Measuring the Impact of Interventions for Promoting Early Child Development: Early Development Instrument in Scotland

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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

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Interventions for Promoting Early Child
Development for Health (July 2010)
Downloadable at www.scphrp.ac.uk
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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

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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)
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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
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Source Power C, Mathews S. Origins of health
inequalities in a national population sample.
Lancet 1997 3501584-89.
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Life-Course Health Problems Linked to Inadequate
Early Life Nurturing
2nd Decade
3rd/4th Decade
5th/6th Decade
Old Age

• School Failure
• Teen Pregnancy
• Criminality

• Obesity
• Elevated Blood
• Pressure
• Depression
• Addictions

• Coronary Heart
• Disease
• Diabetes

• Premature
• Aging
• Memory Loss

Source Clyde Hertzman, Early Child Development
A powerful equalizer.
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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

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Sensitive periods in early brain development
Pre-school years
School years
High
Numbers
Peer social skills
Conceptualization
Sensitivity
Language
Habitual ways of responding
Emotional control
Vision
Hearing
Low
1
2
3
7
6
5
4
0
Years
Graph developed by Council for Early Child
Development (ref Nash, 1997 Early Years Study,
1999 Shonkoff, 2000.)
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The gradient worsens in usual education because
it starts too late.
Source Fairer Society, Healthy Lives. The Marmot
Review.2010.
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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

1. 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
2. OECD. Quality and Equity of Schooling in
   Scotland. Paris OECD, 2007.

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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).
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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.

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Source SCPHRP Environmental Scan, July 2010,
page 62 downloadable at www.scphrp.ac.uk
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No Data, No Problem, No ActionAlfredo Solari

• Data to monitor childrens 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.

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What is the EDI?

• The EDI is teacher-completed (20 minutes)
  checklist that assesses childrens 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
  childrens pre-school (0-5 years) experiences as
  they influence readiness to learn at school and
  thus assist communities to improve local
  pre-school programmes.

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What Does the EDI Measure?
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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 .

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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 childrens 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

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Case study Mirrabooka community, Western
Australia

• Part of the Australians Governments
  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

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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-Pag
es/About-the-video-case-studies/Mirrabooka-Communi
ty-Western-Australia.aspx
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Asset Mapping Perth East Metropolitan region,
Proportion of children vulnerable on one or more
domains
Prepared by AEDI National Support Centre Source
AEDI Communities Data 2004/05
East Metropolitan Perth, WA
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The AEDI community planning process
2. Assessing the local distribution of
childrens developmental vulnerability
1. Identifying areas of particular need
e.g. Mission Australia funds 3 year play group,
language program mums group at school
3. Community asset mapping
4. Mobilising community action
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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
  Unis PIPS
• Provide data to Information Services Division for
  potential anonymous linking with routinely
  collected data such as maternal records and
  health visitor reports

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When, who, and how much?

• 2 phases

Phase Purpose Who When Cost
1 Test EDI tool for content, language, acceptability 20 P1 teachers will each complete EDI for 11 children March 2011 Funds for supply teachers for ½ day training full day to complete EDI
2 Implementation of EDI to determine level of child development in population All P1 teachers will complete EDI for all their P1 pupils November 2011 Training during October in-service day teacher time allocated for EDI completion
4 teachers from each Musselburgh and
Prestonpans 3 teachers from each Tranent,
Haddington, North Berwick and Dunbar
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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

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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

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CONTACT TRAINING DETAILS

• Rosemary.geddes_at_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

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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_id10556
• 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 6180(1)68-71.
• Lloyd JEV, Hertzman C. From Kindergarten
  readiness to fourth-grade assessment
  Longitudinal analysis with linked population
  data. Social Science Medicine.
  200968(1)111-23.
• Hertzman C. Tackling inequality get them while
  theyre young. BMJ 2010 340346-8
• Marmot M. Fair Society, Healthy Lives. London
  University College London 2010.