Williams Elin H, Thompson Nicholas M, McCray Gareth, Crespo-Llado Maria M, Bhavnani Supriya, Gajria Diksha, Mukherjee Debarati, Del Bianco Teresa, Lockwood-Estrin Georgia, Mason Luke, Ngoma Vukiwe, Namathanga Chisomo, Nkhata Richard, Bennie Allan, Ranjan Alok, Kawelama Ulemu, Midha Naina, Singh Anindita, Mpakiza Innocent, Gautam Akshat, Gulati Sheffali, Johnson Mark H, Lancaster Gillian, Belmonte Matthew K, Jones Emily, Patel Vikram, Chandran Sharat, Mbale Emmie, Divan Gauri, Gladstone Melissa, Chakrabarti Bhismadev
Centre for Autism, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
Faculty of Health, Education and Society, University of Northampton, Northampton, UK.
BMJ Open. 2024 Jun 13;14(6):e088263. doi: 10.1136/bmjopen-2024-088263.
Early childhood development forms the foundations for functioning later in life. Thus, accurate monitoring of developmental trajectories is critical. However, such monitoring often relies on time-intensive assessments which necessitate administration by skilled professionals. This difficulty is exacerbated in low-resource settings where such professionals are predominantly concentrated in urban and often private clinics, making them inaccessible to many. This geographic and economic inaccessibility contributes to a significant 'detection gap' where many children who might benefit from support remain undetected. The Scalable Transdiagnostic Early Assessment of Mental Health (STREAM) project aims to bridge this gap by developing an open-source, scalable, tablet-based platform administered by non-specialist workers to assess motor, social and cognitive developmental status. The goal is to deploy STREAM through public health initiatives, maximising opportunities for effective early interventions.
The STREAM project will enrol and assess 4000 children aged 0-6 years from Malawi (n=2000) and India (n=2000). It integrates three established developmental assessment tools measuring motor, social and cognitive functioning using gamified tasks, observation checklists, parent-report and audio-video recordings. Domain scores for motor, social and cognitive functioning will be developed and assessed for their validity and reliability. These domain scores will then be used to construct age-adjusted developmental reference curves.
Ethical approval has been obtained from local review boards at each site (India: Sangath Institutional Review Board; All India Institute of Medical Science (AIIMS) Ethics Committee; Indian Council of Medical Research-Health Ministry Screening Committee; Malawi: College of Medicine Research and Ethics Committee; Malawi Ministry of Health-Blantyre District Health Office). The study adheres to Good Clinical Practice standards and the ethical guidelines of the 6th (2008) Declaration of Helsinki. Findings from STREAM will be disseminated to participating families, healthcare professionals, policymakers, educators and researchers, at local, national and international levels through meetings, academic journals and conferences.
幼儿发展为日后的生活功能奠定基础。因此，准确监测发展轨迹至关重要。然而，此类监测通常依赖耗时的评估，这需要由专业技能人员进行管理。在资源匮乏地区，这一困难更加突出，因为这些专业人员主要集中在城市且往往是私立诊所，许多人难以获得服务。这种地理和经济上的不可及性导致了显著的“检测差距”，许多可能受益于支持的儿童未被发现。心理健康可扩展跨诊断早期评估（STREAM）项目旨在通过开发一个由非专业人员管理的基于平板电脑的开源、可扩展平台来弥合这一差距，以评估运动、社交和认知发展状况。目标是通过公共卫生举措部署STREAM，最大限度地增加有效早期干预的机会。
STREAM项目将招募并评估来自马拉维（n = 2000）和印度（n = 2000）的4000名0至6岁儿童。它整合了三种既定的发展评估工具，使用游戏化任务、观察清单、家长报告和音频视频记录来测量运动、社交和认知功能。将制定运动、社交和认知功能的领域分数，并评估其有效性和可靠性。然后，这些领域分数将用于构建年龄调整后的发展参考曲线。
已获得每个地点的当地审查委员会的伦理批准（印度：Sangath机构审查委员会；全印度医学科学研究所（AIIMS）伦理委员会；印度医学研究理事会 - 卫生部筛查委员会；马拉维：医学院研究与伦理委员会；马拉维卫生部 - 布兰太尔区卫生办公室）。该研究遵循良好临床实践标准和第六届（2008年）《赫尔辛基宣言》的伦理准则。STREAM的研究结果将通过会议、学术期刊和会议在地方、国家和国际层面传播给参与家庭、医疗保健专业人员、政策制定者、教育工作者和研究人员。
