Charles SchelleWhen children in Peru enter the public health system, a nurse is expected to conduct a developmental screening for each child taking about 30 minutes. Given that there are more than 1 million children between the ages of 3 and 5 years old who need the screening, nurses face pressure to rush the screening or risk it being incomplete when the doctor sees the child.
A University of Maryland School of Social Work team, led by associate professor Jay Unick, PhD, believes a new digital screening can help. Partnering with Health Bridges International and Artemis Associates, and with support from the University of Maryland, Baltimore’s (UMB) President’s Global Impact Fund, they are adapting the Neurodevelopmental Ecological Screening Tool (NEST) for Peruvians.
The original NEST model, designed by psychologist Carmela de Caneda, provides a structured way for case managers with basic training to screen children. It was designed to be used in low-resource settings like homeless shelters, Unick explained. The scoring system and algorithm can help case managers determine the urgency and need of patients, signaling who needs further evaluation and who does not.
Parents can complete the screening on a tablet in the waiting room or at home before the appointment.
“What we really wanted to do was enable systems to operationalize and maximize resources in resource-constrained environments,” said Unick, who specializes in psychometrics.
In Peru, which has health systems and programs for different populations, Unick and his colleagues saw parallels of those challenges faced by U.S. shelters.
“We had a partner, Health Bridges International, that had worked with us domestically but has its primary presence in Peru,” he said. “They were like, hey, this sounds like a lot of the issues we’re facing in Peru.”
Addressing Common Concerns in Peru
Adapting the tool has required more than a Spanish translation. NEST-Peru has been reshaped to address conditions more prevalent in the region.
“Anemia is a really big issue in Peru, which is not true in the United States,” Unick noted. “So, we shifted some of those things, allowing the nurse to spend time assessing the child’s psychosocial development in a way that’s evidence-based.”
Parenting assessments also had to change, including assessing the mental health of the caregiver.
“There are different safety concerns, and there’s different parenting norms around how much freedom that you let your kids have,” Unick said.
The safety concerns include within the home.
“They were really much more focused on making sure that we assess for domestic violence in Peru, whereas we did less assessment of that here,” he said.
While NEST brings new tools to Peru, Unick learned a lot about the dedication to physical assessments the nurses completed during the visit in pediatric and primary care settings.
“I’ve never had a 30-minute pediatric session in the United States where at regular developmental intervals, the parent, the child, and the nurse sit down together and look for fine motor coordination development in children,” Unick said, adding that nurses would observe the child stacking blocks.
With the adapted NEST in Peru, the nurses could take the information from the screening for fine motor coordination concerns and have a culturally appropriate task like shelling peas that the caregiver could continue to observe at home, he added.
Building for the Long Term
The project’s goals under the President’s Global Impact Fund are to:
- Strengthen partnerships with Peruvian institutions.
- Adapt and finalize the tool for local use.
- Pilot NEST-Peru in community-based settings to prepare for broader implementation.
The goal is to complete the adaptation this year and then test the tool with a small group of stakeholders early next year. After taking the summer to review data and refine the tool, a pilot would launch from fall 2026 through summer 2027to prepare for a larger trial.
Unick credits UMB’s Center for Global Engagement (CGE) for helping to enable these partnerships in Peru, saying if not for the funding, the research would have stopped after federal funding ceased.
Given that this fund from CGE was launched in the early months of the COVID-19 pandemic in 2020, these funds continue to provide a key bridge for researchers during another era when federal funding is unreliable.
“What began in a moment of uncertainty has become one of the Center for Global Engagement’s most meaningful contributions to UMB’s mission: a way to seed innovation, strengthen international partnerships, and support faculty in bringing their best ideas to the world,” said Virginia Rawthorn, JD, LLM,assistant vice president for global engagement at UMB and executive director of CGE.
For Unick, the work in Peru is only beginning. Additional translations and cultural context are needed. About 13 percent speak Quechua and 2 percent speak Ahmaya, plus the country has a large immigrant population from China and Japan. Versions of the tool are needed for other age ranges, too.
“We started, but it’s not the end of it,” he said. “This is the start of a project that really should have long legs. We have to continuously update and improve the work that we do.”
