using the aedc to - bsl catalogue

Using the AEDC to Change Children’s Chances

Brotherhood of St LaurenceOctober, 2015

Associate Professor Sharon GoldfeldPaediatrician and Research FellowCentre for Community Child Health, Royal Children's HospitalCo-Group Leader, Policy Equity and TranslationMurdoch Childrens Research Institutesharon.goldfeld@rch.org.au

To do list:

Crucial…

Must do…

Can wait…

In time…

Next week…

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Centre for Community Child Health

“A society that is good to children is one with the

smallest possible inequalities for children, with

the vast majority of them having the same

opportunities from birth for health, education, inclusion

and participation.”

(Stanley, Richardson & Prior, 2005)

Centre for Community Child Health

Overview

• Contextual drivers for change

• The importance of data

• What can data tell us about Australian children?

• What can we do to change children’s chances?

Contextual drivers: principles (levers) for change

• Equity

• Ecology

• Early intervention

• Early childhood

Equity

Inequity is the presence of systematic and potentially remediable differences among population groups defined socially, economically, or geographically

International Society for Equity in Health [ http://www.iseqh.org]

Venkatapuram S, Bell R, Marmot M: The right to sutures: social epidemiology, human rights, and

social justice. Health Hum Rights 2010, 12:3-16.

Innovative trials: ideas from the fieldAssociate Professor Sharon Goldfeld

Equality Equity

Social determinants

• “conditions in which people are born, grow, live, work, and age.”

• “social injustice is killing people on a grand scale”

World Health Organization. Closing the gap in a

generation: health equity through action on the social

determinants of health. World Health Organization;

2008.

Three overarching recommendations

1.Improve daily living conditions

2.Tackle the unequal distribution of power, money and resources

3.Measure and understand the problem and assess the impact of action

World Health Organization. Closing the gap in a

generation: health equity through action on the social

determinants of health. World Health Organization;

2008.

Targeting low-ses students v. targeting low performing students Source: Masters (2009) using PISA data

Targeting low-ses students v. targeting low performing students Source: Masters (2009) using PISA data

Ecology

Newacheck, PW, Rising, JP & Kim, SE 2006, ‘Children at risk for

special health care needs’, Pediatrics, vol. 118, pp. 334-342

Early intervention

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CUMULATIVE BENEFITS OF EARLY INTERVENTIONS

James J. Heckman (2013). Giving Kids a Fair Chance (A Strategy That

Works). Cambridge, Massachusetts: MIT Press.

In short, to foster individual success, greater equality of opportunity, a more dynamic economy, and a healthier society, we need a major shift in social policy toward early intervention, with later interventions designed to reinforce those early efforts.

Early childhood

Brain development

Centre for Community Child Health

Building strong foundations

Getting the foundations right is important –healthy brain development is a prerequisite

for future health and wellbeing.

Life course

Developmental health opportunity

Age

Economics of human capital

Return on investment in the early years

Reference: Cunha et. al., 2006.

Adversity

The Adverse Childhood Experiences (ACE) Study (N=17,000)

Abuse:

Emotional • Physical • Sexual

Neglect:

Emotional • Physical

Household Dysfunction:

Mother treated violently • Household substance abuse • Household mental illness • Parental separation or divorce • Incarcerated household member

Relationship of Childhood Abuse and Household

Dysfunction to Many of the Leading Causes of Death in

Adults. Felitti, Vincent J et al. American Journal of Preventive

Medicine , Volume 14 , Issue 4 , 245 - 258

If ACE score more than 4, then…

• Smoking x 2

• Alcoholism x 7

• Cancer x 2

• Heart disease x 2

• Ch. lung disease x 4

• Attempted suicide x12*

• I/V drug use (men) x 46*

* Compared to ACE score of 0

Importance of data

Recognition of the

problem

Identification of the

solution through

policy

Political imperative

Kingdon J. Agendas, Alternatives and Public Policies. 2nd ed. New

York: Harper Collins College Publishers, 1995

Creating sustainable policy

DATA

Keeping the policy

window open for children

No data, no problem – no problem, no action

What do the AEDC data tell us about children in Australia?

