Early Learning and Child Care Programs as Cornerstones of Child Health and Development

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Early Learning and Child Care Programs as
Cornerstones of Child Health and Development

• Dr. Hillel Goelman
• Human Early Learning Partnership
• Symposium on Promoting Healthy Child and Youth
  Development
• The 19th IUHPE World Conference
• June 10, 2007, Vancouver, Canada

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We start with a story
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2 Central Research Questions

• What are the predictors of quality in early child
  development programs?
• What are the child development and health
  outcomes of high quality early child development
  programs?

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Evidence from..

• The Victoria and Vancouver Child Care Research
  Projects.
• The Abecedarian Project
• The Perry Preschool Project
• The NICHD Study of Child Care and Development
• The Canadian Aboriginal Head Start Study
• The U.S. Child Health Head Start Study
• Epidemiologic and retrospective studies.

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The Effectiveness of Early Childhood Development
Programs A Systematic Review

• Anderson, Shinn, Fullilove, Scrimshaw, Fielding,
  Normand, Caraqnde-Kulis and the Task Force on
  Community Preventive Services.
• American Journal of Preventive Medicine, 200324
  (3S) 32-48

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Healthy People 2010 Goals Objectives U.S.
Institute of Medicine

• Maternal and Child Health Goal Improve the
  health and well-being of women, infants, children
  families.
• Prenatal Care Objective Increase the proportion
  of pregnant women who receive early and adequate
  prenatal care.
• Risk Factor Objectives Reduce low birthweight
  and very low birthweight. Reduce the occurrence
  of developmental disabilities
• Education and Community-Based Programs Goal
  Increase the quality, availability and
  effectiveness of educational and community-based
  programs designed to prevent disease and improve
  health and quality of life.

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National Education Goals Objectives US
Department of Education

• Goal 1 By the year 2000 all children will start
  school ready to learn.
• Objectives
• Children will receive nutrition, physical
  activity, experiences, and health care needed to
  arrive at school with healthy minds and bodies
  and to maintain the mental alertness necessary to
  be prepared to learn, and the number of low
  birthweight babies will be significantly reduced
  through enhanced prenatal health systems.
• All children will have access to high-quality and
  developmentally appropriate preschool programs
  that help prepare children for school.

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• Maternal and Child Health Goal Improve the
  health and well-being of women, infants, children
  families.
• Prenatal Care Objective Increase the proportion
  of pregnant women who receive early and adequate
  prenatal care.
• Risk Factor Objectives Reduce low birthweight
  and very low birthweight. Reduce the occurrence
  of developmental disabilities
• Education and Community-Based Programs Goal
  Increase the quality, availability and
  effectiveness of educational and community-based
  programs designed to prevent disease and improve
  health and quality of life.

• Goal 1 By the year 2000 all children will start
  school ready to learn.
• Objectives
• Children will receive nutrition, physical
  activity, experiences, and health care needed to
  arrive at school with healthy minds and bodies
  and to maintain the mental alertness necessary to
  be prepared to learn, and the number of low
  birthweight babies will be significantly reduced
  through enhanced prenatal health systems.
• All children will have access to high-quality and
  developmentally appropriate preschool programs
  that help prepare children for school.

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The Effectiveness of Early Childhood Development
Programs A Systematic Review

• The conclusion

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The Effectiveness of Early Childhood Development
Programs A Systematic Review

• early childhood programs improve childrens
  social competence and social interaction skills,
  which, combined with higher educational
  attainment, helps to decrease social and health
  risk behaviors. As education increases, so does
  income both factors are associated with improved
  health status and a reduction in mortality and
  many morbidities.

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The Effectiveness of Early Childhood Development
Programs A Systematic Review

• The health component of early childhood programs
  leads to preventive screening services,
  improvements in medical care, or both, which
  subsequently can improve health status and
  indirectly improve educational attainment (i.e.,
  by identifying conditions that could impede
  learning through vision screening, hearing
  screening or other means).

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The Effectiveness of Early Childhood Development
Programs A Systematic Review

• What is the chain of evidence that leads to this
  conclusion?

