What the research tells us The early years of a child s life are - - PowerPoint PPT Presentation

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What the research tells us The early years of a child s life are - - PowerPoint PPT Presentation

Mar 28, 2024 324 likes •782 views

What the research tells us The early years of a child s life are critical in impacting on a range of outcomes through the life course The environment experienced by a young child literally sculpts the brain and establishes the

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Centre for Community Child Health

What the research tells us

  • The early years of a child’s life are critical in

impacting on a range of outcomes through the life course

  • The environment experienced by a young child

literally sculpts the brain and establishes the trajectory for long term cognitive and social-emotional

  • utcomes
  • If we want to improve outcomes in adult life we have

to focus on the early years - this has profound implications for public policy

  • Investing in early childhood is a sound economic

investment (‘the best investment society can make’)

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Centre for Community Child Health

The neuroscience of brain development

  • Brain architecture and skills are built in a hierarchical

‘bottom-up’ sequence

  • Foundations important - higher level circuits are built
  • n lower level circuits
  • Skills beget skills - the development of higher order

skills is much more difficult if the lower level circuits are not wired properly

  • Plasticity of the brain decreases over time and brain

circuits stabilise, so it is much harder to alter later

  • It is biologically and economically more efficient to get

things right the first time

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‘Toxic’ stress

  • Strong and prolonged activation of body’s stress

response in absence of buffering protection of adult support

  • Precipitants include extreme poverty, physical or

emotional abuse, chronic neglect, severe maternal depression, substance abuse, family violence

  • Disrupts developing brain architecture and leads to lower

threshold of activation of stress management systems - can lead to life long problems in learning, behaviour, and both physical and mental health

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Centre for Community Child Health

  • Rapid social change - the world more challenging and complex -

conditions under which families are raising children have changed

  • Families who are relatively well-resourced are better able to meet

these challenges. However, poorly-resourced families can be

  • verwhelmed with challenges of daily life and parenting –

increased stress

  • Stresses in family functioning are cumulative: the more

advantaged families are initially, the better they are able to capitalise and build on the enhanced opportunities available, so that the gap between them and those unable to do so progressively widens

  • Increase in number of families with complex needs
  • More intergenerational disadvantage, underachievement and poor

health and developmental outcomes

Social climate change

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Stressful early environments…

  • Problems in childhood
  • Beginning of pathways to problems later in life
  • Evidence that many problems in adult life – including

mental health problems - have their origins in pathways that begin in childhood

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Centre for Community Child Health

Worrying problems in childhood

  • Child abuse and neglect
  • School readiness - many children vulnerable
  • Poor literacy and school achievement
  • Mental health problems - ADHD, conduct disorders,

aggressive and anti-social behaviour

  • Obesity
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Centre for Community Child Health

  • Mental health problems
  • Family violence and anti-social behaviour
  • Crime
  • Poor literacy
  • Chronic unemployment and welfare dependency
  • Substance abuse
  • Obesity
  • Cardiovascular disease
  • Diabetes

Adult problems with roots in early childhood

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Centre for Community Child Health

Early adversity

  • Leads to changes in DNA (methylation)
  • ‘Biological embedding of environmental events’

(Hertzmann)

  • Affects the development of biological systems
  • Immune
  • Cardiovascular
  • Metabolic regulatory
  • What appears to be a social situation is likely to be

a neurochemical situation

  • Helps to explain the intergenerational nature of

disadvantage and social exclusion

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Centre for Community Child Health

The impact of social inequality

  • Psychosocial factors impact on health because of

association with frequent/recurrent stress

  • Major impact in early years - affects developing brain

and establishment of neural circuits

  • Chronic stress affects the body’s physiological systems
  • including the cardiovascular and immune systems -

increasing vulnerability to wide range of diseases and health conditions

  • ‘Double jeopardy’ - have the least access to supports

such as consistent health care, quality childcare and preschool, good schools, and family supports

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Vocabulary growth - first 3 years

Vocabulary Age - Months 1200 600 12 16 20 24 28 32 36 High SES Middle SES Low SES

