The Design and Implementation of a ThreePhase Study of the Developmental Trajectories of AtRisk Chil

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The Design and Implementation of a Three-Phase
Study of the Developmental Trajectories of
At-Risk Children Dr. Hillel Goelman, Dr. Anne
Synnes, Dr. Jill Houbé, Dr. Anne Klassen, Mari
Pighini, Ph.D Student, Dr Sarka Lisonkova, The
Human Early Learning Partnership The University
of British Columbia Dana Brynelsen, Provincial
Advisor. The Infant Development Program of
British Columbia HELP Seminar July 5, 2007
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Background

• Children treated in Neonatal Intensive Care Units
  (NICUS) are at risk for developmental problems
  because of
• anomalies they are born with
• complications of treatments required in the
  newborn period
• effects of their newborn condition on their
  family/ environment
• and/or concomitant risk factors

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To date, there is a dearth of

• longitudinal research from birth to school years
  
• interdisciplinary research to provide the
  multiple perspectives needed to fully understand
  the childs development across various domains of
  development
• ecologically valid research on the social
  determinants of optimal child development

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Objectives of the study

• To better understand the health and developmental
  trajectories of a population of at-risk children
  from birth to age 9
• To better understand the social determinants that
  impact on the developmental health trajectories
  of a population of at-risk children from birth to
  age 9 and
• To conduct an interdisciplinary study of a
  population of at-risk infants that draws on the
  strengths and complementary perspectives of
  psychology, neonatology, and developmental
  pediatrics and population health

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Research Questions

• In comparing a cohort of at-risk children
  admitted to Level II/III NICUs with a matched
  comparison group of non-risk children
• What differences are there in the medical
  histories of the two cohorts?
• What differences are there in the educational
  progress of the two cohorts in their elementary
  school years in such areas as
• Receiving learning assistance services
• Scores on standardized outcome measures

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Phase 1

• To identify at-risk infants born in BC in 1996/7
  admitted to the BC Level II/III NICUs (Cohort 1)
  and a matched comparison group (Cohort 2) of
  non-risk infants born in BC in 1996/7 through the
  BC Linked Health Data Base (BCLHD).

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What data on these children are there in the
BCHLD?

• How many at-risk children were admitted to the
  Level II/III Neonatal Intensive Care Units in
  B.C.,
• the reasons for their referral, and
• the history of their medical treatments,
  intervention and assessments
• data on medical services that have been billed to
  and paid for by provincial health insurance
• Fields include visits to physicians (e.g.,
  chronic illnesses), hospitalizations and
  surgeries and Interventions, therapies (e.g.,
  physiotherapy, speech and language therapy)

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Percentage of non-NICU children vs. NICU Level II
and NICU Level III children with more than 2
hospital admissions in the first year of life
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Percentage of non-NICU children vs. NICU Level II
and NICU Level III children with more than 2
hospital admissions in the 2nd year of life
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Percentage of non-NICU children vs. NICU Level II
and NICU Level III children with more than 2
hospital admissions in the 3rd year of life
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Phase 2

• To link the health information on Cohort 1 and
  Cohort 2 obtained through the BCHLD in Phase I
  with their respective educational outcome
  measures in Grade 4 through Edudata Canada.
• Edudata Canada is a database which includes
  information on children in the public school
  system starting when the child enters
  kindergarten, usually at age 5.

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Linking the databases Edudata Canada

• Edudata Canada includes information on the
  childs developmental and academic progress, as
  well as demographics information, for example In
  Phase 2, these childrens anonymized Personal
  Health Numbers (PHNs) will be linked with their
  Permanent Education Numbers (PENs).
• This will enable us to obtain and compare
  anonymous and confidential records of educational
  achievement and status (for example, standardized
  test scores i.e., FSA scores special education
  designation and school support services, i.e.,
  the student being assigned with a special support
  worker, among others

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The Edudata Database
The BC Linked Health Database
The crosswalk linking the two data bases
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What are some answers we can find from BCHLD
/Edudata Canada crosswalk?

• The crosswalk will enable us to
• Link neonatal medical information on a given
  child with information on that childs school
  performance on standardized assessment measures
  in Grade 4, i.e., the Foundations Skills
  Assessment or FSA.
• Inferential and predictive statistical techniques
  will be used to identify the relative weight
  contributed by different social, economic, health
  and developmental variables to the school outcome
  variables from Edudata Canada

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Phase 3

• To identify and to link health information on
  specific sub-groups of at-risk children in BC who
  were admitted to the BC Level II/III NICUs and
  matched comparison groups.

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Research Team Members

• HELP/CHILD
• Dr Hillel Goelman
• Dr Clyde Hertzman
• Barry Forer
• Keely Kinar
• Mari Pighini
• Dr. William Warburton
• British Columbia Health Centre for Women and
  Children
• Dr Anne Synnes
• Dr Jill Houbé
• Dr Anne Klassen
• Herb WP Chan
• Dr Sarka Lisonkova
• edudataCanada
• Dr. Jennifer Lloyd
• Centre for Health Services Policies and Research
  (CHSPR)

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Thank You!