Vulnerability is not a Permanent State

In 2007, Canada’s Minister of Health asked Dr. K. Kellie Leitch to serve as the Advisor on Healthy Children and Youth. Dr. Leitch consulted with experts, parents, and children and youth across Canada, and developed a number of recommendations. The full report can be found here.  

The following is an excerpt from the report:

Vulnerability not permanentAs Canadians, we believe that ours is a society in which our children and youth should lead happy, healthy lives. At the time this Report was written, Canada ranked 13th out of 21 OECD countries in terms of the health and safety of our children and youth, showing that there is much room for improvement. We owe it to our children to do better.

That starts with setting bold, visionary goals. Canada has the potential and the ability to be the number one place in the world for a child to grow up in from a health perspective. We have the resources and the capabilities to reach this goal.

Canadian children and youth from all socio-economic backgrounds are vulnerable. Vulnerability is measured by key behavioural and cognitive tests measuring vocabulary, mathematics, emotional health, and violent behaviour tendencies.

Vulnerability in childhood and youth is not a permanent state~

The Canadian National Longitudinal Survey of Children and Youth revealed that many vulnerable children did not remain the same from one cycle to the next. The percentage of vulnerable children (28%) remained unchanged; however, in the second cycle, 16% were no longer considered vulnerable, while a new 15% of children became vulnerable. While 13% remained vulnerable throughout both cycles, the results suggest that 87% of children may experience vulnerability, but the situation is not permanent.

New Research: Vulnerability is Not Permanent

Graph indicating percentage of children experiencing levels of vulnerability from 1994 to 1996
Source: Human Resources Development Canada – Applied Research Branch (2000).

This is great news: it means that investments in best practice services and targeted initiatives can have a direct impact on improving and shaping the lives of Canadian children and youth. But to be successful, investments need to be made in the right programs and policies. These policies and programs must be built upon evidence based research, and performance-based techniques. They must also be delivered in a professional, outcome-driven way.

Social Determinants of Health: Indicators

Social Determinants of HealthWe’re working on our Common Agenda, including fine-tuning long-term outcomes, setting targets & selecting indicators for our Collective Impact Initiative.

To engage in shared measurement, we need to adopt shared indicators that can be measured by each service-delivery partner in the initiative, so we can track our collective progress toward our goals.

We know much of this work has already been done, and can be adapted to our purposes.

For example, here’s a list of indicators for monitoring the social determinants of health (SDH) found on the Action:SDH website (find the full list here). The following relate directly to young people in a Canadian context:

  • Proportion of young people not in school or employment, by age and sex;
  • Literacy rate;
  • Completion of primary/secondary education by ethnic/ “race” group in a country;
  • Newborns with low birth weight (% by mother’s education);
  • Children aged <5 years with moderately or extremely low values for weight and height;
  • Prevalence of obesity (by wealth quintiles).

Applying the Social Determinants of Health

Sam Bradd graphically documented strategic-level dialogue around the Social Determinants of Health by the the First Nations Health Authority, First Nations Health Directors Association, and First Nations Health Council in BC in October 2013. Find the graphics he created based on that dialogue here.

Upstream is a Saskatchewan-based organization devoted to using the Social Determinants of Health to leverage social change. According to Upstream: “Upstream interventions start at home. When everyone has access to adequate housing, nutritious food, and support for early childhood development, we are thinking and acting upstream.”

Measuring the Social Determinants of Health

As for using the Social Determinants of Health for measurement, the Action: SDH site notes that “Effective action on social determinants requires monitoring and measurement to inform policy-making, evaluate implementation, and build accountability. Inequities in health outcomes, social determinants, and the impact of policies must be monitored. Key requirements are collecting and monitoring indicators of social determinants from different sectors, linking with health outcomes, and monitoring inequities; establishing whole-of-society targets towards the reduction of health inequities; and disaggregating data to better understand baseline levels and potential impacts of policies.

Indicators selected for monitoring policies aimed at reducing health inequities need to be clearly understood by policy-makers across the different sectors that influence the social determinants as well as by communities. Thus simpler measures may be more transparent and easier to interpret than complex summary measures.”

 

What is poverty costing us in BC?

Alberta is comfortable with an economic argument. That may be the reason they are leaving BC in the dust when it comes to Early Childhood intervention.

