Table Of ContentScreening in Child Health Care
Report of the Dutch Working Party
on Child Health Care
Micha de Winter
Marielle Balledux
Jose de Mare
Ruud Burgmeijer
First published 1995 by Radcliffe Publishing
Published 2016 by CRC Press
Taylor & Francis Group
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© 1995 Micha de Winter, Marielle Balledux, Jose de Mare, Ruud Burgmeijer
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Contents
Introduction-a critical evaluation of Dutch preventive
Child Health Care IX
1 Aims, procedures and outcome measurement in pre-school
Child Health Care 1
1.1 Aims of pre-school Child Health Care 2
1.2 Procedures in pre-school Child Health Care 3
1.2.1 The organized system of care 4
1.2.2 Methods of intervention and prevention 6
1.3 Outcome measurement 10
1.4 The structure of the report 12
2 Immunizations 15
2.1 The National Immunization Programme (R VP) 15
2.1.1 Implementation of the R VP 17
2.1.2 Financing of the R VP 18
2.2 Effects of immunization 19
2.2.1 Effects at individual level 20
2.2.2 Effects at population level 24
2.3 Costs of the R VP and the hepatitis B screening and
immunization 32
2.3.1 Costs of the R VP 32
2.3.2 Costs of hepatitis B screening and immunization 34
iv SCREENING IN CHILD HEALTH CARE
2.4 Cost-effectiveness and cost-benefit ratios 34
2.4.1 General 34
2.4.2 National Immunization Programme (RVP) 35
2.4.3 Hepatitis B screening and immunization 35
2.4.4 Haemophilus influenzae type B immunization 36
2.5 Conclusions 36
2.6 Recommendations 37
3 Screening for phenylketonuria and congenital hypothyroidism 50
3.1 Phenylketonuria (PKU) 50
3.2 Congenital hypothyroidism (CHT) 51
3.3 Organization of the screening 52
3.4 Implementation of the screening 53
3.5 Coverage of the PKU/CHT screening 54
3.6 Effectiveness of PKU screening 54
3.7 Effectiveness of CHT screening 55
3.8 Cost-benefit analysis for PKU 57
3.9 Cost-benefit analysis for CHT 59
3.10 Conclusions 60
3.10.1 The treatment of PKU 60
3.10.2 The method of screening for CHT 61
3.10.3 False positive results in the screening for CHT 62
3.11 Recommendations 62
4 Screening for hearing impairment 66
4.1 Hearing 66
4.2 Hearing impairments 66
CONTENTS V
4.3 Secretory otitis media (SOM) 67
4.4 Aim and outcome measurement of screening for hearing
impairment 69
4.5 Screening for hearing impairment 71
4.6 Screening tests 71
4.7 Conclusions 73
4.8 Recommendations 73
5 Early detection and prevention of vision defects 77
5.1 The normal development of vision 77
5.2 Visual disorders 78
5.2.1 Functional disorders 78
5.2.2 Structural defects 79
5.3 The importance of early detection (and treatment) of vision
defects 79
5.4 The aim and outcome measures of the detection of vision
defects 80
5.5 Tests for early detection of vision defects in the Netherlands 82
5.5.1 The Early Detection method 82
5.5.2 Acuity assessment 85
5.6 Other detection methods 87
5.6.1 Amblyopia and squint 88
5.6.2 Structural deviations 89
5.6.3 Visual acuity defects 89
5.7 Conclusions 90
5.8 Recommendations 91
6 Developmental surveillance 96
6.1 Development 97
vi SCREENING IN CHILD HEALTH CARE
6.2 Developmental impairments 97
6.3 Aim and outcome measures of developmental surveillance 98
6.4 Developmental surveillance methods 99
6.5 Developmental surveillance in the Netherlands 100
6.6 Conclusions 103
6.7 Recommendations 105
7 Detection of speech and language disorders 110
7.1 Normal language acquisition 111
7.2 Disorders in speech and language acquisition 111
7.3 Causes of disorders in language acquisition 112
7.4 Consequences of language acquisition disorders 113
7.5 Aim and outcome measurement of speech and language
surveillance 113
7.6 Methods for the detection of disorders in language acquisition 114
7.6.1 The Early Detection Language Project 114
7.6.2 The Language Development Survey 118
7.6.3 Method of Bax, Hart and Jenkins (1980) 118
7.6.4 Minimum speech standards 119
7.6.5 The use of parents' information 119
7.6.6 Comparing the various methods 120
7.7 The importance of an adequate follow-up route 121
7.8 Conclusions 121
7.9 Recommendations 121
8 The periodic health examination 126
CONTENTS vii
8.1 The periodic health examination: history taking, examination
and interview 129
8.1.1 History taking 129
8.1.2 The examination 130
8.1.3 The interview 131
8.2 Towards further formalization of the periodic health
