COUNCIL OF EDUCATIONAL FACILITY PLANNERS
INTERNATIONAL CONFERENCE
Melbourne, 30th May, 2008
THE IMPORTANCE OF THE EARLY YEARS
AND BEYOND
Tim Moore
Centre for Community Child Health
Royal Children’s Hospital
OUTLINE
• Rationale for change
• Children’s health and developmental
outcomes
• Importance of the early years
• Opportunities and challenges in making
difference
• Implications for facility planners
• Conclusions
Service
delivery
difficulties
Worsening
developmental
outcomes
Changes in
families
New knowledge
about child
development
Changes in
society
New knowledge
about early
intervention
NEED TO CHANGE
We need to reconfigure early childhood
and family support services so as to achieve
better outcomes for children, families and society
CHANGES IN SOCIETY
GLOBAL CHANGES
Over the past few decades, there have been significant changes in
developed nations throughout the world:
• Adoption of free market economic policies – the globalisation of
commerce
• Concurrent rise in general prosperity – dramatic increases over
the last few decades
• Reduction in government control over market and in
government responsibility for provision of public services
• Fall in birth rates – an international phenomenon
• Increased movement of people between countries, leading to
more diverse societies
• Globalisation of ideas and culture – world wide web
LOCAL CHANGES
There have been significant changes in Australia’s demographic
make-up:
• a drop in the birth rate – to 1.77 per woman (2.11 in indigenous
women) which is below the replacement level
• a decrease in proportion of children in society - from 1:3 in
1977 to 1:4 in 2002 (but with a recent upturn)
• Children are less of a social priority – the care of the aged
becomes more of a priority and takes up more and more of the
public budget. (The old used to be the poorest group in society –
now single parents with children are the poorest, followed by twoparent families with four or more children).
• Those who do not have (and do not intend to have) children may
have less of an investment in the future (and therefore less of a
concern about what happens to children)
LOCAL CHANGES (cont)
Over the past 25 years, there have been dramatic changes in
employment opportunities and conditions:
• a decline in men’s participation in the labour market and in their
employment, and an increase in women’s participation and
employment
• a large shift away from full-time and towards part-time work
• a rise in the proportion of workers who are employed as casuals
• a rise in long hours of work
• a fall in the proportion of the workforce employed in manufacturing
(now down to 12%) and a rise in employment in service industries
(now 75%)
• increased inequality in the distribution of pay – pay at the top end
has risen faster than pay at the bottom, especially for men
LOCAL CHANGES (cont)
• Changes in the cost of housing as a proportion of
income – Australia now has one of the highest rates in
the developed world
• Changes in social mobility, with consequent
weakening of the social infrastructure
It should be noted that the Australian governments of all
political persuasions have done (and continue to do) much
to protect families from the adverse effects of these social
and economic changes.
CHANGES IN FAMILIES
CHANGES IN FAMILIES
Families have become more varied in their structure, and more
diverse culturally and ethnically:
• families are smaller (but houses are bigger)
• extended families are also smaller – there are fewer cousins,
uncles and aunts
• childlessness is increasing – there are more people who neither
have children nor intend to have children
• mother’s age at first birth is increasing – from 25 in 1984 to 29
in 2004
• more single parents – due principally to growth in the number of
children born to mothers without a partner, rather than to divorce or
separation
• more blended families
• more shared custody arrangements
• more same sex couple families
CHANGES IN FAMILIES (cont)
These changes have important consequences:
• Children are growing up with fewer siblings, as well as
smaller extended families
• Children see fewer examples of parenting as they
grow up
• Because families have fewer children, parents are
more intensely concerned about their welfare
CHANGES IN FAMILY CIRCUMSTANCES
The circumstances in which families are raising
young children have also changed:
• more parents are working
• more mothers with babies are working
• more parents are doing shift work and
working non-standard hours
• more parents are working longer hours
• more families are jobless
• more children are being raised in poverty
THE IMPACT OF SOCIAL CHANGE
• Partial erosion of traditional family and
neighbourhood support networks, due to factors
such as increased family mobility and the search for
affordable housing
• Increase in the number of parents whose own
experiences of being parented were compromised,
and who therefore have difficulty parenting their own
children
• All these factors have contributed to an increase in
the number of families with complex needs
THE IMPACT OF SOCIAL CHANGE (cont)
• These social changes have also contributed to an
undermining of confidence among parents in their
ability to raise their children well
• There is no longer a social consensus about the
right way to bring up children, or even that there is
a single right way
• Overall, parenting young children has become a
more complex and more stressful business for
many families
PROBLEMS IN MEETING CHILD
AND FAMILY NEEDS VIA CURRENT
SYSTEM
CHALLENGES CURRENTLY FACING SERVICES FOR
CHILDREN AND FAMILIES
• The service system is having difficulty providing support to all
families who are eligible
• Services cannot meet all the needs of families that they do serve no single service is capable of meeting the complex needs of many
families
• Families have difficulty finding out about and accessing the
services they need
• Services are often not well integrated with one another and are
therefore unable to provide cohesive support to families
• Services have difficulty tailoring their services to meet the diverse
needs of families
… cont.
