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COUNCIL OF EDUCATIONAL FACILITY PLANNERS INTERNATIONAL CONFERENCE Melbourne, 30th May, 2008 THE IMPORTANCE OF THE EARLY YEARS AND BEYOND Tim Moore Centre.

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Presentation on theme: "COUNCIL OF EDUCATIONAL FACILITY PLANNERS INTERNATIONAL CONFERENCE Melbourne, 30th May, 2008 THE IMPORTANCE OF THE EARLY YEARS AND BEYOND Tim Moore Centre."— Presentation transcript:

1 COUNCIL OF EDUCATIONAL FACILITY PLANNERS INTERNATIONAL CONFERENCE Melbourne, 30th May, 2008 THE IMPORTANCE OF THE EARLY YEARS AND BEYOND Tim Moore Centre for Community Child Health Royal Childrens Hospital

2 OUTLINE Rationale for change Childrens health and developmental outcomes Importance of the early years Opportunities and challenges in making difference Implications for facility planners Conclusions

3 Changes in society Service delivery difficulties Worsening developmental outcomes New knowledge about child development Changes in families NEED TO CHANGE We need to reconfigure early childhood and family support services so as to achieve better outcomes for children, families and society New knowledge about early intervention

4 CHANGES IN SOCIETY

5 GLOBAL CHANGES Over the past few decades, there have been significant changes in developed nations throughout the world: Adoption of free market economic policies – the globalisation of commerce Concurrent rise in general prosperity – dramatic increases over the last few decades Reduction in government control over market and in government responsibility for provision of public services Fall in birth rates – an international phenomenon Increased movement of people between countries, leading to more diverse societies Globalisation of ideas and culture – world wide web

6 LOCAL CHANGES There have been significant changes in Australias demographic make-up: a drop in the birth rate – to 1.77 per woman (2.11 in indigenous women) which is below the replacement level a decrease in proportion of children in society - from 1:3 in 1977 to 1:4 in 2002 (but with a recent upturn) Children are less of a social priority – the care of the aged becomes more of a priority and takes up more and more of the public budget. (The old used to be the poorest group in society – now single parents with children are the poorest, followed by two- parent families with four or more children). Those who do not have (and do not intend to have) children may have less of an investment in the future (and therefore less of a concern about what happens to children)

7 LOCAL CHANGES (cont) Over the past 25 years, there have been dramatic changes in employment opportunities and conditions: a decline in mens participation in the labour market and in their employment, and an increase in womens participation and employment a large shift away from full-time and towards part-time work a rise in the proportion of workers who are employed as casuals a rise in long hours of work a fall in the proportion of the workforce employed in manufacturing (now down to 12%) and a rise in employment in service industries (now 75%) increased inequality in the distribution of pay – pay at the top end has risen faster than pay at the bottom, especially for men

8 LOCAL CHANGES (cont) Changes in the cost of housing as a proportion of income – Australia now has one of the highest rates in the developed world Changes in social mobility, with consequent weakening of the social infrastructure It should be noted that the Australian governments of all political persuasions have done (and continue to do) much to protect families from the adverse effects of these social and economic changes.

9 CHANGES IN FAMILIES

10 Families have become more varied in their structure, and more diverse culturally and ethnically: families are smaller (but houses are bigger) extended families are also smaller – there are fewer cousins, uncles and aunts childlessness is increasing – there are more people who neither have children nor intend to have children mothers age at first birth is increasing – from 25 in 1984 to 29 in 2004 more single parents – due principally to growth in the number of children born to mothers without a partner, rather than to divorce or separation more blended families more shared custody arrangements more same sex couple families

11 CHANGES IN FAMILIES (cont) These changes have important consequences: Children are growing up with fewer siblings, as well as smaller extended families Children see fewer examples of parenting as they grow up Because families have fewer children, parents are more intensely concerned about their welfare

