1. Early childhood development: understanding the evidence to inform parenting, early learning programs and access to services for Indigenous children

2. Seminar Agenda 9.00Tea/coffee available 9.15Introduction and welcome – Associate Professor Karen Martin, School of Education and Professional Studies, Griffith University 9.20Parenting in the early years: effectiveness of parenting support programs for Indigenous families — Dr Robyn Mildon, Director of Knowledge Exchange and Implementation, Parenting Research Centre 9.45Early learning programs that promote children’s developmental and educational outcomes — Associate Professor Sharon Goldfeld, Centre for Community Child Health, Royal Children’s Hospital and the Murdoch Children’s Research Institute 10.10Improving access to urban and regional early childhood services — Dr Daryl Higgins, Deputy Director (Research), Australian Institute of Family Studies 10.35Question and answer session 11.15Morning tea

3. Parenting in the early years: effectiveness of parenting support programs for Indigenous families Dr Robyn Mildon Director of Knowledge Exchange and Implementation Parenting Research Centre

4. Introduction Families play a critical role in their children’s development and learning. A large body of research provides strong evidence that parents, families and the home environment are the most influential forces in shaping children’s early learning. The responsiveness of parents and families and the manner in which parents talk with and teach their children are important determinants of children’s later wellbeing and development

5. Parenting Shonkoff & Phillips (2000:226) ‘Parenting’ used to ‘capture the focused and differentiated relationship that a young child has with the adult (or adults) who is (are) most emotionally invested in and consistently available to him or her’. They argue that who fulfils this role is far less important than the quality of the relationship she or he establishes with the child.

6. Support for parents in their parenting role has a different context for Indigenous communities. The responsibility for child rearing and teaching children has traditionally been through an extended family, kin and community and is seen as very much still tied to this cultural norm, even when families and children face isolation from their own Indigenous communities (SNAICC 2004).

7. Outline Examine what we know about programs for Australian Indigenous families that effectively support parenting in the early years. Present briefly on the evidence for parenting programs generally and then focus specifically on the evidence for such parenting programs in serving Indigenous families.

8. Programs to support parenting in the early years Programs that focus on supporting parenting in the early years aim to influence children’s, parents’ and/or families’ behaviours in order to reduce the risk or ameliorate the effect of less than optimal social and physical environments. These programs aim to not only prevent the development of future problems such as child abuse and neglect, emotional and behavioural problems, substance abuse and criminal behaviour, but also to promote the necessary conditions for a child’s healthy development in all areas.

9. There are a number of approaches to supporting parenting in the early years. Programs have been grouped according to their primary focus: parenting programs home visiting programs.

10. Parenting programs Parenting programs are typically focused, short-term interventions aimed at helping parents improve their relationship with their child and preventing or treating a range of problems including emotional and behavioural problems (Barlow & Parsons 2003). Parent programs are based on the premise that interventions that promote caring, consistent and positive parenting are central to creating safe and supportive environments for children (Sanders & Cann 2002).

11. Parenting programs the use of a standardised, manualised program or curriculum and are underpinned by a number of theoretical approaches the use of a range of techniques are often used in such programs including discussion, role play and practice of skills in the home (Barlow et al. 2011) are offered in a variety of settings such as clinics, community- based settings and in the home in a number of formats including groups and individual one-on-one programs.

12. Parenting programs A number of recent systematic reviews, published by the Cochrane Database of Systematic Reviews, suggest that parenting programs are: moderately effective in the short term in improving maternal psychosocial health (Barlow et al. 2002), and the emotional and behavioural adjustment of infants and toddlers (Barlow & Parsons 2003), and older children (Barlow & Stewart-Brown 2000) evidence to suggest that they are effective in improving outcomes for both teenage mothers and their children (Barlow et al. 2011). insufficient in reducing child abuse and neglect, however some evidence that they show promise improving some outcomes associated with child abuse and neglect such as poor parent-child interactions.

13. Parenting programs and Australian Indigenous families There is little information available regarding parenting education programs developed specifically for Indigenous families in Australia. Although many programs have been designed to improve Indigenous maternal and childhood health, most have not been rigorously evaluated for their effect on child health and wellbeing.

14. Rapid evidence assessment Of the 106 parenting programs identified in a recent Rapid Evidence Assessment (REA) of Australian evaluations of parenting programs, only 8 programs targeted Indigenous families, and only 1 of these was rated as Supported.

15. Parenting education for Indigenous families case study describing the development and evaluation of The Boomerangs Aboriginal Circle of Security Parenting Camp Program (Lee et al. 2010) adaptation of the evidence-based Group Triple P – Positive Parenting Program (Turner et al. 2007) adaptation of the evidence-based Exploring Together program as part of a preventive strategy in response to serious social problems affecting young Tiwi people, their parents and families (Robinson & Tyler 2008).

