Learning across the UK: a review of public health systems and policy approaches to early child development since political devolution

Factors associated with low school readiness, a linked health and education data study in Wales, UK

BACKGROUND

School readiness is a measure of a child's cognitive, social, and emotional readiness to begin formal schooling. Children with low school readiness need additional support from schools for learning, developing required social and academic skills, and catching-up with their school-ready peers. This study aims to identify the most significant risk factors associated with low school readiness using linked routine data for children in Wales.

METHOD

This was a longitudinal cohort study using linked data. The cohort comprises of children who completed the Foundation Phase assessment between 2012 and 2018. Individuals were identified by linking Welsh Demographic Service and Pre16 Education Attainment datasets. School readiness was assessed via the binary outcome of the Foundation Phase assessment (achieved/not achieved). This study used multivariable logistic regression model and a decision tree to identify and weight the most important risk factors associated with low school readiness.

RESULTS

In order of importance, logistic regression identified maternal learning difficulties (adjusted odds ratio 5.35(95% confidence interval 3.97-7.22)), childhood epilepsy (2.95(2.39-3.66)), very low birth weight (2.24(1.86-2.70), being a boy (2.11(2.04-2.19)), being on free school meals (1.85(1.78-1.93)), living in the most deprived areas (1.67(1.57-1.77)), maternal death (1.47(1.09-1.98)), and maternal diabetes (1.46(1.23-1.78)) as factors associated with low school readiness. Using a decision tree, eligibility for free school meals, being a boy, absence/low attendance at school, being born late in the academic year, being a low birthweight child, and not being breastfed were factors which were associated with low school readiness.

CONCLUSION

This work suggests that public health interventions focusing on children who are: boys, living in deprived areas, have poor early years attendance, have parents with learning difficulties, have parents with an illness or have illnesses themselves, would make the most difference to school readiness in the population.

Using administrative data to evaluate national policy impacts on child and maternal health: a research framework from the Maternal and Child Health Network (MatCHNet)

Reducing health inequalities by addressing the social circumstances in which children are conceived and raised is a societal priority. Early interventions are key to improving outcomes in childhood and long-term into adulthood. Across the UK nations, there is strong political commitment to invest in the early years. National policy interventions aim to tackle health inequalities and deliver health equity for all children. Evidence to determine the effectiveness of socio-structural policies on child health outcomes is especially pressing given the current social and economic challenges facing policy-makers and families with children. As an alternative to clinical trials or evaluating local interventions, we propose a research framework that supports evaluating the impact of whole country policies on child health outcomes. Three key research challenges must be addressed to enable such evaluations and improve policy for child health: (1) policy prioritisation, (2) identification of comparable data and (3) application of robust methods.

Identifying opportunities for upstream evaluations relevant to child and maternal health: a UK policy-mapping review

OBJECTIVE

Interventions to tackle the social determinants of health can improve outcomes during pregnancy and early childhood, leading to better health across the life course. Variation in content, timing and implementation of policies across the 4 UK nations allows for evaluation. We conducted a policy-mapping review (1981-2021) to identify relevant UK early years policies across the social determinants of health framework, and determine suitable candidates for evaluation using administrative data.

METHODS

We used open keyword and category searches of UK and devolved Government websites, and hand searched policy reviews. Policies were rated and included using five criteria: (1) Potential for policy to affect maternal and child health outcomes; (2) Implementation variation across the UK; (3) Population reach and expected effect size; (4) Ability to identify exposed/eligible group in administrative data; (5) Potential to affect health inequalities. An expert consensus workshop determined a final shortlist.

RESULTS

336 policies and 306 strategy documents were identified. Policies were mainly excluded due to criteria 2-4, leaving 88. The consensus workshop identified three policy areas as suitable candidates for natural experiment evaluation using administrative data: pregnancy grants, early years education and childcare, and Universal Credit.