12 CHANGES IN FAMILY CIRCUMSTANCES The circumstances in which families are raising young children have also changed: more parents are working more mothers with babies are working more parents are doing shift work and working non-standard hours more parents are working longer hours more families are jobless more children are being raised in poverty

13 THE IMPACT OF SOCIAL CHANGE Partial erosion of traditional family and neighbourhood support networks, due to factors such as increased family mobility and the search for affordable housing Increase in the number of parents whose own experiences of being parented were compromised, and who therefore have difficulty parenting their own children All these factors have contributed to an increase in the number of families with complex needs

14 THE IMPACT OF SOCIAL CHANGE (cont) These social changes have also contributed to an undermining of confidence among parents in their ability to raise their children well There is no longer a social consensus about the right way to bring up children, or even that there is a single right way Overall, parenting young children has become a more complex and more stressful business for many families

15 PROBLEMS IN MEETING CHILD AND FAMILY NEEDS VIA CURRENT SYSTEM

16 CHALLENGES CURRENTLY FACING SERVICES FOR CHILDREN AND FAMILIES The service system is having difficulty providing support to all families who are eligible Services cannot meet all the needs of families that they do serve - no single service is capable of meeting the complex needs of many families Families have difficulty finding out about and accessing the services they need Services are often not well integrated with one another and are therefore unable to provide cohesive support to families Services have difficulty tailoring their services to meet the diverse needs of families … cont.

17 CHALLENGES CURRENTLY FACING SERVICES FOR CHILDREN AND FAMILIES (cont) Services are typically focused on and/or funded on the basis of outputs rather than outcomes, and therefore tend to persist with service delivery methods that may not be optimally effective Se rvices are typically treatment-oriented rather than prevention- or promotion-focused, and therefore cannot respond promptly to emerging child and family needs The service system does not maintain continuous contact with families of young children during the early years Many families are isolated and lack supportive personal networks - extended family, friends or other families of young children The early childhood field is undervalued and underfunded, and has difficulty attracting and retaining staff

18 SYSTEMIC ISSUES IN PROVIDING SERVICES TO CHILDREN AND FAMILIES Government departments, research disciplines and service sectors tend to work in silos, despite there being strong arguments for greater service integration and a whole of government approach to service delivery Responsibility for provision of services to young children and their families is spread across three levels of government - federal, state, and local - with different planning processes and funding priorities Most specialist intervention services are already underfunded, and it is looking increasingly unlikely that they can ever be fully funded in their present forms

19 WORSENING DEVELOPMENTAL OUTCOMES

20 CONCERN ABOUT WORSENING DEVELOPMENTAL OUTCOMES Mental health - eg. depression, suicide, drug dependence Physical health - eg. asthma, obesity, diabetes, heart disease Academic achievement - eg. literacy levels, retention rates, educational outcomes Social adjustment - eg. employment, juvenile crime

21 CONCERN ABOUT WORSENING DEVELOPMENTAL OUTCOMES The rates of all these developmental outcomes have risen or are unacceptably high The developmental pathways that lead to each of these outcomes can be traced back to early childhood All the poor developmental outcomes identified have associated social and financial costs that cumulatively represent a considerable drain on societal resources These worsening outcomes represent an unintended consequences of other changes and policies which in other respects have been generally successful

22 Modernitys paradox A puzzling paradox confronts observers of modern society. We are witnesses to a dramatic expansion of market-based economies whose capacity for wealth generation is awesome in comparison to both the distant and the recent past. At the same time, there is a growing perception of substantial threats to the health and well-being of today's children and youth in the very societies that benefit most from this abundance. Keating and Hertzman (1999)

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24 WORSENING DEVELOPMENTAL OUTCOMES Stanley, Richardson and Prior (2005) Increasing proportions of our children and youth have complex diseases such as asthma, diabetes, overweight and obesity, intellectual disabilities, and particularly psychological problems such as depression / anxiety, suicide and eating disorders. There have been no improvements in the proportions of our children born prematurely or underweight, or in those diagnosed with physical disabilities such as cerebral palsy. … cont

