Abstract: Aim: Aboriginal children in Western Australia’s Kimberley region have high rates of developmental concerns upon entering school. The purpose of this study was to identify i) current early childhood development (ECD) practices at one Aboriginal Community Controlled Health Service (ACCHS) in the region, ii) barriers and facilitators to detecting developmental concerns, and iii) if health staff deviate from current ECD guidelines, and possible reasons for deviation. Methods: This study utilised a mixed-method design. We audited consults of children aged 0-5yrs between January 1 2016 and December 31 2016 at the participating ACCHS. Formal child health checks (CHCs), developmental enquiry and follow-up of developmental concerns were identified. Five staff members participated in semi-structured interviews regarding ECD practices at the ACCHS. Ethics approval was obtained from the Western Australian Aboriginal Health Ethics Committee (HREC reference number 723). Results: In total 1241 consults were audited for 177 children. A formal CHC was conducted for 56 children over 74 consults and 114 children had development enquiry documented across 190 consults. In ten of these consults a development assessment tool was used. Hearing and speech was the most commonly reviewed domain. Where follow-up was arranged it was documented to have occurred in 18% of referrals. Only 11 consults documented brief interventions or anticipatory guidance. Thematic analysis identified communication issues, practical limitations, lack of early intervention services and need for increased resources and knowledge as potential barriers to increasing ECD activities. Participating staff recognised the importance of developmental assessment. Conclusions: We identified significant recognition of the importance of ECD assessment but also several barriers to implementation and low documented follow-up rates. There is a need to empower staff through upskilling in brief developmental assessments and interventions, to provide adequate resources, to improve communication between organisations and to promote supportive systems for early developmental interventions.