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
Interventions for Promoting Early Child
Development for Health (July 2010)*
*Downloadable at: www.scphrp.ac.uk
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
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)
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
Source: Power C, Mathews S. Origins of health inequalities in a national
population sample. Lancet 1997: 350:1584-89.
Life-Course Health Problems Linked
to Inadequate Early Life Nurturing
2nd
Decade
3rd/4th
Decade
• School Failure
• Obesity
• Teen Pregnancy
• Elevated Blood
Pressure
• Criminality
• Depression
• Addictions
Source: Clyde Hertzman, Early Child Development: A powerful equalizer.
5th/6th
Decade
Old Age
• Coronary Heart
Disease
•Premature
Aging
• Diabetes
• Memory Loss
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
`Sensitive periods’ in early brain development
“Pre-school” years
High
School years
`Numbers’
Peer social skills
Conceptualization
Language
Habitual ways of responding
Emotional control
Vision
Hearing
Low
0
1
2
3
4
Years
5
6
7
Graph developed by Council for Early Child Development (ref: Nash, 1997; Early Years
Study, 1999; Shonkoff, 2000.)
The gradient worsens in usual
education… because it starts too late.
Source: Fairer Society, Healthy Lives. The Marmot Review.2010.
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.
2.
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
OECD. Quality and Equity of Schooling in Scotland. Paris: OECD, 2007.
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).
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.
Source: SCPHRP
Environmental
Scan, July 2010,
page 62 –
downloadable at
www.scphrp.ac.uk
“No Data, No Problem, No Action”
Alfredo Solari
• Data to monitor children’s 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 latestage 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.
What is the EDI?
• The EDI is teacher-completed (20 minutes)
checklist that assesses children’s 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
children’s pre-school (0-5 years) experiences
as they influence readiness to learn at
school– and thus assist communities to
improve local pre-school programmes.
What Does the EDI Measure?
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 .
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
children’s 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
Case study: Mirrabooka
community, Western Australia
• Part of the Australian’s Government’s “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
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-Pages/About-the-video-casestudies/Mirrabooka-Community-Western-Australia.aspx
Asset Mapping
Perth East Metropolitan region, Proportion of children
vulnerable on one or more domains
Muchea
Muchea
Bullsbrook
Bullsbrook
Proportion of children vulnerable
N=Percent
34.4 to 63.9
24.5 to 34.3
18.5 to 24.4
10.5 to 18.4
0 to 10.4
Gidgegannup
Gidgegannup
The
The Vines
Vines
Upper
Upper Swan
Swan
Belhus
Belhus
Ellenbrook
Ellenbrook
Darch
Darch
Henley
Henley Brook
Brook
Alexander
Alexander Heights
Heights
Marangaroo
Marangaroo
Ballajura
Ballajura
Girrawheen
Girrawheen
Koondoola
Koondoola
Balga
Balga
Mirrabooka
Mirrabooka
Westminster
Westminster
Herne
Herne Hill
Hill
Beechboro
Beechboro
Morley
Morley
Mount
Mount Hawthorn
Hawthorn
North
North Perth
Perth
Stoneville
Stoneville
West
West Swan
Swan
Middle
Middle Swan
Swan
Jane
Jane Brook
Brook
Stratton
Stratton
Caversham
Caversham
Lockridge
Swan View
View
Lockridge
Midland
Midland Swan
Eden
Eden Hill
Hill Woodbridge
Woodbridge
Greenmount
Greenmount
Guildford
Guildford
South
South Guildford
Guildford
Helena
Helena Valley
Valley
Parkerville
Parkerville
Chidlow
Chidlow
Mount
Mount Helena
Helena
Hovea
Hovea
Mahogany
Mahogany Creek
Creek
Glen
Glen Forrest
Forrest Mundaring
Mundaring
Darlington
Darlington
Sawyers
Sawyers Valley
Valley
Highgate
Highgate
East Metropolitan Perth, WA
Prepared by: AEDI National Support Centre
Source: AEDI Communities Data 2004/05
The AEDI community planning process
1. Identifying areas of particular need
2. Assessing the local distribution of children’s
developmental vulnerability
e.g. Mission Australia funds 3
year play group, language
program & mums group at
school
3. Community asset mapping
4. Mobilising
community action
Mirrabooka C4C - Change in AEDI Results from 2003-2009
60
Proportion of Children Vulnerable
50
40
Phys
30
Soc
Emot
Lang
Comm
20
Low 1+
10
0
2003 (n=538)
2004 (n=354)
2008 (n=228)
Year
2009 (n=589)
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 Uni’s PIPS
• Provide data to Information Services Division for potential
anonymous linking with routinely collected data such as
maternal records and health visitor reports
When, who, and how much?
2 phases:
Phase Purpose
Who
When
1
Test EDI tool for
content, language,
acceptability
20 P1 teachers* March
will each
2011
complete EDI for
11 children
2
Implementation of
EDI to determine
level of child
development in
population
All P1 teachers
will complete
EDI for all their
P1 pupils
Cost
Funds for supply
teachers for ½ day
training & full day
to complete EDI
November Training during
2011
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
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
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
CONTACT & TRAINING DETAILS
Rosemary.geddes@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
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_id=10556
• 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
6;180(1):68-71.
• Lloyd JEV, Hertzman C. From Kindergarten readiness to fourth-grade
assessment: Longitudinal analysis with linked population data. Social
Science & Medicine. 2009;68(1):111-23.
• Hertzman C. Tackling inequality: get them while they’re young. BMJ
2010; 340:346-8
• Marmot M. Fair Society, Healthy Lives. London: University College London;
2010.