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Monitoring Early Child Development in Scotland

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Monitoring Early Child Development in Scotland Powered By Docstoc
					        Measuring the Impact of Interventions
       for Promoting Early Child Development:
           Early Development Instrument in
                       Scotland
Presenters:
Professor John Frank
Director, Scottish Collaboration for Public Health Research and Policy
Professor and Chair, Public Health Research and Policy, University of Edinburgh
Dr Rosemary Geddes
Career Development Fellow, MRC Human Genetics Unit, Scottish Collaboration for Public Health Research and
Policy
Co-Author:
Sally Haw
Senior Scientific Adviser, Scottish Collaboration for Public Health Research and Policy
Interventions for Promoting Early Child
  Development for Health (July 2010)*




                  *Downloadable at: www.scphrp.ac.uk
WHAT IS THE KEY PUBLIC HEALTH
  PROBLEM IN SCOTLAND?
      •Lifelong health and functional
  inequalities, by socio-economic status,
    that are NOT improving in Scotland

     •Dysfunctional bottom 10-20% of
   population: not competitive in global
 economy, and very costly to for the public
         purse to “carry,” lifelong
           Absolute range: Healthy life expectancy,
                Males – Scotland 1999- 2006
                                     (Data not available 2003/04)




Source: Scottish Government Health Analytical Services (2008) Long-term monitoring of health inequalities
                 (updated in September, 2009, but very few changes in long-term trends)
           Absolute range: Healthy life expectancy,
                Females Scotland 1999-2006
                                      (Data not available 2003/04)




Source: Scottish Government Health Analytical Services (2008) Long-term monitoring of health inequalities
Source: Power C, Mathews S. Origins of health inequalities in a national
population sample. Lancet 1997: 350:1584-89.
     Life-Course Health Problems Linked
     to Inadequate Early Life Nurturing

         2nd                                3rd/4th                           5th/6th
                                                                                                 Old Age
       Decade                               Decade                            Decade

• School Failure                      • Obesity                            • Coronary Heart   •Premature
                                                                             Disease           Aging
• Teen Pregnancy                      • Elevated Blood
                                        Pressure                           • Diabetes         • Memory Loss
• Criminality
                                      • Depression

                                      • Addictions
  Source: Clyde Hertzman, Early Child Development: A powerful equalizer.
WHAT DETERMINES THESE
     OUTCOMES?
 The cumulative effect of genetics, prenatal life,
and post-natal environmental factors – especially
love, skilled parenting, cognitive stimulation and
social role-modelling, in a positive society – most
  of which is strongly set in motion before age 5
     `Sensitive periods’ in early brain development

High              “Pre-school” years                          School years


                                                        `Numbers’
                                                             Peer social skills

                                           Conceptualization             Language
                                             Habitual ways of responding
                                               Emotional control
                                                      Vision
                                                         Hearing

 Low
       0        1         2          3         4          5          6         7
                                         Years
Graph developed by Council for Early Child Development (ref: Nash, 1997; Early Years
Study, 1999; Shonkoff, 2000.)
         The gradient worsens in usual
      education… because it starts too late.




Source: Fairer Society, Healthy Lives. The Marmot Review.2010.
Determinants of School Outcomes in Scotland –
       Why Schools Are Not to Blame

         • “While individuals may defy this trend, no school in a
           deprived area is able to record a similar level of
           success to that achieved by almost all schools in the
           most affluent areas.”¹
         • “...but the gaps between them (schools) are far less
           important than differences between students. In
           Scotland, who you are is far more important than
           what school you attend.”²

•   Literacy Commission. A Vision for Scotland: The Report and Final Recommendations of the Literacy Commission. Scottish Labour,
    December 2009. http://www.scottishlabour.org.uk/literacy
•   OECD. Quality and Equity of Schooling in Scotland. Paris: OECD, 2007.
                                                 Can we influence this?




Source: Sloat E, Willms JD. The International Adult Literacy Survey. Literacy Scores for Youth Aged 16-25 years (Statistics Canada & the OECD, 1995).
How can this be influenced?
            •Increase or redirect resources to early
            years
            •Detailed plans/strategies required for the
            implementation of the Early Years
            Framework. Central guidance based on
            scientific evidence is required in
            programme design, implementation &
            evaluation.
            •Early childhood development programmes
            to equitably address cognitive &
            behavioural development should be
            adopted.
            •Robust methods to identify pregnant
            women and infants at high social and
            developmental risk are necessary if
            targeted approaches are to be adopted.
            •Programmes should provide a seamless
            continuum of care and support from
            pregnancy through to school entry.
Source: SCPHRP
Environmental
Scan, July 2010,
page 62 –
downloadable at
www.scphrp.ac.uk
“No Data, No Problem, No Action”
                           Alfredo Solari

• Data to monitor children’s development and functioning in
  the Scottish population, and the effectiveness of related
  programmes, are lacking – every local area does its own thing.
• More early-stage measures are needed as well as better late-
  stage measures (e.g. mental health), which would require
  data linkage. These measures should span developmental
  milestone attainment via standardized assessments (collected
  in the primary health care system, and (ideally) by home
  visitors, Child Centre/nursery staff) with an overall “school
  readiness” assessment around school entry.
• All these data need to be collated and analysed centrally to
  reveal patterns of “unmet need” – for appropriate resource
  allocation -- in child development by geographic, ethnic and
  socioeconomic position.
What is the EDI?

• The EDI is teacher-completed (20 minutes)
  checklist that assesses children’s readiness
  to learn when they enter school.
• As a result, the EDI is able to predict how
  children will do in primary school.
• In other words, it measures the effects of all
  children’s pre-school (0-5 years) experiences
  as they influence readiness to learn at school
  – and thus assist communities to improve
  local pre-school programmes.
What Does the EDI Measure?
     A Population-Based Measure


• The EDI is designed to be
  interpreted at the group level.