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The Predictors and Outcomes of Quality Child Care
Programs The Victoria and Vancouver Child Care
Research Projects

• Goelman Pence, 1987, 1988, 2001, 2003

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Sample, methods
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Predictors of quality in ECE programs
Practicum site
Teacher-child ratio
Quality
Teacher education
Teacher wages
Teacher job satisfaction
Free/subsidized rent
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What experiences do children have in high quality
ECD programs compared to children in low quality
ECD programs?

• They are read to more often.
• They engage in more dramatic play.
• They spend more time with puzzles and
  problem-solving materials.
• They spend more time in art and music activities.
• They spend more time in gross motor activities.
• They spend more time in collaborative play and
  less time in solitary play.
• Their caregivers are more sensitive and more
  responsive to the children.

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What kinds of language interactions do the
children have in high quality ECD programs
compared to children in low quality programs?

• The children speak more often to adults and to
  other children.
• Their speech is characterized by longer MLUs
  (mean length of utterance).
• Their language includes more cognitive
  questions (Why do you thinkWhat would happen)
  rather than naming questions (What is this
  called?)

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What kinds of language interactions do the
children have in high quality ECD programs
compared to children in low quality programs?
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What kinds of language interactions do the
children have in high quality ECD programs
compared to children in low quality programs?

• Their language includes more metacognitive
  verbs, e.g., think, remember, forget,
  say, mean.
• More requests for and productions of language
  repairs and clarifications.
• More examples of metalinguistic awareness the
  structure, form and uses of language.

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Outcomes of the Victoria and Vancouver Child Care
Research Projects?

• Children in high quality child care programs had
  higher scores on measures of expressive language
  development at school entry in kindergarten.
• Children in high quality child care programs had
  higher scores on measures of receptive language
  development at school entry in kindergarten.
• ? Both are predictive of early literacy and
  school readiness.

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Outcomes of the Victoria and Vancouver Child Care
Research Projects
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Outcomes of the Victoria and Vancouver Child Care
Research Projects

• Children from lower resource home environments in
  higher quality child care environments performed
  significantly better than children lower resource
  home environments in lower quality child care
  environments.

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Home environments, child care quality and child
language development
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Structure and process variables at home and in
child care that impact on child language
development
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Consistent with Competent at 14 Results. New
Zealand-based longitudinal study of children from
preschool to adolescence.

• Features of the preschool environment
• Overall program quality.
• ECE staff responsiveness to children.
• ECE staff ask open-ended questions.
• ECE staff guide childrens activities.
• ECE staff join children in their play.

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Competent at 14 Outcomes

• Curiousity
• Perseverance
• self-efficacy
• social skills
• communication skills
• mathematics achievement
• problem solving
• Cognitive composite score
• Attitudinal composite score

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The Carolina Abecedarian Project

• XXXX

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Evidence from Experimental Studies

• Carolina Abecedarian Project
• 57 treatment 54 control children
• 8 hrs/day, 5 days/wk, 50 wk/yr, 1st 5 yrs
• Center-based, language focus, high-quality model
  program
• Early intervention school intervention
• Source The Future of Childhood

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Components of School Readiness

• Cognitive skills memory, attention
• Language skills comprehension, expression
• Pre-academic skills letters, numbers
• Social competence work play well with peers,
  work well with adults
• Emotional well-being

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Abecedarian Findings Results comparing the early
intervention group and the control group

• Higher IQ scores at ages 8 and 12
• Higher Achievement tests scores at ages 8, 15, 21
• Higher rates of college attendance at age 21
• Lower rates of referral to special education
  classes at age 15
• Lower rates of grade retention at age 15
• Lower rates school drop out by age 21
• Cost-Benefit Analysis 35,864 cost 136,000
  benefit to society

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The Perry Preschool Project

• XXXX

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Perry Preschool ResultsIntellectual Performance
Over Time
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Perry Preschool Results Educational Effects
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Perry Preschool Results Economic Effects at Age
27
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Perry Preschool Results Mean Number of Arrests
by Age 27
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Perry Preschool Results Strong Effects on Females
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Perry Preschool Results Strong Effects on Males
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The NICHD Study of Early Child Care and
Development

• XXXX

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Unique Features of the NICHD Study of Early Child
Care