16. Home visiting programs Home visiting does not refer to a specific service, program or intervention, but refers to the manner in which a service, program or intervention is delivered (Gomby 2007; Higgins et al. 2006; Sweet & Applebaum 2004). Home visiting programs (HVP) may deliver various programs, supports and services; however, the common feature of these programs is that they are delivered to the family by a person visiting the home.

17. Home visiting programs A meta-analytic review of of 60 studies on HVP for young children conducted since 1965 in the USA (Sweet & Applebaum 2004) In general, home visiting was beneficial for young children compared to control groups, with children receiving HV having improved socioeconomic and cognitive outcomes frequency and potential for abuse was also reduced positive effect on parent factors such as parenting attitudes and behaviour changes were mostly small, indicating that the degree of positive change that occurs in families as a result of HVP may be modest.

18. Home visiting programs for Indigenous families Little information available regarding home visiting programs developed specifically for Indigenous families in Australia. Four articles on home visiting programs for Indigenous families: 1 review article 2 studies reporting on the use of a mainstream home visiting program that included Indigenous families as participants findings of 1 pilot study.

19. Herceg (2005) conducted a review of the evidence for home visiting programs for Indigenous mothers, babies and young children. No published studies were identified that reported on home visiting specifically for Indigenous families. However, two Australian studies that included Indigenous families as participants were identified.

20. Quinlivan and colleagues (2003) conducted a randomised, controlled trial in Western Australia with first-time teenage mothers. Thirty per cent of mothers who received the home visiting program and 18% of mothers in the control group were Indigenous. Mixed results.

21. In one of the most rigorous studies examining an Australian home visiting program, child health nurses in Brisbane were used as home visitors in a randomised, repeated measures trial of 181 families. Six per cent of participants in the intervention group and nine per cent of participants in the control group were Indigenous. (Armstrong et al. 1999).

22. The program consisted of weekly visits for the first 6 weeks after birth, fortnightly until 3 months of age, then monthly until the child was 12 months of age. A minimum of 18 home visits were provided to each family. At 6 weeks, the group participating in the home visiting program showed: a reduction in post natal depression scores improvements in the perception of their parenting role more positive parent–child interactions better quality of the home environment related to child development. However, results not maintained.

23. Sivak and colleagues (2008) Preliminary findings from a home visiting program for Indigenous families—the Family Home Visiting Program (FHVP)—being delivered by the Children, Youth and Women’s Health Service in SA. Families valued the cross ‐ cultural partnership of the FHVP nurses and Indigenous workers. The most important feature: qualities of the staff, including honesty, friendliness, warmth, non ‐ judgmental attitudes and listening skills, and the relationships they built with the families.

24. Evidence from home visiting programs for indigenous families in other countries Little international evidence exists regarding the effectiveness of home visiting programs for Indigenous families. 2 studies, conducted in the United States, have shown that a HV delivered to Indigenous families by Indigenous paraprofessionals demonstrates some effectiveness.

25. Evidence from home visiting programs for indigenous families in other countries Johns Hopkins Centre for American Indian Health in the US has conducted two separate trials of a HVP developed specifically for American Indian mothers. The primary aims of this program were to improve mothers’ childcare knowledge, skills and involvement. Delivered by paraprofessionals who were bilingual American Indian women with experience in tribal health and human services.

26. Results indicate that this program, delivered by Native American paraprofessionals to young Native American mothers, can improve childcare knowledge. Demonstrate that American Indian home visitors who are members of the local community and speak the native language can be engaged to deliver a home visiting program to young American Indian mothers. Unclear whether the program itself or the method of delivery limited findings of effectiveness.

27. Is a structured, manualized, evidence-based treatment protocol culturally competent and equivalently effective among American Indian Parents in Child Welfare? Chaffin et al. (2012)

28. Promising practices and recommendations for programs supporting parenting in the early years Use cultural consultants in conjunction with professional parent education facilitators and home visitors. Use long-term home visiting/community based programs rather than short-term programs. Focus on the needs of both the primary care giver and child.

29. Promote parenting and home visiting programs as being supportive to parents and families, and focus on family strengths within the program. Use structured program content while also responding flexibly to families. Programs must take into account the cultural norm in Aboriginal and Islander communities of extended family, relatives and community being involved in raising children.

30. Programs for Aboriginal families are likely to be more successful when there is community involvement. Strong focus on communication and relationship building. Focus on linking families with other services in the community. The use of mainstream programs may not be appropriate for Aboriginal communities.

