AMCHP 2005 Conference

Transition to Early Childhood

Marie C. McCormick

Harvard School of Public Health

February, 2005

AMCHP 2005 ConferencePathways for Environmental Effects

on Neurodevelopment• Parental Processes

AMCHP 2005 ConferencePathways for Environmental Effects

on Neurodevelopment• Parental Processes

– Parental physical and emotional health– Provision of stimulating experiences in the home– Parental sensitivity– Parental harshness

AMCHP 2005 ConferenceModel for Effect of Socioeconomic

Factors

Mat. Ed

EarningsFinancial Strain

Depressive Sx

Social Support

Parenting

Outcomes

AMCHP 2005 ConferencePathways for Environmental Effects

on Neurodevelopment• Parental Processes

• Neighborhood Processes

AMCHP 2005 Conference

Neighborhood Processes

• Resources for Parents

• Relationships

• Norms or Collective Efficacy

AMCHP 2005 ConferencePathways for Environmental Effects

on Neurodevelopment• Parental Processes

• Neighborhood Processes

• Child Care Processes

AMCHP 2005 Conference

The Infant Health and Development Program

An Example of Child Care Processes

AMCHP 2005 ConferenceIHDP

Intervention Follow-up

Mediating Variables

ChildOutcomes

SecondaryEffects

Intervening Variables

ChildOutcomes

SecondaryEffects

PHASE

1

PHASE

2-4

AMCHP 2005 Conference

Study EnrollmentScreened for Enrollment : 4551

Protocol Exclusions -3249

Eligible for Recruitment: 1302Refused Consent -274

Randomized: 1028Withdrawn:

-43Primary Analysis Group: 985

AMCHP 2005 ConferenceReasons for Exclusion

(n=3249)

7%

19%

7% 20%

47%

Out of Area

Death

Ges Age >37

Med Excl

Other

AMCHP 2005 ConferenceIHDP

985LBW,PT Infants

Interventionn=382

Follow-upn=623

MediatingVariables

ChildOutcomes

SecondaryEffects

AMCHP 2005 ConferenceIHDP

InterventionFU ServicesHome Visits

Child Dev. Ctr.

Parent Supp.Grp.

Follow-upFU Services

Mediating Variables

Child Outcome Secondary Effects

AMCHP 2005 Conference

Content of IHDP• Follow-up Services

(Every 3-6 Months)Frequent Health and DevelopmentalSurveillanceReferral for Health and Social Services

• Home Visits(Every week until 12 mons.then every other week)Partners for Learning CurriculumParent Problem SolvingSocial Support

• Child Developmental Centers

(5 days/week, 8 hours/day, 12-36 months)

Partners for Learning

• Parent Support Groups

Parent Education

Social Support

AMCHP 2005 ConferenceIHDP

INT FU

MED VARS

Child OutcomesCognitive Development

(IQ)

SE

AMCHP 2005 ConferenceCognitive Outcomes of IHDP at Age

8-Total

78

80

82

84

86

88

90

92

94

Age3-SB Age5-WPPSI Age8-Wechsler

IntFU

(SB=Stanford Binet, WPPSI=Weschler Preschool)

p<0.05

AMCHP 2005 ConferenceCognitive Outcomes of IHDP at Age

BWT=2001-2500

75

80

85

90

95

100

Age3-SB Age5-WPPSI Age8-Wechsler

IntFU

(SB=Stanford Binet, WPPSI=Weschler Preschool)

