early years health and development - improvement science works in populati…

Early Years Health and Development - Improvement Science works in Population and Public Health Mary Smillie

This Session is sponsored by:

Early Years Health and Development Improvement Science in Population and Public Health

Presentation and Discussion at Inspire Conference, April 10, 2013 Dr. Julie Kryzanowski, Saskatoon Health Region & Mary Smillie, Improvement Advisor

Needed to define a path forward

Need: Improve outcomes for 0 -5 year olds. Challenge: Time Opportunity: Child Health Report Interest: Improvement Science

Went looking for help

Health Promotion Manager Tanya Dunn-Pierce called Mary Smillie.

• Public Health

• Health Promotion

• Improvement Science

How could improvement science help?

• Leadership team

• Project team

• Content Consultants Engaged Leadership

Five Dedicated Staff plus Mary

3 Month Focus and Finish

DMAIC – define, measure and analyse

The Early Years Health and Development Project Team

Weekly Meetings As needed and twice as a group

Every two weeks Through PDSAs, focus groups, one to one meetings

http://www.youtube.com/watch?v=GbSp88PBe9E&feature=related

Video – Change the First Five Years and You Change Everything

Neighbour Discussion

• What do you think needs to be done to improve health and development outcomes for small children?

(5 minutes)

Health Inequities Exist Among Children

• Saskatoon Health Region

children generally healthy, but

• Many indicators revealed

health inequities by

neighbourhood and Registered Indian Status – Almost 25% of the children in

Saskatoon lived in areas of

highest deprivation

Early Years Report

Early Years Report

Socioeconomic Status

Ethnicity

• Birth rates of the RIS

population is up to three times higher than the non-

RIS population (33.4

compared to 12.3 in 2009)

• Higher rates of: – Preterm births (10.5% vs.

7.1%)

– Low and high birth weights

– Teen pregnancy (160.5 vs.

23.5 per 1,000)

– Vulnerable IHBQ score (70.3

vs. 27.7%)

Early Years Report

Readiness to Learn

Based on Early Development

Instrument (EDI)scores across

the five key domain areas:

• Physical health & well-being

• Social competence

• Emotional maturity

• Language & cognitive

development

• Communication skills &

general knowledge

Early Years Report

What we learned through the project:

A life course perspective Health trajectories are the pathways that individuals follow from a health perspective.

These pathways evolve over time, and the directions taken depend on individual actions, as well as the circumstances and conditions experienced throughout life.

Impacts of Poverty on Marginalized Groups

MCH Life Course Toolbox: www.citymatch.org/lifecoursetoolbox

Adverse experiences in childhood

Parents view of help available

Parents and CBOs

Many agencies with mandate for children

What we learned about Canadians

• So many programs exist to reduce isolation – single family dwellings

• Parents connect with each other through scheduled appointments – play dates

• Ideal community size is walkable, services and basic household commodities available

Dr. James Heckman

• Economist

• Nobel Laureate

• University of Chicago

http://www.heckmanequation.org/content/resource/why-early-investment-matters

Video – Why Early Investment Matters

The Heckman Equation

“One dollar spent in the early years is estimated to save between $3 and $9 in future spending on health, social and justice services.” Grunewald, R. & Rolnick, A. (2006), from The Chief Public Health Officer’s Report on The State of Public Health in Canada 2009

Neighbour discussion

• What to do?

• 5 min

Aim, Measures and Strategies

• Less than 18% EDI by 2018

• Measurement infrastructure

• 25 Recommendations

– Support parents

– Invest in early years

– Act as one system

Measures for Early Childhood

In-Hospital

Birth

Questionnaire

Early

Development

Instrument

Bookends of Early Childhood

Community Risk Indicators

What is the community like where children are growing up?

% teen

mothers

% low

birth

weights

% Social

Assistance

Program

recipients

% of housing

in need of

major repair

% of adults

with low

education

% lone

parents

Prenatal Birth Age 1 Age 3 Age 2 Age 4 Age 5 Age 6

Grade 1 –

Mandated

school

attendance

Kindergarten

Entry

RECOMMENDATIONS

Encourage and

Support Health

Sector Action

Develop and Implement a

Provincial Early Childhood Health

and Development Strategy

1. Agreement on a key goal = “18 by 18”

2. A focus on family needs

4. Commitment of targeted investments

5. Robust monitoring tools

1. Deliver family-centred,

accessible, integrated

services.

2. Bolster health promotion

and protection, illness and

injury prevention efforts

3. A holistic approach for improving the

health and development of First Nations

and Métis children

3. Work with partners to better

protect children from

environmental health risks

Learning from Quality Improvement

What worked well:

• Engaged leadership with questions

• Dedicated staff and dedicated time

• Focus and Finish

• Plan Do Study Act cycles

• Engaged parents and community agencies

• Mapping

• Compelling data

• Elegant design for learning

Even better if:

• More time prior to getting started

• More time to develop trust and relationships with First Nations and New Canadian parents

Much better when:

We achieve EDI scores less than 18% by 2018 When we set a new aim for EDI less than 10% and achieve it. A child born to any family anywhere in Saskatchewan has the same opportunity for success as the next child born.

Thank you!

For more information contact: Dr. Julie Kryzanowski julie.kryzanowski@saskatoonhealthregion.ca Or Mary Smillie msmillie@sasktel.net