25 WORSENING DEVELOPMENTAL OUTCOMES Stanley, Richardson and Prior (2005) There have been perceived dramatic increases in a range of behaviour problems such as attention deficit disorder and hyperactivity; dangerous activities such as substance abuse; and the high levels of teenage pregnancies. Trends in behavioural and learning outcomes in schools are challenging teachers, and education departments are voicing concern at the levels of social and other problems in schools and how these may affect educational achievement. … cont

26 WORSENING DEVELOPMENTAL OUTCOMES Stanley, Richardson and Prior (2005) Not all types of juvenile crime have increased, but the most aggressive ones certainly have, such as assault and rape. Child abuse and neglect is reported more than ever before, although it may be that the occurrence is not really increasing, but that it is more acceptable to report it. Whatever the case, child protection services everywhere are in a state of crisis

27 Over the course of the last 50 years, there have been tremendous improvements in the physical health of children and in the life expectancy of adults. It is chastening to realise that there have not been parallel improvements in psychological functioning or mental health …On the contrary, psychosocial disorders in young people have tended to increase in frequency over the last half century. Why has this been so? I would argue that this has to be an answerable question. If we had a proper understanding of why society has been so spectacularly successful in making things psychologically worse for children and young people, we might have a better idea as to how we can make things better in the future. Rutter (2002)

28 Measures of social well-being used to increase in parallel with wealth as countries got richer during the course of economic development. But now, although rich countries have continued to get richer, measures of well-being have ceased to rise, and some have even fallen back a little. Since the 1970s saw earlier, there has been no increase in average well-being despite rapid increases in wealth. Wilkinson (2005)

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30 THE IMPACT OF INEQUALITY Psychosocial factors affect health through the extent to which they cause frequent or recurrent stress. Chronic stress affects numerous physiological systems, including the cardiovascular and immune systems, increasing our vulnerability to a very wide range of diseases and health conditions. There are three psychosocial risk factors which play a major role in triggering biological stress responses: low social status, poor social affiliations, and early childhood experiences.

31 NEW RESEARCH FINDINGS ABOUT EARLY CHILD DEVELOPMENT, FAMILY FUNCTIONING AND COMMUNITY DEVELOPMENT

32 NEW RESEARCH ABOUT EARLY CHILD DEVELOPMENT: KEY AREAS The nature and significance of the early years The role and significance of relationships in child development The neurobiology of interpersonal relationships Cumulative impact of multiple risk and protective factors on child functioning The interplay between genes and environment

33 DEVELOPMENTAL PATHWAYS There are three ways in which exposure to both beneficial and adverse circumstances over the life course contribute to each persons unique life exposure trajectory, which will manifest as different expressions of health and well-being: Latency: There are relationships between an exposure at one point in the life course and the probability of health expressions years or decades later, irrespective of intervening experience. Cumulative: Cumulative refers to multiple exposures over the life course whose effects on health combine. Pathways: These represent dependent sequences of exposures in which exposure at one stage of the life course influences the probability of other exposures later in the life course. Hertzman and Power (2003)

34 LATENCY PATHWAYS There is a major paradigm shift taking place in science that while simple is profound. It states that the root of many diseases, including reproductive diseases and dysfunctions, will not be found by examination of disease onset or etiology hours, days, weeks, or even years prior to disease onset. The new paradigm suggests that susceptibility to disease is set in utero or neonatally as a result of the influences of nutrition and exposures to environmental stressors / toxicants. In utero nutrition and/or in utero or neonatal exposures to environmental toxicants alters susceptibility to disease later in life as a result of their ability to affect the programming of tissue function that occurs during development. Heindel (2007)

35 KEY FEATURES OF CHILD DEVELOPMENT Young children develop through their relationships with others – early relationships are formative and constitute a basic structure within which all meaningful development unfolds. Brains are built over time. Both brain architecture and developing abilities are built from the bottom up Simple neurological circuits and skills providing the scaffolding for more advanced circuits and skills over time. Children's emotional development is built into the architecture of their brains. Emotional development begins early in life, is a critical aspect of the development of overall brain architecture, and has enormous consequences over the course of a lifetime. … cont.

