amchp 2005 conference transition to early childhood marie c. mccormick harvard school of public...
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AMCHP 2005 Conference
Transition to Early Childhood
Marie C. McCormick
Harvard School of Public Health
February, 2005
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AMCHP 2005 ConferencePathways for Environmental Effects
on Neurodevelopment• Parental Processes
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AMCHP 2005 ConferencePathways for Environmental Effects
on Neurodevelopment• Parental Processes
– Parental physical and emotional health– Provision of stimulating experiences in the home– Parental sensitivity– Parental harshness
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AMCHP 2005 ConferenceModel for Effect of Socioeconomic
Factors
Mat. Ed
EarningsFinancial Strain
Depressive Sx
Social Support
Parenting
Outcomes
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AMCHP 2005 ConferencePathways for Environmental Effects
on Neurodevelopment• Parental Processes
• Neighborhood Processes
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AMCHP 2005 Conference
Neighborhood Processes
• Resources for Parents
• Relationships
• Norms or Collective Efficacy
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AMCHP 2005 ConferencePathways for Environmental Effects
on Neurodevelopment• Parental Processes
• Neighborhood Processes
• Child Care Processes
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AMCHP 2005 Conference
The Infant Health and Development Program
An Example of Child Care Processes
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AMCHP 2005 ConferenceIHDP
Intervention Follow-up
Mediating Variables
ChildOutcomes
SecondaryEffects
Intervening Variables
ChildOutcomes
SecondaryEffects
PHASE
1
PHASE
2-4
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AMCHP 2005 Conference
Study EnrollmentScreened for Enrollment : 4551
Protocol Exclusions -3249
Eligible for Recruitment: 1302Refused Consent -274
Randomized: 1028Withdrawn:
-43Primary Analysis Group: 985
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AMCHP 2005 ConferenceReasons for Exclusion
(n=3249)
7%
19%
7% 20%
47%
Out of Area
Death
Ges Age >37
Med Excl
Other
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AMCHP 2005 ConferenceIHDP
985LBW,PT Infants
Interventionn=382
Follow-upn=623
MediatingVariables
ChildOutcomes
SecondaryEffects
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AMCHP 2005 ConferenceIHDP
InterventionFU ServicesHome Visits
Child Dev. Ctr.
Parent Supp.Grp.
Follow-upFU Services
Mediating Variables
Child Outcome Secondary Effects
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AMCHP 2005 Conference
Content of IHDP• Follow-up Services
(Every 3-6 Months)Frequent Health and DevelopmentalSurveillanceReferral for Health and Social Services
• Home Visits(Every week until 12 mons.then every other week)Partners for Learning CurriculumParent Problem SolvingSocial Support
• Child Developmental Centers
(5 days/week, 8 hours/day, 12-36 months)
Partners for Learning
• Parent Support Groups
Parent Education
Social Support
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AMCHP 2005 ConferenceIHDP
INT FU
MED VARS
Child OutcomesCognitive Development
(IQ)
SE
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AMCHP 2005 ConferenceCognitive Outcomes of IHDP at Age
8-Total
78
80
82
84
86
88
90
92
94
Age3-SB Age5-WPPSI Age8-Wechsler
IntFU
(SB=Stanford Binet, WPPSI=Weschler Preschool)
p<0.05
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AMCHP 2005 ConferenceCognitive Outcomes of IHDP at Age
BWT=2001-2500
75
80
85
90
95
100
Age3-SB Age5-WPPSI Age8-Wechsler
IntFU
(SB=Stanford Binet, WPPSI=Weschler Preschool)
* * *
*p<0.05
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AMCHP 2005 ConferenceSchool Achievement Scores at Age 8
in IHDP
88
90
92
94
96
98
100
102
104
T-rd T-ma H-rd H-ma L-rd L-ma
INTFU
p<0.05
T=Total,H=Bwt 2001-2500,L=BWT<=2000,rd=reading,ma=math
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AMCHP 2005 ConferenceIHDP
INT FU
MED VARS
Child OutcomesBehavior
SE
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AMCHP 2005 Conference
Behavioral Outcomes of IHDP-Total
05
101520253035404550
Age 3 Age 5 Age 8
INTFU
Parental Report on the Achenbach