• adaptation of the Canadian Early Development Instrument

• 104 item questionnaire

• Items form scores on 5 domains• Physical health and development

• Social competence

• Emotional maturity

• Language and cognitive skills (school based)

• Communication skills and general knowledge

• Developmental vulnerability reported for each domain and for one or more and two or more domains

What is the AEDC?

National implementation:

• National data collection from 1 May to 31 July 2009 and 2012

• Data collected by teachers through a secure web based data entry system

• Schools provided with funding of 1 hour for teacher training and 30 minutes per completed checklist

• Data analysed and reported based on where children live

2012 snapshot of Australia’s children

Total = 289,973 children (96.5% of estimated population)

Developmentally vulnerable on one or more, or two or more domains

AEDI 2009-2012 results: domains

AEDI 2009-2012 results: states and territories

What can other data tell us about children?

Population distribution of inequalities

Antenatal

A Picture of Australia’s Children 2009

Preschool

School entry

AEDI Domain comparison – vulnerability by SEIFAN=261,000

Domain Vulnerability by SEIFA

4

6

8

10

12

14

Most

Disadvantaged

3 Least

disadvantaged

SEIFA

Pe

rce

nt

vu

lne

rab

le

Physical health and Wellbeing

Social Competance

Emotional Maturity

Language and Cognitive

Development

Communication Skills and General

Knowledge

Disadvantage begins early in life ….

NSW Vic Qld WA SA Tas ACT NT Aust

AEDI developmental scores of 5 year olds: Australia, 2009

Nationalmean

Indig Non-

Indig

Indig Non-

Indig

Indig Non-

Indig

Indig Non-

Indig

Indig Non-

Indig

Indig Non-

Indig

Indig Non-

Indig

Indig Non-

Indig

Indig Non-

Indig

50–100 %ile

25%ile

10%ile

25–50 %ile

NAPLAN

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69% of NT Indigenous

children score below

national minimum

standard

Secondary school

300

350

400

450

500

550

600

-2 -1.5 -1 -0.5 0 0.5 1 1.5 2

SocialAdvantagePISA Index of social background

Low

Rea

din

g lit

erac

yHigh

Finland

Germany

Canada

This gap is in the order of 3 years of schooling.

Steeper slope = less equitable results

Source: OECD (2001) Knowledge and skills for life, Appendix B1, Table 8.1, p.308

Social background & reading literacy (PISA 2000)

Australia

Geographic distribution of inequalities

Children living in very remote areas of Australia are more likely to be developmentally vulnerable

0

5

10

15

20

25

30

35

40

45

50

Very remote

Australia

Remote

Australia

Outer

regional

Australia

Inner

regional

Australia

Major cities

of Australia

Pe

r ce

nt

Developmentally vulnerable on one or

more domains

Developmentally vulnerable on two or

more domains

Geographic Location (ARIA+) AEDI 2009

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Centre for Community Child Health

Centre for Community Child Health

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What can we do to change children’s chances?

Centre for Community Child Health

How to make a difference

• More EQUITABLE use of universal health and education platforms

• High quality ECEC

• Strong home learning environments

• Supportive communities

More EQUITABLE use of universal health and education platforms

Locations of speech pathologists

Source: NHMRC CRE in Child Language, 2014

Source: NHMRC CRE in Child Language, 2014

H

E

Percent: AEDI Vulnerability by Indigenous and SEIFA (2009)

Red= Vulnerable on one or more domains

Blue = No vulnerability

Number: Vulnerability by Indigenous and SEIFA (AEDI 2009)

Red= Vulnerable on one or more domains

Blue = No vulnerability

Focusing solely on the most disadvantagedwill not reduce health inequalities sufficiently.To reduce the steepness of the socialgradient in health, actions must be universal,but with a scale and intensity that isproportionate to the level of disadvantage.We call this proportionate universalism.