36 KEY FEATURES OF CHILD DEVELOPMENT (cont) The growth of self-regulation is a cornerstone of early childhood development that cuts across all domains of development. It underpins the subsequent development of emotional and social competences, as well as the mastery of academic tasks and general life skills. Early experiences can influence later health and developmental outcomes through a process of biological embedding. This is a process whereby experiences are programmed into the structure and functioning of biological and behavioral systems, and set the child on a developmental trajectory that becomes increasingly difficult to modify. … cont.

37 KEY FEATURES OF CHILD DEVELOPMENT (cont) Excessive stress disrupts the architecture of the developing brain. Toxic stress in early childhood is associated with persistent effects on the nervous system and stress hormone systems that can damage developing brain architecture and lead to lifelong problems in learning, behaviour, and both physical and mental health. Exposure to toxins prenatally or early in life can have a devastating and lifelong effect on the developing architecture of the brain. Exposures to many chemicals have much more severe consequences for embryos, foetuses, and young children, whose brains are still developing, than for adults.

38 CUMULATIVE PATHWAYS Human development is shaped by the ongoing interplay among sources of vulnerability or risk and sources of resilience or protection. Exposure to adverse conditions does not inevitably lead to poor outcomes, but does significantly increase the risk Children who are exposed to risk factors at an early age are more likely to experience problems in later life, while those exposed to protective factors are better equipped to deal with subsequent adverse experiences The earlier in life risk factors occur and the longer they are sustained the greater the risk of poor outcomes Risk and protective factors are multiplicative rather than additive in their effects

39 Strategies to improve school readiness trajectories (Halfon and McLearn, 2002)

40 Interplay of protective and stress processes and their influence on individual competence across the life span (Leadbeater, Schellenbach, Maton and Dodgen, 2004)

41 THE IMPACT OF RISK AND OPPORTUNITY FACTORS ON ADOLESCENT DEVELOPMENT Sameroff, Gutman and Peck (2003) analysed the results of a study of nearly 500 young adolescents (11-14 year olds) and their parents to determine the effects of multiple risk factors on the adolescents development and functioning. The risk variable studies were as follows:

42 RISK FACTORS AFFECTING ADOLESCENT DEVELOPMENT

43 IMPACT OF MULTIPLE RISK FACTORS ON THE FUNCTIONING OF YOUNG ADOLESCENTS Sameroff, Gutman and Peck (2003)

44 Dong et al (2004)

45 EARLY CHILD DEVELOPMENT (cont) Development is weakly determined – individual causal factors, whether genetic or environmental, rarely have a significant impact on development on their own Risk and protective factors are multiplicative rather than additive in their effects. Development is multiply determined, with both direct and indirect factors within and outside the child contributing to particular outcomes Thus, many different risk or protective factors can lead to any particular developmental outcome, and particular risk or protective factors can lead to many different developmental outcomes.

46 NEW RESEARCH ABOUT FAMILY AND COMMUNITY FUNCTIONING: KEY AREAS The relationship between parenting practices and child development Cumulative impact of multiple risk and protective factors on family functioning The importance of social support for parental and family functioning The prevalence of social gradient effects The role of social capital

47 DEVELOPMENTAL PLASTICITY – THE RELATIVE CONTRIBUTION OF EARLY AND LATER EXPERIENCES

48 WHAT ARE THE RELATIVE CONTRIBUTIONS OF EARLY AND LATER EXPERIENCES? There are two contrasting perspectives: The early years are critical for development and lay down patterns of behaviour and functioning that can have lifelong consequences Behaviour and functioning at any point in time are more strongly influenced by the immediate social and physical environment than by past experience