* * *

*p<0.05

AMCHP 2005 ConferenceSchool Achievement Scores at Age 8

in IHDP

88

90

92

94

96

98

100

102

104

T-rd T-ma H-rd H-ma L-rd L-ma

INTFU

p<0.05

T=Total,H=Bwt 2001-2500,L=BWT<=2000,rd=reading,ma=math

AMCHP 2005 ConferenceIHDP

INT FU

MED VARS

Child OutcomesBehavior

SE

AMCHP 2005 Conference

Behavioral Outcomes of IHDP-Total

05

101520253035404550

Age 3 Age 5 Age 8

INTFU

Parental Report on the Achenbach

**p<0.05

AMCHP 2005 ConferenceIHDP

INT FU

MED VARS

Child OutcomesHealth Status

SE

AMCHP 2005 ConferenceMEAN REPORTED MORBIDITY INDEX

IHDP Intervention and Follow-up Groups, 36 months

0

2

4

6

8

10

12

IntFU

<=2000g

2001-2500g

Mean(S.D.)ReportedMorbidityIndex

N.S.p<0.001

AMCHP 2005 ConferenceOTHER HEALTH STATUS MEASURES

IHDP Intervention and Follow-up Groups, 36 months

Measure

Reported Serious Morbidity Index NSStein Functional Status Scale NSGrowth NS Length NS Body Mass Index NSGeneral Health Ratings Scale NS

AMCHP 2005 ConferenceIHDP

INT FU

MED VARS

Child Outcomes

Secondary EffectsHealth Services

Use

AMCHP 2005 ConferenceMEAN NUMBER OF DOCTOR VISITS

IHDP Intervention and Follow-up Groups, 36 Months

0

5

10

15

20

25

30

35

40

45

50

INTFU

Mean(SD)ofDoctors Visits

<=2000g 2001-2500g

p=0.04

AMCHP 2005 ConferenceIHDP

INT FU

MED VARS

Child Outcomes Secondary EffectsMaternal Outcomes

AMCHP 2005 ConferenceCHILD AGE AT MATERNAL ENTRY INTO WORKFORCE

IHDP Intervention and Follow-up Groups

0

10

20

30

40

50

60

70

80

90

0 5 10 15 20 25 30 35

IntFU

% Employed

Child Age (mons.)

AMCHP 2005 ConferenceOTHER MATERNAL OUTCOMES

IHDP Intervention and Follow-up Groups

• Subsequent Child-bearing NS

• Further Educational Attainment NS

AMCHP 2005 Conference

Early Intervention

• Modalities– Home visiting– Center-based

• Activities– Education/Developmental stimulation– Therapeutic (PT, OT, etc.)– Parenting skills to prevent abuse

AMCHP 2005 Conference

Early Intervention

• Target Populations– Socially disadvantaged infants– Infants with identified neurodevelopmental

disabilities– Low birth, premature infants.

AMCHP 2005 Conference

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

AMCHP 2005 Conference

Summary of Meta-analysis

Category of Disability

#Studies Effect (SD)

All 46 0.62

MR 29 0.42

Dev. Delay 20 0.70

Mixed 24 0.94

Shonkoff, 1987

AMCHP 2005 ConferencePerry Preschool Study:

Economic effects at age 27

Source: http://www.highscope.org

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

Never on welfareas adult

Own home

Earn $2,000+monthly

Program groupNo program

7%

29%

36%

13%

41%

20%

AMCHP 2005 ConferencePerry Preschool Study:

Mean number of arrests by age 27

0 1 2 3 4 5 6

No program

Program

Number of arrests

FelonyMisdemeanorJuvenile

0.7 1.2 0.5 2.3 arrests

1.5 2.5 0.6 4.6 arrests

AMCHP 2005 ConferenceAbecedarian Project: Reading scores at 8, 12, 15,

and 21 years by preschool group

80

85

90

95

100

8 years 12 years 15 years 21 years

Stan

dard

ized

sco

re

Treatment

Control

Note: Standardized reading scores as measured by the Woodcock-Johnson.Source: Campbell, Ramey, Pungello, Sparling, & Miller-Johnson, in press.

AMCHP 2005 ConferenceAbecedarian Project: Mathematics scores at 8, 12,

15, and 21 years by preschool group

80

85

90

95

100

8 years 12 years 15 years 21 years

Stan

dard

ized

sco

re

Treatment

Control

Note: Standardized mathematics scores as measured by the Woodcock-Johnson.Source: Campbell, Ramey, Pungello, Sparling, & Miller-Johnson, in press.

AMCHP 2005 Conference

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