1. AMCHP 2005 Conference Transition to Early Childhood Marie C. McCormick Harvard School of Public Health February, 2005

2. AMCHP 2005 Conference Pathways for Environmental Effects on Neurodevelopment Parental Processes

3. AMCHP 2005 Conference Pathways for Environmental Effects on Neurodevelopment Parental Processes –Parental physical and emotional health –Provision of stimulating experiences in the home –Parental sensitivity –Parental harshness

4. AMCHP 2005 Conference Model for Effect of Socioeconomic Factors Mat. Ed Earnings Financial Strain Depressive Sx Social Support Parenting Outcomes

5. AMCHP 2005 Conference Pathways for Environmental Effects on Neurodevelopment Parental Processes Neighborhood Processes

6. AMCHP 2005 Conference Neighborhood Processes Resources for Parents Relationships Norms or Collective Efficacy

7. AMCHP 2005 Conference Pathways for Environmental Effects on Neurodevelopment Parental Processes Neighborhood Processes Child Care Processes

8. AMCHP 2005 Conference The Infant Health and Development Program An Example of Child Care Processes

9. AMCHP 2005 Conference IHDP InterventionFollow-up Mediating Variables Child Outcomes Secondary Effects Intervening Variables Child Outcomes Secondary Effects PHASE1PHASE1 P H A S E 2-4

10. AMCHP 2005 Conference Study Enrollment Screened for Enrollment : 4551 Protocol Exclusions -3249 Eligible for Recruitment: 1302 Refused Consent -274 Randomized: 1028 Withdrawn: -43 Primary Analysis Group: 985

11. AMCHP 2005 Conference Reasons for Exclusion (n=3249)

12. AMCHP 2005 Conference IHDP 985LBW,PT Infants Intervention n=382 Follow-up n=623 Mediating Variables Child Outcomes Secondary Effects

13. AMCHP 2005 Conference IHDP Intervention FU Services Home Visits Child Dev. Ctr. Parent Supp.Grp. Follow-up FU Services Mediating Variables Child Outcome Secondary Effects

14. AMCHP 2005 Conference Content of IHDP Follow-up Services (Every 3-6 Months) Frequent Health and Developmental Surveillance Referral for Health and Social Services Home Visits (Every week until 12 mons.then every other week) Partners for Learning Curriculum Parent Problem Solving Social Support Child Developmental Centers (5 days/week, 8 hours/day, 12-36 months) Partners for Learning Parent Support Groups Parent Education Social Support

15. AMCHP 2005 Conference IHDP INT FU MED VARS Child Outcomes Cognitive Development (IQ) SE

16. AMCHP 2005 Conference Cognitive Outcomes of IHDP at Age 8-Total (SB=Stanford Binet, WPPSI=Weschler Preschool) p<0.05

17. AMCHP 2005 Conference Cognitive Outcomes of IHDP at Age BWT=2001-2500 (SB=Stanford Binet, WPPSI=Weschler Preschool) * * * *p<0.05

18. AMCHP 2005 Conference School Achievement Scores at Age 8 in IHDP p<0.05 T=Total,H=Bwt 2001-2500,L=BWT<=2000,rd=reading, ma=math

19. AMCHP 2005 Conference IHDP INT FU MED VARS Child Outcomes Behavior SE

20. AMCHP 2005 Conference Behavioral Outcomes of IHDP-Total Parental Report on the Achenbach * *p<0.05

21. AMCHP 2005 Conference IHDP INT FU MED VARS Child Outcomes Health Status SE

22. AMCHP 2005 Conference MEAN REPORTED MORBIDITY INDEX IHDP Intervention and Follow-up Groups, 36 months <=2000 g 2001-2500g Mean (S.D.) Reported Morbidity Index N.S.p<0.001

23. AMCHP 2005 Conference OTHER HEALTH STATUS MEASURES IHDP Intervention and Follow-up Groups, 36 months Measure Reported Serious Morbidity IndexNS Stein Functional Status ScaleNS GrowthNS LengthNS Body Mass IndexNS General Health Ratings ScaleNS

24. AMCHP 2005 Conference IHDP INT FU MED VARS Child Outcomes Secondary Effects Health Services Use

25. AMCHP 2005 Conference MEAN NUMBER OF DOCTOR VISITS IHDP Intervention and Follow-up Groups, 36 Months Mean (SD) of Doctors Visits <=2000g2001-2500g p=0.0 4

26. AMCHP 2005 Conference IHDP INT FU MED VARS Child Outcomes Secondary Effects Maternal Outcomes

27. AMCHP 2005 Conference CHILD AGE AT MATERNAL ENTRY INTO WORKFORCE IHDP Intervention and Follow-up Groups % Employed Child Age (mons.)

28. AMCHP 2005 Conference OTHER MATERNAL OUTCOMES IHDP Intervention and Follow-up Groups Subsequent Child-bearingNS Further Educational AttainmentNS

29. AMCHP 2005 Conference Early Intervention Modalities –Home visiting –Center-based Activities –Education/Developmental stimulation –Therapeutic (PT, OT, etc.) –Parenting skills to prevent abuse

30. AMCHP 2005 Conference Early Intervention Target Populations –Socially disadvantaged infants –Infants with identified neurodevelopmental disabilities –Low birth, premature infants.

31. AMCHP 2005 Conference Early Intervention for Disabled 53 Studies Criteria for Enrollment –<36 months of age –Principal problem was not poverty –Child in home/foster care Shonkoff, 1987

32. AMCHP 2005 Conference Summary of Meta-analysis Category of Disability #StudiesEffect (SD) All460.62 MR290.42 Dev. Delay200.70 Mixed240.94 Shonkoff, 1987

33. AMCHP 2005 Conference Perry Preschool Study: Economic effects at age 27 Source: http://www.highscope.org 7% 29% 36% 13% 41% 20%

34. AMCHP 2005 Conference Perry Preschool Study: Mean number of arrests by age 27 0.71.20.5 2.3 arrests 1.52.50.6 4.6 arrests

35. AMCHP 2005 Conference Abecedarian Project: Reading scores at 8, 12, 15, and 21 years by preschool group Note: Standardized reading scores as measured by the Woodcock-Johnson. Source: Campbell, Ramey, Pungello, Sparling, & Miller-Johnson, in press.

36. AMCHP 2005 Conference Abecedarian Project: Mathematics scores at 8, 12, 15, and 21 years by preschool group Note: Standardized mathematics scores as measured by the Woodcock-Johnson. Source: Campbell, Ramey, Pungello, Sparling, & Miller-Johnson, in press.

37. AMCHP 2005 Conference Conclusion Post-natal environment is a powerful predictor of child outcomes, for all children Evidence is increasing that early childhood interventions can improve outcomes for children at risk for a variety of reasons Intensive programs may have lasting effects