Tiered system of universal service delivery

2-5%

10-15%

100%

High need

Low need

Targeted high

intensity

Universal low

Intensity

Tiered system of universal service delivery

2-5%

10-15%

100%

High need

Low need

Targeted high

intensity

Universal low

Intensity

Tiered system of universal service delivery

2-5%

10-15%

100%

High need

Low need

Targeted high

intensity

Universal low

Intensity

Tiered system of universal service delivery

2-5%

10-15%

100%

High need

Low need

Targeted high

intensity

Universal low

Intensity

A national sustained nurse home visiting trial to promote family wellbeing and child development

A research collaboration between the Australian Research Alliance for Children and Youth (ARACY), the Centre for Health Equity Training Research and Evaluation (CHETRE) and the Centre for Community Child Health (CCCH)

High quality ECEC

AEDI Results and preschool participation

31.9

25.523.5

20.3

16.2

28.6

22.320.5

17.7

14.5

39.1

34.3

32.2

29.1

24.1

.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

1 Most disadvantaged

2 3 4 5 Least Disadvantaged

Pe

r ce

nt

SEIFA IRSD Quintile

Developmentally vulnerable on one or more AEDI domain

All children

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

No preschool or kindergaren program

5

10

15

20

25

Attended preschool Did not attend preschool

Lowest 20% SES

Middle 60% SES

Highest 20% SES

Percent of children living in the top 20% of advantaged SES communities, middle 60% of SES communities, and bottom

20% of disadvantaged communities who are developmentally vulnerable on two or more AEDI domains.

Goldfeld, Sayers, O’Connor, O’Connor, Moore, Brinkman The relationship between early childhood education and care and children’s developmental

outcomes in Australia. (2013)

Equity and ECEC

Community and neighbourhood as a platform for change

Kids in Communities Study

KICS modelMeasuring community level factors that may be influencing children’s

development in 5 key domains or environments:

• Social capital environment

• Service environment

• Governance environment

• Physical environment

• Socio-demographic environment

State and federal government policiesState & federal government policies

Local Government

Community

Family

Child

Governance domain:Governance structures & policies

Service domain:Quantity, quality, access and coordination of services

Social domain:Social capital, neighbourhood, attachment, crime, trust, safety

Physical domain:Parks, public transport, road safety, housing

Governance domain:Citizen engagement

Socio-economic domain:Community SES

Kids in Communities Study

Goldfeld at al

Social Indicators, 2014

Project Partners:

Environments of influence

Domains/Environments

Key proposed indicator areas

Physical Parks, public transport, road safety, housing

Social Social capital, neighbourhood attachment, crime, trust, safety

Socio-economic Community SES, Community demographics

Service Quality, quantity, access, coordination

Governance Citizen engagement, governance structures and policies

State and federal government policiesState & federal government policies

Local Government

Community

Family

Child

Governance domain:Governance structures & policies

Service domain:Quantity, quality, access and coordination of services

Social domain:Social capital, neighbourhood, attachment, crime, trust, safety

Physical domain:Parks, public transport, road safety, housing

Governance domain:Citizen engagement

Socio-economic domain:Community SES

Kids in Communities Study

Goldfeld at al

Social Indicators, 2014

Service efficiency: the Blue Sky Project (Vic DET)

Equality of outcome is possible in Australia….

Two-year-old children on the ACIR who are fully immunised,

by selected population groups, 2011

Source:A Picture of Australia’s Children 2012Australian Childhood Immunisation Register,

Not everything that seems good…is good

Centre for Community Child Health

106

..but some things are!

‘It is the burden on good leadership to make the currently unthinkable thinkable, to question the obvious, to make the present systems unavailable as options for the future. The boundaries in our minds create fear about the consequences of crossing over to the undiscovered country. But the possibilities we really need do not lie on this side of our mental fences. Once crossed, these fences will look as foolish in retrospect as the beliefs of other times now often look to us.’

Don Berwick - 1998

Many things we need can wait, the child cannot. Now is the time his bones are being formed, his blood is being made, his mind is being developed. To him we cannot say tomorrow, his name is today.

Gabriela Mistral (1889-1957)

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www.rch.org.au/ccch

sharon.goldfeld@rch.org.au