit children dress themselves a full 10 months before 90% of a comparison sample dress themselves ◦ E.g. 90% of a comparison sample were able to count 3 objects 3 months before 90% of Inuit children were able to
‐Findlay et al. 2014 Recommendations from the Literature
• No checklist, profile or test, however carefully constructed, can provide a complete picture of a child’s development
• Use variety of sources of information for assessment
• Most tools have been developed outside of Inuit culture, language, knowledge and sense of place.
• Parents, families, guardians, teachers and Elders should be included in all stages of developmental screening and assessment processes. Family, community and culture are interactive developmental influences and therefore essential to gathering and understanding screening and assessment data How an Inuit‐Specific Tool Kit might Differ?
• Tools and deployment needs to be in Inuktut • Culturally appropriate with child/family/ community placed at the centre • Strength‐based approach –test children on what they know, not what they don’t know. • Need to assessed in the child’s day to day context “It needs to be done where families are, in their homes, their camps, out in the community fishing and harvesting –this is where you will see the child be who they are” • Engage communities in tool development to ensure they reflect community specific cultures and values. Overall Findings Agreement from all Regions that an Inuit‐specific tool kit (modified/ adapted or created new) is needed.
Any Inuit‐specific tools must be child‐centric, inclusive of parents and extended families, and embedded in the land, culture, language and societal norms as defined by Inuit.
To create such a toolkit will require a deep and meaningful engagement with Inuit world‐views, Inuit conceptions of the child and Inuit visions for vibrant childhoods. 7 Recommendations
1. Engage with communities on screening and assessment
2. Conduct a review on how Inuit children learn, grow and develop, and Inuit parenting practices around nurturing, care and child development
3. Establish Inuit‐specific developmental milestones and approaches
4. Clarify our understanding of speech and language development
5. Collaborate with institutions training ECE Educators
6. Strengthen integrated service delivery partnerships
7. Ongoing engagement with regional partners & national partners Towards health equity • A catalyst for systems change • Improves communication and collaboration across jurisdictions and sectors •Increase access to timely, high quality care, services and support for Inuit children and families • Self determination – Inuit led • Validates Inuit culture, language and ways of knowing •Giving every Inuit child the best start to life Next Steps
• Continue collaboration with partners and stakeholders • Regional & Community Engagement • Develop project charter for phase 2 •Implement Recommendations Nakurmiik! Thank you! Question? Comments? Anna Claire Ryan [email protected] Inuit Early Childhood Development
Nunavik Early Learning Monitoring Tool
Kativik Regional Government Childcare Working Group
Julie‐Ann Berthe Maryse Turcot Annie Augiak Jeannie Aragutak Ariane Quirion Marie‐Claude Larrivée (consultant) PRESENTATION PLAN n Overview of the project o Creation of the developmental monitoring toolkit: main steps p Pilot testing of the toolkit and evaluation q Further development OVERVIEW OF THE PROJECT Nunavik “The place where we have landed”
14 communities situated in Northern Québec along the coasts of Hudson Bay, Hudson Strait and Ungava Bay
12,000 permanent residents, 90% of whom are Inuit; Inuktitut widely spoken
Approximately 2,000 children aged 0 to 5
Parent‐operated childcare centres located in each community, with technical support provided by the Kativik Regional Government
Nunavik
http://newtallestbuilding.blogspot.ca Situation in Nunavik childcare centres
Special needs children are well integrated
Educators have day‐to‐day contact with the children; they are professionals in charge of supporting child development
Educators are largely Inuktitut speaking
Source : to completed How this project came to be?
Through a multiphase project, Inuit Tapiriit Kanatami identified the need for an evidence‐ informed, community‐driven, Inuit‐specific developmental screening and assessment toolkit
The project is funded under the Aboriginal Head Start Strategic Fund and by the Kativik Regional Government (2016‐2017 pilot phase) Collaboration with other organizations
Aboriginal Head Start in Urban and Northern Communities (Canada)
Services intégrés en périnatalité et pour la petite enfance (Québec)
Kativik School Board (regional)
Nunavik Regional Board of Health and Social Services (regional)
Cégep St‐Félicien (early childhood educator training)
Inuit Tapiriit Kanatami (national)
Nunavik childcare centres (regional) objective of the project Initial objective To create an innovative user‐friendly and culturally appropriate assessment toolkit designed to identify children with special needs
Formal Informal Assessment continuum assessment assessment
MONITORING SCREENING ECD ASSESSMENT
Every child Every child Children at risk
Carried out by Carried out by childcare Carried out by highly trained childcare educators educators and healthcare professionals (pediatricians, professionals speech language therapists, etc.)
Inspired by Connections: A Strength‐Based, Family‐Centred Approach to Assessment, developed by the BC Aboriginal Child Care Society, and by Harrop and Associates Inc. (2015). A Literature Review of Developmental Screening and Assessment Tools Used across Inuit Nunangat (for Inuit Tapiriit Kanatami). Appropriate objective To create an innovative user‐friendly and culturally appropriate developmental monitoring toolkit for children aged 4 to 5, who are attending childcare centres in Nunavik Why do we need a toolkit?
