Post on 13-Apr-2022
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
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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?
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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
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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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