The Royal College of Physicians and Surgeons of Canada published it’s first position statement on Early Childhood this year. It made 15 recommendations:

Recommendation #7:  A pan-Canadian poverty reduction strategy, including the eradication of child poverty, with clear accountability and measurable targets.

We can be motivated by justice or by economics. Either way, the math is the same.

What is poverty costing us in BC?

Father Involvement: a summary of evidence

dad30What if there was something that could improve the health, well-being, executive function, academic achievement social relationships, & life-long career success of children?

According to the 2007 Research Summary of Evidence conducted by Sarah Allen & Kerry Daly at the University of Guelph, there is.

Find the full report, The Effects of Father Involvement: An Updated Research Summary of Evidence, here.

Outcomes for Children

“Father absence has deleterious effects on a wide range of child development outcomes including health, social and emotional, and cognitive outcomes” (Wertheimer & Croan, 2003).

The following is an overview of this research summary:

Infants of involved fathers:

  • are more cognitively competent at 6 months and score higher on the Bayley Scales of Infant Development.

Young children of involved fathers:

  • Continue to have higher cognitive functioning at age one;
  • Are better problem solvers as toddlers; and
  • Have higher IQ’s at age three.

School-aged children of involved fathers:

  • Are more likely to demonstrate a greater tolerance for stress and frustration;
  • Have superior problem-solving and adaptive skills;
  • Are better able to manage their emotions and impulses in an appropriate manner;
  • Have peer relationships that are typified by less negativity, less aggression, less conflict, more reciprocity, more generosity, and more positive friendship qualities;
  • Are better academic achievers: they are more likely to get A’s & have higher grade point averages;
  • Have better quantitative and verbal skills.

Teenaged children of involved fathers:

  • are less likely to engage in delinquent behaviour, including less drug use, stealing and truancy;
  • were 80% less likely to have been in jail and 75% less likely to become unwed parents.

Adult children of involved fathers:

  • Are more likely to have higher levels of economic and educational achievement;
  • Are more likely to score high on measures of self-acceptance and personal and social adjustment;
  • Are more likely to have career success including occupational competency;
  • Are more likely to have higher educational attainment; and
  • Are more likely to have psychological well-being.

“Overall, father love appears to be as heavily implicated as mother love in offspring’s psychological well-being and health, as well as in an array of psychological and behavioural problems” (Rohner & Veneziano, 2001).

Benefit for Fathers

Fathers who are involved in their children’s lives are more likely to:

  • exhibit greater psychosocial maturity;
  • be more satisfied with their lives; and
  • feel less psychological distress.

Fathers who are involved in their children’s lives have:

  • fewer accidental and premature deaths;
  • less than average contact with the law;
  • less substance abuse;
  • fewer hospital admissions; and
  • a greater sense of overall well being.

Measures of Father Involvement

dad5The summary offers three measures of father involvement.

These include father involvement measured as:

  1. Time spent together;
  2. Quality of father-child relationships;
  3. Investment in paternal role.

 

 

 

 

 

Early Childhood: Royal College Position Statement

The Royal College of Physicians and Surgeons of Canada published it’s first position statement on Early Childhood this year.

Find the full statement here.

OLYMPUS DIGITAL CAMERAExecutive Summary

Early childhood or ‘the early years’ is the most important developmental phase of life in which
crucial advancements in physical, social, cognitive, emotional and language domains take place. Experiences during this time – and even before birth – influence health, education and economic prospects throughout life.

Experiences in the first six years can become biologically embedded and influence outcomes throughout the life course in a positive way but also in a negative way. Disruptions during this period can significantly impact behavior and learning as well as adult health outcomes.

Fortunately, intervening early and often can have a tremendous influence to promote
positive outcomes and minimize or mitigate the impact of adverse childhood experiences and
events.

Research clearly shows that health promotion and disease prevention programs targeted at
adults would be more effective if investments were also made early in life on the origins of those
diseases and behaviours.

Early childhood development interventions (such as education and care, parenting support, and poverty reduction) yield benefits throughout life that are worth many times the original investment.

