1. A Follow-Up of Children At-Risk For Developmental Disabilities and Their Families
Presenters: Dr. Hillel Goelman, Dr. Jill Houbé, Mari Pighini,
Dr. Anne Synnes
Dr. Hillel Goelman, Dr. Anne Synnes, Dr. Jill Houbé,
Dr. Anne Klassen, Mari Pighini, Dr Sarka Lisonkova, Zhen Li
The Human Early Learning Partnership
The University of British Columbia
Children and Women’s Health Centre of British Columbia
Mc Master University
Dana Brynelsen, Provincial Advisor.
The Infant Development Program of British Columbia
The Early Years Conference 2008: Valuing All Children
Vancouver, BC, February 1st, 2008

2. Outline for Today’s Presentation:
An Interdisciplinary Study of the Trajectories of At-Risk Infants and Children
1. Background: What do we know about the development at risk children from the research in:
Neonatology (Dr. Anne Synnes)
Early child development (Dr. Hillel Goelman)
Developmental pediatrics (Dr. Jill Houbé)
Quality of life studies (Dr. Anne Klassen)
Rationale for study (Dr. Hillel Goelman)
The early years: Background on early child development/Research challenges

3. Outline for Today’s Presentation (2)
3. Objectives of study
4. Research questions
Phases of the study
Phase 1: Finding the children
Finding children in databases: BCLHD, Edudata Canada
Preliminary findings on health service utilization of non risk vs. at-risk children
Phase 2: Linking health and educational information of at-risk infants and children (1996/7 Birth cohort)
The role of the Population Health and Learning Observatory (PHLO)

4. Outline for Today’s Presentation (3)
Phase 3: (a) Linking health and educational information of at-risk infants and children (1997 Birth cohort until present) (b) Identifying and linking information of special subgroups of at-risk children
Cases Studies of Children and Families in the Infant Development Program of BC (Mari Pighini)
6. Concluding thoughts

5. 1. Background (a) At-Risk children (Anne Synnes)
“At risk children” are those, who as a result of medical, biological or environmental factors are more likely than typical children to have developmental delays and school difficulties
Level II and III regional neonatal-perinatal centers (NICUs) provide care for high risk pregnancies & intensive care for severely ill infants.
Babies born in BC with extremely low birth weight (ELBW, under 801 grams), are followed by the provincial Neonatal Follow-up Programme at the Women’s and Children’s Health Centre of BC.

6. anomalies they are born with
Children treated in Neonatal Intensive Care Units (NICUS) are at risk for developmental problems because of:
anomalies they are born with
complications of treatments required in the newborn period
effects of their newborn condition on their family/environment and/or concomitant risk factors

7. Background continued ( b ) Health Related Quality of Life (Anne Klassen)
Definitions of HRQL vary, but most view HRQL as being….
Subjective -- assessed from the patient’s perspective whenever possible
Multidimensional -- e.g., the WHO’s definition of health, which is “a state of complete physical, mental, and social well-being and not merely the absence of disease

8. Definitions of HRQL vary, but most view HRQL as being
Subjective -- assessed from the patient’s perspective whenever possible
Multidimensional -- e.g., the WHO’s definition of health, which is “a state of complete physical, mental, and social well-being and not merely the absence of disease

9. 2. The Early Years : Challenges to studying the developmental trajectories of at-risk children (1) Hillel Goelman, Jill Houbé
The early years are critical for children’s physical, cognitive, language, social and emotional development.
Pre-term and other at-risk babies admitted in the NICUs are at risk for neurodevelopmental, behavioral and social dysfunction

10. There is a dearth of:
interdisciplinary research to provide the multiple perspectives needed to fully understand the child’s development across various domains of development
“ecologically valid” research on the social determinants of optimal child development
Clyde Hertzman: “What differences make a difference?” (or maybe Gertrude Stein).

