title: Challenges in monitoring the development of young children in remote Aboriginal health services: clinical audit findings and recommendations for improving practice.
abstract: Early detection of developmental difficulties is universally considered a necessary public health measure, with routine developmental monitoring an important function of primary healthcare services. This study aimed to describe the developmental monitoring practice in two remote Australian Aboriginal primary healthcare services and to identify gaps in the delivery of developmental monitoring services.
  
  
  
  A cross-sectional baseline medical record audit of all resident children aged less than 5 years in two remote Aboriginal health centres in the Northern Territory (NT) in Australia was undertaken between December 2010 and November 2011.
  
  
  
  A total of 151 medical records were audited, 80 in Community A and 71 in Community B. Developmental checks were more likely among children who attended services more regularly. In Community A, 63 (79%) medical records had some evidence of a developmental check and in Community B there were 42 (59%) medical records with such evidence. However, there was little indication of how assessments were undertaken: only one record noted the use of a formal developmental screening measure. In Community A, 16 (16%) records documented parent report and 20 (20%) documented staff observations, while in Community B, the numbers were 2 (3%) and 11 (19%), respectively. The overall recorded prevalence of developmental difficulties was 21% in Community A and 6% in Community B.
  
  
  
  This is the first study to describe the quality of developmental monitoring practice in remote Australian Aboriginal health services. The audit findings suggest the need for a systems-wide approach to the delivery and recording of developmental monitoring services. This will require routine training of remote Aboriginal health workers and remote area nurses in developmental monitoring practice including the use of a culturally appropriate, structured developmental screening measure.
authors.affiliation: University of Melbourne, Carlton, Victoria, Australia. anita.daprano@unimelb.edu.au.
authors.forename: Anita
authors.initials: A
authors.lastname: D'Aprano
authors.affiliation: Centre for Child Development and Education, Menzies School of Health Research, Norther Territory, Australia. sven.silburn@menzies.edu.au.
authors.forename: Sven
authors.initials: S
authors.lastname: Silburn
authors.affiliation: Department of Health, Royal Darwin Hospital, Tiwi, Northern Territory, Australia. nessjohnston@gmail.com.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Johnston
authors.affiliation: Centre for Primary Health Care Systems, Menzies School of Health Research, Queensland, Australia. ross.bailie@menzies.edu.au.
authors.forename: Ross
authors.initials: R
authors.lastname: Bailie
authors.affiliation: Murdoch Children's Research Institute, Parkville, Victoria, Australia. fionah.mensah@mcri.edu.au.
authors.forename: Fiona
authors.initials: F
authors.lastname: Mensah
authors.affiliation: Centre for Community Child Health at The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia. frank.oberklaid@rch.org.au.
authors.forename: Frank
authors.initials: F
authors.lastname: Oberklaid
authors.affiliation: Centre for Child Development and Education, Menzies School of Health Research, North Casuarina, Norther Territory, Australia. gary.robinson@menzies.edu.au.
authors.forename: Gary
authors.initials: G
authors.lastname: Robinson
mesh_terms: D001315:Australia; D002657:Child Development; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006303:Health Services, Indigenous / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D015876:Northern Territory; D019035:Rural Health Services / Q000458:organization & administration*
keywords: Australia/Pacific; Community-Controlled Health Services; Health Service reform; Indigenous Health Worker; Maternal and Child Health; Medical; Paediatrics