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Aboriginal primary health care, Early Childhood and the Nurse Family Partnership and Abecedarian programs Donna Ah Chee, CEO. Introduction. Central Australian Aboriginal Congress Aboriginal Health Status in the NT and early childhood development Early Childhood: the evidence base - PowerPoint PPT PresentationTRANSCRIPT
Aboriginal primary health care, Early
Childhood and the Nurse Family Partnership and Abecedarian programs
Donna Ah Chee, CEO
Introduction
1. Central Australian Aboriginal Congress 2. Aboriginal Health Status in the NT and early
childhood development3. Early Childhood: the evidence base4. The Nurse Family Partnership Program5. The Abecedarian Educational Day care
Program and the Congress pre-school program
Children’s Services
Health Education & Training
CAACAC Board
CEO
Deputy CEO
Alukura
ChildcareIngkintja
Services
Social & Emotional
Heath
Lowitja
AMSANT
Remote Health
NACCHOCARHDS
DirectoratePublic Health
headspace
Congress Urban Unique Clients: Health Service Area and Visitors
Unique Congress Urban Clients
0
2000
4000
6000
8000
10000
12000
2007 2007-2008
2008 2008-2009
2009 2009-2010
2010 2010-2011
2011 2011-2012
2012 2012-2013
Year
Num
ber o
f Clie
nts
Visitors
Health Service Area
Congress Episodes of Health Care (all)
Congress Urban Episodes of Care
0
20000
40000
60000
80000
100000
120000
2007 2007-2008
2008 2008-2009
2009 2009-2010
2010 2010-2011
2011 2011-2012
2012 2012-2013
Number of Episodes
Year Number of Episodes
Aboriginal Health Status in the NT and Early Childhood
COAG Reform Council report. Healthcare 2011-2012: Comparing performance across Australia. May 2013
COAG Target 1: Life expectancy
70 7568
7465
7062
69 6773
79 83 79 83 79 8376
81 79 83
0
20
40
60
80
100
M F M F M F M F M F
NSW QLD WA NT AUS
Year
s
Indig. Non-Indig.
Life expectancy at birth, by Indigenous status, sex and selected state/territory, 2005–2007
COAG Target 1: Life expectancy
27
1815
8 8
0
10
20
30
Circulatorydisease
Cancer External causes Diabetes Respiratory
Perc
ent
Main causes of Indigenous mortality, NSW, Qld, WA, SA and NT, 2004-2008
Australian Early Development Index
NAPLAN Year 3 Reading
Early Childhood:The Evidence base
“Babies are born with 25 per cent of their brains developed, and there is then a rapid period of development so that by the age of 3 their brains are 80 per cent developed.”
Ref: Allen G. Early Intervention: The Next Steps. An Independent Report to Her Majesty’s Government. HM
Government, UK. Jan 2011. http://www.dwp.gov.uk/docs/early-intervention-next-steps.pdf
“A child’s development score at just 22 months can serve as an accurate predictor of educational outcomes at 26 years.”
Ref: Allen G. Early Intervention: The Next Steps. An Independent Report to Her Majesty’s Government. HM
Government, UK. Jan 2011. http://www.dwp.gov.uk/docs/early-intervention-next-steps.pdf
Evidence is clear that nutrition and experiences in the early years of a child’s life influence the infant’s brain development.
“In the brain, the ability to hold onto and work with information, focus thinking, filter distractions, and switch gears is like an airport having a highly effective air traffic control system to manage the arrivals and departures of
dozens of planes on multiple runways. Scientists refer to these capacities as executive function and self-regulation—a set of
skills that relies on three types of brain function: working memory, mental flexibility, and self-control. Children aren’t born with these skills—they are born with the potential to
develop them”.
Regulation needed by other
Capacity for regulation by self
Regulation needed by other
Capacity for regulation by self
Development
Healthy development Child has experiences in early life that enable development of regulation. Child becomes less dependant of external figure (ie parent) to regular emotions and is able to manage challenges without emotional breakdown or physical outburst
Unhealthy development Child does not have experiences in early life that enable self regulation in adult life. Functioning is never developed to the extend that emotions and impulses can be managed. Individuals who do not have regulation display problems in later life such as alcohol abuse, mental health problems, impulse control that require control by external systems including legislation and agencies such as police and mental health services
Major longitudinal study 2011 www.pnas.org/cgi/doi/10.1073/pnas.1010076108
Followed a cohort of 1000 children from birth to age 32 96% retention, Dunedin, New Zealand
The California Adverse Childhood Experiences Study
• Links between childhood maltreatment and later life health and well-being.
• 17,000 participants.• Adults who had adverse childhoods showed higher
levels of violence and antisocial behaviour, adult mental health problems, school underperformance and lower IQs, economic underperformance and poor physical health.
• The scientific rationale for Early Intervention is overwhelming
Anda RF, Felitti VJ, Walker J, Whitfield CL, Bremner JD,Perry BD, Dube SR, Giles WH (2006) The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience 256(3): 174–86.
Negative experiences in the early years have long-lasting effects that can be difficult to overcome later.
Ref. McCain MN, Mustard JF. Reversing the real brain drain: Early Years Study- Final Report. Ontario Children’s Secretariat 1999. pp25-26
Hart and Risley in Shenk, D, the Genius in All of Us, Doubleday, 2010
“ The differences were astounding. Children in professionals' homes were exposed to an average of more than fifteen hundred more spoken words per hour than children in welfare homes. Over one year, that amounted to a difference of nearly 8 million words, which, by age four, amounted to a total gap of 32 million words. They also found a substantial gap in tone and in the complexity of words being used “
In addition there were 560 000 more positive affirmations in the professional households compared with 150 000 more negative affirmations in the welfare households
Mothers’ Speech and Infant Vocabulary
Ref: Huttenlocher et al, Developmental Psychology, (1991)
Audible television is associated with decreased exposure to discernible human adult speech and decreased child vocalizations. These results may explain the association between infant television exposure and delayed language development.
