People living in place: Circumstances for early childhood development and learning

Professor Stephen Zubrick

CoLAb: Declaration for Young Children Telethon Kids Institute 27 November 2017

Setting the scene

• Increasingly high expectations for children
• Beliefs about early childhood enrichment, interventions – “early years”
• Downward pressure for identification of children in need

2

Setting the scene

• General neglect in policy and practice of
  • demographic characteristics of children (who)
  • applying a mix of policy prerogatives (what)
  • governance for local priorities/action zones (where)

3

Place-based thinking

Who, what, where?

• General neglect in policy and practice of

  • demographic characteristics of children (who)
  • applying a mix of policy prerogatives (what)
  • governance for local priorities/action zones (where)

• New research on the development of Australian children

  • Who should we look for?
  • What are the different policy prerogatives?
  • How are local priorities informed to govern well?

4

Developmental circumstances

There are known risks for poorer child development These risks occur in “batches” They don’t occur “one at a time” They define developmental circumstances These circumstances offer different ways of thinking about how to design intervention strategies

Developmental circumstances

Children and their families are exposed to varying numbers of risks that affect the level and the rate of child development

Developmental circumstances

Simply counting the number of risks conceals what happens with the level and rate of child development!

Knowing something about the type/nature of the risk opens avenues for policy considerations

Developmental circumstances

Developmentally enabled

46% of children are Developmentally Enabled N = 79,520 WA children 0-4 years

Their development is on time and robust

• Older mothers, more educated, smaller families, no multiple stresses
• Prevalent book reading

Policy prerogative

• Maintain developmental encouragements and opportunities
• Monitor population progress
• Provide light-touch universal interventions

Child development delay (months) by developmental circumstance

[Chart showing child development delay by age for Developmentally enabled (ref.)]

9

Developmental circumstances

172,871 children in WA aged 0-4 as at 30 June 2016

• Developmentally enabled (ref.) 46% = 79,520
• Working poor 20% = 34,574
• Overwhelmed 10% = 17,288
• Developmental delay 9% = 15,558
• Low human capital 8% = 13,830
• Resource poor NESB 7% = 12,101

(~36,300 births per year)

Developmental circumstances

• Developmentally enabled (ref.) 46% = 79,520
• Working poor 20% = 34,574
• Overwhelmed 10% = 17,288
• Low human capital 8% = 13,830

(~36,300 births per year)

Developmental circumstances

Overwhelmed

17,288 Western Australian children 0-4 years

• Very low maternal education, unemployment
• Low income, health care card, area poverty
• Maternal mental health distress
• Very low school readiness

Policy prerogative

• These families are readily identifiable
• They have diminished capabilities to use existing services
• They require early, repeated, sustained developmental support – delivered differently (e.g. Child and Family Centres)

Child development delay (months) by developmental circumstance

[Chart showing child development delay by age for Overwhelmed and Developmentally enabled (ref.)]

13

Child development delay (months) by developmental circumstance

At this rate of improvement it would take overwhelmed children 13 years to achieve the same outcome as those developmentally enabled children.

[Chart showing child development delay by age for Overwhelmed and Developmentally enabled (ref.)]

14

Developmental circumstances

Low human capital

13,830 Western Australian children 0-4 years

• Lowest income quintile exclusively – deep, persistent disadvantage
• Teenage mothers, low maternal education, unemployed
• Healthcare card

Policy prerogative

• Family planning
• Maternal education/training opportunities linked with enriched early education and child care

Developmental circumstances

Working poor

34,574 Western Australian children 0-4 years

• parent(s) are employed, 45% are in 4th quintile of income ($600-999 per week)
• Larger families, Low maternal education
• Area disadvantage
• Families that are cash poor and time poor

Policy prerogative

• Family benefit increases/better pay/parent education, training
• Enriched early education and child care
• Family friendly workplace arrangements and services

