What do parents, professionals and policy colleagues want from a universal assessment of child development in the early years? A qualitative study in England

Objective: Every child in England should be offered a health and development review at age 2-2½ years by the health visiting service, part of which includes an assessment of child development. The Department of Health and Social Care mandates the use of the Ages and Stages Questionnaire (ASQ-3) at this review as a tool to collect population-level data on children's early development for monitoring of trends and disparities. This tool also forms part of the practitioner's assessment of the child's early development. To inform policy and practice, the present study gathered the views and experiences of parents and health visiting professionals on key priorities for, and barriers to, a universal assessment of early child development at age 2-2½ years.

Design, setting, participants: We held 15 focus groups with 29 parents, 24 health visitors and nursery nurses, five service managers and five policy colleagues in England. Participants were asked to reflect on their experiences of, and priorities for, measuring child development at the 2-2½ year universal review.

Analysis: We analysed data using Reflexive Thematic Analysis.

Results: We identified two overarching themes in the data. The first theme, 'just a part of the puzzle': a useful tool in a holistic review, reflected a consistent priority-across all focus groups-for a measure of child development that was well embedded in the wider review, that facilitated conversations about the child and family system and allowed negotiation of parent and professional judgement of the child's development and had a clear stated purpose. The second theme, 'they need to know why they're doing it: a need for clarification' reflected the need for a clear purpose for, and less variable delivery of, the tool, including a need for clarification on its intended purpose to provide population-level data.

Conclusions: Parents and practitioners wanted a tool that facilitated a holistic conversation about development, well-being and health across the family system, with direct observation of the child by the professional. Used skilfully, the tool can constitute an intervention in itself, as it helps scaffold a conversation about how parents can support their child's optimal growth and development. Consideration should be given to the experience of and support available to the practitioner using the tool within the health and developmental review.