Uniform Screening for Speech & Language delays in the Dutch Child Health Care Evaluation of screening for speech/language and non-speech/language

BACKGROUND Dutch Child Health Care (CHC) professionals systematically monitor the speech language development of children with the Van Wiechenontwikkelings-onderzoek. However, the psychometric properties of the routine screening for speech and language delays in Child Health Care (CHC) are unkown. Furthermore, several protocols exist to detect children with speech and language delay and to guide them to appropriate care (Protocol Taaldiagnostiek Groningen and Procol Taaldiagnostiek Enschede). Though, the balance between health benefits, costs, scope and adverse results of these protocols are not evaluated. In 2009, the RIVM and the NCJ formulated a practice based guideline for the screening of children with speech and language delays in CHC. This position statement is based on consensus in the field. We will use the derived guideline of this position statement of Pijpers & Carmiggelt (2011) as a basis for our project. We want to evaluate the screening and follow-up of this guideline for speech and language and non-speech and language outcomes. This project consists of two parts: (1) the development of a standardized and validated Dutch uniform screening instrument (DUSI) for speech and language delays in children from 1 to 4 years of age, and (2) a prospective cohort study to the evaluation of the practice based guideline and improvements of speech and language outcomes as well as non speech and language outcomes a year after CHC-screening 2-year-old children. METHODS For the first part, we will compose a set of items for the DUSI based on existing screening instruments (VTO taal 2 jarigen, SNEL, Lexilijsten Nederlands, Lexilijst begrip and the NCDI's). Furthermore, we will compose a list of environmental factors. We will connect to the prediction model of Dusseldorp et al. (2011). We standardize the DUSI and the list of environmental factors (parental questionnaire) based on a sample of 1200 children from 1 to 4 years of age in Amsterdam, Friesland, Groningen and Zeeland. We apply the Item Response Theory to construct the DUSI. A bottom-up strategy of automatic item-selection procedures is used to construct one or more scales of a set of items. For the validation of the DUSI, we will investigate the relationship between the scores on DUSI and the raw scores of the reference tests (speech and language development, quality of interaction, quality of life and the opinion of a speech and language pathologist). For the second part of our project, we conduct a prospective cohort study and follow a group of screened children of 2 years of age in order to evaluate speech and language outcomes as well as non speech and language outcomes a year after the CHC-screening. The cohort consist of children who did not pass the CHC-screening and a matched reference group. The practice based guideline (Pijpers & Carmiggelt, 2011) has formulated 3 possible follow-ups for 2-year-old children who fail the screening. To evaluate the CHC-screening and these follow-ups, we test and screen the speech and language development, the quality of interaction and the quality of life of 2-year-old children (for concern and no concern) shortly after the screening (=T0), and one year after the screening (=T1). IMPLEMENTATION This project meets the needs of CHC to develop a national uniform screeningsinstrument and to evaluate the practice based guideline for speech and language delays of preschool children. In this project, we will collect evidence for the scientific underpinnings of the current practice-based guidelines of the NCJ. The TNO-report (TNO-report, 2007) as well as the Rijksinstituut voor Volksgezondheid en Milieu (RIVM, 2009) advised to do research on the integration of the items of several Dutch screening instruments in the Van Wiechenonderzoek at the CHC. The DUSI has added value, because is composed of several Dutch screeninginstruments, and is then standardized and validated for children from 1 to 4 years of age. We organize a meeting with professionals (consortium and partners) to evaluate the results of our project and to exchange knowledge about the accuracy of the DUSI and the evaluation of the practice based guideline. Based on these evaluations we will formulate recommandations for CHCs. We discuss about the way how we can transfer the results to other Dutch CHC-organizations, taking into account the regional differences. Together with the NCJ and Actiz, we will figure out how the results can be implemented in practice.