Presentation on theme: "Measuring the Impact of Interventions for Promoting Early Child Development: Early Development Instrument in Scotland Presenters: Professor John Frank."— Presentation transcript:
1 Measuring the Impact of Interventions for Promoting Early Child Development: Early Development Instrument in ScotlandPresenters:Professor John FrankDirector, Scottish Collaboration for Public Health Research and PolicyProfessor and Chair, Public Health Research and Policy, University of EdinburghDr Rosemary GeddesCareer Development Fellow, MRC Human Genetics Unit, Scottish Collaboration for Public Health Research and PolicyCo-Author:Sally HawSenior Scientific Adviser, Scottish Collaboration for Public Health Research and Policy
2 *Downloadable at: www.scphrp.ac.uk Interventions for Promoting Early Child Development for Health (July 2010)**Downloadable at:
3 WHAT IS THE KEY PUBLIC HEALTH PROBLEM IN SCOTLAND? Lifelong health and functional inequalities, by socio-economic status, that are NOT improving in ScotlandDysfunctional bottom 10-20% of population: not competitive in global economy, and very costly to for the public purse to “carry,” lifelong
4 Absolute range: Healthy life expectancy, Males – Scotland 1999- 2006 (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)
5 Absolute range: Healthy life expectancy, Females Scotland 1999-2006 (Data not available 2003/04) Source: Scottish Government Health Analytical Services (2008) Long-term monitoring of health inequalities
6 Source: Power C, Mathews S Source: Power C, Mathews S. Origins of health inequalities in a national population sample. Lancet 1997: 350:
7 Life-Course Health Problems Linked to Inadequate Early Life Nurturing 2nd Decade3rd/4th Decade5th/6thDecadeOld AgeSchool FailureTeen PregnancyCriminalityObesityElevated BloodPressureDepressionAddictionsCoronary HeartDiseaseDiabetesPrematureAgingMemory LossSource: Clyde Hertzman, Early Child Development: A powerful equalizer.
8 WHAT DETERMINES THESE OUTCOMES? The cumulative effect of genetics, prenatal life, and post-natal environmental factors – especially love, skilled parenting, cognitive stimulation and social role-modelling, in a positive society – most of which is strongly set in motion before age 5
9 `Sensitive periods’ in early brain development The Council for Early Child Development - Putting Science into Action for Children“Pre-school” yearsSchool yearsHigh`Numbers’Peer social skillsSensitivityConceptualizationLanguageHabitual ways of respondingEmotional controlChildren’s early experiences have far-reaching and solidifying effects on the development of their brains and behaviours. This diagram indicates the most sensitive periods of brain development, the foundation for cognitive learning, emotional and social skills, language and expression are laid before children in Canada begin formal schooling.We know there are critical periods of development. For example:Children born with cataracts who don’t have them removed shortly after birth will never have normal sight – the critical period for vision development will have been missed.Children born deaf will unlikely have the same language skills as a child who becomes deaf later in early childhood. The child born deaf will miss the sensitive period of language development.Children exposed to more than one language before the age of 7 months will be able to speak both languages as first languages and more easily acquire additional languages. We know that when we learn a second language later in life we learn it in the memory, rather than the language part of our brain. Our physiology will be unable to form certain sounds and we will likely always have an accent.Children who do not have regular contact with other young children before 4 years old will have underdeveloped social-emotional skills.Trajectories for children with developmental vulnerabilities can be changed but the major effort has to be made in the early years when neural systems are most plastic and compromises or constrictions are most readily overcome. Later interventions are more difficult and less effective.‘Sensitive periods’ in early brain development – this slide is based on the following references:Doherty, G. (1997). Zero to Six: the Basis for School Readiness. Applied Research Branch R-97-3E Ottawa: Human Resources Development Canada.McCain & Mustard (1999). Early Years Study. Toronto, Ontario: Publications Ontario.Shonkoff, Jack (Ed) (2000). From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington, D.C.: National Academy Press.VisionHearingLow1234567YearsGraph developed by Council for Early Child Development (ref: Nash, 1997; Early Years Study, 1999; Shonkoff, 2000.)Created: August 24, 2005
10 The gradient worsens in usual education… because it starts too late. Even those ‘optimally born’, if of low socio-economic status, will eventually underperform.Source: Fairer Society, Healthy Lives. The Marmot Review.2010.
