Expanding access to early childhood developmental screening for children of recently arrived migrant families through community health fairs

Early childhood represents an important and vulnerable developmental period shaped by the intersection of socio-structural factors (1). Timely intervention is crucial for children’s future well-being (2); however, children from marginalized backgrounds, including migrant families, encounter barriers to developmental delay detection and intervention. Addressing disparities before the transition into the school system can impact a child’s developmental trajectory (3). Leveraging existing community infrastructure for preschool developmental delay detection can help to support timely intervention for underserved communities. Governments and clinical associations globally, including in Canada, have developed guidelines and programs to promote healthy development and intervene early when development is delayed (4,5). Despite cost-free initiatives like the Agir Tôt program in Quebec, which aims to identify children from 0 to 5 years of age with developmental difficulties and quickly link them to services (4), significant barriers exist for families in accessing the services, particularly among recently arrived migrant families to Canada, including asylum seekers, resettled refugees, immigrants and others. Community-based interventions, such as community health fairs, have been used to help bridge cultural and linguistic barriers and provide health resources and information to recently arrived migrants in the Global North (6). Here, we describe a model that integrates developmental screening into community health fairs to reach children of recently arrived migrant families and help reduce obstacles to early intervention. On September 30, 2023, in collaboration with a community organization, a non-profit organization and the government-run local integrated health and social services centre, a developmental screening intervention was held at a community health fair organized by members of the predominantly Haitian community of Montreal-Nord, a borough in Montreal, Canada (7). Montreal-Nord is one of Montreal’s most ethnoculturally diverse and socio-economically disadvantaged neighbourhoods, with an estimated 43% of the population in 2016 identifying as immigrants to Canada, and 22% of those identifying as immigrants having arrived in the previous 5 years (8). Further, approximately 42% of the people in Montreal-Nord declared an annual income below the Canadian poverty level (8). Recently arrived migrant families and families whom the community identified as having unmet social needs were invited and supported in attending the event. An interdisciplinary team that included a psychoeducator, speech and language pathologist, social worker, paediatricians, and medical trainees ran a developmental screening activity for 50 children from 0 to 5 years of age. The team members, some of whom were from the community and spoke French and Haitian Creole, interacted with children for 15 minutes at three stations to observe various developmental domains. At a crayon and block station, participants’ fine motor skills were observed along with their cognitive ability to follow instructions. During transitional activities between stations, gross motor skills and social–emotional regulation were observed. At a storytelling station with various books, children’s language, social–emotional, and cognitive skills were assessed. History was obtained from parents about languages spoken at home, attendance at daycare, and interactions with other children. At the end of the 15-minute observation period, if a team member flagged the child due to suspicion of developmental delay, the team documented the child and parents’ information to expedite referral for assessment and access to early intervention resources through the local integrated health and social services centres. In the interim, parents also received recommendations to assist their child based on the screening assessment. Some recommendations included encouraging the child to ask for things in complete sentences or activities to exercise their fine motor skills, for example. Parents were also given information about resources and support available in the community. This article describes a feasible, community-based intervention aimed at increasing access to developmental screening for underserved communities. Previous research indicates that health fairs assist newly arrived migrants by addressing language barriers, connecting them with community resources and providing health information (6). While health fairs have been shown to be effective in assessing community health and social needs, to our knowledge, their role in addressing disparities in childhood developmental delay detection and intervention remains unexplored. Research on broader community outreach strategies and culturally sensitive interventions has demonstrated the benefit of these interventions in enhancing service use and improving outcomes for children with autism spectrum disorder and their families (9,10). Future research is needed to measure the effectiveness of community health fairs as a culturally safe outreach intervention to facilitate developmental assessments for preschool children from newly arrived families. Future work should measure the prevalence of children flagged as having developmental concerns across a care continuum. This continuum includes being screened for developmental delays, being recommended for further assessment, receiving a follow-up call to arrange a formal developmental assessment, accessing early intervention services, completing a developmental assessment, being lost to follow-up, and long-term developmental outcomes. Implementation science approaches should be used to evaluate this type of intervention at the community level on indicators of early intervention, educational attainment, and health and community well-being. Future work should also aim to understand and address barriers to follow-up and formal developmental assessment. Addressing early childhood development disparities for children from newly arrived families requires sustained collaboration between community organizations, healthcare providers and government entities. The initiative described herein provides an example of a community-based model to facilitate developmental screening, expedite referral to early intervention and empower newly arrived migrant families with information and culturally sensitive support. To scale similar efforts, partnerships with local community organizations and existing community engagement initiatives should be sought. Funding can be sourced through a combination of government-funded programs, academic–community partnerships and philanthropic foundations. As paediatricians, we hold respected and privileged positions as professionals and academics affiliated with various institutions, and as clinicians who have established meaningful relationships with children and families of diverse backgrounds. We can leverage our connections and our credible voice to work with communities to advocate for the implementation, evaluation and sustained investment in equitable developmental screening and interventions that address systemic barriers for newly arrived migrant families. Lessons from this initiative and future impact assessments of community health fairs will be key to building support for this model to address developmental disparities. The authors wish to thank Drs. Melissa-Zoraya Corvalan Cifuentes and Meredith Remy for contributing to this event. None declared.

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