How does the program engage parents in child/parent relational repair?
The EYEP model recognises that parents are children’s first and most important educator (National Early Years Learning Framework, (EYLF, DEEWR, 2009).
EYEP practices/strategies that engaged families and supported repairing or nurturing relationships with their children included:
*Parent (usually the mother) was expected to stay with their baby or very young child during transition into the centre until the parent, the lead teacher and the Infant Mental Health consultant agreed that the child had formed an attachment with their primary care educator. This experience gave parents/mothers the opportunity to observe how the educators built relationships and attachment with their child.
*In the EYEP model, the parent/s are encouraged to visit the centre anytime and to observe their child/ren playing and learning with peers and with educators. Educators modelled caring, responsive relationships with children which parents observed and discussed over the three years of their engagement in the program.
*A primary educator model is used in the EYEP. Each educator was the primary care educator for three children and their parent/s. This model supported attachment and repair processes for the child as well as providing parent/s with a ‘go to’ person who understood their issues, was supportive and non-judgemental and who could provide parents with referrals for more intensive clinical support if needed.
*Twelve weekly goal setting for each child’s learning and development was undertaken as a collaboration between the family/parent and educators. This partnership approach helped to empower parents as their child’s educator as well as providing them with practical support as parents.
*The embedded Infant Mental Health consultant/clinician was available to provide parents with advice and support in building nurturing relationships with their child/ren. The Family Support practitioner was also able to work with the IMH consultant in supporting families.
What proportion of randomised children were included in the analysis?
The number of children with at least some information collected is 136 (93.7%) for baseline study and 104 (71.7%) for 24-months follow up. For impact estimation, the sample size varies depending on which outcome was analysed and what model specification was used (due to varying non-response between items). The sample sizes for all estimates can be found in the 24 months research report.
Is it possible to look at the impact of each component of the EYEP model?
The research design of the current EYEP trial is to evaluate the impact of the complete model. Because each component enhances the functioning of other components, we are not able quantify the impact of each component that is introduced on its own. To quantify the impact of each component, we will need to run separate trials for each component.
Jane’s point about the importance of integrating services is critical. Did EYEP find any factors that were particularly important in achieving successful integration of services around the needs of children and families?
The EYEP model has elements that support an integrated approach to services for the families in the intervention including:
*Embedded Infant Mental Health and Family Support worker positions.
*Families were able to and encouraged to access other support services in the community through the professional networks and collaboration that was part of the EYEP staff team approach. For example, educators built professional relationships with local schools and kindergartens and worked closely with them when EYEP children and families were transitioning to a new setting such as starting school. Similar professional collaboration was developed with Maternal and Child Health nurses and early intervention services for children with a disability or developmental delay.
*The multi-disciplinary approach of the EYEP model supports a more integrated approach to children’s health, wellbeing and education.
While an 'incremental scaling-up' of EYEP may help ensure efficacy, what are the implications for the cost of such an incremental rollout?
The incremental scaling-up should not have a large effect on the cost of the EYEP program per child. In the scale-up phase the main costs will be from: (i) operation of the child care centres; and (ii) the implementation hub. Costs associated with operation of child care centres should not vary significantly with the speed of scale-up. There may be slightly higher costs per child associated with the implementation hub at the start of scaling up, but once the number of children increases sufficiently, the unit cost should be fairly constant. The largest cost to society comes from an effective intervention not being available to all children facing extreme adversity.
On the other hand, a large-scaled rollout will make the intervention available to more children earlier. However, given that the program is highly specialised and individual focused, rushing into it without rigorous tests of replication process may significantly heighten the risk of ineffective intervention, which may result in waste of resources (large total program delivery cost but little benefit). The cost of not providing effective intervention remain high.
Therefore, using an incremental scaling-up approach where the speed of increment is designed such that it allows the test of replication process as well as workforce capacity building and minimises the number of children facing extreme adversity missing out on the program intervention is preferred.
Was there a difference in outcomes for boys and girls?
Yes, the outcomes are very different between boys and girls at 24 months.
For children’s IQ and language skills the estimated impact of EYEP is larger and more statistically significant for boys than girls. Non-cognitive skills show the biggest difference between boys and girls. For protective factors related to resilience a large (about one-half standard deviation) and highly significant impact is found for boys, compared to a zero impact for girls. The estimated impact of EYEP on social- emotional development exhibits the opposite pattern. For girls there is a substantial and highly statistically significant estimated impact, with EYEP decreasing the proportion in the clinical range by 50 percentage points, whereas the impacts for boys the estimated impact is a decrease of only 10 percentage points which is not statistically significant. Further details can be found in the research report
The research team is also undertaking in-depth analyses to further understand the gender differences.
Children with high support needs live in many communities around Australia. How can a program like this be replicated to the extent that it is accessible for all children/families who might benefit?
The EYEP project was designed to recruit children with significant family stress and social disadvantage and the profiles of both the intervention and the control groups indicate that we did recruit as intended. The slide presentation showed how the EYEP participants were more disadvantaged than the low SES cohort in the LSAC study of Australian children (For more details, see Report 1: Participants in the Trial of the Early Years Education Program)
One of the aims of the replication studies of the EYEP model is to ensure that it can be implemented in different contexts and communities while maintaining fidelity to the model.
The selection criteria for eligibility into the EYEP research project (2 or more identified risk factors, and referral by child protection or other agencies working with a family/child) will be used in replication study sites. The findings of replication study can also provide evidence to allow specific, theory-informed, targeted alterations to the model or referral process.
Although we recommend the replication starting with small numbers of sites, the ultimate goal is to progressively increase the number of sites such that the program is accessible to all children facing extreme adversity. The speed of increment is expected to increase over time especially after successful replication is demonstrated. Of course, support from government and community is important to make the program accessible to all children facing extreme adversity.