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.”²Literacy Commission. A Vision for Scotland: The Report and Final Recommendations of the Literacy Commission. Scottish Labour, DecemberOECD. Quality and Equity of Schooling in Scotland. Paris: OECD, 2007.
12 Can we influence this?Source: Sloat E, Willms JD. The International Adult Literacy Survey. Literacy Scores for Youth Aged years (Statistics Canada & the OECD, 1995).
13 How can this be influenced? Increase or redirect resources to early yearsDetailed plans/strategies required for the implementation of the Early Years Framework. Central guidance based on scientific evidence is required in programme design, implementation & evaluation.Early childhood development programmes to equitably address cognitive & behavioural development should be adopted.Robust methods to identify pregnant women and infants at high social and developmental risk are necessary if targeted approaches are to be adopted.Programmes should provide a seamless continuum of care and support from pregnancy through to school entry.
14 Source: SCPHRP Environmental Scan, July 2010, page 62 – downloadable at www.scphrp.ac.uk
15 “No Data, No Problem, No Action” Alfredo Solari Data to monitor children’s development and functioning in the Scottish population, and the effectiveness of related programmes, are lacking – every local area does its own thing.More early-stage measures are needed as well as better late-stage measures (e.g. mental health), which would require data linkage. These measures should span developmental milestone attainment via standardized assessments (collected in the primary health care system, and (ideally) by home visitors, Child Centre/nursery staff) with an overall “school readiness” assessment around school entry.All these data need to be collated and analysed centrally to reveal patterns of “unmet need” – for appropriate resource allocation -- in child development by geographic, ethnic and socioeconomic position.
16 What is the EDI?The EDI is teacher-completed (20 minutes) checklist that assesses children’s readiness to learn when they enter school.As a result, the EDI is able to predict how children will do in primary school.In other words, it measures the effects of all children’s pre-school (0-5 years) experiences as they influence readiness to learn at school– and thus assist communities to improve local pre-school programmes.
18 A Population-Based Measure The EDI is designed to be interpreted at the group level.The EDI does not provide diagnostic information on individual children – schools do that already, but not community-level assessment to guide preschool action .
20 What the maps reveal…• Large local area differences in the proportion of developmentally vulnerable children: typically 10% to 50 % range• The high proportion of avoidable vulnerability – i.e. not biologically predetermined, but rather preventable by improving children’s home and community learning environmentsThe degree to which socioeconomic context explains and does not explain variations in early development: room for hope!Which communities are doing better or worse than predicted: prompts the study of ‘why’ and learning between communitiesChange over time – so that community preschool programme improvements can be evaluated
22 Case study: Mirrabooka community, Western Australia Part of the Australian’s Government’s “Communities for Children (C4C)”First in Australia to have undertaken the AEDI four times (in 2003, 2004, 2008 and 2009)Community have been able to use their AEDI results to inform and implement change including supporting the planning of C4CAsset mapping exercise: positioning of community infrastructure – e.g. parks, libraries, playgroups, child health centres – compared to the AEDI results, to inform planning in relation to needThe AEDI was completed in 2004 and The community have been able to use their AEDI results to inform and implement change including supporting the planning of the Australian Government’s Communities for Children initiative across the Mirrabooka region. The AEDI results have also supported and guided a number of initiatives in Mirrabooka including:An asset mapping exercise. This looked at where community infrastructure – such as parks, libraries, playgroups and child health centres – are placed compared to the AEDI results. In this way, planning can be better informed in relation to need.Planning and implementation of Communities for Children initiatives. These have included the Literacy Links project, which focuses on early literacy; and the Community Parks project, where the focus is on health and community networking.Collaborative working with schools to help increase scholarships, further support home to school transition programs as well as increasing the social cohesion between schools and communities through the implementation of programs such as FAST (Families and Schools Together).Supporting applications for the funding of projects that helps address areas of vulnerability identified.
