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Thank you for the feedback.
After consultations during the feedback phase we made two changes to our idea. We conducted comprehensive consultations with the District Medical Officer and staff from both Temeke and Mbagala Rangi Tatu (MRT) hospitals and examined data available from both hospitals. As a result we decided to change the location for the project from Temeke hospital to MRT hospital because: 1) as a regional referral hospital, Temeke serves mothers who come from far away thus increasing the likelihood of dropout from the Early Intervention (EI) service. MRT hospital has a much higher percentage of people attending the clinic from the nearby community which is densely populated by low income families, which are at a higher risk of having babies with MSI; 2) Temeke hospital only provides immunizations for babies that are born at the hospital whereas MRT provides a full Reproductive and Child Health (RCH) clinic 5 days a week which provides the perfect opportunity to raise awareness about sensory impairments and the need for screening. In addition there are Community Health Workers (CHWs) attached to MRT that are ideally positioned to raise awareness in the surrounding community; 3) The model for replication at national scale is to provide risk factor screening at RCH clinics in all health centers whilst providing sensory screening at the level of district hospital (which MRT is one); 4) MRT have committed to providing us with a temporary therapy room to test the EI service and the space to build a permanent low-cost structure following testing.
We will identify children with MSI through a 5-step approach:
1) Awareness raising; 2) risk factor screening; 3) sensory screening; 4) functional assessment; 5) specialist assessment. Please see the uploaded document ‘5-step process for identifying children with MSI’ for the technical details of this approach.
We plan to test this intervention using a phased approach:
P1 – testing of awareness raising approaches
During this phase we will make adjustments based on monitoring of the following: 1) effectiveness of the awareness raising approaches by conducting regular surveys at the RCH and the community to find out how many parents have improved knowledge on MSI and what percentage are willing to take up the service – making adjustments as needed. 2) feedback from parents on their experience of the awareness raising process; and 3) capacity of nurses and CHWs to conduct awareness raising.
P2 – testing of screening
We will conduct the risk factor questionnaire to a small sample of parents whilst simultaneously conducting sensory screening of the same sample group in order to test the effectiveness of the risk factor questionnaire in identifying children that might have sensory impairments. If any children fail the sensory screening tests but who were not picked up by the risk factor questionnaire we will make necessary adjustments. During this phase we will monitor the following whilst also continuing to monitor the phase 1 indicators: 1) feedback from parents on their experience of the screening process; 2) the capacity of staff to conduct screening; 3) failure rate of the screening equipment.
P3 – gradual increase of screening and EI from 1 day per week to 5 days per week:
We will test the effectiveness of the referral processes from risk factor screening to sensory screening to functional assessment, to specialist assessment – monitoring the time taken between referral and appointment and the dropout rates. We will obtain feedback from parents about their experience of the counselling, assessment, and EI therapy and will use a technical committee of local medical specialists to conduct ongoing quality assurance of the entire service. We will continue to monitor all other indicators from previous phases and will analyse the screening data obtained on a regular basis to start to get an idea of prevalence rates of different disabilities and their casual factors which will enable us to make adjustments to the programme as required.
We will provide ongoing support and intervention for the children that we help through:
•Counselling for parents to help them come to terms with their child’s disability – to decrease the risk of the father leaving the family, and to motivate the parents to start EI services as quickly as possible.
•Development of an IDP by the Early Interventionist and parents.
•Provision of assistive devices, learning and play materials as required.
•Functional assessments every 6 months and specialist assessments as required.
•Weekly to monthly EI therapy appointments in accordance with the IDP and EI curriculum.
•Training for parents on how to follow the IDP at home in order to maximize the rate of their child’s development.
•Follow-up phone calls and home visits by CHWs for parents that miss appointments or drop out of the program
•Transition planning to arrange inclusion for children into Pre-Primary school when 5 years