The problem
Interpersonal experience is the primary influence on brain development in early life [1–3]. Caregivers therefore have a critical role in brain activation and must provide nurturing, protective, secure and consistent relationships to ensure a young child’s optimal development [4–6]. Exposure to physical, emotional and/or sexual abuse and traumatic experiences early in life may have profound adverse effects on brain development including emotion regulation capacities and ability to cope with stress [7, 8]. Entrenched neglect can impair all aspects of young children’s growth and development [9–12].
Disruption to brain development affects the ability to learn, with recent studies for example showing that self-regulation is linked to the development of literacy and numeracy skills [13]. Gaps between children in the development of cognitive and social skills early in life are likely to become entrenched in later years. This happens because skill development is dynamic and hierarchical. Children who miss out at an early age lack the necessary building blocks and foundation for subsequent learning [14, 15].
Deficiencies in cognitive and social skills that develop before the age of five are likely to become the basis of problems such as low education attainment, unemployment, teenage pregnancy, and involvement in crime. There is also some evidence that children with this background of neglect and abuse cause negative spill-over effects on learning to other children without that background with whom they associate [16]. The consequences of neglect and trauma extend to health. Early adversity has been linked to a variety of health-threatening behaviours in adolescence and adulthood [17]. It also has been shown to cause physiological disruptions that persist into adulthood and can lead to disease; an example is alterations in immune function [18, 19].
Approaches to dealing with the problem
A variety of early years education and care programs targeted at increasing the human capital of disadvantaged children have been implemented. These programs have consisted primarily of intensive early years education and care and/or home visiting and parent education [20], pp41-51].
Notable examples are the Perry Preschool program and the Abecedarian Project [21], pp.115-16]. The Perry program provided one to two years of part-day education and weekly home visits for low-IQ African American children aged three to four years living in low-income households in Ypsilanti, Michigan, during the 1960s. The Abecedarian program provided year-round full-time center-based care for five years, starting from the first year of life, for mostly African American children from low-income households from Chapel Hill, North Carolina.
Programs that increase the human capital of children from disadvantaged backgrounds can benefit those individuals, and reduce inequality in childhood human capital development. Summary evidence on the impact of early years interventions is available from a meta-analysis of 84 studies of outcomes from programs implemented between the early 1960s and mid 2000s. Only studies that met minimum standards for quality of research methods were included in the review. The meta-analysis found an average effect size on cognitive and achievement scores of 0.35 standard deviations at the end of the treatment period. This effect decayed at a rate of 0.03 standard deviations per year after the end of treatment. Less evidence is at present available to evaluate the effect of early years programs on non-cognitive or behavioural outcomes; and findings are mixed [21]. Other reviews of studies of early years programs obtain similar findings, with somewhat stronger evidence for effects on behavioural outcomes [20, 22–26].
Early years interventions can also provide spillover benefits for society. By increasing the human capital of children from disadvantaged backgrounds, future expenditures that a society might otherwise be required to make are avoided [20], pp. xxiii-xxiv]. Endowing children with higher levels of skills is likely to improve their school outcomes, meaning that less money needs to be spent on remedial education services such as repeated grades or special education classes. Where better school performance brings a higher level of educational attainment and improved labour market outcomes, then the government may benefit from higher tax revenues and reduced outlays for social welfare programs. Furthermore, staying longer in education and a greater likelihood of being in employment will reduce contact with the criminal justice system and the costs that would otherwise be incurred by government. Studies of the benefit-cost to society of early years interventions have generally found positive outcomes. For example, a recent review of the Perry program found an internal rate of return of 6–10 percent [27]; and an earlier summary of findings from studies of several programs found benefit-cost ratios from 1.3 to 17.1 [20], pp109-11].
Some existing early years programs in Australia have provided the same type of interventions for children from disadvantaged backgrounds – having a focus on either educational and learning outcomes or a focus on parenting and socialisation outcomes [28]. Only limited work to evaluate these programs has been undertaken. What research is available suggests mixed outcomes [26]; although one quasi-experimental study of a centre-based intervention for children at risk has found a positive impact on the well-being of children and parents [29].
The Early Years Education Program (EYEP) is a new program offered by the Children’s Protection Society (CPS), an independent not-for-profit child welfare organisation based in the north-east of Melbourne, Australia. CPS designed the EYEP to be targeted at the particular needs of children who have been or are at risk of being abused or neglected, and who would commence in the program prior to 3 years of age. EYEP’s objective is to ensure that these children realise their full potential and arrive at school developmentally and educationally equal to their peers.