CHALLENGES CURRENTLY FACING SERVICES FOR
CHILDREN AND FAMILIES (cont)
•
Services are typically focused on and/or funded on the basis of
outputs rather than outcomes, and therefore tend to persist with
service delivery methods that may not be optimally effective
•
Services are typically treatment-oriented rather than prevention- or
promotion-focused, and therefore cannot respond promptly to
emerging child and family needs
•
The service system does not maintain continuous contact with
families of young children during the early years
•
Many families are isolated and lack supportive personal networks
- extended family, friends or other families of young children
•
The early childhood field is undervalued and underfunded, and
has difficulty attracting and retaining staff
SYSTEMIC ISSUES IN PROVIDING SERVICES TO
CHILDREN AND FAMILIES
• Government departments, research disciplines and service sectors
tend to work in ‘silos’, despite there being strong arguments for
greater service integration and a ‘whole of government’ approach to
service delivery
• Responsibility for provision of services to young children and their
families is spread across three levels of government - federal, state,
and local - with different planning processes and funding priorities
• Most specialist intervention services are already underfunded, and
it is looking increasingly unlikely that they can ever be fully funded
in their present forms
WORSENING DEVELOPMENTAL
OUTCOMES
CONCERN ABOUT WORSENING
DEVELOPMENTAL OUTCOMES
• Mental health - eg. depression, suicide, drug
dependence
• Physical health - eg. asthma, obesity, diabetes,
heart disease
• Academic achievement - eg. literacy levels,
retention rates, educational outcomes
• Social adjustment - eg. employment, juvenile
crime
CONCERN ABOUT WORSENING
DEVELOPMENTAL OUTCOMES
• The rates of all these developmental outcomes have
risen or are unacceptably high
• The developmental pathways that lead to each of
these outcomes can be traced back to early childhood
• All the poor developmental outcomes identified have
associated social and financial costs that cumulatively
represent a considerable drain on societal resources
• These worsening outcomes represent an unintended
consequences of other changes and policies which in
other respects have been generally successful
‘Modernity’s paradox’
A puzzling paradox confronts observers of modern
society. We are witnesses to a dramatic expansion of
market-based economies whose capacity for wealth
generation is awesome in comparison to both the distant
and the recent past. At the same time, there is a
growing perception of substantial threats to the health
and well-being of today's children and youth in the very
societies that benefit most from this abundance.
Keating and Hertzman (1999)
WORSENING DEVELOPMENTAL OUTCOMES
Stanley, Richardson and Prior (2005)
• Increasing proportions of our children and youth have
complex diseases such as asthma, diabetes, overweight
and obesity, intellectual disabilities, and particularly
psychological problems such as depression / anxiety,
suicide and eating disorders.
• There have been no improvements in the proportions of
our children born prematurely or underweight, or in
those diagnosed with physical disabilities such as
cerebral palsy.
… cont
WORSENING DEVELOPMENTAL OUTCOMES
Stanley, Richardson and Prior (2005)
• There have been perceived dramatic increases in a
range of behaviour problems such as attention deficit
disorder and hyperactivity; dangerous activities such as
substance abuse; and the high levels of teenage
pregnancies.
• Trends in behavioural and learning outcomes in schools
are challenging teachers, and education departments
are voicing concern at the levels of social and other
problems in schools and how these may affect
educational achievement.
… cont
WORSENING DEVELOPMENTAL OUTCOMES
Stanley, Richardson and Prior (2005)
• Not all types of juvenile crime have increased, but the
most aggressive ones certainly have, such as assault
and rape.
