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Terrific 2’s

• Gilda Lewis

• Health Visitor Practice Teacher

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What I’m going to cover

• Brief over view of brain development up to age 2

• What that means for behaviour and why• How we assess two year old

development, and the tools we use• What we do if we find something of

concern

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An embryo’s brain produces many more neurons, or nerve cells, than it needs, then eliminates the excess

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Spontaneous bursts of electrical activity strengthen some of these connections, while other (the connections not reinforced by activity) atrophy

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The axons spin out to create connection branches between many targets

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The connections that are used most are now insulated to further speed up connections

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Needs met

Appropriate stimulation/external environmental

factors

Yes

•Reinforcing of desirable pathways

•Secure attachment established

•Concentration skills improve

•Learning takes place

Abusive or stressful situation continues

No

Hyperaroused or dissociated infant

Yes

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The Healthy Child Programme

• The Healthy Child Programme for the early life stages focuses on a universal preventative service, providing families with a programme of screening, immunisation, health and development reviews, supplemented by advice around health, wellbeing and parenting.

• DoH 2009

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The Healthy Child ProgrammeHV Service delivery contacts

Antenatal (targeted)10-14 days post delivery6-8 weeks post delivery2,3,4,12 months and 3yrs 4 months8-12 months2 yearsAdditional support as required on assessment

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• The Health Visitor Implementation plan • levels of service delivery

Universal partnership plus

Universal

Universal plus

Community

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Process:

Health Visitor to oversee process and consider local services and practices alongside.

Type of Contact

Venue Setting

Staff Mix

Type of invitation sent out:

23 Months 24 Months

Letter Birthday card Email Text

Child Health Clinic

GP Surgery Children’s

Centres Home

Community Nursing.

Community Staff Nurse

Health Visitor Family Nurse

Individual

Or Group

LOW MEDIUM HIGH

Content of Reviews Elicit and respond to parental concerns. Assessment of: Raise Awareness of:

General development Healthy Nutrition Growth Immunisation Speech and Language Dental Health Social and emotional development. Injury Prevention

Offer Guidance: Sleep Management Behavioural Management Toilet Training Nutrition and Active Play Language Promotion Personal and emotional development in response to parental concerns

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What are Ages and Stages Questionnaires?

• ASQs are developmental screening tools to identify infants/children in need of further assessment

• ASQs development is the result of careful and thorough research and response to the need for a cost-effective, highly accurate tool for screening young children.

• Tool developed in US

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Why use ASQ?

• Actively involves parents• Researched for sensitivity, specificity,

reliability and positive predictive values.• Parent led questionnaires where parents

answer a series of simple questions regarding child’s behaviour

• Not a pass or fail approach

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• Enables assessment of child’s progress• Can be done by parent or WITH parent• Enables discussion regarding child’s

development• Enables matching of child and parent with

resources

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ASQ as a Parent Education Tool

• Each questionnaire discusses developmental activities tied to the age of the child being screened.

• In completing and reviewing the questionnaire, parents learn about general developmental milestones as well as their own child’s strengths.

• Parents find it helpful to receive suggested learning activities they can work on with their child. (Learning activity sheets can be photocopied from ASQ-3 User’s Guide, and more are available in the Ages & Stages Learning Activities.

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Scoring

• ASQ provides a score in each developmental area

• ASQ: SE provides a total score• LOW scores in ASQ are an indication of

concern• HIGH scores in ASQ:SE are an indication of

concern

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Conclusion

• We now know how the brain develops from birth to three

• How vital this period of brain development is as a basis for future development

• How understanding the services for two year olds can support optimum development through working effectively together