Dr Sharon Goldfeld, Child Health Advisor, Office for Children, Victoria Dr Judy Straton

Developing Headline Indicators to monitor the health, development and wellbeing of for Australia’s children ISCI Conference June 2007 Dr Sharon Goldfeld, Child Health Advisor, Office for Children, Victoria Dr Judy Straton Director, Statewide Policy and Planning, Western Australia Ronelle Hutchinson Senior Program Analyst - National Headline Indicators

Creating sustainable policy 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

Data should be at the centre of child health, not in the periphery of monitoring Child Health Indicators of Life Development Report to the European Union 2002

Priority-policy cycle Priority Setting Evidence Based strategies Data Driven/Evidence Based Policy Improved Outcomes Data Research Data Data

National Child Health, Development and Well-Being Headline Indicators A project undertaken on behalf of the Child Health and Well-being Reform Initiative Steering Committee Under the auspices of the Australian Health Ministers’ Conference (AHMC) and the Community and Disability Services Ministers’ Conference (CDSMC)

Headline Indicators Project Overview The aim of the Headline Indicators project was to: Establish a national, jurisdictionally agreed set of Headline Indicators for children’s health, development and well-being Scope an ongoing program to collate, coordinate and report on Headline Indicators

What are Headline Indicators? • Headline Indicators form a key set of high level summary statistics for reporting on the progress made in the health, development and well-being of Australia’s children • Headline Indicators focus the policy attention of all Governments on a subset of priority issues for children and assist in guiding and evaluating policy development

Inter-relationships between the Headline Indicators, current national reporting on children’s indicators and jurisdictional data collections

National Headline Indicators – the benefits A national, jurisdictionally agreed set of Headline Indicators has the capacity to: • Promote commitment to improving key child outcomes across Governments • Direct policy attention to a set of priority issues that are potentially amenable to change over time • Monitor key outcomes through comparison of State and Territory and National data • Monitor key outcomes for sub-populations of children • Children with disability • Children from culturally and linguistically diverse backgrounds • Children living in disadvantage • Aboriginal and Torres Strait Islander children • Facilitate jurisdictional and organisational coordination and collaboration around data collection • Enhance the quality, consistency and availability of data relating to the Headline Indicators • Reduce duplication of effort across sectors

The Development of Child Health, Development and Well-Being Headline Indicators • Managed by cross-jurisdictional steering group • A review of the national and international work • Two rounds of consultation with jurisdictions using semi structured interviews and with national data committees across health, community services and education • Feedback on ‘draft’ of proposed Headline Indicators • Received formal support of final recommendations from NHIG, NCSIMG and AESOC • Reported to AHMC and CDSMC in July 06

ABS ACT Government AESOC Early Learning Working Group AESOC PMRT AESOC Senor Officials Working Party on Indigenous Education AIHW Antenatal Guidelines Project Steering Group Australian Government DoHA Australian Government FaCSIA Housing Ministers Policy Research Working Group National Advisory Group on Aboriginal and Torres Strait Islander Health Information and Data (NAGATSIHID) National Child Protection and Support Services (NCPASS) National Community Services Data Working Group (NCSDWG) NDA NCSIMG NPHIWG NSW Commission for Children NSW Department of Community Services NSW Department of Health NT Government QLD Government SA Government SIMC Tasmania (TAS) Department of Health and Human Services Telethon Institute for Child Health Research Victorian DHS WA Department of Community Development WA Department of Health Women’s Hospitals Australasia Consultations

Consultations Priority areas Indicators Consultations Final report

Start with want you want to know… NOT what you have

Priority area criteria • broadly cover the domains of child health, development and learning, safety and well-being; • recognise issues at the individual, family and community level, and hence be based on an ecological approach; • include both risk and protective factors for health, development and well-being; • be based on a prevention approach to health, development and well-being; • amenable to change through policy • include a mix of outcomes, determinants and system performance indicators; • be able to reflect any differences for sub-groups of children; • be relevant to all Australian children; and • be relevant to State/Territory and Australian Governments policy and agendas.

Indicator criteria • indicator is sensitive to evidence based intervention strategies; • indicator is unambiguous in meaning and interpretation and is based on sound empirical evidence; • data collection is methodologically rigorous; • data are potentially capable of reflecting differences and diversity in sub-groups including: • Aboriginal and Torres Strait Islander children • children with a disability • children from CALD backgrounds • children from socio-economically disadvantaged backgrounds • geographically defined groups (i.e. rural and remote areas).