11. There are few population-based studies of preterm infant outcomes that permit interpretation of the impact of environmental factors/multiple determinants of long-term outcomes (family, community and health policy)
Limited number of population based longitudinal research on at-risk children who are NICU survivors is also due to many methodological challenges.

12. Neonatal Follow-Up Clinics provide multidisciplinary diagnostic services for former preterm infants
Community intervention services provide on-going support for children and families
Almost all intervention services terminate upon school entry
Education policy, budgets and staffing prohibit on-going provision of remedial services to all but the most disabled school-age former preterm infants

13. The challenges to studying the developmental trajectories of these children (2)
Data collected on these children in BC are stored in (at least) different databases and in different formats:
The BC Health Linked Database (BCHLD)
Neonatal Follow-up Programme (NFUP) at BC Children’s Hospital
Edudata Canada
There is currently no systematic way of tracking the development of any of these children from their treatment in the NICUs through to school entry at age 5.
There have been no previous attempts to link the children’s health records in their early childhood to their later school performance

14. When at risk infants reach school age
Research has shown:
Approx. 50% of extremely low birth weight children have a learning disability (Walther, den Ouden & Verloove-Vanhorick, 2000; Wolke & Meyer, 1999) but it is less clear how “bigger” low birth weight children do
behavioural difficulties are “common” but little is known how this affects school performance (Whitfield, Grunau & Holsti, 1997)
Early identification/ intervention of at-risk children can have a significant positive effects upon the children’s development (Goelman et al, 2005)

15. 3. Objectives of the study
To better understand the health and developmental trajectories of a population of at-risk children from birth to age 9
To better understand the social determinants that impact on the developmental health trajectories of a population of at-risk children from birth to age 9 and
To conduct an interdisciplinary study of a population of at-risk infants that draws on the strengths and complementary perspectives of psychology, neonatology, and developmental pediatrics and population health

16. 4. Research Questions:
In comparing a cohort of at-risk children admitted to Level II/III NICUs with a matched comparison group of non-risk children:
What differences are there in the medical histories of the two cohorts?
What differences are there in the educational progress of the two cohorts in their elementary school years in such areas as:
Receiving learning assistance services
Scores on standardized outcome measures

17. 5. Phases of Study
Phase 1
To identify at-risk infants born in BC in 1996/7 admitted to the BC Level II/III NICUs (Cohort 1) and a matched comparison group (Cohort 2) of non-risk infants born in BC in 1996/7 through the BC Linked Health Data Base (BCLHD).

18. What data on these children are there in the BCLHD?
How many at-risk children were admitted to the Level II/III Neonatal Intensive Care Units in B.C.,
The reasons for their referral, and
The history of their medical treatments, intervention and assessments
Data on medical services that have been billed to and paid for by provincial health insurance
Fields include visits to physicians (e.g., chronic illnesses), hospitalizations and surgeries and Interventions, therapies (e.g., physiotherapy, speech and language therapy)
Preliminary findings,
Some examples of the type of information being currently examined 

19. What are some of the diagnoses identified through these analyses?

20. Percentage of non-NICU children vs
Percentage of non-NICU children vs. NICU Level II and NICU Level III children with more than 2 hospital re-admissions in the first year of life
Mean days spent in hospital: Non-NICU <4 days; NICU Level II, 8 – 24days; NICU Level III, up to 40+ days (Jan 2008)

21. Percentage of non-NICU children vs
Percentage of non-NICU children vs. NICU Level II and NICU Level III children with more than 2 hospital re-admissions in the 2nd year of life

22. Percentage of non-NICU children vs
Percentage of non-NICU children vs. NICU Level II and NICU Level III children with more than 2 hospital re-admissions in the 3rd year of life

23. Preliminary findings (2): September 2007-January 2008
Updated reports on:
An overall “population” view: Who are these children? Where do they live? Where do they go to get their medical care?
Look at all the at-risk children admitted to NICU’s –not only the VLBW or ELBW
Identify whether services are hospital vs ambulatory based, where children live (urban vs rural locations)
Overview of clinical, hospitalization and other medical and non-medical interventions between birth and age 9 years old
Comparing health and service utilization trends in at-risk vs. non-risk children in BC
Some examples of the type of data that is currently being analysed include…