EYEP has a dual focus: addressing the consequences of abuse and neglect on children’s brain development, and redressing their learning deficiencies. Jack Shonkoff has argued that most current programs for children from disadvantaged backgrounds do not have this dual focus – instead they mainly provide enriched learning experiences for children and parenting education for mothers. He suggests that a better approach for redressing inequalities in skill development is to adopt the dual focus: ‘by linking high-quality pedagogy to interventions that prevent, reduce, or mitigate the disruptive effects of toxic stress on the developing brain’ [30], p.982]. It is exactly this task that EYEP is taking up.
EYEP employs a holistic model in early education and care. Key features are high staff/child ratios (1:3 for children under 3 years, and 1:6 for children over 3 years), qualified staff, a rigorously developed curriculum, and the use of relationship-based pedagogy. The program involves direct intervention with a child to address his or her identified needs, reverse developmental delays, and reduce the impact of risk factors and adverse events. An innovative feature of the program is a trans-disciplinary model which includes an education leader who has graduate qualifications in early childhood curriculum (supported by a part-time early childhood curriculum consultant), an in-house infant mental health consultant, and family support consultant. There is a focus on developing relational pedagogical strategies to reduce the behavioural and emotional dysregulation resulting from living in a situation of toxic stress to enable the children to be more available for learning.
The basis for care in EYEP is an attachment-focused, trauma informed, primary-care model which recognises the significance of respectful, responsive relationships for every child’s learning and development. Every child is allocated a key worker who is that child’s primary carer. Purposeful, warm greetings and a clear idea of the routines and opportunities of the day are essential components of the model, which help to give children a sense of security, predictability and consistency. The objective of the primary care model is to encourage the fostering of significant attachments for children who are likely to be experiencing disrupted and compromised attachment relationships in their home environments.
The education model in EYEP is a pedagogically-driven reflective teaching model that is child-focused and built on the National Early Years Learning Framework of ‘Belonging, Being and Becoming’ [31]. Each child has individual learning goals developed by the educators in partnership with families. Educators plan a curriculum using play-based approaches and intentional teaching to support each child’s learning and development across learning outcomes in the Early Years Learning Framework. Play-based approaches and intentional teaching support children to develop a positive sense of identity as they explore, create, imagine, solve problems, learn communication skills, and develop friendships. It is understood that how children learn is just as important as what they learn. Reflection on practice guides the on-going planning cycle. Educators document, monitor and assess each child’s learning over time.
The EYEP model actively engages with parents to encourage on-going participation in the program, as well as in enhancing their usage of all available health, educational and social services available, in order to improve outcomes for children. At-risk children and their families characteristically have concurrent barriers which affect their inclusion in early childhood services; for example, chaotic lifestyles; mental health and substance abuse issues; family violence; low levels of educational attainment; insecure housing arrangements; and antisocial behaviour. Consequently, EYEP aims to sustain parental involvement and minimize attrition levels by improving parental engagement in their children’s development. In order to achieve this, care team meetings incorporating parents and family support/child protection workers and the early years educators (primary worker for the child) will take place every 12 weeks. These meetings aim to identify, with parents, the goals and aims they would like to achieve for their children, which is then documented on agreement forms and reviewed every 12 weeks.
EYEP can be seen as addressing a variety of barriers that might otherwise exist to families taking advantage of supportive services – such as affordability; families beliefs that may place low priority on early education services; and inter-personal barriers including beliefs and attitudes on the part of service providers that might compromise engagement [32].
EYEP is designed for children who are at serious risk of, or who have experienced abuse and neglect and are already demonstrating problems in emotional and behavioural regulation, delays in development, and whose families struggle to participate in universal early education services. It can therefore be considered a tertiary level intervention, equivalent to critical intensive care in the health sector. For that reason we do not anticipate that all features of EYEP would be needed in every universal early education and care program. Rather, specific features of EYEP could potentially be implemented to different degrees, as needed, in universal and secondary early education and care services. Some aspects of EYEP, such as strategies for sustaining participation, and skilling educators to assist vulnerable children with emotional and behavioural regulation, will be relevant for all universal early education and care settings. This interpretation of the potential application of EYEP fits well with recent reviews which conclude that an ideal system of early education and care should be based on a strong and inclusive universal set of services, backed by a tiered system of services to be provided to those with extra needs [33].
Aims and hypotheses
We aim to conduct a randomised controlled trial of EYEP, in order to determine whether this intervention can improve the school readiness of participants. We hypothesise that, compared to the control group, the benefits of participation in EYEP at the end of the intervention, and six months after commencing the first year of school (Prep grade), will include:
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1.
Improved child outcomes
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a.
Better health and development outcomes
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b.
Demonstration of a higher level of academic ability and achievement
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c.
Better emotional and behavioural regulation
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2.
Parents of children
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a.
Reduced incidence of poor parenting practices
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b.
Increased engagement with neighbourhood and community services.