B Hart & T Risley Meaningful Differences in Everyday Experiences of Young American Children 1995

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Key Findings - 2012

Percentage of children developmentally vulnerable (DV) across Australia by jurisdiction

DV ≥ 1 domains (%) DV ≥ 2 domains (%) Australia 22.0 10.8 New South Wales 19.9 9.2 Victoria 19.5 9.5 Queensland 26.2 13.8 Western Australia 23.0 11.2 South Australia 23.7 12.2 Tasmania 21.5 10.1 Northern Territory 35.5 20.9 Australian Capital Territory 22.0 9.8

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Results: Socio-economic status

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Centre for Community Child Health

Disadvantage and preschool participation (‘double jeopardy’)

75.6 79.6 80.3 82.2 86.0 50 55 60 65 70 75 80 85 90 95 100 1 Most disadvantaged 2 3 4 5 Least Disadvantaged Per cent SEIFA IRSD QUINTILE

Preschool or kindergarten program (including in a day care centre)

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Centre for Community Child Health

So what are the answers?

  • ‘Different, rather than more.’
  • Need major shift in public policy, focusing not just
  • n treatment but also on prevention and early

intervention (fence on top of cliff rather than more ambulances at the bottom)

  • There is evidence from successful demonstration

programs that early intervention works - ie the research tells us how to build the fences

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Making a difference

  • Address risk factors and emerging difficulties before

they become entrenched problems

  • Goal is to diminish or remove risk factors and

strengthen protective factors, so improving chances

  • f good outcome
  • The earlier the better - more leverage in younger

years

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Intervention effects and costs of social-emotional mental health problems over time (Bricker)

Time High Low

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Centre for Community Child Health

Infrastructure of existing services

  • Child care
  • Family day care
  • GPs
  • MCH nurses
  • Preschool
  • School
  • Specialist services
  • Parenting programs
  • Neighbourhood houses
  • Family support
  • Telephone counselling
  • Family violence
  • Problem gambling
  • Child protection
  • Adoption/foster care
  • Mental health services
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Just because you have a service system in place does not mean that all families use it.

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Parenting programs Disability services Child health information Childcare Pediatrician Preschool Children’s library services Kindergarten School Family support Child protection agency

Early intervention programs

Fragmentation of services

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Parenting programs Disability services Child health information Childcare Pediatrician Preschool Children’s library services Kindergarten School Family support Child protection agency

Early intervention programs

Linking services

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Parenting programs Disability services Child health information Childcare Pediatrician Preschool Children’s library services Kindergarten School Family support Child protection agency

Early intervention programs

Child & Family Hub

Integrating services

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Centre for Community Child Health

A different approach

  • Population focus and place based approach
  • Strengthen capacity of universal services
  • Increased responsibility for communities
  • Engaging the community
  • Using data
  • Working with communities to implement change
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Centre for Community Child Health

Where are our investments today?

Population/ Community Individual Reactive Preventive

X

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Where our investments should be

Population/ Community Individual Reactive Preventive

X

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P O P U L A T I O N

Developmental risk

Low High

Effort is devoted to identifying and managing the high risk group

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P O P U L A T I O N

Developmental risk

Low High

Effort is devoted to reducing the risk amongst the entire population

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Centre for Community Child Health

A different approach

  • Population focus and place based approach
  • Strengthen capacity of universal services
  • Increased responsibility for communities
  • Engaging the community
  • Using data
  • Working with communities to implement change
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Centre for Community Child Health

MARI BYRNONG AEDI Com m unity, Victoria 5 km W est of Melbourne

Prepared by: AEDI National Support Centre, GI S Source: AEDI Com m unities Data 2 0 0 5

Proportion of children vulnerable on tw o or m ore dom ains

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Prepared by: AEDI National Support Centre, GI S Source: AEDI Com m unities Data 2 0 0 X

AEDI Com m unity Profile Sum m ary MARI BYRNONG Geographic Area, Victoria

5 km West of Melbourne CBD

Proportion of children developm entally Vulnerable ( % ) Average Scores ( 0 -1 0 )

