1. Building partnerships and establishing linkages for early childhood intervention (ECI) Sub-Theme 3: Session 1 Wiedaad Slemming Division of Community Paediatrics University of the Witwatersrand National Early Childhood Development Conference 26-30 March 2012

2. Child survival, health and development Child development - the role of prevention and early childhood intervention (ECI) What does ECI have to do with ECD? Partnerships and linkages Gauteng experience Way forward Outline

3. Commitment to reduce child mortality by 2015 (Millennium Development Goal 4) 72 per 1000 live births in 200756 per 1000 live births in 2009/10 (Department of Health 2011; Unicef 2010). Latest data trends show a decline in the under 5 mortality rate from 72 per 1000 live births in 2007 to 56 per 1000 live births in 2009/10 (Department of Health 2011; Unicef 2010). 47 per 1000live birthsin 1990 40 per 1000 live births in 2009/10 (Department of Health 2011; Unicef 2010). Same trend can be seen with the infant mortality rate – from 47 per 1000 live births in 1990 to 40 per 1000 live births in 2009/10 (Department of Health 2011; Unicef 2010). Increased child survival – how do we optimise the chances for children to reach their full developmental potential ? Risk profile of SA’s children Child survival, health and development

4. Walker et al. 2007

5. 64% of South African children live in the poorest 40% of households (Hall 2010) 30-45% postnatal depression Several studies report that approximately 30-45% of our mothers present with postnatal depression (Cooper et al 2009; Madu and Roos 2006; Peltzer 2011) 1 in 5 stunted5% severely stunted Approximately 1 in 5 children are stunted and 5% are severely stunted (Labadarios 2007) Profile of children in SA only 46 (32.6%) were presently receiving therapy In a situational analysis of children with disabilities in Orange Farm (Saloojee et al 2007) – 141/156 children would have benefited from rehabilitation; only 46 (32.6%) were presently receiving therapy About 1 out of every 10 babies born alive weigh less than 2,500g (low birth weight) (Berry and Hendricks 2009) maternal depression and impaired growth Significant association between maternal depression and impaired growth (underweight and stunting) and child behavioural problems (Avan et al 2010; Surkin et al 2011). Stunting developmental delay impaired cognitive function the strongest predictor of child mortality Stunting is associated with developmental delay and impaired cognitive function and is considered the strongest predictor of child mortality in children younger than five years

6. Prevention and Early Childhood Intervention ?

8. Includes efforts to control the underlying cause or condition that results in disability, e.g. immunisation; Tetanus toxoid/ Calcium during pregnancy Primary prevention aims at preventing an existing illness or injury from progressing to long- term disability, e.g. newborn hearing screening Secondary prevention refers to specialised measures to mitigate the effects and improve outcomes once a disability is established, e.g. appropriate rehabilitation services Tertiary prevention

9. Early intervention for child development ‘Coming between’ any negative effects that exposure to particular risk factor/s (e.g. poverty, low birth weight, family stress etc.), a developmental delay or disability might have on a child’s development Early Childhood Intervention Early Developmental Intervention Early Childhood Intervention or Early Developmental Intervention

10. multidisciplinary services birth to five years multidisciplinary services provided to children from birth to five years of age promotechild health and well-being, to promote child health and well-being, enhance emerging competencies, enhance emerging competencies, minimise developmental delays, minimise developmental delays, remediate existing emerging disabilities, remediate existing or emerging disabilities, prevent functional deterioration, prevent functional deterioration, and promote adaptive parenting and family functioning and promote adaptive parenting and overall family functioning. Handbook of Early Childhood Intervention – Shonkoff and Meisels (2000) multidisciplinary services birth to five years multidisciplinary services provided to children from birth to five years of age promotechild health and well-being, to promote child health and well-being, enhance emerging competencies, enhance emerging competencies, minimise developmental delays, minimise developmental delays, remediate existing emerging disabilities, remediate existing or emerging disabilities, prevent functional deterioration, prevent functional deterioration, and promote adaptive parenting and family functioning and promote adaptive parenting and overall family functioning. Handbook of Early Childhood Intervention – Shonkoff and Meisels (2000) ECI consists of…

11. The literature on ECI are dichotomized on the basis of program participants: children judged at risk for poor developmental outcomes children with identified developmental disabilities or delays children judged at risk for poor developmental outcomes versus children with identified developmental disabilities or delays. at-risk populations preventive interventions known problems treatment programs The programs targeted for at-risk populations often are conceptualized as preventive interventions, whereas those serving children with known problems are considered treatment programs. (S. L. Ramey & Ramey 1992) The literature on ECI are dichotomized on the basis of program participants: children judged at risk for poor developmental outcomes children with identified developmental disabilities or delays children judged at risk for poor developmental outcomes versus children with identified developmental disabilities or delays. at-risk populations preventive interventions known problems treatment programs The programs targeted for at-risk populations often are conceptualized as preventive interventions, whereas those serving children with known problems are considered treatment programs. (S. L. Ramey & Ramey 1992)

12. ECI and ECD Early child development (ECD ) Early childhood intervention (ECI)

13. Treatment programs (for children with additional needs, i.e. established difficulties/ disabilities) Current ECD programmes in SA (target most vulnerable) ~ overlap NB: Early detection / identification, referral, intervention and follow- up for e.g. newborn hearing screening; ELBW; premature babies Primary focus of early intervention at present (international perspective) Available to all children with established developmental difficulties or disabilities but primarily targets 0-3 years (international perspective); Gauteng ~ school entry. Recognition that there should be a stronger focus on maternal health and family strengthening interventions for all ‘at risk’ Targeted prevention for at risk/vulnerable children and families

14. Linkages and Partnerships

17. Continuum of care approach 1.

18. 2. Continuum of care approach

19. Child and Family-Centred Care Information- sharing/ education Partnership Strengths- based Empowerment Shared decision making Respect

21. Gauteng experience Motivation: Motivation: -Children identified and referred late; fragmented services; varied access and quality in service delivery Formed provincial task team in 2010 – initiated by Gauteng Health Directorate: Rehabilitation/ Specialised Services Objectives: Objectives: -Raise profile of ECI in the province -Link with relevant partners in the field of early child development, education, social development and other health directorates -Improve co-ordination and standardisation of ECI service delivery in Gauteng at all levels of care -To develop a provincial ECI strategy to inform practice

22. Stronger ECI emphasis Stronger ECI emphasis in policy and programming at all levels Basic package of care Basic package of care for ECI Alternate ways of working Inclusion Standardised Standardised protocols and referral processes Linkages and partnership working Linkages and partnership working with other sectors Multidisciplinary team (MDT) working Prevention vs treatment Caregiver/ family community-based interventions involvement Caregiver/ family and community-based interventions and involvement ECI workshop ECI indaba

23. Progress Gauteng Office of the Premier Increased participation from various stakeholders – academia, NGO, Gauteng ECDI, education, social development, health promotion Health promotion material aimed at caregivers Basic package of care in development Biannual provincial workshops for all relevant health professionals Monitoring and evaluation

24. Way forward Develop provincial ECI strategy and framework for service delivery Establishing consensus around different models of working; referral systems; guidelines; increased preventative focus; parent/ caregiver involvement Intersectoral collaboration/ developing linkages with other sectors, e.g. ECD (training and ‘nodes’ for outreach); education (inclusion) etc. Improve multidisciplinary practice at all levels of care

25. Thank you Contact details: Wiedaad.Slemming@wits.ac.za Tel. 011 481 5196