Ref: Christaki DA et al. Audible television and decreased adult words, infant vocalizations, and conversational turns. Arch Pediatr Adolesc Med.
2009;163(6):554-558.
“What parents do is more important than who they are. Especially in a child’s earliest years, the right kind of parenting is a bigger influence on their future than wealth, class, education or any other common social factor.”
Ref: Allen G. Early Intervention: The Next Steps. An Independent Report to Her Majesty’s Government. HM
Government, UK. Jan 2011. http://www.dwp.gov.uk/docs/early-intervention-next-steps.pdf
Key Initiatives For Health Improvement
Immunisation
Smoking Preventio
n/ Cessation
Home Visiting School Connectedness
Breastfeeding
Early Educational Infant Day-care
Maternal Education
Advocacy - enhance social, political, economic and physical environment; legislation (eg. seatbelts), structural changes (eg housing design)
Conception Birth 2 years 5 years 12 years 18 years
Community Development
Population Parenting Programs
NURSE FAMILY PARTNERSHIP’STHREE GOALS
1. Improve pregnancy outcomes
2. Improve child health and development
3. Improve parents’ economic self-sufficiency
TRIALS OF PROGRAM
• Low-income whites
• Semi-rural
• Low-income blacks
• Urban
• Large portion of Hispanics
• Nurse versus paraprofessional visitors
Elmira, NY1977
N = 400
Memphis, TN1987
N = 1,138
Denver, CO1994
N = 735
CONSISTENT RESULTS ACROSS TRIALS Improvements in women’s prenatal health
and dramatic reduction in arrests, convictions and jail
Reductions in child abuse, mortality and children’s injuries
Fewer subsequent pregnancies and greater intervals between births
Increases in fathers’ involvement Increases in employment and reductions in
welfare dependency Improvements in school outcomes Less addictions, sexual partners and a
healthier lifestyle at age 15
NFP at Congress• 6 nurse home visitors and 3
Aboriginal community workers• Recruitment has not been a
problem• Need to present prior to 28
weeks• 140 births per year• 70% acceptance rate higher
for first time mothers• Increasing early presentations • Reduction in smoking and
enhanced language development in children
The Home Visit / Domains• Mother is visited by the same Nurse Home Visitor and throughout the program
(therapeutic relationship, linked to outcomes).
• Frequency is between weekly and bi-weekly (potentially over 60 visits)
• Content of visits is prescribed (Pregnancy, Infancy and Toddler NFP guidelines)
The 6 program domains: 1. Personal Health (e.g. access to ANC, substance use, nutrition, mental health)2. Environmental Health (e.g. safety around the home)3. Life Course Development (e.g. resume schooling)4. Maternal Role (e.g. physical and emotional care of baby, parenting)5. Family and Friends (e.g. building strong net works)6. Health and Human Services (e.g. housing)
Congress Nurse Family Partnership
38
NFP: Outcomes for 213 accepted clients
39
40
Washington State Institute for Public Policy Economic Analysis
Nurse Family Partnership producedlarge return on investment:
– Implementation costs $9, 118– Benefits $26, 298 – Return on investment $17, 180
*Benefits and Costs of Prevention and Early Intervention Programs for Youth, S. Aos, et al.. Washington State Institute for Public Policy: Olympia, WA, 2004.
• Learning Games: Teachers daily engage in short interactive sessions (adult/child interaction games) with individual children or very small groups (e.g., 2 children).
• Conversational Reading: Teachers use a 3S strategy to read a book individually every day to every child.
• Language Priority: Teachers use a 3N strategy to surround spontaneous events with adult language.
• Enriched Caregiving: Teachers encourage children to practice skills (e.g., cooperating, listening, counting, colour recognition) during care routines.
The Abecedarian Approach
All 4 elements of the Abecedarian Approach are shared with parents through home visits and through carers in day care Centre's from 1 to 3 years
Abecedarian studies
Long-term Health Results forat risk Children with Abecedarian
• Fewer risky behaviors at age 18 (p<.05)
• Fewer symptoms of depression (p<.03) at age 21
• Healthier life styles. The odds of reporting an active lifestyle in young adulthood were 3.92 times greater compared to the control group: if there was a medicine that produced this odds ratio all children would be on it!
McCormick, et al. 2006. Pediatrics.McLaughlin. 2007. Child Development.Campbell et al., 2008. Early Childhood Research Quarterly.
% of children in Normal IQ Range (>84) by Age (longitudinal analysis)
Martin, Ramey, & Ramey. 1990. American Journal of Public Health
Stanford-Binet X Maternal Education
Ramey & Ramey. 1998. Preventive Medicine..
Educational Attainment:Percent College Attendance
Campbell et al., 2002. Applied Developmental Science.
At age 21, almost three times as many individuals in the treated group (39.5%) compared to the control group (13.7%) had attended, or were still attending,a 4-year university.
χ2(1, N = 104) = 6.78, p < .01
Post-High School Education for Teen Mothers Whose Children Were in the Abecedarian Program
Ramey et al. 2000. Applied Developmental Science
Entry 4 Years Later
8 Years Later
15 Years Later
0
20
40
60
80
100
Preschool InterventionControl
Perc
ent o
f Gro
up
Outcome for vulnerable children with 7 week Abecedarian pre-school intervention
Once enrolled children stay enrolled
Ref: Early Learning & Development - The first five years determine a lifetime. Children Now http://dev.childrennow.org.s78640.gridserver.com/index.php/learn/early_learning_and_development/
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YOU