**p<0.05
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AMCHP 2005 ConferenceIHDP
INT FU
MED VARS
Child OutcomesHealth Status
SE
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AMCHP 2005 ConferenceMEAN REPORTED MORBIDITY INDEX
IHDP Intervention and Follow-up Groups, 36 months
0
2
4
6
8
10
12
IntFU
<=2000g
2001-2500g
Mean(S.D.)ReportedMorbidityIndex
N.S.p<0.001
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AMCHP 2005 ConferenceOTHER HEALTH STATUS MEASURES
IHDP Intervention and Follow-up Groups, 36 months
Measure
Reported Serious Morbidity Index NSStein Functional Status Scale NSGrowth NS Length NS Body Mass Index NSGeneral Health Ratings Scale NS
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AMCHP 2005 ConferenceIHDP
INT FU
MED VARS
Child Outcomes
Secondary EffectsHealth Services
Use
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AMCHP 2005 ConferenceMEAN NUMBER OF DOCTOR VISITS
IHDP Intervention and Follow-up Groups, 36 Months
0
5
10
15
20
25
30
35
40
45
50
INTFU
Mean(SD)ofDoctors Visits
<=2000g 2001-2500g
p=0.04
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AMCHP 2005 ConferenceIHDP
INT FU
MED VARS
Child Outcomes Secondary EffectsMaternal Outcomes
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AMCHP 2005 ConferenceCHILD AGE AT MATERNAL ENTRY INTO WORKFORCE
IHDP Intervention and Follow-up Groups
0
10
20
30
40
50
60
70
80
90
0 5 10 15 20 25 30 35
IntFU
% Employed
Child Age (mons.)
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AMCHP 2005 ConferenceOTHER MATERNAL OUTCOMES
IHDP Intervention and Follow-up Groups
• Subsequent Child-bearing NS
• Further Educational Attainment NS
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AMCHP 2005 Conference
Early Intervention
• Modalities– Home visiting– Center-based
• Activities– Education/Developmental stimulation– Therapeutic (PT, OT, etc.)– Parenting skills to prevent abuse
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AMCHP 2005 Conference
Early Intervention
• Target Populations– Socially disadvantaged infants– Infants with identified neurodevelopmental
disabilities– Low birth, premature infants.
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AMCHP 2005 Conference
Early Intervention for Disabled
• 53 Studies
• Criteria for Enrollment– <36 months of age– Principal problem was not poverty– Child in home/foster care
Shonkoff, 1987
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AMCHP 2005 Conference
Summary of Meta-analysis
Category of Disability
#Studies Effect (SD)
All 46 0.62
MR 29 0.42
Dev. Delay 20 0.70
Mixed 24 0.94
Shonkoff, 1987
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AMCHP 2005 ConferencePerry Preschool Study:
Economic effects at age 27
Source: http://www.highscope.org
0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
Never on welfareas adult
Own home
Earn $2,000+monthly
Program groupNo program
7%
29%
36%
13%
41%
20%
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AMCHP 2005 ConferencePerry Preschool Study:
Mean number of arrests by age 27
0 1 2 3 4 5 6
No program
Program
Number of arrests
FelonyMisdemeanorJuvenile
0.7 1.2 0.5 2.3 arrests
1.5 2.5 0.6 4.6 arrests
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AMCHP 2005 ConferenceAbecedarian Project: Reading scores at 8, 12, 15,
and 21 years by preschool group
80
85
90
95
100
8 years 12 years 15 years 21 years
Stan
dard
ized
sco
re
Treatment
Control
Note: Standardized reading scores as measured by the Woodcock-Johnson.Source: Campbell, Ramey, Pungello, Sparling, & Miller-Johnson, in press.
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AMCHP 2005 ConferenceAbecedarian Project: Mathematics scores at 8, 12,
15, and 21 years by preschool group
80
85
90
95
100
8 years 12 years 15 years 21 years
Stan
dard
ized
sco
re
Treatment
Control
Note: Standardized mathematics scores as measured by the Woodcock-Johnson.Source: Campbell, Ramey, Pungello, Sparling, & Miller-Johnson, in press.
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AMCHP 2005 Conference
Conclusion
• Post-natal environment is a powerful predictor of child outcomes, for all children
• Evidence is increasing that early childhood interventions can improve outcomes for children at risk for a variety of reasons
• Intensive programs may have lasting effects