49 WHAT ARE THE RELATIVE CONTRIBUTIONS OF EARLY AND LATER EXPERIENCES? The early years are critical for development and lay down patterns of behaviour and functioning that can have lifelong consequences This is the prevailing wisdom and is behind the push to invest and intervene during the early years The early years last a lifetime. Although this statement can be dismissed as a truism, it is profoundly significant. There is now an impressive body of evidence, from a wide range of sources, demonstrating that early child development affects health, well-being and competence across the balance of the life course. (Hertzman, 2004)

50 WHAT ARE THE RELATIVE CONTRIBUTIONS OF EARLY AND LATER EXPERIENCES? Behaviour and functioning at any point in time are more strongly influenced by the immediate social and physical environment than by past experience Thus, developmental change is not gradual and continuous, earlier events are not precursors of later events, and the earliest events are not the most influential of all (Lewis, 1997). Instead, How people act is determined by their attempt to adapt to situations and problems as they find them Since real life environments are rarely stable over time, our lives are more characterized by zigs and zags than by some predetermined, connected, and linear pattern

51 WHAT ARE THE RELATIVE CONTRIBUTIONS OF EARLY AND LATER EXPERIENCES? Early behaviour and functioning are predictive of later behaviour and functioning to the extent that childrens social and physical environments remain unchanged. The link between early experience and later behaviour occurs because childrens environments tend not to change. We should be looking not only at the correlations between early and later behaviour / functioning, but also between early and later environments.

52 WHAT ARE THE RELATIVE CONTRIBUTIONS OF EARLY AND LATER EXPERIENCES? Childrens environments tend to remain unchanged because of feedback and feedforward loops that maintain established patterns of interactions between the child, family and community What this means is that it is difficult for children and families to extricate themselves from adverse circumstances – particularly when there are multiple risk or adverse factors in their lives. Current behaviour and functioning are the result of an interaction between learnings and patterns of behaviour arising from earlier environments and experiences, and the childs adaptation to the current environment.

53 NEW RESEARCH FINDINGS ABOUT EARLY INTERVENTION AND THE IMPORTANCE OF THE EARLY YEARS

54 EFFICACY OF EARLY INTERVENTION AND THE IMPORTANCE OF THE EARLY YEARS Long term effects of early childhood and early childhood intervention programs Cost effectiveness of early childhood and early childhood intervention programs The effectiveness of parenting interventions Benefits of investments in the early years

55 LONG TERM OUTCOMES High/Scope Perry Preschool Study - results at age 27 Schweinhart (2003) Males Females

56 Cunha, Heckman et al, 2006

57 Cost-benefit analysis and rate-of-return calculations have provided evidence that early childhood programs have the potential to save government money in the long run and produce benefits for society as a whole. The costs savings for government could be large enough to not only repay the initial costs of the program but also to possibly generate savings to government or society as a whole multiple times greater than the costs….. These findings moved early childhood policy from being strictly a social-service policy and philanthropic endeavor that might benefit only participating children and families to also be considered an economic-development strategy. Kilburn & Karoly (2008)

58 Changes in society Service delivery difficulties Worsening developmental outcomes New knowledge about child development Changes in families WHAT TO CHANGE More supportive communities Better interface between services and communities Better integrated service system New knowledge about early intervention

59 More supportive communities Better interface between services and communities Better integrated service system WHAT TO CHANGE To build rich and supportive social environments for families with young children To develop ways in which the service system is able to respond promptly and effectively to the emerging needs of young children and their families To build a well-coordinated and easily accessible system of services for young children and their families Improved health and developmental outcomes for young people AIMSLONG -TERM OUTCOMES

