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