• Child abuse and neglect is reported more than ever
before, although it may be that the occurrence is not
really increasing, but that it is more acceptable to report
it.
• Whatever the case, child protection services everywhere
are in a state of crisis
‘Over the course of the last 50 years, there have been
tremendous improvements in the physical health of children and
in the life expectancy of adults. It is chastening to realise that
there have not been parallel improvements in psychological
functioning or mental health …On the contrary, psychosocial
disorders in young people have tended to increase in frequency
over the last half century.
Why has this been so? I would argue that this has to be an
answerable question. If we had a proper understanding of why
society has been so spectacularly successful in making things
psychologically worse for children and young people, we might
have a better idea as to how we can make things better in the
future.’
Rutter (2002)
Measures of social well-being used to increase in
parallel with wealth as countries got richer during the
course of economic development. But now, although
rich countries have continued to get richer, measures
of well-being have ceased to rise, and some have
even fallen back a little. Since the 1970s saw earlier,
there has been no increase in average well-being
despite rapid increases in wealth.
Wilkinson (2005)
THE IMPACT OF INEQUALITY
• Psychosocial factors affect health through the extent to which
they cause frequent or recurrent stress.
• Chronic stress affects numerous physiological systems, including
the cardiovascular and immune systems, increasing our
vulnerability to a very wide range of diseases and health
conditions.
• There are three psychosocial risk factors which play a major role
in triggering biological stress responses: low social status, poor
social affiliations, and early childhood experiences.
NEW RESEARCH FINDINGS ABOUT
EARLY CHILD DEVELOPMENT,
FAMILY FUNCTIONING AND
COMMUNITY DEVELOPMENT
NEW RESEARCH ABOUT EARLY CHILD
DEVELOPMENT: KEY AREAS
• The nature and significance of the early years
• The role and significance of relationships in child
development
• The neurobiology of interpersonal relationships
• Cumulative impact of multiple risk and protective
factors on child functioning
• The interplay between genes and environment
DEVELOPMENTAL PATHWAYS
There are three ways in which exposure to both beneficial and
adverse circumstances over the life course contribute to each
person’s unique life exposure trajectory, which will manifest as
different expressions of health and well-being:
• Latency: There are relationships between an exposure at one
point in the life course and the probability of health expressions
years or decades later, irrespective of intervening experience.
• Cumulative: Cumulative refers to multiple exposures over the
life course whose effects on health combine.
• Pathways: These represent dependent sequences of exposures
in which exposure at one stage of the life course influences the
probability of other exposures later in the life course.
Hertzman and Power (2003)
LATENCY PATHWAYS
There is a major paradigm shift taking place in science that while
simple is profound. It states that the root of many diseases,
including reproductive diseases and dysfunctions, will not be found
by examination of disease onset or etiology hours, days, weeks, or
even years prior to disease onset. The new paradigm suggests that
susceptibility to disease is set in utero or neonatally as a result of
the influences of nutrition and exposures to environmental stressors
/ toxicants.
In utero nutrition and/or in utero or neonatal exposures to
environmental toxicants alters susceptibility to disease later in life as
a result of their ability to affect the programming of tissue function
that occurs during development.
Heindel (2007)
KEY FEATURES OF CHILD DEVELOPMENT
• Young children develop through their relationships with
others – early relationships are formative and constitute a basic
structure within which all meaningful development unfolds.
• Brains are built over time. Both brain architecture and
developing abilities are built ‘from the bottom up’ Simple
neurological circuits and skills providing the scaffolding for more
advanced circuits and skills over time.
• Children's emotional development is built into the
architecture of their brains. Emotional development begins early
in life, is a critical aspect of the development of overall brain
architecture, and has enormous consequences over the course of
a lifetime.
… cont.
KEY FEATURES OF CHILD DEVELOPMENT (cont)
• The growth of self-regulation is a cornerstone of early
childhood development that cuts across all domains of
development. It underpins the subsequent development of
emotional and social competences, as well as the mastery of
academic tasks and general life skills.
• Early experiences can influence later health and
developmental outcomes through a process of biological
embedding. This is a process whereby experiences are
programmed into the structure and functioning of biological and
behavioral systems, and set the child on a developmental
trajectory that becomes increasingly difficult to modify.
… cont.
