A screening mechanism to recognize and support at-risk Aboriginal children

Abstract

OBJECTIVES: The Aboriginal Children’s Health and Well-Being Measure© (ACHWM) was developed to assess health from the perspectives of Aboriginal children. The purpose of this paper is to document the screening process, embedded within the ACHWM, and assess its effectiveness.

METHODS: The ACHWM was implemented in 2014/2015 with children 8 to 18 years of age living on the Wiikwemkoong Unceded Territory. Survey responses were screened to identify potential risk, using an automated algorithm run on computer tablets. Local mental health workers conducted brief mental health assessments to identify and support children at-risk. Data were analyzed to estimate effectiveness of this screening process.

RESULTS: A total of 293 children completed the ACHWM. The screening tool identified 35% with potential risk. Mental health workers confirmed 18% of all participants as being at-risk, and all were referred for support. The sensitivity of the tool was 75% while specificity was 79%. Improvements to the screening algorithm resulted in a specificity of 97% and negative predictive value of 95%, with no loss of sensitivity.

CONCLUSION: Responsible population health surveys require a process to recognize and respond to answers indicative of health risks. This paper provides an example of a screening and triage process that enabled our survey team to screen responses in real time, respond to potential risk immediately, and connect participants to local support services. This process proved essential to conducting an ethical survey. The high specificity and negative predictive value make it an effective triage tool that is particularly valuable in Aboriginal communities and with higher-risk populations.

Résumé

OBJECTIFS: On a élaboré l’outil de sondage Aboriginal Children’s Health and Well-Being Measure (ACHWM) pour évaluer la santé selon la perspective des enfants autochtones. Le but de notre article est de décrire le processus de dépistage intégré dans l’ACHWM et d’en évaluer l’efficacité.

MÉTHODE: L’ACHWM a été administré en 2014–2015 à des enfants et des jeunes de 8 à 18 ans vivant sur le territoire non cédé des Wiikwemkoong. À l’aide d’un algorithme automatisé exécuté sur des tablettes électroniques, les réponses au sondage ont été criblées pour repérer les personnes potentiellement à risque. Des intervenants locaux en santé mentale ont mené de brefs examens de santé mentale pour repérer et soutenir les enfants et les jeunes à risque. Les données ont été analysées pour estimer l’efficacité de ce processus de dépistage.

RÉSULTATS: En tout, 293 enfants et jeunes ont répondu au questionnaire ACHWM. L’outil de dépistage en a identifié 35% comme présentant un risque potentiel. Les intervenants en santé mentale ont confirmé que 18% des participants étaient à risque et les ont aiguillés vers des services de soutien. La sensibilité de l’outil était de 75%, et sa spécificité, de 79%. Des améliorations à l’algorithme de dépistage ont donné lieu à une spécificité de 97% et à une valeur prédictive négative de 95% sans perte de sensibilité.

CONCLUSION: Pour être responsables, les enquêtes sur la santé de la population ont besoin d’un processus d’intervention pour les réponses qui soulèvent des inquiétudes. Notre article présente l’exemple d’un processus de dépistage et de triage qui a permis à notre équipe de sondage de cribler les réponses en temps réel, d’intervenir immédiatement en cas de risque potentiel et de mettre les participants en rapport avec des services de soutien locaux. Ce processus s’est avéré essentiel à la conduite d’un sondage éthique. La haute spécificité et la valeur prédictive négative du sondage en font un outil de triage efficace particulièrement précieux dans les communautés autochtones et auprès des populations à haut risque.

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Correspondence to Nancy L. Young PhD.

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Young, N.L., Jacko, D., Wabano, M.J. et al. A screening mechanism to recognize and support at-risk Aboriginal children. Can J Public Health 107, e399–e403 (2016). https://doi.org/10.17269/CJPH.107.5539

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Key words

  • Mental health
  • early medical intervention
  • child
  • adolescent
  • Indigenous population
  • surveys and questionnaires

Mots clés

  • santé mentale
  • intervention médicale précoce
  • enfant
  • adolescent
  • population d’origine amérindienne
  • enquêtes de santé