Transcript Early childhood development: understanding the evidence to

Early childhood development: understanding the
evidence to inform parenting, early learning
programs and access to services for
Indigenous children
Seminar Agenda
9.00
9.15
9.20
9.45
10.10
10.35
11.15
Tea/coffee available
Introduction and welcome – Associate Professor Karen Martin, School of
Education and Professional Studies, Griffith University
Parenting in the early years: effectiveness of parenting support programs
for Indigenous families — Dr Robyn Mildon, Director of Knowledge Exchange
and Implementation, Parenting Research Centre
Early learning programs that promote children’s developmental and
educational outcomes — Associate Professor Sharon Goldfeld, Centre for
Community Child Health, Royal Children’s Hospital and the Murdoch
Children’s Research Institute
Improving access to urban and regional early childhood services —
Dr Daryl Higgins, Deputy Director (Research), Australian Institute of Family
Studies
Question and answer session
Morning tea
Parenting in the early years:
effectiveness of parenting support
programs for Indigenous families
Dr Robyn Mildon
Director of Knowledge Exchange and
Implementation
Parenting Research Centre
Introduction
Families play a critical role in their children’s development and
learning.
A large body of research provides strong evidence that parents,
families and the home environment are the most influential
forces in shaping children’s early learning.
The responsiveness of parents and families and the manner in
which parents talk with and teach their children are important
determinants of children’s later wellbeing and development
Parenting
Shonkoff & Phillips (2000:226)
‘Parenting’ used to ‘capture the focused and differentiated
relationship that a young child has with the adult (or adults) who
is (are) most emotionally invested in and consistently available to
him or her’.
They argue that who fulfils this role is far less important than the
quality of the relationship she or he establishes with the child.
Support for parents in their parenting role has a different context
for Indigenous communities.
The responsibility for child rearing and teaching children has
traditionally been through an extended family, kin and
community and is seen as very much still tied to this cultural
norm, even when families and children face isolation from their
own Indigenous communities (SNAICC 2004).
Outline
Examine what we know about programs for Australian
Indigenous families that effectively support parenting in the early
years.
Present briefly on the evidence for parenting programs generally
and then focus specifically on the evidence for such parenting
programs in serving Indigenous families.
Programs to support parenting in the
early years
Programs that focus on supporting parenting in the early years aim to
influence children’s, parents’ and/or families’ behaviours in order to
reduce the risk or ameliorate the effect of less than optimal social and
physical environments.
These programs aim to not only prevent the development of future
problems such as child abuse and neglect, emotional and behavioural
problems, substance abuse and criminal behaviour, but also to
promote the necessary conditions for a child’s healthy development in
all areas.
There are a number of approaches to supporting parenting
in the early years.
Programs have been grouped according to their primary
focus:
• parenting programs
• home visiting programs.
Parenting programs
Parenting programs are typically focused, short-term interventions
aimed at helping parents improve their relationship with their child and
preventing or treating a range of problems including emotional and
behavioural problems (Barlow & Parsons 2003).
Parent programs are based on the premise that interventions that
promote caring, consistent and positive parenting are central to
creating safe and supportive environments for children (Sanders &
Cann 2002).
Parenting programs
• the use of a standardised, manualised program or curriculum
and are underpinned by a number of theoretical approaches
• the use of a range of techniques are often used in such
programs including discussion, role play and practice of skills
in the home (Barlow et al. 2011)
• are offered in a variety of settings such as clinics, communitybased settings and in the home in a number of formats
including groups and individual one-on-one programs.
Parenting programs
A number of recent systematic reviews, published by the Cochrane
Database of Systematic Reviews, suggest that parenting programs are:
• moderately effective in the short term in improving maternal
psychosocial health (Barlow et al. 2002), and the emotional and
behavioural adjustment of infants and toddlers (Barlow & Parsons
2003), and older children (Barlow & Stewart-Brown 2000)
• evidence to suggest that they are effective in improving outcomes for
both teenage mothers and their children (Barlow et al. 2011).
• insufficient in reducing child abuse and neglect, however some
evidence that they show promise improving some outcomes
associated with child abuse and neglect such as poor parent-child
interactions.
Parenting programs and Australian
Indigenous families
There is little information available regarding parenting
education programs developed specifically for Indigenous
families in Australia.
