Dr. Neal Halfon - CEDJE - Centre d'excellence pour le ... for Healthier Children, Families &...

Center for Healthier Children,Center for Healthier Children,Families & CommunitiesFamilies & Communities

MeasuringMeasuring ECD ECD conferenceconference

Dr. Neal HalfonDr. Neal Halfon

UCLA Center for Healthier Children, Families and UCLA Center for Healthier Children, Families and CommunitiesCommunities

& & National Center for Infancy and Early Childhood Health National Center for Infancy and Early Childhood Health

PolicyPolicy

Centre of Excellence for Early Childhood Development, Vaudreuil (Québec) April 26-28, 2006

Center for Healthier Children,Center for Healthier Children,Families & CommunitiesFamilies & Communities Centre of Excellence for Early Childhood Development, Vaudreuil (Québec) April 26-28, 2006


The EDI and ECDThe EDI and ECDHow good is the EDI?How good is the EDI?How will the EDI help us know how well How will the EDI help us know how well children are really doing? children are really doing? How can the EDI be used to change How can the EDI be used to change policy, engage communities, and make policy, engage communities, and make changes in the ECD systems that are changes in the ECD systems that are emerging around the world? emerging around the world? What needs to be done next? What needs to be done next?



The EDI and ECDThe EDI and ECDHow good is the EDI?How good is the EDI?

Its GoodIts Good-- but can be improved, with usebut can be improved, with use

How will the EDI help us measures and How will the EDI help us measures and monitor how well children are really doing? monitor how well children are really doing?

by linking to EDI like measures done earlier by linking to EDI like measures done earlier (age birth, 18 months, 3 years) in order to (age birth, 18 months, 3 years) in order to measures developmental/ school readiness measures developmental/ school readiness trajectoriestrajectories



The EDI and ECDThe EDI and ECDHow can the EDI be used to change How can the EDI be used to change policy, engage communities, and make policy, engage communities, and make changes in the ECD systems that are changes in the ECD systems that are emerging around the world? emerging around the world?

Positioning EDI results appropriately to Positioning EDI results appropriately to reframe the vision, goals, strategies of ECD reframe the vision, goals, strategies of ECD services, programs, systems, and policiesservices, programs, systems, and policies

What needs to be done next? What needs to be done next? Spread the innovation, improve its function, Spread the innovation, improve its function, link it to systems building activities, keep link it to systems building activities, keep changing the ECD changing the ECD PardigmPardigm



Paradigm-busters

New Knowledge of :

Brain Development

Sensitivity of ECD

Long reach of ECD

Role of Risk, Protective and Promoting Factors

New Demands of Changing IT/ Flatter/ Aging Population

Transition to a

New ECD Paradigm

∆ Deep Structure

Transactional

Ecological

Life-course Development

∆ Operating System

Optimizing

Multi level, sector, integrated

Asset focused

∆ Culture of ECD

Values, meaning

Changing Paradigms Changing Systems

∆ Strategies

Vision, goals

Leadership

Framing, Comm.

∆ Op Programs

integrated

longitudinal

∆ Parameters & Imperatives

Outcomes/ expectations

Performance Monitoring


>>>>The ECD Revolution<<<


From Maturational to From Maturational to Transactional DevelopmentTransactional Development

Maturational ModelMaturational ModelUnfolding of preset Unfolding of preset genomegenomeStages and milestonesStages and milestonesMinimize disabilities Minimize disabilities (chronic disease (chronic disease model)model)Screen for disabilitiesScreen for disabilitiesDeficit based/focusDeficit based/focus

Transactional ModelTransactional ModelBiBi--directional genedirectional gene--environment interactionsenvironment interactions

Continuous processContinuous processOptimize Optimize developmental developmental potentialpotentialContinuous surveillance Continuous surveillance of developmental of developmental competencycompetency

Developmental AssetsDevelopmental Assets



Source: Sameroff

Low APGAR

Fussy baby

Slow to speak

Language delay

DepressionWithdrawalAnxious mother

0 months 18 months 2 years



New Operating SystemNew Operating SystemNew GoalsNew Goals

School Readiness = Healthy developmentSchool Readiness = Healthy developmentNew Strategies New Strategies ––optimizing optimizing devleopmentdevleopmentNew ProgramsNew ProgramsNew Measures and Systems Performance New Measures and Systems Performance GoalsGoals

Clinical developmental Assessments Clinical developmental Assessments Population Developmental Surveillance and Population Developmental Surveillance and MonitoringMonitoring---- EDIEDI



Paradigm Shift: School Readiness Paradigm Shift: School Readiness MeasurementMeasurement

Prior to 1990Prior to 1990’’ssChild level measureChild level measureMaturational modelMaturational modelSchool entry regulationSchool entry regulation

NowNowMultilevel, dynamic measureMultilevel, dynamic measureTransactional modelTransactional modelPromoting optimal developmental inputs and Promoting optimal developmental inputs and creating developmental assets in communitiescreating developmental assets in communities



School Readiness School Readiness (NEGP)(NEGP)

National Ed Goals Panel National Ed Goals Panel –– School ReadinessSchool Readinessi.i. Schools ready for childrenSchools ready for childrenii.ii. Children ready for SchoolsChildren ready for Schoolsiii.iii. Families and Communities support Families and Communities support

NAEYC NAEYC ––children ready for schoolschildren ready for schoolsCognition and general knowledgeCognition and general knowledgeSocial Emotional DevelopmentSocial Emotional DevelopmentPhysical Well Being & Motor DevelopmentPhysical Well Being & Motor DevelopmentLanguage DevelopmentLanguage Development