60 COMMUNITY PLATFORM SERVICE PLATFORM INTERFACE AIMS PROCESS SHORT-TERM OUTCOMES LONG-TERM OUTCOMES To build rich and supportive social environments for families with young children Mapping community social and cultural demographics Identifying individual and collective priorities of families Identifying and building on community strengths and resources Ensuring families of young children have multiple opportunities to meet Promoting family-friendly services and facilities A better informed and empowered community A community environment that is more supportive of families Stronger social support networks for families Fewer isolated or marginalised families To develop ways in which the service system is able to respond promptly and effectively to the emerging needs of young children and their families Engaging communities as partners in planning and monitoring services and resources Developing effective ways for parents and professionals to share their concerns, knowledge and expertise Training professionals in how to establish partnerships with families Training professionals in ways of helping families monitor their childrens development Training professionals in how to help families identify concerns about parenting and family functioning More effective communication between parents and professionals A service system that responds promptly to the emerging needs of young children and their families Earlier identification of children with developmental or health needs Provision of more effective interventions To build a well-coordinated and easily accessible system of services for young children and their families Mapping professional services Simplifying parental access to information and services Developing common service philosophies and protocols Promoting services based on evidence and best practice Promoting provision of high quality services Providing systematic training for professionals Developing innovative service models based on strong evidence and clear rationales Improved coordination and collaboration between services Improved capacity of services to address holistic needs of families Easier access to services Greater consistency of service delivery across the system Services reoriented to prevention and early intervention IMPROVED HEALTH AND DEVELOPMENTAL OUTCOMES FOR YOUNG PEOPLE

61 BUILDING INTEGRATED SERVICES

62 Effective solutions never come from separate programs or services tackling the problems in isolation from the surrounding community. They come from integrated, wraparound, linked efforts across a whole range of community agencies aimed at improving the quality of life and support. Halfon, 2005

63 FORMS OF COLLABORATION / INTEGRATION Policy (or whole-of-government) integration Regional and local planning integration Service delivery integration Teamwork integration All forms of collaboration are needed for successful collaboration and integration of services.

64 AIMS AND OUTCOMES Main aims for improved service integration: improved access for consumers, increased efficiency by achieving more from the use of limited resources, and enhanced effectiveness, resulting in enhanced outcomes for consumers and funders.

65 AIMS AND OUTCOMES (cont) Other aims include: Coordinated systems planning will make a more comprehensive set of services available There will be a better fit between consumers and community needs and the array of services made available because of more coordinated planning, information sharing, and pooling of agency funds Direct service workers will be more knowledgeable of the entire array of services available and become more capable in delivering a wide range of services NB. Integration of early childhood and family support services is a means to an end, not an end in itself – integration is a strategy to achieve improved outcomes for children and families.

66 EMERGING MODELS OF COLLABORATIVE PRACTICE AND INTEGRATED SERVICE DELIVERY Integrated childrens centres and hubs Integrated early years / school models

67 CHILDRENS CENTRES Sure Start Childrens Centres (UK) Toronto First Duty (Canada) CAFÉ Enfield (South Australia) DHS Childrens Centres (Victoria) BestChance (Victoria) Springvale Integrated Childrens Services Hub (Victoria)

68 SURE START CHILDRENS CENTRES Programs offered include: good quality early learning combined with full day care provision for children (minimum 10 hours a day, 5 days a week,48 weeks a year) good quality teacher input to lead the development of learning within the centre child and family health services, including ante-natal services parental outreach family support services a base for a childminder network support for children and parents with special needs, and effective links with Jobcentre Plus to support parents/carers who wish to consider training or employment.

69 DHS CHILDRENS CENTRES Programs provided: A range of early childhood services including kindergarten programs integrated with long day care and/or occasional care and specialist family services In addition, all facilities must have the capacity to provide at least two of the following specialist support services: counselling services parenting services psychological counselling services community health services including nutritionists, speech therapists family day care programs coordination family support services.