24. At-Risk Infants – Time in NICU
Table 1(a). Mean birth weight (BW) and gestational age (GA) of at risk infants in the study cohort when compared with non-risk children-Urban
URBAN
Non-Risk
At-Risk Infants – Time in NICU
Level II, >= 24 hours
Level II, >48 hours
Level III, >= 24 hours
Level III, >48 hours
Gender M F T
Number
28407
27157
55564
2413
1931
4344
1403
1119
2522
432
339
771
150
125
275
Per cent
51.1
48.9
100
55.5
44.5
55.6
44.4
56.0
44.0
54.5
45.5
Outborn (n=)
N/A
1122
901
2023
688
550
1238
0.00
Outborn (%)
34.97
2733
61.4
27.29
22.12
49.1
(N) GA
55501
2515
Mean gestational age (GA) (weeks)
39.25
39.3
39.28
37.48
37.55
37.51
36.68
36.01
36.69
35.5
35.15
35.35
35.24
32.64
32.59
(N) BW (Hosp)
Mean birth weight (BW) (grams) Hosp.
3446.7

25. At-Risk Infants – Time in NICU
Table 1(b).Mean birth weight (BW) and gestational age (GA) of at risk infants in the study cohort when compared with non-risk children-Rural
RURAL
Non-Risk
At-Risk Infants – Time in NICU
Level II, >= 24 hours
Level II, >48 hours
Level III, >= 24 hours
Level III, >48 hours
Gender M F T
Number
4751
4626
9377
188
159
347
119
102
221 43 31 74 19 15 34
Per cent
50.66
49.3
100
54.2
45.8
53.8
46.2
58.81
41.9
55.9
44.1
100[
Outborn (n=)
N/A
185
158
343
141
122
263
.00
Outborn (%)
33.27
27.97
61.24
33.03
28.37
61.4
(n=) for GA
4733
4611
9344
187
346
117
101
219
Mean gestational age (GA) (weeks)
39.42
39.43-
36.90
37.19
37.0
35.96
36.40
36.16
34.23
33.81
34.05
33.21
30.80
32.15
(N=) fo[ BW (hosp)
171
145
316
118
220
Mean birth weight (BW) (gram) H
2452.4
2315.0

26. Phase 2
To link the health information on Cohort 1 and Cohort 2 obtained through the BCHLD in Phase I with their respective educational outcome measures in Grade 4 through Edudata Canada.
Edudata Canada is a database which includes information on children in the public school system starting when the child enters kindergarten, usually at age 5.

27. Linking the databases: Edudata Canada
Edudata Canada includes information on the child’s developmental and academic progress, as well as demographics information, for example: In Phase 2, these children’s anonymized Personal Health Numbers (PHNs) will be linked with their Permanent Education Numbers (PENs).
This will enable us to obtain and compare anonymous and confidential records of educational achievement and status (for example, standardized test scores i.e., FSA scores; special education designation and school support services, i.e., the student being assigned with a special support worker, among others

28. The BC Linked Health Database
The Edudata Database
The BC Linked Health Database
The crosswalk linking the two data bases

29. The crosswalk will enable us to:
What are some answers we can find from BCHLD /Edudata Canada crosswalk?
The crosswalk will enable us to:
Link neonatal medical information on a given child with information on that child’s school performance on standardized assessment measures in Grade 4, i.e., the Foundations Skills Assessment or FSA.
Inferential and predictive statistical techniques will be used to identify the relative weight contributed by different social, economic, health and developmental variables to the school outcome variables from Edudata Canada

30. Phase 3
To identify and to link health information on specific sub-groups of at-risk children in BC who were admitted to the BC Level II/III NICUs and matched comparison groups.
Population-based study informed by case studies:

