early years health and development - improvement science works in populati…
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Early Years Health and Development - Improvement Science works in Population and Public Health Mary Smillie
This Session is sponsored by:
Early Years Health and Development Improvement Science in Population and Public Health
Presentation and Discussion at Inspire Conference, April 10, 2013 Dr. Julie Kryzanowski, Saskatoon Health Region & Mary Smillie, Improvement Advisor
Needed to define a path forward
Need: Improve outcomes for 0 -5 year olds. Challenge: Time Opportunity: Child Health Report Interest: Improvement Science
Went looking for help
Health Promotion Manager Tanya Dunn-Pierce called Mary Smillie.
• Public Health
• Health Promotion
• Improvement Science
How could improvement science help?
• Leadership team
• Project team
• Content Consultants Engaged Leadership
Five Dedicated Staff plus Mary
3 Month Focus and Finish
DMAIC – define, measure and analyse
The Early Years Health and Development Project Team
Weekly Meetings As needed and twice as a group
Every two weeks Through PDSAs, focus groups, one to one meetings
http://www.youtube.com/watch?v=GbSp88PBe9E&feature=related
Video – Change the First Five Years and You Change Everything
Neighbour Discussion
• What do you think needs to be done to improve health and development outcomes for small children?
(5 minutes)
Health Inequities Exist Among Children
• Saskatoon Health Region
children generally healthy, but
• Many indicators revealed
health inequities by
neighbourhood and Registered Indian Status – Almost 25% of the children in
Saskatoon lived in areas of
highest deprivation
Early Years Report
Early Years Report
Socioeconomic Status
Ethnicity
• Birth rates of the RIS
population is up to three times higher than the non-
RIS population (33.4
compared to 12.3 in 2009)
• Higher rates of: – Preterm births (10.5% vs.
7.1%)
– Low and high birth weights
– Teen pregnancy (160.5 vs.
23.5 per 1,000)
– Vulnerable IHBQ score (70.3
vs. 27.7%)
Early Years Report
Readiness to Learn
Based on Early Development
Instrument (EDI)scores across
the five key domain areas:
• Physical health & well-being
• Social competence
• Emotional maturity
• Language & cognitive
development
• Communication skills &
general knowledge
Early Years Report
What we learned through the project:
A life course perspective Health trajectories are the pathways that individuals follow from a health perspective.
These pathways evolve over time, and the directions taken depend on individual actions, as well as the circumstances and conditions experienced throughout life.
Impacts of Poverty on Marginalized Groups
MCH Life Course Toolbox: www.citymatch.org/lifecoursetoolbox
Adverse experiences in childhood
Parents view of help available
Parents and CBOs
Many agencies with mandate for children
What we learned about Canadians
• So many programs exist to reduce isolation – single family dwellings
• Parents connect with each other through scheduled appointments – play dates
• Ideal community size is walkable, services and basic household commodities available
Dr. James Heckman
• Economist
• Nobel Laureate
• University of Chicago
http://www.heckmanequation.org/content/resource/why-early-investment-matters
Video – Why Early Investment Matters
The Heckman Equation
“One dollar spent in the early years is estimated to save between $3 and $9 in future spending on health, social and justice services.” Grunewald, R. & Rolnick, A. (2006), from The Chief Public Health Officer’s Report on The State of Public Health in Canada 2009
Neighbour discussion
• What to do?
• 5 min
Aim, Measures and Strategies
• Less than 18% EDI by 2018
• Measurement infrastructure
• 25 Recommendations
– Support parents
– Invest in early years
– Act as one system
Measures for Early Childhood
In-Hospital
Birth
Questionnaire
Early
Development
Instrument
Bookends of Early Childhood
Community Risk Indicators
What is the community like where children are growing up?
% teen
mothers
% low
birth
weights
% Social
Assistance
Program
recipients
% of housing
in need of
major repair
% of adults
with low
education
% lone
parents
Prenatal Birth Age 1 Age 3 Age 2 Age 4 Age 5 Age 6
Grade 1 –
Mandated
school
attendance
Kindergarten
Entry
RECOMMENDATIONS
Encourage and
Support Health
Sector Action
Develop and Implement a
Provincial Early Childhood Health
and Development Strategy
1. Agreement on a key goal = “18 by 18”
2. A focus on family needs
4. Commitment of targeted investments
5. Robust monitoring tools
1. Deliver family-centred,
accessible, integrated
services.
2. Bolster health promotion
and protection, illness and
injury prevention efforts
3. A holistic approach for improving the
health and development of First Nations
and Métis children
3. Work with partners to better
protect children from
environmental health risks
Learning from Quality Improvement
What worked well:
• Engaged leadership with questions
• Dedicated staff and dedicated time
• Focus and Finish
• Plan Do Study Act cycles
• Engaged parents and community agencies
• Mapping
• Compelling data
• Elegant design for learning
Even better if:
• More time prior to getting started
• More time to develop trust and relationships with First Nations and New Canadian parents
Much better when:
We achieve EDI scores less than 18% by 2018 When we set a new aim for EDI less than 10% and achieve it. A child born to any family anywhere in Saskatchewan has the same opportunity for success as the next child born.
Thank you!
For more information contact: Dr. Julie Kryzanowski julie.kryzanowski@saskatoonhealthregion.ca Or Mary Smillie msmillie@sasktel.net
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