Birth

Early Infancy

Late Infancy

Early Toddler

Late Toddler

Early Preschool

Late Preschool

Reading to child

Pre-school

Age6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs

Rea

dy to

lear

nStrategies to Improve

School Readiness Trajectories

Appropriate Discipline

Poverty

Lack of health servicesFamily Discord

Social-emotional, PhysicalCognitive, Language

function

Lower trajectory: With diminished function

Parent educationEmotional literacy



Optimizing Early Child Health Optimizing Early Child Health and Developmentand Development

Optimizing early childhood health and brain Optimizing early childhood health and brain development requiresdevelopment requires

Integration of clinical, targeted prevention, universal Integration of clinical, targeted prevention, universal and broader social interventionsand broader social interventionsCurve shifting strategies that Curve shifting strategies that minimize risksminimize risks and and maximize protective factorsmaximize protective factors are necessaryare necessaryPolicies that align levels of government and service Policies that align levels of government and service delivery sectors (silos) within government in a delivery sectors (silos) within government in a common effortcommon effortPlace based programs that integrate early childhood Place based programs that integrate early childhood services and program into a more integrated system services and program into a more integrated system of careof care



CHILD

FAMILY

NEIGHBORHOODSERVICES

COMMUNITY

POLICY Includes:DoctorsSchools

Child CareFamily Resource

Centers

Child HealthChild Welfare

Education

Clinical/Individual

Targeted/community

UniversalPolicy Level/Civic Society

Integrating ECD Services

Sectors and Levels


““The definition of hell is a The definition of hell is a place where nothing connects place where nothing connects

with nothingwith nothing””T.S. EliotT.S. Eliot



An Integrated Model of ECD Systems:An Integrated Model of ECD Systems:cycles of continuouscycles of continuous improvement improvement

FRAMINGFRAMING SYSTEMS DESIGNSYSTEMS DESIGN IMPROVINGIMPROVING

Child Development Outcomes

Integrate ECD System

Joining up approaches

Bridging Strategies, Tool, Pathways

Policy

Measuring,Monitoring,Analyzing,

Interpreting, &Changing

(PDSA cycles)

SocialEcology

Promoting Optimal

Development

CommunityBuilding

LifeCourse

*adapted from A.Best, D.Stokels, L.Green, et al., AJHP, 2003. Centre of Excellence for Early Childhood Development, Vaudreuil (Québec) April 26-28, 2006


Tracking Population ECDTracking Population ECD--School Readiness School Readiness TrajectoriesTrajectories

School Readiness EDI

5 ysBirth 1.5 ys 4 ys3 ys2 ys

Pediatric Early Child Assessment

Birth Certificate

Preschool EDI

• Physical Wellbeing & motor dev’t• Social & emotional dev’t• Approaches to learning• Language dev’t• Cognition & general knowledge



Type of MeasuresType of MeasuresLevel of Level of

MeasurementMeasurement I: Prevalence of AssetI: Prevalence of Asset II: Performance of II: Performance of AssetAsset

III: Interconnectivity III: Interconnectivity within Person, Program within Person, Program

or Policy Portfolioor Policy PortfolioIndividual/ Individual/

ChildChildParent/FamilyParent/Family

Community Community Service Service ProviderProviderCounty/ County/

CommunityCommunity

State Policy/ State Policy/ SystemSystem

ECD Assets: Performance Measurement Framework



Type of MeasuresType of MeasuresLevel of Level of

MeasurementMeasurement I: Prevalence of AssetI: Prevalence of Asset II: Performance of II: Performance of AssetAsset

III: Interconnectivity III: Interconnectivity within Person, Program within Person, Program

or Policy Portfolioor Policy Portfolio

Individual/ Individual/ ChildChild

Language capacity Language capacity ––EDIEDI Performance in Performance in School SettingSchool Setting

How well Language How well Language ability related to other ability related to other EDI domainsEDI domains

Parent/FamilyParent/Family Family Reading Family Reading Frequency and Frequency and ImpactImpact

Library outings, and Library outings, and utilizationutilization

Community Community Service Service ProviderProvider

ROR Programs in ROR Programs in Pediatric offices / Ready Pediatric offices / Ready to Read in ECE sitesto Read in ECE sites

Number of children Number of children Served & improvedServed & improved

ROR connect to ROR connect to Developmental Developmental ScreeningScreening

County/ County/ CommunityCommunity

Number of Early Number of Early Literacy programs Literacy programs ––ROR, RTRROR, RTR

Number of Children Number of Children ServedServed

ROR & RTR programs ROR & RTR programs connected to Family connected to Family Resource CentersResource Centers

State Policy/ State Policy/ SystemSystem

State/Provincial Policy , State/Provincial Policy , Funding levels for Funding levels for

S/P impact S/P impact assessment assessment ––Effectiveness, Effectiveness, Efficiency , Efficiency , AccessibilityAccessibility

Linkage of ECD with Linkage of ECD with medical care, child medical care, child welfare, child mental welfare, child mental health treatment health treatment servicesservices

ECD Assets: Performance Measurement Framework



UCLA Center for Healthier Children, UCLA Center for Healthier Children, Families and CommunitiesFamilies and Communities

& & National Center for Infancy and Early National Center for Infancy and Early

Childhood Health PolicyChildhood Health Policy

Http.//healthychild.ucla.eduHttp.//healthychild.ucla.edu


Dr. Neal Halfon - CEDJE - Centre d'excellence pour le ... for Healthier Children, Families &...

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