Child development delay (months) by developmental circumstance

[Chart showing child development delay by age for multiple developmental circumstances]

17

Summing up

Children are not rockets

Helping vulnerable children develop faster than their typically developing peers is a huge task

It requires changing two aspects of their development:

• Where they start relative to typical children
• How rapidly they grow relative to typical children

Summing up

• The research evidence firmly establishes what works in providing early prevention and child development opportunities – most intervention effects are very small
• We don’t know how to get these opportunities nearer to the individuals that want or need them – it’s about effectiveness
• Place-based initiatives are intuitively sensible - can governance arrangements change how things get arranged, located, and close to “wants and needs”?

Summing up

• Be sure people/agencies/leaders/users actually know the developmental circumstances of their local child population (how many children are in this area, zone, community, place?)
• The numbers of children you are targeting really matter – scale, effort, impact!
• Think about the size of the population of children 0-4 years before you design intervention strategies
• Universal services are important – quality and reach

Appendix

Supplementary slides

Thank you

Developmental circumstances

Developmental delay

15,558 Western Australian children 0-4 years

They will enter the system at any age

• generalized developmental delay and/or disability with low school readiness
• Children have high reactive temperament and low persistence
• low parenting consistency with increased maternal psychological distress
• low maternal education

Policy prerogative

• Require regular developmental monitoring and support services over an extended period

Developmental circumstances

NESB – resource poor

12,101 Western Australian children 0-4 years

• Migrant and refugee background
• Maternal mental health distress, Low employment, low income, area disadvantage
• Low book reading

Policy prerogative

• Monitor their progress
• Provide family support and pathways to child development services
• Cultural appropriateness

Child development delay (months) by developmental circumstance

(Graph showing child development delay by developmental circumstance across age in years, with lines representing Developmentally enabled (ref.), Working poor, Overwhelmed, Developmental delay, Low human capital, and Resource poor non-English speaking)

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Inquiry into child development services WA

Prepared by: Ngala
Date: 25 October 2022

Contents

• Executive Summary

• About Ngala

• How child development services impact on a child’s overall development, health and wellbeing

• Opportunities that exist to increase engagement in the primary care sector including improved collaboration across both government and non-government child development services

• How child development service models and programs outside of Western Australia could be applied in Western Australia

• References

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Executive Summary

The following submission provided by Ngala addresses the following points of the Select Committee into Child Development Services;

‘How child development services impact on a child’s overall development, health and wellbeing’

‘What opportunities exist to increase engagement in the primary care sector including improved collaboration across both government and non-government child development services’

‘How child development service models and programs outside of Western Australia could be applied in Western Australia.’

About Ngala

Ngala is Western Australia’s leading non-government provider of early parenting and early childhood services, from pre-birth up till early adulthood (0-18 years of age). At Ngala, we believe every child deserves the opportunity to be their best and that raising children should be a joyful and rewarding experience for all.

Ngala has a passion for supporting and guiding families and young children through their journey of parenting. With 130+ years of working with families across Western Australia, Ngala continues to use the latest research and training alongside community stories and experiences, to develop and deliver services that meet the needs of today’s parents and children.

At Ngala, our purpose is to support parents, families, and communities to enhance the well-being and development of children and young people.

Ngala welcomes the opportunity to provide this submission as part of the inquiry into child development services, especially given how aligned our history, approach and service delivery methods are with achieving the best possible outcomes for child and parent development.

Ngala’s key focus is to hold the child at the center of everything we do. Having this valuable opportunity to shine the light on the importance of early intervention and to promote seamless, no wrong door access to child development services, will go some way to reduce the impact of delays on a child’s overall development, health and wellbeing.

Innovative, evidence-based interventions are required to increase access to effective care and support. If we work to reduce stigma and reduce the gap between population need and effective intervention, we will go some way to lessening the gap currently experienced. Low cost or no cost access to services and supports ensures that all communities have the opportunity to receive the right service at the right time thereby avoiding the current unacceptable wait lists and time delays, causing increased negative developmental impact and potential health and wellbeing outcomes.