Although many programs have been designed to improve
Indigenous maternal and childhood health, most have not
been rigorously evaluated for their effect on child health and
wellbeing.
Rapid evidence assessment
Of the 106 parenting programs identified in a recent Rapid
Evidence Assessment (REA) of Australian evaluations of
parenting programs, only 8 programs targeted Indigenous
families, and only 1 of these was rated as Supported.
Parenting education for Indigenous
families
• case study describing the development and evaluation of The
Boomerangs Aboriginal Circle of Security Parenting Camp
Program (Lee et al. 2010)
• adaptation of the evidence-based Group Triple P – Positive
Parenting Program (Turner et al. 2007)
• adaptation of the evidence-based Exploring Together program
as part of a preventive strategy in response to serious social
problems affecting young Tiwi people, their parents and families
(Robinson & Tyler 2008).
Home visiting programs
Home visiting does not refer to a specific service, program or
intervention, but refers to the manner in which a service, program or
intervention is delivered (Gomby 2007; Higgins et al. 2006; Sweet &
Applebaum 2004).
Home visiting programs (HVP) may deliver various programs, supports
and services; however, the common feature of these programs is that
they are delivered to the family by a person visiting the home.
Home visiting programs
A meta-analytic review of of 60 studies on HVP for young children
conducted since 1965 in the USA (Sweet & Applebaum 2004)
• In general, home visiting was beneficial for young children
compared to control groups, with children receiving HV having
improved socioeconomic and cognitive outcomes
• frequency and potential for abuse was also reduced
• positive effect on parent factors such as parenting attitudes and
behaviour
• changes were mostly small, indicating that the degree of positive
change that occurs in families as a result of HVP may be modest.
Home visiting programs for Indigenous
families
Little information available regarding home visiting programs
developed specifically for Indigenous families in Australia.
Four articles on home visiting programs for Indigenous families:
• 1 review article
• 2 studies reporting on the use of a mainstream home visiting
program that included Indigenous families as participants
• findings of 1 pilot study.
Herceg (2005) conducted a review of the evidence for home
visiting programs for Indigenous mothers, babies and young
children.
No published studies were identified that reported on home
visiting specifically for Indigenous families. However, two
Australian studies that included Indigenous families as
participants were identified.
Quinlivan and colleagues (2003) conducted a randomised, controlled
trial in Western Australia with first-time teenage mothers.
Thirty per cent of mothers who received the home visiting program and
18% of mothers in the control group were Indigenous.
Mixed results.
In one of the most rigorous studies examining an Australian home
visiting program, child health nurses in Brisbane were used as home
visitors in a randomised, repeated measures trial of 181 families.
Six per cent of participants in the intervention group and nine per cent
of participants in the control group were Indigenous.
(Armstrong et al. 1999).
The program consisted of weekly visits for the first 6 weeks after birth,
fortnightly until 3 months of age, then monthly until the child was
12 months of age. A minimum of 18 home visits were provided to each
family. At 6 weeks, the group participating in the home visiting program
showed:
• a reduction in post natal depression scores
• improvements in the perception of their parenting role
• more positive parent–child interactions
• better quality of the home environment related to child development.
However, results not maintained.
Sivak and colleagues (2008)
Preliminary findings from a home visiting program for Indigenous
families—the Family Home Visiting Program (FHVP)—being
delivered by the Children, Youth and Women’s Health Service in SA.
Families valued the cross‐cultural partnership of the FHVP nurses
and Indigenous workers.
The most important feature:
• qualities of the staff, including honesty, friendliness, warmth,
non‐judgmental attitudes and listening skills, and the relationships
they built with the families.
Evidence from home visiting programs for
indigenous families in other countries
Little international evidence exists regarding the
effectiveness of home visiting programs for Indigenous
families.
2 studies, conducted in the United States, have shown that a
HV delivered to Indigenous families by Indigenous
paraprofessionals demonstrates some effectiveness.
Evidence from home visiting programs for
indigenous families in other countries
Johns Hopkins Centre for American Indian Health in the US has
conducted two separate trials of a HVP developed specifically for
American Indian mothers.
The primary aims of this program were to improve mothers’
childcare knowledge, skills and involvement.
Delivered by paraprofessionals who were bilingual American
Indian women with experience in tribal health and human services.