31. Early learning programs that promote children’s developmental and educational outcomes Associate Professor Sharon Goldfeld Centre for Community Child Health, Royal Children's Hospital and the Murdoch Children’s Research Institute

32. Acknowledgements Linda J Harrison, Sharon Goldfeld, Eliza Metcalfe and Tim Moore

33. “A society that is good to children is one with the smallest possible inequalities for children, with the vast majority of them having the same opportunities from birth for health, education, inclusion and participation.” (Stanley, Richardson & Prior, 2005)

34. We know that the early years can predict later outcomes Children’s literacy and numeracy skills at age 4–5 are a good predictor of academic achievement in primary school. Social gradients in language and literacy, communication and socioemotional functioning emerge early and persist. The majority of Australian Indigenous children are developmentally on track on the AEDI domains, with the exception of language and cognitive skills.

35. Brain development

36. Building strong foundations Getting the foundations right is important – healthy brain development is a prerequisite for future health and wellbeing.

37. Brain development

38. Life course

41. Developmental health opportunity Age Current practice Ideal child-development trajectory At-risk child-development trajectory without intervention Opportunity

42. Economics of human capital

43. Return on investment in the early years Reference: Cunha et. al., 2006.

44. Impact of adversity early in life Hackman D, Farah M, Meaney M. Socio economic status and the brain: mechanistic insights from human and animal research. Neuroscience. Vol11 2010; 651-659

46. AEDI Results (2009): ATSI PhysicalSocialEmotionalLang/cogCommDV1DV2 POR ATSI2.92.62.24.72.93.13.4 95% CI2.8-3.12.5-2.72.1-2.44.5-4.82.7-3.03.0-3.33.2-3.5 Prevalence (%) ATSI-yes (12,416) 21.920.317.128.621.347.329.5 ATSI-no (248,731) 8.79.08.57.98.622.311.0

47. AEDI Results (2009): ATSI PhysicalSocialEmotionalLang/cogCommDV1DV2 POR ATSI2.92.62.24.72.93.13.4 95% CI2.8-3.12.5-2.72.1-2.44.5-4.82.7-3.03.0-3.33.2-3.5 Prevalence (%) ATSI-yes (12,416) 21.920.317.128.621.347.329.5 ATSI-no (248,731) 8.79.08.57.98.622.311.0

48. Disadvantage begins early in life ….

49. 69% of NT Indigenous children score below national minimum standard

50. We know that quality early years education programs can help to improve outcomes At-risk children benefit from attending high-quality education and care programs in the years before school. Evidence-based, well-attended, well-resourced early learning programs are a key contributor to good early childhood outcomes, especially programs that are supported by the community and provided by qualified educators. Helping families and communities to be supportive and effective in their roles in children’s lives is a key protective factor and a key component in high-quality, effective early years programs.

51. Pre-school compared to none enhances children’s development. The duration of attendance is important with an earlier start (between 2 and 3) being related to better intellectual development and improved independence, concentration and sociability. Full time attendance led to no better gains for children than part-time provision. Disadvantaged children (and those ‘at risk’ of SEN) in particular can benefit significantly from good quality pre-school experiences, especially if they attend centres that cater for a mixture of children from different social backgrounds. Key Findings over the Pre-School period: Attendance

52. The quality of the learning environment of the home (where parents are actively engaged in activities with children) promoted intellectual and social development in all children. Although parent’s social class and levels of education were related to child outcomes the quality of the home learning environment was more important. The home learning environment is only moderately associated with social class. What parents do is more important than who they are. Key Findings over the Pre-School period: Home learning environment

53. Abcedenarian Project

54. There are particular considerations for Indigenous children Indigenous children are less likely to attend an early childhood program than their non-Indigenous peers. Indigenous families want a culturally safe environment for their children in education and care programs. Indigenous families are more likely to use early learning programs that involve community partnerships, appropriate teacher training and support, and culturally relevant practice that values local Indigenous knowledge.

55. © Anne Hanning Kngwarreye

57. We know that children attending poor quality early learning programs show poorer outcomes at school entry Service delivery approaches that are too narrowly targeted can miss many of the children and families who need support. Programs that lack stability and continuity, and/or do not integrate families’ access to programs, reduce the potential benefits. Early learning programs that do not reflect the culture and knowledge of the Indigenous community are not seen as culturally safe and tend not to be used by families in that community.

58. Indigeneity by State & Territory (AEDI national sample - mean age 5 yr 7 mo) 4.5%1.1%6.7%6.5%3.8%4.8%2.5%40.5% % Indigenous 6.8%4.4%25.5%36.2%36.6%18.3%1.8%77.7% % LBOTE Silburn 2010

59. Percent: AEDI Vulnerability by Indigenous and SEIFA Red = Vulnerable on one or more domains Blue = No vulnerability

60. Number: AEDI Vulnerability by Indigenous and SEIFA Red= Vulnerable on one or more domains Blue = No vulnerability

61. Focusing solely on the most disadvantaged will not reduce health inequalities sufficiently. To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. We call this proportionate universalism.

