The pilot model of integrated care at the Integrated Maternal and Child Wellness Hub (IMCWH) located at SingHealth Polyclinics (SHP) – Punggol will soon be rolled out to more polyclinics across Singapore to benefit more mothers and their children. Mother-child dyad services – from vaccinations to developmental screenings – will be available to empower mothers to better care for their babies.
The Integrated Maternal and Child Wellness Hub (IMCWH) at SingHealth Polyclinics (SHP) – Punggol
Introduction
The pilot IMCWH at Punggol Polyclinic in Singapore takes a holistic healthcare approach to enhance care coordination for mothers and young children. Driven by Temasek Foundation’s grant of more than S$2.5 million, it offers support during the most critical stage of a child’s development — from birth to three years old.
Together with KK Women’s and Children’s Hospital (KKH) and SHP, it optimises maternal and child wellbeing in four ways:
At 18 and 30 months, young children undergo Enhanced Developmental Screening (EDS), using additional screening tools to screen for developmental delays and autism
Postnatal Depression Screening
Nutrition and Growth
Parenting Education
The programme adopts a two-tier approach. The first tier is helmed by a team of trained primary care nurses. At the second tier, specialists and allied health professionals will care for those who require further support.
Gap
The IMCHW pilot was initiated to address various gaps in care coordination for expectant mothers and young children.
“We first conceptualised this programme from evidence that the first thousand days are very important for the child’s brain development. It is also a period of vulnerability that offers opportunities for intervention to be effective,” explained Associate Professor Chan Yoke Hwee, Chairman, Division of Medicine, KKH.
Low literacy about nutrition and health is a concern for mothers, so educating them about the postnatal period and how to manage their newborns is critical, as it helps to sooner detect and attend to developmental issues.
During a child’s routine checks in the community, its rudimentary height and weight are recorded, and it receives basic developmental screenings and physical assessments. Although more comprehensive screening tools are available to enable better pick-up rates for developmental issues, these can be operationally challenging to conduct in a fast-paced primary care setting with high patient volumes.
After being introduced to IMCWH, I felt very well supported, and I always know that I can approach the nurses during the polyclinic visits, if I need help.
In addition, screening for postnatal depression (PND), which affects up to 15 per cent of new mothers, was not routinely done. Healthcare professionals recognise PND as a serious problem. The sooner they can identify mothers who may be at a higher risk (e.g. past psychiatric history, obstetric complications, complicated delivery), the sooner she can be treated.
Intervention
To address these gaps, nurses and doctors at Punggol Polyclinic received training by KKH healthcare professionals. This included early identification of children at risk of developmental delays and autism spectrum disorders, and providing postnatal support in areas such as lactation and emotional wellness.
Because polyclinics already provide immunisation and basic health checks for babies, they are able to ramp up these services. Enhanced screenings include an assessment of mothers’ mental health and lactation concerns, along with child development, nutrition and child growth.
PND screening and counselling occurs at the two-month mark for mothers, while lactation support is offered from zero to six months. For babies, enhanced developmental screening and nutritional screening take place at 18 and 30 months.
Concurrently, education outreach was conducted to engage the community, and raise awareness of child development, wellness and parenting. Materials covered topics ranging from anticipatory guidance, development milestones, growth and nutrition, oral health, PND to injury prevention for children from zero to three years old.
These materials, including 13 educational videos, are available online, and accessible via QR codes on the clinic’s wall murals, programme’s website and KKH’s YouTube page. Hard copy brochures on PND were also distributed to all mothers screened.
Outcomes & Impact
By December 2021, more than 14,000 screenings had been carried out. Brochures, webinars and online resources reached over 13,000 families.
Around 709 of 8,624 children (8%) who underwent EDS were screened positive for developmental delays and given subsequent support. About 471 of 4,046 (12%) 18-month-olds with a body mass index above the 90th percentile received intervention, while 136 of 5,561 (2.4%) mothers screened positive for PND were given support.
There was an increased referral rate for children with developmental delays. The 18-month touchpoint for EDS had the highest pick-up rate (10%). The number of referrals to KKH Department of Child Development, among those aged one to two years, increased by 70 per cent, and was double that of other SHP clinics.
The standard Child Development Screening (CDS) tools at 18 and 30-months were enhanced based on the learnings from IMCWH. Since the roll-out of the revised CDS in November 2020, the referral rates to KKH Department for Child Development from other SingHealth polyclinics saw a 67 per cent increase for 18-month screening.
About 471 of 4,046 (12%) 18-month-olds with a body mass index above the 90th percentile received intervention, while 136 of 5,561 (2.4%) mothers screened positive for PND were given support.
Importantly, enhanced screening has opened up conversations between healthcare professionals and mothers such as Ms Michelle Kee, who has three children. “After being introduced to IMCWH, I felt very well supported, and I always know that I can approach the nurses during the polyclinic visits, if I need help. The current new polyclinics’ design and environment are also enhanced to better suit mothers and children.”
Efforts to Scale Impact
This pilot at Punggol Polyclinic drove the start of stronger care support for mothers and their babies across Singapore, in recognition of the growing importance of maternal mental wellness, breastfeeding and childhood development.
As part of the first phase of expansion, SHP has scaled the IMCWH model starting with the EDS to two other polyclinics with higher maternal and child health load, and plans to expand to another polyclinic by the end of 2023. Progressively, components such as postnatal depression screening, nutrition and growth, and parenting education will be added.
In March 2022, the Ministry of Health announced that mother-child dyad services will be rolled out to more polyclinics and targets to scale these services to 14 polyclinics by 2025.