31. “Case Studies of the Infants and Children in the IDP of BC ~ Preliminary findings”
Background
Absence of systematic data gathering in early childhood development -- this creates a gap in ability to conduct longitudinal research for children who are developmentally at risk.
The IDP Programs have collected invaluable medical, developmental and family information on more than children in British Columbia since 1975 (Brynelsen, 2003).
Information: entered manually and stored in different files until recently
Currently: Key information is being entered under a Central Registry database (e.g. fields like “date of intake,” “reason for referral”)
Academic and community partnership: First time for IDP to participate in a study of this kind

32. Collaborative partnership study ~ guided and inspired by:
Discussions with an IDP Program Coordinator; IDP consultants, and with the IDP Provincial Advisor;
Informal discussions with a few parents: “Tell us about your experience with IDP”; used the IDP Post Service Evaluation Questionnaire
These statements:
” … how help is provided matters as much, if not more, than what is done if positive consequences are to be realized…”(Karuza, Rabinowitz & Zevon, 1986), and
“…in effective home-based, family-centred early intervention programs parents “complement” the intervention program instead of “supplementing it…” (Mahoney et al, 1998)

33. Objectives of Study
This qualitative, retrospective case study looks into the experiences of families with children who are at-risk for/ identified with developmental disabilities from their child’s birth to their entry into school

34. ◊Literature with previous research on and/or descriptions of…
1. FRAMING OF STUDY
◊Literature with previous research on and/or descriptions of…
Children “at-risk” for “developmental disabilities,” children with “developmental delays,” and children who develop “typically”
(Synnes et al, 1994; Walther, den Ouden, & Verloove-Vanhorick, 2000)
Early intervention programs – effectiveness of early intervention (Mahoney, 2003; McCollum, 2002)
Special needs services and programs in British Columbia
Family centred programs
Therapy/Center focused programs
(Brynelsen, Cummings & Gonzales, 1993; Goelman et al, 2005)
Academic-Community Collaboration/Partnerships
(Goelman et al, 2005)
2. MEANING OF STUDY
◊ Unique perspectives through the voices of parents (different tradition in literature concerning special needs)
◊ A first step in trying to “connect the dots” of children’s life paths, from the time of their birth and into to their school ages, within their individual family contexts.

35. Research Questions
1. What are some of the unique experiences of developmentally at-risk children and their families who participated in the IDP in terms of access to resources and programs?
2. What are some of the unique experiences of developmentally at-risk children and their families who participated in the IDP in terms of their child current developmental needs?
3. In what ways do the experiences described in a) and b) relate to the current preschool/school demands on these parents; to the demands from other family members, and to financial/work pressures?

36. Methods and Procedures
◊ Naturalistic qualitative research design; multiple case study approach: (Creswell, 1998, 2003); two stages
◊ Stage 1: Purposefully targeted sample of 12 participants of four families (8 parents, four children)
Two mail-outs to 28 IDP families
◊ Criteria for Inclusion for participant families comprised, among others:
Received IDP home visitation services for their children between the ages of zero to three years
Expressed their wish to be re-contacted for research purposes during the discharge process ( “IDP Post Service Evaluation Questionnaire”)
◊ Two-step ethics approval for participation in study

37. Table 1. Family Demographics
Family
Composition
Children in participating
families
Age
of siblings
Languages
spoken
at home
by parent(s)
Parent's
Level of
Education
Employment
Status
Families  F M
# of
children # E.
Other
H. S
Post
Sec.
0001 Y 2 1
7 yrs; 10 mos.
10 years N
Y (F, M)
full-time
part-time
0002
6 yrs; 9 mos.
N/A
Y (F,M)
full- time
0003
4 yrs; 8 mos
6 years
Y (M)
Y (F)
home-business
self-employed
0004
2 yrs; 10 mos.
7 years
part time
◊All two- parent families with high-school/post-secondary education ◊ At least one parent per family employed/self-employed –no income assistance ◊ Three families also spoke another language ◊ 0002 child had no siblings