Suburb No Phys Soc Em o Lang Com Vul 1 Vul 2 Phy s Soc Em o Lang Com Braybrook 103 21.1 18.9 18.9 23.2 41.1 52.6 34.7 8.00 7.08 7.12 8.46 5.63 Footscray 93 10.5 3.5 12.8 4.8 15.1

  • 26. 7

14.0 8.86 9.17 8.46 9.23 8.75 Footscray West 97 15.4 13.2 9.9 14.6 20.9 44.0 18.7 9.00 8.33 8.08 9.62 8.13 Kingsville 21 5.0 10.0 5.0 5.0 15.0 20.0 10.0 9.32 9.38 8.56 9.42 8.44 Maidstone 56 9.8 21.6 9.8 24.0 31.4 47.1 29.4 8.64 7.50 7.31 8.65 6.2 5 Maribyrnong 32 3.4 13.8 6.9 0.0 27.6 34.5 10.3 9.09 9.58 9.23 8.85 8.75 Seddon 39 2.6 5.1 2.6 10.3 5.1 15.4 5.1 10.00 9.79 9.42 10.00 10.00 Yarraville 139 2.9 8.1 3.7 4.5 11.8 19.1 5.9 9.55 9.17 8.82 10.00 9.38

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Centre for Community Child Health

Prevention

  • The idea of prevention is deeply ingrained in the

was many people think about their own lives, and the way parents think about their children’s lives - many examples - immunisation, children’s car seats and seat belts, bicycle helmets.

  • Proverbs
  • A stitch in time saves nine
  • An apple a day keeps the doctor away
  • Better safe than sorry
  • after Head BW, Redmond B. Aust Rev Pub Affairs 2011; 10: 5-22
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Centre for Community Child Health

‘If the science and the economics of prevention are highly persuasive to policymakers, why have not all governments taken great steps towards adopting the new paradigm?’

  • Head BW & Redmond G, 2011
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Why indeed?

  • Challenge of balancing treatment and prevention -

the old squeaky door (recurrent crises) gets the attention

  • Difficulty in framing the message
  • Complexity of message - causes and remedies
  • Long term benefits vs short term political cycles

and culture

  • Institutional complexity of comprehensive programs -

require complex joined up approaches at multiple levels (policies, programs, services, professionals)

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‘The challenges of applying these multidimensional models lie in their complexity…the numerous interactive influences on developmental outcomes underscores the futility of searching for simple solutions to complicated problems.’

  • Shonkoff, 2010
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‘For every complex problem there is an answer that is clear, simple, and wrong’.

  • H.L Mencken
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Time Cost per child/ family

Children’s Centres ‐ $443 for each 0‐5 year old Schools ‐ $7385 per pupil

Family Information Direct $50.10 per family via telephone helpline $2.90 per family via digital services Parenting Program $1331 ‐ $1479 per family Family Nurse Partnerships $4438 per family per year Family Intervention Projects $11,835 ‐ $29,586 per family per year Child looked after in foster care $36,983 per year Multidimensional /treatment Foster Care $103,552 per year Child looked after in children’s home $184,914 per year Child looked after in secure accommodation $198,228 per year Costs increase as children get older

Reference: Mike Powell C4EO Project Accountant (2010)

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CUMULATIVE BENEFITS OF EARLY INTERVENTIONS

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Rates of return to human development investment across all ages

6 8 4 2 Return per $ invested Age R 6

Pre- school School Post school

Pre-school programs School Job training

18

Pedro Carneiro, James Heckman, Human Capital Policy, 2003

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Age

Developmental health - Aims

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Conclusion

  • Promoting the healthy development of children is

both an ethical imperative and a critical economic and social investment

  • Our agenda for the 21st century has to be the

application of science to policy and practice - to close the gap between what we know and what we do

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Centre for Community Child Health

  • frank.oberklaid@rch.org.au
  • www.rch.org/ccch