The Hon. Donna Faragher MLC in her Parliamentary Motion on 31st August 2022, expressed the need to implement the Select Committee, stating “When a child is not hearing properly in the classroom, they are not learning; it is as simple as that. When a child is having difficulty with their speech and language, and they are having difficulty communicating, that will have an impact. It will impact on how they communicate with their family and how they interact with their teachers. It will impact on their ability to make friends in the playground. It is really hard for these kids, and it should not be. I do not accept, and I do not think anyone in this house accepts, that it is okay that thousands upon thousands of kids in Western Australia are on these waitlists”.

In support of the motion, Ngala provides the following responses to the points raised.

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How child development services impact on a child’s overall development, health and wellbeing

Research from Harvard University’s Center on the Developing Child and other international studies teaches us that for babies and infants to develop to their full potential at all stages of their life, babies require strong minds and bodies, and families that provide loving, supporting environments in which to grow. Secure, nurturing and responsive relationships between parents and their babies are a crucial ingredient in the healthy brain development necessary for children to thrive.

In Australia 30% of new mothers are subjected to difficulties in taking care of their newborns in regard to sleep, breastfeeding and settling during their early stages of parenthood (Priddis et.al 2018) Moreover because of the stress from the added exhaustion, physical and psychological changes, new mums are exposed to mental health issues such as anxiety and depression that can have both short- and long-term impacts on both the new born child, individual parents and family units more broadly. Evidence suggests that there is a strong correlation between these issues with infant and mother attachment (Lupien et. al 2019)

Without these relationships and supportive environments children can and do experience significant mental and developmental challenges. For example, a 2020 Bankwest Curtin Economic Centre report found that:

• 16% of toddlers in Western Australia had socio-emotional competence problems, 24% had behavioural problems and 20% had delayed language development. These numbers increased alarmingly to an estimated 44%, 44% and 40% respectively if the infant was growing up in an environment of limited or no parental affection or engagement.
• Approximately 30% of toddlers from households living in severe poverty were estimated to have delays in language development, twice as prevalent as those not living in poverty.
• 50% of children living in the most disadvantaged areas in Western Australia are developmentally vulnerable on two or more domains, compared with national average of 11%.

These statistics demonstrate that the current Child Development Services are not effective. It further highlights the impact a family’s economic position and post code is having on the developing child.

In 2017 Professor Stephen Zubrick presented at the CoLab: Declaration for Young Children1 research demonstrating how demographic circumstances, impact the developmental circumstances of the developing child. He further provided evidence explaining how these demographic circumstances, when considered to achieve best outcomes, offer different ways for government to design intervention strategies and determine policy prerogatives.

While these findings are based on data from 2016 it is clear from the Bankwest Curtin Economic Centre report (2020) that the developmental circumstances haven’t improved they have potentially worsened.

Prof. Zubrick’s research, based on the 30 June 2016 figures of 172,871 children in WA aged 0-4 years, showed that 46% of children (0-4years) are developmentally enabled – meaning their development is on time and robust – for government the policy prerogatives here would be to maintain developmental encouragement and opportunities and provide light touch universal interventions.

1 https://colab.telethonkids.org.au/SysSiteAssets/media-docs—colab/colab––evidence-for-the-australian-declaration-for-young-children-final-for-uploading.pdf

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However, this is not the same for other demographics. The following table of ‘Developmental Circumstances’ shows the research statistics. (for the full presentation please see Appendix 1).

Early intervention, regardless of which developmental circumstance, must start in the antenatal period of an infant’s life.