KEY FEATURES OF CHILD DEVELOPMENT (cont)
• Excessive stress disrupts the architecture of the developing
brain. Toxic stress in early childhood is associated with persistent
effects on the nervous system and stress hormone systems that
can damage developing brain architecture and lead to lifelong
problems in learning, behaviour, and both physical and mental
health.
• Exposure to toxins prenatally or early in life can have a
devastating and lifelong effect on the developing architecture
of the brain. Exposures to many chemicals have much more
severe consequences for embryos, foetuses, and young children,
whose brains are still developing, than for adults.
CUMULATIVE PATHWAYS
Human development is shaped by the ongoing interplay among
sources of vulnerability or risk and sources of resilience or
protection.
• Exposure to adverse conditions does not inevitably lead to poor
outcomes, but does significantly increase the risk
• Children who are exposed to risk factors at an early age are more
likely to experience problems in later life, while those exposed to
protective factors are better equipped to deal with subsequent
adverse experiences
• The earlier in life risk factors occur and the longer they are
sustained the greater the risk of poor outcomes
• Risk and protective factors are multiplicative rather than additive
in their effects
Strategies to improve school readiness trajectories
(Halfon and McLearn, 2002)
Interplay of protective and stress processes and their influence on
individual competence across the life span
(Leadbeater, Schellenbach, Maton and Dodgen, 2004)
THE IMPACT OF RISK AND OPPORTUNITY
FACTORS ON ADOLESCENT DEVELOPMENT
Sameroff , Gutman and Peck (2003) analysed the results
of a study of nearly 500 young adolescents (11-14 year
olds) and their parents to determine the effects of multiple
risk factors on the adolescents’ development and
functioning.
The risk variable studies were as follows:
RISK FACTORS AFFECTING
ADOLESCENT DEVELOPMENT
Domain
Variables
Family process
Support for autonomy
Discipline effectiveness
Parental investment
Family climate
Parent characteristics
Education
Efficacy
Resourcefulness
Mental health
Family structure
Marital status
Household crowding
Welfare receipt
Management of
community
Institutional involvement
Informal networks
Social resources
Economic adjustment
Peers
Prosocial
Antisocial
Community
Neighbourhood SES
School climate
Neighbourhood
problems
IMPACT OF MULTIPLE RISK FACTORS ON THE
FUNCTIONING OF YOUNG ADOLESCENTS
Sameroff, Gutman and Peck (2003)
Dong et al (2004)
EARLY CHILD DEVELOPMENT (cont)
Development is ‘weakly’ determined – individual causal
factors, whether genetic or environmental, rarely have a
significant impact on development on their own
• Risk and protective factors are multiplicative rather than additive
in their effects.
Development is multiply determined, with both direct and
indirect factors within and outside the child contributing to
particular outcomes
• Thus, many different risk or protective factors can lead to any
particular developmental outcome, and particular risk or
protective factors can lead to many different developmental
outcomes.
NEW RESEARCH ABOUT FAMILY AND
COMMUNITY FUNCTIONING: KEY AREAS
• The relationship between parenting practices and child
development
• Cumulative impact of multiple risk and protective factors
on family functioning
• The importance of social support for parental and family
functioning
• The prevalence of social gradient effects
• The role of social capital
DEVELOPMENTAL PLASTICITY –
THE RELATIVE CONTRIBUTION OF
EARLY AND LATER EXPERIENCES
WHAT ARE THE RELATIVE CONTRIBUTIONS OF
EARLY AND LATER EXPERIENCES?
There are two contrasting perspectives:
• The early years are critical for development and lay down
patterns of behaviour and functioning that can have
lifelong consequences
• Behaviour and functioning at any point in time are more
strongly influenced by the immediate social and physical
environment than by past experience
WHAT ARE THE RELATIVE CONTRIBUTIONS OF
EARLY AND LATER EXPERIENCES?
The early years are critical for development and lay down
patterns of behaviour and functioning that can have lifelong
consequences
This is the prevailing wisdom and is behind the push to invest and
intervene during the early years
‘The early years last a lifetime. Although this statement can be
dismissed as a truism, it is profoundly significant. There is now an
impressive body of evidence, from a wide range of sources,
demonstrating that early child development affects health, well-being
and competence across the balance of the life course. (Hertzman,
2004)
WHAT ARE THE RELATIVE CONTRIBUTIONS OF
EARLY AND LATER EXPERIENCES?