• The EDI does not provide
  diagnostic information on
  individual children – schools
  do that already, but not
  community-level assessment
  to guide preschool action .
       What the maps reveal…
• Large local area differences in the proportion of
developmentally vulnerable children: typically 10% to 50 % range

• The high proportion of avoidable vulnerability – i.e. not
biologically predetermined, but rather preventable by improving
children’s home and community learning environments

• The degree to which socioeconomic context explains and does
not explain variations in early development: room for hope!

• Which communities are doing better or worse than predicted:
prompts the study of ‘why’ and learning between communities

• Change over time – so that community preschool programme
improvements can be evaluated
       Case study: Mirrabooka
    community, Western Australia
• Part of the Australian’s Government’s “Communities
  for Children (C4C)”
• First in Australia to have undertaken the AEDI four
  times (in 2003, 2004, 2008 and 2009)
• Community have been able to use their AEDI results
  to inform and implement change including
  supporting the planning of C4C
• Asset mapping exercise: positioning of community
  infrastructure – e.g. parks, libraries, playgroups, child
  health centres – compared to the AEDI results, to
  inform planning in relation to need
           Case study: Mirrabooka
        community, Western Australia
   • Planning and implementation of C4C initiatives:
     projects focussed on early literacy, child health,
     community networking, increasing the social
     cohesion between schools and communities through
     the implementation of programs such as FAST
     (Families and Schools Together), and programs
     which support home to school transition
   • Supporting applications for the funding of projects
     that helps address areas of vulnerability identified

Source: http://training.aedi.org.au/Secondary-Pages/About-the-video-case-
studies/Mirrabooka-Community-Western-Australia.aspx
   Asset Mapping         Perth East Metropolitan region, Proportion of children
   vulnerable on one or more domains




                                                          Prepared by: AEDI National Support Centre
East Metropolitan Perth, WA                               Source: AEDI Communities Data 2004/05
The AEDI community planning process
                                                   2. Assessing the local distribution of children’s
    1. Identifying areas of particular need         developmental vulnerability




        3. Community asset mapping                                                e.g. Mission Australia funds 3
                                                                                  year play group, language
                                                                                  program & mums group at
                                                                                  school




                                              4. Mobilising
                                                 community action
EDI pilot in Scotland led/funded by SCPHRP
               - main objectives
• Adapt Canadian EDI to Scottish context and school system
• Implement in at least one local authority: East Lothian 2011
• Link mean scores in each developmental domain to
  socioeconomic status
• Determine % ‘vulnerable’ children in each developmental
  domain, and overall
• Generate reports, present results to stakeholders in LA & to
  Scottish Government, using user-friendly charts & maps
• Validate results, if possible, against Durham Uni’s PIPS
• Provide data to Information Services Division for potential
  anonymous linking with routinely collected data such as
  maternal records and health visitor reports
        When, who, and how much?
2 phases:
Phase   Purpose              Who                 When       Cost

1       Test EDI tool for    20 P1 teachers* March          Funds for supply
        content, language,   will each        2011          teachers for ½ day
        acceptability        complete EDI for               training & full day
                             11 children                    to complete EDI
2       Implementation of    All P1 teachers     November Training during
        EDI to determine     will complete       2011     October in-service
        level of child       EDI for all their            day & teacher
        development in       P1 pupils                    time allocated for
        population                                        EDI completion

*4 teachers from each Musselburgh and Prestonpans; 3 teachers from each
Tranent, Haddington, North Berwick and Dunbar
            Proposed timelines
• 7-11 February: Education cluster meetings in East
  Lothian where 20 P1 teachers will be identified
• 28 Feb and 2 March: teacher training half days
• Mon 21 Feb: Parent information sheets are
  distributed
• Mon 7 March-Friday 18 March: 2 weeks for P1
  teachers to complete EDI tools for 11 children each
• 21 March for two weeks: ADS will do data entry
• 4 April: beginning of data analysis (Strathclyde) of
  220 EDI questionnaires & teacher demographics
            Proposed timelines
• 5 May: East Lothian Project Implementation Team
  would like 'initial feed-back' on the process
• Mid-October: Training for approximately 60 P1
  teachers
• Mid to end November: EDI completion for
  approximately 1200 P1 pupils
• December data entry
• Beginning January: Data analysis Strathclyde starts
  1200 EDI questionnaires
• Spring 2012: Results presented
  CONTACT & TRAINING DETAILS
Rosemary.geddes@hgu.mrc.ac.uk
Names of 20 nominated P1 teachers & their
  schools, cluster and an email address/contact
  details for the teacher sent to me by end of
  Friday 11 February.
Training:
Musselburgh - Monday 28 Feb 09h00-12h30
Haddington - Wednesday 2 March 09h00-12h30
      Useful websites & references
•  Scottish Collaboration for Public Health Research and Policy:
   www.scphrp.ac.uk
• Offord Centre for Child Studies
http://www.offordcentre.com/index.html
• Australian Early Development Index - click on AEDI
http://www.rch.org.au/ccch/index.cfm?doc_id=10556
• British Columbia ECD mapping portal
http://www.ecdportal.help.ubc.ca/archive/faq.htm
• Hertzman C, Williams R. Making early childhood count. CMAJ. 2009 Jan
   6;180(1):68-71.
• Lloyd JEV, Hertzman C. From Kindergarten readiness to fourth-grade
   assessment: Longitudinal analysis with linked population data. Social
   Science & Medicine. 2009;68(1):111-23.
• Hertzman C. Tackling inequality: get them while they’re young. BMJ
   2010; 340:346-8
• Marmot M. Fair Society, Healthy Lives. London: University College London;
   2010.

				
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