CONCLUSION

Our comprehensive policy review identifies valuable opportunities to evaluate sociostructural impacts on mother and child outcomes. However, many potentially impactful policies were excluded. This may lead to the inverse evidence law, where there is least evidence for policies believed to be most effective. This could be ameliorated by better access to administrative data, staged implementation of future policies or alternative evaluation methods.

Study protocol: evaluation of the 0-5 public health investment in England - a mixed-methods study integrating analyses of national linked administrative data with in-depth case studies

INTRODUCTION

Health visiting is a long-established, nationally implemented programme that works with other services at a local level to improve the health and well-being of children and families. To maximise the impact and efficiency of the health visiting programme, policy-makers and commissioners need robust evidence on the costs and benefits of different levels and types of health visiting, for different families, in different local contexts.

METHODS AND ANALYSIS

This mixed-methods study will analyse individual-level health visiting data for 2018/2019 and 2019/2020 linked with longitudinal data from children's social care, hospitals and schools to estimate the association of number and type of health visiting contacts with a range of children and maternal outcomes. We will also use aggregate local authority data to estimate the association between local models of health visiting and area-level outcomes. Outcomes will include hospitalisations, breast feeding, vaccination, childhood obesity and maternal mental health. Where possible, outcomes will be valued in monetary terms, and we will compare total costs to total benefits of different health visiting service delivery models. Qualitative case studies and extensive stakeholder input will help explain the quantitative analyses and interpret the results in the context of local policy, practice and circumstance.

ETHICS AND DISSEMINATION

The University College London Research Ethics Committee approved this study (ref 20561/002). Results will be submitted for publication in a peer-reviewed journal and findings will be shared and debated with national policy-makers, commissioners and managers of health visiting services, health visitors and parents.

Mapping Geographic Trends in Early Childhood Social, Emotional, and Behavioural Difficulties in Glasgow: 2010-2017

Measuring variation in childhood mental health supports the development of local early intervention strategies. The methodological approach used to investigate mental health trends (often determined by the availability of individual level data) can affect decision making. We apply two approaches to identify geographic trends in childhood social, emotional, and behavioural difficulties using the Strengths and Difficulties Questionnaire (SDQ). SDQ forms were analysed for 35,171 children aged 4-6 years old across 180 preschools in Glasgow, UK, between 2010 and 2017 as part of routine monitoring. The number of children in each electoral ward and year with a high SDQ total difficulties score (≥15), indicating a high risk of psychopathology, was modelled using a disease mapping model. The total difficulties score for an individual child nested in their preschool and electoral ward was modelled using a multilevel model. For each approach, linear time trends and unstructured spatial random effects were estimated. The disease mapping model estimated a yearly rise in the relative rate (RR) of high scores of 1.5-5.0%. The multilevel model estimated an RR increase of 0.3-1.2% in average total scores across the years, with higher variation between preschools than between electoral wards. Rising temporal trends may indicate worsening social, emotional, and behavioural difficulties over time, with a faster rate for the proportion with high scores than for the average total scores. Preschool and ward variation, although minimal, highlight potential priority areas for local service provision. Both methodological approaches have utility in estimating and predicting children's difficulties and local areas requiring greater intervention.

Relationships between Child Development at School Entry and Adolescent Health-A Participatory Systematic Review

