Historical Background
THE Bangladesh Protibondhi Foundation (BPF) has been committed to reaching services to disadvantaged children in unreached populations or those who have poor access to available services, since its establishment in 1984. Towards this aim it has been simplifying technology for early identification and early intervention of children with a range of neurodevelopmental impairments (NDIs) and neurodevelopmental disabilities (NDDs), which can be used by lesser trained professionals, para-professionals and frontline community workers at low-cost. All these scales, tools and procedures have had one major factor in common, ie, their quality has been comparable to international standards worldwide. This has only been possible through investment in quality research in collaboration with some of the best institutes of the world.
Development of a Screening Tool: the Ten Questions. Through the facilitation of the World Health Organization (WHO), and in collaboration with Professors Zena Stein and Mervyn Susser at the Sergievsky Center for Research in the Epidemiology of Brain Disorders, Columbia University, School of Public Health, New York, USA, the BPF was able to be part of an international team who developed the ‘Ten Questions (TQ)’ which allows frontline community workers to conduct home-based screening for identifying children at-risk for NDIs and NDDs. It is presently the most used screening tool worldwide, according to UNICEF (2008) estimates.
The TQ, however, was not developed for use on its own, as it can only identify the child at-risk. A second stage of comprehensive assessment is needed to identify specific functional limitations. Since the first publication on the TQ by BPF in 1990, and for the next two decades, this has not been possible in any developing country as it requires a multi-professional team (MPT) of child physicians, child psychologists and therapists, who are scarcely available in most countries.
Comprehensive ascertainment of functional limitations: the RNDA. The Rapid Neurodevelopmental Assessment (RNDA) is a set of unique tools which have been developed over several years by a team of committed researchers, including child health physicians, developmental pediatricians, child neurologists, neuro-epidemiologists, child psychologists, special education teachers, and developmental therapists whose aim was to simplify the multi professional team (MPT) assessment, so that single professionals (such as primary school teachers, therapists, doctors, or community workers with graduate degrees, etc) are able to conduct the assessment. The tools have been validated against psychometric tests and tests of adaptive behavior which were either developed or adapted for Bangladesh.
Publications based upon validity studies of the RNDA
- Khan NZ, Muslima H, Begum N, Begum N, Shilpi AS, Batra M, Darmstadt GD. Reliability and Validity of a Structured Tool for Neurodevelopmental Assessment of 0-24 month Olds for use by Multiple Professionals in Bangladesh. Pediatrics. 2010 Apr;125(4):e755-62. Epub 2010 Mar 22.
- Khan NZ, Muslima H, Shilpi AB, Begum D, Parveen M, Akter N, Ferdous S, Nahar K, McConachie H, Darmstadt GL. Validation of Rapid Neurodevelopmental Assessment for 2 to 5-Year-Old Children in Bangladesh. Pediatrics 131.2 (2013): e486-e494.
- Khan NZ, Muslima H, El Arifeen S, McConachie H, Shilpi AB, Ferdous S, Darmstadt GL. Validation of a Rapid Neurodevelopmental Assessment Tool for 5 to 9 Year-Old Children in Bangladesh. J Pediatrics. 2014 Feb 6. pii: S0022-3476(13)01583-7. doi: 10.1016/j.jpeds.2013.12.037. [Epub ahead of print]
- Muslima H, Khan NZ, Shilpi AB, Begum D, Parveen M, McConachie H, Darmstadt GL. Validation of a Rapid Neurodevelopmental Assessment Tool for 10 to 16 Year-Old young adolescents in Bangladesh. Accepted for publication 11 May 2016
Developmental Domains Assessed
- Primitive Reflex (0-<1) Month
- Gross Motor
- Fine Motor
- Vision
- Hearing
- Speech
- Cognition
- Behavior
- Self Care (>5-16) Years
Qualification of Assessors
- A professional or para-professional who is familiar with children and families in her/his work place.
- With a college degree. Note: A high school graduate may apply the tool under supervision.
total number of forms by age group, domain assessed and outcomes
| Form Number | Age Group | Domains Assessed | Outcomes (Grading by Risk/Impairment) |
|---|---|---|---|
|
1 |
0-<1 Month |
Primitive Reflex, Gross motor, Fine motor, Vision, Hearing, Speech, Cognition, Behavior, Seizure |
|
|
2-13 |
1 - 60 Months |
Gross motor, Fine motor, Vision, Hearing, Speech, Cognition, Behavior, Seizure |
|
|
14 And 15 |
>5 - 16 Years |
Gross Motor, Fine Motor, Vision, Hearing, Expressive Language, Cognition, Behavior, Self Care, Seizure |
For Gross Motor, Fine Motor, Expressive Language, Cognition and Self Care:
For Vision and Hearing:
For Behavior and Seizures:
|
Training conducted directly within Bangladesh protibondhi foundation (bpf)
An training schedule is made for direct training workshops. 6 days training workshop is usually prepared for 1-4 participants for assessment of 12 children among age group (0-16) years. Days depend on number of participants and age of children needed for assessment. Each participant should assess at least three children of different ages. The training runs from 9 am to 4 pm. Each day four children of different ages are assessed by the participants. On the 1st and 2nd day basic underlying concepts and procedures of the tool are discussed. These include history-taking, calculation of age (chronological and corrected), ascertainment of nutritional status, ie, wasting and stunting (optional), components of the tool (forms, scoring, summary sheets), equipment. Few sample videos are also shown. Hands-on assessment of children usually starts from the 3rd day. For evaluation by the trainers, each trainee is asked to assess one child. Rapport building with the child and family; and procedures of assessment are observed and evaluated by the trainer. On the last day certificates are given to each successful participant.
Video Based Training
The demand for application of the RNDA has risen over the years. This has led the establishers of the tool to think about alternative means of reaching the potential users across their own country and internationally. Towards this purpose a set of videos have been developed. These videos clearly demonstrate the techniques applied for assessment of each item of the RNDA by age groups. A study on the fidelity of the tool when applied by those trained via video demonstrations has been conducted. This demonstrates a high degree of fidelity (paper to be published soon).
Post training Supervision and Certification
Certification for trainees is provided by BPF, both for those obtaining direct training, as well as those trained via videos. Those trained within BPF are assessed during the training period. Those who are found to be correctly applying the tool are given a certificate at the end of the training. Those who train via videos are requested to send video copies of full assessments. The RNDA experts rate these videos, provide written feedbacks via emails, and provide a certificate when these videos are rated to have been applied correctly. For each individual a set of four assessments (those who are obtaining direct training) or four videos (those who are training through videos) is required for certification. Each of the four children assessed belong to the four age groups which the RNDA is divided into.
by BrandBuzz