Priority Area: Smoking in PregnancyHeadline Indicator: Proportion of women who smoked during the first 20 weeks of pregnancy Data Sources: • In future, Australian Institute of Health and Welfare (AIHW)National Perinatal Statistics Unit (NPSU) • Data not currently available Notes: • Indicator sourced from the Women’s Hospitals Australiasia (WHA) core maternity indicators project • Core maternity indicators require piloting and feasibility testing prior to implementation in the Perinatal Forms in all States and Territories

Priority Area: Infant MortalityHeadline Indicator: Mortality rate for infants less than one year of age Data Sources: • ABS Birth and ABS deaths Frequency of Data: • Annual administrative data Disaggregation possible: • Indigenous status for QLD, NT, SA and WA • Socio-Economic Indexes for Area (SEIFA) • Australian Standard Geographical Classification (ASGC) remoteness

Priority Area: Birth WeightHeadline Indicator: Proportion of live born infants of low birth weight (<2500 grams at birth) Data Sources: • Australian Institute of Health and Welfare (AIHW) National Perinatal Statistics Unit (NPSU) Frequency of Data: • Annual administrative data Disaggregation possible: • State and territory • Indigenous status of mother • maternal country of birth • Socio-Economic Indexes for Area (SEIFA) for some jurisdictions • Australian Standard Geographical Classification (ASCG) remoteness classification

Priority Area: BreastfeedingHeadline Indicator: Proportion of infants exclusively breast-fed at 4 months of age Data Sources: • No consistent national data collection source • Data not currently available for all states

Priority Area: ImmunisationHeadline Indicator: Proportion of children on the Australian Childhood Immunisation Register who are fully immunised at 2 years of age Data Sources: • Australian Childhood Immunisation Registry (ACIR) • National data source Frequency of Data: • Quarterly from 1996 Disaggregation possible: • State and Territory • Indigenous status (although improvements are needed) • Socio-Economic Indexes for Area (SEIFA)

Priority Area: Overweight and ObesityHeadline Indicator: Proportion of children whose BMI score is above the international cut off points for ‘overweight’ and ‘obese’ for their age and sex Data Sources: • The National Children’s Nutrition and Physical Activity Survey 2007 could be a source of gathering information in relating to weight and BMI in children • Current data not available (since 1995) Disaggregation possible: • Disaggregation of proposed data not known

Priority Area: Dental HealthHeadline Indicator: Mean number of decayed, missing or filled teeth (dmft/DMFT) among primary school children ‘DMFT’ is the decayed, missing or filled teeth for children aged 12 years ‘dmft’ is the decayed, missing or filled teeth for children aged 6 years Data Sources: • The Child Dental Health Survey Frequency of Data: • Annual Disaggregation possible: • Sex of child • birth place of child • indigenous status of child • state and territory

Priority Area: Social and Emotional Well-beingHeadline Indicator: ??? • No indicator identified at present • Further work required to identify relevant existing indicators of children’s social and emotional wellbeing • Further work required in relation to a data collection source for this Headline Indicator

Priority Area: Injuries Headline Indicator: Age specific death rates from all injuries for children aged 0-4, 5-9 and 10-14 years Data Sources: • Australian Bureau of Statistics (ABS) Cause of Death collection Frequency of Data: • Annual from 1964 Disaggregation possible: • State and territories • Indigenous status • Sex • Age • remoteness index

Priority Area: Attending Early Childhood Education ProgramsHeadline Indicator: Proportion of children attending an educational program in the two years prior to beginning primary school Data Sources: • Children’s Service National Minimum Data Set (CSNMDS) • CSNMDS not yet implemented – data not currently available Disaggregation proposed: • Indigenous status • Sex • Age • main language other than English spoken at home • disability status • State and Territory Notes: • Further work required in regards to the definition of ‘attending’ and ‘educational program’ in line with implementation of the CSNMDS and data collection.

Priority Area: Transition to Primary SchoolHeadline Indicator: Proportion of children entering school with basic skills for life and learning Notes: • There is no current national source of information about children’s transition to Primary School • Identified as a priority area by Council of Australian Governments (COAG) • Precise definition of this indicator, numerator and denominator and methodology for data collection yet to be determined. • The Australian Early Development Index (AEDI) may provide information on children’s successful transition to schooling • The Longitudinal Study of Australian Children (LSAC) may provide information on the factors which relate to children’s success in transition to schooling and the factors behind this success

Priority Area: Attendance Rate at Primary SchoolHeadline Indicator: Attendance rate of children at Primary School Notes: • Data not currently available • Work is being progressed by the MCEETYA Performance Measurement and Reporting Taskforce • Precise definition of this indicator, numerator and denominator and methodology for data collection yet to be determined.

