Improving Access to Developmental Assessments Before School: Evaluation of Targeted 'School Starter Blitz' Clinics in Metropolitan Sydney.

BACKGROUND: Timely developmental assessment is essential for children with neurodevelopmental concerns, particularly before starting school. In public health systems, long wait times for multidisciplinary assessments disproportionately affect vulnerable populations, especially those from culturally and linguistically diverse (CALD) backgrounds. To address this, the South Western Sydney (SWS) Local Health District introduced 'School Starter Blitz' clinics-targeted initiatives prioritising school-entry-age children for diagnostic assessment. METHODS: This retrospective cohort study analysed data from October 2022 to September 2024 for children aged 1 to 16 years referred to the Child Development Assessment Service (CDAS) with the objective of assessing impact of Blitz intervention on waiting times. Blitz clinics were held during 4 targeted months. Structured phone screening prioritised children nearing school age, particularly those without previous diagnoses. Demographic, clinical, and service-use data were analysed using descriptive and inferential statistics. RESULTS: Of 1957 eligible children, 23.5% were assessed during Blitz months. These children were more likely to be younger (≤5.5 years), first-time patients, without prior diagnoses and classified as high priority at the time of referral triage (39% vs 22%, P < .001). Waiting times were significantly shorter reduced by 89 days on average (223 vs 312 days, P < .001) during blitz months. Regression analysis identified CALD background and children with diagnosis other than autism as additional factors associated with shorter wait times. Despite the Blitz months having generally shorter waiting times for various clinical factors, overall, there was no significant difference according to socioeconomic place of residence. CONCLUSION: The 'School Starter Blitz' effectively prioritised younger, first-time children from CALD backgrounds for developmental assessment. It represents a feasible and scalable service redesign that improves access and reduces delays in assessment. However, successful implementation requires investment in administrative support and staff satisfaction. The findings also underscore the persistent influence of the Inverse Care Law in public health access. Broader adoption of this model has the potential to enhance both equity and efficiency across public health systems.