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Transition to Early Childhood

Transition to Early Childhood. Marie C. McCormick Harvard School of Public Health February, 2005. Pathways for Environmental Effects on Neurodevelopment. Parental Processes. Pathways for Environmental Effects on Neurodevelopment. Parental Processes Parental physical and emotional health

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Transition to Early Childhood

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  1. Transition to Early Childhood Marie C. McCormick Harvard School of Public Health February, 2005

  2. Pathways for Environmental Effects on Neurodevelopment • Parental Processes

  3. Pathways for Environmental Effects on Neurodevelopment • Parental Processes • Parental physical and emotional health • Provision of stimulating experiences in the home • Parental sensitivity • Parental harshness

  4. Model for Effect of Socioeconomic Factors Earnings Mat. Ed Financial Strain Parenting Depressive Sx Social Support Outcomes

  5. Pathways for Environmental Effects on Neurodevelopment • Parental Processes • Neighborhood Processes

  6. Neighborhood Processes • Resources for Parents • Relationships • Norms or Collective Efficacy

  7. Pathways for Environmental Effects on Neurodevelopment • Parental Processes • Neighborhood Processes • Child Care Processes

  8. The Infant Health and Development Program An Example of Child Care Processes

  9. P H A S E 1 IHDP Intervention Follow-up Mediating Variables Child Outcomes Secondary Effects P H A S E 2-4 Intervening Variables Child Outcomes Secondary Effects

  10. Study Enrollment Screened for Enrollment : 4551 Protocol Exclusions -3249 Eligible for Recruitment: 1302 Refused Consent -274 Randomized: 1028 Withdrawn: -43 Primary Analysis Group: 985

  11. Reasons for Exclusion(n=3249)

  12. IHDP 985LBW,PT Infants Intervention n=382 Follow-up n=623 Mediating Variables Child Outcomes Secondary Effects

  13. IHDP Intervention FU Services Home Visits Child Dev. Ctr. Parent Supp.Grp. Follow-up FU Services Mediating Variables Child Outcome Secondary Effects

  14. Follow-up Services (Every 3-6 Months) Frequent Health and Developmental Surveillance Referral for Health and Social Services Home Visits (Every week until 12 mons.then every other week) Partners for Learning Curriculum Parent Problem Solving Social Support Child Developmental Centers (5 days/week, 8 hours/day, 12-36 months) Partners for Learning Parent Support Groups Parent Education Social Support Content of IHDP

  15. IHDP INT FU MED VARS SE Child Outcomes Cognitive Development (IQ)

  16. Cognitive Outcomes of IHDP at Age 8-Total p<0.05 (SB=Stanford Binet, WPPSI=Weschler Preschool)

  17. Cognitive Outcomes of IHDP at Age BWT=2001-2500 * * * (SB=Stanford Binet, WPPSI=Weschler Preschool) *p<0.05

  18. School Achievement Scores at Age 8 in IHDP p<0.05 T=Total,H=Bwt 2001-2500,L=BWT<=2000,rd=reading, ma=math

  19. IHDP INT FU MED VARS SE Child Outcomes Behavior

  20. Behavioral Outcomes of IHDP-Total * *p<0.05 Parental Report on the Achenbach

  21. IHDP INT FU MED VARS Child Outcomes Health Status SE

  22. MEAN REPORTED MORBIDITY INDEXIHDP Intervention and Follow-up Groups, 36 months p<0.001 N.S. Mean (S.D.) Reported Morbidity Index <=2000g 2001-2500g

  23. OTHER HEALTH STATUS MEASURESIHDP Intervention and Follow-up Groups, 36 months Measure Reported Serious Morbidity Index NS Stein Functional Status Scale NS Growth NS Length NS Body Mass Index NS General Health Ratings Scale NS

  24. IHDP INT FU MED VARS Secondary Effects Health Services Use Child Outcomes

  25. MEAN NUMBER OF DOCTOR VISITSIHDP Intervention and Follow-up Groups, 36 Months p=0.04 Mean (SD) of Doctors Visits <=2000g 2001-2500g

  26. IHDP INT FU MED VARS Secondary Effects Maternal Outcomes Child Outcomes

  27. CHILD AGE AT MATERNAL ENTRY INTO WORKFORCEIHDP Intervention and Follow-up Groups % Employed Child Age (mons.)

  28. OTHER MATERNAL OUTCOMESIHDP Intervention and Follow-up Groups • Subsequent Child-bearing NS • Further Educational Attainment NS

  29. Early Intervention • Modalities • Home visiting • Center-based • Activities • Education/Developmental stimulation • Therapeutic (PT, OT, etc.) • Parenting skills to prevent abuse

  30. Early Intervention • Target Populations • Socially disadvantaged infants • Infants with identified neurodevelopmental disabilities • Low birth, premature infants.

  31. Early Intervention for Disabled • 53 Studies • Criteria for Enrollment • <36 months of age • Principal problem was not poverty • Child in home/foster care Shonkoff, 1987

  32. Summary of Meta-analysis Shonkoff, 1987

  33. Perry Preschool Study: Economic effects at age 27 29% 7% 36% 13% 41% 20% Source: http://www.highscope.org

  34. Perry Preschool Study: Mean number of arrests by age 27 0.7 1.2 0.5 2.3 arrests 4.6 arrests 1.5 2.5 0.6

  35. Abecedarian Project: Reading scores at 8, 12, 15, and 21 years by preschool group Note: Standardized reading scores as measured by the Woodcock-Johnson. Source: Campbell, Ramey, Pungello, Sparling, & Miller-Johnson, in press.

  36. Abecedarian Project: Mathematics scores at 8, 12, 15, and 21 years by preschool group Note: Standardized mathematics scores as measured by the Woodcock-Johnson. Source: Campbell, Ramey, Pungello, Sparling, & Miller-Johnson, in press.

  37. Conclusion • Post-natal environment is a powerful predictor of child outcomes, for all children • Evidence is increasing that early childhood interventions can improve outcomes for children at risk for a variety of reasons • Intensive programs may have lasting effects

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