Developmental toolkits used in the childcare centres in southern Canada do not take into account language and cultural differences
To complement the Learning Stories narrative assessment project implemented in Nunavik childcare centres in 2012
To help educators monitor child development and learning
To reinforce the educators’ skills in observing and supporting child development
To foster the successful transition from childcare to kindergarten Toolkit CRITERIA / characteristics
Available in Inuktitut
Respectful of Inuit culture and values
Covering multiple developmental areas (physical, intellectual and social‐ emotional)
Quickly and easily administered on a tablet
To be completed by educators in collaboration with parents
Focus on children aged 4 to 5 for the pilot project (time constraints; gap in services from 3 to 5; transition to kindergarten) Creation of the Toolkit: main steps Literature Review
Documentation from the Inuit Tapiriit Kanatami multiphase project
Literature review focusing on Inuit child development Inuit parenting/community practices
Review completed by Jessica Ball and others on Aboriginal child developmental screening and assessment
Main conclusion: There is a lack of comprehensive information to create questions from a 100% Inuit‐specific perspective. Decision not to create a brand new toolkit
Main conclusion of the literature review Time constraints did not allow for community consultations to gather the information missing from the literature review
Decision to adopt an adaptation strategy
The questions in the monitoring section of the toolkit could be inspired from existing tools and adapted to Inuit culture and values
• Ages and Stages Questionnaire (ASQ; ASQ‐SE) • Nipissing District Developmental Screening (NDDS) Inventory of • Early Development Instrument (EDI) existing tools • etc.
Decision to rely on the general knowledge of educators (and parents) and child observations (a task performance questionnaire) Based on the tools inventoried, a listing was created of the sub‐areas and aspects assessed For example, for aspects pertaining to Gross motor skills, the sub‐area was: running, jumping, standing, hopping, walking, catching, etc.
Based on the sub‐areas and aspects identified, prioritization exercises were performed with collaborators and childcare centre staff to select the most relevant sub‐areas and aspects (respectful of Inuit culture and values) The Kativik Regional Government Childcare Working Group made the final decisions on which sub‐areas and aspects to monitor in the toolkit.
For each sub‐area selected, one question was developed in line with the tools inventoried and the Nunavik context. A speech language therapist assisted with the questions on the sub‐areas of Inuktitut language development. Our collaborators reviewed the questions and provided feedback. The questions (and scale) were pre‐tested with some childcare centre educators. FINAL Sub‐areas and aspects monitored (18 questions)
| PHYSICAL DEVELOPMENT ~ Gross motor skills ~ Fine motor skills ~ Self‐help 3 questions
| INTELLECTUAL DEVELOPMENT ~ Understanding Inuktitut ~ Inuktitut speaking ~ Inuktitut pronunciation ~ Counting in Inuktitut 6 questions ~ Memory ~ Interest in Inuit cultural activities
| SOCIAL‐EMOTIONAL DEVELOPMENT ~ Respect for adults ~ Relationships with other children ~ Caring for other children ~ Self‐control 5 questions ~ Attention span
| OVERALL DEVELOPMENT
~ Concerns about the child’s health
~ Concerns about the child’s behaviour 4 questions ~ Special needs or diagnosis An innovative questionnaire was developed based on a story about two young fictional children, aged 4 to 5, who attend a childcare centre in Nunavik: Una and Inna.
Inna is developing very well in all areas (physical, intellectual and social‐emotional). Una is facing some developmental difficulties in different areas.
For each question, the educators (and parents) have to indicate which character the child is most like. Depending on the question, the child could be most like Una or Inna.
Four‐point response scale:
| A lot like Inna
| A little bit like Inna
| A little bit like Una
| A lot like Una
Pilot testing of the toolkit and evaluation Toolkit IMPLEMENTATION
The toolkit will be implemented in each childcare centre in Nunavik, according to the following steps:
Introduction at regional educator training (March 21‐22, 2017) In‐house presentation, training and coaching in the different childcare centres Meetings with parents and educators Toolkit implementation in the childcare centres with support provided by the Kativik Regional Government Childcare Working Group PROJECT EVALUATION
Evaluation of childcare centre in‐house training and coaching
Evaluation of the tablet app (design, satisfaction, use, etc.)
Project report submitted to the Aboriginal Head Start Strategic Fund Further Development Depending on the results of the project…
If the tool is appreciated and considered useful, culturally relevant, etc., then:
The toolkit could be updated in order to take into account educators and parents’ feedback
The toolkit could be validated scientifically (reliability, validity, …)
The toolkit could be shared with the Inuit Tapiriit Kanatami multiphase project
A similar toolkit could be developed to monitor the development of younger children attending childcare centres (ex. aged from 18 to 23 months; 24 to 35 months, etc.) ᓇᑯᕐᒦᒃ Nakurmiik!
Thank you! Photo Credit All photos used in the presentation are the property of: Inuit Tapiriit Kanatami