38. Data collection
Reviews of children’s files conducted at IDP Program site
No personal names and/or identifiers included
Three to four 45 minutes open ended individual interviews - digitally recorded
Final individual session with participating parents revising information from reviewed files
Two focus groups (before and after interviews)
Only parents participated in interviews and focus groups
Transcriptions: combination of verbatim and summaries (Quinn-Patton, 1999)
Post-data collection: Member-check in sessions to ensure integrity of transcribed interviews

39. Table 2. Interview of Parent Participation in the Focus Groups, Interview Sessions and File Revision Sessions*
Families
Focus Group 1
Interview
Session 1
Session 2
Interview Session 3
Interview Session 4
File Reviews
Session 2
0001 X M F
0002
0003
0004 FM
N/A
*F=Father; M= Mother; X= no attendance/participation; N/A= no session
◊ Only one family had both parents participating throughout interviews
◊ Focus groups attendance was limited due to unforeseen circumstances
◊ Focus Group 1 questions introduced before Interview 1 for 0002/0004

40. Data Analysis
◊ Data sources: File reviews; digitally recorded and transcribed interviews, focus groups, memos
◊ Mostly thematic content analysis to interpret the identified themes (Krippendorf, 2004)
◊ Ensuring integrity of study, through rigorous three-step process of:
Inter-coded reliability with 90% + agreement; inter-coding disagreement was reported and alternatives presented
Inter-coder audibility -- until themes, categories and subcategories established (Use of NVIVO software)
Second set of member-checks with participants confirming their agreement with identified themes and categories

41. Preliminary Findings: File Reviews ~ Information Fields
Referral source
Identified condition
Medical history
IDP intake
Wait time
Developmental status
IDP home visitation (frequency)
Therapy/ies
Other Programs (accessed)
Other Referrals
Other Services (provided)
Assessment
Transition
Discharge
Excerpts: Consultant’s comments
Family feedback:
Artifacts

42. Summary of Researchers’ Perceptions of Family Profiles
“Memos” added to information fields re:
◊ Family profile (memo)
◊ Level of family involvement with program, e.g. family 0001:
◊ Responses to reviews
◊ Unique connections between families and consultants, e.g., comments, artifacts, letters
◊ Memo summarizing
characteristics of consultant/
-family contact and relationship:
Family regularly involved with IDP consultant and Physiotherapy services ( once every 3-4 weeks)
Overwhelming number of medical-related information … 3 specialists; in-depth… assessment process: …screening and formal assessments. Complex process of referrals/ gathering documents for different programs & agencies –t… all in place; successful referrals/intakes

43. Preliminary Findings, Stage 1: File Reviews ~ Across families
◊ Age of referral to the IDP: by 6 months
◊ Referral sources: Pediatrician (2), Community Health Nurse (2)
◊ Wait-times before intake: under four months
◊ Home visits: monthly (IDP consultant, IDP physiotherapy consultant or both.
◊ Medical/developmental diagnosis by year 1; developmental delays: Moderate to severe level of intensity (All)
◊ Ongoing medical surveillance by a pediatrician (All)
◊ Additional complications or conditions - specialists, physio-, occupational, speech-language therapists (All)
◊ Other programs, e.g., Parent-Child Mother Goose (3)
◊ Designation: “special needs” designation by age three (special funding for support) (All)
◊ Referrals to: “Therapy” program; “3-12” Program after their discharge (3)
◊ Transition into an inclusive preschool/daycare setting (age 3)
◊ Family childcare support (1)

44. Interviews-Topic 1: Early experiences
Preliminary Conclusions Themes emerged through coded categories /subcategories
Interviews-Topic 1: Early experiences
“What are things you recall…e.g. at the time your child was referred to the IDP?
Early memories and experiences are difficult to recall – time span, emotional
Importance of referral to IDP – the value of home visitation, within a family centred model “comfort”, “flexible”, “safe”; the value of the information, access/availability of resources; consultant as an ally and an advocate for other referrals and services

