title: Improving school readiness with the Before School Check: early experience in Hawke's Bay.
abstract: OBJECTIVE
  The New Zealand Ministry of Health's Before-School Check (B4SC) aims to identify those 4-year-old children with health, developmental or behavioural problems likely to impact on their education so these can be remediated before school entry. This evaluation aims to demonstrate the outcomes of the first 10 months of the B4SC programme in Hawke's Bay and the lessons learnt.
  
  
  METHODS
  The B4SC was implemented in Hawke's Bay using an intersectoral, collaborative approach including all major stakeholders, led by the Hawke's Bay Primary Health Organisation (HBPHO). Local clinical practice and referral processes were established by a Clinical Advisory Group. Eighty-four practice nurses, Well Child/Tamariki Ora nurses and independent practitioners have been trained in group and individual settings. All referrals come through a clinical nurse leader to an intersectoral triage group.
  
  
  RESULTS
  In the 10 months since the first training the nurses have assessed 1848 out of 2180 or 84% of the cohort, including 75% of children in quintile 5. Referrals average 55% and have been of high quality with 74% accepted, 14% already known, and only 8% declined at triage.
  
  
  CONCLUSIONS
  The intersectoral Clinical Advisory Group has been critical to the success of the programme, as it has achieved engagement and commitment from all stakeholders to the clinical processes and referral pathways. Training nurses with existing community health skills, relationships with families and strong community networks has led to high rates of children seen from the most deprived quintile. The training and the referral pathway, via the Clinical Nurse Leader to an intersectoral triage group, have led to high quality referrals and a low rate of referrals declined.
authors.affiliation: Women's, Children's and Youth Service, Hawke's Bay District Health Board, Hastings, New Zealand. Russell.wills@hawkesbaydhb.govt.nz
authors.forename: Russell
authors.initials: R
authors.lastname: Wills
authors.forename: Kay
authors.initials: K
authors.lastname: Morris Matthews
authors.forename: Cath
authors.initials: C
authors.lastname: Hedley
authors.forename: Trish
authors.initials: T
authors.lastname: Freer
authors.forename: Helen
authors.initials: H
authors.lastname: Morris
mesh_terms: D002669:Child Welfare; D002675:Child, Preschool; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D009520:New Zealand; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014218:Triage