Strengthening early interventions for children with disabilities
How health workers are identifying disabilities in children with the Bhutan Child Development Screening Tool
Trashigang: For the last four years, health assistant Tenzin Gyalmo has been screening children for disabilities when they come for their routine immunization and growth monitoring check-up.
Using the Bhutan Child Development Screening Tool (BCDST), health workers like Tenzin screen children for likelihood of disability from two and half months (10 weeks) in four domains of physical, cognitive, problem solving and communication.
“The tool is mainly for early intervention so that we can diagnose and provide timely treatment to manage the disabilities,” she said.
Health assistants Tenzin and her colleague Ngawang Yangdon are among the 379 (84 female) health workers that UNICEF in partnership with the Ministry of Health trained on the use of the BCDST, which is incorporated in the revised Mother and Child Handbook.
Ngawang said they use the tool for children from the time they turn two and half months until the child is five years old. “At two and half years, we use the tool to see if they can kick a ball, walk sideways with support, and play with dolls.”
Yeshey Choden, a mother of five from the highlands of Sakteng village said the BCDST is a good initiative to monitor a child’s development and screen them for disabilities, if any. “We parents will know if our child is growing well and if we would need to do more to support their growth.”
Since the hospital started using the BCDST, Tenzin said they get few cases of children with cerebral palsy, down syndrome or birth asphyxia. “There are 11 sessions per child and if we observe any forms of delayed development or disability, we refer the child to the physiotherapist,” she said. “We also refer cases to the physiotherapist when parents say their children do not speak.”
The Community Health Unit sees about 30-40 children during clinic days where parents bring children for routine immunization and growth monitoring visits. The BCDST, the health assistants said, is used as part of a child’s routine health monitoring where they ask parents or the caregiver questions, and the child if he/she is able to talk, in each domain to assess the child’s development. “We also check their hearing and see if they are able to identify themselves by showing them the mirror,” says Ngawang.
Tenzin says that every domain has a red flag, which means they have to refer the child to the physiotherapist. “For pre-term babies though, we adjust their age because some developmental delays are expected.”
At the hospital’s physiotherapy unit, Tshoki Wangmo, a mother, watches her youngest son play with the blocks with the physiotherapist. “These assessments help our children with timely interventions,” she says. “Parents also learn about their child’s development and provide support where possible.”
Physiotherapist Tshering Choden says that when a child is referred to them, they use their screening tool, called the RNDA (Rapid Neurodevelopmental Assessment), designed to ascertain functional status across multiple neurodevelopmental domains.
“It is more elaborate here and if the child is found to have either mild or moderate disability, we call them for a second screening and if severe, we refer the child to the pediatrician,” she said. “The important domains are hearing and speech and if there is any defect, we directly refer the child to the regional referral hospital.”
Bhutan is a developing country and does not have advanced levels of screening. “So, these tools are affordable, effective and we can intervene at an early stage to support children’s development,” says Tshering.
“We parents will know if our child is growing well and if we would need to do more to support their growth.”