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N Z Med J. 2010 Nov 26;123(1326):47-58.

Improving school readiness with the Before School Check: early experience in Hawke's Bay.

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  • 1Women's, Children's and Youth Service, Hawke's Bay District Health Board, Hastings, New Zealand.



The New Zealand Ministry of Health's Before-School Check (B4SC) aims to identify those 4-year-old children with health, developmental or behavioural problems likely to impact on their education so these can be remediated before school entry. This evaluation aims to demonstrate the outcomes of the first 10 months of the B4SC programme in Hawke's Bay and the lessons learnt.


The B4SC was implemented in Hawke's Bay using an intersectoral, collaborative approach including all major stakeholders, led by the Hawke's Bay Primary Health Organisation (HBPHO). Local clinical practice and referral processes were established by a Clinical Advisory Group. Eighty-four practice nurses, Well Child/Tamariki Ora nurses and independent practitioners have been trained in group and individual settings. All referrals come through a clinical nurse leader to an intersectoral triage group.


In the 10 months since the first training the nurses have assessed 1848 out of 2180 or 84% of the cohort, including 75% of children in quintile 5. Referrals average 55% and have been of high quality with 74% accepted, 14% already known, and only 8% declined at triage.


The intersectoral Clinical Advisory Group has been critical to the success of the programme, as it has achieved engagement and commitment from all stakeholders to the clinical processes and referral pathways. Training nurses with existing community health skills, relationships with families and strong community networks has led to high rates of children seen from the most deprived quintile. The training and the referral pathway, via the Clinical Nurse Leader to an intersectoral triage group, have led to high quality referrals and a low rate of referrals declined.

[PubMed - indexed for MEDLINE]
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