45. Preliminary Conclusions Themes emerged through coded categories /subcategories
Interviews-Topics 2 & 3:
What were your experiences during each transition (to Preschool, to School )
Changing needs: As children grow and develop their disability remains, but the special needs change
Awareness of Special Needs: Child grows but does not become independent, parent MUST grow stronger, more, independent --an advocate
Multiple Roles: Perception he/she has to become Case Manager—on top of their family duties—as service providers move towards an agency-focused, therapy centred approach

46. How did you and your family cope with transitions and change?
Preliminary Conclusions Themes emerged through coded categories /subcategories cont. (2)
Interviews -Topic 4:
How did you and your family cope with transitions and change?
Stressors were mainly job related and financial and juggling with family logistics
Extended family/community network support was key
Role of IDP consultant: Central case manager providing help for access to programs and services; empowering parents: supporting parents to become advocates; providing information/knowledge translation to understand child’s needs and to understand system

47. Follow up: What are some of the most relevant issues for parents Common themes through interview topics, and across themes & categories:
Home based, family centred model appears to be preferred one – in contrast to centre-based and exclusively therapy and child focused
Relationship with consultant in home based services is a key feature for parents; e.g., Frequently coded terms that reflect participants’ values: (quotes) “trust”, “feeling comfortable”, and “friendship”, “wonderful”…
Inclusion and participation of siblings in home-visits and therapies are highly valued. Example of quote “… siblings are teachers too”

48. Follow up…(contd..)
Transitions from IDP to other centre-based programs appear to be hard on parents;
e.g. (quote) “Feeling you have been dropped” and “Wanting to be ‘hand held’ until the school years”
Parents suggest: a chart showing how system and services work
Hardest transition: from preschool to school
Lack of centralized case management; shortage of resources; insufficient contact with teachers/administrators
Key contact person: School Support Worker

49. Themes within participant families…
Values and belief: protecting the public health/education systems
Conflicts of interest: shortage of resources or difficulty matching professionals with child/family’s unique needs –hiring private practitioner (family 0001)
The value of network and support
Learning the difference of their child’s growth and development through the experiences and stories shared by other families re anticipating needs and resources (e.g. requiring a w (family 0002) wheelchair; different type of child minding arrangements)
The need to ally, to search for answers and to advocate
Recognizing that there is a “fight” to be fought every step of the way and that families need allies to overcome major barriers (family 0003)
Inclusion of all members above all
Listening to the needs of the family to have all members participate in each process and decision, recognizing their lifestyle and validating their complex needs –more valuable than any measurable (developmental) progress (family 0004)

50. Stage 2: Update Method and Procedures in Multiple Case Study (Winter 2007-2008)
Rationale: Gilliam, Meisels & Mayes (2005): The need for screening and surveillance for children who are “at-risk” for developmental disabilities, who do not have identifiable special needs by age 3; but who exhibit indicators of specific learning, behavioural, social-emotional, motor difficulties between ages 3 – 5 and who required some kind of special assistance in the Elementary years.

51. Stage 2: Update Method and Procedures in Multiple Case Study (Winter 2007-2008, cont.)
Purpose: To present a more comprehensive portrayal of the experiences of families receiving early intervention support in B.C.:
Participants: Targeted sample of two to three families
Representing families with children in the “grey area”
Children identified as “at-risk” for developmental delays shortly after birth (e.g. premature, very low-birth weight (< 1500 gr.)
Followed by the IDP of BC in the “monitoring” level of services (as opposed to home visitation) --discharged by age e.g. “Child caught up to norm”
Recruitment, Procedures, Data Collection and Proposed Data Analyses: Similar to Stage 1
Timeline: Study completion anticipated for August 2008

