EarlyCheck

1. Reference standard. Validated developmental diagnostic assessments and ADOS are available at few urban centres, limiting rural access. The pilot compared screening outcomes with a blinded structured neurological examination. The next stage will include reference-standard assessment in a defined subsample.

2. Data capture. During the pilot, 21% of records (54/256) lacked a codable verdict due to narrative documentation and retrospective classification. The next stage uses a structured electronic case report form with predefined outcome categories and independent verification to ensure complete, reproducible data.

3. Service pathway. Risk identification does not guarantee access to care, particularly in districts without paediatric neurologists. Referral pathways with regional health authorities are being formalised before scaling, with defined response times for at-risk children.

4. Stakeholder engagement. Clinicians may view parent-facing screening as replacing clinical judgement, while families may distrust automated decisions. Implementation includes primary care staff training, clear communication that screening supports rather than replaces clinical assessment, and transparent reporting of limitations.

5. Regulatory and funding context. The regulatory classification of digital screening tools remains undefined, complicating large-scale deployment. Validation awaits funding. The programme is designed to build clinical evidence independently of any single funding source.

Best practices identified

Blinded neurological assessment ensured credible validation and remains the standard for subsequent rounds. Two-tier triage distinguishes children requiring specialist referral from those needing early intervention without referral, reducing unnecessary referrals. Monthly screening enables developmental monitoring and compensates for missed findings. Privacy by design, with no personal identifiers collected, simplified ethical approval and reassured parents. Items are based on ASQ-3, Denver II, M-CHAT and the Guide for Monitoring Child Development, supporting clinical familiarity and specialist acceptance.

Factors that facilitated implementation

Key facilitators included district paediatricians collaborating with the study neurologist, strong parental motivation where specialists were unavailable, and easy access through a messenger application requiring no installation or local IT infrastructure.

Implications for policy, practice, technology and research

Policy priorities include referral protocols agreed with regional health authorities and recognition of digital screening in primary care. Practice requires staff training in two-tier triage. Minimal infrastructure and no data storage support technological scalability. Research priorities include a reference-standard substudy and peer-reviewed publication of the combined dataset. Sustainability may be supported through provider- or state-funded usage fees, keeping screening free for families.