Results indicate that this program, delivered by Native
American paraprofessionals to young Native American
mothers, can improve childcare knowledge.
Demonstrate that American Indian home visitors who are
members of the local community and speak the native
language can be engaged to deliver a home visiting program
to young American Indian mothers.
Unclear whether the program itself or the method of delivery
limited findings of effectiveness.
Is a structured, manualized, evidence-based
treatment protocol culturally competent and
equivalently effective among American Indian
Parents in Child Welfare?
Chaffin et al. (2012)
Promising practices and recommendations for
programs supporting parenting in the early
years
Use cultural consultants in conjunction with professional
parent education facilitators and home visitors.
Use long-term home visiting/community based programs
rather than short-term programs.
Focus on the needs of both the primary care giver and child.
Promote parenting and home visiting programs as being
supportive to parents and families, and focus on family
strengths within the program.
Use structured program content while also responding
flexibly to families.
Programs must take into account the cultural norm in
Aboriginal and Islander communities of extended family,
relatives and community being involved in raising children.
Programs for Aboriginal families are likely to be more
successful when there is community involvement.
Strong focus on communication and relationship building.
Focus on linking families with other services in the
community.
The use of mainstream programs may not be appropriate
for Aboriginal communities.
Early learning programs that
promote children’s developmental
and educational outcomes
Associate Professor Sharon Goldfeld
Centre for Community Child Health,
Royal Children's Hospital and
the Murdoch Children’s Research Institute
Acknowledgements
Linda J Harrison, Sharon Goldfeld,
Eliza Metcalfe and Tim Moore
“A society that is good to
children is one with the
smallest possible inequalities
for children, with the vast
majority of them having the
same opportunities from birth
for health, education,
inclusion and participation.”
(Stanley, Richardson & Prior,
2005)
We know that the early years can predict later outcomes
• Children’s literacy and numeracy skills at age 4–5 are a good
predictor of academic achievement in primary school.
• Social gradients in language and literacy, communication and
socioemotional functioning emerge early and persist.
• The majority of Australian Indigenous children are
developmentally on track on the AEDI domains, with the
exception of language and cognitive skills.
Brain
development
Building strong foundations
Getting the foundations right is important – healthy
brain development is a prerequisite for future health
and wellbeing.
Life course
Developmental health opportunity
Age
Economics of
human capital
Return on investment in the early years
Reference: Cunha et. al., 2006.
Impact of adversity early in life
Hackman D, Farah M, Meaney M. Socio economic status and the brain: mechanistic insights from
human and animal research. Neuroscience. Vol11 2010; 651-659
AEDI Results (2009): ATSI
Physical
Social
Emotional Lang/cog
Comm
DV1
DV2
2.9
2.6
2.2
4.7
2.9
3.1
3.4
2.8-3.1
2.5-2.7
2.1-2.4
4.5-4.8
2.7-3.0
3.0-3.3
3.2-3.5
21.9
20.3
17.1
28.6
21.3
47.3
29.5
8.7
9.0
8.5
7.9
8.6
22.3
11.0
POR
ATSI
95% CI
Prevalence
(%)
ATSI-yes
(12,416)
ATSI-no
(248,731)
AEDI Results (2009): ATSI
Physical
Social
Emotional Lang/cog
Comm
DV1
DV2
2.9
2.6
2.2
4.7
2.9
3.1
3.4
2.8-3.1
2.5-2.7
2.1-2.4
4.5-4.8
2.7-3.0
3.0-3.3
3.2-3.5
21.9
20.3
17.1
28.6
21.3
47.3
29.5
8.7
9.0
8.5
7.9
8.6
22.3
11.0
POR
ATSI
95% CI
Prevalence
(%)
ATSI-yes
(12,416)
ATSI-no
(248,731)
Disadvantage begins early in life
….
AEDI developmental scores of 5 year olds: Australia, 2009
50–100 %ile
National
mean
25–50 %ile
25%ile
10%ile
NSW
Indig NonIndig
Vic
Qld
WA
SA
Tas
ACT
NT
Aust
Indig NonIndig
Indig NonIndig
Indig NonIndig
Indig NonIndig
Indig NonIndig
Indig NonIndig
Indig NonIndig
Indig NonIndig
69% of NT Indigenous
children score below
national minimum
standard
We know that quality early years education programs can
help to improve outcomes
• At-risk children benefit from attending high-quality education and
care programs in the years before school.