62. Knowledge gaps and research opportunities There are limited publicly available national data on the attendance rates of children in early learning programs in the years before entering formal schooling. o Data on children in remote locations are particularly problematic. There is no Australian research that has examined: o the relative benefits of targeted and universal programs for early learning o the long-term effects of attending an early learning program through a cost-benefit analysis.

63. Knowledge gaps and research opportunities There have been no rigorous trials or evaluations of early childhood programs in Australia, particularly programs for Indigenous and at-risk children. There is limited Australian research on how to address the challenge of low use of early learning programs by Indigenous and disadvantaged families.

67. Two-year-old children on the ACIR who are fully immunised, by selected population groups, 2011 Source: Australian Childhood Immunisation Register, unpublished data.

68. Improving access to urban and regional early childhood services A research synthesis Dr Vicki-Ann Ware Presented by Dr Daryl Higgins Deputy Director (Research) Australian Institute of Family Studies

69. Disclaimer The Australian Institute of Family Studies (AIFS) is committed to the creation and dissemination of research-based information on family functioning and wellbeing. Views expressed here are those of individual authors and may not reflect those of the Australian Institute of Family Studies, the Australian Institute of Health and Welfare or the Australian Government.

70. Closing the Gap Clearinghouse About the Clearinghouse COAG Building blocks –Early childhood –Schooling –Health –Economic participation –Healthy homes –Safe communities –Governance and leadership What we do…

71. Provider level barriers Limited capacity for administration of government funds Limited coordination between service providers Disjointed services or regular staff turnover Lack of qualified local Indigenous staff Challenges in providing appropriate training Lack of cultural competence fear of tokenism Inappropriate venues Lack of flexibility

72. Background to study Importance of early childhood programs Estimates of Indigenous participation in early childhood programs Why the urban and regional focus?

73. What are early childhood programs? Health, welfare and education programs targeting children 0–8 years, and their families. Include: –kindergarten/preschool and transition to school programs –playgroups and toy libraries –child care and crèches –parent support groups and parenting skills classes –nutrition and other health promotion service –immunisation and health screening

74. What access is and is not… Four facets of accessible early childhood services: –Physically accessible –Affordability –Appropriateness –Acceptability Access ≠ engagement

75. Barriers to Indigenous access to early childhood programs 5 main types of barriers: –Individual –Provider –Program –Social and Neighbourhood –Cultural.

76. Individual level barriers Fear of removal of children Individual distress or dysfunction Poverty Lack of awareness of available services and/or their benefits Reluctance to be separated from children

77. Program level barriers Lack of cultural sensitivity resistance to services Evidentiary base for funding effective traditional approaches Short-term funding and programs Perceptions of barriers as insurmountable can become a barrier in itself

78. Social and neighbourhood level barriers Social stigma Limited access to transport Lack of understanding of the importance of early childhood services Past experiences and community-level distress resistance to services

79. Cultural barriers Lack of awareness and celebration of legitimate cultural differences Lack of consultation with local communities Lack incorporation of local Indigenous parenting styles into programs

80. Facilitators to improved access

81. Individual facilitators Provision of transport Locating services close to relevant community Low-cost or no-cost services Continuity of service with one agency from pre-pregnancy through to middle childhood

82. Provider level facilitators Advocates who can promote and foster support for a program Employ, train and retain Indigenous staff Culturally competent and secure services Flexibility

83. Program level facilitators Involve the Indigenous community in planning and delivering services Comprehensive services (one-stop-shop) Continuity of services Multiple entry points Choice between Indigenous-specific and mainstream services Utilise existing resources, services, and staff with relational networks

84. Social and neighbourhood facilitators Co-locate services with other existing services in the community Provide transport Provide childcare for parenting services

85. Cultural facilitators Train and employ Indigenous staff Cultural training for non-Indigenous staff Involve the community in planning and delivering services Involve Elders in early childhood education and health services Encourage extended kinship to get involved

86. Indigenous childrearing practices

87. To sum up: The concept of access Access is not engagement What works to improve access What doesn’t work

88. Acknowledgements This presentation is based on the following Clearinghouse publication: –Ware V 2012. Improving access to urban and regional early childhood services. Resource sheet no. 17. Produced for the Closing the Gap Clearinghouse. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. For Clearinghouse publications, see http://www.aihw.gov.au/closingthegap/ http://www.aihw.gov.au/closingthegap The Closing the Gap Clearinghouse is a Council of Australian Governments initiative jointly funded by all Australian governments. It is being delivered by the Australian Institute of Health and Welfare in collaboration with the Australian Institute of Family Studies.