Early Childhood Education and Health

1. Early Childhood Education and Health  Judith S. Palfrey, MD Harvard University Santiago, Chile July, 2006 Introduction and thanks. I have been asked to talk about the linkages between health and education in early childhood. Introduction and thanks. I have been asked to talk about the linkages between health and education in early childhood.

2. Will be talking about our experience in the US with linking health and education.Will be talking about our experience in the US with linking health and education.

3. Sharing Our Experiences What we have learned from the US experience The visiting team is thrilled to be learning so much from our Chilean colleagues at this historic moment for children here. The visiting team is thrilled to be learning so much from our Chilean colleagues at this historic moment for children here.

4. Propositions To improve the well-being of our children, we need to integrate educational, medical and public health approaches We need to address social, economic and cultural inequities We have models for doing this What stands in our way are: - Inadequate political will - Incompletely developed social strategies I would like to consider 4 propositions:I would like to consider 4 propositions:

5. Early Childhood and Health Background Early Childhood Integration with Health Services Long Term Payoff To address these propositions, lets look at some background data on health, think about early childhood, define what is meant by integration of health services and look at integrated models that have shown long term pay-off in terms of education and health. To address these propositions, lets look at some background data on health, think about early childhood, define what is meant by integration of health services and look at integrated models that have shown long term pay-off in terms of education and health.

6. 21st Century Community Factors that Affect Child Health and Development Poverty Ethnicity Geography Environment Family configuration Parental occupation Stress Isolation As regards background children�s well-being is determined by many factors. Some of them are outlined here. As regards background children�s well-being is determined by many factors. Some of them are outlined here.

7. Worldwide Child Mortality Around the world, infectious diseases, malnutrition and birth problems continue to be the big health hazards for children. Around the world, infectious diseases, malnutrition and birth problems continue to be the big health hazards for children.

8. Millennial Morbidities Related as much to lifestyle as to viruses and bacteria Injuries and violence Nutrition related concerns (overweight and obesity) Environmental concerns (asthma) Behavioral issues (autism, ADHD, mental health) Habits (smoking, alcohol, drugs, sexuality) In the more developed countries such as Chile and the US, much of the current health picture for children has changed as infectious causes and malnutrition have come into better control. In the more developed countries such as Chile and the US, much of the current health picture for children has changed as infectious causes and malnutrition have come into better control.

9. Poor Children = Poorer Health One thing is not changing�poverty and illness are tightly linked. One thing is not changing�poverty and illness are tightly linked.

10. Percentage of Children in Poverty by Family Type, Race, and Ethnicity in the US, 2002 Poverty is differentially distributed among people of different racial and ethnic backgrounds. Poverty is differentially distributed among people of different racial and ethnic backgrounds.

11. Poverty and poor health have a devastating effect on children throughout their life cycle. Poverty and poor health have a devastating effect on children throughout their life cycle.

12. But, there is some good news under the sun�..But, there is some good news under the sun�..

13. Percentage of 6th-12th graders with high risk behaviors, by number of assets[from Benson, Leffert, Scales, & Blyth (n=99,462)] Well documented studies of community assets show that communities can make a huge difference for children if they use their human assets to support children�s growth, health and well-being. Well documented studies of community assets show that communities can make a huge difference for children if they use their human assets to support children�s growth, health and well-being.

14. Early Childhood Period of rapid growth Foundation for all later health Foundation for all later learning Biologic and social processes linked Critical role(s) of caring adults and community Now lets turn our attention to early childhood. Now lets turn our attention to early childhood.

15. Early Childhood Period of rapid growth Foundation for all later health Foundation for all later learning Biologic and social processes linked Critical role(s) of caring adults and community One of the main reasons that it is key for health and education programs to be linked in early childhood is that the first 5 to 6 years of life are the period during which children�s bodies are setting the agenda for life long growth (height, weight and head circumference). They are sealing the foundation for all later health events. One of the main reasons that it is key for health and education programs to be linked in early childhood is that the first 5 to 6 years of life are the period during which children�s bodies are setting the agenda for life long growth (height, weight and head circumference). They are sealing the foundation for all later health events.

16. Monitoring Growth Early childhood providers working together with health consultants and partners can ensure that children are growing along a healthy weight and height curve�.that they are neither under nor overnourished. Early childhood providers working together with health consultants and partners can ensure that children are growing along a healthy weight and height curve�.that they are neither under nor overnourished.