The relationship between child development and adolescent health, and how this may be modified by socio-economic conditions, is poorly understood. This limits cross-sector interventions to address adolescent health inequality. This review summarises evidence on the associations between child development at school starting age and subsequent health in adolescence and identifies factors affecting associations. We undertook a participatory systematic review, searching electronic databases (MEDLINE, PsycINFO, ASSIA and ERIC) for articles published between November 1990 and November 2020. Observational, intervention and review studies reporting a measure of child development and subsequent health outcomes, specifically weight and mental health, were included. Studies were individually and collectively assessed for quality using a comparative rating system of stronger, weaker, inconsistent or limited evidence. Associations between child development and adolescent health outcomes were assessed and reported by four domains of child development (socio-emotional, cognitive, language and communication, and physical development). A conceptual diagram, produced with stakeholders at the outset of the study, acted as a framework for narrative synthesis of factors that modify or mediate associations. Thirty-four studies were included. Analysis indicated stronger evidence of associations between measures of socio-emotional development and subsequent mental health and weight outcomes; in particular, positive associations between early externalising behaviours and later internalising and externalising, and negative associations between emotional wellbeing and later internalising and unhealthy weight. For all other domains of child development, although associations with subsequent health were positive, the evidence was either weaker, inconsistent or limited. There was limited evidence on factors that altered associations. Positive socio-emotional development at school starting age appears particularly important for subsequent mental health and weight in adolescence. More collaborative research across health and education is needed on other domains of development and on the mechanisms that link development and later health, and on how any relationship is modified by socio-economic context.

Impact of child development at primary school entry on adolescent health-protocol for a participatory systematic review

BACKGROUND

Reducing child health inequalities is a global health priority and evidence suggests that optimal development of knowledge, skills and attributes in early childhood could reduce health risks across the life course. Despite a strong policy rhetoric on giving children the 'best start in life', socioeconomic inequalities in children's development when they start school persist. So too do inequalities in child and adolescent health. These in turn influence health inequalities in adulthood. Understanding how developmental processes affect health in the context of socioeconomic factors as children age could inform a holistic policy approach to health and development from childhood through to adolescence. However, the relationship between child development and early adolescent health consequences is poorly understood. Therefore the aim of this review is to summarise evidence on the associations between child development at primary school starting age (3-7 years) and subsequent health in adolescence (8-15 years) and the factors that mediate or moderate this relationship.

METHOD

A participatory systematic review method will be used. The search strategy will include; searches of electronic databases (MEDLINE, PsycINFO, ASSIA and ERIC) from November 1990 onwards, grey literature, reference searches and discussions with stakeholders. Articles will be screened using inclusion and exclusion criteria at title and abstract level, and at full article level. Observational, intervention and review studies reporting a measure of child development at the age of starting school and health outcomes in early adolescence, from a member country of the Organisation for Economic Co-operation and Development, will be included. The primary outcome will be health and wellbeing outcomes (such as weight, mental health, socio-emotional behaviour, dietary habits). Secondary outcomes will include educational outcomes. Studies will be assessed for quality using appropriate tools. A conceptual model, produced with stakeholders at the outset of the study, will act as a framework for extracting and analysing evidence. The model will be refined through analysis of the included literature. Narrative synthesis will be used to generate findings and produce a diagram of the relationship between child development and adolescent health.

DISCUSSION

The review will elucidate how children's development at the age of starting school is related to subsequent health outcomes in contexts of socioeconomic inequality. This will inform ways to intervene to improve health and reduce health inequality in adolescents. The findings will generate knowledge of cross-sector relevance for health and education and promote inter-sectoral coherence in addressing health inequalities throughout childhood.

PROTOCOL REGISTRATION

This systematic review protocol has been registered with PROSPERO CRD42020210011 .

Relationship of George Floyd protests to increases in COVID-19 cases using event study methodology

Background

Protests ignited by the George Floyd incident were examined for any significant impact on COVID-19 infection rates in select US cities.

Methods

Eight US cities were studied in which protestors in the tens of thousands were reported. Only cities that reside in states whose stay-at-home orders had been rescinded or expired for a minimum of 30 days were included in the sample to account for impact of growth rates solely due to economies reopening. Event study methodology was used with a 30-day estimation period to examine whether growth in COVID-19 infection rates was significant.

Results

In the eight cities analyzed, all had positive abnormal growth in infection rate. In six of the eight cities, infection rate growth was positive and significant.

Conclusions

In this study, it was apparent that violations of Centers for Disease Control and Prevention (CDC)-recommended social distancing guidelines caused a significant increase in infection rates. The data suggest that to slow the spread of COVID-19, CDC guidelines must be followed in protest situations.