Recommendations

  1. The federal government, in collaboration with the provinces and territories, implement an early child development system with supports for families including but not limited to
    supports during pregnancy; early childhood learning opportunities; and high quality,
    universal, accessible and developmentally appropriate child care, including for Indigenous children living both on and off reserve.
  2. The federal government commit to increasing funding for early childhood development to 1% of GDP to bring Canada in line with other OECD countries.
  3. Evidence based home visiting programs such as the Nurse Family Partnership be made
    available to all vulnerable families in Canada.
  4. Governments support the expansion of community resources for parents and caregivers
    which provide parenting programs and family supports, creating a system where all families have access.
  5. Governments increase public awareness and support to optimize health and reduce potential remediable risk factors for pregnancy and before conception.
  6. Governments increase accessible prenatal care, educational programs and parental supports.
  7. The federal government work with provinces and territories to implement a pan-Canadian poverty reduction strategy, including the eradication of child poverty, with clear accountability and measurable targets.
  8. The federal government work with the provinces and territories to create a robust collection, monitoring and reporting system on early childhood to ensure proper monitoring of development and effectiveness of interventions including:
    ~the identification of data gaps related to disadvantaged populations and Indigenous
    children including Métis
    ~ongoing implementation of the Early Development Instrument (EDI) in all jurisdictions
    ~a similar tool for 18 months and middle childhood.
  9. Curriculum on early brain, biological development and early learning be incorporated,
    including education on the developmental origins of adult health and disease and the impact of the determinants of health specific to Indigenous children such as colonization and racism into all Canadian medical schools and residency programs.
  10. Continuing medical education on early brain, biological development and early learning be available to all care providers, particularly but not limited to those in primary care.
  11. All provinces and territories implement an enhanced 18-month well-baby visit strategy with appropriate compensation, access to tools, adequate electronic medical records and resource pathways to community supports.
  12. Physicians and other primary care providers integrate the enhanced 18-month visit into their regular clinical practice.
  13. Comprehensive resources be developed for primary-care providers to identify community supports and services to facilitate referral for expecting parents, parents, and children.
  14. Physicians be educated about the evidence base for the impact of early family literacy and the importance of discussing and recommending literacy promotion in routine clinical encounters with children of all ages.
  15. National and Provincial/Territorial Medical Associations work with governments and the
    non-profit sector to explore the development of a clinically based child literacy program for Canada working in collaboration with community literacy efforts .

How do we rate for Early Childhood Education?

As we begin to improve population-level outcomes for children, youth & families we are also gathering exisiting data to establish a baseline.

How Do We Rate for quality Early Childhood Education?

According to data pulled together at Longwoods.com, we lagging as a nation & as a province.

Innocenti Report Card

Kerry McCuaig in the same article explains that the Early Childhood Education Index is a 15-point scale designed to assess governance, funding and accountability of early childhood programming by province.

ECE Index 2011

Kerry McCuaig summarizes: “In 2011, only three jurisdictions made it past the halfway mark in this first iteration (Figure 1). Yet there are reasons for optimism. In 2006, Quebec would have stood alone. At that time, only three provinces offered full-day kindergarten; today six do. Province-wide curricula anchored in learning through play were the exception instead of the norm. No province had merged oversight for education and child care; today four have a single lead ministry, and the monitoring and reporting of vulnerability in preschool-aged children is no longer a rarity. We now have many examples of good practice and the steps that jurisdictions took to achieve their results. Their experiences can serve as a guide to others. The index does not suggest that there is only one route to success. Indeed, the two leading jurisdictions (Quebec and Prince Edward Island) reached their destinations using very different methods. The index is now housed at the Atkinson Centre at the Ontario Institute for Studies in Education, University of Toronto. It will undergo additional validation before going into the field again in 2013–2014.”

How Early Experiences Shape Executive Function

Continuing with the theme introduced by video in P2P’s last post, this post summarizes a working paper from Harvard University that describes how executive function is shaped by early childhood experiences & the outcomes of research in this area.

beach youthBuilding the Brain’s Air Traffic Control System: How Early Experiences Shape the Development of Executive Function

Working paper 11 from the National Scientific Council on the Developing Child & the National Forum on Early Childhood Policy & Programs. Published by the Center of the Developing Child at Harvard University.

Find the full paper here.

What is Executive Function?