• Prospective, longitudinal study
• Wide range of child-care arrangements and family
  characteristics
• Large sample, diverse in terms of geography,
  ethnicity, education, income, and family
  composition
• Multiple, broad-based assessments of childrens
  development
• Direct observations of home and child-care
  experiences
• Public access to data available to
  qualified/supervised investigators

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Families in the Study

• 1,364 eligible births occurring during 1991
• Sampling designed to assure adequate
  representation of major socio-demographic niches
• Ten data collection sites
• Two sites in PA.
• 24 hospitals

Recruited in these locations
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Relations of interest at any given age and over
time
Family and maternal characteristics
Demographic characteristics
Home environment
Childcare and school environments
Child characteristics
Outcomes Child Parent-child relationships Family
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Data Collection Schedule Phase 1 and 2

• Child age (in months)

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Data Collection Schedule Phase III

• Home, lab and school visits at third and fifth
  grades.
• Lab Visit and School Visit at 4th grade.
• Intervening phone contacts every 3 - 6 months.
• Health assessment at 9 1/2, 10 1/2,
• 11 1/2, and 12 1/2 years old.

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Child care measures

• Maternal report data amount, type, stability,
  satisfaction
• Observational data at the child care settings
  two hours, twice at each assessment point
• Frequencies of interactions of different types
• Quality ratings of different types
• Child care provider information
• Director report data
• Staff characteristics
• Regulables Group size, ratios, education, staff
  turnover

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Caregiving Quality Observed

• Sensitive to child behavior
• Cognitive stimulation
• Warm and positive
• Not emotionally detached, not harsh

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Child Outcomes

• Interactions and relationships with Parents,
  Peers, Friends, Teachers
• Behavior Problems and Adjustment
• Social competence
• Externalizing
• Internalizing
• Language
• Intellectual
• Health and Growth

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OBSERVED CAREGIVING FROM AGES 6 TO 36 MONTHS WAS
MOST POSITIVE WHEN

• Group sizes were smaller
• Child-adult ratios were smaller (decreasing in
  importance at 36 months)
• Caregivers had more child-centered beliefs about
  childrearing at all ages, and more education and
  experience from 15-36 months
• Physical environments were safe, clean, and
  stimulating

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Observed Caregiving Quality

• MORE POSITIVE WHEN
• Smaller group sizes
• Smaller child-adult ratios
• Caregivers with child-centered beliefs about
  childrearing
• Caregivers with more education experience
• Physical environments safe, clean, and stimulating

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Importance of quality

• Higher quality child care is
• related to
• Greater school readiness
• Better language
• Greater social competence
• Better peer interaction skills

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Main findings over the years

• Children enter into care at an early age.
• Families use nonmaternal care of various sorts in
  large amounts
• By age 54 months, nearly all families are using
  nonmaternal care, and most, center care.
• Quality of parenting has stronger effects on
  child outcomes than any aspect of child care
  experience.
• Predictors of child outcomes are similar whether
  child is in many hours of child care or none at
  all.
• More child care (amount per week) is associated
  with
• More school readiness (smart)
• More behavior problems (but nasty)
• However, these behavior problems were within the
  normal range

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Evidence from Studies of Head Start

• XXXX

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Head Start program objectives include

• To provide a comprehensive health services
  program that encompasses a broad range of
  medical, dental, nutrition, and mental health
  services, including handicapped children
• To promote preventive health services and early
  intervention.
• To attempt to link the childs family to an
  ongoing health care system to insure that the
  child continues to receive comprehensive health
  care even after leaving the Head Start program,

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Health Services in Head StartZigler, Piotrkowski
Collins,Annual Review of Public Health, 1994,
15511-534

• Health Services and Head StartHale, Seitz
  Zigler
• Journal of Applied Developmental Psychology
• (1990), 11447-458

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Health care components of Head Start programs

• Collect nutrition assessment data (height,
  weight, hemoglobin/hematocrit) feeding problems,
  family eating habits.
• Collect medical, dental and developmental history
  of the child.
• Screening measures vision, hearing, dental.
• Immunization status

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Health care outcomes of children in Head Start
programs

• More likely to be screened for lead, tuberculin,
  blood pressure, vision, screening and dental than
  matched group on waitlist.
• One in five children who were screened identified
  with a need for medical treatment and 81 of
  these children received the needed treatment.
• 32 needed follow-up dental treatment and 96.5
  of them received the treatment.
• 13 identified with a development disability of
  some kind (e.g., hearing impairment, speech
  impairment, learning disability).

