Reducing Health Inequality: Early Childhood Interventions to Improve School Readiness in Scotland

1. Reducing Health Inequality:Early Childhood Interventions to Improve School Readiness in Scotland Presenter: Dr Rosemary Geddes Career Development Fellow, MRC Human Genetics Unit, Scottish Collaboration for Public Health Research and Policy Contributors: Professor John Frank Director, Scottish Collaboration for Public Health Research and Policy Professor and Chair, Public Health Research and Policy, University of Edinburgh Sally Haw Senior Scientific Adviser, Scottish Collaboration for Public Health Research and Policy

2. WHAT IS THE PROBLEM?

3. UNICEF Children Well-being across the OECD

4. Inequalities in Health Outcomes and Risk Factors in Pregnancy, at Birth and Up to 3mths * Prevalence in most deprived divided by prevalence in least deprived Source: Bromley & Cunningham-Burley, 2010

5. Inequalities in Health up to 48 months Source: Bromley & Cunningham-Burley, 2010

6. Source: Power C, Mathews S. Origins of health inequalities in a national population sample. Lancet 1997: 350:1584-89.

7. 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)

8. 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

9. Education, Employment, Wealth & Health Source: Fairer Society, Healthy Lives. The Marmot Review.2010.

10. Scotland: Media reports December 2009 “Fifth of Scots have poor literacy” • The BBC: • http://news.bbc.co.uk/1/hi/scotland/8393805.stm “Literacy report shows Russell there really is a crisis in education” • The Scotsman: • http://news.scotsman.com/opinion/Literacy-report--shows-Russell.5883656.jp “Zero-tolerance approach to poor literacy needed, experts say” • The Herald: • http://www.heraldscotland.com/news/education/zero-tolerance-approach-to-poor-literacy-needed-experts-say-1.989347

11. Determinants of School Outcomes in Scotland – Why Schools Are Not to Blame • 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. “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

12. WHAT DETERMINES THESE OUTCOMES?

13. `Sensitive periods’ in early brain development “Pre-school” years School years High `Numbers’ Peer social skills Conceptualization Sensitivity Language Habitual ways of responding Emotionalcontrol Vision Hearing Low 1 2 3 4 5 6 7 0 Years Source: Graph developed by Council for Early Child Development (ref: Nash, 1997; Early Years Study, 1999; Shonkoff, 2000.)

14. Synaptic Density At Birth 6 Years Old 14 Years Old Source: Founders’ Network, slide 03-012. Rethinking the Brain, Families and Work Institute, Rima Shore, 1997.

15. The gradient worsens Source: Fairer Society, Healthy Lives. The Marmot Review.2010.

16. Life Course Problems Related to Early Life 2nd Decade 3rd/4th Decade 5th/6th Decade Old Age • School Failure • Teen Pregnancy • Criminality • Obesity • Elevated Blood • Pressure • Depression • Addictions • Coronary Heart • Disease • Diabetes • Premature • Aging • Memory Loss Source: Clyde Hertzman, Early Child Development: A powerful equalizer.

17. How can this be influenced?

18. WHAT WORKS?

19. Main findings of a rapid literature review • Early childhood intervention programmes can help to reduce disadvantage due to social and environmental factors • Improvements in all domains of child development, school achievement, delinquency & crime prevention, & life success • Successful interventions utilize a mixed (centre & home-based), two-generation (child & parents) approach • Greatest effects are seen in those at highest social risk • High quality preschool can help to reduce disadvantage & can raise early language, pre-reading & maths skills with the most deprived children displaying the strongest gains • Home learning environment of more importance for intellectual & social development than parental occupation, education or income • Activities influence children’s cognitive development & can moderate, but not eradicate, effect of socio-demographic disadvantage Source: Geddes et al. Interventions for promoting early child development for health: an environmental scan with special reference to Scotland. April 2010.

20. SPECTRUM OF RISK Source: Scottish Collaboration for Public Health Research & Policy. 2010.

21. Source: Seven things legislators need to know about school readiness. US State Early Childhood Policy Technical Assistance Network. March 2003.

22. Monitoring • Data to monitor children’s development and functioning in the Scottish population, and the effectiveness of related programmes, are lacking. • More early-stage measures are needed as well as better late-stage measures, which would require data linkage. • Data need to be collated and analysed centrally to reveal patterns of “unmet need” in child development by geographic, ethnic and socioeconomic position.

24. What is the EDI? • The EDI is teacher-completed (20 minutes) checklist that assesses children’s school readiness when they enter school. • It measures the outcomes of children’s pre-school (0-5 years) experiences as they influence their readiness to learn at school. • As a result, the EDI is able to predict how children will do in primary school. • The EDI is designed to be interpreted at the group level & does not provide diagnostic information on individual children.

25. What Does the EDI Measure?

26. 1) Physical Health and Well-Being Physical readiness for school day - e.g., arriving to school hungry Physical independence - e.g., having well-coordinated movements Gross and fine motor skills - e.g., being able to manipulate objects

27. turity 2) Social Competence Overall social competence - e.g., ability to get along with other children Responsibility and respect - e.g., accept responsibility for actions Approaches to learning - e.g., working independently Readiness to explore new things - e.g., eager to explore new items 3) Emotional Maturity 3) Emotional Maturity Pro-social and helping behaviour - e.g., helps other children in distress Anxious and fearful behaviour - e.g., appears unhappy or sad Aggressive behaviour - e.g., gets into physical fights Hyperactivity and inattention - e.g., is restless

28. 4) Language & Cognitive Development Basic literacy - e.g., able to write own name Interest in literacy/numeracy and memory - e.g., interested in games involving numbers Advanced literacy - e.g., able to read sentences Basic numeracy - e.g., able to count to 20

29. 5) Communication Skills and General Knowledge (No subdomains) - Ability to clearly communicate one’s own needs and understand others - Clear articulation - Active participation in story-telling (not necessarily with good grammar and syntax) - Interest in general knowledge about the world

30. Trajectories Established Early - Vulnerability on EDI and Grade 6 outcomes N of domains with low scores: Percentage of Grade 6 students not meeting provincial standards in relation to number of vulnerabilities in Kindergarten (EDI) Source: TDSB, 2007

34. International Early Development Instrument implementations

35. Translating School Readiness into Community Actions • School readiness assessment provides communities with the opportunity to better understand how they can allocate resources & concentrate their efforts to work towards improving outcomes for children. The Early Years SOA is already set up for LAs to do this! • EDI: brought stakeholders together; encouraged, established a forum for community mobilisation; developed & cemented inter-sectoral coalitions • Numerous community initiatives resulted from the process – parenting programmes & resources; nutrition & dental interventions; literacy projects

36. Decrease in the % of vulnerable children as a result of improved ECD in Western Australia Year 2003 2006 Floreat 47.22% 14.3% Wembley 47.11% 11.8% AEDI

37. Useful websites & references 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. Contact details: Rosemary.Geddes@hgu.mrc.ac.uk