70 COEXISTENCECOOPERATIONCOORDINATIONCOLLABORATIONINTEGRATION Stand alone / autonomous Services operate independently, are located separately, and have no formal or informal links Services operate independently and are located separately, but meet to network and share information Services operate independently and are located separately, but coordinate to provide multi-agency services to families with multiple needs Services operate independently and are located separately, but collaborate to provide a multi-disciplinary / multi- agency service Services combine to form a single entity providing integrated interdisciplinary services but operating from a variety of locations Co-location Services operate independently and have no formal or informal links, but are co-located Services operate independently, but are co-located and meet to network and share information Services operate independently, but are co-located and coordinate to provide multi-agency services to families with multiple needs Services operate independently, but are co-located and collaborate to provide a multi-disciplinary / multi- agency service Services combine to form a single entity operating from a single location and providing integrated interdisciplinary centre-based services Outreach Services operate independently and are located separately, but coordinate to provide multi-agency outreach services to families with multiple needs Services operate independently and are located separately, but collaborate to provide a multi-disciplinary / multi- agency service Services combine to form a single entity and provide integrated interdisciplinary centre-based and outreach services SERVICE COORDINATION GRID

71 INTEGRATED EARLY YEARS-SCHOOL MODELS Full Service Extended Schools (UK) Toronto First Duty (Canada) Schools of the 21 st Century (USA) Coalition for Community Schools (USA) Elizabeth Learning Center (USA) Schools as Community Centres (NSW) Linking Schools and Early Years Project (Victoria)

72 KEY ACTIVITIES Child care Holiday care programs Opportunities for learning to whole family Parental guidance and support Integrated early years learning environment Provision of information about and referral to a range of specialist support servicesHealth education and direct health care services Networks and training for child care providers Core early learning framework The promotion of the use of school facilities by the community

73 MAINSTREAM AND SPECIALIST SERVICES: EXISTING SYSTEM TERTIARY SPECIALIST SERVICES SECONDARY SUPPORT SERVICES MAINSTREAM SERVICES Location: Specialist services are usually located separately Children / families have to go to where the specialist services are, rather than vice versa Referral arrangements: Children have to meet eligibility criteria There are more children needing support than the specialist services are able to accept This results in bottlenecks and some children not receiving help at all Information flow: Information tends to flow one way only – from the mainstream services to the specialist Collaboration between specialist and mainstream services is limited

74 MAINSTREAM AND SPECIALIST SERVICES: INTEGRATED SYSTEM Location: Specialist services have outreach bases co-located with mainstream services Specialist services provide at least some support in family and early childhood settings Referral arrangements: Specialist services work directly with some eligible children, and provide consultant support for all others Specialist services also provide consultant support to mainstream services on a broad range of child and family issues Information flow: Information flows both ways between mainstream and specialist services Specialist and mainstream service providers collaborate as equal partners MAINSTREAM SERVICES SECONDARY SUPPORT SERVICES TERTIARY SPECIALIST SERVICES

75 IMPLICATIONS FOR FACILITY PLANNERS

76 Facilities need to be flexible, catering for children of different ages and a constantly evolving range of child, family and community activities Facilities need to be inclusive, ie. built to cater for the needs of all children and families – following principles of universal design (www.design.ncsu.edu/cud)www.design.ncsu.edu/cud The process of designing facilities should be outcomes-based, ie. driven by the outcomes that are being sought rather than immediate needs of services The planning of facilities needs to be done in collaboration with the children, families, communities and services who will be using them Facilities should be family-friendly, easy to access and providing spaces and facilities for parents to mix with other parents and with professionals

77 CONCLUSIONS

78 The early years of life are profoundly important for subsequent development, and can have life-long effects for health, well-being and achievement Changing childrens developmental trajectories becomes increasingly difficult and expensive as they get older High-quality early childhood services and intervention programs are cost-effective and represent an essential investment in social infrastructure To improve outcomes for children and young people, we need communities that are more supportive, services that are better integrated, and more effective ways in which communities and service systems can communicate

79 DR. TIM MOORE Senior Research Fellow Centre for Community Child Health, Murdoch Childrens Research Institute, Royal Childrens Hospital, Flemington Road, Parkville, Victoria, Australia 3052 Phone: +61·3·9345 5040 Fax:+61·3·9345 5900 Email:tim.moore@mcri.edu.au Websites:www.rch.org.au/ccch www.ecconnections.com.au


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