Transforming Global Maternal, Adolescent, and Child Health: From Research Evidence to Practice and Policy Assessing the Child in Developmental Context September 28, 2015 Durham, North Carolina Karen O’Donnell, Ph.D. Center for Child and Family Health Duke Global Health Initiative Center for Child and Family Policy Duke University Durham, North Carolina USA

TO-DO IN 7 MINUTES 1.Updating global approaches to maternal child health 2.Driving global efforts toward consistency with developmental theory 3.Adapting theory to practice in child assessment

HOW DO WE THINK ABOUT OUR CHILDREN LOCALLY AND GLOBALLY? Historically, children were seen as miniature adults then, There emerged arguments about nature versus nurture in child development then, given those theories We reformed society for the benefit of the child now, also We aim to reform the child for the benefit of society

CHILD DEVELOPMENTAL THEORY: FROM WHICH WE CONSTRUCT ASSESSMENTS There is a usual developmental sequence with multiple forces active: Maturation theory. Child and context: Effects are reciprocal The care a child receives affects his/her development. The child also affects the kind of care received. Child develops within a system, every aspect warrants attention and assessment: Developmental theory 4

GLOBAL PRACTICE CONSISTENT WITH DEVELOPMENTAL THEORY Many biological and environment factors contribute to youth outcomes. THE DIALECTIC AND THE TRANSACTIONAL 5

THE DEVELOPING CHILD FAMILY CONTEXT COMMUNITY CONTEXT ECONOMIC AND POLITICAL CONTEXT

POLITICAL, COMMUNITY, FAMILY CONTEXT CHILD BECOMES THE ADULT CHILD INTELLECTUAL DEVELOPMENT CHILD EMOTIONAL DEVELOPMENT

ASSESSMENT OF THE CHILD IN DEVELOPMENTAL CONTEXT MULTIPLE FACTORS

Measure Evaluation

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11 PEPFAR OVC Service DomainChild Status Index factor 1 – Food and Nutrition 1A. Food Security 1B. Nutrition & Growth 2 – Shelter and Care 2A. Shelter 2B. Care 3 – Protection 3A. Abuse and Exploitation 3B. Legal Protection 4 – Health 4A. Wellness 4B. Health Care Services 5 – Psychosocial 5A. Emotional Health 5B. Social Behavior 6 – Education and Skills Training 6A. Performance 6B. School and Work

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DOMAINS AND FACTORS: THE FAMILY SUPPORT MATRIX Health Care Support for a Safe Home 1. Maternal Health 1.Household Safety / 2. Infant Health Material Supports 3. Health Care Plans2. Parenting History 3. Family and Community Safety Caring for Infant Support for Parent(s) 1. Child Care Plans 1. Parent Well-Being 2. Parent-Child Relationship 2. Substance Abuse 3. Management of Infant Crying 3. Parent Emotional Support