ASQ-TRAK: Culturally responsive tool transforming health screenings for Aboriginal and Torres Strait Islander children

One of the standard tools used by early childhood professionals to measure development is the globally recognised Ages and Stages Questionnaire  (the ASQ^®-3). It is a widely used screening tool, however because it was developed in the US for non-Indigenous children, it doesn’t consider the unique factors and environments impacting the childhood experiences of Aboriginal and Torres Strait Islander peoples. Paediatrician Associate Professor Anita D’Aprano realised that because of this lack of cultural context, it simply wasn’t being used in clinical settings in remote Australia. It was this realisation that led to development of the culturally responsive ASQ-TRAK screening tool for Aboriginal and Torres Strait Islander children .

“Using a tool like the ASQ-TRAK will enable earlier detection of developmental difficulties, meaning earlier access to interventions that will transform trajectories over the course of a child’s life” explains Associate Professor D’Aprano.

The research

The ASQ-TRAK tool  was developed from the ASQ^®-3 and adapted by Associate Professor D’Aprano, ASQ^®-3 authors, and Aboriginal community partners. The tool was in development for about two years and includes features such as plain language for ESL users, and images in addition to text to demonstrate developmental stages. Qualitative studies  involving Aboriginal Health Workers, allied health workers, and caregivers in urban, regional and remote settings found the adapted tool to be culturally relevant.

Associate Professor D’Aprano commenced her post-doctoral research through the University of Melbourne in 2014 and it was during this work that the tool was validated. “There was growing interest from practitioners on the ground who wanted to use the tool. I was talking about it at conferences and more people started to show an interest in using it. This interest and need progressed to validation of the ASQ-TRAK, so that we could be confident in its accuracy.”

The involvement of key partners in this development and validation phase was critical for its cultural relevance and accuracy. This increased its uptake once it was finalised as a viable tool for clinical use. “It was important to work with partners such as the Department of Health in the NT, who provided essential local access to community partners. Then partnering with Congress (an Aboriginal Community Controlled Health Organisation in Alice Springs) and Families as First Teachers (FaFT – NT Department of Education) on the validation study, connected them to the project in a way that increased the chance of the product being implemented.”

The business model

As demand for the ASQ-TRAK tool and the accompanying practitioner training increased, the team grew. “We couldn’t continue to operate at small scale so in 2019 we partnered with the Royal Children’s Hospital for distribution of the tool . We continued doing the research, but we also had to learn what was involved in building up the commercial side of it.”

This was where the University’s commercialisation team became invaluable. “The knowledge and tech transfer team gave a lot of advice and support – and continue to. They work closely with the legal team and have been fundamental with advice on things like IP and developing the licencing and end-user agreements.”

The impact

The hope for Associate Professor D’Aprano is that clinical implementation of the ASQ-TRAK tool will transform the lives of Aboriginal and Torres Strait Islander families and in time, contribute to longer, stronger futures. “My goal is to see that all Aboriginal and Torres Strait Islander kids have access to the best culturally responsive developmental care and support so they can reach their full potential and have success throughout their life.”

This vision is reflected in the successes achieved so far with over 1000 ASQ-TRAK kits distributed nationally through around 160 different organisations – almost 60 of them Aboriginal Community Controlled Health Organisations (ACCHO). More than 1000 staff have been trained to use the tool across all sectors in remote, rural, and urban parts of Australia. In 2023, the tool was developed further and the ASQ-TRAK2 now includes all 21 age intervals between two months and 5 ½ years.

“As we scale up, we’d like to partner with Aboriginal and Torres Strait Islander peak bodies to secure more funding to enable us to build a sustainable workforce that delivers the solution in an affordable way to those who need it most.”

The University of Melbourne acknowledges the Traditional Owners of the unceded land on which we work, learn and live: the Wurundjeri Woi-wurrung and Bunurong peoples (Burnley, Fishermans Bend, Parkville, Southbank and Werribee campuses), the Yorta Yorta Nation (Dookie and Shepparton campuses), and the Dja Dja Wurrung people (Creswick campus).

The second iteration of the tool, ASQ-TRAK 2, is being used by healthcare workers, educators and other childcare professionals in Aboriginal and Torres Strait Islander communities to help track children’s development.