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Reducing Health Inequality: Early Childhood Interventions to Improve School Readiness in Scotland Presenter: Dr Rosemary Geddes Career Development Fellow,

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Presentation on theme: "Reducing Health Inequality: Early Childhood Interventions to Improve School Readiness in Scotland Presenter: Dr Rosemary Geddes Career Development Fellow,"— Presentation transcript:

1 Reducing Health Inequality: Early Childhood Interventions to Improve School Readiness in Scotland Presenter: Dr Rosemary Geddes Career Development Fellow, MRC Human Genetics Unit, Scottish Collaboration for Public Health Research and Policy Contributors: Professor John Frank Director, Scottish Collaboration for Public Health Research and Policy Professor and Chair, Public Health Research and Policy, University of Edinburgh Sally Haw Senior Scientific Adviser, Scottish Collaboration for Public Health Research and Policy

2 WHAT IS THE PROBLEM?

3 UNICEF Children Well-being across the OECD

4 Inequalities in Health Outcomes and Risk Factors in Pregnancy, at Birth and Up to 3mths Risk Factors% Least Deprived % Most Deprived Relative Risk *Risk Difference Unplanned pregnancy Smoked in pregnancy Planned to bottle feed Never breast fed Health Outcome Low birth weight * Prevalence in most deprived divided by prevalence in least deprived Source: Bromley & Cunningham-Burley, 2010

5 Inequalities in Health up to 48 months Risk Factors% Least Deprived % Most Deprived Relative RiskRisk Difference Maternal smoking Eating habits--1.5 – Low physical activity Health Outcomes Fair/bad health 1+ since birth Behaviour to other children Language development Total difficulties (SDQ) Conduct Hyperactivity Source: Bromley & Cunningham-Burley, 2010

6 Source: Power C, Mathews S. Origins of health inequalities in a national population sample. Lancet 1997: 350:

7 Absolute range: Healthy life expectancy, Males – Scotland (Data not available 2003/04) Source: Scottish Government Health Analytical Services (2008) Long-term monitoring of health inequalities (updated in September, 2009, but very few changes in long-term trends)

8 Absolute range: Healthy life expectancy, Females Scotland (Data not available 2003/04) Source: Scottish Government Health Analytical Services (2008) Long-term monitoring of health inequalities

9 Education, Employment, Wealth & Health Source: Fairer Society, Healthy Lives. The Marmot Review.2010.

10 Scotland: Media reports December 2009 Fifth of Scots have poor literacy The BBC: Literacy report shows Russell there really is a crisis in education The Scotsman: Zero-tolerance approach to poor literacy needed, experts say The Herald: needed-experts-say needed-experts-say

11 Determinants of School Outcomes in Scotland – Why Schools Are Not to Blame While individuals may defy this trend, no school in a deprived area is able to record a similar level of success to that achieved by almost all schools in the most affluent areas.¹...but the gaps between them (schools) are far less important than differences between students. In Scotland, who you are is far more important than what school you attend.² 1.Literacy Commission. A Vision for Scotland: The Report and Final Recommendations of the Literacy Commission. Scottish Labour, December OECD. Quality and Equity of Schooling in Scotland. Paris: OECD, 2007.

12 WHAT DETERMINES THESE OUTCOMES?

13 `Sensitive periods in early brain development Vision High Low Years Habitual ways of responding Language Emotional control Conceptualization Peer social skills `Numbers Hearing Source: Graph developed by Council for Early Child Development (ref: Nash, 1997; Early Years Study, 1999; Shonkoff, 2000.) Pre-school yearsSchool years

14 Synaptic Density Source: Founders Network, slide Rethinking the Brain, Families and Work Institute, Rima Shore, At Birth6 Years Old14 Years Old

15 The gradient worsens Source: Fairer Society, Healthy Lives. The Marmot Review.2010.

16 Life Course Problems Related to Early Life 2 nd Decade 3 rd /4 th Decade 5 th /6 th Decade Old Age School Failure Teen Pregnancy Criminality Obesity Elevated Blood Pressure Depression Addictions Coronary Heart Disease Diabetes Premature Aging Memory Loss Source: Clyde Hertzman, Early Child Development: A powerful equalizer.

17 How can this be influenced?

18 WHAT WORKS?

19 Main findings of a rapid literature review Early childhood intervention programmes can help to reduce disadvantage due to social and environmental factors Improvements in all domains of child development, school achievement, delinquency & crime prevention, & life success Successful interventions utilize a mixed (centre & home-based), two-generation (child & parents) approach Greatest effects are seen in those at highest social risk High quality preschool can help to reduce disadvantage & can raise early language, pre-reading & maths skills with the most deprived children displaying the strongest gains Home learning environment of more importance for intellectual & social development than parental occupation, education or income Activities influence childrens cognitive development & can moderate, but not eradicate, effect of socio-demographic disadvantage Source: Geddes et al. Interventions for promoting early child development for health: an environmental scan with special reference to Scotland. April 2010.