52. * List of References available upon request*
6. Concluding Thoughts
Significance of studies
Anticipated outcomes and benefits
Theory to Practice: The Social Inclusion for At-Risk Children and Families Project (SDPP)
* List of References available upon request*

53. “Social Inclusion for At-Risk Children and Their Families” Linking research to practice, to families and communities Social Development Partnership Program, Social Development Canada
A partnership between IDP of BC, The CHILD Project and HELP
At The University of British Columbia
SDPP TEAM: Hillel Goelman, Ph.D.,SDPP Project Director ◊ Clyde Hertzman, Ph.D, Director, HELP ◊ Dana Brynelsen, Provincial Advisor, IDP of BC ◊ Lara El-Khatib, Ph.D.,SDPP Project Coordinator, HELP ◊ Mari Pighini, Ph.D. Cand., SDPP, Research Coordinator, HELP ◊ Ginny Chu, SDPP Project Assistant, HELP
WHAT IS THE SDPP PROJECT? 1
PROJECT OBJECTIVES 1 4
DELIVERABLES COMPONENT: 6
To provide…
…the parents of developmentally at- risk infants and young children with information to better understand and address their concerns regarding their children’s developmental needs
… a model for a seamless continuum of services for at risk children and their families
…parents and professionals with centralized online and printed information about resources, as well as training (including online courses)
…service providers with key information to support them in better serving the children and families they work with
Deliverables follow Bronfenbrenner’s ecological framework (Bronfenbrenner 1976, 1989). Tools/ (questionnaires) organized as follows:
A micro system level addressing concerns about children’s development
Meso and exo system levels addressing the identification of barriers to social inclusion of at risk children and their families
Online/printed lists of resources addressing child development
concerns for parents and professionals, to be accessed by geographic area or developmental domain
A two-fold project set in BC’s Lower Mainland targeting the most vulnerable children and families –those who experience social exclusion in both “mainstream” and “special needs” contexts.
PROJECT GOAL 2
Timeline
Building community capacity and knowledge creation and dissemination, through a research and a deliverables component.
September-October 2007
Search/ review online resources for parents,
professionals and
community service providers
Develop a list
of relevant community
agencies and professionals
Develop
questionnaires addressing
concerns about young
children’s development
November-December 2007
Hold focus
groups with parents and professionals for input and feedback
Handouts and posters available throughout communities in BC’s Lower Mainland; e.g., local libraries, grocery stores, community centers/neighbourhood houses, day care centers, preschools and schools, among other places
January-February 2008
Further updating and dissemination of online tools and resources
Introduction of online courses and TV/video production
Design and production of the training and information dissemination component
March-April 2008
Project wrap-up
Project follow-up
Presentations/publication executive summaries
Proposal to expand project throughout BC
DESCRIPTION OF PROJECT 3 5 2
RESEARCH COMPONENT: PRELIMINARY FINDINGS 5
Research Component
1. Case Studies of the Infants and Families of the Infant Development Program of BC or (IDP Case Study):
1.1.Parents are expressing the need of a family-centred,
continuous, seamless system of early intervention services between birth and the early school years (K – 1)
1.2. Services should include screening, diagnostic and referral programs for at-risk children and their families
2. An Interdisciplinary Study of the Trajectories of At-Risk Infants and Children or “NICU”study:
2.1. At-risk children who were admitted to Level II/II NICU’s in BC continue to require additional medical attention over time, when compared to non-risk children (not admitted to NICU LevelII/III)
Two studies:
1. A series of case studies of the children and families of the IDP of BC, and,
2. A population-based study that will link the health and developmental trajectories of at- risk children
Deliverables Component
1. Information about resources and tools for parents and service providers in the Lower Mainland, and,
2. Training and dissemination of information
Poster template: Angela Jaramillo, The CHILD Project
Poster design: Lara El Khatib and Mari Pighini, SDPP, HELP
In consultation with Ellen Larcombe, GIS, HELP

54. Questions? Comments? Feedback?
Thank you!
Questions? Comments? Feedback?