17. Longterm Importance Lifelong consequences Diabetes Heart Disease High Blood Pressure Mental and Emotional Concerns While in the past, much of our concern was with undernutrition, now in countries like the US (and increasingly in much of the rest of the world the concern is with overweight . While in the past, much of our concern was with undernutrition, now in countries like the US (and increasingly in much of the rest of the world the concern is with overweight .

18. Longterm Importance In Chile, there is already a concern about high blood pressure. As the population of children becomes increasingly obese, this problem will also increase. In Chile, there is already a concern about high blood pressure. As the population of children becomes increasingly obese, this problem will also increase.

19. Early Childhood Period of rapid growth Foundation for all later health Foundation for all later learning Biologic and social processes linked Critical role(s) of caring adults and community Health is critical for children because of the biologic substrate of all human development. Health is critical for children because of the biologic substrate of all human development.

20. Brain Growth/Organization During the past 50 years, the explosion of scientific evidence in neurobiology has created the theoretical underpinnings for early childhood work. This diagram was used by Dr. Richmond during his early days of arguing for the importance of Head Start. It shows how children�s brains create interconnections and organize for information processing. These complex processes continue throughout early childhood with ever increasing sophistication as the children learn and then physically encode their learning into their biology. During the past 50 years, the explosion of scientific evidence in neurobiology has created the theoretical underpinnings for early childhood work. This diagram was used by Dr. Richmond during his early days of arguing for the importance of Head Start. It shows how children�s brains create interconnections and organize for information processing. These complex processes continue throughout early childhood with ever increasing sophistication as the children learn and then physically encode their learning into their biology.

21. Critical Role of Stimulation Equally important were studies that demonstrated that this encoding depends on external environmental stimulation and that without such stimulation, young beings do not develop along the normal path. Equally important were studies that demonstrated that this encoding depends on external environmental stimulation and that without such stimulation, young beings do not develop along the normal path.

22. Early Childhood Period of rapid growth Foundation for all later health Foundation for all later learning Biologic and social processes linked Critical role(s) of caring adults and community Finally, the successful models we have demonstrate the importance of integrated community based programs for providing children�s minds and bodies with what they need to develop fully. Finally, the successful models we have demonstrate the importance of integrated community based programs for providing children�s minds and bodies with what they need to develop fully.

23. Integration of Health Services with Early Childhood Access to Primary Care Well Child Visits ( for Immunizations) Injury Prevention Detection of Sensory Defects Dental Screening Speech/Language Assessments Behavioral Screening (ADHD, autism, withdrawal) Rapid Intervention From the Head Start and other experiences, here are the components of health that are necessary in an integrated process. There are many models for achieving this that we can talk about in the workshops. From the Head Start and other experiences, here are the components of health that are necessary in an integrated process. There are many models for achieving this that we can talk about in the workshops.

24. Successful Models Head Start Perry Preschool Project AbeCeDarian Brookline Early Education Project Now let me tell you about the successes. Now let me tell you about the successes.

25. BEEP Program Home Visits/Center Visits Language based curriculum Parents as first and best teachers Diagnostic Program Health screenings Developmental monitoring The Brookline Early Education Project is the one I know best..having worked there as the Health Consultant during the experiment. BEEP is one of the most completely evaluated of the programs. There were 3 intervention groups. A.B. and C and matched control groups. Of importance for the discussion here, the main difference in A, B and C was that there were many more services for A and B including home visits. The Brookline Early Education Project is the one I know best..having worked there as the Health Consultant during the experiment. BEEP is one of the most completely evaluated of the programs. There were 3 intervention groups. A.B. and C and matched control groups. Of importance for the discussion here, the main difference in A, B and C was that there were many more services for A and B including home visits.

26. 2nd Grade Findings Impact on behavior Impact on reading Differential effects To measure the effects of the BEEP, there was a major evaluation when the children were in 2nd Grade. There were clear impacts on behavior and on reading, but there were differential effects by socio-economic status (as measured by mother�s education).To measure the effects of the BEEP, there was a major evaluation when the children were in 2nd Grade. There were clear impacts on behavior and on reading, but there were differential effects by socio-economic status (as measured by mother�s education).

