Dr Anita D’Aprano is a consultant paediatrician and a senior research fellow, in Indigenous child health, in the Department of Paediatrics. Dr D’Aprano undertook her PhD studies in the Northern Territory exploring developmental monitoring practices in Aboriginal populations, work which led to the creation of the ASQ-TRAK developmental screening tool – the first culturally appropriate tool for use with Australian Aboriginal children.
Since completing her PhD, Anita has continued to lead ethical Indigenous child health research, principally in the development of culturally appropriate and validated measures. She has a particular interest and commitment to optimising translational outcomes and in engaging Aboriginal communities. Dr D’Aprano’s current research program is focused on implementation of the ASQ-TRAK and developing a culturally appropriate early childhood outcome measure for Australian Aboriginal children, the ASQ: EXTENDED TRAK. Her career vision is to continue to provide leadership in the design, implementation and translation of research with Aboriginal communities that makes a significant difference to the well-being of Aboriginal children and families.
Implementation of the ASQ-TRAK: protocol for a mixed methods evaluation
Recently in Australia a culturally appropriate developmental screening tool has become available - the Ages and Stages Questionnaire –Talking about Raising Aboriginal Kids (ASQ-TRAK). The ASQ-TRAK is the culturally adapted ASQ-3 for Aboriginal children. It is highly acceptable to Aboriginal families and has acceptable psychometric properties.
ASQ-TRAK uptake is increasing nationally. However, implementation has not been systematic or included ongoing evaluation, and participation in available training has been inconsistent. There have been calls for implementation research addressing early childhood development programs and particularly exploring how developmental screening tools can be integrated into primary health care systems.
Implementing developmental screening tools in multiple health services is a complex process that occurs in stages that culminate in full and effective implementation. Without developing implementation capacity through appropriate training, ongoing leadership and organisational support, we risk the ASQ-TRAK being administered incorrectly, losing fidelity and cultural safety.
This study aims to evaluate the implementation of ASQ-TRAK.
Using a multi-site case study design, we will undertake a mixed-methods process evaluation of the implementation of ASQ-TRAK in mainstream and Aboriginal Community Controlled Health Services.
We designed a culturally relevant training program to support services to implement the ASQ-TRAK. The 2.5 day practitioner training includes principles of early childhood development and competencies required for ASQ-TRAK administration. Prior evaluation of training has demonstrated high satisfaction and improved practitioners’ skills, knowledge, competence and confidence.
Implementation will be coordinated and supported by Regional implementation teams will include Regional Coordinators, Aboriginal facilitators and cross-cultural research partners. Teams will work with staff and leaders to create and maintain the conditions, systems and structures required to mediate change. This will develop the capacity and capability of services to effectively implement the ASQ-TRAK, and develop the depth of reform knowledge necessary to sustain implementation. This is vital for the effective implementation and fidelity of ASQ-TRAK and the provision of culturally safe, responsive, and accessible developmental monitoring services to Aboriginal children and families.
We developed a program logic describes the resources, activities and expected changes at each stage of implementation. Drawing on mixed-methods data, we will assess implementation processes, the fidelity of training, and use of the ASQ-TRAK.
Data will be gathered through service audits, observation of training and practice, tests of knowledge pre- and post-training, interviews with, and self-reports from: practitioners, facilitators, regional training coordinators, research partners, service leaders and managers.
Descriptive analysis will be used for quantitative data. Qualitative data will be analysed thematically, according to competency (training and support), leadership and organisational drivers. We will identify the implementation stage; factors that shaped implementation and how these impacted on fidelity; outcomes in each service; and what is needed to progress implementation.
Results are expected to inform the development of an ASQ-TRAK implementation model to support the effective use of ASQ-TRAK in services nationally.