Priority Area: Literacy SkillsHeadline Indicator: The proportion of primary school children who achieve the literacy benchmark • MCEETYA has established national benchmarks for reading and writing that represents the minimum standards of performance of children • Reporting of % of children meeting the literacy benchmark for grades 3 and 5. Data Sources: • Ministerial Council on Education, Employment, Training and Youth Affairs (MCEETYA) annual National Report on Schooling Disaggregation possible: • State and Territory • Language spoken at home • Indigenous status • Socio-economic situation • Sex Notes: • Recent changes to the design and administration of literacy testing aims to increase comparability of results across States/Territories, consistency of data collection and effectiveness in recording of demographic details of children.

Priority Area: Numeracy SkillsHeadline Indicator:The proportion of primary school children who achieve the numeracy benchmark • MCEETYA has established national benchmarks for numeracy that represents the minimum standards of performance of children • Reporting of % of children meeting the numeracy benchmark for grades 3 and 5. Data Sources: • Ministerial Council on Education, Employment, Training and Youth Affairs (MCEETYA) annual National Report on Schooling Disaggregation possible: • State and Territory • Language spoken at home • Indigenous status • Socio-economic situation • Sex Notes: • Recent changes to the design and administration of literacy testing aims to increase comparability of results across States/Territories, consistency of data collection and effectiveness in recording of demographic details of children.

Priority Area: Teenage BirthsHeadline Indicator: Age specific fertility rate for 15-19 year old women Data Sources: • Australian Bureau of Statistics (ABS) Births Australia Frequency of Data: • Annual administrative data Disaggregation possible: • State and Territory • Indigenous status of mother • country of birth of mother • Socio-Economic Indexes for Area (SEIFA)

Priority Area: Family Economic SituationHeadline Indicator: Average real equivalised disposable household income for households with children in the 2nd and 3rd income deciles Data Sources: • Births Australia Australian Bureau of Statistics (ABS) Survey of Income and Housing Frequency of Data: • Most years from 1994-1995 to 2003-2004 Disaggregation possible: • State and Territory Notes: • Recognised that indicator has some limitations in addressing cause and type of financial hardship facing families – in the future, the indicator may be altered to measure more accurately family economic situation.

Priority Area: ShelterHeadline Indicator: ??? • No indicator identified at present • Further work required to identify most relevant indicators of shelter – including affordability, availability and quality • Further work required in relation to a data collection source for this Headline Indicator

Priority Area: Child Abuse and NeglectHeadline Indicator: Rate of children aged 0-12, who were the subject of child protection substantiation in a given year Data Sources: • Australian Institute of Health and Welfare (AIHW) Child Protection Statistics Disaggregation possible: • State and Territory • Indigenous status of child • Sex • age Notes: • National aggregation from this data source is problematic – data are a measure of the activity/services of the Government departments responsible for statutory child protection services in each State and Territory. Data and the definitions of ‘substation are influenced by differences in legislation, policy, practices and data systems.

Priority Area: Family Social Network Headline Indicator: ??? • No indicator identified at present • Further work required to identify most relevant indicators of family social network • Further work required in relation to a data collection source for this Headline Indicator

Headline Indicator Program: Next steps • Providing national leadership and coordination with existing data initiatives • Facilitating data development activities • Data management • Reporting of data for Headline Indictors (publicly and to government)

Acknowledgments • Project was managed by steering group • Dr Sharon Goldfeld (Chair) - Statewide Outcomes for Children, Office for Children, DHS VIC • Dr Michael Ackland - Health Surveillance and Evaluation, DHS VIC • Dr Judy Straton – Child and Community Health, WA Health • Ms Shalini Bellis - National Children and Youth Statistics Unit, ABS • Ms Lesley Martin - National Children and Youth Statistics Unit, ABS • Dr Penny Allbon, Director, AIHW • Ms Cynthia Kim - Children, Youth and Families Unit, AIHW • Dr Indrani Pieris Caldwell – Children, Youth and Families Unit, AIHW • Dr Caroline Pappas, Child Health and PHOFA, DoHA • Ms Padmaja Jha - Child Health and PHOFA, DoHA • Ms Lauren Heller - Child Health and PHOFA, DoHA • The project was supported by Dr Ronelle Hutchinson - Senior Program Analyst and Project Manager, Statewide Outcomes for Children, Office for Children, DHS VIC

Not everything that is faced Can be changedBut nothing can be changed Until it is faced James Baldwin 1924-87

Dr Sharon Goldfeld, Child Health Advisor, Office for Children, Victoria Dr Judy Straton