• Evidence-based, well-attended, well-resourced early learning
programs are a key contributor to good early childhood outcomes,
especially programs that are supported by the community and
provided by qualified educators.
• Helping families and communities to be supportive and effective in
their roles in children’s lives is a key protective factor and a key
component in high-quality, effective early years programs.
Key Findings over the Pre-School period:
Attendance
•
•
•
•
Pre-school compared to none enhances children’s development.
The duration of attendance is important with an earlier start (between 2
and 3) being related to better intellectual development and improved
independence, concentration and sociability.
Full time attendance led to no better gains for children than part-time
provision.
Disadvantaged children (and those ‘at risk’ of SEN) in particular can
benefit significantly from good quality pre-school experiences,
especially if they attend centres that cater for a mixture of children from
different social backgrounds.
Key Findings over the Pre-School period:
Home learning environment
• The quality of the learning environment of the home (where
parents are actively engaged in activities with children)
promoted intellectual and social development in all children.
• Although parent’s social class and levels of education were
related to child outcomes the quality of the home learning
environment was more important. The home learning
environment is only moderately associated with social
class.
What parents do is more important than who they are.
Abcedenarian Project
There are particular considerations for Indigenous children
• Indigenous children are less likely to attend an early childhood
program than their non-Indigenous peers.
• Indigenous families want a culturally safe environment for their
children in education and care programs.
• Indigenous families are more likely to use early learning
programs that involve community partnerships, appropriate
teacher training and support, and culturally relevant practice
that values local Indigenous knowledge.
© Anne Hanning Kngwarreye
We know that children attending poor quality early learning
programs show poorer outcomes at school entry
• Service delivery approaches that are too narrowly targeted
can miss many of the children and families who need support.
• Programs that lack stability and continuity, and/or do not
integrate families’ access to programs, reduce the potential
benefits.
• Early learning programs that do not reflect the culture and
knowledge of the Indigenous community are not seen as
culturally safe and tend not to be used by families in that
community.
Indigeneity by State & Territory
(AEDI national sample - mean age 5 yr 7 mo)
100000
Indigenous
90000
Non-Indigenous
80000
70000
60000
50000
40000
30000
20000
10000
0
NSW
VIC
QLD
WA
SA
TAS
ACT
NT
% Indigenous
4.5%
1.1%
6.7%
6.5%
3.8%
4.8%
2.5%
40.5%
% LBOTE
4.4%
6.8%
25.5%
36.2%
36.6%
18.3%
77.7%
Silburn 2010
1.8%
Percent: AEDI Vulnerability by Indigenous and SEIFA
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
Non Indigenous
Indigenous
Red = Vulnerable on one or more domains
Blue = No vulnerability
Least
disadvantaged
4
3
2
Most
disadvantaged
Least
disadvantaged
4
3
2
Most
disadvantaged
0%
Number: AEDI Vulnerability by Indigenous and SEIFA
70000
60000
50000
40000
30000
20000
10000
Non Indigenous
Indigenous
Red= Vulnerable on one or more domains
Blue = No vulnerability
Least
disadvantaged
4
3
2
Most
disadvantaged
Least
disadvantaged
4
3
2
Most
disadvantaged
0
Focusing solely on the most
disadvantaged will not reduce health
inequalities sufficiently.
To reduce the steepness of the social
gradient in health, actions must be
universal,
but with a scale and intensity that is
proportionate to the level of
disadvantage.
We call this proportionate
universalism.
Knowledge gaps and research opportunities
• There are limited publicly available national data on the
attendance rates of children in early learning programs in the
years before entering formal schooling.
o Data on children in remote locations are particularly
problematic.
• There is no Australian research that has examined:
o the relative benefits of targeted and universal programs
for early learning
o the long-term effects of attending an early learning
program through a cost-benefit analysis.
Knowledge gaps and research opportunities
• There have been no rigorous trials or evaluations of early
childhood programs in Australia, particularly programs for
Indigenous and at-risk children.
• There is limited Australian research on how to address the
challenge of low use of early learning programs by Indigenous
and disadvantaged families.
Two-year-old children on the ACIR who are fully immunised,
by selected population groups, 2011
Source: Australian Childhood Immunisation Register,
unpublished data.
