Scalable Transdiagnostic Early Assessment of Mental health (STREAM): Study Protocol
Authors: Williams Elin H. , Thompson Nicholas. M. , McCray Gareth , Crespo-Llado Maria. M. , Bhavnani Supriya , Gajria Diksha , Mukherjee Debarati , Del Bianco Teresa , Lockwood-Estrin Georgia , Mason Luke , Ngoma Vukiwe , Namathanga Chisomo , Nkhata Richard , Bennie Allan , Ranjan Alok , Kawelama Ulemu , Midha Naina , Singh Anindita , Mpakiza Innocent , Gautam Akshat , Gulati Sheffali , Johnson Mark H. , Lancaster Gillian , Belmonte Matthew K. , Jones Emily J. H. , Patel Vikram , Chandran Sharat , Mbale Emmie , Divan Gauri , Gladstone Melissa , Chakrabarti Bhismadev 
Published: May 2024

ABSTRACTIntroductionEarly childhood development forms the foundations for functioning later in life. Thus, the ability to accurately monitor developmental trajectories is critical. However, such monitoring is complicated by reliance on time-intensive assessments which often necessitate administration by skilled professionals. This difficulty is exacerbated in low-resource settings where such professionals are predominantly concentrated in urban and often private clinics, rendering them inaccessible to a large portion of the population. This geographic and economic inaccessibility contributes to a significant ‘detection gap’ where many children who might benefit from additional support remain undetected. The Scalable Transdiagnostic Early Assessment of Mental Health (STREAM) project aims to bridge this gap by developing an open-source, scalable, tablet-based mobile platform administered by non-specialist workers to assess motor, social, and cognitive developmental status. The ultimate goal is to deploy STREAM through public health initiatives, maximising opportunities for effective early interventions.Methods and analysisFour thousand children aged 0-6 years from Malawi (n=2000) and India (n=2000) will be enrolled and assessed using the STREAM platform. STREAM integrates three established developmental assessment tools measuring motor, social, and cognitive functioning using gamified tasks, observation checklists, parent-report, and audio-video recordings. Domain scores for motor, social, and cognitive functioning will be developed and assessed for their validity and reliability. These domain scores will then be used to construct age-adjusted developmental reference curves.Ethics and disseminationThe STREAM project has received ethical approval from local ethics review boards at each study site, is carried out in accordance with Good Clinical Practice (GCP) standards, and adheres to ethical guidelines presented in the 6th (2008) Declaration of Helsinki.Strengths and limitations of this studyThis study will collect data from N=4000 children in Malawi and India to assess the reliability and validity of the Scalable Transdiagnostic Early Assessment of Mental Health (STREAM) tablet-based platform;Community-based recruitment and the inclusion of children with known or suspected neurodevelopmental conditions will enable us to test the utility of STREAM in identifying children whose developmental status is below that expected for their age;The user-friendly nature of the tablet-based platform, coupled with its data security features and adaptability to different linguistic and cultural contexts, enhances its potential for widespread use in different populations;The reference curves generated in this study are expected to be applicable in the sampled contexts but may necessitate validation in other settings;The duration of the STREAM assessment in its current version may pose challenges, and is an area for refinement following data analysis.