Behaviour and functioning at any point in time are more strongly
influenced by the immediate social and physical environment
than by past experience
• Thus, developmental change is not gradual and continuous, earlier
events are not precursors of later events, and the earliest events
are not the most influential of all (Lewis, 1997).
• Instead, ‘How people act is determined by their attempt to adapt to
situations and problems as they find them’
• Since real life environments are rarely stable over time, our
lives are ‘more characterized by zigs and zags than by some
predetermined, connected, and linear pattern’
WHAT ARE THE RELATIVE CONTRIBUTIONS OF
EARLY AND LATER EXPERIENCES?
Early behaviour and functioning are predictive of later behaviour
and functioning to the extent that children’s social and physical
environments remain unchanged.
• The link between early experience and later behaviour occurs
because children’s environments tend not to change.
• We should be looking not only at the correlations between
early and later behaviour / functioning, but also between early and
later environments.
WHAT ARE THE RELATIVE CONTRIBUTIONS OF
EARLY AND LATER EXPERIENCES?
Children’s environments tend to remain unchanged because of
feedback and feedforward loops that maintain established
patterns of interactions between the child, family and
community
• What this means is that it is difficult for children and families
to extricate themselves from adverse circumstances –
particularly when there are multiple risk or adverse factors
in their lives.
Current behaviour and functioning are the result of an
interaction between learnings and patterns of behaviour arising
from earlier environments and experiences, and the child’s
adaptation to the current environment.
NEW RESEARCH FINDINGS ABOUT
EARLY INTERVENTION AND THE
IMPORTANCE OF THE EARLY YEARS
EFFICACY OF EARLY INTERVENTION AND THE
IMPORTANCE OF THE EARLY YEARS
• Long term effects of early childhood and early childhood
intervention programs
• Cost effectiveness of early childhood and early
childhood intervention programs
• The effectiveness of parenting interventions
• Benefits of investments in the early years
LONG TERM OUTCOMES
High/Scope Perry Preschool Study - results at age 27
5 or more arrrests by
age 27
Social services ever in
previous 10 years
Males
Homeowner at age 27
Ever in program for
special education
High school graduate
Females
Married at age 27
No program
0
Program
20
40
60
Schweinhart (2003)
80
100
Cunha, Heckman et al, 2006
Cost-benefit analysis and rate-of-return calculations have
provided evidence that early childhood programs have the
potential to save government money in the long run and produce
benefits for society as a whole. The costs savings for
government could be large enough to not only repay the initial
costs of the program but also to possibly generate savings to
government or society as a whole multiple times greater than
the costs…..
These findings moved early childhood policy from being strictly a
social-service policy and philanthropic endeavor that might
benefit only participating children and families to also be
considered an economic-development strategy.
Kilburn & Karoly (2008)
Service
delivery
difficulties
Worsening
developmental
outcomes
Changes in
families
New knowledge
about child
development
New knowledge
about early
intervention
Changes in
society
WHAT TO CHANGE
More
supportive
communities
Better interface
between services
and communities
Better integrated
service system
WHAT TO
CHANGE
AIMS
More supportive
communities
To build rich and supportive
social environments for families
with young children
Better interface
between services
and communities
To develop ways in which the
service system is able to respond
promptly and effectively to the
emerging needs of young
children and their families
Better integrated
service system
To build a well-coordinated and
easily accessible system of
services for young children and
their families
LONG -TERM
OUTCOMES
Improved
health and
developmental
outcomes for
young people
COMMUNITY
PLATFORM
AIMS
PROCESS
SERVICE
PLATFORM
To build rich and supportive
social environments for families
with young children
To develop ways in which the service
system is able to respond promptly and
effectively to the emerging needs of young
children and their families
To build a well-coordinated and
easily accessible system of
services for young children and
their families
• Mapping community social and
cultural demographics
• Identifying individual and
collective priorities of families
• Identifying and building on
community strengths and
resources
• Ensuring families of young
children have multiple
opportunities to meet
• Promoting family-friendly services
and facilities
• Engaging communities as partners in
planning and monitoring services and
resources
• Developing effective ways for parents and
professionals to share their concerns,
knowledge and expertise
• Training professionals in how to establish
partnerships with families
• Training professionals in ways of helping
families monitor their children’s development
• Training professionals in how to help families
identify concerns about parenting and family
functioning
• Mapping professional services
• Simplifying parental access to
information and services
• Developing common service
philosophies and protocols
• Promoting services based on evidence
and best practice
• Promoting provision of high quality
services
• Providing systematic training for
professionals
• Developing innovative service models
based on strong evidence and clear
rationales
• More effective communication between
parents and professionals
• A service system that responds promptly to
the emerging needs of young children and
their families
• Earlier identification of children with
developmental or health needs
• Provision of more effective interventions
• Improved coordination and
collaboration between services
• Improved capacity of services to
address holistic needs of families
• Easier access to services
• Greater consistency of service delivery
across the system
• Services reoriented to prevention and
early intervention
• A better informed and empowered
SHORT-TERM community
OUTCOMES • A community environment that is
more supportive of families
• Stronger social support networks
for families
• Fewer isolated or marginalised
families
LONG-TERM
OUTCOMES
INTERFACE
IMPROVED HEALTH AND DEVELOPMENTAL
OUTCOMES FOR YOUNG PEOPLE
BUILDING INTEGRATED SERVICES
Effective solutions never come from separate
programs or services tackling the problems in
isolation from the surrounding community. They
come from integrated, wraparound, linked efforts
across a whole range of community agencies
aimed at improving the quality of life and support.