examination in the Netherlands 131
8.3 The British Joint Working Party on Child Health Surveillance 139
8.4 Similarities and differences between the Netherlands and the
United Kingdom 143
8.4.1 Content and frequency 143
8.4.2 Open clinics and the role of parents 144
8.4.3 The possibilities for comparison 145
8.5 Recommendations 146
9 Prevention of psychosocial and educational problems 149
9.1 Psychosocial problems 150
9.2 Educational problems 151
9.3 Working methods in pre-school Child Health Care 154
9.4 Scientific state-of-the-art 155
9.4.1. Outcome measures 155
9.4.2. Problems in outcome measurement 156
9.5 First step towards a prevention model 158
9.6 Conclusions 160
9.7 Recommendations 161
10 Health education 166
10.1 Investigation into the effectiveness of health education 168
10.1.1 Education on nutrition 168
viii SCREENING IN CHILD HEALTH CARE
10.1.2 The Growth Book: information on child care and
child raising 169
10.1.3 Dental health education 172
10.104. Accident prevention 173
10.2 A model for the systematic setting up, implementation and
assessment of health education 176
10.3 Conclusions 179
lOA Recommendations 180
11 Activities directed at the social and physical environment of
children and parents 184
11.1 Health and environment factors 184
11.1.1. Social inequality 185
11.1.2 Physical environment 186
11.1.3 Primary lifeworld 186
11.1.4 Professionalization 187
11.2 Implications for pre-school Child Health Care: recognition,
guidance and cooperation 187
11.3 Consequences for policy, professionals and executive
organizations 189
1104 Recommendations 190
Index 193
Introduction
a critical evaluation of Dutch
preventive Child Health Care
Child Health Care for the pre-school age range has in many Western
countries increasingly grown into a subject of scientific, social and political
debate over the last few years. In Britain, the Joint Working Party on Child
Health Surveillance published a report in 1989, in which existing services
were critically examined and recommendations were made for future
practice (Hall et al. 1989). In the Netherlands as well, there were strong
reasons to do this. To put it briefly: Dutch Child Health Care, which for a
long time had enjoyed wide social support and appreciation, found itself
faced with the obligation to legitimize itself under the influence of new
political developments; society demanded a more accurate insight into the
results of its efforts. Within this context, the project called 'Integral
Evaluation of Child Health Care' was initiated. The Board of the National
Association for Community Nursing and Home Carel commissioned the
Centre for Research and Development of Youth Health Care and Youth
Social Work of the University of Utrecht to subject the Dutch Child Health
Care system to a scientific study. In this study special attention had to be
paid to quality, cost effectiveness and general effectiveness, efficiency, and
shortcomings in care. The project was financially supported by the
Ministry of Weifare, Public Health and Cultural Affairs, and the
Foundation for Research and Development of Social Services. Even before
the project was wound up in the middle of 1992, another political
discussion flared up, shaking the sector to its foundations: at the end of
1991 Christian Democrat and Labour MPs proposed a motion to transfer
the responsibility for the Child Health Care system, plus its financing, to
local authorities. The Integral Evaluation Project then took on a somewhat
different aspect. While it was initially meant to provide a better insight into
the effects of the health care system, its results were now expected to play
IFor a long time 'Cross Associations' (Kruisverenigingen) have been active in the
Netherlands in the fields of social and preventive medicine and home nursing on behalf
of their members as well as of the general public. The National Cross Association
(Nationale Kruisvereniging) represented the regional cross associations at national level. In
1990 the National Cross Association merged with the National Council for Home Help
(Centrale Raad voor de Gezinsverzorging) to form the National Association for community
Nursing and Home Care (Landelijke Vereniging voor Thuiszorg), established at Bunnik. In
this book the regional organizations will be referred to as 'Community Health Care'.