Perinatal Infant Mental Health (PIMH), covering the emotional and psychological wellbeing of babies and their parents from conception through the first 1000 days of life, acknowledge that the wellbeing of parents and babies is intrinsically interdependent. Unfortunately, this critical nexus between infant and parental mental health and physical health is too often not considered as a whole, with services focused on either the baby or the parents in isolation of each other. It also does not factor in the role that Community can play in supporting families with a peer-to-peer approach – an environment that is often ‘less scary’, more comfortable for parents without fear of being judged – often by the very system that they believe has previously ‘let them down’.

The massive benefits associated with Early Intervention in child development cannot be understated in this inquiry. Not only from the aspect of achieving strong child, parent and family outcomes, but also on the fiscal impact to the broader economy with early intervention investment reducing the need to later in life intervention at a more costly and often broader scale.

The delays that parents and families are experiencing in accessing appropriate supports is causing significant impacts to the overall development including neural development, health, and wellbeing of WA children. This in turn highlights the importance of early access to child development services — including paediatric and allied health services.

A report released in 2016, How Australia can invest in children and return more: A newlook at the $15b cost of late action, clearly articulates that supporting children and young people is a social and economic priority. Early intervention is known to improve the lives of children and young people whilst at the same time, strengthens our communities, while reducing pressure on government budgets, enabling more efficient and effective spending.

Stepping in early to provide evidence-based support for parents, children and young people can make a significant difference in children’s lives and will likely reduce demand for high-intensity and crisis services over time.

The report explains that Early intervention works by:

• preventing problems occurring in the first place
• tackling problems holistically and assertively when they first arise, before they get more difficult to resolve
• fostering the strengths and skills that ensure children and young people have the best opportunity to thrive and can participate in, and contribute to, their communities.

Whilst it is unlikely that increased spending and focus on early intervention will eliminate all spending on late intervention, it will go some way to reducing the intricacy of some of the complexities that

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may be experienced in later life. There will always be a need for intervention strategies so there must be resources in place to respond effectively and support parents, children and young people overcome challenging times throughout their lives. However, the number of children and young people reaching crisis or significant difficulties demonstrates the system is not preventing issues from escalating, nor is it adequately responding when they first need help.

A broken system

Currently, the WA system adopts a reductionist view to the complex needs of families during pregnancy and the early years of life. This has resulted in a fragmented approach to supporting the emotional wellbeing of babies and their families and a lack of appropriate Perinatal Infant Mental Health (PIMH) clinical services.

The ‘Better Together’ study (2019) revealed that families seeking help during pregnancy and in the early years of a baby’s life are fearful of being judged when talking to a professional about their mental health. Families stated that they often experienced disrespect and a lack of compassion when interacting with service providers. This experience may be exasperated if the parent believes that the broader ‘system’ has somehow let them down previously – maybe removing a family member, reducing payments or access to appropriate services.

PIMH clinical services aim to meet the needs of families experiencing significant adversity, including infant difficulties, parental mental ill-health, parental substance abuse, family and domestic violence and trauma. Sadly, many of the families most in need of PIMH services are also economically vulnerable and require low-cost, if not no cost, access to services.

Whilst there are some government, community and private practices offering PIMH services, highly vulnerable families struggle to access no cost or low cost specialised PIMH community services in WA. Unfortunately, where a baby is born, and the parent’s income level, determines the PIMH services a family is able to access and receive. There are also limited services to families, ‘at risk’ or with complexity, for whom early detection and prevention efforts could reduce unnecessary suffering and avert the need for more costly clinical, tertiary services.

The psychosocial needs of families outstrip available service provision. Evidence based interventions are scarce, less likely to be available to, or accessible by, families who are vulnerable or living with disadvantage. (Cassells R. et al 2020).

With parents and children currently experiencing excessive waiting times to access specialised care and allied health support, there is a gap in service provision that can be met by child development services. Families need choice. There is the ability to better utilise Child Parent Centres across the state in order to support parents navigate through the often-complex systems whilst also offering parents the opportunity for to enter a ‘safe’ space to gain support, a place where they do not feel judged, a place that is not considered as part of ‘the system’ a system that they believe causes them more harm. Parents who feel judged and not ‘safe’ to be a parent lends parents to not getting babies checks done, no hearing tests completed, or health concerns followed up at an early stage. Going into a CPC that is familiar, where a child health nurse comes to you enables parents to be more relaxed to openly discuss concerns and be supported to follow up with the required interventions and health checks.

