6059 Inequity in childhood developmental outcomes in an inner-London borough: a secondary analysis of children’s characteristics and the ASQ-3

Objectives Early childhood development shapes children's future well-being.¹ ² The Ages and Stages Questionnaire-3 (ASQ-3) is used to assess children's development aged between 2–2.5 years as part of England's Healthy Child Programme (HCP).³ This study aims to use secondary data to understand whether children living in Lambeth experiencing risk factors for disadvantage, social vulnerability and different levels of health visiting input (Universal, Targeted and Specialist) are at greater risk of poorer developmental outcomes at age 2–2.5 years. Methods Data was cross-sectional and came from the local health visiting dataset. Chi-square and analysis of variance tests were used to test associations between children's characteristics, HCP-level and ASQ-3 outcomes. Logistic regression was used to further evaluate the association between HCP-level and ASQ-3 outcomes. Results The final sample included 12,712 children living in Lambeth who were assessed using the ASQ-3 at age 2–2.5 years between the 30th of June 2015 and the 2nd of August 2022. Sex, ethnicity, income deprivation affecting children index (IDACI) and HCP-level were very strongly associated with ASQ-3 outcomes (p<0.001). Males (Odds Ratio(OR) 2.33, 95%CI 2.13–2.55,p<0.001), Black children (OR 2.34, 95%CI 2.01–2.72,p<0.001) and children living in the most deprived areas (OR 2.13, 95%CI 1.76–2.59, p<0.001) had the highest odds of scoring below the expected ASQ-3 threshold, relative to White children, females and children living in the least deprived areas. After controlling for other variables, there was strong evidence that Targeted HCP was associated with five times the odds (OR 5.16, 95%CI 4.21–6.19, p<0.001) and Specialist HCP was associated with twice the odds (OR 2.13, 95%CI 1.45–3.12,p<0.001) of scoring below the expected ASQ-3 threshold compared with children receiving Universal HCP. Conclusion Early-years services need to target children at greater risk of poorer developmental outcomes in a way that reduces inequities and is universally proportionate. The HCP in Lambeth needs to be reviewed using a cross-disciplinary approach to ensure each HCP- level meets the needs of all families whilst considering the limited resources. References The United Nations Children's Fund (UNICEF). Early Childhood Development. Switzerland2022 [cited 05/08/2023. Available from: https://www.unicef.org/early-childhood-development. Early Years Healthy Development Review. The Early Years Healthy Development Review Report. England 2021. Department of Health. Healthy Child Programme: Two year review England; 2009.