27. BEEP 2nd Grade OutcomeReading Difficulty Lets look at the reading findings for the children of highly educated parents. Twenty percent of a random control group of children had reading problems. For the BEEPgroup, there was a dose response effectLets look at the reading findings for the children of highly educated parents. Twenty percent of a random control group of children had reading problems. For the BEEPgroup, there was a dose response effect

28. BEEP 2nd Grade OutcomeReading Difficulty . The children in the least intense group had fewer concerns than the controls;. The children in the least intense group had fewer concerns than the controls;

29. BEEP 2nd Grade OutcomeReading Difficulty The moderate outreach group had fewer still, andThe moderate outreach group had fewer still, and

30. BEEP 2nd Grade OutcomeReading Difficulty Reading problems were nearly eradicated in the most intensive outreach group.Reading problems were nearly eradicated in the most intensive outreach group.

31. BEEP 2nd Grade OutcomeReading Difficulty The story was a little different for the children of the less well educated families. The impact of BEEP in this case was seen only among the intense and moderate services group. The story was a little different for the children of the less well educated families. The impact of BEEP in this case was seen only among the intense and moderate services group.

32. BEEP 2nd Grade OutcomeReading Difficulty There was no diminution of reading difficulties among the C or low intensity intervention group. Similar patterns to these were seen for behavioral concerns. There was no diminution of reading difficulties among the C or low intensity intervention group. Similar patterns to these were seen for behavioral concerns.

33. BEEPers at Age 25 Objective: To assess the health status and general well-being of young adults (age 25) who were enrolled as infants and children in the BEEP program in comparison with matched controls The BEEP young people have now grown up, come of age. Several of the staff who had worked together on the original studies, were fortunate enough to obtain funding from the Robert Wood Johnson Foundation to carry out a long term follow-up study, Our objective was to access the health status and general well being of the young adults who were enrolled as infants and young children in the BEEP.The BEEP young people have now grown up, come of age. Several of the staff who had worked together on the original studies, were fortunate enough to obtain funding from the Robert Wood Johnson Foundation to carry out a long term follow-up study, Our objective was to access the health status and general well being of the young adults who were enrolled as infants and young children in the BEEP.

34. BEEPers at Age 25 Outcomes Improved Educational Outcomes Improved Job Placement Improved Health Outcomes Improved Health Care Utilization Improved Mental Health Outcomes What pleased us all so much was the finding of long term HEALTH and MENTAL HEALTH benefits for the BEEP group. What pleased us all so much was the finding of long term HEALTH and MENTAL HEALTH benefits for the BEEP group.

35. So we can succeed. So we can succeed.

36. Propositions To improve the well-being of our children, we need to integrate educational, medical and public health approaches We need to address social, economic and cultural inequities We have models for doing this What stands in our way are: - Inadequate political will - Incompletely developed social strategies What gets in our way? What gets in our way?

37. Richmond Model Lets go back to Dr. Richmond�s model. He argues we need the 3 components of knowledge base, social strategy and political will in dynamic equilibrium. Lets go back to Dr. Richmond�s model. He argues we need the 3 components of knowledge base, social strategy and political will in dynamic equilibrium.

38. Lack of Political Will �Public�. �Other People�s Problem� �Public Health� equated with Poverty Problems that appear too difficult Successes not celebrated or remembered The Dangerfield Dilemma �After all it�s not rocket science� Often the big problem is lack of political will, but�.Often the big problem is lack of political will, but�.

39. Early Childhood/Chile 2006 There is strong Political Will The problem is seen as OUR problem A goal has been articulated And the work is going forward That is certainly not the case here now. That is certainly not the case here now.

40. Social Strategy Defining Constraints Defining Contributions Designating Clear Goals Identifying Players Articulating Responsibilities Evaluating Results Institutionalizing Success So the next steps of which this conference is playing a big part are: So the next steps of which this conference is playing a big part are:

41. Components for Success Health services including nutritional and oral health services Early childhood education Social services Parental involvement The goals for succeeding at the social strategy may be summed up in the components that the Head Start planners held so dear. The goals for succeeding at the social strategy may be summed up in the components that the Head Start planners held so dear.

42. Components for Success (cont.) Volunteer recruitment Local governance to implement �maximum feasible participation of the poor.� Training, technical assistance, evaluation, and research in collaboration with local institutions of higher education The goals for succeeding at the social strategy may be summed up in the components that the Head Start planners held so dear. The goals for succeeding at the social strategy may be summed up in the components that the Head Start planners held so dear.

43. The kids are well on their way. Thanks to all of you. The kids are well on their way. Thanks to all of you.