Halfon, 2005
FORMS OF COLLABORATION /
INTEGRATION
• Policy (or whole-of-government) integration
• Regional and local planning integration
• Service delivery integration
• Teamwork integration
All forms of collaboration are needed for successful
collaboration and integration of services.
AIMS AND OUTCOMES
Main aims for improved service integration:
• improved access for consumers,
• increased efficiency by achieving more from the use of
limited resources, and
• enhanced effectiveness, resulting in enhanced
outcomes for consumers and funders.
AIMS AND OUTCOMES (cont)
Other aims include:
•
Coordinated systems planning will make a more comprehensive
set of services available
•
There will be a better fit between consumers and community
needs and the array of services made available because of more
coordinated planning, information sharing, and pooling of agency
funds
•
Direct service workers will be more knowledgeable of the entire
array of services available and become more capable in delivering
a wide range of services
NB. Integration of early childhood and family support services is
a means to an end, not an end in itself – integration is a strategy
to achieve improved outcomes for children and families.
EMERGING MODELS OF COLLABORATIVE
PRACTICE AND INTEGRATED SERVICE
DELIVERY
• Integrated children’s centres and hubs
• Integrated early years / school models
CHILDREN’S CENTRES
•
Sure Start Children’s Centres (UK)
•
Toronto First Duty (Canada)
•
CAFÉ Enfield (South Australia)
•
DHS Children’s Centres (Victoria)
•
BestChance (Victoria)
•
Springvale Integrated Children’s Services Hub
(Victoria)
SURE START CHILDREN’S CENTRES
Programs offered include:
•
good quality early learning combined with full day care provision
for children (minimum 10 hours a day, 5 days a week,48 weeks
a year)
•
good quality teacher input to lead the development of learning
within the centre
•
child and family health services, including ante-natal services
•
parental outreach
•
family support services
•
a base for a childminder network
•
support for children and parents with special needs, and
•
effective links with Jobcentre Plus to support parents/carers who
wish to consider training or employment.
DHS CHILDREN’S CENTRES
Programs provided:
• A range of early childhood services including kindergarten
programs integrated with long day care and/or occasional care
and specialist family services
In addition, all facilities must have the capacity to provide at least two
of the following specialist support services:
• counselling services
• parenting services
• psychological counselling services
• community health services including nutritionists, speech
therapists
• family day care programs coordination
• family support services.