20 Suggested mixed, two-generation approach to Universal Early Childhood Social-emotional & Cognitive Development based on evidence of promising interventions DeliveryPopulationCONTINUUM OF CARE Pregnancy0-12 months12-36 months months Highest risk of develop- mental and/or attachment disorder Medium risk Universal Children Enrichment of home environment e.g. Nurturing of holistic child development Childrens centres with use of multi- agency integrated services Full- or half-day child care at high quality child development centre (higher risk - higher number of hours up to a max. 30 hrs/wk) Enrichment of home environment Full-day* high quality preschool Enrichment of home environment Child training e.g. Incredible Years Specialist input as required Parent-Child Intensive midwifery support NFP Attachment-based interventions to improve parent sensitivity§ Intensive midwifery & home visiting support NFP Intensive home visiting support NFP Positive Parenting e.g. Triple P, Parents As Teachers Specialist input as required Parents Maternal education & literacy Parenting preparation Support for addictions Training to understand stages of child development & how to nurture Parenting/child management support e.g. Incredible Years More intensive support in accessing services, problem solving, adult education for high school completion, job/employment support, accessing benefits, addiction management etc Children Enrichment of home environment e.g. Nurturing of holistic child development Childrens centres Half-day preschool Parent-ChildPromotion of sensitive parenting with provision of support as needed Parents Support for behaviour change Antenatal care according to medical risk Support for breastfeeding initiation & maintenance Support in accessing services Problem solving techniques Adult education for high school completion, job/employment support Children Childrens centres e.g. drop-in centres, toy & book libraries Resources e.g. Bookstart# Enrichment of home environment Half-day preschool Parent-ChildAccess to information on positive, sensitive parenting Parents Standard antenatal care. Promotion of healthy diet, physical activity, breastfeeding & smoking cessation. Ready Steady Baby# Information on healthy child development Information on available child, parent & family services Core child health promotion programme with routine child development reviews SPECTRUM OF RISK Source: Scottish Collaboration for Public Health Research & Policy

21 Source: Seven things legislators need to know about school readiness. US State Early Childhood Policy Technical Assistance Network. March 2003.

22 Monitoring Data to monitor childrens development and functioning in the Scottish population, and the effectiveness of related programmes, are lacking. More early-stage measures are needed as well as better late-stage measures, which would require data linkage. Data need to be collated and analysed centrally to reveal patterns of unmet need in child development by geographic, ethnic and socioeconomic position.

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24 What is the EDI? The EDI is teacher-completed (20 minutes) checklist that assesses childrens school readiness when they enter school. It measures the outcomes of childrens pre- school (0-5 years) experiences as they influence their readiness to learn at school. As a result, the EDI is able to predict how children will do in primary school. The EDI is designed to be interpreted at the group level & does not provide diagnostic information on individual children.

25 What Does the EDI Measure?

26 1) Physical Health and Well-Being Physical readiness for school day - e.g., arriving to school hungry Physical independence - e.g., having well-coordinated movements Gross and fine motor skills - e.g., being able to manipulate objects

27 turity 2) Social Competence 3) Emotional Maturity Overall social competence - e.g., ability to get along with other children Responsibility and respect - e.g., accept responsibility for actions Approaches to learning - e.g., working independently Readiness to explore new things - e.g., eager to explore new items Pro-social and helping behaviour - e.g., helps other children in distress Anxious and fearful behaviour - e.g., appears unhappy or sad Aggressive behaviour - e.g., gets into physical fights Hyperactivity and inattention - e.g., is restless 3) Emotional Maturity

28 4) Language & Cognitive Development Basic literacy - e.g., able to write own name Interest in literacy/numeracy and memory - e.g., interested in games involving numbers Advanced literacy - e.g., able to read sentences Basic numeracy - e.g., able to count to 20

29 5) Communication Skills and General Knowledge (No subdomains) - Ability to clearly communicate ones own needs and understand others - Clear articulation - Active participation in story-telling (not necessarily with good grammar and syntax) - Interest in general knowledge about the world

30 Trajectories Established Early - Vulnerability on EDI and Grade 6 outcomes Percentage of Grade 6 students not meeting provincial standards in relation to number of vulnerabilities in Kindergarten (EDI) Source: TDSB, 2007 N of domains with low scores:

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34 International Early Development Instrument implementations

35 Translating School Readiness into Community Actions School readiness assessment provides communities with the opportunity to better understand how they can allocate resources & concentrate their efforts to work towards improving outcomes for children. The Early Years SOA is already set up for LAs to do this! EDI: brought stakeholders together; encouraged, established a forum for community mobilisation; developed & cemented inter-sectoral coalitions Numerous community initiatives resulted from the process – parenting programmes & resources; nutrition & dental interventions; literacy projects

36 Decrease in the % of vulnerable children as a result of improved ECD in Western Australia Year Floreat47.22%14.3% Wembley47.11% 11.8% AEDI

37 Useful websites & references Offord Centre for Child Studies Australian Early Development Index - click on AEDI British Columbia ECD mapping portal Hertzman C, Williams R. Making early childhood count. CMAJ Jan 6;180(1): Lloyd JEV, Hertzman C. From Kindergarten readiness to fourth-grade assessment: Longitudinal analysis with linked population data. Social Science & Medicine. 2009;68(1): Hertzman C. Tackling inequality: get them while theyre young. BMJ 2010; 340:346-8 Marmot M. Fair Society, Healthy Lives. London: University College London; Contact details:


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