Abstract
Young children from impoverished backgrounds experience high levels of family and environmental stress, adversely impacting developmental functioning. Early identification provides a pathway to solutions, but many children are never evaluated. In addition, the child-serving workforce lacks resources and expertise to use traditional measures. Furthermore, existing measures do not account for the substantial influence of a child's ecology. To bridge these gaps, we developed the Neurodevelopmental Ecological Screening Tool (NEST) and conducted a pilot study (n = 60) to test its feasibility for use with caregivers of children 3-5 years of age in low-resource settings. We developed an item pool across 3 domains (child, caregiver, and environment), vetted it with experts, and conducted cognitive interviewing with parents (n = 15) and case managers (n = 10). Simultaneously, we built an online, user-friendly delivery platform. We used a one-parameter Item Response Model and a Rasch-based Rating Scale Model and fit confirmatory factor analytical models to test for unidimensional and construct validity. The results support the feasibility of screening children from low socioeconomic status populations within low-resource settings using an ecological perspective and support the work of child-serving paraprofessionals in identifying and addressing risks in the lives of young children.