The Department of Child Development (DCD) in
KK Women’s and Children’s Hospital (KKH) has a team of 140 staff members, including paediatricians who focus on child development; psychologists; nurses; speech and language, occupational and educational therapists; medical social workers; and clinical research coordinators, supported by administrative and ancillary staff.
The focus is the preschool child with developmental, learning and behavioural problems. Much emphasis is also given to family-centred care through support for parents and caregivers, who are critical partners for intervention. The range of skilled staff within the same department is one of its strengths, as it can provide both integrated care and trans-disciplinary care in a team-based and collaborative manner, with increased efficiency and reduced cost.
CHILD DEVELOPMENT PROGRAMME
DCD runs the Child Development Programme of the Ministry of Health (MOH), together with the National University Hospital. In 2018, DCD saw more than 4,000 preschool children with a wide range of diagnoses, the most common being language delay (35%), autism spectrum disorder (ASD) (23%) and global developmental delay (11%).
These children are assessed in KKH and receive their intervention in two community satellite therapy centres in the Health Promotion Board and in Riverdale. Over 20,000 therapy sessions were delivered by DCD in 2018.
Whenever appropriate, children are transferred to Early Intervention Programmes for Infants and Children (EIPIC) run by social service agencies, where groupbased intervention can be provided in their naturalistic environment till school entry, if needed.
In addition to assessment and family-centred, rightsited intervention, DCD supports children’s behaviour; ensures that they are enrolled in programmes and schools where they can thrive best; facilitates seamless transition into their school years and continues to support the families as needed.
SPECIALISED ASD TRACK
DCD has a strong focus on ASD. In 2018, 932 preschool children seen by DCD were diagnosed with ASD. Through a specialised ASD track, the clinical diagnosis is made by paediatricians before formal psychological testing is performed. An ASD nurse supports the parents as they start their challenging journey into intervention. In partnership with Temasek Foundation, in the BabySibs - Autism Screening Service in Singapore Toddlers (B-ASSIST), siblings of children with ASD (whose risk of ASD is 10 to 20 times higher than the general population) are screened for early identification of ASD.
LEARNING AND BEHAVIOUR TRACK
The Learning and Behaviour Track focuses on kindergarten-aged children with learning, development and behavioural problems that are likely to affect their academic journey. School readiness is the focus of this track, with screening of learning skills and behaviour, and timely intervention to maximise the narrow window of intervention before school entry. Very high-risk children are supported during their transition into primary school through DCD’s collaboration with the Ministry of Education (MOE).
Behaviour management is another strong focus of the department, which adopted the programme “Signposts for better parenting” from the Parenting Resource Centre (PRC) in Melbourne.
Four DCD staff are trained by PRC, and are the only trainers endorsed outside of Australia. They have trained several hundred Signposts facilitators in numerous community organisations in Singapore, who have gone on to train over 5,000 parents in KKH and in the community to manage their children’s challenging behaviour.
DCD adopted the Supportive Parenting for Anxious Childhood Emotions (SPACE) Programme from Yale University and adapted it for local preschool children, in partnership with Temasek Foundation. The developer of the programme, Dr Eli R. Lebowitz, trained a team of DCD psychologists to administer this programme to parents, so that anxious children can be supported in the preschool years before they enter primary school (a key but highly stressful transition point), and the risk of developing the mental health disorder of anxiety may be reduced.
The department’s psychologists also train early childhood educators to manage behaviour problems in the preschool classroom, in collaboration with the PAP Children’s Foundation (PCF).
DCD also has an active presence in the community, focusing on capacity and capability building with right-siting and appropriateness of intervention and assessment, through programmes at home, preschools and EIPIC centres.
The process often begins with a small pilot project to determine the suitability of intervention before collaborating with a larger organisation to test the model of care.
i. A small pilot programme of preschool-based intervention with supportive funding from MOH was the basis of a larger community-based programme,Mission I’m Possible, which was funded by the Lien Foundation. This programme was adopted by the Ministry of Social and Family Development (MSF) and is now run as the preschool-based Developmental Support-Learning Support Programme (DS-LS), which has since reached more than 500 preschools across the island.
ii. The Early Childhood Holistic Outcome (ECHO Programme, adapted by DCD from an existing American model), has also been adopted by MSF for the EIPIC centres so that children can be assessed in a holistic and meaningful manner that accurately reflects their abilities in their natural environment and their daily lives. DCD staff currently forms the implementation team for the ECHO project, and the consultancy team for the DS-LS programme.
