Background: Despite broad scientific consensus about the importance of the early years in the lifelong health and wellbeing of children, there is debate about whether and how healthcare professionals can optimise early child development through monitoring or screening. The evidence in support of a systematic population-level intervention is disputed, which is reflected in the diversity of approaches to developmental screening internationally. Methods: Using a case-study design, and interpretive qualitative methods, we explored how Canadian experts in child health (n=39): a) rationalise why they do, or would, pursue population-level developmental screening; b) articulate the policy goals of such an intervention, and; c) justify the practice with reference to evidence. Findings: Respondents identified three distinct framings, or policy agendas, for what developmental screening can and should seek to achieve, specifically: 1) as medical intervention, facilitating the early identification of health risk or disorder; 2) as social intervention, providing an opportunity for communication and connection with parents for all children; and 3) as political intervention, staking a claim for early child health on the broader political agenda. Discussion and conclusions: Each agenda is justified by distinct types of evidence, posing a challenge to simplistic models of evidence-based policymaking, and demonstrating that evidence is not just an input, but a contested part of a dynamic and political policymaking process.

中文翻译：

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“早期干预”：儿童发育健康的议程和合理化

背景：尽管早年对儿童终生健康和福祉的重要性已获得广泛的科学共识，但关于医疗保健专业人员是否以及如何通过监测或筛查优化儿童早期发育仍存在争议。支持系统性人口水平干预的证据存在争议，这反映在国际上发育筛查方法的多样性上。方法：使用案例研究设计和解释性定性方法，我们探索了加拿大儿童健康专家（n=39）如何：b) 阐明此类干预的政策目标，以及；c) 参考证据证明实践的合理性。调查结果：受访者确定了三个不同的框架或政策议程，发育筛查可以并且应该寻求实现的目标，特别是：1）作为医疗干预，促进健康风险或障碍的早期识别；2) 作为社会干预，为所有儿童提供与父母沟通和联系的机会；3) 作为政治干预，在更广泛的政治议程上争取早期儿童健康。讨论和结论：每个议程都由不同类型的证据证明是合理的，这对基于证据的政策制定的简单模型提出了挑战，并证明证据不仅是一种投入，而且是动态和政治决策过程中一个有争议的部分。2) 作为社会干预，为所有儿童提供与父母沟通和联系的机会；3) 作为政治干预，在更广泛的政治议程上争取早期儿童健康。讨论和结论：每个议程都由不同类型的证据证明是合理的，这对基于证据的政策制定的简单模型提出了挑战，并证明证据不仅是一种投入，而且是动态和政治决策过程中一个有争议的部分。2) 作为社会干预，为所有儿童提供与父母沟通和联系的机会；3) 作为政治干预，在更广泛的政治议程上争取早期儿童健康。讨论和结论：每个议程都由不同类型的证据证明是合理的，这对基于证据的政策制定的简单模型提出了挑战，并证明证据不仅是一种投入，而且是动态和政治决策过程中一个有争议的部分。