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Opportunities that exist to increase engagement in the primary care sector including improved collaboration across both government and non-government child development services

Australia’s National Framework of Universal Child and family care services identified key services all Australian families ought to receive with no incurred costs regardless of the location, living standards or how much of other health services they are utilising. This framework discusses universal healthcare made accessible to families and children starting from birth to eight years of age all the while concentrating on the needs and requirements for specialist services for children with additional needs (National Framework for Universal Child and Family health services, 2011).

Bring child development services to the table! The request and subsequent demand to increase engagement in the primary care sector including improved collaboration across both government and non-government child development services is not new. The sector has been demanding it.

Increased engagement across the primary care sector is part of the solution – the importance of government and non-government organisations working together as equals is paramount to successful outcomes being achieved.

The state needs to be comfortable with the fact that it does need the support of the sector and to stop trying to take back control and manage systems and services that are not ultimately supporting the development of healthy babies, parents, families and communities. Working in partnership with organisations who hold specific focus and specialized skill sets will only enhance the outcomes experienced by parents and young people.

Raising the profile and need through inquiries such as this one, will go some way to increasing collaboration and engagement. Prior to COVID, Child Wellbeing was considered a government priority and held its place on the State Government Agenda with a working group at the Supporting Communities Forum. This forum was ceased during COVID and when it did resume new priorities were set and child well-being was dropped from the list of priorities. It is imperative that Government brings Child Wellbeing back on the State Government Agenda, this must become and remain a priority.

Increased engagement and collaboration between Government and non-government sectors, will allow for the experts in the field to be heard. It will raise the opportunities that exists to bring about the change needed. No one sector, organisation or initiative can meet the challenge of creating large scale, positive change for all children. We all have a role to play.

How child development service models and programs outside of Western Australia could be applied in Western Australia

As mentioned previously, the WA system currently adopts a reductionist view to the complex needs of families during pregnancy and the early years of life. This has resulted in a fragmented approach to supporting the emotional wellbeing of babies and their families Residential Parenting Services, offered in all states of Australia are ideally placed to be part of the solution to this gap. RPS’s identify early indications of parental mental health issues, parental stress, postanal depression and anxiety. Parental mental health concerns (including perinatal depression, anxiety and stress) and factors that affect the mother-infant relationship (such as maternal distress, parent-child dysfunctional interactions, difficult child characteristics/behaviours and lower parenting confidence) can adversely affect mothers, and their infants and the quality of dyadic interactions. A powerful component of RPS is the role it takes of supporting families to navigate through the myriad of supports they may require.

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A Residential Parenting Services (RPS) study carried out in NSW showed that 83% of the women were admitted for sleep and settling (Priddis et.al 2018). Besides adjusting to the baby (73%), RPS Services also helped mothers get over fatigue exhaustion (84%), traumatic pregnancies (16.5%) and family issues (4.0%) by providing continuous help through a team of GPs, Nurses, Social Workers, Psychiatrists and Psychologists (Priddis et.al 2018).

One example of service models and programs outside of Western Australia is that of Residential Parenting Services - which help to close the gap by providing the highest quality, evidence-based care with a focus on prevention and early intervention addressing the serious cases in which the infant difficulties are the primary reason for referral, in contrast to Mother Baby Units that focus on the mental health of the mother only.

WA is the only jurisdiction where universal access to RPS is not available, that is, it does not provide families with equitable and universal access to RPS. Aside from funding by the Department of Communities ($1.9Mpa), which relates to supporting parents who are at risk of their baby/infant being taken into care of the Department, Western Australia government does not support universal access to RPS as there is currently no budget allocation for non-financial/uninsured families in need of this critical service.