Collaboration is a key DCD strength. To date, it has collaborated with 38 community agencies to develop and lead programmes, provide training, consultancy and supervision, and identify ways to enhance services for the community.
These collaborations have allowed DCD to be involved in numerous ongoing community and intervention projects. With the support of Lien Foundation, its staff is leading the Circle of Care, a project with Canossaville Children and Community Services, as well as a new programme, Relational Invitational Approach (RIA), which aims to improve the collaboration between clinicians and parents (whose actions, priorities and perspectives are critical for effective intervention for the child).
With Nanyang Polytechnic, the department has developed early versions of literacy apps for children with literacy difficulties.
With FPG in USA, it has also co-developed the CONNECT module, a web-based learning framework for educators on early literacy.
The journey towards the creation of a more inclusive community landscape in Singapore is continuously evolving. With multiple stakeholders and service providers, it is important for DCD to be always alert to movements that will affect the children under its care and to respond quickly to changing needs. The department’s large collaborative network is very important in this aspect of its work.
As a department that has strongly supported the education of its staff, DCD is very fortunate to have nine Allied Health Professionals with PhDs. This strong professional team has allowed the department to have an impact on the standards and service delivery in both the department and the community, as they lead in research, needs analyses for external organisations, programme development and consultancy and technical assistance teams for community projects. They mentor the junior staff and critically review the departmental work.
Paediatric residents spend a total of two months in DCD. A fellowship programme for non-Singaporean paediatricians has also been developed, as the department sees the need to support its developmental colleagues in other countries as they develop their own childhood development programmes. In addition, psychiatry residents, medical students, student psychologists and therapists rotate through the department, so that they can benefit from the large preschool population seen in DCD.
Research is a small but growing part of DCD’s work. The Developmental and Behaviour Problems in Toddlers (TIDBIT) study, supported by a grant from the
National Medical Research Council (NMRC), aims to screen up to 1,050 children over a period of three years. It aims firstly to compare the effectiveness of established tools for developmental screening in young children, and secondly, to determine the screening tool that is preferred by local parents to monitor their child’s development.
This study will help DCD make recommendations for nationwide timely identification of developmental delay to facilitate early intervention while the child’s brain has the greatest neuroplasticity.
The first autologous cord blood study in children with ASD in Singapore is in progress and will provide useful information on how research in this area can progress. There are only three published studies on this mode of treatment in the world.
“Our work in DCD is wide-ranging in its scope and impact. There is much more to be achieved, many more journeys to take, many service gaps to bridge, many more children to reach and many mountains to climb. But, we are privileged to be in this field, to do this work and experience the joy of working with children and families every day of our working lives." Adjunct Associate Professor Lourdes Mary Daniel, Head and Senior Consultant, Department of Child Development, KKH
Head and Senior ConsultantAdj Assoc Prof Lourdes Mary Daniel
Senior ConsultantsAdj Assoc Prof Lim Sok BeeDr Pratibha Keshav Agarwal Adj Asst Prof Sylvia Choo Henn TeanAdj Assoc Prof Winnie Goh Hwee SuatProf Ho Lai YunAdj Asst Prof Wong Chui MaeAdj Asst Prof Padmini Sita Yeleswarapu
ConsultantsAdj Asst Prof Sandra Sylvia MascarenhasDr Ellen Tay Ghim Hoon
Associate ConsultantDr Sharline SuhumaranDr Christelle Tan
Senior Staff Registrars Dr Anitha Madayi Dr Shilpee Raturi
Staff RegistrarDr Heng Yi Ching, Katrina
Visiting Consultants Assoc Prof Yeo Cheo Lian (from SGH)Assoc Prof Chan Kwai Lin Daisy (from SGH)Assoc Prof Varsha Atul Shah (from SGH)Dr Ho Kah Ying Selina (from SGH)
GPs can call for appointments through the GP Referral Hotline at 6692 2984.
HEAD AND NECK
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11 Hospital Crescent, Singapore 169610 +65 6436 8000