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Health care outcomes of children in Head Start
programs

• for these low-income children, the formal Head
  Start health services delivery system made an
  important difference in their access to
  preventive care.
• receiving services comparable to those received
  by middle class children, at least while they are
  enrolled in the program.
• Most children brought up to date on their
  immunizations, participate in comprehensive
  health screenings, and eight or more out of ten
  complete the needed medical and dental treatments

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Health care outcomes of children in Head Start
programs

• Head Start children experienced a lower
  incidence of pediatric problems and a level of
  health comparable to more advantaged children.
• Immunization against childhood infectious
  diseases is the single most effective
  intervention to reduce illness and mortality in
  children. Given what appear to be high rates of
  immunization of Head Start children, on its face,
  Head Start is effectively promoting positive
  health outcomes.

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Head Start findings dovetail with epidemiologic
data

• Does childhood health affect chronic morbidity in
  later life?
• Blackwell, Hayward Crimmins (2001), Social
  Science and Medicine, 521269-1284

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Head Start findings dovetail with epidemiologic
data

• Does childhood health affect chronic morbidity in
  later life?
• Blackwell, Hayward Crimmins (2001), Social
  Science and Medicine, 521269-1284

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Head Start findings dovetail with epidemiologic
data
Table 3 shows the prevalence of diseases in
middle age by the presence or absence of any
incapacitating childhood illness or condition.
Persons who experienced a major childhood illness
were more likely to report having cancer, chronic
lung conditions, arthritis and cardiovascular
conditions.
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Head Start findings dovetail with epidemiologic
data
Additionally, our data suggest that it is
important to distinguish between infectious and
non-infectious diseases whenever possible.
Non-infectious diseases are associated with
higher rates of cancer and arthritis or
rheumatism in later life, while infectious
diseases are strongly associated with emphysema
and bronchitis childhood health experiences
appear to have extraordinary long-term
consequences that are not ameliorated by adult
life circumstances.
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Other evidence from epidemiologic and
retrospective studies

• XXXX

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The Community Guides Model for Linking the
Social Environment to Health

• Anderson, Scrimshaw, Fullilove, Fielding and the
  Task Force on Community Preventive Services.
• American Journal of Preventive Medicine, 200324
  (3S) pp. 12-20.

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ECD programs can improve readiness to learn and
to prevent developmental delay
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ECD programs can improve readiness to learn and
to prevent developmental delay
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ECD programs can improve readiness to learn and
to prevent developmental delay
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ECD Programs to improve readiness to learn and
to prevent developmental delay
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The Community Guides Model for Linking the
Social Environment to Health

• We expect that center-based, early childhood
  development interventions will be most useful and
  effective as part of a coordinated system of
  supportive services for families, including child
  care, housing and transportation assistance,
  nutritional support, employment opportunities and
  health care. (39)

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Promoting Health Intervention Strategies from
Social and Behavioral ResearchU.S. Institute of
Medicine

• Recommendation 6
• High-quality, center-based early education
  programs should be more widely implemented.
  Future interventions directed at infants and
  young children should focus on strengthening
  other processes affecting child outcomes such as
  the home environment, school and neighborhood
  influences, and physical health and growth.
  (Smedley, et al p10).

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Promoting Health Intervention Strategies from
Social and Behavioral ResearchU.S. Institute of
Medicine

• Child development programs (e.g., Head Start)
• Parenting classes in schools, churches, or health
  agencies.
• Funding for expansion of community preschool
  programs. Training programs for providers of
  home-based child care
• Development of high quality foster child care
  systems.
• Programs to support young mothers (e.g., home
  nursing visits and educational programs/materials)

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We end with a story
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An old Jewish proverb states You are not
responsible for completing the task. But, neither
are you permitted to walk away from the task.
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We cant claim to have all of the right answers
(or even all of the right questions). But we
cant use this as an excuse for not using what we
do know to try improve the quality of programs
that improve the lives of children.