SERVICE COORDINATION GRID
COEXISTENCE
COOPERATION
COORDINATION
COLLABORATION
INTEGRATION
Stand alone /
autonomous
Services operate
independently, are
located separately,
and have no formal
or informal links
Services operate
independently and are
located separately, but
meet to network and
share information
Services operate
independently and are
located separately, but
coordinate to provide
multi-agency services to
families with multiple
needs
Services operate
independently and are
located separately, but
collaborate to provide a
multi-disciplinary / multiagency service
Services combine to
form a single entity
providing integrated
interdisciplinary
services but operating
from a variety of
locations
Co-location
Services operate
independently and
have no formal or
informal links, but are
co-located
Services operate
independently, but are
co-located and meet to
network and share
information
Services operate
independently, but are
co-located and
coordinate to provide
multi-agency services to
families with multiple
needs
Services operate
independently, but are
co-located and
collaborate to provide a
multi-disciplinary / multiagency service
Services combine to
form a single entity
operating from a
single location and
providing integrated
interdisciplinary
centre-based services
Services operate
independently and are
located separately, but
coordinate to provide
multi-agency outreach
services to families with
multiple needs
Services operate
independently and are
located separately, but
collaborate to provide a
multi-disciplinary / multiagency service
Services combine to
form a single entity
and provide integrated
interdisciplinary
centre-based and
outreach services
Outreach
INTEGRATED EARLY YEARS-SCHOOL MODELS
•
Full Service Extended Schools (UK)
•
Toronto First Duty (Canada)
•
Schools of the 21st Century (USA)
•
Coalition for Community Schools (USA)
•
Elizabeth Learning Center (USA)
•
Schools as Community Centres (NSW)
•
Linking Schools and Early Years Project (Victoria)
KEY ACTIVITIES
• Child care
• Holiday care programs
• Opportunities for learning to whole family
• Parental guidance and support
• Integrated early years learning environment
• Provision of information about and referral to a range of
specialist support servicesHealth education and direct health
care services
• Networks and training for child care providers
• Core early learning framework
• The promotion of the use of school facilities by the community
MAINSTREAM AND SPECIALIST SERVICES:
EXISTING SYSTEM
Location:
TERTIARY
SPECIALIST
SERVICES

Specialist services are usually located separately

Children / families have to go to where the
specialist services are, rather than vice versa
Referral arrangements:
SECONDARY
SUPPORT SERVICES
MAINSTREAM SERVICES

Children have to meet eligibility criteria

There are more children needing support than
the specialist services are able to accept

This results in bottlenecks and some children not
receiving help at all
Information flow:

Information tends to flow one way only – from the
mainstream services to the specialist

Collaboration between specialist and mainstream
services is limited
MAINSTREAM AND SPECIALIST SERVICES:
INTEGRATED SYSTEM
Location:
TERTIARY
SPECIALIST
SERVICES
• Specialist services have outreach bases co- located
with mainstream services
• Specialist services provide at least some
support in family and early childhood settings
Referral arrangements:
SECONDARY SUPPORT
SERVICES
•
Specialist services work directly with some
‘eligible’ children, and provide consultant
support for all others
•
Specialist services also provide consultant
support to mainstream services on a broad
range of child and family issues
MAINSTREAM SERVICES
Information flow:
•
Information flows both ways between mainstream
and specialist services
•
Specialist and mainstream service providers
collaborate as equal partners
IMPLICATIONS FOR FACILITY
PLANNERS
IMPLICATIONS FOR FACILITY PLANNERS
• Facilities need to be flexible, catering for children of different ages
and a constantly evolving range of child, family and community
activities
• Facilities need to be inclusive, ie. built to cater for the needs of all
children and families – following principles of universal design
(www.design.ncsu.edu/cud)
• The process of designing facilities should be outcomes-based,
ie. driven by the outcomes that are being sought rather than
immediate needs of services
• The planning of facilities needs to be done in collaboration with
the children, families, communities and services who will be using
them
• Facilities should be family-friendly, easy to access and providing
spaces and facilities for parents to mix with other parents and with
professionals
CONCLUSIONS
CONCLUSIONS
• The early years of life are profoundly important for subsequent
development, and can have life-long effects for health, well-being
and achievement
• Changing children’s developmental trajectories becomes
increasingly difficult and expensive as they get older
• High-quality early childhood services and intervention programs
are cost-effective and represent an essential investment in
‘social’ infrastructure’
• To improve outcomes for children and young people, we need
communities that are more supportive, services that are better
integrated, and more effective ways in which communities and
service systems can communicate
DR. TIM MOORE
Senior Research Fellow
Centre for Community Child Health,
Murdoch Childrens Research Institute,
Royal Children’s Hospital, Flemington Road,
Parkville, Victoria, Australia 3052
Phone:
Fax:
Email:
+61·3·9345 5040
+61·3·9345 5900
tim.moore@mcri.edu.au
Websites:
www.rch.org.au/ccch
www.ecconnections.com.au