Improving access to urban and
regional early childhood services
A research synthesis
Dr Vicki-Ann Ware
Presented by Dr Daryl Higgins
Deputy Director (Research)
Australian Institute of Family Studies
Disclaimer
The Australian Institute of Family Studies (AIFS) is
committed to the creation and dissemination of
research-based information on family functioning
and wellbeing.
Views expressed here are those of individual
authors and may not reflect those of the Australian
Institute of Family Studies, the Australian Institute
of Health and Welfare or the Australian
Government.
Closing the Gap Clearinghouse
About the Clearinghouse
• COAG Building blocks
–
–
–
–
–
–
–
Early childhood
Schooling
Health
Economic participation
Healthy homes
Safe communities
Governance and leadership
• What we do…
Provider level barriers
• Limited capacity for administration of government
funds
• Limited coordination between service providers
• Disjointed services or regular staff turnover
• Lack of qualified local Indigenous staff
• Challenges in providing appropriate training
• Lack of cultural competence fear of tokenism
• Inappropriate venues
• Lack of flexibility
Background to study
• Importance of early childhood programs
• Estimates of Indigenous participation in
early childhood programs
• Why the urban and regional focus?
What are early childhood programs?
• Health, welfare and education programs targeting
children 0–8 years, and their families.
• Include:
– kindergarten/preschool and transition to school
programs
– playgroups and toy libraries
– child care and crèches
– parent support groups and parenting skills classes
– nutrition and other health promotion service
– immunisation and health screening
What access is and is not…
• Four facets of accessible early childhood
services:
–
–
–
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Physically accessible
Affordability
Appropriateness
Acceptability
• Access ≠ engagement
Barriers to Indigenous access to
early childhood programs
• 5 main types of barriers:
– Individual
– Provider
– Program
– Social and Neighbourhood
– Cultural.
Individual level barriers
•
•
•
•
Fear of removal of children
Individual distress or dysfunction
Poverty
Lack of awareness of available services and/or
their benefits
• Reluctance to be separated from children
Program level barriers
• Lack of cultural sensitivity resistance to
services
• Evidentiary base for funding effective traditional
approaches
• Short-term funding and programs
• Perceptions of barriers as insurmountable can
become a barrier in itself
Social and neighbourhood
level barriers
• Social stigma
• Limited access to transport
• Lack of understanding of the importance of early
childhood services
• Past experiences and community-level distress
resistance to services
Cultural barriers
• Lack of awareness and celebration of
legitimate cultural differences
• Lack of consultation with local
communities
• Lack incorporation of local Indigenous
parenting styles into programs
Facilitators to improved
access
Individual facilitators
• Provision of transport
• Locating services close to relevant
community
• Low-cost or no-cost services
• Continuity of service with one agency from
pre-pregnancy through to middle childhood
Provider level facilitators
• Advocates who can promote and foster
support for a program
• Employ, train and retain Indigenous staff
• Culturally competent and secure services
• Flexibility
Program level facilitators
• Involve the Indigenous community in planning and
delivering services
• Comprehensive services (one-stop-shop)
• Continuity of services
• Multiple entry points
• Choice between Indigenous-specific and
mainstream services
• Utilise existing resources, services, and staff with
relational networks
Social and neighbourhood
facilitators
• Co-locate services with other existing
services in the community
• Provide transport
• Provide childcare for parenting services
Cultural facilitators
• Train and employ Indigenous staff
• Cultural training for non-Indigenous staff
• Involve the community in planning and delivering
services
• Involve Elders in early childhood education and
health services
• Encourage extended kinship to get involved
Indigenous childrearing
practices
To sum up:
•
•
•
•
The concept of access
Access is not engagement
What works to improve access
What doesn’t work
Acknowledgements
• This presentation is based on the following
Clearinghouse publication:
– Ware V 2012. Improving access to urban and regional early
childhood services. Resource sheet no. 17. Produced for the
Closing the Gap Clearinghouse. Canberra: Australian Institute of
Health and Welfare & Melbourne: Australian Institute of Family
Studies.
• For Clearinghouse publications, see
http://www.aihw.gov.au/closingthegap/
The Closing the Gap Clearinghouse is a Council of Australian Governments initiative
jointly funded by all Australian governments. It is being delivered by the Australian
Institute of Health and Welfare in collaboration with the Australian Institute of Family
Studies.