An Alternative Model for Development in Childhood: Extinction and Interoperability

Abstract

"More than 40% of children under 5-years-old in middle-low income countries are under risk of not reaching developmental potential for causes associated with poverty and psychosocial deprivation. The reason for that is probably associated with a low relevance of development as a biological decline more than an increasing process. A way to improve the life chances and opportunities of low-income children, families, and communities is described in a model of extinction and interoperability characteristics. An original model for interoperability considers three levels of data exchange: facility-to-facility (macrotier), intra-facility (meso-tier), and at the point of care (micro-tier). Focused in developmental-care, the model needs a transformation toward parent-child interaction-driven and institutional support in Children’s Centres (CCs). To optimize our model, we use information from multiple sources, devices, and organizations across the development-care continuum. A short-scaled interoperability model was designed and probed in Colombia. First components of this model include a baseline with previous measurement of developmental outcomes in children of two major geopolitical regions in a middle-low income country (n=1177), and the use of a tool administrated by parents to report different items related to sociocognitive milestones. First analysis within a regression model founded 14 variables significant associated with a sociocognitive development index. Second component is related to results obtained in a specific CC, where developmental screening indicates the effect of intra-facility activities as a positive factor that avoids the loss of development potential that can be expected in uncontrolled environments or institutions, such as those in the first sample (t(207)=-2.026, p=0.044). Finally, at the point of care, the use of a tool administrated by parents, a compilation of activities to report enhanced development (CARE®), denotes optimal psychometric properties for child development screening (Sensitivity = .80, Specificity = .76, LR + = 3.8, LR- = .26) and significant changes in the risk indexes for a control group of children (Delayed items: Avr.= 4.5 , SD = 3.8) compared with those who used the booklet with their parents or caregivers (Avr.= 1.2, SD = 1.1); t (17) = -2.82, p = 0.012)."