Governance of Child Health Policy: The Canadian Context for Developmental Screening

Child health policymaking is complex, necessitating collaboration among various sectors and actors. This is particularly evident in “developmental screening.” The potential to routinely assess development in early childhood— to ‘screen’ for developmental problems— holds a potent if contested promise to optimize child health. Clinical evidence supporting systematic population-level interventions is insufficient, yet many health-professional associations have endorsed the practice and several developmental-screening initiatives have been implemented internationally, including in Ontario— the only Canadian province to implement developmental screening (the Enhanced Well-Baby Visit). The controversies surrounding developmental screening suggests that the ‘problem’ is not solely technical: it reflects political contests over the intervention’s aims, the justifications that warrant action, and the arrangements of actors who debate and authorize policy change. In brief, it reflects the policy challenges of agenda-setting and governance. This research describes approaches to the governance of child health, and explores relationships between governance arrangements and decision-making, particularly the impacts on agenda-setting and evidence use. Using a comparative case study design involving interpretive qualitative methods, I analyzed policy documents and conducted interviews (n=40) with child-health policy experts in Ontario and Manitoba. I found jurisdictional differences in policy attention and governance, specifically in the structure of institutions, the organization of interests, and the ideas of stakeholders as they apply to screening programs. The study reveals how framing impacts agenda-setting and how governance arrangements influence the design and delivery of policy. Presented as three manuscripts, key findings include: (1) developmental screening is framed, and understood, as three distinct agendas (medical, social, political) for child health; (2) comparing Manitoba and Ontario’s efforts for ‘joined-up’ governance reveals that perceptions of policy success depends on whether collaboration or action is prioritized; and (3) Ontario’s implementation experience for the 18-mos visit illustrates that the choice of primary care as the venue for delivery shapes how interventions are defined and delivered. Overall, this work highlights the complexity of child health policy, illuminates challenges in screening for social risk, and contributes to current debates about how professionals intervene in early child health.Ph.D.2021-06-22 00:00:0