At a time where both public and private allied health and perinatal specialist (?) waitlists have exploded across WA, only families who meet a key criterion or are from certain postcodes or with specific financial means, have the ability to access the very support that is considered the most appropriate and essential at that time and during the first 1000 days of a baby’s life.

Other Jurisdictions

As an example of the inequitable approach, in NSW where there are two service providers Karitane and Tresillian, the NSW Dept. of Health funds Tresillian’s operating costs of circa $23M per year which includes $16M for 63 adult beds and 63 infant beds along with a further $7.2M ($600,000 for each of the twelve (12) day centres).

Similarly, Victoria Dept. of Health provides $3.9M per year of recurrent funding for the delivery of RPS in an 18-bed facility and 8 day stay beds.

A further example that the previous Federal Government saw value in is the ForWhen program which is a National Perinatal Infant Mental Health – Connect and Care Program (NPIMH-CCP). This is a consortium of members of the Australasian Association of Parent and Child Health (AAPCH) 2

2 AAPCH is a national organisation of agencies providing early parenting services including centre based residential and community outreach model of care We are experienced PIMH service providers, with services that are family-centered, strengths based, inclusive, multi-disciplinary, evidence based, and outcomes focused. Our PIMH services focus on attachment relationships as an essential component of early parenting and early brain development in the infant.

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(including Ngala for WA) and Parenting Research Centre and UNSW Academic Child Psychiatry South West Sydney.

ForWhen is a transformative care and navigation system that provides a comprehensive stepped continuum of care for parents experiencing moderate /severe PIMH concerns, supporting them to navigate the complex and fragmented PIMH service landscape.

A no-stigma intake service leverages existing pathways (no wrong door approach) to ensure parents are referred to the right intensity of services that best match their support needs. Care navigators provide active case coordination to support the parent to access appropriate services, in a trauma informed and culturally safe way.

The NPIMH navigation model of care’s principles of practice could be translated into a similar model of care for WA Child Development services and would result in a cohesive, joined up, child-centered, family friendly model that places the child’s outcomes at the centre of the service.

The NPIMH-CCP Care navigation is an evidence-based model designed to support better access to services and was drawn together from a range of resources including NSW Agency for Clinical Innovation Care Enablement Guide and NHS Care Navigation Competency Framework.

Investing in the emotional and physical health of infants and families is committing to a healthier, more creative and more productive Western Australia and will impact on the resilience of our State for the next 100 years.

The fact that there are many Western Australian parents traveling interstate for diagnosis and prescriptions that aren’t recognized in WA, out of pure desperation for a better life for their children is not ok. We must work together to create the environment that enables all parents and children to access appropriate services in a more times, appropriate way.

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Appendix 1.

Please see PDF Power Point attachment -

People living in place: Circumstances for early childhood development and learning Professor Stephen Zubrick CoLAb: Declaration for Young Children Telethon Kids Institute 27 November 2017

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References

• A FrameWorks Map the Gaps Report
  L’Hôte E., Hendricks R., Volmert A., Kendall-Taylor N.
• Cassells R., Dockery M., Duncan A., Kiely D., Kirkness, M., Nguyen T., Seymour, R., and Twomey C., (2020), ‘The Early Years: Investing in Our Future, Focus on Western Australia Report Series, No. 13, August 2020
• Cultivating Nature
  Mapping the Gaps Between Expert and Public Understandings of Early Development in Australia, February 2019
• How can Australia invest in children and return more, 2016
  https://colab.telethonkids.org.au/SysSiteAssets/media-docs—colab/coli/full-report-how-australia-can-invest-in-children-and-return-more—final.pdf
• National Framework for Universal Child and Family health services, 2011
• People living in place: Circumstances for early childhood development and learning
  Professor Zubrick S.
  CoLAb: Declaration for Young Children, Telethon Kids Institute
  November 2017

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