“As adults, our capacities to multitask, to display self-control, to follow multiple-step directions even when interrupted, and to stay focused on what we are doing despite ever-present distractions are what undergird the deliberate, intentional, goal directed behaviour that is required for daily life and success at work… Without them we could not solve complicated problems and make decisions, persist at tedious but important tasks, make plans and adjust them when necessary, recognize and correct mistakes, control our impulsive behaviour, or set goals & monitor progress toward meeting them” (p.1).

Executive function skills are “biological foundation for school readiness” (p. 4).

They include:

  • Working Memory: “the capacity to hold and manipulate information in our heads over short periods of time. It provides the mental surface on which we can place important information so it is ready to use” (p. 2).
  • Inhibitory Control: “the skill we use to master and filter our thoughts and impulses so we can resist temptations, distractions, and habits and pause to think before we act. It makes possible selective, focused, and sustained attention, prioritization, and action.” (p. 2).
  • Cognitive Flexibility: “The capacity to nimbly switch gears and adjust to changed demands, priorities, or perspectives… Children deploy this skill to learn exceptions to rules of grammar, to approach a science experiment in different ways until they get it to work, or to try different strategies when they are working out a conflict with another child” (p. 2).

Executive function is developed throughout childhood

“By age 7, some of the capabilities and brain circuits underlying executive function skills are remarkably similar to those found in adults. Once these foundational capacities for directing attention, keeping rules in mind, controlling impulses, and enacting plans are in place, the subsequent developmental tasks of refining them and learning to deploy them more efficiently can proceed into the adolescent and early adult years” (p. 4).

Executive function inoculates against stress & trauma

“The brain regions and circuits associated with executive functioning have extensive interconnections with deeper brain structures that control the developing child’s response to threat and stress. This implies that the developing executive function system both influences and is affected by the young child’s experience and management of threat, stress and strong emotions. Thus, extended exposure to threatening situations can compromise the development of executive function skills, yet well-developed capabilities in these areas can also help children (and adults) manage stress effectively” (p. 4).

Likewise, Toxic Stress inhibits the development of executive function

“Exposure to highly stressful early environments is associated with deficits in the development of children’s working memory, attention, and inhibitory control skills. Damaging fear and toxic stress and likely mechanisms that explain these effects, in part, because they affect the chemistry of the brain circuits involved” (p. 7).

Undeveloped executive function: a ‘social contagion’

“Even when only a couple of children have underdeveloped executive function abilities, an entire classroom can become disorganized” (p. 3)

Intervention is effective

“These capacities do not automatically develop with maturity over time. Furthermore, it is even less well-known that the developing brain circuitry related to these kinds of skills follows an extended timetable that begins in early childhood and continues past adolescence” (p. 10).

“Children who have problems with these skills will not necessarily outgrow them” (p. 10).

“The same neuroplasticity that leaves executive functioning skills vulnerable to genetic and environmental disruption also presents the possibility of actively promoting the successful development of these skills” (p. 8).

“Children’s social play is believed to be an important practice ground for the development of executive function skills” (p. 6).

Children in programs designed to support the development of executive functioning “showed significant reductions in teacher-rated problem behaviour… and also performed better than their ‘usual practice’ peers on tests of early literacy abilities as well as on measures of emotional understanding and social problem-solving” (p. 10).

Policy & program response

“The most effective early education programs of the future are likely to teach preschool curriculum content (e.g., early literacy, math, social skills) in a way that optimizes the scaffolding and practice of executive function skills” (p. 12).

“The lack of services that directly address sources of toxic stress during the earliest years of life indicates a disconnect between policies and the known vulnerability of many aspects of brain development (including executive function skills)” (p. 12).

“The current evidence base is strong enough to warrant systematic scaled-up initiatives to teach executive function skills in early care and education programs that focus on vulnerable populations: (p. 12).

“Interventions that have proven successful in fostering executive functioning in young children hold considerable promise for incorporation into parent-focused interventions, such as home visiting, parenting education, and family support programs” (p. 13).

“Adding assessments of executive function skills to the repertoire of evaluation tools used in early childhood programs would not only provide important data for program planning but would also encourage attention to this critical domain” (p. 13).

Reference

Center on the Developing Child at Harvard University (2011). Building the Brain’s “Air Traffic Control” System: How Early Experiences Shape the Development of Executive Function: Working Paper No. 11. Retrieved fromwww.developingchild.harvard.edu