23 Case study: Mirrabooka community, Western Australia Planning and implementation of C4C initiatives: projects focussed on early literacy, child health, community networking, increasing the social cohesion between schools and communities through the implementation of programs such as FAST (Families and Schools Together), and programs which support home to school transitionSupporting applications for the funding of projects that helps address areas of vulnerability identifiedSource:
24 Asset Mapping Perth East Metropolitan region, Proportion of children vulnerable on one or more domainsEast Metropolitan Perth, WAPrepared by: AEDI National Support CentreSource: AEDI Communities Data 2004/05
25 We can also map barriers to access or the actual access routes themselves. This map shows the bus routes in the area and is graduated from thin to heavier lines depending on the number of services along a particular route. This can help us when we plan for future programs or services. We can either locate them within easy access of public transport in communities that may have limited access to vehicles or you can request additional services from Transperth if your area has significant shortages.25
26 The AEDI community planning process 2. Assessing the local distribution of children’s developmental vulnerability1. Identifying areas of particular neede.g. Mission Australia funds 3 year play group, language program & mums group at school3. Community asset mapping4. Mobilising community action
28 EDI pilot in Scotland led/funded by SCPHRP - main objectives Adapt Canadian EDI to Scottish context and school systemImplement in at least one local authority: East Lothian 2011Link mean scores in each developmental domain to socioeconomic statusDetermine % ‘vulnerable’ children in each developmental domain, and overallGenerate reports, present results to stakeholders in LA & to Scottish Government, using user-friendly charts & mapsValidate results, if possible, against Durham Uni’s PIPSProvide data to Information Services Division for potential anonymous linking with routinely collected data such as maternal records and health visitor reports
29 When, who, and how much? 2 phases: Phase Purpose Who When Cost 1 Test EDI tool for content, language, acceptability20 P1 teachers* will each complete EDI for 11 childrenMarch 2011Funds for supply teachers for ½ day training & full day to complete EDI2Implementation of EDI to determine level of child development in populationAll P1 teachers will complete EDI for all their P1 pupilsNovember 2011Training during October in-service day & teacher time allocated for EDI completion*4 teachers from each Musselburgh and Prestonpans; 3 teachers from each Tranent, Haddington, North Berwick and Dunbar
30 Proposed timelines7-11 February: Education cluster meetings in East Lothian where 20 P1 teachers will be identified28 Feb and 2 March: teacher training half daysMon 21 Feb: Parent information sheets are distributedMon 7 March-Friday 18 March: 2 weeks for P1 teachers to complete EDI tools for 11 children each21 March for two weeks: ADS will do data entry4 April: beginning of data analysis (Strathclyde) of 220 EDI questionnaires & teacher demographics
31 Proposed timelines5 May: East Lothian Project Implementation Team would like 'initial feed-back' on the processMid-October: Training for approximately 60 P1 teachersMid to end November: EDI completion for approximately 1200 P1 pupilsDecember data entryBeginning January: Data analysis Strathclyde starts 1200 EDI questionnairesSpring 2012: Results presented
32 CONTACT & TRAINING DETAILS Names of 20 nominated P1 teachers & their schools, cluster and an address/contact details for the teacher sent to me by end of Friday 11 February. Training: Musselburgh - Monday 28 Feb 09h00-12h30 Haddington - Wednesday 2 March 09h00-12h30
33 Useful websites & references Scottish Collaboration for Public Health Research and Policy:Offord Centre for Child StudiesAustralian Early Development Index - click on AEDIBritish Columbia ECD mapping portalHertzman C, Williams R. Making early childhood count. CMAJ Jan 6;180(1):68-71.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 they’re young. BMJ 2010; 340:346-8Marmot M. Fair Society, Healthy Lives. London: University College London; 2010.